What Do I Do for Hip Pain?

I am 61 years old and am most happy when I am hiking, biking, dancing or kayaking.  Degenerative joint disease in my right hip (which an x-ray showed at my last check-up) does not fit into that lifestyle. I have recently been in enough pain to the point that simple walking and even garden work causes pain. I do not want medication.  I want to cure this.

I am going to do your “tailgator” program for my hip.  What other exercises should I do? I have been helped by a physical therapist who gave me exercises to strengthen the muscles in the area…what else should I do? 

I figure that the only aerobic exercise that would be low impact would be swimming, but what about weight bearing exercise for osteopenia?

I am motivated to do anything to fix my problem.

Thanks!

Deborah

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First, thanks for reading Deborah. And, for sending in a question that a lot of people may also have.

To overcome the effects of osteoarthritis, you have to assemble a game plan that includes several things. And the game plan is modified some according to your unique set of problems so this a general strategy to get you started.

• Anti-inflammatory diet. Here's a really good overview of the anti-inflammatory food pyramid. What we eat or drink can greatly influence how our body reacts to physical and emotional stress and can even create inflammation from the nutrients. An anti-inflammatory diet helps you reduce the pro-inflammatory markers produced by these stresses.
• Adequate flexibility of the lumbar spine, hip, and ankle. When joints are sensitive to load, as in OA, inflexibility above and below the joint, can increase force transmitted through the painful joint. Your physical therapist should be able to tell you whether you have enough flexibility and how to improve it. I perform a series of biomechanical tests to help identify movement faults due to weakness or inflexibility but that process is way too detailed to go into in a blog.
• Excellent core muscle endurance. You can test your core endurance with the side plank test. You should be able to hold the position for 20 seconds on each side (see image). If you fail this test,  you have to work on developing the core. You're after endurance not strength. Read anything by Stuart McGill for ideas.
• Low load, high volume motion. I prefer the Total Gym for this. There are other devices that are similar ( Body Rail , Vigor ), but I haven't used them. You have to find a level of force that is very comfortable to your hip. Usually that will be around the 3rd or 4th rung on the Total Gym. You squat until your knee approaches 90 degrees. It's not a sprint. Slow, comfortable pace. Lots of repetitions. I usually start with 10 minutes, take a break, work on other things, then come back and do another 10 minutes gradually working up to 30 total minutes per day.
• High volume motion with almost no load. Hip swingers is what I use most of the time.
• Muscle strengthening. You know about this, but you have to be careful. The loads produced by the muscle contractions can overload the joint. The muscles to concentrate on are the hip rotators and abductors. 
• Cardiorespiratory exercise. What you do for this depends on how much force your joint can withstand. I will use swimming, ellipticals, walking or exercising in water. In the clinic, we have an anti-gravity treadmill so we can help people walk or even jog without overloading the joint. I shoot for 30 minutes with a 12-13 Rating of Perceived Exertion .
• Supplements. Here's an article I wrote about this. Try to avoid taking NSAIDs as much as you can. Sometimes you have to but I've had clients who turn to NSAIDs at the first sign of pain. Give your body a chance to fight through it. NSAIDs have been shown to weaken the joint cartilage with prolonged use.
• Get real. This is the hard part. You have to accept how much your body can do without injuring your self over and over. While you're working on rebuilding your joint capacity, you'll likely have to let go of doing certain things, and most of these are things you really love to do, until your joint is strong enough to withstand the loads of those activities. If you don't do this, you not only continue to hurt, you'll advance the disease process and simply lose more and more things from your life over time. There's a phrase from Buddhism that I like a lot - "The Middle Way". It means finding the path between too much and too little. Avoid the extremes. 
• Meditate. Meditation calms the sympathetic nervous system - the fight or flight part of your body. It helps you clear your mind of the past and future and just focus on now. I especially like Dale Goldstein's "Awareness Meditation" audio guide.
• Journal. Gratitude for what you have, for what you can do. There are always people worse off the you.

If you start working this list, you should start feeling better. The thing to remember is that your body is amazingly adaptable. Just give it a chance and you can really improve a lot of things in your life. Just because you have changes on x-ray doesn't mean you're doomed to a life of sitting on the sidelines watching everyone else enjoy themselves. But, you must be patient, persistent and disciplined.

I hope this helps you.

Follow my recovery from a rotator cuff tear here. I post new stuff every day or two generally.

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