The Human Hip-Part 3

Posted by admin Filed in Common Diseases on Saturday, October 17th 2009

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We looked at the relevance of a discrepancy in length of leg on the ability to use the hip in a previous article. The leg which is the longer has to stay slightly bent to manage to keep the eyes and head level, preventing the hip from achieving full extension as we take each step. The inability of the hip joint to move back into full extension ensures it has to rotate an amount to achieve the walking pattern required. As an occasional problem this may not be significant, but when multiplied by the thousands of steps we take each day it can develop a painful condition with restriction of joint movement.

The hip can give problems and deteriorate into a severely painful joint very quickly after a traumatic event such as a fall, strain or jar. However, this is less common on average as hip problems usually come on slowly over a long period. A small event can set off a painful process which starts with some muscle spasm and a reduction in the extension range typically used in walking. The hip joint is at its tightest and most pressured when it is put into extension, and when we have a painful joint we avoid this kind of joint position in order to avoid pain.

A typical reaction to a painful hip is the development of a limp, a common finding in hip and knee pain problems. Whilst possible to eradicate a limp, once practiced for a while, is very difficult. A limp changes the mechanical stresses through the hip radically, alters the muscle function to different angles and allows the joint to restrict its ranges of motion. This can encourage the hip capsule to tighten up further and perpetuate the cycle. This is why physiotherapists encourage people with hip problems to perform as normal a gait as possible.

Osteoarthritis is the commonest joint problem suffered by the large weight bearing joints such as the hip and the knee. Osteoarthritis is a degenerative joint condition with many factors important in its development, with genetic factors such as family history of relevance. The incidence of osteoarthritis rises rapidly with age and most older people have a least a few joints affected. As the process proceeds, the joint may tighten, lose further range of movement and heal slowly due to its relatively poor blood supply.

Gradual destruction of the cartilaginous joint lining continues, with some muscle spasm and increasing limp. At some point some arthritic joints deteriorate quickly, perhaps after a trivial traumatic event, and the exact reason for this is not clear, but increased pain and consequent increased muscle spasm may be responsible. Typically hip pain is felt in the lower buttock, the side of the hip, the groin and the front of the thigh. Some patients go to the doctor thinking that they have a thigh or knee problem and end up being diagnosed with hip arthritis.

In the initial stages the x-rays will indicate little of value and the x-ray findings often are not easily correlated with the patient’s disability or pain. As the osteoarthritis worsens joint changes become gradually more apparent such as loss of some of the joint space from cartilage thinning. If severe the head of the femur may become misshapen and osteophytes (bony outgrowths) may occur at the joint margins. In severe arthritis movement and weight bearing may be accompanied by obvious shuddering and grating.

The losses of joint movement in the hip occur in a characteristic order, with extension being lost first, followed by abduction, the ability to move the hip out to the side and finally of internal rotation of the joint. On examination of a hip with an osteoarthritic joint the hip will be held forwards and lack extension, the leg will be rotated outwards and can be held close to the other leg as it cannot easily be moved away. The lack of extension and shortening of the leg due to the arthritis can force the trunk to twist in gait and the person to go up on their toes slightly to compensate for the shortening.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, Physiotherapists in Bournemouth, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

Article Source:http://www.articlesbase.com/diseases-and-conditions-articles/the-human-hippart-3-1346823.html

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