This article is a transcribed edited summary of a video Bob and Brad recorded in June of 2021. For the original video go to https://www.youtube.com/watch?v=7HRV0y7pRUY&t=430s.
Bob: Today we’re going to talk about hip pain arthritis. We got eight strongly recommended treatments by experts. And who are these experts? I’m going to reveal this right away, Brad.
Bob: It’s physicians from the American College of Rheumatology and Arthritis. So, all these doctors got together and in 2019, they did this. They’ve been doing it for years. They re-update it every so often. They looked through the research, they scanned all the research that’s out there and they figure out what is working and what is not working.
Bob: They kind of hedge their bet by saying they strongly recommend, just recommend, or strongly recommend against.
Brad: Okay, so the pros, what’s going to make it better? What’s going to make it worse? And in between.
Bob: So, I picked out only the stuff they strongly recommended for hip arthritis.
Brad: Okay, to make it better?
Bob: Yes, to make it better. All right, number one, no surprise here. Hip exercise is strongly recommended for patients with hip osteoarthritis. Now when I think of hip exercise, I think of stretching. Because we want to make sure the hip has as much motion as possible.
Brad: Right, maintain the motion.
Bob: And we have a lot of videos on that. And what else?
Brad: We have a program section on that already.
Bob: No, I know, but hip strengthening.
Bob: Yeah, there we go. Just cousins. So, the thing is, as you get pain in a joint you stop using it as much and it becomes weak. It’s important that you do some strengthening exercises.
Brad: You’re not going to do them if they create pain, particularly sharp pain. You’re going to find out which exercise are tolerated, and stretches are tolerated well and make it feel better. Then go from there.
Bob: Let me just say this too, it can make a huge difference. It can take people from having pain to no pain, even though they have osteoarthritis doesn’t mean you’re going to live with pain. Give this one a try. Number two is again, blatantly obvious, but weight loss is strongly recommended for patients with hip osteoarthritis if they’re overweight or obese. Now I know this is daunting for many of you, but even a loss of 5% of body weight, they found can make a big clinical or mechanistic outcomes.
Brad: You don’t have to lose a lot. It’s going to help you out.
Bob: Yeah, about 50 pounds. So, give it a shot.
Brad: We know that’s difficult. It can be a real challenge for anyone to lose weight. But, you know, it can help.
Bob: I’m not sure what this one means, but I’m going to give you my interpretation. So, they strongly recommend self-management programs. I think the idea behind this, is Brad and I have talked about this one a lot with patients and you must feel like you’re in control and that you’re in charge of getting this better. If you’re waiting for somebody else to give you a pill or something to take care of it. You must take the bull by the horns. Right?
Brad: Well, a good example is the first two you just mentioned. You must get your exercise, your strengthening, your range of motion and then change your diet and see if that can help lose some weight. Those two things that’s all under you own self-management. You’re in control of it.
Bob: Right. I think this is a good time to mention, Brad, they didn’t include this, but physicians are a little bit slow to embrace this, I think, but there are anti-inflammatory foods.
Brad: Right, I agree.
Bob: You may want to know, I would check that out because you might be able to knock the pain down, just by partaking in some of those.
Brad: You’re going to lose some weight, if you happen to have not such a good diet, if you eat a lot of carbs and sugars and that kind of thing. It’s just all part of the problem.
Bob: Right. Number four, Tai Chi is strongly recommended. Not surprisingly, because when you have knee or hip arthritis it’s not only slow gentle movements and graceful, but it’s also good breathing and relaxation but you’re getting strength and it’s also helping your balance. So, you’re going to prevent falls.
Brad: Right. I’m surprised they didn’t have yoga in there too because they’re similar. I’ve never taken either one. I’m familiar with some of the Tai Chi, but one way or another it’s part of range of motion.
Bob: You must be careful with yoga sometimes. Some of them are good, and some of the exercises may not be good for your hip.
Brad: In our opinion, of course.
Bob: Yeah, sorry yoga people! All right, number five. I was glad they had this one, Brad. In one study I saw where they didn’t recommend it, they recommended use of a cane. I always say to people, I’m not saying that you must use a cane forever. But sometimes, the hip kind of flares up and if you can use the cane to let it calm down and maybe do some strengthening while you use the cane, I think it makes a big difference. If you start, for example, you’re not using the cane and you’re waddling along because of the pain, that makes things worse. People go, “Well I’m not going to use a cane, I’m not that old.” And they’d rather waddle along and really draw attention to themselves as opposed to if they used a cane and walk normally.
Brad: It’s one of those things you just have to think of a cane giving you some dignity.
Bob: Right, there you go. Or use a single crutch of walking stick or something, it’s a little less obvious. Number six, Oral NSAIDs, non-steroidal anti-inflammatory drugs. They’re strongly recommended for people with hip OA.
Brad: So, we’re talking like Ibuprofen, Aleve, Tylenol.
Bob: No, not Tylenol.
Brad: Oh, that’s right. I’m glad you picked that out. Also make sure you are aware, if you’re taking another medication, you should talk to your doctor and find out if there’s any precautions with and NSAID.
Bob: Well even with Ibuprofen, you’re only supposed to take a small amount. It can be hard on your stomach; you must take it with food. We’re not doctors, we’re not pharmacists, so get advice from them.
Brad: We do have two outstanding videos with a pharmacist talking about these. You’ll get some good information on that.
Bob: Number seven and number eight are kind of similar, Brad. They’re both talking about glucocorticoid injections, in other words, steroid injections. They’re both recommended. The one says for the hip, they recommend that you use the ultrasound guided version.
Brad: And you don’t have to worry about this. A doctor makes the decision for you.
Bob: Well, you want to make sure the doctor’s doing it. You know that he’s not going to just stick in there blindly, because they used to do that. They used to never use an ultrasound to guide it. And they did it in the back too, which I would never get a cortisone shot in my back without it being guided.
Brad: In other words, if the doctor doesn’t do it you may want to go to a doctor that does use it, so they can see the needle go in and it goes to the joint or the specific area without near as much guessing. It’s more accurate, so if a doctor says, “Well, I don’t do that because I don’t feel I need it.” then you can say, “Well, maybe I’ll go to someone else who does have it.”
Bob: Now, they did say it’s okay, in your knee, to not use the ultrasound. Apparently, it’s just easy to find the spot.
Brad: It’s more superficial.
Bob: And the same with your hands. But for the hip they think you should be guided by the ultrasound. And this is something that you can’t do too much of because you can’t take too many steroids, but they’ll know that. I think they can usually do two shots a year, maybe three shots a year, so.
Brad: Yeah, their putting that needle with the steroids and they try to get it, I believe, right into the capsule. How are you going to see it? Because there’s a lot of soft tissue around that joint.
Bob: I have had people that have done well with it, and I’ve had people who didn’t know at all that it’d even helped. It made a difference, so. But it’s enough that the research has shown that it’s worth a try. Strongly recommended. So, there they are. You can look these up yourself. Just look up 2019 the American College of Rheumatology Arthritis guidelines. I think for hip, for osteoarthritis and it’ll pop up.
Brad: All right, take care and we hope your hips last a long time.
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