Why So Many Hip Replacements?

I have been asked recently in one of my massage continuing education classes if I have many clients who have had a hip replacement. I answered plenty, and some with both hips replaced. I marvel at our trauma medicine and what it has been able to accomplish in the past 100 years!

The illiofemoral joint is a deeply cupped ball and socket joint with very strong muscles and ligaments attached to it. Consequently, many of the impacts and pulls that are placed upon can  create pain and dysfunction  Dr. Ida Rolf, the founder of Structural Integration commonly known as Rolfing, believed that the hip joint was the greatest determining factor in postural symmetry.

For any massage therapist who is pursuing insights in the hip and lower back pain in a massage continuing equation courses,  they should explore methodologies and approaches that bring balance into the joint because of the long term wear and tear that usually leads to the necessity of a replacement. Often times when I ask my clients if there was anything that precipitated their painful condition that necessitated the surgery, there was no determining factor that could be addressed that could be considered responsible for the replacement…only conjecture. So, its extremely important for the  therapist to begin to educate their clients to the necessity of focused work in the hip as a preventative measure.

How did we end up in our society with so many hip replacement in individuals that might be considered elderly, or athletes who participated in violent sports that accelerated the demise of their hip joint? The problem in diagnosis is challenging. Is it overuse, or a sedentary lifestyle? There are 30 muscles that are responsible for the hips symmetry and if we want our clients to have a long life with the biological equipment in tack, its important to keep the muscles balanced. And its easy for the muscles to become either inhibited or facilitated. So, I can’t tell you how important it is to attend to the hip and bring balance and symmetry through which ever modalities of touch that you employ.

If you opened an anatomy book to study the joint, it isn’t always easy to visualize the three dimensional aspects of the joint. Get in front of a skeleton to really grasp the concepts of balancing the “figure eight twisted” hip joint. When you look down at the hip the iliac crest is angled at 45 degrees moving out from the spine and widening at the front. The ramus is wide at the back, moving medially as it comes forward until it meets its opposite at the pubic symphysis which is a fibrocartilage disc. Each hip is also joined to the sacrum at the sacroiliac joint. Now let’s turn to the ligaments of the hip joint as they wind around the neck of the femur resembling a twisted towel. The ligaments unwind as we flex the joint and tighten as we extend. Back bends are limited by the powerful ligaments. And in full extension the ligaments also inhibit lateral rotation which subsequently keep the hip joint from popping out. Although we have these very powerful ligaments in place for the stability of the joint, it has a remarkable range of motion due to the ball and joint architecture and the slick articular capsule and synovial fluid acting as a lubricant. When you look at the anatomy it is absolutely fascinating to see all the directional flow of the muscles which are necessary to balance and provide stability and the necessary control which is imperative for all the upper body movements as well as the necessary precision of the joint itself. You can easily imagine how small increments of imbalance could eventually create enough of an attrition to create an unbearable discomfort, necessitating a total hip replacement.

When you look closely at the muscular arranged around the joint there are muscle groups  which have a fan like appearance. Each group performs a specific function of either flexion, abduction, rotation, etc. Let’s now return to the original question of why so many hip replacements today? Is it totally due to the mass numbers of us on the Planet? Simple math? Is it the fact that we are living so much longer and body parts just wear out? The average lifespan in 1901 was 47! Probably all of the above would be true, but, if you want to keep the joint for your entire existence, I recommend a few ingredients. The hip is a very complicated joint and requires it to be kept in as much balance as possible. You can approach it from several disciplines and angles. Stretching and creating space is vital. Free squats are one of the best exercises for keep it strong and allowing it to move in its full range of motion. I recommend it to all my clients and it may be the single most important I “dish out” to change their condition. Of course one can eventually add weight to the exercise, but for my older clients, 50-100 free squats a day is a “game changer” for almost all of them, unless there is a spinal condition that needs more appropriate focus. And most importantly, intelligent touch from a talented therapist can create the balance that will keep the joint healthy. Also, as part of our discipline, regardless if your practice a solid foundation of nutritional support can prove invaluable! Many times the joint is endangered due to an inflammatory condition, and a simple regimen of dietary change and nutritional supplement support can change the paradigm completely in favor of wellness.