The spine is possibly the most problematic area of the body. From the base of the spine up to the upper back and neck, there are various ways in which pain can manifest and produce disability. Although pain is most common in the lower back, several issues may cause bothersome pain in the upper spine as well. The most common of these is a condition called myofascial pain syndrome, which is closely related to rhomboid trigger points and levator scapulae pain.

Fascia is thin, connective tissue that surrounds and connects every muscle in the body. Fasciae (plural of fascia) hold muscles together and allow them to stretch and contract smoothly, without creating any friction that can damage the muscles. This explains the root word “fascia” in myofascial pain syndrome, whereas “myo” refers to muscles the muscles that these fasciae connect.

Common sites of myofascial pain

Myofascial pain involves triggers points, which are areas of tenderness and stiffness within muscles and fasciae that reduce range of motion. These trigger points are essentially muscle fibers that are stuck in contraction, which causes the muscle(s) to tighten and eventually prevents blood from flowing to the area. Trigger points feel like small bumps or knots when touched, and when enough of these occur in a certain area, the result is myofascial pain. Trigger points—and resulting myofascial pain—can develop in any muscle of the body but are most common in the upper back, shoulders, and neck, especially the following muscles:

• Trapezius: the trapezius is a large, broad muscle shaped like a triangle that extends from the base of the skull to the middle of the back; it helps give you the ability to tilt and turn your head and neck, shrug and stabilize your shoulders, and twist your arms; the upper trapezius is one of the most common sites for myofascial pain because it takes on a significant amount of pressure, especially when carrying items
• Levator scapulae: this is a long and slender pair of muscles shaped like straps that run from the top of the spine to the top edge of the shoulders; the main function of these muscles is assisting with the raising and rotating of your shoulder blade; they also stabilize this region
• Rhomboids: this is a pair of upper back muscles that run diagonally from the neck and chest vertebrae of the spine down to the back of the shoulder blades; the rhomboids attach the upper limbs to the shoulder blades and help to pull the shoulder blades together during contraction

Approximately 44 million Americans are affected by myofascial pain syndrome, and about 85% of people will experience it at some point in their lives. Middle–aged women who are not physically active appear to have the highest risk for myofascial pain syndrome. Experts are yet to determine why myofascial pain syndrome occurs, but it’s believed that injury or trauma to the spine—from physical activity or repetitive muscle strain—likely plays a role. Other possible causes include consistently using poor posture, which can strain muscles, as well as lack of muscle activity or muscle weakness, stress, working in cold environment, and a pinched nerve.

Although symptoms vary from person to person, myofascial pain is usually described as a deep aching, a throbbing sensation, or tightness and stiffness, which occurs either at the trigger point or in a nearby area (referred pain). Patients will also report the presence of trigger points that cause pain when touched—and sometimes without being touched—tender or sore muscles, and/or weakness. Trigger points and dysfunction of the muscles described above can lead to pain and reduced range of motion neck and shoulders as well.

Red flags

If you notice these symptoms, it’s best to see a physical therapist sooner rather than later, as they can effectively treat myofascial pain with a comprehensive and individualized treatment program. But there are also certain signs that may suggest something else is afoot that may require treatment from another medical professional. These red flags include the following:

• History of fever, chills, or recent illness (could suggest the presence of an infection)
  • Other signs of infection include pus or fluid, redness, fever, blisters, and worsening swelling
• New episode of low back pain under 18 years or over 50 years
  • For those under 18 years, pain may suggest a congenital defect, spondylolysis, or vertebral fracture
  • For those over 50 years, pain may suggest a tumor or infection
• Bowel or bladder dysfunction (associated with a condition called cauda equina syndrome)
• Extreme bruising, swelling, or throbbing pain
• Significant bone pain (may suggest a bone tumor)
• Persistent swelling and pain that develops without a recent injury
• Compromised immune system
• Recent surgery or spinal injection

In our next post, we’ll describe 4 exercises that will help to reduce your risk for experiencing myofascial pain syndrome.

In our last post, we summarized a meta–analysis that investigated the use of spinal manipulation and found ample evidence from numerous studies that it was effective for chronic low back pain. But spinal manipulation is just one of many interventions that may be used during physical therapy, as all treatment plans are comprehensive and comprised of several techniques and treatments.

Another key feature of physical therapy is that therapists consider it to be of the utmost importance to individualize treatment for all patients. This means that the therapist will carefully consider the patient’s physical capacity, injury history and severity, pain tolerance, goals, and several other factors when designing the treatment plan, and these factors will help determine which interventions are most appropriate and what duration of therapy is needed to increase the likelihood of a positive outcome.

Individualized physical therapy may be particularly effective for low back pain, as research has shown that low back pain is driven by a variety of factors—like sleep, anxiety, and social factors like work engagement—that are not yet completely understood. Therefore, individualized physical therapy can target several of these factors simultaneously to provide maximum benefit, and some studies have found small but promising results in this population; however, the research on this topic is limited, and a powerful study called a Bayesian network analysis was conducted to further explore how physical therapy treatments work for patients with low back pain.

300 patients randomly assigned to one of two groups and followed up for one year

Individuals with a current episode of low back pain for a minimum of 6 weeks and no more than 6 months were recruited to participate and screened, which led to 300 patients being enrolled in the study. These patients were randomly assigned to receive either individualized physical therapy or guideline–based advice, both of which took place over 10 weeks. Participants in the guideline–based advice group underwent two 30–minute sessions over the 10 weeks, which included education about the source of their pain, reassurance about a favorable prognosis, advice to remain active, and instructions regarding appropriate lifting techniques.

Participants in the individualized physical therapy group underwent 10 30–minute sessions over the 10 weeks. Treatment was individualized based on each patient’s specific condition and included a combination of education, self–management strategies, exercises, inflammation–reducing strategies, and manual (hands–on) therapy. All patients were evaluated before the 10–week period, immediately afterwards, and then again at a one–year follow–up for various outcome measures, including low back pain and leg pain intensity, disability, pain persistence, and pain coping. These data were used to conduct the Bayesian network analysis and answer the questions posed about individualized physical therapy.

Results showed that individualized physical therapy directly led to early changes (within 10 weeks) in both disability and pain coping. Individualized physical therapy also indirectly improved back pain intensity, recovery expectations, sleep, fear, anxiety, and depression, and researchers found that these indirect improvements resulted from the early changes in disability. In other words, the gains in physical abilities that patients experienced within the 10 weeks of individualized physical therapy helped to alleviate depression, fear, anxiety and elicit other improvements as well.

This study shows that individualized physical therapy not only helps patients move more easily and with less pain but may address some of the psychological symptoms that many patients with low back pain deal with as well. Since low back pain is a complex condition driven by many varied factors, individualized physical therapy may be a key solution because it accounts for these variables and targets them with unique approaches. Therefore, if you’re dealing with low back pain, we strongly recommend contacting us to schedule an appointment for us to evaluate your problem and get you started on a path to recovery.

As we explained in our first post, physical therapy is strongly recommended as one of the best treatments for most causes of low back pain, and there’s an abundance of research showing that it leads to a variety of improvements. One intervention physical therapists commonly use to treat low back pain is spinal manipulation, a technique in which the therapist applies a controlled thrust with their hands to a joint of the lower spine. Although many studies suggest that spinal manipulation is effective for reducing pain and improving function, international guidelines do not consistently recommend it for low back pain. For this reason, researchers decided to conduct a powerful study called an individual participant data (IPD) meta–analysis to compare the effectiveness of spinal manipulation to other commonly used interventions for low back pain.

A meta–analysis is a comprehensive study that collects and analyses multiple studies on the same topic to determine if an intervention is effective; however, one disadvantage of traditional meta–analyses is that the investigator must rely on how the data are presented in each study, which means poor reporting may often be included in the analysis. An IPD meta–analysis overcomes these issues because the individual data are made available, which leads to more precise data and possibly a more accurate assessment of the treatment’s effectiveness.

For the meta–analysis, researchers performed a search to identify randomized–controlled trials (RCTs)—the gold standard for individual studies—published in 2000 or later on the use of spinal manipulation for low back pain. This search led to 43 RCTs being accepted, about half of which (21) provided data on 4,223 participants. Once these 21 RCTs were established as the sample set for the meta–analysis, researchers documented the specific interventions and their effectiveness on low back pain in each trial. Researchers also assessed the level of bias for each included trial.

Results showed that there was evidence of moderate quality that spinal manipulation reduces pain and improves functional status to a similar degree as other recommended treatments. These improvements were reported at short–term, intermediate–term, and long–term follow–ups. In addition, moderate–quality evidence was identified that spinal manipulation is similarly effective to spinal mobilization, another commonly used manual physical therapy intervention.

Collectively, these findings suggest that spinal manipulation is just as effective as other recommended therapist interventions and may therefore serve a key role in physical therapist treatment plans for patients with chronic low back pain.

If you have low back pain, you’re far from alone. Tens of millions of Americans are affected by it, some of which are only bothered by it occasionally and others who are burdened on a nearly constant basis. Regardless of where you fall along this spectrum, there’s a strong chance you’ve probably searched for remedies to quickly alleviate your pain.

Just as there are lots of people with low back pain, there are also lots of treatment options out there that claim to heal it. Many are probably not worth your time, but one of the easiest and most effective steps you take do for your back is to bolster the strength and increase the flexibility of the structures that could be contributing to pain. This can best be accomplished by staying physically active on a regular basis and by performing specific exercises that target the lower back, abdominal, and core muscles.

To that end, below we share our picks for the 4 best exercises you can do to treat and prevent low back pain.

Our top 4 exercises for low back pain To see videos of each exercise, go to www.MyRTR.net and enter prescription code JS8MY6HX

1. Spine flexion stretch seated
   • Sit in a chair with your feet shoulder–width apart
   • Lean forward while relaxing your arms and keeping your head down toward the floor
   • Hold the position for 30 seconds
   • Repeat for three repetitions total
   • Complete this exercise three times per week
2. Trunk rotation stretch in sidelying
   • Lie on your side with your head supported on a pillow and arms extended in front of you with one hand resting on top of other
   • Bend your hips and knees to 90 degrees
   • Extend your top arm up toward the ceiling, then to floor behind you; follow your hand with your eyes while completing this motion
   • Hold the position for 30 seconds
   • Repeat for three repetitions total
   • Complete this exercise three times per week
3. Extension: prone press–up
   • Lie on your stomach
   • Place both hands flat on the ground, slightly wider than your shoulders
   • Press up, lifting only your upper body only off the ground
   • Return to the starting position
   • Hold the position for 5 seconds
   • Repeat for five repetitions total
   • Complete this exercise three times per week
4. Tensor fasciae latae/iliotibial band (TFL/IT) band stretch against wall
   • Place the foot of your inside leg behind your opposite ankle
   • Shift your weight and hips toward the wall until you feel a stretch
   • Hold the position for 5 seconds
   • Repeat for five repetitions total
   • Complete this exercise three times per week

Regularly performing these exercises will help keep your spine strong and flexible, lowering your chances for low back pain in the process; however, pain may still develop, since there are numerous factors that contribute to the development of low back pain. When this occurs, physical therapy is your best option, and in our next two posts, we summarize some research that shows why.

Low back pain is incredibly common. Nearly one–half of all working Americans notice painful symptoms in the lower back at least once each year, and roughly 31 million individuals are affected by it at any given point in time. Thus, low back pain is essentially just a part of life and something that most of us will eventually encounter, like it or not.

Dealing with low back pain can be troublesome and place a strain on everyday life. Typical movements like bending over to pick something up off the ground or twisting your torso when looking to the side might suddenly give you pause and make you less mobile. Being regularly bothered by pain and movement limitations will often lead one to wonder what’s causing the pain and what steps can be taken next to address it.

The truth is that the specific cause of low back pain is usually difficult to pinpoint, and regardless of its cause, the most effective treatment is almost always a comprehensive and individualized physical therapy treatment program. Nonetheless, although rare, there are a few signs that may be “red flags” and warrant further investigation. To help you better understand what could be causing your back pain and what to do next, below are the 6 most common low back pain conditions seen by physical therapists and some red flags to be aware of:

The 6 most common low back pain conditions treated by physical therapists

• Sprain: occurs when a ligament in the spine is pushed beyond its limits, which can damaged or tear it; typically leads to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
• Strain: involves a tendon or muscle that supports the spine being twisted, pulled, or torn; as with sprains, strains in the lower back usually lead to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
  • Sprains and strains are responsible for most cases of back pain, particularly in younger patients; these injuries can occur either from a single incident or result from repetitive stress over time
• Herniated disc: a condition in which the softer jelly–like substance of a disc in the spine pushes out through a crack in the tough exterior ring; a “bulging disc” means that the inner layer has protruded outwards, but the outer layer remains intact; common symptoms include arm or leg pain, numbness or tingling, and weakness
• Spinal stenosis: a condition in which the spinal canal–the space around the spinal cord filled with a fluid that bathes the nerves and nerve roots of the spine–narrows over time, which puts pressure on the spinal cord and spinal nerve roots; spinal stenosis is typically only seen in older adults
• Degenerative disc disease: an age–related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to a herniated disc or other related issues; degenerative disc disease is another one of the most common causes of low back pain
• Osteoarthritis: involves the breakdown of protective cartilage that surrounds the ends of joints and discs in the spine; osteoarthritis can occur anywhere in the spine, and has been referred to as the most common cause of low back pain in patients over the age of 50; patients typically experience pain and stiffness, while weakness or numbness may also occur for some

Red flags

• History of fever, chills, or recent illness (could suggest the presence of an infection)
  • Other signs of infection include pus or fluid, redness, fever, blisters, and worsening swelling
• New episode of low back pain under 18 years or over 50 years
  • For those under 18 years, pain may suggest a congenital defect, spondylolysis, or vertebral fracture
  • For those over 50 years, pain may suggest a tumor or infection
• Bowel or bladder dysfunction (associated with a condition called cauda equina syndrome)
• Extreme bruising, swelling, or throbbing pain
• Significant bone pain (may suggest a bone tumor)
• Persistent swelling and pain that develops without a recent injury
• Compromised immune system
• Recent surgery or spinal injection

For more information about red flags to consider with low back pain, click here. In our next post, we describe our picks for the best exercises to reduce your risk for low back pain.

Physical therapy frequently produces notable and lasting improvements that allow patients to lead more mobile lives and participate in activities that they were once unable to complete. As such, it can also help reduce the need for opioids and other pain medications and help patients avoid surgery.

But surgery remains an extremely common intervention that may be necessary for patients that have not tried physical therapy or for those whose condition is too severe. Yet even in these cases, physical therapy can still serve a vital role in helping patients recover as quickly and safely as possible. Physical therapy is typically prescribed to patients immediately after surgery, and the benefits of this approach are exemplified in a recently published study that is described below.

Half of patients complete 7 treatment sessions over 14 weeks

This study was a randomized–controlled trial of patients with femoroacetabular impingement published in July of 2021. Randomized controlled trials involve randomly assigning participants two or more treatment groups, and these types of studies are considered the gold standard for investigating the effectiveness of an intervention.

Patients with symptomatic femoroacetabular impingement for at least three months who were scheduled to undergo hip surgery were recruited to participate and screened for inclusion. This search led to 94 patients fitting the inclusion criteria, who were then randomized to either the experimental group or the control group at a ratio of 1:1.

Patients in the comparison group followed usual care, which consisted of an education program with advice on movements that should be avoided, how to use certain devices and postures, and nonspecific strengthening and stretching exercises for the legs. Patients in the experimental group participated in this education program but also completed a comprehensive exercise program led by a physical therapist. The program was designed to reduce pain and restore range of motion and strength, and consisted of seven 45–minute sessions completed in the 14 weeks following surgery. The featured exercises focused on stabilization, proprioception, flexibility, and strengthening specifically intended for common deficits in femoroacetabular impingement.

In the final assessment taken 14 weeks after surgery, patients in the experimental group reported significantly greater improvements than the comparison group in all movements evaluated, including hip flexion, extension, and range of motion. Patients in the experimental group also reported significantly greater pain reductions, as well as significantly better scores on a test of hip function than the comparison group at 14 weeks after surgery. Hip function was rated as “excellent” in the experimental group and “good” in the comparison group.

These findings show that a comprehensive physical therapy program can lead to less pain, greater hip mobility, and a faster restoration of functional abilities in patients with femoroacetabular impingement who undergo surgery. This study also highlights why physical therapy is regarded as a necessity for all patients who go on to have surgery for hip pain or any other musculoskeletal condition. Therefore, if your hip is bothering you and you’re scheduled for surgery or considering this route, we can’t recommend physical therapy strongly enough if you’d like to bounce back from the procedure as quickly and safely as possible.

As we discussed in our first post, physical therapy is the best option available for the vast majority of hip pain cases because it empowers patients to regain their lost abilities with their own targeted movements. There’s also large and growing body of evidence that supports physical therapy as a safe and effective intervention for a range of hip conditions, and to give you a better sense of what this research has shown, we describe a recently published study below.

More patients with hip osteoarthritis take medications instead of exercise therapy

Hip osteoarthritis is one of the most common types of osteoarthritis and an extremely prevalent cause of hip pain. Although exercise therapy, education, and in some cases weight loss are recommended as the best tools to address hip osteoarthritis, only about one in three patients are offered these treatments. Instead, pain medications like acetaminophen, non–steroidal anti–inflammatory drugs (NSAIDs), and even opioids are frequently used to manage hip pain in these patients, even though these medications lead to similar outcomes as exercise therapy and are associated with several risks—particularly opioids.

Therefore, a study was conducted to determine if an exercise program had an impact on the use of pain medications in patients with knee and hip osteoarthritis. To be eligible for the study, patients with knee and/or hip osteoarthritis were evaluated against a set of inclusion criteria, and this process led to 16,499 patients being included. All these patients participated in an intervention that consisted of 2–3 sessions of patient education and 12 sessions of supervised exercise therapy over six weeks. The education sessions were led by a physical therapist and provided patients with knowledge about osteoarthritis and treatments for it, particularly self–help and exercise. The exercise therapy sessions focused on neuromuscular control and lasted one hour each, becoming gradually more challenging as the program progressed. Patients were also encouraged to become more physically active and exercise more frequently, and the physical therapist discussed individual strategies with each patient at the final session.

Results showed that there was a significant reduction in the use of all pain medications after these patients completed the intervention. The number of patients using acetaminophen, NSAIDs, or opioids reduced from 62% before the intervention to 44% afterwards, which corresponded to a relative reduction of 29%. Among the patients who were using pain medications at the start of the study, most (52%) either changed to a lower risk medication or discontinued medications altogether, while about 46% continued using the same medication. It was also found that overall pain scores improved after completing the intervention, and greater improvements were associated with a greater reduction in the use of pain medications.

These findings show that an exercise therapy program can substantially reduce the proportion of patients with knee or hip osteoarthritis who use pain medications, as they often switch to lower–risk options. Exercise therapy is considered an extremely effective and safe intervention with minimal to no risk for adverse events, whereas pain medications are associated with various side effects and—in the case of opioids—a high risk for abuse, addiction, and overdose–related death.

Therefore, if you are currently affected by hip osteoarthritis or any other cause of hip pain that’s complicating your daily life, we strongly advise you to see a physical therapist promptly for an individualized treatment program that will empower you to regain your function through a targeted exercise program.

As we saw in our last post, several conditions can develop in the hip and can go on to cause pain and dysfunction. These problems can strike at any age, but are more likely to develop later in life and in females, with the highest incidence of hip pain occurring in women aged 40–60 years.

In most cases, a combination of age–related changes and overuse are responsible, while traumatic injury may be the culprit for certain patients. Whatever the cause, the toll that hip pain takes is often similar, as patients will variably lose their ability to move and function freely. Walking, running, and sitting/standing typically become more labor–intensive tasks, and these limitations will likely persist if no action is taken.

While it’s not possible to reverse or stop natural age–related changes, you can take preventive steps on your own that will lower your risk for hip pain. One of the most effective tactics is to regularly perform exercises that target the muscles of the hip. Doing so will improve both the strength and flexibility of the hip, which means less strain and better overall functioning that equates to a reduced injury risk.

Large, thick muscles of the buttocks and thighs surround the hip and are responsible for the significant amount power that the joint can generate. These muscles are typically classified according to the type of movement that they permit:

• Flexors and extensors: move the leg back and forth
• Abductors: move the leg out to the side
• Adductors: move the leg inward toward the other leg
• Rotators: move the toes inward (internal rotation) or outward (external rotation)

Of these, the hip abductors are usually the weakest group of muscles. The abductors are found in the buttocks and include the gluteus maximus, gluteus minimus, and tensor fascia lata muscles. These muscles contribute in major ways to our ability to stand, walk, and rotate our legs easily, meaning weak abductors can interfere with daily functioning in significantt ways. With that in mind, here are 4 of our favorite exercises to stretch and strengthen the hip abductors and reduce your risk for pain:

Our top 4 exercises to help you avoid hip pain To see videos of each exercise, go to www.MyRTR.net and enter prescription code PW3LGZ2U

1. Clam shell side lying
   • Lie on your side with your knees slightly bent
   • Keep your heels together and raise your top knee up toward the ceiling
   • Repeat for two sets of 12 repetitions
   • Switch sides and repeat
   • You can add a resistance band to make the exercise more challenging
2. Hip abduction in hook lying with band
   • Lie on your back with your knees bent and feet shoulder–width apart
   • Place a resistance band around your thighs, just above the knees
   • Separate your knees about 6 inches by pressing your knees into the band and tightening your buttocks
   • Repeat for two sets of 12 repetitions
3. Hip burners (foot pointed down)
   • Lie on your side with your top leg straight and bottom leg slightly bent at the hip and knee
   • Raise your top leg up about 6 inches and slightly point your foot down toward floor
   • Keeping your top leg straight, slowly move it up and back in a diagonal pattern
   • Make sure to move only through the hip while keeping your spine straight
   • Repeat for two sets of 12 repetitions
   • Switch sides and repeat
4. Hip abduction in quadruped
   • Begin on your knees with your hands flat on the floor and looking downwards
   • Draw in your stomach muscles
   • Keeping your spine straight, move your leg out to the side about 4–6 inches, keeping your knee bent throughout the motion
   • Repeat for two sets of 12 repetitions
   • Switch sides and repeat
5. Regularly performing these exercises—every other day or so—will keep your hips strong and will lower your injury risk. But if an issue does arise, it’s best to consult with a physical therapist, who will perform a comprehensive evaluation and design a personalized treatment program that’s suitable for your needs, abilities, and goals. In our two next posts, we’ll look at some evidence that shows why a physical therapy program is effective for various hip–related conditions.

The hip is a resilient joint that can sustain repeated strain and a significant amount of wear and tear. This durability is due to the joint’s complex and multifaceted anatomy, which includes a robust architecture that is built for stability. The hip is also incredibly flexible, allowing for a massive range of motion that is second only to the shoulder in this capacity.

But despite these strengths, the hip also has a concrete set of limits, just like every other joint in the body. Regularly participating in activities that engage the hip, not taking enough time to recover after exercise, and aging all take a toll on the joint. And over time, the sum of these factors can often result in an injury or lasting pain.

Many conditions can negatively affect the functioning of the hip and complicate the daily life of sufferers as a result. After hip pain develops, movement can become a taxing affair. Standing up from a chair, getting into a car, and walking even short distances may be met with intense strain and discomfort. As a result, some individuals will become less active to avoid this pain, even though inactivity can lead to worse outcomes in the long run.

Common hip conditions versus red flags

When hip pain occurs, a targeted intervention will be needed to address a patient’s deficits and help them regain functional abilities. Physical therapy is often the best option available for most of these cases because it not only reduces pain levels, but also teaches patients to overcome their limitations independently by moving better and more efficiently. Physical therapy is also appropriate for patients of all ages and for most conditions that produce hip pain, with a few exceptions. To help you determine if physical therapy is right for you, here are five of the most common hip conditions that physical therapists treat, followed by some red flags, which usually suggest a more serious problem is present that requires the care of another health professional:

5 common hip conditions seen by physical therapists

1. Femoroacetabular impingement
   • Arises when small bony projections (bone spurs) develop along either the femur (upper leg bone) or acetabulum (socket of hip), causing these bones to rub against each other directly without protection
   • Over time, the resulting friction between these two bones can damage the hip joint
   • Symptoms include pain or stiffness in the groin or outside the hip, which grows worse with turning, twisting, or squatting motions
2. Labral tear
   • A rip in the labrum, which covers the acetabulum and secures the head of the femur in place
   • The labrum can be torn by sudden trauma or repetitive motion and overuse in sports like hockey, golf, and soccer, age–related changes, structural problems, or some combination of these factors
   • Femoroacetabular impingement can also damage the labrum and lead to a tear over time
   • Symptoms are similar to those of femoroacetabular impingement, including pain or stiffness, pain in the buttocks area, a clicking or locking sound in the hip, and instability
3. Arthritis
   • Rheumatoid arthritis and osteoarthritis are among the most common causes of hip pain
   • While the course of both conditions is slightly different, both involve the wearing away of the cartilage that surrounds the ends of bones in the hip joint, resulting in less protection and eventually friction between them as it progresses
   • In osteoarthritis, this wearing process is due to age–related changes, while rheumatoid arthritis is an autoimmune condition in which the body mistakenly attacks the joint’s cartilage
   • Symptoms include pain, swelling, tenderness, and stiffness, and a general inability to move the hip and perform routine hip–related activities
4. Hip bursitis
   • Each hip joint contains two bursae (singular bursa), which are fluid–filled sacs that ease friction between the bones, muscles, and tendons that comprise it
   • Bursitis is the inflammation of a bursa, which typically results from repeated overuse or strain of the hip
   • The primary symptom is a dull, burning pain on the outer hip that’s made worse with excessive walking or climbing stairs
5. Hip tendinitis
   • Inflammation of any of the tendons that flex the hips
   • Usually caused by repetitive strain and overuse, often from sports or other forms of physical activity
   • Symptoms include pain that develops gradually over time, tenderness, and stiffness in the morning or after long periods of rest

Red flags

• History of a severe fall
• Suspected hip fracture
• Signs of infection (eg, pus or fluid, redness, fever, blisters, worsening swelling)
• Known or suspected cancer (eg, significant bone pain, which may suggest a bone tumor)
• Extreme bruising, swelling, or throbbing pain
• Persistent swelling and pain without any recent injury
• Severe muscle spasm
• Inability to place any pressure on the leg of the injured hip

If you notice any of these red flags, see your primary care physician as soon as possible or—for severe injuries—go to the emergency department or urgent care clinic immediately. But in the absence of any red flags, we strongly recommend seeing a physical therapist for your hip pain as soon as possible to get started on a comprehensive treatment program that will help you regain your abilities.

As we described in our first post, knee osteoarthritis is a disorder that involves the cartilage in a knee joint. In a normal knee, the ends of each bone are covered by cartilage, a smooth substance that protects the bones from one another and absorbs shock during impact. In knee osteoarthritis, this cartilage becomes stiff and loses its elasticity, which makes it more vulnerable to damage. Cartilage may begin to wear away over time, which greatly reduces its ability to absorb shock and increases the chances that bones will touch one another. When this occurs, it typically leads to pain within and around the knee that gets worse with activities like walking, going up/down stairs, or sitting/standing, as well as swelling, tenderness, and stiffness.

Although no treatment can slow or stop this loss of cartilage, physical therapy is strongly recommended as an initial intervention for all cases of knee osteoarthritis. Undergoing a course of physical therapy can help reduce pain levels and preserve knee function through movement-based strategies like stretching and strengthening exercises, hands-on therapy, bracing, and recommendations on how to modify bothersome activities.

But many patients with knee osteoarthritis still wind up needing to have their knee joint replaced surgically with a total knee arthroplasty (TKA) at some point in the future. These patients usually fail to improve to an adequate degree with physical therapy and other non-surgical interventions. In addition, most—or all—of the protective cartilage surrounding the ends of the bones has completely worn away. This results in bone rubbing against bone when the knee moves, which is extremely painful and makes walking and other movements extremely challenging. Prior to surgery, however, some patients are referred to physical therapy for a preoperative treatment program, which is intended to improve outcomes after surgery.

Below, we describe the findings of two recent studies that highlight how physical therapy is effective both for patients with active knee osteoarthritis and for those who are preparing to have a TKA for their damaged knee:

Study #1

In the first study, published in 2021, 40 patients with knee osteoarthritis were randomly assigned to either the exercise group or the control group. Participants in the exercise group completed an exercise program that included three 50-minute treatment sessions per week for six weeks. These patients completed two sets of exercises that were intended to strengthen the quadriceps muscles of the thigh. Participants in control group received 10 minutes of infrared therapy to the knee without any other interventions and were otherwise advised to continue with their daily activities. All patients were assessed for pain, range of motion, and several other outcomes before beginning treatment and immediately afterwards.

Results showed that patients in the exercise group experienced significantly greater improvements in pain, stiffness, physical function, and passive and active range of motion. Therefore, it appears that participating in an exercise therapy program can lead to notable gains that will likely improve quality of life for patients with knee osteoarthritis.

Study #2

The other study was a 2021 systematic review and meta-analysis in which researchers performed a comprehensive search of five medical databases to identify trials that evaluated the effectiveness of participating in an exercise therapy program prior to undergoing a TKA. This search led to 12 studies fitting the necessary inclusion criteria, which included data on 889 patients who were evaluated at regular intervals for up to 12 weeks after surgery.

According to results, patients who underwent the preoperative exercise intervention had more knee flexibility at 6–12 weeks after surgery, stronger quadriceps muscles, better scores on an arthritis-specific test, and greater quality of life scores compared to patients in the control group. This suggests that preoperative exercises can lead to major improvements in the early rehabilitation period after surgery.

We hope these recent studies have provided you with an even better understanding of the various benefits of physical therapy for patients with knee and thigh pain. And if you’re currently bothered by pain in these regions or anywhere else in the body, we invite you to come in for a visit so we can determine the cause and get you started on path to recovery right away.