Info on Hip OA Requested from any health pros reading

To back up my criticisms of the handling of OA cases by health pros...

This is taken directly from the NICE guidelines on OA. If you are over 45 years old, then if you have joint pain and you aren't stiff for more than 30 mins in the mornings then you will be given an OA diagnosis. You could make the diagnosis yourself - the only benefit to going to a doc is so that things like gout or inflammatory arthritis can be ruled out:

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"1.1 Diagnosis

1.1.1Diagnose osteoarthritis clinically without investigations if a person:

is 45 or over and

has activity-related joint pain and

has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes. [new 2014]

1.1.2 Be aware that atypical features, such as a history of trauma, prolonged morning joint-related stiffness, rapid worsening of symptoms or the presence of a hot swollen joint, may indicate alternative or additional diagnoses. Important differential diagnoses include gout, other inflammatory arthritides (for example, rheumatoid arthritis), septic arthritis and malignancy (bone pain). [new 2014]"

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There is no mention of ruling out Repetitive Stress Injures and Muscle Imbalances which are KNOWN to cause joint pain. Now this is perhaps understandable because there is no one in the health service that's trained to identify and treat these things. It's extremely unlikely that a doctor or surgeon will have the skills, and nowadays the physio is also unlikely to be adequately trained. HOWEVER, THE PATIENT HAS A RIGHT TO KNOW THIS SO THAT THEY CAN DECIDE IF THEY WANT TO PURSUE THESE POSSIBILITIES PRIVATELY.

We have this ludicrous situation where poor quality studies looked at ridiculously over-simplified diagnostic and treatment approaches (carried out by physios) and found them NOT to be reliable/effecctive. So, rather than trying BETTER approaches to diagnosis and treatment of pathological muscle imbalances, or accepting the limitations of the research methodology, the powers that be decide to conclude that there is no such thing as joint pain caused by muscle imbalances....even though plenty of research actually shows that it is a major factor in a great deal of chronic pain. Net result of this is that physios are no longer adequately trained in treating these things. 

As time goes by, the evidence points more strongly AWAY from the joint being the root cause of problems. We're left in a situation where surgeons are seen as experts in OA when in actual fact it is not looking like it's a surgical problem. The 'experts' are pretty much clueless about the real cause in the cases like mine where it's ALL down to muscle imbalance. It SHOULD be physiotherapists at the helm, but flawed methodologies are leaving a trail of breadcrumbs that seem to be taking us away from the solution and over a cliff edge!  The physios that SHOULD be able to solve this are losing the relevant skills.

Is it just me that sees that sees this as irresponsible to the point of being criminal?  To tell someone that they have an incurable disease with NO EVIDENCE to support that claim? When a treatable cause is equally or perhaps more likely? 

THERE IS NEXT TO NO RESEARCH INTO TREATMENT OF HIP OA

Even NICE draw attention to this fact and point out that as hip and knee OA are very different beasts you can't apply results of research into knee OA to hip OA. So what do they do? Well, they used to make things up, but nowadays they're tightening up more and they simply don't tell you what exercise to do for hip OA - just that you should 'exercise'. Most people with hip pain / hip OA know better than the health pros how well that's likely to go over the long term!!!  

Many people try exercise - perhaps they're given a little exercise sheet (with exercises plucked out of thin air) by a doc or physio. It doesn't work and that re-enforces the belief that they have an incurable disease. It becomes a self-fulfilling prophecy.

Yet for those that have figured it out for themselves - highly TARGETED exercise based upon a detailed understanding of the underlying muscle imbalance can lead to massive improvements and even complete resolution of symptoms. 

Things like trigger point treatment that most people that try it know can bring tremendous pain relief and improved function don't even get a mention. Some quotes from people on this very forum that tried it:

"It is good to feel empowered, to be able to relieve the symptoms oneself. I cannot thank you enough, Susan. To be able to walk normally makes me feel euphoric!"

"Woke up at 4 am. Pain in thigh. Maybe I was too keen doing exercises yesterday. But no longer do I reach for the Anadin. I am no longer in a state of learned helplessness. I start taking control. I feel for my known trigger points, run through the glutes, the TFL, the IT band, then hit the spot on QL. Eureka. I know I have found it. Massage both sides, relief, followed by deep,restful sleep until 7.30, when I wake up pain free and exulting in the control I now have over my so-called “Osteoarthritis”."

""I am amazed and frankly stunned that no-one of the so called 'health experts' I have visited has ever mentioned it [trigger point self treatment] to me and I had to discover it through the dedicated efforts of someone like you online"

Harmless, DIY treatment that doesn't cost a penny yet no one sees fit to suggest it to patients. Why? There is even a pilot study that shows trigger point treatment eliminated symptoms in pretty much all subjects in the study - these were people on a waiting list for knee replacement surgery! 

Would it be so bad just to be honest and say "Sorry folks - we have no idea why you have joint pain and there is no research to guide us. Treatable muscle imbalance and RSI is a possibility but you'd need to look into that for yourself". I wish to god I'd been told that over a decade ago. I successfully treated my muscle imbalances, but the biggest hurdle was battling with health pros that were full of confidence yet 100% wrong. Guys - you have no idea how damaging your unfounded negativity is. I get that some people just want a prescription and a sympathetic ear. But there are people out here that will move heaven and earth to get their lives back and they (we) deserve honesty. 

The explanation I got from a GP and a physio was (paraphrasing):

"Most people are too lazy and inactive to help themselves. In most cases it doesn't matter what you diagnose as the outcome will be the same - drugs and possibly surgery".

I don't think that's good enough. Apathy isn't an excuse to lie to patients. 

Hello Susan,

You talk about so many pertinent topics WRT OA, and these are the same things I've been saying for a long time. If you think that drs are remiss in knowledge for hip OA, try getting any sound science for diagnostics and safe treatment for shoulder joint OA. 

I have a failed scope on my right shoulder from 3 years ago, and I had got high hopes up for cartilage implants recently as there are a few surgeons in the US that claim to perform them. It has turned out to be all smoke and mirrors. Good luck in getting a health "pro" to respond here. 

You are correct about the harmful psychology of being told that OA is incurable. I like to call it the "non notable" disease because it gets very little attention in R&D when compared to other diseases.  

Oh Susan I echo your sentiments! It appears to me that we are running around almost like doctor shoppers seeking quality advice and management without further damage to our health: yet thousands of dollars later over a few months (for me) same position! I feel like a doctor shopper and each have OPINIONS and do not dare consult with each other let alone the patient - then they take us down another course of meaningless causes and solutions to something they cannot describe what it is. My latest Dr says he will cure my eroded wrists and neck by diet. Yeh meantime more erosion. I wish there was a active group attempting at minimum to get  all these therapies for relief on the medical benefits  scheme . At least that would be a start and then begin with honesty - they don't know and any erosion is thought to be osteoarthritis- when it may be in the final stage but the beginning is another question. I would be writing all day at the variations from each doctor ! You go girl! We need some fight for our physical wellness. Kes 

I wanted to say just a bit about diagnostics since that should be the baseline for all decisions and treatments. It seems that most ortho drs I have seen in the US are deficient in this area because they do not know how to read images and rely on the rad report. One of the surgeons who I have seen and was referred to as "elite top dr" ordered an x-ray shortly after I had checked in to his office. Before i had set a foot outside the imaging room I was already being offered a cortisone injection by the technician. I got the same line when the PA came into the waiting room for the eval. The first thing he asked was would I like an injection? I asked for what reason or diagnosis would i be treated with an injection because as of yet I had not even been seen by the dr. Then the almighty dr came in with an entourage of trainees and proceeded to offer me an injection also, before even doing any evaluations. Then the sales pitch for an artificial shoulder was made, as that is how this dr treats the majority of his patients. 

I abruptly explained that I would in no way be accepting this kind of radical surgical treatment, especially with such scanty diagnostics as an x-ray. The room fell silent and you could have heard a pin drop. I asked how he would understand the extent of my joint damage without any other diagnostic tools and he succumbed to ordering an MRI. At this point, he realized I would not be the "cash cow" he was hoping for, so he didn't have any more time for me and didn't bother to show up for the appt when i picked up the MRI results. 

This is how diagnostics is done in the US - follow the injections and the $.