As of Friday, August 15, 2014
DEAR DOCTOR K: I have constant knee and hip pain. How can I relieve my pain without drugs or surgery?
DEAR READER: For several years, I asked myself the same question. I had severe arthritis in my right hip, the result of a sports injury when I was a young adult. The pain really was interfering with my life. I was limping, and that made me feel old. Worse, I loved long walks — particularly in new places, on vacation — and I just couldn’t do it anymore. But I didn’t want to have surgery.
The pain from a bad hip or knee can come from the hip or knee joint itself. But it also can come from tissues and muscles near the hip or knee that are strained by trying to compensate for the bad hip or knee. In my case, almost all of my pain came not from the bad hip joint, but from the leg muscles and tendons that were being overworked because my hip could not bear my weight normally.
Fortunately, there are ways to relieve pain without drugs or surgery. Three non-surgical treatments are particularly helpful:
ULTRASOUND. Therapeutic ultrasound sends sound waves into tissues near your hip or knee. The sound waves help to increase blood flow, relax muscle spasms and aid healing. The therapist applies gel to your skin and glides an ultrasound wand over your skin around the painful area. The wand gives off sound waves, which penetrate the skin and enter the deeper tissues.
THERAPEUTIC EXERCISE. Strengthening the muscles around a damaged knee or hip can help reduce stress on a joint. For example, your hips have to do less work to support your body weight if the muscles in your thighs, buttocks and abdomen are strong. Strong thigh muscles can also take on some of the shock-absorbing work normally done by the knee. The proper balance of strength in surrounding muscles can hold the knee and hip joints in the most functional and least painful position.
Flexibility exercises (to stretch and relax specific muscles) are another important component of an exercise plan to improve joint function. I’ve put descriptions and photos of a few knee and hip strengthening exercises on my website, AskDoctorK.com.
GAIT RETRAINING. Knee and hip problems can cause pain, restrict joint movement or weaken muscles. To compensate, you may change the way you stand, walk or run. Over time, your modified standing, walking or running patterns may further injure your joints. It’s a vicious cycle. A physical therapist can analyze your gait, or walking pattern, and help you learn to move more efficiently.
I eventually needed surgery: My hip joint was basically destroyed. I’m glad I had the surgery, but I’m also glad I was able to get relief from non-surgical treatments. For some of my patients, the non-surgical treatments are all they ever need.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.