Physiotherapy

Our hip joints allow us to do an amazing number of things – walk on two legs, pivot, squat, even kick a ball. It is an engineering marvel to combine the stability required to balance the weight of the torso over a structure the size of a golf ball, with the substantial degree of mobility available. The high demands on the hip joints can, however, take their toll over a lifetime.

Osteoarthritis is the most common hip disorder affecting adults. Primary osteoarthritis (OA) has no recognizable cause, while secondary OA is thought to occur due to altered joint mechanics or following joint trauma.  Obesity, excessive loading due to occupational or sport demands can contribute to the breakdown of articular cartilage. There is likely a genetic component as well. Muscle imbalances around the hip are also predisposing factors, as shearing forces or high compression load will cause abnormal wear and tear. Alignment issues of the low back, pelvis and leg can also contribute to abnormal forces around the joint.

Muscle imbalances occur as a result of weak, tight, or inappropriately recruited muscles. Our neuro-muscular system can develop certain abnormal pathways of firing, creating suboptimal movement, and potential damage to joint structures. If these are retrained before the cartilage damage is severe, it can halt the progression and reduce the symptoms of arthritis.

One of the most important groups of muscles for maintaining optimal compression and centring the ball, (or head) of the femur in its socket are the Gluteal muscles on the lateral side of the hip. Core strength and balance are also very important components of optimal hip health.

A second common diagnosis of hip pain is trochanteric bursitis. The most prominent lateral point on the hip bone is called the greater trochanter.  It was commonly thought that the bursa overlying this point was the most common local cause of lateral hip pain. However, in a recent study, using real-time ultrasound, 80% of patients with lateral hip pain did NOT have bursitis. 50% of the 877 patients studied had tendinosis of their gluteal muscles, ie. a degeneration of the deep hip rotators tendon’s collagen in response to overuse, occurring when other stabilizer muscles weaken. It is part of what has been labelled Greater Trochanteric Pain Syndrome (GTPS).

Symptoms of both OA and GTPS can be similar. Pain from OA is usually felt in one or more of the following areas: the groin (most common), over the greater trochanter, or down the front of the thigh and knee. Usually, arthritis pain is reported with or after activity, progressing to pain at night or at rest.

With GTPS, point tenderness is noted at or behind the greater trochanter, typically worse at night, especially when lying on the affected side.  Lateral hip pain with repeated stair climbing and squatting is more likely due to GTPS.

Maintaining adequate strength and flexibility of the hip muscles is an important component of treatment and prevention of both hip osteoarthritis and trochanteric pain syndrome. Physiotherapists are trained to assess these disorders. They can prescribe individual exercise where deficits in strength, mobility and balance are noted.

What is a concussion?

A concussion is a type of traumatic brain injury caused by a direct blow to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.

It considered a mild, reversible brain injury that affects the normal functioning of the brain.

What is so special about the brain?

The brain is made up of billions of neurons and the communications between these neurons are how we think, move, and feel. We want to protect these neurons and connections so we can accomplish our day to day activities and long term goals.

What should be done if a concussion is suspected?

If the signs and symptoms of a suspected concussion are observed, it is imperative to immediately be removed from the activity (whether it be work, school, or a sport).

The individual should first be evaluated for any signs and symptoms that would warrant a referral to the emergency department. There are many tools designed to help with the detection of concussion, including the Sports Concussion Assessment Tool 5 (SCAT 5) which is intended to be used by licensed healthcare professionals and the Concussion Recognition Tool 5 (CRT 5) which is intended for use by anyone.

These tools help with recognition of the signs/symptoms of concussion, removal from the activity as well as provide guidance surrounding the immediate care of a suspected concussion.

How do you manage concussions (based on the Berlin International Consensus Statement)

It is important to be assessed by a healthcare professional if a concussion is suspected.

The assessment for concussion is multifaceted and may include evaluation of cognition, balance/coordination, neurological function, neck joints & musculature, and temporomandibular (jaw) joints & musculature based on the symptoms being experienced.

After the assessment is completed, the 24-48 hours immediately following a concussion require both cognitive and physical rest to ease discomfort and decrease demands on the brain during the early stages of healing. After this immediate rest and the acute symptoms resolve, both physical and cognitive activities can then be gradually incorporated once again provided they do not increase symptoms.

There are designated Return to School and Return to Sport protocols that will help to gradually increase cognitive and physical demands. Although these protocols can be performed simultaneously, returning to cognitive demands (such as school or work) are to be completed prior to physical demands (such as sports or rigorous physical activity).

The majority of concussions resolve on their own within 14 days for adults and up to 4 weeks in children. However, if the concussion does not resolve as expected, rehabilitation can be done based on findings of an individualized assessment.

Concussion Treatment may include:

• Cervicovestibular rehabilitation
• Manual therapy of the cervical spine and temporomandibular joints and
  muscles
• Adaptation, habituation, and balance exercises
• Gait and head movement
• Activity/sport-specific training drills”