Hip arthritis is a common condition among middle to older aged adults leading to hip pain, lost function, and disability. Patient’s at our Boulder Physical Therapy practice with this condition often present with a loss of hip mobility, hip weakness, and altered gait mechanics. Interestingly, 1 in 5 adults around 50 years of age will demonstrate arthritic changes on x ray but only 1 in 25 will report hip symptoms. In our experience, these aforementioned impairments play a significant role in the presentation of arthritic symptoms. With PT treatments including joint mobilizations, strengthening exercises, and gait training many of these patients with hip arthritis will report minimal symptoms or loss of function despite no change in their x ray findings. As the old saying goes, the difference between pathology and pain is the patient. A recent study shows the impact of altered gait mechanics on the symptoms of hip arthritis.
The Journal of Orthopedic and Sports Physical Therapy published a study to analyze the association of altered gait mechanics and hip symptoms in patients with hip arthritis (Liao et al. 2019). Authors studied 48 patients hip arthritis and 95 of their age matched peers. Each participant was provided with x ray, MRI, outcome measures of function and pain, as well as, gait analysis. Unfortunately, strength was not assessed. As expected, patients with hip arthritis demonstrated increased motion into hip flexion and hip adduction (drop of opposite side of pelvis) during gait. In addition, increased peak forces were found in the stance phases of their walking cycles. These altered gait mechanics helped explain in part the severity of symptoms within the group with hip arthritis. For example, greater alterations in walking were associated with more symptomatic patients.
The study design does not allow us to determine a cause and effect for these variables, but in our practice impairments in walking perpetuate symptoms of hip arthritis. Symptoms improve quickly with treatment including gait retraining and strength training.
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