Lower limb injuries

Your lower limbs are put under strain every day and there are many different ways you can injure yourself.

Below is a list of some of the most common injuries which we face on a daily basis. We have compiled information to help asses and manage your injury but if you find you need a personal review or diagnostic please ask your GP for a referral.

Achilles tendon pain

The Achilles tendon is a combined tendon of the two muscles in the calf, the larger muscle being Gastrocnemius and smaller muscle being Soleus.  This tendon is the strongest tendon in the body, it can still become overloaded or suffer from overuse resulting in pain and discomfort.

What causes Achilles pain?

This is caused by a condition call Achilles Tendinopathy (previously called Achilles tendonitis as it is now known that the Achilles does not inflame).  The condition is typically seen in running and jumping type activities and does develop in those who do not play sport.  The incidence of increased tightness can increase during the summer months as people are more inclined to wear flat sandals / flip-flops for longer periods and this type of footwear results in a longer stretch being applied to the Achilles tendon which can result in developing tendinopathy. 

As the tendon becomes overloaded it often becomes thicker in the middle of the tendon just above (approx 5 cm above) where the Achilles tendon inserts in to the heel bone.  It will feel tight and sore first thing in the morning or when starting exercise.  Pain may also start during exercise as the tendon tires and will often continue even after stopping the activity.

Insertional Achilles Pain

This is more complex and can be related to a number of influencing factors including tendinopathy, inflammation of bursa and pressure from the heel bone. You would require advice from a Physiotherapist or Podiatrist to help improve the condition so if your pain is more pinpoint to where the Achilles tendon actual inserts into the heel bone please contact your doctor

Inflammation

As previously stated the Achilles tendon does not become inflamed but very occasionally the outside sheath of the tendon can become inflamed. Swelling will be diffuse and associated with a crunchy feeling (crepitus) when touched.  This condition is rare and if you suspect you have it then please contact your doctor

How do I treat Achilles tendinopathy?

The tendon is painful and thickened, this occurrs because it is too weak to cope with the loads placed upon it.  As weakness is already part of the problem, absolute rest is only going to make the problem worse by contributing to the weakness, but you should consider trying to avoid activities that bring on the pain.    Achilles pain responds well to a simple heel drop exercise which in many cases resolves the problem.  The exercise will be painful at first and should be carried out each day with the expectation that you will need to do this exercise for up to 3 months.  The exercise can be seen above on the plantar fasciitis exercise sheet with the exception of the bottle rolling exercise.

If every day working is causing you Achilles pain you may wish to consider wearing a shoe with a small heel or a small heel raise in your shoe to reduce the stretch the tendon is experiencing.  This alone will not resolve pain and must be done in conjunction with the stretching exercise.

Please ss the video to demonstrate planter fasciitis and Achilles tendon pain exercises.

It is ok to take simple painkillers such as paracetamol as required, particularly during the first couple of weeks of completing the exercises

Prevention

Prevention is always better that cure so continue to do your strengthening and stretching exercise on a regular basis and not just when the symptoms reoccur and review your foot wear regularly

Ankle Sprain

Ankle sprains can happy to any of us at any time and usually involve a sprain to one the ligaments in the image below.  The most common mechanism of injury involves going over on the ankle such as when slip off a step, stumble on uneven ground or when shoes with a high heel.  Most simple sprains will resolve in 2 to 4 weeks.

How can I manage / treat my ankle sprain?

  • Protect the ankle by not exposing it to the same activity that caused the injury
  • Rest. This should be relative not absolute. Maintain your range of movement and do not confine yourself to bed
  • Ice – use ice packs for up to 20 minutes every 2 – 3 hours that you are awake
  • Compression – if you have access to some tubi-grip of the correct size use it
  • Elevation – when resting try elevating the knee slightly up on a pillow length ways so it is above the height of the hip
  • Drugs – painkillers such as paracetamol provide good relief. Debate remains on the use of anti-inflammatory drugs in the first 48 hours as although all these steps are designed to control swelling/inflammation some swelling is still required as this is the body's injury response mechanism, so it may delay the overall healing process in the longer term

After the first 48 hours

  • Stretch the calf muscle – with your leg straight place a towel around the ball of the foot and gently pull your foot towards you until you feel a stretch in the calf. Hold this for 20 seconds and repeat.  Aim to build up to repeating this 20 times per day
  • When you can comfortably weight bear on the injured ankle stand facing a wall. Take a step backwards with the injured leg, rest your hand upon the wall and push your hips slowly forward until you feel a stretch in the calf. Hold for 20 seconds.  Do this 10 times twice a day (you may need to build this up)
  • Maintain your ankle range of movement by writing the alphabet using your big toe.  Write the entire alphabet twice a day
  • Strengthening – it is important to strengthen the muscles that turn the ankle outwards as these will support the sprained ligaments.  You will need a looped piece of elastic fitness band. Place both feet in the loop and, using your injured foot, turn your foot outwards against the resistance and return to the starting position. Build up to complete 3 sets of 10 twice a day
  • Balance training – this will help prevent sprains in the future. Stand next to a stable object such as table or kitchen counter and hold on for support when starting to balance on the injured foot/ankle.  Stand and balance on the injured leg and build up to do 3 sets of 1 minute balances twice a day.  Once confident try this same exercise standing on a cushion.  Once you have achieved this go back to balancing on the floor but this time with your eyes closed.

For demonstrations of these exercises please see video

Footwear

We all need a variety of footwear for different activities but we so often get it wrong resulting in inappropriate or incorrect fitting shoes, contributing to the development of many foot and ankle conditions.  Please see footwear advice information below from the Society of Chiropodists and Podiatrists.

Downloads

Anterior and posterior cruciate ligament injury (ACL & PCL)

The ACL and PCL are vital for stabilising the forward and backwards movement of the knee and when either is ruptured the knees' stability is severe compromised.

Torn ACL is a relatively common injury amongst sports people and is more common in female athletes. It usually occurs as a result of a twisting injury when the foot is firmly planted on the floor, resulting in the knee having to deal with all of the rotational force rather than the foot moving.  It can be caused by a direct blow to the knee often on the outside aspect of the knee e.g. a football or ruby tackle. 

Such injuries may be combined with MCL injuries; although, the majority of ACL injuries do not involve any form of contact with another sports person.

What are the symptoms of a torn ACL?

  • There may be an audible popping or cracking at the time of the injury
  • Sudden pain at  the time of the injury
  • Immediate extensive swelling (this can be delayed in some cases)
  • An immediate feeling of instability but later swelling may mask or reduce this sensation
  • Inability to continue to exercise

How do I manage / treat my ACL injury?

  • Stop any sport or activity immediately
  • Contact your doctor or attend A&E

PRICED

  • Protect the knee by not exposing it to the same activity
  • Rest. This should be relative not absolute, and maintain your range of movement and do not confine yourself to bed
  • Ice – use ice packs for up to 20 minutes every 2 – 3 hours that you are awake
  • Compression – if you have access to some tubi-grip of the correct size use it
  • Elevation – when resting try elevating the knee slightly up on a pillow length ways so it is above the height of the hip
  • Drugs – painkillers such as paracetamol provide good relief, debate remains on the use of anti-inflammatory drugs in the first 48 hours, as although all these steps are designed to control swelling/inflammation some swelling is still required as this is the body's injury response mechanism so it may delay the overall healing process in the longer term

How will I be treated once an ACL rupture diagnosed?

  • A full assessment of the knee is required to ascertain if and what other structures have been injured
  • You will need to be seen by an Orthopaedic consultant to explore surgical and nonsurgical options
  • MRI scans are commonly used but not always, and so is the use of arthroscopic surgical procedures as the symptoms are so obvious that the need for surgical repair is highly likely to be the outcome
  • Non-surgical treatment is likely to include physiotherapy (including strengthening and proprioception, isokinetic assessment) rehabilitation and bracing

Surgery – the techniques and approaches used will vary depending upon the severity of the injury and surgery is performed more often than not following an ACL injury.  The decision to operate will be based on a number of factors;

  • Age
  • Lifestyle
  • Sporting activities
  • Occupation
  • Degree of knee instability
  • Ability to comply with the extensive and complex post operative rehabilitation

PCL injuries are less common than ACL but the advice remains the same.

Anterior knee pain

Anterior knee pain is a generalised term used by the medical profession to encompass a wide range of related, yet significantly different, conditions which produce pain at the front of the knee and as a result may need different treatment.

It is the most common presenting disorder involving the knee and up to 25% of the population are affected by anterior knee pain at some point in their lives.  Only back pain affects more people. 
Anterior Knee Pain is also recognised to be the most common cause of knee pain in adolescents and is also the most common overuse knee condition in sportspeople

Symptoms include;

  • Sharp twinges and dull aches in the front of the knee
  • Occasional swelling
  • Painful locking at the front of the knee
  • Feeling of weakness and giving way – worse going down hills or stairs
  • Clicking or grating at the front of the knee

Symptoms are aggravated by;

  • Walking down hill or stairs
  • Sports activities and sitting for prolonged periods

How can I manage or treat my anterior knee pain?

  • It is most often caused by overuse so try and identify aggravating factors and reduce them
  • Look at any lifestyle changes, have you changed job, have you put on weight or changed your shoes.  Try and reverse what you may have identified as the cause, especially if the changes coincided with the onset of the knee pain
  • Stretch the muscles that support the knee joint. Stretches should be held for 30 seconds. Please see lower limb stretching video
  • Strengthen the muscles that support the knee please see lower limb strengthening video
  • Gradually return to normal activity as pain improves

How can I prevent my anterior pain?

  • Anterior Knee pain is usually caused by overuse so vary your activities such as running, with cycling or gym work. Don’t always do hill walks
  • Keep yourself flexible, make your stretches part of your routine not just when in pain
  • Keep your leg muscles in good shape, again incorporate exercises into your routine and not just when in pain

Think about your footwear, are they well-fitting and suitable for your activities?

Foot pain

Plantar fasciitis is a very common foot condition that causes pain in the heel, across the sole of the foot and sometimes into the arch area of the foot.  Foot pain is a normal part of life but if you are suffering it can be worrying and bring daily duties to a standstill. But it can be treated, and in most cases you can do this yourself at home or at work with the right advice.

The pain is caused by swelling of the plantar fascia which is a form of connective tissue that is very important to the biomechanics of the foot.  This tissue connects the heel to the ball of the foot and supports the arch of the foot and takes considerable strain when standing, walking and running.

This condition can affect anyone but is more common in people over the age of 40. Overuse is the most common cause, as well as being overweight, or having altered biomechanics e.g. flat feet, high arches or tight calf muscles.

Plantar Fasciitis symptoms

Pain in the heel, across the sole of the foot (the part in contact with the ground) and possibly spreading to the arch of the foot.  The pain is usually described as sharp, burning and aching and usually develops slowly and doesn’t go away.  It is often at its worst when you first put weight through your foot, so more noticeable in the morning.
Pain can worsen as the day progresses or after long periods of standing and may feel as if the more you do the worse it becomes.

Why does it develop?

It can affect anyone but is more common over the age of 40.  There are a number of theories as to why it develops, and includes factors such as overuse (prolonged standing or walking), being overweight and/or altered biomechanics.  Occupation can also influence its development, ie completing a shift whereby you are stood for 8 hours.

How do I manage my Plantar Fasciitis?

As with many foot and ankle pains it can be treated yourself at home or work without having to see a Physiotherapist or Podiatrist.

Rest and modified activity – for most people keeping off your feet isn’t an option. For this reason alone the pain may take some time to fully resolve, but by trying to reduce activity levels in the first instance, and then gradually increasing them as the pain improves, will aid your recover.  You should use your pain to monitor your progress, for instance if your pain is worse in the  morning, reduces quickly after taking a few steps, and is absent for the remainder of the day you know you are on the road to recovery.  If you have increased your activity and the pain then takes longer to decrease the next day you can be confident that you have over done it and make changes accordingly.

ICE (Cryo-therapy) and massage – it may be tender initially but try massaging the heel and arch area of the foot.  This should become comfortable over time as the areas around the plantar fascia spasm less the tenderness will reduce.  You can simply use your fingers to do this, or ask someone else, or even use something like a rolling pin or golf/tennis ball over the area.

Do this a couple of times a day for approx 5 minutes. Afterwards the heel may feel tender and now would be a good time to consider using ice on the area for 5 -10 minutes in order to get maximum affect. You ,may choose to combine the two by using a frozen water bottle.

Stretching – stretching the foot and ankle has also been proven to be effective in treating the condition.  Stretching should not be painful and you should hold the stretch for at least 30 seconds. As you stretch the resistance will begin to ease as the tissues in the foot start to give.  You should repeat the stretches approx 5 times and aim to repeat all stretches a couple of times a day at least.  Example stretches can be seen below

Poor footwear – can be a contributing factor so it is important to consider the appropriateness and condition of your current footwear and make changes as necessary.  Footwear should;

  • Fit well
  • Not excessively compress the feet
  • Have a cushioned sole
  • Be supportive

For more information please see our footwear information.

Insoles or Orthotics – these can be useful in aiding your recovery and can be purchased from a range of pharmacies and sport shops. Over the counter insoles will primarily aim to cushion your heel and support your arches.  You may, in the first instance, choose to try some felt or similar material to see if additional support provides any relieve or increased comfort.

 

Remember if your symptoms continue without improvement or are getting worse as your GP to refer to PhysioHey and we will provide you with advice, reassurance that you’re doing the right thing, or invite you in to review the situation and help get you back on track.  If you do need to attend for treatment you will still need to complete your exercises at home and it is this combined approach that will be key to resolving your foot pain.

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Hints for avoiding hip pain

Trochanteric bursitis

  • Keep the muscles in your legs flexible by stretching regularly
  • Keep the muscles around your hip strong by regular strengthening exercises
  • Wear appropriate footwear at all times when doing sporting activities

Clicking/snapping hip

  • The clicking/snapping sensation may reduce on its own accord
  • Keep the muscles in your legs flexible by stretching regularly

Labral Tear

  • Keep the muscles in your legs flexible by stretching regularly
  • Keep the muscles around your hip strong by regular strengthening exercises

Osteoarthritis

  • Make sure you are not overweight as this will increase the load on your hip joint
  • Keep active
  • Keep the muscles in your legs flexible by stretching regularly
  • Keep the muscles around your hip strong by regular strengthening exercises

Hip pain

The hip is a ball and socket joint connecting your thigh bone to your pelvis and is the type of joint called a ball and socket joint.  The hip joint's special design means you can twist, bend, sit cross legged or curl up in a chair.  The hip is weight bearing and so is subject to a lot of stresses and strains everyday so it no wonder that it may occasionally ache.  Common causes of hip pain include osteoarthritis (wear and tear), labral tear or Trochanteric bursitis.

Knee ligament injuries

Ligaments connect one bone to another and provide stability to the knee by limiting the amount of movement in certain directions.  There are two main groups of ligaments and four major ligaments of the knee in total.

Collateral Ligaments

Medial and Lateral (MCL & LCL) these ligaments run down the inside and outside of the knee and provide sideways stability

Cruciate ligaments

Anterior or Posterior (ACL & PCL) these ligaments cross inside the knee joint and provide stability of the joint, from moving forwards and backwards
Knee pain related to ligament injury is usually directly related to trauma e.g. sports injury, accident.  Pain is more likely to be very sudden in onset, so if the pain has gradually developed, it is very unlikely to a ligament related condition.

How do I prevent a ligament injury?

As ligament injuries are usually caused by sports injury or accidents prevention is difficult although the following may help;

  • Warm up before exercise or intense activity
  • Maintain a good level of general fitness through stretching and strengthening the muscles around the knee joint (see lower limb strengthening and stretching video)
  • Wear footwear appropriate to the activities you are doing and replace when showing sign of wear and tear

Knee pain

Your knees along with the hip are one the most important joints in the body as when injured/ restricted your function and activities of daily living can be impacted upon considerably

The most common causes of are:

  • Osteoarthritis
  • Anterior knee pain
  • Lateral knee pain
  • Ligament/cartilage injuries

Osteoarthritis (OA) Knee

The knee is a hinge joint with both opposing surfaces of the bones (Femur and Tibia) being covered in cartilage which allows smooth movement when bending or straightening the knee joint.
When the cartilage is gradually worn away, either with age or following injury, the two surfaces rub together which you may hear or feel and the movement is no longer as smooth as it once was.  This usually happens at the points of greatest pressure and can lead to pain, stiffness, loss of movement, swelling and deformity.  As the muscles around the knee become weak you may experience giving way of the knee.

What can I do to help my OA knee?

Look after your feet and choose sensible footwear.  Well fitting supportive shoes with cushioned insoles reduce the impact when walking and minimise the jarring.  Slippers are not supportive footwear so you should avoid them all day

When standing – straighten your knees fully when standing

When Lying – try no tot lie with your knees bent especially if confined to bed for any period of time

Reducing Stiffness – avoid long periods of sitting. Aim to bend and stretch your legs 5 times every 30 minutes and just before you get up.  Please see the lower limb strengthening and range of movement exercise video.

Strengthening – if your symptoms persist you may find yourself doing less which in turn causes the muscles which support the knee joint to weaken and you may experience the knee giving way.  This can be improved by increasing the strength of the muscles around knee joint.  Please see the lower limb strengthening and range of movement exercise video.

Swelling / Inflammation

  • Cold / Ice therapy. Please see information on how to apply Heat and Cold therapy
  • Anti-inflammatory gels – available from most Pharmacists
  • Tubigrip Bandage – for occasional use, it can help control swelling

Pain Relief

  • Heat – this can be soothing and help decrease pain, see information on how to apply Heat and Cold therapy
  • Cold / Ice – this can reduce pain and swelling see information on how to apply Heat and Cold therapy
  • Paracetamol – This is commonly used to treat OA and works well to ease the pain when taken regularly, rather than just taking now and again when pain flares-up.  A normal adult dose is two500mg tablets taken four times a day, there are usually little or no side-effects and can usually be taken longer term without reducing in effectiveness. If you have never taken paracetamol or are unsure as to whether it can be taken with other medication, please speak to a pharmacist in the first instance or GP
  • Co-codamol – This is paracetamol combined with codeine, another painkiller. They are available in different amounts.  Lower doses are available over the counter from pharmacies but codeine can cause side-effects such as drowsiness and constipation. If you have never taken paracetamol or are unsure as to whether it can be taken with other medication please speak to a pharmacist in the first instance or GP
  • Anti-inflammatory painkillers – There are many different brands but are generally ibuprofen based, and can be used in conjunction with paracetamol or co-codamol for effective pain relief.  However, they do have side-effects including gastrointestinal upset / irritation and kidney damage and should be avoided by some people.  If you have never taken paracetamol or are unsure as to whether it can be taken with other medication please speak to a pharmacist in the first instance or GP
  • Transcutanious Electrical Nerve Stimulation (TENS) – This can help ease the pain associated with OA.  TENS works using the ‘pain gate theory’ and the TENS electrical signal serves to block that of the pain signal that is trying to tell the brain that part of the body is in pain.  TENS can be used as part of a longer term pain relief or used to reduce pain enough to allow you to comply with the advice and exercises advised by you physiotherapist.
  • Acupuncture - This is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body.  Acupuncture is based on the belief that an energy, or 'life force', flows through the body in channels called meridians. This life force is known as Qi (pronounced 'chee').   Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi cannot flow freely through the body, this can cause illness. They also believe that acupuncture can restore the flow of Qi, and so restore health. Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for any beneficial effects and can be used as part of a longer term pain relief or used to reduce pain enough to allow you to comply with the advice and exercises advised by you physiotherapist.

TOP Tips for OA Knee and Hip;

  • Know your limitations and what aggravates your symptoms
  • When walking up stairs, kerbs etc lead with the best leg first
  • When walking down stairs, kerbs etc lead with the affecting / painful leg first
  • Take care on uneven surfaces
  • Raise the height of chairs if getting out is proving a problem (try a cushion in the first instance)
  • If getting out of bed is difficult try rolling on to your side and lower your legs down at the same time so they act as a counter weight
  • Limit or avoid carrying extra / heavy loads as this increases the strain through the joints
  • Moving your knees up and down can help as can swimming as this is a non weight baring form of exercise. You may need to adapt your swimming stroke as breaststroke may prove painful
  • Avoid putting on weight by remaining active and healthy eating as the more the you weigh the more strain is on the joints
  • Walking is an excellent form of exercise, try to walk at a pace that does not aggravate your symptoms
  • If using a stick ensure it strikes the ground at the same time as the painful leg and use it in the opposite hand to the painful leg

Clinical decision making tool

For you to make a clear, informed decision about how to move forward in the management of your OA of the knee please click here for more information.

Lateral collateral ligament injury (LCL)

Lateral Collateral Ligament Injury (LCL)

LCL injuries are less common than MCL injuries and are more often associated with a significant trauma to the knee.  When it does occur in isolation this normally requires a force to the inside aspect of the thigh or knee. The knee joint will be painful and tender on the outside aspect.

How do manage / treat my LCL injury?

PRICED Advice

Protect the knee by not exposing it to the same activity
Rest .This should be relative not absolute and maintain your range of movement but do not confine yourself to bed
Ice – use ice packs for up to 20 minutes every 2 – 3 hours that you are awake
Compression – if you have access to some tubi-grip of the correct size use it
Elevation – when resting try elevating the knee slightly up a pillow length ways so it is above the height of the hip
Drugs – painkillers such as paracetamol provide good relief, debate remains on the use of anti-inflammatory drugs in the first 48 hours, as although all these steps are designed to control swelling/inflammation some swelling is still required as this is the body's injury response mechanism so it may delay the overall healing process in the longer term
Most simple LCL sprains will recover in 2-4 weeks if this does not happen ask your GP to refer you to PhysioHey

What else might help my recovery?

In most cases advice is all that is needed to aid recovery but this depends on the severity of the injury
Strengthening exercises may be required
Supporting the knee in a brace may help  (usually on partial ruptures or for those individuals who can not avoid aggravating factors due to occupation etc)

Medial collateral injury (MCL)

This ligament is strong but can be sprained or completely ruptured (torn) mechanism of injury often involve combined forces and movements such as twisting on a straight leg whilst receiving a side on impact to the knee e.g. ruby tackles and skiing injuries

This ligament is strong but can be sprained or completely ruptured (torn) mechanism of injury often involve combined forces and movements such as twisting on a straight leg whilst receiving a side on impact to the knee e.g. ruby tackles and skiing injuries.

  • Pain will be felt immediately on the inner aspect of the knee and will be tender when pressed
  • In Severe strains there may also be cartilage involvement (medial meniscus) which will cause the knee to swell rapidly

How do manage / treat my MCL injury?

PRICED Advice;

  • Protect the knee by not exposing it to the same activity
  • Rest this should be relative not absolute and maintaining your range of movement but do not confine yourself to bed
  • Ice – use ice packs for up to 20 minutes every 2 – 3 hours that you are awake
  • Compression – if you have access to some tubi-grip of the correct size use it
  • Elevation – when resting try elevating the knee slightly up a pillow length ways so it is above the height of the hip
  • Drugs – painkillers such as paracetamol provide good relief, debate remains of the use anti-inflammatory drugs in the first 48 hours as although all these steps are designed to control swelling/inflammation some swelling is still required as this is the bodies injury response mechanism so it may delay the overall healing process in the longer term

Most simple MCL sprains will recover in 2-4 weeks if this does not happen ask your GP to refer you to PhysioHey

What else might help my recovery?

  • In most cases advice is all that is needed to aid recovery but this depends on the severity of the injury
  • Strengthening exercises may be required
  • Supporting the knee in a brace may help  (usually on partial ruptures or for those individuals who can not avoid aggravating factors due to occupation etc)
  • In rare cases surgery may be required this is usually arthroscopic in nature

Osteoarthritis (OA) hip

What is Osteoarthritis (OA) of the hip?

The bony surfaces within a joint are covered with smooth cartilage which allows the bones to move smoothly and painlessly over one another.  The joint also contains a small amount of fluid (synovial fluid) which acts to lubricate the joint.

OA is the most common form of arthritis affecting 8.5 million people in the UK.  OA develops gradually over time causing the joints to become stiff and painful.  Any joint can be affected but it is common in hips, knees, hands, feet and spines. 

In joints affected by OA the cartilage becomes worn and damaged and the bone tissue next to the damage can also be affected and bony spurs develop around the joint edge.  The bony spurs are osteophytes and may be visible on X-ray and the tissues around the joints can also become inflamed (known as synovitis)

Factor that may influence the osteoarthritis development –

  • Age – OA is more common as you age.  This may be because the blood supply and natural repair mechanism become less efficient as people age
  • Obesity – knee and hip OA are more likely to develop or be more severe in obese people.  This is due to the increased loads going through the joints resulting in increased damage
  • Genetics – there may some inherited factors that lead to some people developing OA
  • Gender – women are more likely to develop OA than men
  • Previous damage, deformity or injury – this may include joint infections, fractures or congenital problems such as dislocation

What are the symptoms of osteoarthritis in the hip?

  • Pain, in the groin especially
  • Stiffness and reduced range of movement, this tends to be worse in the morning
  • Poor walking pattern and poor mobility as the OA worsens
  • Severe OA patients may have a classic limp that in turn increases the risks of falls
  • With severe OA you may have difficulty bending to put on your socks and shoes or getting in out of the car
  • In women, restricted hip movement may make sex uncomfortable or painful
  • No symptoms at all – many people may have an x-ray that indicates quite a severe degree of OA but the individual experiences no or only mild symptoms
  • The opposite of the previous point may also be true, x-ray may indicate minimal OA changes yet symptoms are severe
  • Some people may become depressed due to the pain and symptoms and the impact it is having on their work and home life

What test do I need?

X-rays are commonly done to confirm the presence of OA in the hip and knee but not essential if the history provided clearly indicates OA

How can I prevent Osteoarthritis of the hip?

Factors such as aging, family genetics and congenital problems cannot be influenced but keeping healthy, active and avoiding becoming obese will minimise the chances of developing osteoarthritis

What can I do to help my symptoms of osteoarthritis?

Exercise

If possible exercise regularly. This helps strengthen muscles around affected joints, to keep you fit and maintain range of movement of the joint.  None weight bearing exercise such as swimming is better than none at all and most people can manage to regularly walk.

Weight Control

If you are overweight trying losing even a modest amount of weight as this will make a real difference to your symptoms.

Shoe insoles or Orthotics

If insoles are considered to be of benefit your physiotherapist, podiatrist or osteopath will make the necessary arrangements

Walking Aids

If you think a stick would provide some extra support when walking make sure you use it in the opposite hand to the affected part of the body. This will relieve some of the pressure on the affected joints.

Physiotherapy/Podiatry/Osteopathy

Advice on exercise and modification of activities may prove useful if you feel you need addition advice or your symptoms have not improved ask your GP to refer you to PhysioHey

Pain Relief

  • Paracetamol – is commonly used to treat OA and works well to ease the pain, and when taken regularly, helps to keep the pain away, rather than just taking now and again when pain flares-up.  A normal adult dose is two 500mg tablets taken four times a day, there are usually little or no side-effects and can usually be taken longer term without reducing in effectiveness.   If you have never taken paracetamol or are unsure as to whether it can be taken with other medication please speak to a pharmacist in the first instance or GP
  • Co-codamol – is paracetamol combined with codeine another painkiller. They are available in different amounts.  Lower doses are available over the counter from pharmacies but codeine can cause side-effects such as drowsiness and constipation. If you have never taken paracetamol more or are unsure as to whether it can be taken with other medication please speak to a pharmacist in the first instance or GP
  • Anti-inflammatory painkillers – There are many different brands but are generally ibuprofen based and can be used in conjunction with paracetamol or co-codamol for effective pain relief.  However, they do have side-effects including gastrointestinal upset / irritation and kidney damage and should be avoided by some people.  If you have never taken paracetamol or are unsure as to whether it can be taken with other medication please speak to a pharmacist in the first instance or GP
  • Transcutanious Electrical Nerve Stimulation (TENS) – can help ease the pain associated with OA.  TENS works using the ‘pain gate theory’ and the TENS electrical signal serves to block that of the pain signal that is trying to tell the brain that part of the body is in pain.  TENS can be used as part of a longer term pain relief or used to reduce pain enough to allow you to comply with the advice and exercises advised by you physiotherapist.
  • Acupuncture - is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body.  Acupuncture is based on the belief that an energy, or 'life force', flows through the body in channels called meridians. This life force is known as Qi (pronounced 'chee').   Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi cannot flow freely through the body, this can cause illness. They also believe that acupuncture can restore the flow of Qi, and so restore health.Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for any beneficial effects and can be used as part of a longer term pain relief or used to reduce pain enough to allow you to comply with the advice and exercises advised by you physiotherapist.

Surgery for OA

Most cases of OA are not severe enough to warrant surgery and can be managed conservatively. But if the OA in a joint becomes so severe, then replacement with an artificial joint may be necessary.  There are many different types of artificial joints and such surgery has become a standard procedure for severe osteoarthritic joints.  This obviously does require an operation and a hospital stay from 48 hours to 5 days following hip replacement surgery, but like any operation joint replacement surgery is not without risk.

Clinical decision making tool

For you to you make a clear informed decision about how to move forward in the management of your OA of the hip please click here for more information.