Back in the 60s, the word "hip" entered our lexicon with the meaning "cool," or "the pinnacle of what is it." That generation is older, and the focus of "hip" is more anatomical.
A hip is a ball and socket joint. There is a round, regularly shaped head of the femur, or thigh bone, that fits into a round socket in the pelvis. It is padded with cartilage and lubricated with a fluid made inside the joint space. They are designed to last us a lifetime with normal wear and tear.
Sometimes these joints do not form perfectly in utero. Occasionally the socket is too shallow, causing him dislocation of the hip. This is easily tested and is part of the neonatal exam as soon as a baby is born.
Many of the "hip" generation are older now. Many of these were health-conscious and took up jogging, tennis, handball, basketball, and other sports to stay fit. High impact sports increase the rate of wear and tear on a hip. The ladies in this generation are about the right vintage to have osteopenia or osteoporosis, conditions that soften bones, making them more brittle and easier to break.
That's where Elaine comes in. She had a serious limp and an even more serious countenance that day. Some of her friends had already had hip replacements. When her hip began to hurt to the extent that it interfered with her daily activities and caused her to limp, she was fearful that surgery was in her picture. She dreaded the thought.
She is an active senior athlete. She lives in a community of people like her who exercise individually and as a group to stay as young as possible. As the saying goes, "The trick in life is to die young--as late as possible." Various athletic activities are more than staying healthy for this group. They are social activities that meet other needs as well. If Elaine's hip keeps her from participating, it not only curtails something she enjoys, but it also isolates her socially.
On exam, her hip had lost range of motion in internal and external rotation. At the end of these ranges of motion, there was a sharp pain in the hip joint radiating down the thigh. This pattern is typical of hip pain. What we needed to know next was how the joint looked. So, to x-ray we went.
We obtained a front view of the pelvis and both hip joints and a view called a "frog leg." With the patient standing on her good leg, we turned the affected hip outward so that we can x-ray the joint from an inside angle. This gives us two good views of the head of the femur. If it had been irregularly shaped, we would know it had been damaged. We also look at the joint space to get an idea of the condition of the cartilage that pads that joint.
Elaine's hip structure looked good on film. She did have some osteopenia, but there were no fractures, and the femur head was nice and round with a good joint space around it, indicating that her cartilage was intact. This was good news indeed.
We went to a special adjusting table that has a drop piece built into it. I adjusted the affected hip using a drop table technique. Following this procedure, range of motion was tested and found to be greatly improved. We continued to address her sore hip with deep ultrasound to affect the small rotator muscles around the hip joint.
Imagine her surprise when she stood from the table and walked without pain! There was great relief, to be sure, but not all of it was from reduced pain. She would be able to resume her activities and enjoy the relationships that were important to her. I suspected that was the major part of her relief.
I am telling Elaine's story because it is not unusual at all for seniors to have hip pain. The problem needs to be investigated thoroughly because pain in the hip may be a harbinger of a hairline crack in the neck of the femur or a degenerative process in the hip joint. Once these have been ruled out, this can often be addressed with a simple adjustment and some light physiotherapy, such as ultrasound. The small rotator muscles around the hip joint that control it will sometimes go into spasms that can be very painful and limit range of motion.
On the other hand, if we had seen deterioration or damage to the hip on film, the next step would be an MRI of the hip joint to assess the cartilage and the rest of the joint space. Significant MRI findings would trigger an orthopedic opinion. I would have discussed options with Elaine to find one that suited her best. As always with such referrals, I look for not only the skill set we need, but for a caring physician as well.
Elaine is back to doing what she wants to do. She walks her dog on the dog track, so even the dog is happy. You might say that Elaine has rejoined the "hip" generation indeed.