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Hip, Knee & Ankle Problems
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Hip Problems
Hip pain and back pain are often mixed up. Most true
hip pain is felt in the groin, whereas back pain can
often be felt in the buttock.
Restrictions in hip mobility due to contracture of
muscles around the hip can have knock-on effects.
Reduced hip extension (backward bending) can be
compensated for by an increased demand for extension
in the low back, compressing the tissues at the back
of the lumbar spine. In such a case, the osteopath
will address the hip mobility in order to help a low
back problem.
One of the most common painful hip problems is
osteoarthritis. Hip replacements – or hip
resurfacing – operations are usually good solutions
to hip arthritis. In the early stages and in younger
patients surgeons may be reluctant to operate.
Osteopaths can help in these cases by freeing off
the muscles around the joint and improving mobility.
Hip pain in children is unusual. However there are
some conditions such as
“slipped femoral epiphysis” or “Perthes disease”,
which would normally require an orthopaedic
referral.
Most other hip conditions involve the muscles and
tendons around the hip. “Snapping hip” may come from
the psoas or gluteal muscle flicking over bone. The
gluteal muscle on the side of the hip can suffer
from tendonitis or cause a bursitis. (This is
inflammation of a small bag of fluid that reduces
friction between the bone or skin and a tendon).
Dislocations are rare and only follow serious
trauma. Patients occasionally are concerned that
they have a “slight” dislocation of the hip. This
would be extremely unlikely to happen as the hip is
a very stable joint. Elderly people with
osteoporosis can fracture the hip in a fall. It is
believed that what actually happens is the hip
fractures spontaneously and then the patient falls,
rather than the other way around. An x-ray taken
just after the fall may not show the fracture. The
best way to avoid this is pre-screening for
osteoporosis, which can then be treated if found.
Knee Problems
The knee moves like a hinge with a slight twist on
full straightening. As the knee bends, the knee cap
rides up the thigh bone. Inside the knees are two
menisci, which are C shaped cartilages and two cruciate ligaments that hold the knee together. On
the outside are the inner and outer collateral
ligaments that brace against sideways shears.
Another joint close to the knee is the small
superior tibia-fibular joint that attaches the
thin bone on the outside of the shin, (the fibula) to
the larger tibia. This joint is often overlooked.
Early arthritis of the knee can be helped by
osteopathy; if advanced, a knee replacement may be
needed. If in just one side of the knee, an
off-loader knee brace can help. Weight loss in the
overweight can give a marked improvement. Sometimes
pain can be referred from the hip to the knee.
Ligament tears can respond to osteopathic treatment,
although the cruciate ligaments are more difficult
and severe tears may need surgery, especially if
they
cause recurrent locking or collapsing. Elite sports people
often have surgery because they need their knees to
be as close to perfect as possible.
Recurrent meniscal tears may also need surgery, and
loose bodies may need a “wash out”. The tendons of
the muscles around the knee can also give pain and
respond to osteopathy.
Osteopaths also see patients with Osgood Sclatters
disease, which affects boys in the early teens,
especially footballers. In this, the tibial
tuberosity just below the knee cap gets inflamed due
to the tightness of the quadriceps muscles. Advice
and a temporary tendon support band usually works.
Ankle Problems
The ankle is the joint between the bone at the top
of the foot, (the talus) and the lower ends of the
shin bones (the tibia and fibula) It is called the talo-crural joint. Its main movement is plantar
flexion (when you go on tip toes) and dorsiflexion
(toes pulled back toward you).
A common injury is a “sprained ankle”, either
through an inward twist (“inversion”) or outward (”eversion”).
Most commonly, there is a severe strain on the
ligaments that run either side of the joint.
Occasionally this can cause a fracture.
Like most weight bearing joints the ankle can suffer
from degenerative conditions. These may include
osteoarthritis, which can cause pain and stiffness,
mainly when walking. Joint replacements are becoming
more common for this joint.
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