The hips, knees and ankles are the main weight bearing joints of the body. Though they are meant to last a lifetime, it is common to see hip degenerative problems from the 50’s onwards. 

 

Arthritis can affect many joints or just one. In a single joint we tend to use the terms ‘degenerative wear’ or ‘wear and tear’, especially in early stages, rather than using the more frightening medical term ‘arthritis’.

 

Degeneration affects articular cartilage and this can begin to thin long before old age. Articular cartilage is a shock absorbing layer which covers every moving part of the joint. It provides a friction-free surface to assist smooth, catch-free motion. 

 

It also has shock absorbing properties, helping to protect the inside of the joint.  Thinning is both the cause and effect of joint ‘wear and tear’. As the process worsens it gradually evolves into arthritis where the underlying bone is exposed.

 

Wear occurs through trauma and cumulative overloading from perhaps being overweight or walking miles a day every day. Increasingly evidence is emerging that genetics play a part too, as is seen where several members of a family have arthritic issues while some families have none.

 

 

It used be thought that once the wear process started, arthritis was inevitable and that ultimately surgical joint replacement would be necessary. 

 

Thankfully, our understanding of how the wear process proceeds means we can positively affect the outcome. It is now possible to at least slow down the thinning process and in some cases actually reverse problems within a wearing joint.

 

The first thing is to recognise early symptoms of lower limb joint wear: local joint stiffness and difficulty in some movements. Symptoms often present a specific pattern with stiffness first thing in the morning. The middle of the day can feel quite good. Increasing aching pain (more than stiffness) comes on towards the end of the day. 

 

In terms of the hip area, pain is commonly felt in the groin region, occasionally extending right down to the knee. Generally symptoms are felt more in the front of the leg rather than the buttock or back of the thigh. On examination the wearing hip will show limitation of some normal joint movements and a classic muscle pattern of muscles of the front and inner thigh being short and tight while muscles on the outside and back of the hip are weak.

 

So, if this sounds familiar, what can you do? Looking after the sore joint is the first thing. Note specific activities that cause pain and reduce the time spent doing these aggravating things.

 

Consult a Chartered Physiotherapist, the movement and muscle specialists in healthcare who can give you a specific regime to improve hip movement, strengthen weak muscles and stretch tight ones. Manual therapy can improve movement within the joint, allowing the joint function better, which of itself will reduce pain. Electrotherapy and medical acupuncture along with even simple over-the-counter medication can clear pain.

 

If you are overweight, losing weight helps immediately by reducing the weight of loading on the joint. Exercise is an essential component of a successful weight loss programme, but if you have a wearing hip or knee you need to modify your exercise to protect the thinning cartilage.

 

Weight bearing, high impact or high load exercises can wear the joint surface more quickly. Swap from walking or running to cycling or swimming. In the gym, choose the exercise bike (a hip joint ‘favourite’) and cross trainer instead of the treadmill and stepper. This reduces both shock to the joint and extra loading. 

 

Even changing the time of the day at which you exercise can make a difference. First thing in the morning, when the joint feels stiff, is not the ideal time for heavy exercise.   If possible it is optimal to take exercise in the middle of the day or early evening. 

 

The floor surface where you exercise can be a help too. A sprung floor, grass or artificial turf is kinder than unyielding tarmac or concrete. If you are on your feet a lot, shock absorbing footwear makes good sense. If your feet are flat provision of custom-made orthotic inserts can improve biomechanics of the whole leg and lower back.

 

Your GP, pharmacist, podiatrist and local Chartered Physiotherapist can each be worth consulting for best advice earlier rather than when the cartilage wear becomes critical.   

 

Essentially, the message is to deal with grumbling joint symptoms early to prevent arthritis later.

 

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