Nonsurgical Treatments

Nonsurgical Hip Treatments

Injuries to the hip can be caused by degenerative disease such as arthritis, traumatic injuries and sports injuries. These conditions may affect the bones & joints and impair the mobility as well as the quality of life of the patients. All these conditions require appropriate treatment, may be surgical or non-surgical to restore to normal activities. The non-operative orthopaedic treatment options include nonpharmacological and pharmacological interventions. They are aimed at providing symptomatic relief and improving the quality of life of the patients. They can be used as a treatment option to treat certain conditions or to decrease pain as well as promoting functioning and quality of life after the surgical treatment.

Non- pharmacological intervention

Non-pharmacological interventions may range from simple lifestyle modification or the physical exercises and rehabilitation programs. Some of the non-pharmacological interventions include:

Weight reduction and physical exercise – The lifestyle changes resulting in weight loss in obese individuals and doing appropriate physical exercises plays an important role in prevention and management of the hip and knee conditions.The optimal weight (BMI) should be 18.5 to 25. BMI of 25-29 is considered over weight and BMI over 30 is considered as obese.Exercises are contraindicated in individuals suffering from cardiovascular diseases. Therefore rigorous exercises is not ideal for all patients and must be individualized for every patient and done under the supervision of a trained professional.

Transcutaneous electrical nerve stimulation – The transcutaneous electrical nerve stimulation (TENS) method involves the use of low-voltage electric impulses to relieve the pain. It is believed to provide pain relief by inhibiting the conduction of pain impulses to reach the receptors in the brain and spinal cord. Patient is made to worn a device and this device generates the impulses that offer pain relief to the patients. Frequency of the impulses, duration of treatment and location of the electrical electrodes on the body are decided by your physician based on the severity of condition as well the response of the patient. Use for at least 4 weeks may provide better pain relief.It should not be used by patients having pacemaker or cochlear implants, or those suffering from epileptic conditions. It should also not be used during pregnancy.

Thermotherapy – Thermotherapy involves application of hot or cold packs at the affected area. There is some evidence to support the use of cold therapy in providing symptomatic relief. It is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease and hypertension, or who are pregnant should use it with caution.

Acupuncture – This method involves insertion of sterile needles into specific acupuncture points or pressure points. It is believed that insertion of needles at specific points restore the flow of “qi”, a form of energy and thereby relieves the pain. A modification in acupuncture is electro-acupuncture where the needles are stimulated by and electro-stimulator. Acupuncture performed by trained professionals is considered to be safe and offers pain relief however may have certain risks if treated by untrained professionals.

Patellar tapping – Patellar tapping is used as a short term treatment particularly when performing normal activities deteriorates the knee condition. The principle behind the treatment is stabilization of knee joint by altering the distribution of stress and joint pressure. The response depends on the strapping technique used and the time for which it is strapped.

Massage therapy – It is one of the oldest methods of treatment and reduces pain by increasing the circulation of blood and lymph as well by reduction of muscle tension or because of the therapeutic effect of the touch.

Pharmacological interventions

Pharmacological interventions include management of pain using medicinal preparations such as pain relieving capsules or injections.
Non-steroidal anti-inflammatory drugs – These are known as NSAIDs and are found to be effective in reducing pain and inflammation of the hip and the knee. Caution must be taken while using NSAIDs for overdosing as they are known to cause hepatotoxicity. Patients with liver diseases must have extreme care while using them. They cause a range of side effects, chances of which increase with the concomitant use of diuretics, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants or oral corticosteroids.

Weak and strong opioids – Opioids are prescribed when use of analgesic medications or NSAIDs does not offer symptomatic pain relief, if other treatments have intolerable side effects or in whom the surgery is delayed or contraindicated. Though they offer better pain relief they are known to cause side effects such as dry mouth, nausea, vomiting, dizziness and constipation. Overdose may lead to respiratory depression. The dose is reduced slowly otherwise cause withdrawal effects. They are also known for addiction.

Disease modifying anti-rheumatic drugs and biological agents – Disease modifying anti-rheumatic drugs (DMARDs) aim at halting the progression of disease and offer symptomatic relief. Biological agents are the antibodies against the disease causing agents manufactured using genetic engineering technology. These agents are recommended in individuals with severe disease condition.

Other treatments – Your physician may recommend the use of braces and orthoses, prescribe chondroitin sulphate, electromagnetic therapy, vitamin supplements, herbal and other dietary therapies. Therapeutic ultrasound has very less scientific proof of being effective.

Though there is little scientific evidence for various non-surgical techniques, in offering symptomatic pain relief, they were found to be effective in certain cases and are considered to possess minimal side effects. Discuss with your physician about these therapeutic options before initiating the treatment.

Hip Injections

Hip joint injections involve injecting medicine directly into the hip joint to diagnose the source of pain or treat pain due to conditions such as arthritis, injury or mechanical stress of the hip joint. Hip pain may be experienced in the hip, buttock, leg or low back. The injection contains a combination of a numbing medicine and cortisone (an anti-inflammatory agent). Numbing medicine delivers temporary relief from pain, provided the hip joint is the source of the pain. It thus serves a diagnostic function and helps to confirm or deny whether the joint is the source of pain. Cortisone serves to reduce the inflammation in the joint providing long term pain benefit.

Procedure
If needed, a relaxation medicine is given to the patient through an IV line. The patient lies face down on an X-ray table. The small area where the injection needs to be given is numbed with an anaesthetic. The patient may feel a sting for a few seconds. A small needle is then accurately placed by the doctor into the joint guided by the real time X-ray images (fluoroscopy). Before injecting the medicine, a contrast dye is injected through this needle into the joint to confirm that the medicine will reach the joint. A combination of anaesthetic and anti-inflammatory cortisone is then slowly injected into the joint. The whole procedure usually takes about 30 to 60 minutes.

After the procedure
After the injection the patient is made to rest for 20 to 30 minutes and is then asked to move the joint, provoking pain. The patient may or may not find a decrease in pain depending on whether the injected joint is the main source of the pain. The patient is also asked to maintain a record of relief in pain during the coming week. Physical therapy may also be recommended. Even when pain relief is significant the patient should increase activities gradually over one to two weeks to avoid reappearance of pain.

Risk and complications
The possible risks of hip injections include: swelling and pain in the joint after the injection, infection, depigmentation of skin, local thinning of the skin and rupture of a tendon.

If the injected hip joint is the source of the pain, the pain may reduce two to five days after the injection. However, if no improvement is found within ten days after the injection further diagnostic tests may be required to ascertain the cause of pain.

Physiotherapy
Physiotherapy or physical therapy is an exercise program thathelps you to improve movement, relieve pain, encourage blood flow for faster healing, and restore your physical function and fitness level. The main aim of physical therapy is to make your daily activities, such as walking, getting in and out of bed, or climbing stairs, easier. It can be prescribed as an individual treatment program or combined with other treatments. Physiotherapy is usually ordered to help you recover after certain surgeries, injuries and long-term health problems such as arthritis.

A physiotherapist will examine your symptoms and daily activities, and make a treatmentplan, which primarily focuses on reducing your pain and swelling. The different procedures used by your therapist depend on your specific physical ailment. Physical therapy involves a combination of education, manual therapy, exercises and techniques. Some of the procedures commonly used are:

Stretching Exercises: Surgery, age and conditions, such as arthritis and osteoporosis, can cause inflammation and stiffness in your joints and muscles, and restrict your movement. Physiotherapists guide you step by step to stretch certain areas of your body in order to restore flexibility, and enhance the movement of joints and muscles.

Core Strengthening and Stability Exercises: Specific exercises are designed to make the core (pelvis and lower back) strong enough to support the whole body.

Ice and Heat: Applying heat or coldtreatment on muscles can stimulate the blood flowand reduce swelling. Heat treatment helps to reduce joint pain and spasm in the lower back and neck, and loosen muscles. Cooling works best for ankle sprains.

Ultrasound: An ultrasound sends high frequency sound waves over your body and stimulates deep body tissues. Vibrations produced by sound waves help to stimulate blood flow and facilitate the healing process. This procedure can also be used to improve metabolism and enhance the adhesiveness of bones after a fracture.

Electrostimulation: In this procedure, an electric current is passed through the area which requires treatment. This helps in relieving pain, stimulating muscles and nerves, and expanding blood vessels.

These treatments may cause mild soreness or swelling. You can talk to your therapist in case it is prolonged. For further information on the different types of physiotherapy and the best program for you, please call (02) 9524 3000.