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May, 2009, Vol. 09, Issue 05 >> Diagnosis & Diagnostic Equip

Prevention and Rehabilitation of Conditions Leading to Hip Replacements


If you are doing therapeutic work, there will be clients who are in pain from hip problems, with hip replacements being the most severe.

Unfortunately, many clients, especially the elderly, never fully recover proper alignment, full range of motion or pain-free function after having surgery for hip replacements. The criteria for hip replacements involves waiting until the client experiences constant and/or severe pain for a period of time before the surgery is performed. The tragedy here is that these clients are offered little, if any, intervention other than drugs for their pain, even after chronic or acute arthritic or degenerative changes are noted in the hip joint. This is very short-sighted especially when deep-tissue therapy, properly applied, can relieve and rehabilitate much of the problem. I have had clients who were told they were in need of a hip replacement due to pain and degeneration who, after rehabilitative massage techniques, were pain-free for years without having this drastic surgery.

Conditions Leading to Hip Replacements

A very basic condition is a pelvic imbalance (an anterior/posterior rotation of the iliums) resulting in the contraction of the musculature of the hip which often involves compression of the nerves. This may occur in the gluteals (maximus, medius, minimus), the piriformis or rotators. Other muscles that directly affect the rotation of the iliums and cause a tightening of the gluteals in compensation are the quadriceps, adductors, hamstrings, quadratus lumborum, TFL, iliacus and psoas. These muscles are all involved either in compensation for, or in support of, the pelvic distortion. I have found that when the pelvic imbalance is released, the tension in these muscles is reduced and there is a marked improvement in any hip condition.

To facilitate the release of the pelvic imbalance, the deeper tissues of the pelvis and hip need to be treated. Often these muscles and other soft tissue are inflamed and painful. Even so these tissues can be effectively treated by using a three-step approach that releases fluids and toxins and surface tensions; unwinds the myofascial holding patterns; and releases deep fibers and adhesions. This sequence not only directly affects the musculature and structure of this area, but reduces the amount of sensation that the client will experience while the contracted tissue is being treated.

It is important to release the tissues responsible for the anteriorly rotated ilium in a hip problem before releasing the compensating contracted or overstretched muscles that counter that rotation. I find the best results are produced when following this sequence: quadriceps, adductors, hamstrings, gluteals, quadratus lumborum, rotators, TFL and abdominals. If the pain and problem is in the hip joint of the posteriorly rotated ilium, it is still necessary to release the anteriorly rotated ilium first. Otherwise, the pelvis will slip into compensation for the anteriorly rotated ilium, and little will be gained for long-term recovery.

Don't hesitate to work with the hip if it is arthritic or the cartilage is degenerated. I have had many clients come to me with severe pain from arthritis and hip degeneration who are presently walking and fully functional. The soft tissue changes from the balanced pelvis took the stress off the hip. So, my message to you is: By all means do intervention therapy before surgery is ever considered. Unfortunately, many clients will not believe you can make a significant change because a medical doctor has diagnosed a problem, and they feel medical treatment such as surgery or cortisone is the only way to treat the pain. However, people want to feel better. Usually, that is enough of a reason for them to allow you to work with deep-tissue therapy on this type of problem.

Treating Clients With Hip Replacements

Many clients who have had hip replacement surgery will still be in considerable pain. Once again, proper soft-tissue therapy can release that pain and facilitate rehabilitation. Limiting factors from the surgery are pelvic imbalance, misalignment of leg and hip, leg-length difference from an inappropriate length of surgical apparatus, scar tissue and adhesion, and improper gait while walking.

Oftentimes the pelvic imbalance that existed before surgery that was responsible for the degeneration of the hip will not have been addressed and will be a stress factor on the surgically repaired hip. It is therefore necessary to bring the hips into structural alignment by balancing the anterior/posterior hip distortion. When this is accomplished, the structure supports the hip and the pressure is equal on the hip joints. Many times, this is the key component for the client's recovery. This process is similar to the pelvic balancing that we would have applied before surgery as previously described in this article. The complications are increased scar tissue and adhesions from surgery, uneven leg length due to surgical apparatus and misalignment of the leg/knee/ankle being nonsupportive.

I hope this has opened your eyes to the very real possibility of successfully treating hip problems using deep-tissue massage therapy techniques.

Click here for more information about Don McCann, MA, LMT, LMHC, CSETT.


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