By Emily D’Alterio for Yoga Medicine.
Chronic joint injuries or illnesses are common limitations in physical activity. However, this inactivity can result in increased symptoms, compensation musculature or movement patterns, weakening or hypertension in their muscles, and decrease in overall mental health and overall wellbeing.
There are numerous conditions that impact joint health including labral tears, impingement, bursitis, fractures, tendonitis, and arthritis. Osteoarthritis (OA) is a degenerative joint disease that can affect any joint in your body, predominantly affecting the hands, spine, and joints such as hips, knees, and ankles. It is the most common joint disorder in the United States 1 and it is globally estimated that 10-15% of adults over 60 have some degree of OA. 2 It is more common with an aging population, however, occurs in the younger population with physically demanding work or lifestyles.
OA is diagnosed as the thinning and damage of cartilage with formation of bony spurs and cysts. Articular cartilage is the surface covering the end of bones to allow joints to smoothly glide over each other and absorbs any forces not dispersed by muscles surrounding the joint. Without the cushioning of the articular cartilage, bone rubs on bone that causes the degeneration of cartilage. This is associated with the following specific symptoms:
- Joint pain, tenderness, swelling, or stiffness
- Reduced joint mobility and stability
- Weakening or muscle atrophy around the joint
- Change in movement patterns (e.g. abnormal gait or limp) and referred pain (e.g. people present with tenderness or reduced mobility in another region of their body due to compensatory movement or muscle imbalance)
OA is very common in weight bearing joints, specifically the hip. The symptoms of hip OA can impact a person’s most basic daily tasks such as walking, stairs, driving, and sitting. Persons with hip OA typically experience groin and buttock pain which gradually worsens over time with referred pain often felt in the thigh and knee. Painful sensations of the hip catching or becoming stuck and night pain are also common symptoms.
The articular cartilage cannot be regenerated: the degree of the joint condition as well as the extent of the symptoms experiences will influence the treatment and determine where surgery is required. Many people with OA benefit from non-surgical treatments and that the pain associated with the chronic hip disease may be managed through stretching, strengthening, and releasing exercises. Research indicates that patient education, manual therapy, or exercise intervention can be beneficial in preventing or delaying surgery as well as reducing pain pre-surgery and assisting with recovery post-surgery. 4 It is essential that doctor’s clearance is provided and potentially they’re involved in a treatment plan.
In my experience as an Exercise Physiologist and Yoga Medicine® Therapeutic Specialist, self-myofascial release techniques (MFR) have been specifically helpful to increase mobility, range of motion, reduce pain levels and compensatory movement patterns and muscle tension in both early condition and pre- and post-surgery. MFR works by targeting fascia which is the second largest sensory organ behind our skin. MFR is a compassionate practice that is both accessible and easy to use that can provide a valuable self-care tool to release tension, restore hydration, and reconnect people to their body for improved function, relaxation, and support injury/illness.
Fascia is influences by our movement patterns and posture by communicating between our muscles, organs, and nervous system. The communication function of fascia allows MFR techniques to be beneficial by increasing a person’s body awareness through enhancing their interception. Improved internal awareness can aid in reducing the intensity of pain or physical tension associated. Therefore, MFR not only assists with physical symptoms but can also reduce pain levels.
The techniques and tools can be used to manipulate muscles and fascia in order to free up tension and adhesions, bring hydration, and promote fluid movement around the body. For OA, modifications can be made to assist, for example, exercises can be done whilst standing using a wall, lying down, or sitting. This is specifically important based on the restrictions in the joint and where the individual can find ease to relax into the posture.
Working with a number of regular clients, there has been improvement in range of motion, pain levels and gait/posture which has in turn assisted with increased mood, better sleep and daily activities. These improvements have been measured through self-reporting and functional assessments. In my opinion this is due to a number of things:
- The practice of self-myofascial release teaches us to explore our own bodies, that less is more and that compassion to our own body allows us to relax and release
- Engaging diaphragmatic breathing during MFR is important to stimulate the vagus nerve and trigger the parasympathetic nervous system response to allow our body to relax through the increased sensations and allow the deeper breath to increase blood flow and release toxins
- Release what is tight both around the joint and where muscular imbalances have presented in other areas of the body
- Restores directional order to collagen fibers which is particularly important with sedentary and compensatory postures associated with OA
- Accessibility of the practice and ability to incorporate regularly even during periods of pain or functional restrictions
- Instantaneous sensations of relief of symptoms (e.g. that it is actually helping)
- Regaining control of their own body and that they can self-soothe. The sense of autonomy gained from MFR can lead to a reduced reliance on medical professionals.
In summary, by incorporating myofascial techniques that target areas that maybe holding responsibility for pain or restrictions, MFR may help restore the fascial structure, improve range of motion, down regulate pain, and assist with improving posture or movement patterns (e.g. minimize or remove limps). Here are a few MFR techniques that may be helpful when working with a hip joint condition.
Place ball below the outer edge of the hip below, breathe & let the balls sink in. Work the whole area, leaning back, bend top leg &place foot behind, to increase intensity you can lift & lower bottom leg.
Place ball on your quad starting above knee & work slowly up thigh. Roll & compress on trigger points. Lower leg can relax or slowly moving heel to glutes.
Top of ITB – Lay on your side, please ball on the front of your hip (at your pocket), below bony protrusion. Compress then move lower, cover the whole outer edge of hip.
4. Erector Spinae & QL
Place two balls on either side of the spine, above the pelvis. Roll up & down the back, pausing to compress in lower, middle & upper back. Pause in the lower back, take knees to one side and pause. Repeat other side.
Place ball under foot – make slow circles under the foot, pause on trigger points at toe mounds, ball of foot and arch, scribble the heel, roll from toes to heel covering entire surface.
1.“OA is the most common joint disorder in the United States” Zhang, Y., & Jordan, J., 2011, ‘Epidemiology of Osteoarthritis’. Clin Geriatr Med. 2010 Aug; 26(3): 355-369 –> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920533/
Tuhina, N. 2013, ‘The Epidemiology and Impact of Pain in Osteoarthritic. Osteoarthritis. 2013 Sep; 21(9): 1145-1153 –> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753584/
2. WHO Department of Chronic Diseases and Health Promotion. Available at: http://www.who.int/chp/topics/rheumatic/en/
3. ‘The Epidemiology and Impact of Pain in Osteoarthritic. Osteoarthritis. 2013 Sep; 21(9): 1145-1153 –> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753584/
4. “research indicates that patient education, manual therapy, or exercise intervention…” https://www.medicalnewstoday.com/articles/7621.php https://www.arthritis.org/about-arthritis/types/osteoarthritis/treatment.php
Svege, I., Nordsletten, L., Fernandes, L., & Risberg, M. (2015). Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: A long-term follow-up of a randomised trial. Annals of the Rheumatic Diseases, 74(1), 164. Poquet, N., Williams, M., & Bennell, K. (2016). ‘Exercise for Osteoarthritic of the Hip.’ Physical Therapy 2016 Nov; 96(11):1689-1694.