Non-Surgical Treatments

Hip Injections

Hip joint injections involve injecting medicine directly into the hip joint to diagnose the source of pain or treat pain due to conditions such as arthritis, injury or mechanical stress of the hip joint. Hip pain may be experienced in the hip, buttock, leg or low back. The injection contains a combination of a numbing medicine and cortisone (an anti-inflammatory agent). Numbing medicine delivers temporary relief from pain, provided the hip joint is the source of the pain. It thus serves a diagnostic function and helps to confirm or deny whether the joint is the source of pain. Cortisone serves to reduce the inflammation in the joint providing long term pain benefit.

Procedure

If needed, a relaxation medicine is given to the patient through an IV line. The patient lies face down on an X-ray table. The small area where the injection needs to be given is numbed with an anesthetic. The patient may feel a sting for a few seconds. A small needle is then accurately placed by the doctor into the joint guided by the real-time X-ray images (fluoroscopy). Before injecting the medicine, a contrast dye is injected through this needle into the joint to confirm that the medicine will reach the joint. A combination of anesthetic and anti-inflammatory cortisone is then slowly injected into the joint. The whole procedure usually takes about 30 to 60 minutes.

After the procedure

After the injection, the patient is made to rest for 20 to 30 minutes and is then asked to move the joint, provoking pain. The patient may or may not find a decrease in pain depending on whether the injected joint is the main source of the pain. The patient is also asked to maintain a record of relief in pain during the coming week. Physical therapy may also be recommended. Even when pain relief is significant the patient should increase activities gradually over one to two weeks to avoid reappearance of pain.

Risk and complications

The possible risks of hip injections include: swelling and pain in the joint after the injection, infection, depigmentation of skin, local thinning of the skin and rupture of a tendon.

If the injected hip joint is the source of the pain, the pain may reduce two to five days after the injection. However, if no improvement is found within ten days after the injection further diagnostic tests may be required to ascertain the cause of pain.

Physiotherapy

Physiotherapy or physical therapy is an exercise program that helps you to improve movement, relieve pain, encourage blood flow for faster healing, and restore your physical function and fitness level. The main aim of physical therapy is to make your daily activities, such as walking, getting in and out of bed, or climbing stairs, easier. It can be prescribed as an individual treatment program or combined with other treatments. Physiotherapy is usually ordered to help you recover after certain surgeries, injuries and long-term health problems such as arthritis.

A physiotherapist will examine your symptoms and daily activities, and make a treatment plan, which primarily focuses on reducing your pain and swelling. The different procedures used by your therapist depend on your specific physical ailment. Physical therapy involves a combination of education, manual therapy, exercises and techniques. Some of the procedures commonly used are:

  • Stretching exercises: Surgery, age and conditions, such as arthritis and osteoporosis, can cause inflammation and stiffness in your joints and muscles, and restrict your movement. Physiotherapists guide you step by step to stretch certain areas of your body to restore flexibility, and enhance the movement of joints and muscles.
  • Core strengthening and stability exercises: Specific exercises are designed to make the core (pelvis and lower back) strong enough to support the whole body.
  • Ice and heat: Applying heat or cold treatment on muscles can stimulate the blood flow and reduce swelling. Heat treatment helps to reduce joint pain and spasm in the lower back and neck, and loosen muscles. Cooling works best for ankle sprains.
  • Ultrasound: An ultrasound sends high frequency sound waves over your body and stimulates deep body tissues. Vibrations produced by sound waves help to stimulate blood flow and facilitate the healing process. This procedure can also be used to improve metabolism and enhance the adhesiveness of bones after a fracture.
  • Electrostimulation: In this procedure, an electric current is passed through the area which requires treatment. This helps in relieving pain, stimulating muscles and nerves, and expanding blood vessels.

These treatments may cause mild soreness or swelling. You can talk to your therapist in case it is prolonged.

Platelet Rich Plasma Therapy

Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots. They also consist of special proteins, known as growth factors, which help with our body’s healing process. Platelet-rich plasma or PRP is a high concentration of platelets and plasma.  A normal blood specimen contains only 6% platelets, while platelet-rich plasma contains 94% of platelets and 5 to 10 times the concentration of growth factors found in normal blood, thus greater healing properties.

Indications

PRP is a relatively new method of treatment for several orthopaedic conditions such as muscle, ligament, and tendon injuries; arthritis; and fractures. PRP injections can help alleviate painful symptoms, promote healing and delay joint replacement surgeries.

Procedure

Your doctor will first draw about 10 ccs of blood from the large vein in your elbow. The blood is then spun in a centrifuge machine for about 10 to 15 minutes to separate the platelets from the remaining blood components.

The injured part of your body is then anesthetized with a local anesthetic. The platelet-rich portion of your blood is then injected into your affected area. In some cases, your doctor may use ultrasound guidance for proper needle placement.

Post-Procedural Care

  • It is normal to feel some discomfort at the injection site for a few days after your procedure.
  • You will be prescribed pain medications by your doctor.
  • You may use cold compresses to alleviate your symptoms.
  • You will be instructed to stop any anti-inflammatory medications.
  • You may resume your normal activities but should avoid any strenuous activities such as heavy lifting or exercises.

Risks and complications

There are very minimal risks associated with PRP injections.  Some of the potential risks include

  • Increased pain at the injection site
  • Infection
  • Damage to adjacent nerves or tissues
  • Formation of scar tissue
  • Calcification at the injection site

Shock-wave therapy

Shock wave therapy is application of the sound waves to treat musculoskeletal conditions and sports-related injuries. It is an effective treatment for trochanteric bursitis. Trochanter bursitis also called hip bursitis or greater trochanter bursitis is a common problem caused by inflammation of the bursa that overlies the greater trochanter (bony prominence at the outer side of the hip). The condition causes pain in the outer portion of the upper thigh. Greater trochanter bursitis most commonly affects runners and athletes participating in soccer and football.

Shock wave therapy is given only when the other conservative treatment methods such as rest, pain medications and physical therapy do not show improvement even when used over a period of 6 months. It is used as an alternative treatment modality to surgery.

Most of the patients who undergo shock wave therapy show significant reduction of pain and improvement in movements of the affected part comparable to other conservative options. It has advantage of being as effective as surgery, with no complication of infection. The side-effects include only temporary redness, pain and swelling at the site of treatment. You can return to work or do normal activities within one or two days after the therapy.

The mechanism of action of the therapy although not very clear has shown to increase the blood flow in the applied site and is believed to thus increase natural tissue repair in the region.

Procedure

Shock wave therapy is given after numbing the region by giving local anesthesia. Shock waves are directed through a hand-held probe which is moved over the skin of the affected site after applying the ultrasound gel. The sound waves are given as short pulses of less than 1 microsecond. Only 1 to 4 pulses are given per second. Treatment usually involves 1000 to 4000 pulses. Thus, the treatment takes only 14 to 30 minutes. The number and intensity of the sound waves will depend on the severity of the conditions. Complete treatment may require one or more sessions of therapy.

The safety of the shock wave therapy has not been evaluated in pregnant women and children and should not be used for them.

Professional Memberships

  • Anderson Orthopaedic Research Institute
  • American Academy of Orthopaedic Surgeons
  • American Association Of Hip and knee Surgeons
  • American Osteopathic Academy Of Orthopedics
  • International Congress For Join Reconstruction
  • Nebraska Medical Association
  • Methodist Physicians Clinic