Are x-rays definitive for diagnosing hip pain?  The answer is a resounding no!  A study done by Birrell¹ and others showed that a group of 195 patients, 40 years of age or older, had no hip pain in the 12 months previously; however, they did have positive findings on x-rays.  How often have people gone to doctors and are told they have arthritis? When patients are told that they have degeneration of the joint, commonly they believe there is no hope for them and therefore, because of their “arthritis”, they will be forced to do less and less.  Based on the work of Radin², the major shock absorbing mechanism of the joint is the muscle.  The muscle absorbs 80% of the shock.  We believe, based on the work of Slemenda³ that if physicians instead would send patients for a muscle dynamometry strength test, they would find that these people have weak muscles.  Slemenda^3, in the Annals of Internal Medicine, showed that weak muscles are direct predictor of pain and disability in osteoarthritis.

 Therapist should get this article, send it to physicians, and encourage them to send patients for dynamometry tests.  Once a muscle weakness is noted, based on norms for that person's age, a specific strengthening program based on the one repetition max principle should begin and progressed until the person attains normal strength levels.  Then and only then will the patient have significant shock absorbing capacity to be able to pursue his or her daily activities.

Reference:

1. Birrell F et al., “Health impact of pain in the hip region with and without radiographic evidence of Osteoarthritis:  A study of new attenders to primary care, Annals of Rheumatic Diseases, 2000; 59:857-63.
2. Radin EL, et al.  “Relationship Between Lower Limb Dynamics and Knee Joint Pain.”  Journal of Orthopaedic Research 9(3), 1991

3. Slemenda C, et al “Quadriceps Weakness and OsteoArthritis of the Knee.”  Annals of Internal Medicine 127(2): 97-104; 15 July 1997.