Hip Arthritis and Running: How to Manage and Conquer your Arthritic Hip Pain

Arthritis is the inflammation (-itis) of a joint (-arthro). You can get arthritis in any joint of the body over the lifespan and this risk generally increases as we age. Although there are many types of arthritis, some worse than others (I’m looking at you, rheumatoid arthritis), the most common type and most easily treated is osteoarthritis. This generally comes from gradual wear and tear on the joint over the years, based on body type, current activity level, prior activity level, nutritional intake, genetics, and numerous other factors. If left untreated, osteoarthritis can become “bone-on-bone” which means the articulating bone has lost its protective covering (articular cartilage) so it is “rubbing” against the receptive bone (which has often lost its articular cartilage covering, too).

See the picture below. We’re looking at the front of a left hip. The blue (articular cartilage) surrounding the femoral head (“ball”) and acetabulum (“concave socket”) looks great on the healthy hip joint picture but on the osteoarthritic side, the articular cartilage has faded and thinned, leading to less protection of the hip from the ground-reaction forces that come from running (Newton’s Third Law of Motion).

I get this question all the time: “So why can’t I just heal the cartilage?” Articular cartilage has poor blood supply which means it is lacking the ability to receive nutrition from the blood to repair the damage. On the contrary, think about a muscle strain (or “pull”). Although these can be incredibly painful, through a combination of rest, exercise, physical therapy, etc, they have the capacity to heal well because blood supply to muscles is generally quite good. Not everybody puts in the time and effort to properly rehabilitate this injury, which can lead to chronic dysfunction and poor movement patterns, increasing the risk of reinjury and chronic pain.

But don’t be discouraged! Hip osteoarthritis is ABSOLUTELY treatable!

Try this one out with me, and please don’t hurt yourself: take a pen and remove its cap. Poke yourself on the back of your hand with the bigger end of the pen, with a reasonable amount of force. Take note of what that felt like, pain/discomfort intensity, speed the feeling disperses, etc. Then flip the pen around and poke yourself with the writing part of the pen with the SAME AMOUNT OF FORCE! Take note of your sensations. What did it feel like? How do they contrast?

If you poked yourself with the same amount of force each time, chances are that the pointy end of the pen felt worse than the bigger part of the pen. Why? Surface area and physics! Remember from your high school physics class that Pressure = Force / Area. When the surface area decreased dramatically with the point of the pen, and the force stayed the same, pressure went up. Ouch!

How does this relate to hip arthritis? A similar principle can be applied to range of motion. When runners have arthritis-related hip discomfort, pain, and inflammation, it causes a lack of flexibility in the joint. It’s often stiff in the morning, loosens up and feels better, then stiffens up again later in the day. Rinse and repeat the next day. So when your arthritic hip lacks flexibility (think about surface area) but you’re trying to manage the forces associated with running, your already-irritated hip is now dealing with a higher degree of pressure to disperse. It’s not a nice cycle to be in.

This is a complicated topic. There are a lot of moving pieces and everyone is different; running styles vary and significantly change loads placed on the joints of the body, and this changes further based on job demands, flexibility, strength, neuromuscular control, etc. I’d recommend you see your performance-based physical therapist (www.premierptnc.com if you’re local to Huntersville, NC) who specializes in gait analysis and biomechanical assessment with some heavy-duty technology usually reserved for professional athletes.

If there is one takeaway from this post, it is to focus on your bilateral hip flexibility to prevent and manage arthritis symptoms. Try dynamic hip flexor, piriformis, and hamstring stretching pre-run (5-10 minutes total as part of your warm-up routine) and statically post-run for about 2 minutes per muscle per side. If that isn’t doing the trick, come check us out at Premier Physical Therapy! We are here to help get you back to running as quickly as possible.