Rachael Bailey presents a study on how rheumatoid arthritis affects hip joints, and some effective exercises supported by scientific research, that can help reduce pain in the hip.

We discuss in this interview:

• How rheumatoid arthritis affects hip joints
• How exercise can help with arthritic hip pain
• Nordic walking
• Exercises to target arthritic hip pain
• Targeting the specific muscles that help to support and stabilize the hip

Hello, it’s Rachel Bailey here from Rheumatoid Solutions. Today we’re going to be talking about reducing hip pain for rheumatoid arthritis patients. So if you’ve got pain in the hip, then this video is going to be very interesting for you. We’re going to show you some exercises that are supported by the science that can help you to reduce pain in your hip. And of course, this is not medical advice, so please consult with your doctor before making any changes to your treatment plan.

How does rheumatoid arthritis affect the hip joint? Well, firstly, the smaller joints are typically affected first before the disease progresses and moves on to the larger joints such as the hips. As a consequence of having pain in our hips, we tend to lose muscle mass in the lower body as we become more tentative and careful in our movements to cope with the pain. But targeting these muscle groups with regular exercise could prove beneficial for improving our hip pain, so we’re going to talk about that in a second. So what does the science tell us? Well, first of all, exercise improves hip pain by improving joint flexibility, reducing stiffness and increasing strength. And together those three things will help to reduce the overall pain levels in the body. So here’s a really interesting study which looks at the effects of exercise on arthritic hip pain and an exercise routine that had been specifically designed for patients with arthritis was shown to massively reduce the need for hip replacement surgery.

Now let’s see how we can use all of this information to help to get you feeling better and to reduce your pain levels. So after finding plenty of evidence to support the positive role that exercise can play in helping with arthritic hip pain, I wanted to find out more specifically what types of exercise could help. Was there a specific type of exercise that we should be doing or more of a broad range of different activities? And I found plenty of evidence to suggest that aerobic strengthening and range of motion exercises all have a very beneficial role to play in helping to alleviate arthritic hip pain. And I’ll just talk a little bit more about these specific types of exercises in the next few slides. So firstly, let’s talk a little bit about aerobic exercises. And when I say aerobic exercises, I mean exercise that gets the heart rate up. And the types of exercises that I’ve highlighted on this slide, such as walking, cycling, swimming, and sports activities, are all low-impact aerobic exercises. So these are ideal for those of us who are suffering from arthritic hip pain because they’re not going to aggravate that muscle pain further. And in this blue box here is one particular study that I found very interesting during my research, and this study was looking at the effects of Nordic walking on patients with hip osteoarthritis. And for those of you who don’t know what Nordic walking is, it’s a particular walking technique that uses Poles as part of the walking process. So it actually is a workout for the upper body as well as the lower body. And in this particular study, the authors found that Nordic walking actually was better than strength training and other exercises that were done at home for improving function in the hip of patients with hip osteoarthritis. Much of the scientific literature supports the beneficial role of strength training in improving arthritic hip pain. And this goes back to the concept that we were discussing before, where arthritic hip pain is associated with reduced strength in certain areas of the body, and particularly the lower body. And by building strength in these muscles, we can help to improve pain levels and mobility. So weight-bearing exercises are a great way to build up strength in the lower body, and they’re very safe and effective for patients with rheumatoid arthritis. And as shown in this study here, which was a randomized controlled trial, these types of exercises can also help to slow down bone loss in patients with rheumatoid arthritis. And then finally, the last type of exercise that can be beneficial for arthritic hip pain are range of motion exercises. And these are exercises that involve gentle stretching or bending of the joints. And they can either be performed in a standing, sitting or lying down position, and they can also be done either with or without equipment. And so they’re very simple, easy exercises to try out at home. These two studies that I’ve just highlighted on this slide were some interesting studies that found while researching into this area. The top one was a randomized controlled trial that was looking at the effectiveness of these types of range-of-motion exercises. To try and improve muscle function in patients with osteoarthritis of the hip and or the knee. Again, this was a 12 week exercise intervention program with patients exercising between 1 and 3 times a week. The exercise therapy was found to reduce both pain and increase function, and mobility in these patients. Then, the second study was looking at a range of motion exercises in combination with a regular aerobic exercise program. This particular intervention was found to significantly improve mobility in juvenile idiopathic arthritis patients.

Now, we’ve briefly covered the science and the background of hip pain in arthritis. We’re going to move on to the much more exciting part of the podcast, which is looking at the specific exercises that we can use to target arthritic hip pain. All of the exercises that we’re going to discuss in this section are backed up by the science that we’ve found. To make things a bit easier, we’ve divided each of the exercises into groups based on the specific muscles that they are targeting. Just before we discuss the specific exercises that we can use, it is important that we choose the right type of exercise and that we’re targeting the right muscles to help with our hip pain. It’s also important to use appropriate techniques so that we don’t exacerbate any existing pain. We’re only working to improve it.

In this first section, we’re looking at specific exercises that can target the quadriceps. These are one of the biggest groups of muscles within the body. This is a particular muscle group that can be weakened when we have arthritic hip pain. It’s very important to build strength in these big muscles. In order to do that there are some very simple exercises that we can do at home. We can adapt them to make them much easier if we have severe hip pain. For example, by using chairs and doing the exercises in a seated position, as we can see in the images here. We can use basic bodyweight exercises to target these muscles. For example, bodyweight squats, which are very simple and easy to do at home. Quad stretches and also use some kind of step or platform to do step-ups to build strength in that area. Then, the next group of muscles that it’s very important to target. Obviously, if we’ve got hip pain and targeting the muscles that actually support the hip joint itself. The hip abductor muscles can be targeted using simple exercises such as a glute bridge or a lateral leg raise. Also, clam shells, which are a very popular and effective exercise to help with hip pain and to improve hip strength. We can use resistance bands to add extra resistance. For example, do resistance band walking and standing hip abduction, which again is is working on these hip abductor muscles. Then we have the hip flexor muscles, which again are muscles that support and allow movement through the hip. They’re located at the front of the hip and they actually help us to flex the leg and knee upwards. It is a very simple way of targeting this is through a standing hip flexor stretch. We use a very sturdy chair or a platform or step to help us lean forwards into that stretch, which is working those hip flexor muscles at the front of the hip. Then we have the calf muscles, which it’s very easy to forget because they are lower down the leg. We often don’t associate them with the hip joint and hip stability. However, they are very important for maintaining stability through the hip and strength, through the lower body itself. Again, there are many exercises that we can use to target these muscles. Again, step-ups using a sturdy platform and simple calf raises and a calf stretch using a wall or other surface to stabilize ourselves. These are the kinds of exercises that we can start simple and then we can build them up. For example, with the calf raises, we can start it as just a bodyweight workout. But then as our strength progresses and we need to build up, we can do the same kinds of exercises using weights. So have a weight in each hand and do the calf raises as before. Then, we have the knee extensor muscles. The knee joint and the hip joint are very intimately connected in the way that they move. The knee supports the hip and the hip supports the knee. By building strength in the knee extensor muscles, we can help to reduce hip pain. An example of an exercise that we can use to target these muscles is a knee extension. They are done in a seated position and short arc quads where we use a towel or a foam roller underneath the knees to support them as we raise the lower part of the leg. Then we have the glute muscles, which are another large muscle group in the body. They are an important hip stabilizer. So they help to keep the hips in position, the pelvis in position, and the knees and to keep them stabilized throughout our movement.

Again, there are various exercises and ways in which we can target these muscles. For example, very simple exercises, lifting the knee to chest in alternate knees and also a glute bridge, which we discussed before and can help to train the quads and the glutes. We could do just a standard glute bridge or make things a little bit harder. We can do a bridge and then lift our alternate legs. Then finally, as the pelvis itself is connected to the hip bones, it all forms one complex structure. The strength and mobility of the pelvis itself are very important for helping to stabilize the hips and to reduce hip pain. So to target the pelvic area and we can do exercises such as lateral step-ups. So rather than stepping up forward onto a platform with step side to side onto the platform and clamshells. As we mentioned before, they’re great for strengthening the hip joints themselves and the general pelvic area. I guess what a lot of people ask and want to know the answer to is, what if you have a lot of hip pain? Should you still be exercising and what other modifications you should be made to your exercise routine? The key thing here is that you should do the adaptations that you need to do to help you to get through the exercises. For example, if your ability is very low and you do have a lot of pain, then a great starting point can be using elastic bands. Resistance bands and these don’t necessarily need to be high resistance. You can start out with very low resistance and build this up over time as your strength builds up. Obviously, as with any other exercise routine, you should check with your physiotherapist or a doctor before starting a new program or adapting an existing program. You should never push through pain and you should listen to your body and make adaptations and rest when you need to.

Just at the bottom of this note and I’d just like to highlight this study that I’ve found and this was another randomized controlled trial. This was looking at the effects of resistance training on muscle function, muscle properties, and physical performance in people with hip osteoarthritis. Then, what this study found was this high-velocity resistance training program. Then, what we mean by high velocity is resistance training with very low weight but quick movement. These exercises focused on the different muscle groups that we’ve discussed in this podcast. Also, it actually improved the composition of the muscles surrounding the hips and the different parts of the body and physical performance. They improved mobility and function in a group of patients with osteoarthritis of the hip. The key thing that I wanted to mention here was that these exercises were high velocity, yet very low impact. It’s not necessarily the weight of the resistance or the weight of the weights used in your weight-bearing exercises, it’s just the movement. So if you need to make modifications to get through the exercise routines, then listen to your body.

Just to quickly summarize what we’ve been talking about in this podcast. We’ve shown that exercise can be used as an effective way to manage arthritic hip pain. We can use low-impact activities and aerobic exercises such as walking, swimming, cycling, and sports activities. These can effectively help to reduce hip pain, stiffness, improve mobility and general joint health in the hip. It’s important that we target the specific muscles that help to support and stabilize the hip. So to build up strength in these muscles and these are the muscle groups that we’ve discussed in the podcast. To build these up, we need to use the types of exercises that we’ve discussed. It’s very important to listen to our bodies to start slowly and to slowly increase the intensity of the exercises as we build up strength. Then, become more comfortable with them and obviously listen to your body. If you’re in any pain stop or make modifications to the exercises that you’re doing. Finally, just want to say thank you so much for listening to my podcast today. I’ve been really excited to talk to you about this topic as I’ve spent a lot of time researching it. If you would like to download the exercises that we’ve discussed in the podcast, you can use the link at the bottom of this video. If you’re already a member of Rheumatoid Solutions, you can now find the PDF inside your member’s area for easy download. If you’re not already a member of Rheumatoid Solutions, you can join us at www.rheumatoidsolutions.com. Also, don’t forget to subscribe to the Rheumatoid Solutions YouTube channel, if you haven’t already done so for access to more great content. Thank you so much for listening and hope to see you again soon. Thank you. Bye.