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Are You Still Hip?

Presenting Team

Jody Strik - Manager of Work-Fit Total Therapy Centre

Henry Candelaria, BPHE, DCDoctor of Chiropractic

Medical Acupuncture ProviderAdvanced Practice Clinician

Alexandra Tarkowski, BHSc, DCDoctor of Chiropractic

Medical Acupuncture ProviderActive Release Techniques® Provider

B.ScKin, B.ScPT, M.C.P.A., MBHM (Cand.)Medical Acupuncture

Provider

Agenda

• Review the Anatomy of Hip/Knee• Identify Early Signs and Symptoms

of Osteoarthritis• Referred Pain Patters that can

replicate Hip/Knee Pain• Discuss Management Options• Alternative Medicine - What Works?• Interactive Session

Anatomy of the Hip Joint

Anatomy of the Knee Joint

Muscles

• Morning Joint Stiffness

• Joint Inflammation

• Inability to bend to the ground

without pain

• Constant aching pain in the joint

• Pinching sensation when

crossing legs

• Difficulty with transitional

movement from sit to stand

• Limping

• Joint Pain

• Limited Range of Motion

• Crepitus (Crackling, grinding

noise with movement)

Early Signs & Symptoms

Signs & Symptoms• Knee Pain • Stiffness • Swelling

• Popping • Crunching •

• Knee Buckling or Locking Up

• Morning Stiffness

• Difficulty climbing or descending stairs

• Inability to squat to the ground without pain

• Feeling of knee locking or giving out

• Limping

• Pressure behind knee

Synovial Joint

Referred Pain Pattern

Normal Disk

Degenerative Disc

Bulging Disc

Herniated Disc

Thinning Disc

Degenerative Disc

Spinal Anatomy

• Vertebrae• Facet Joints• Intervertebral disc• Ligaments

The Lumbar Spine

Management• Visit a reputable rehabilitation centre

• Ensure they have the right modalities and equipment to assist you in getting better faster

• Combination of active and passive care is necessary

• Manual therapy: mobilizations, manipulations, soft tissue therapy

• Active Release Techniques ®

• Pain management: Acupuncture, IFC/ TENS

• Supervised exercise program specific to complaint and pattern**

• **Individualized rehabilitation programs

Current Evidence

American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee

Arthritis Care & ResearchVol. 64, No. 4, April 2012, pp 465–474 DOI 10.1002/acr.21596© 2012, American College of Rheumatology

MARC C. HOCHBERG, et al

Table 3. Non-pharmacologic recommendations for the management of

knee OA

We strongly recommend that patients with knee OA should do the following:

• Cardiovascular / resistance land-based exercise• Aquatic exercise• Self-management programs• Manual therapy in combination with supervised exercise• Patellar taping• Custom Orthotics• Thermal agents• Walking aids, as needed• Tai chi programs• Acupuncture• Transcutaneous electrical stimulation

Current EvidenceTable 5. Non-parmacologic

recommendations for the management of hip osteoarthritis (OA)

We strongly recommend that patients with knee OA should do

the following:

• Cardiovascular resistance land-based exercise• Aquatic exercise• Lose weight (for persons who are overweight)• Self-management programs• Manual therapy in combination with supervised exercise• Group arthritis classes• Thermal agents• Walking aids, as needed

At Home Management

ICE OR HEAT • Ice - initial stage (24 - 48 hours)

• Ice reduces inflammation and pain.

• Apply crushed ice in a bag, package of frozen vegetables or a gel pack.

• Apply for only 15 minutes maximum and repeat every 2-3 hours.• Heat may be used after 48 hours.

• Maintain proper posture

• Avoid flexing forward, twisting/reaching out.

• Stabilize the back & deep core muscles keeping your back straight and your chin tucked in.

• Strengthen your quads and gluts as these are the major stabilizers for the hip and knee joint.

GOOD HABITS FOR PREVENTION

Alternative Medicine

1. National Institutes of Health. National Center for Complimentary and Alternative Medicine. “Questions and Answers: NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT).” 2004. http://nccam.nih.gov/research/results/gait/qa.htm?nav=gsa.

1

• Glucosamine • Chondroitin • MSM •

Naturally found in connective tissues in the human body, such as those covering the ends of bones in the joints.

• Glucosamine is extracted from animal tissues (crab, lobster or shrimp shells).

• Chondroitin is found in animal cartilage (tracheas or shark cartilage).

• MSM, also known as methyl sulfonyl methane, is a compound found naturally

in (cow's milk, meat, seafood, fruits and vegetables).

Glucosamine, chondroitin & MSM are believed to impact the cartilagedegeneration process of osteoarthritis in the following ways:

• Helps slow or prevent the degeneration of joint cartilage.

• Helps alleviate existing joint pain.

• Has very few side effects.

• May not offer the desired pain relief for all osteoarthritis patients.

At the time of this article, the benefits and risks of taking glucosamine, chondroitin & MSM have not been definitively proven, and long term studies are needed to better understand their effects.

•Circulation and Lubrication•Postural Correction

Interactive Session

•Glut and Quad Activation•Balance

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