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Title | Know your body: Muscles, Bones & Co | Technology & Training | Strength for Life | ARCHIVE

HIP

The human hip joint is well constructed for its intended use: standing and walking.

It is the largest ball-and-socket joint in your body. The “ball“ is the rounded end of the femur (femoral head). The “socket“ is a concave depression in the lower side of the pelvis (acetabulum). The femoral head fits into the acetabulum to form the hip joint. This anatomy allows for plenty of motion within the joint — for instance, walking, running and climbing.

Every step taken burdens one of the hips with three to four times the body weight. A pad consisting of connective tissue and fat that acts as a shock absorber is located deep in the acetabulum. The joint is surrounded by a stiff capsule strengthened by strong ligaments. These ligaments operate like a screw and stabilise the joint, depending upon the hip position. When in flexion, the ligaments are applied loosely, allowing good movement, but with increasing extension the ligaments “tighten” and hold the hip securely when fully extended.

Hip muscles
The hip is surrounded by thick muscles. The posterior muscles behind the hip consist of the gluteals. The inner thigh is formed by the adductor muscles. The main adductor function is to pull the leg inwards towards the other leg. The muscles that flex the hip are in front of the hip joint and include the iliopsoas muscle. This deep muscle begins in the lower back and pelvis region and is connected to the inside edge of the upper femur. The rectus femoris is another hip flexor. It is one of the quadriceps muscles, the largest group of muscles on the front of the thigh. Smaller muscles from the pelvis to the hip help to stabilize and rotate the hip.

Hip degeneration
The most common cause of a hip joint disorder is increasing destruction of the joint cartilage. This can develop into coxarthrosis. As the protective cartilage is worn away, bare bone is exposed within the joint.

Hip arthrosis typically affects people over 50 years of age. It is more common in people who are overweight and weight loss tends to reduce the symptoms associated with hip arthritis. There is also a genetic predisposition of this condition, demonstrating that hip arthrosis is generally passed on to new generations within families. Other factors which can contribute to the development of hip arthritis include traumatic injuries to the hip and fractures to the bone around the joint.

Interestingly, the severity of the destruction of the joint cartilage does not necessarily correspond to the discomfort suffered by the patient.

What effect does Kieser Training have on …

... hip arthrosis?

The symptoms of coxarthrosis normally start in the groin. Initially, pain only occurs after intensive physical exertion but later occurs at rest as well. Typically, pain occurs first thing in the morning with the initial few steps being difficult and painful. It is as if the joint has gone rusty. The pain becomes less after walking a short distance. As the condition progresses, mobility and the distance you are able to walk without pain both decline. At an early stage, inward rotation and leg abduction become restricted, making it difficult to dress or put on shoes and socks. The joint is stiff and this, combined with the loss of cartilage, shrinkage of the joint capsule, flexion contracture and a shortening of the hip flexors often makes one leg seem shorter than the other. To avoid the pain, patients develop a distinctive limp. A recurring inflammation of the hip joint may also cause pain at night which disturbs sleep.

Training recommendations:
Customers with coxarthrosis should train on A1, A2, A3 and A4 with the backrest in the middle position, if possible through the entire ROM. Tolerance depends less on the severity of the arthrosis and more on the extent of the inflammation. Hip abduction is most effective if the flexion is 60°. This corresponds roughly to the middle position of the backrest on A3. In addition, the abduction angle can be improved by rotating the leg outwards slightly.

Regain muscle balance
Hip arthrosis is invariably accompanied by changes to the joint capsule and often by serious muscle imbalances. Typically, the hip flexors (iliopsoas muscles) and adductors are shortened and the hip extensors and abductors are weak. The aim should be to strengthen extensors (A1) and abductors (A3) at high intensity and to train the hip flexors (A2) and adductors (A4) at low to medium intensity, whilst emphasising extension. This not only helps to eliminate strength deficits but also corrects the overall muscle imbalance. B6 can be incorporated into the programme as soon as the customer can cope with the basic programme. Training intensity should depend upon tolerance but customers should not exploit the strength potential on B6 in full as it is often very high. Pain may be activated on both B6 and J1 if latent hip arthrosis exists.

Doctor’s Tip

Treatment for hip prosthetics

Treatment of coxarthrosis aims to reduce pain and improve joint mobility. If conservative treatment does not provide adequate relief, a prosthetic hip replacement may be considered. Hip replacement surgery normally eliminates the pain and improves the hip function. The replacement joint lasts a minimum of 10 – 15 years, after which further surgery may be necessary to replace the implant.

Rehabilitation after hip replacement has evolved from daily walking or floating in a swimming pool, using supervised exercise programmes which are monitored and controlled by experts in rehabilitation using various international protocols. However, despite the lack of consensus in post-surgical rehabilitation, experience with patients who work on preintervention strength and flexibility confirms that they experience less post-operative pain faster and achieve better results.

If a customer is about to undergo total hip replacement, one-to-one supervised strength training will provide optimum preparation. Naturally, restricted mobility must be taken into account. Muscle imbalances should be reduced. This period before surgery should be used as intensively as possible in order to strengthen the lumbar/pelvic/hip regions and also to train the shoulder girdle and arm, including the grip function (important for using crutches).

If the time remaining before surgery is less than 6 months, it may be appropriate to increase training frequency to three sessions per week. Training should only be reduced to medium or low intensity if the customer cannot tolerate high-intensity training.

Following total hip replacement, training may be resumed at low intensity after 6 weeks, provided that there are no complications. Customers generally come following completion of the standard rehabilitation period and are able to cope well with the training load. Training at high intensity must be avoided until 12 weeks after surgery. To achieve a good range of motion, the backrest on A3 and A4 should be set in the middle position and the hip rotated slightly outwards. On A1, A2 and B6, hip flexion should normally not exceed 90° even in the long term.

Title | Know your body: Muscles, Bones & Co | Technology & Training | Strength for Life | ARCHIVE