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Lateral Hip Pain (Osteoarthritis (Treatment (Education - General…
Lateral Hip Pain
Osteoarthritis
Presentation
Reports of stiffness - Often reported in the morning, late at night and during periods of prolonged activity.
Generally older population (50+) - Repeated activity over period of life reduces the amount of joint space which causes narrowing and irritation to the joint line.
? Weakness ? - Often associated with reducing activity due to pain and secondary effects to exercise or beliefs of negatives from regular exercise.
Reduced ROM - Reduced external rotation and flexion of the hip are most commonly seen in OA. The reduced ability to reach these positions stem from the narrowing of joint space,
Treatment
Education - General management, activity modification, how osteoarthritis affects movement, encouraging regular activity.
Exercise - Weight bearing exercises and general activity, increases the lubrication within joint spaces. Maintains muscle strength, stamina, cardiovascular fitness, bone health.
Surgery / replacements - Use of Oxford hip score to determine how severe arthritis is. If exercise and general conditioning continued to be limited, surgery and replacements may be offered.
Injection therapy - The use of Hyaluronic Acid Injections and Platlet Rich Plasma have been studied recently. One study found PRP to be most beneficial when comparing the two. However, HA was studied in a year previous to this study which found positive effects in pain relief and function when compared to NSAIDS, steroid injections and physical activity. The use of injection therapy could be concluded a good adjunct treatment to physical therapy to help in overall conditioning and pain alleviating effects.
Hydrotherapy - Utilising buyoncey to reduce effects of weight-bearing in joint space. Allowing movement and production of lubricating fluid to line affected joints. Improves fitness, balance and strength. Social benefits of group activities and reduced inactivity improves mental health.
Differential diagnosis
Rheumatoid arthritis - Presence of Heberden's nodes in OA which are not found in RA. X-RAY and blood tests are used to differentiate between loss of joint space and the presence of anti-CCP rheumatic inflammatory markers.
Gout / pseudogout - Marked by intense flare-ups of inflammation. The presence of uric acid crystals and calcium phosphate crystals are found in gout.
Labral tear - Pain in certain movements (particularly end range flexion and adduction). Use of compressive force into the joint often reproduced pain. CAM and pincer impingements are the most common types.
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Lumbar spine
Presenting Complaint
Shooting / pins and needles / numb / tingling - Often into the gluteus and lower limb region. May indicate irritation and compression on the sciatic nerve. Reuced facet joint space narrows the exit roots for the nerve to pass from the spinal canal to the peripheries.
Aching or stiff - Often in the lower lumbar region which reduces active movement of the lumbar spine. Reduced movement may be deemed as guarding which is an adoption of actively or passively reducing movement due to fear of damage.
Distinguishing - Important to rule out other pathologies such as piriformis syndrome which may mimic injuries of the lumbar spine.
Treatment
Education - Give encouragement to use the spine as it is designed to bend and twist. Movement of the spine is neccerseary for increasing joint movement and strengthening surrounding muscles.
Exercise / activity Increasing activity and usage of back. Starting with range of movement exercises and gradually building up to a strengthening programme.
Hydrotherapy - Utilising buyoncey to reduce weight-bearing through spine. Complete exercises that engage the core and lower back. Complete ROM exercises to increase mobility of the spine.