The hip — that multiaxial ball and socket joint which allows movement in every direction. It’s the body’s largest. Our hip joint makes it possible for us to walk, run, squat, jump, engage in dance, sports and the martial arts. We enjoy mobility — until pain causes us limited action.
Conservative and regenerative care
“Oftentimes hip pain can be from a referred source from the lumbar spine,” says chiropractic neurologist Gregory Cofano. “A disc herniation or a nerve that’s being compressed can cause referred pain that presents in the hip.” At Bellevue Pain Institute — an integrative clinic in Seattle, Washington — Cofano’s younger hip pain patients have mostly experienced sports injuries. Older adults with this pain are primarily challenged with osteoarthritis. His geriatric patients with former injuries and osteoarthritis may develop more serious conditions such as avascular necrosis, where there is a limited blood supply to the tissues of the hip.
Cofano stresses the importance of an initial diagnosis in order to offer optimal care. “X-rays can show loss of joint space and calcification, which implies osteoarthritis,” Cofano says. “MRIs can get more detail — imaging all the cartilage, all the connective tissue looking at the labrum (cartilage lining the hip joint socket), and the muscular attachments.” Here a more specific diagnosis can be made to see if there’s tearing of the labrum, inflammation or bursitis — or how much cartilage is still left and intact. Hip pain from a referred back issue or the beginnings of sciatica can be treated with spinal decompression, laser therapy and joint mobilization with exercise.
Causes of hip pain
• Rheumatoid arthritis
• Tendinitis • Bursitis
Cofano recalls working with a 55-year-old female patient with spine and lumbar disc herniation plus hip osteoarthritis. After an MRI of the hip, osteoarthritis and cystic formation with bursitis were discovered. “Our treatment protocol used non-surgical spinal decompression and a class four laser therapy for the spine issues,” Cofano says. The patient did well, continued with chiropractic care and flexibility exercises. This ensured that the muscles around the hip and back were not overly tight or weak.
“Stem cell therapy has started to make a big impact in today’s medical community,” Cofano says. The procedure includes the isolation of stromal stem cells from human adipose — the body’s own fat tissue. These cells are further processed and then injected into the joint. This has been highly effective for orthopedic conditions, since the stem cells have an active inclination to change into cartilaginous tissue, which the joint surfaces need the most. “Research has demonstrated that stem cell therapy can help in osteo-necrotic femoral heads, or hip joints,” Cofano says. “It certainly is very good for osteoarthritis.”
A 77-year-old male received stem cell therapy for knee pain. The hip pain was fully resolved with this procedure, but there was little change in the knee. His knee was bone-on-bone at that point. “If you don’t have any cartilage left, stem cells are not going to have the effect that’s intended,” Cofano says. “You need some tissue intact to identify the problem and aid in the regenerative aspect.”
“The things that we are doing are so simple, yet far more effective and pleasing to the patients because they’re not invasive,” says Molly Allison, MS, OT and structural medicine specialist. At Holistic Orthopedics in Seattle, Washington, Allison and her team apply both conventional and alternative methods of care. Allison observes patients’ hip pain (with the exception of severe rheumatoid arthritis and fractures) diminish considerably with heat application. Warm paraffin wax with vitamin E oil is applied to the hip and covered with a hot pack, offering penetrating heat. “There’s (also) a whole range of topical anti-inflammatory, non-synthetic salves,” Allison says, referring to herbal and essential oil blends.
Allison works with a patient’s fascia, a thin sheath of fibrous tissue throughout the body. “Fascia is the elasticity in our body, which is what allows our heart to beat, eyes to move and food to pass through our intestines and be digested,” Allison says. “Fascia is from the superficial to the deep structure that lets us move and allows us to function.”
Fascia lines within the body parallel Chinese meridians and connect the front of the forehead to the bottom of the foot. Fascial length and muscle length can affect the joint capsule, referring here to the hip. Allison implements Bowen therapy, a soft tissue relaxation technique that addresses the fascia and has been effective in relieving hip pain. “I do Bowen in a light way, working with the principle of vibration,” Allison says. A plucking or strumming over the muscle belly vibrates the fascia and brings the body into homeostasis. Moves on certain anatomical sites such as the gluteus, hamstring, iliotibial (IT) band or quadriceps address each muscle but also the entire fascia of the body.
Craniosacral therapy applies gentle touch to the cranium or skull, thus working with a rhythm of the cerebrospinal fluid from the brain to the sacrum (triangular bone in the lower back.) In applying this method, Allison claims to many times having “come in the back door so patients feel settled and safe in their own skin by helping quiet the nervous system.
“Also, whether one holds on to their breath or breathes into their diaphragm can have effect on the hip,” Allison says. She has found that patients can hold their bodies in certain ways for years, as result from past emotional trauma. Muscles become tight and misaligned, causing the hip to break down. A tight body is more at risk for fracture, which requires immobilization in order to heal.
“I look at how people walk. It’s like walking meditation, but through a medical lens.” Allison observes a patient’s fascial lines — those that are tight and addresses how a patient is breathing. This is connected to the hip by way of fascia. “A simple shift of a patient’s awareness of his or her walking can be practiced and helpful,” she says.
Allison worked with a 75-year-old female patient who began to experience pain almost one year after recovering from hip surgery. The patient received contrast hot and cold packs on the hip plus deep tissue structural work from Allison. “She had the full gamut,” Allison says referring to the Bowen and craniosacral work applied plus nutrition classes and Pilates exercise practice.
After the walking exercise, the patient claimed she was carrying around 40 years of the “hardships of mothering” in her body. With bringing awareness to this, she was able to make a shift and walk in a way that did not hurt her hip. This served as an emotional release by raising her cognition and staying present in the body. The woman claimed afterward that the “hardships of mothering” were swept away.
Allison’s clinic offers yoga and Pilates classes in a way that does not push beyond a patient’s capability. “I will have tested their fascia length and muscle length. I like to help my patients gain a good ratio of strength and flexibility, then joints prove to have a higher likelihood of staying healthy,” Allison says.
Botanicals used in topical pain salves
• Arnica Montana • Cayenne
• Ginger root • Turmeric
• Camphor • Peppermint
• Melaleuca (Tea tree)
A 30-year-old male mountain climber, who led groups carrying a heavy backpack, came to Allison with hip pain. “His muscles were too tight. I did soft tissue work and educated him on the muscles and fascia lines which were tighter than they ought to be,” Allison says. She guided the patient on how to move and stretch to get improved circulation to the hip joint capsule. “He did really well — it’s not just old people with arthritis,” Allison says in regard to her to hip pain patients.
“I always take a holistic approach when treating patients,” Cofano says. He initially recommends an anti-inflammatory diet to all patients, “no matter what condition they present.” Secondly, Cofano asks, “How much water are they getting?” He notes that lack of sufficient water intake can lead to muscle spasms, muscle tightness and joint pain. “Hip pain is definitely correlated with a patient in a chronic state of dehydration.
According to the National Academies of Sciences, Engineering and Medicine, an adequate daily fluid intake is about 15.5 cups (3.7 liters) of fluids for men. Females require about 11.5 cups (2.7 liters) of fluids. About 80 percent of an individual’s total water is from drinking water and beverages, and the remaining 20 percent is from food.
Allison can discern specifics of a patient’s food intake through her work. “I have my hands on the human body all day long,” she says. “(I can tell) — are they puffed up (with) lymph, is their circulation flowing or is it clogged?” Lymphatic stagnation or systemic clogging can indicate overconsumption of sugar and carbohydrates. “Alcohol, rice, pasta and potato chips roll right into sugar — (and) you’d be surprised how much sugar there is in milk and yogurt,” Allison says.
Marley Braun, MS, RDN, co-instructs nutrition classes with Allison. “Most of what I teach is a generic anti-inflammatory introduction,” Braun says. She addresses individual questions and recommends private consult with a dietician or nutritionist for specific needs and conditions such as food sensitivities.
“According to the Harvard Public School of Nutrition, the first anti-inflammatory food on the list is tomatoes,” Braun says. Yet, anecdotal evidence has linked nightshade foods (i.e. tomatoes, peppers, eggplant and potatoes) as contributing to arthritis pain. These foods contain the chemical solanine, which some claim aggravates arthritis.
A 74-year-old male with hip pain who had a hip replacement plus bursitis found much relief from using turmeric. He made golden honey, mixing one tablespoon of turmeric with seven tablespoons of honey—and consumed one teaspoon of the mixture every two hours. “He had a dramatic decrease in pain, after just a couple of months,” Braun says. “I have also had patients take curcumin in capsule form, they have decreased pain and increased mobility.
Braun notes the positive mental effects from consuming omega-3 fatty acids. “Increasing oily fish in one’s diet, to three or four times a week has a big impact on well-being.” Braun recommends decreasing sources of omega-6 (e.g. sunflower, safflower, corn, soy or cottonseed oils) which signal the body to increase the inflammatory state. “The omega-3 fatty acids down-regulate inflammation.”
To start a patient on an anti-inflammatory diet, Braun recommends an anti-inflammatory detox program, eliminating allergy potential foods (e.g. dairy, peanuts, eggs, soy, wheat and corn) along with decreasing sugar and caffeine plus consuming more water. “This calms the inflammation in the body and serves as the prep phase for a cleanse.”
Braun then recommends adding omega-3 fatty acids, more vegetables and fruits, lean proteins, nuts and seeds. After 21 to 30 days, some of the allergenic foods may be introduced back in the diet to detect which are problematic. “But, if you’re in a state of chronic inflammation, the tendency is to react to a whole lot of foods,” Braun says. “It isn’t that one is intolerant to those foods (e.g. blueberries or lettuce) — it’s just that the body is so inflamed that eating those foods just pushes one over the edge.”
By simply eliminating allergenic or inflammatory foods, the entire body will calm down. Braun claims that results can occur within a month. “A skilled dietitian will take one through shopping, meal planning, packing snacks and focus on what the patient can eat instead of what he or she cannot eat,” Braun says, “so their taste needs are eventually being met.”
Want to learn more about hip pain relief? Read “Long-Term Exercise After Knee or Hip Replacement,” “Best Exercises for Hip Pain” and “4 Easy Stretches to Help With Hip Pain.”