Whether you’re a tennis fan or not, it’s sad to see a superstar like Andy Murray face the prospect of early retirement due to injury (Image 1). Considered the greatest British men’s player ever, Murray has been one of the four best in the world this decade. Recently, an emotional Murray admitted his time as a professional tennis player is nearly up due to osteoarthritic hip pain.

Murray’s orthopedic surgeon, the legendary John O’Donnell, MD, believes the only hope for relieving the tennis star’s sharp groin pain is a total hip replacement or hip resurfacing surgery, the latter of which Murray underwent in late January. “It’s like the brake linings of your car,” O’Donnell says. “If you rag them too hard, they wear out earlier, particularly if the hip has suffered previous injury.”

In Murray’s case, degenerative joint disease damaged the articular cartilage of his right femoral head, resulting in repetitive grinding of the femur on the rim of the acetabulum, a condition known as femoroacetabular impingement syndrome, or FAI (Image 2). Murray’s doctors have diagnosed him with hip osteoarthritis, but there is not enough evidence to validate an inflammatory process in these “wear-and-tear” degenerative joint disease cases. Therefore, I will refer to his condition with the more appropriate term osteoarthrosis (OA).

For Murray, the severity of his hip OA, coupled with a history of related issues and injuries, landed him in the operating room for relief from OA pain. However, for our clients with more moderate OA, manual therapy can play a key role in recovery.

Primary and Secondary Osteoarthrosis

For a better understanding of this condition, let’s take a look at the two types of OA—primary and secondary. In primary OA, the initiating factor is unknown, and it’s commonly seen in weight-bearing joints of women in their 50s and 60s. Conversely, in secondary OA, the factor or event is known. In Murray’s case, repetitive movements, recurring injuries, and abnormal joint loading during his teenage growth spurts are suspected causes. Joint alignment, muscle strength, and nutritional status also seem to contribute to the development of secondary OA, and the most frequently affected areas are the neck, low back, hips, knees, acromioclavicular joints, wrists, and fingers.

Although OA is considered a natural part of the human aging process, most bodyworkers have seen how articular cartilage damage and joint compression can cause the brain to lock down an area with protective muscle guarding. Digging on the spasm does little good until proper joint mobility, neurology, and hydration are restored. During a typical history intake, OA clients presenting with hip pain often describe a lifetime of overuse, underuse, or plain old abuse, leading to disruption of the delicate mobility-stability balance around their affected femoroacetabular joint.

This is where massage and mobilization may help. According to recent research, a number of manual therapy modalities have shown promise in treating those with mild to moderate hip OA, including soft-tissue manipulation and joint stretching techniques.1 Given the close kinetic link between the hips, lumbar spine, sacroiliac joint, and peripheral joints, it’s best to approach OA from a global viewpoint, which is one of the goals of myoskeletal alignment techniques (MAT).

How MAT Can Help

MAT is a great foundation for exercise therapy due to its effect on pain modulation, joint limitations, and muscle hypertonicity. MAT uses graded exposure stretches and gentle articular oscillation maneuvers to optimize joint lubrication and reduce neuromuscular tone—the perfect combo for those suffering with mild to moderate hip pain. Images 3–5 demonstrate an example of a simple but effective femoroacetabular MAT routine for clients presenting with OA pain and limited functional mobility.

When performing these techniques, remember that by increasing range of motion in any one cardinal plane you reciprocally increase range in the other two planes. Therefore, if you encounter a resistant or painful barrier, don’t bulldoze it. Instead, perform an indirect mobilization technique and retest. For example, if hip flexion and adduction trigger FAI pain, start by decompressing the hip (Image 3) and then gently distract the femur while adding a bit of adduction (Image 4). To help restore pelvic alignment and balance, have the client adduct against your resistance while they slowly do a bridge (Image 5), then retest for less FAI pain. Always drape properly.

Summary

It’s clear hip OA is more than an overuse problem, as seen in athletes like Murray. While clients may worry that exercising with OA could harm their joints and cause more pain, research shows people with this condition can and should exercise.2 A tailored program that includes a balance of three types of exercises—range of motion, strengthening, and endurance—can help ease OA symptoms and protect joints from further damage. MAT, combined with a comprehensive movement plan to improve joint mobility, muscle strength, and overall physical conditioning, may be the most effective non-drug treatment for reducing pain and improving movement in our OA clients.  

Notes

1. J. H. Abbott et al., “Manual Therapy, Exercise Therapy, or Both, in Addition to Usual Care, for Osteoarthritis of the Hip or Knee: A Randomized Controlled Trial,” Osteoarthritis and Cartilage 21, no. 4 (2013): 525–34.

2. P. Nejati, A. Farzinmehr, and M. Moradi-Lakeh, “The Effect of Exercise Therapy on Knee Osteoarthritis: A Randomized Clinical Trial,” Medical Journal of the Islamic Republic of Iran, 29 (2015): 186.