Non-Surgical Hip Pain Treatment

Osteoarthritis is a chronic, degenerative, and progressive disease resulting in cartilage degeneration, osteophyte formation (bone spurs), joint deformity, and loss of joint function. The typical symptom of hip arthritis is joint pain that occurs either in the groin or the buttock, NOT on the SIDE of the hip. (Pain on the side of the hip is usually something else, not arthritis.) This pain can occur with walking but especially when going up and down stairs. It makes it difficult and painful to put your socks and shoes on because you can’t bring your leg up to your hands without pain. A simple physical exam test for hip arthritis is the ‘windshield wiper’ test. In this test, the patient sits on the exam table with the legs hanging free. The examiner grasps the patient’s ankle and moves the lower leg back and forth sideways like the motion a windshield wiper makes. If the patient has significant arthritis of the hip joint, this test will cause pain especially when the ‘wiper’ is moved away from the midline. The best test to confirm the diagnosis of hip arthritis is a plain x ray. MRI’s or CAT scans are unnecessary in most cases. Why doesn’t cartilage in hip joints repair itself similar to a cut on your hand or a broken bone? Why can’t our bodies repair damaged hip cartilage before it gets thinner and thinner, eventually leading to denuded areas of bone-on-bone arthritis? The simple reason is that joints do not have good circulation. There is no artery inside a joint. Cartilage gets oxygen and nutrients that diffuse in from tissue fluid that comes from the underlying bone. This circulation is enough to keep it alive but is not adequate to repair damage that occurs with trauma, repetitive use, and aging. So, over time and after trauma, our joint cartilage starts to wear out, sometimes slowly over years and sometimes very quickly over a few months. The only alternative to invasive hip joint replacement surgery is stem cell therapy. Do not agree to undergo hip joint replacement surgery until you have gotten a second opinion to see whether or not stem cell therapy can help get rid of your pain and improve the quality of your life.

Hip joint arthritis, like arthritis in the knee joint, usually occurs in what we call ‘high mileage’ patients. These are older patients who have accumulated many years of wear and tear on their joints but it also includes younger patients who have placed several years of increased stress on their joints, such as college athletes, professional or semi-professional athletes, runners, or other patients who through extreme sports or other high impact activities have stressed their joints much more than the average person does. Arthritis can also run in families, and it’s not unusual for a patient to have one or both parents who had similar problems.

In the past, the only remedy for a worn-out hip joint was an invasive surgical procedure. In less severe cases, the surgeon would ‘clean out’ areas of worn or frayed cartilage during an arthroscopic procedure. In advanced cases, a total joint replacement was usually recommended. At NeoGenix, we have seen a significant problem with this approach. First, we very commonly see patients who have been told by their orthopedist that they are ‘bone on bone’ and that total joint replacement is their only option. Yet when we review their x rays we frequently find that not only are they NOT ‘bone on bone’ but their arthritis is NOT severe enough to warrant joint replacement at all! This is not an uncommon occurrence….we see this all the time. If we think your arthritis is really ‘too far gone’ to benefit from stem cell therapy, WE WILL TELL YOU. Dr. Altizer turns away patients that he feels would not benefit from stem cell therapy. We have treated many advanced cases of arthritis and have gotten great results. Would we rather have gotten to the patient before they became such an advanced case? Certainly. The earlier you intervene in the course of arthritis before it progresses to severe bone on bone disease the better your results will be. But even in advanced cases, we still see improvement in pain and function, and even in those cases we have been able to postpone joint replacement surgeries for those patients who are not ready either psychologically or for medical reasons or are too young for joint replacement surgery. The bottom line is this…arthritis is a progressive disease. It gets roughly 5% worse every year if you do nothing to slow it down. ‘Nothing’ also includes cortisone/steroid shots and gel shots which do not slow down the progression of arthritis. But we firmly believe that stem cell therapy actually slows down the yearly progression of arthritis in many patients. Since January of 2016, Dr. Altizer has used stem cell therapy to keep thousands of patients out of the operating room and has prevented thousands of unnecessary joint surgeries.

The greater trochanter is the boney prominence that you can feel on the side of your hip. It is an important attachment point for several muscles. The IT band (iliotibial band) is a large tendon that originates from the wing of the pelvis and travels down the outside of the hip directly over the trochanter continuing down the outside of the thigh and knee where it attaches to the lower leg bone just below the knee joint. This dense strap of connective tissue passes back and forth over the trochanter when we walk. If the IT band becomes too tight, it rubs against the trochanter and can cause inflammation and pain known as trochanteric bursitis (or IT band syndrome). The obvious symptoms of this are pain on the SIDE of the hip when walking or running and also pain in the same area when the patient tries to sleep on either side. When the inflamed side is down, the mattress rubs on the inflamed area causing pain. When the patient flips over onto the ‘good side,’ the thigh on the ‘bad side’ drops down stretching the ITB causing more pain. The only way these patients can sleep on their side is to sleep with the bad side up with a pillow between their knees, taking the stretch out of the IT band. Sometimes the IT band will make a snapping sound that patients can even feel when they walk as the IT band moves back and forth over the trochanter. The diagnosis is suspected when a patient complains of the above symptoms and when the patient experiences pain when the doctor pushes directly on the trochanter on the side of their hip. Pain with pushing on the side of the hip is NOT arthritis, it’s BURSITIS. The typical treatment for this involves exercises to stretch the IT band and non-steroidal anti-inflammatory drugs like motrin, etc. However, if these do not work, an injection of stem cells or growth factors into the inflamed area can help it to heal much faster. Surgery is almost never indicated for this problem.

Tendinopathy of the gluteus medius and gluteus minimus tendons is now recognized as a significant cause of lateral hip pain. The condition mostly occurs in mid-life both in athletes and in subjects who do not regularly exercise. Females are afflicted more than males. This condition interferes with sleep (side lying) and common weight-bearing tasks, which makes it a debilitating musculoskeletal condition with a significant impact. The gluteus medius (GM) is one of the smaller, lesser-known buttocks muscles, providing stability and support to the hip and pelvis during weight-bearing activity. Most commonly affecting distance runners, gluteus medius tendinopathy can also strike those beginning a new exercise program or increasing their workout intensity. The GM muscle functions to contract the weight-bearing hip during running or walking. When this muscle activates, your hip flexors release and vice versa.

The most common symptoms of gluteal tendinopathy are stiffness, pain and strength loss in the hip. The pain typically worsens during weight-bearing exercise, including running, walking or climbing. For many patients, the pain radiates down the thigh, similar to the symptoms of sciatica and hamstring tendinopathy. Many patients also report pain when lying on the affected hip in bed, as well as stiffness or pain during the night and upon rising in the morning. If the condition progresses beyond the initial stage, the hip bursa may become inflamed (trochanteric bursitis), causing swelling, tenderness, redness or warmth in the hip.

We can use ultrasound to directly visualize the gluteus medius muscle and tendon. Inflammation and degeneration of the tendon can be seen, and injections of stem cells can be done directly into the affected areas. In addition, the doctor will likely recommend that you back off your routine temporarily and apply the RICE treatment protocol (rest, ice, compression and elevation). Physical therapy and deep tissue massage may also be recommended. You may also be given specific muscle activation, strengthening and hip mobility exercises to do at home.

The hip labrum is a gasket-like structure that lines the socket of the hip joint. Like the gaskets that seal the joints between the pipes in your house, the acetabular labrum provides a suction seal for your hip joint — adding to the stability to the joint. Similar to rubber, it is made of a spongy substance referred to as fibrocartilage that is susceptible to injury and degeneration.

Tears of the labrum can be divided into several different categories that include both acute or sudden traumatic injury or tearing, or chronic conditions leading to degeneration or fraying of the tissue. When disruption of the normal tissue occurs, hip pain and dysfunction often ensue. This manifests as pain in the groin, or front of the hip, mechanical catching or seizing sensations, and pain with deep flexion or twisting at the hip that is common to athletic activities.

Several factors are important in guiding the treatment of a labral tear. Those factors include the underlying shape of both the ball and socket of the hip. Deep sockets and shallow sockets place extra stress on the labral tissue making it susceptible to tearing. A bony prominence of the edge of the femur, or ball portion of the joint, referred to as a cam deformity can also lead to tearing of the labrum. The shape of the hip joint is best evaluated with x-rays, which is why they are often obtained as the first step in the evaluation of hip pain. Additionally, the amount of hip joint space narrowing, or arthritis, is also an important factor that is best evaluated with plain x-rays.

Treatment of labral tears often begins with a period of relative rest, use of anti-inflammatory medications, and course of physical therapy to strengthen hip and core musculature. We can use ultrasound to directly visualize the labrum and injections of stem cells can be done directly into the affected areas.