Tom Hutyler: Welcome to IRG’s Sports Medicine Update

Tom Hutyler: I’m Tom Hutyler and along with Shannon O’Kelley, physical therapist and president of IRG physical and hand therapy and our guest Dr. Phil Downer, Orthopedic Specialist from Orthopedic Specialists of Seattle.

Tom Hutyler: Dr. Downer, welcome.

Tom Hutyler: Hey, hip surges come a long way, a lot of changes. Tell us about some of the changes in hip surgery.

Dr. Downer: We’re now doing a lot of work to try and preserve the hip. We’re seeing hips now that are painful, but do not have enough damage to justify replacing it so now we’re trying to preserve the hip so labral tears are something that people now hearing a lot more about and labral tear what we see are typically caused by mechanical problem of the hip.

Dr. Downer: Two of the main are hip dysplasia and hip impingement. Those are the big ones we’re seeing now and we’re trying to treat these hips when they’re painful, but before they’re so damaged that they’re non-preservable.

Tom Hutyler: As a hip surgeon, how do you decide to repair or replace?

Dr. Downer: That’s a good question. I mean, first of all, the hips need to be painful. That’s how they come to us, pain. And then we’re trying to see, is the damage such that it’s not so bad that we can preserve it or has it past the point and are we better off trying to manage this without surgery or eventually replace it.

Tom Hutyler: Well great. Thank you for your information. Always nice to hear the latest and greatest.

Dr. Downer: Thanks very much.

Tom Hutyler: If you like more information on this topic as well as how to contact Dr. Phil Downer, go to orthopedicspecialistsofseattle.com or go to irgpt.com and click on the health experts tab.

Tom Hutyler: Welcome to IRG’s Sports Medicine Update

Tom Hutyler: I’m Tom Hutyler and along with Shannon O’Kelley, physical therapist and president of IRG physical and hand therapy and our guest Dr. Phil Downer, Orthopedic Specialist from Orthopedic Specialists of Seattle.

Tom Hutyler: Dr. Downer, thanks for joining us.

Tom Hutyler: Hey, athletes and just people that sometime injure their lower leg muscles, particularly their groin muscles, sometimes that’s a hip problem that goes undiagnosed. Tell us about your experience there.

Dr. Downer: Well most things are not serious, but some are. And people who are getting these recurring what they call groin pulls may want to have them checked first by their family doctor and then possibly somebody more specialized just to make sure they’re not dealing with something that is more boney origin and can be addressed early to avoid bigger problems in the future.

Tom Hutyler: Yeah, those muscles that attach on that hip area or pelvis area, pretty big muscles and sometimes can you pull of a chunk of bone and just assume it’s like a strain?

Dr. Downer: That is one issue. Big muscles, powerful muscles, but the bigger issue I’m referring to are architectural problems with the hip, the shape of the hip that can predispose one to big problems in later in life.

Tom Hutyler: Recurring hip problems, continuous strains might be problematic have it looked at.

Dr. Downer: Yes, have a check.

Tom Hutyler: Yeah, that hip joint often overlooked in the sports medicine population. Thanks for coming back.

Dr. Downer: It’s been a pleasure.

Tom Hutyler: If you like more information on this topic as well as how to contact Dr. Phil Downer, go to irgpt.com and click on the health experts tab.

By Dr. Phil Downer

This is a discussion on the non-surgical treatment of hip arthritis.

First thing I recommend for people is to modify their activities. So this involves doing more of the light, low impact activities such as swimming, biking, walking or hiking.
You’re trying to avoid the higher impact activities such as running on the pavement or cutting-type sports, soccer, or hiking, you know, going up and down, steep inclines or declines. These types of heavy pounding, heavy impact activities generally irritate the hip more while they give you, can give you a workout, they often irritate the hip and therefore cause more harm than good.

In terms of medications, first thing we always recommend is Tylenol. This is purely a pain medication. And if this isn’t effect of its own, adding an anti-inflammatory is a good combination so you can take Tylenol with anti-inflammatory such as ibuprofen or Naproxen or Aleve. Together this combination is more effective than any of the medications on their own.

Physical therapy is often a thing we recommend. This can be done with a physical therapist or done on your own. It involves stretching, strengthening the hip, in the midrange of motion, so gentle stretching and strengthening, like I’ve said, mid-range, best type of activities are things again, like I said, swimming, walking, bike, stationery bike, trying elliptical or step machine, these low impact, Nautilus type machines on a very low setting, they move the hip through mid-range of motion and avoid the high impact that can irritate the joint.

Massage can often be very helpful. This reduces inflammation and can reduce muscle spasm and either done on your own or with a professional masseuse, it can be quite effective.
Diet is another thing. People talk about dietary triggers and I know there’s work being done on certain inflammatory diets that are, you know, can cause problems for more people. It’s difficult for me to discuss it, and difficult to make good comments. It’s not something I have much expertise in, but I know I have heard from patients and read that the diet plays a fairly large role in pain from arthritis.

And related to this is losing weight. The big reason why patients have difficult moving and dealing with arthritis is because they’re overweight. So losing weight and getting closer to your ideal body mass is critical.

Finally, cortisone injections are a way we use finally for certain patients to reduce inflammation. Basically we’re putting in steroids in the joint, inside the joint capsule to reduce inflammation and this can last from very little at all to 2-3 months for some patients and is sometimes an effective way. One of the reasons I typically recommend it is to patients, who can’t have surgery or can’t have surgery at the present time are in severe pain and also a good use of it is when you’re going on vacation and can’t have your hip treated prior to vacation. It’s a good way of enjoying your vacation.

So hopefully you find that helpful. That’s a brief discussion on non-surgical ways of dealing with hip arthritis.