Chiropractor Chandler AZ

PLATELET-RICH PLASMA PROLOTHERAPY FOR HIP IMPINGEMENT

Hip impingement, also known as femoroacetabular impingement (FAI), is a condition in which extra bone grows on one or both bones of the ball and socket hip joint. This overgrown bone gives the hip joint irregular shape. In a normal hip joint, the ball-like end of the thigh bone fits perfectly into the cup area of the pelvis, but in the case of hip impingement, the head of the thigh bone and the socket of the pelvic bone do not fit together and cause the bones to rub against each other every time the hip joint moves. Over the passage of time, this condition can damage the hip joint, causing pain and inflammation.

30% of the general population is affected by hip impingement. 90% of the athletes who participate in sports like football and ice hockey suffer from hip impingement. It is the cause of osteoarthritis in people below the age of 40.

ANATOMY OF THE HIP JOINT

The hip joint is a ball and socket joint. A part of the pelvis, called acetabulum, makes the socket of the joint while the ball is the head of the femur bone. The surface of the ball and the socket is covered by articular cartilage which provides smoothness and lowers the friction to help make hip movement easy. Additionally, the acetabulum is covered by fibrocartilage called labrum. It gives stability to the hip joint. In hip impingement, a bone overgrowth develops either around the femur head or acetabulum. It is called bone spurs. This bone spur hinders the smooth sliding of bones in the hip joint. Over time, it can result in the labrum and articular damage and can lead to osteoarthritis.

CAUSES OF THE HIP IMPINGEMENT

Hip impingement can be caused by the abnormal development of the hip bones during childhood. Abnormal development of hip bones increases the chances of the hip impingement during adulthood.

Hip impingement can be asymptomatic and the person may not feel the pain. Athletes use the hip joint more vigorously, thus they can experience pain if they are suffering from hip impingement. However, sports do not cause hip impingement.

SYMPTOMS OF THE HIP IMPINGEMENT

The most common symptoms of the hip impingement are:

• Pain, more often in the groin area
• Stiffness
• Loss of hip's full range of motion

HOME REMEDIES FOR HIP IMPINGEMENT

If a person is suffering from hip pain, it is advised to identify the activity that may cause the pain and avoid it. Resting can be helpful in relieving pain in this situation. Over the counter anti-inflammatory drugs such as ibuprofen and naproxen are also helpful in some cases. If these measurements do not help, the person must see a doctor to determine the exact cause of the pain as the hip impingement can get worse with time if left untreated.

DOCTOR EXAMINATION

The doctor will ask general questions about the overall health of the patient and the hip symptoms. The doctor will also examine the hip to determine the cause of pain.

IMPINGEMENT TEST

During the physical examination, the doctor will perform an impingement test. For this, the doctor will lift the patient's knee up towards the chest and rotate it inwards. If the patient feels pain, he is suffering from impingement.

IMAGING TEST

The doctor can ask for imaging tests to confirm if the person is suffering from impingement.

• X-ray: X-ray is helpful as it provides a good image of the bones and shows if there is any abnormality in the hip bones. It can also show signs of arthritis.
• Computed tomography (CT) scan: it provides more details than an X-ray. It helps the doctor to see the exact abnormal shape of the bone in the hip joint.
• Magnetic resonance imaging (MRI) Scan: An MRI scan provides better images of the soft tissues. It can help the doctor to determine the extent of damage to the labrum and articular cartilage. A dye is injected into the joint during the MRI scan that visualizes the damage in the hip joint.
• Local anesthetic: the doctor will inject the patient with local anesthesia into the hip joint as a diagnostic test. If the anesthesia relieves the pain, it confirms that the patient is suffering from hip impingement.

TREATMENT FOR HIP IMPINGEMENT

NONSURGICAL TREATMENT ACTIVITY CHANGE

The doctor can recommend a change in daily activities to avoid stressful activities that may cause pain in the hip and enhance the hip impingement symptoms.

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS

The doctor can prescribe non-steroidal anti-inflammatory drugs such as ibuprofen to relieve pain and swelling.

PHYSICAL THERAPY

Certain exercises are helpful in increasing the range of motion in the hip and improving the strength of the muscles that support the joint. It helps in reducing stress from injured labrum or cartilage.

SURGICAL TREATMENT

If hip impingement is confirmed by tests but nonsurgical treatments fail to relieve the pain and improve the hip joint condition, then the doctor may recommend surgery.

ARTHROSCOPY

Arthroscopy is performed to treat hip impingement invasively. The procedure is performed with a small incision and very fine instruments. The surgeon uses an arthroscope to view the hip joint from inside. During arthroscopy, the surgeon may remove the outgrowth on the labrum or articular cartilage in order to correct the hip impingement.

The open operation may be required to treat severe cases of hip impingement.

Surgery can prevent further damage to the hip impingement, but if the treatment is delayed and more damage is done, then it is difficult to repair the damage fully. Currently, surgery is the best way to treat hip impingement.

ALTERNATIVE TREATMENT

Hip impingement is a painful condition that requires medical care as soon as possible because any delay in the treatment can increase the damage to the hip joint. Surgery is an effective option to treat the hip impingement, but it cannot repair the damage already caused by the impingement. Any treatment option that can repair the joint structure can be very helpful for patients with severe hip impingement.

None of the surgical/nonsurgical techniques use the body's natural healing mechanism to initiate and accelerate the repair process in the damaged hip. Some work is being done in this field and Platelet-rich plasma prolotherapy is being used to treat such problems with the help of the body's own repair machinery. PRP prolotherapy is a part of a new branch of medicine known as Regenerative Medicine. It uses the body's healing ability to repair the damage and relieve the pain and inflammation. The platelet-rich plasma Prolotherapy works on a very simple principle: "when the platelet concentration is increased in a certain area of the body, it accelerates the healing process." Platelets contain many chemicals known as:

• Glycogen
• Lysosomes
• Alpha granules
• Beta granules

Alpha granules contain growth factors and they are the main focus of platelet-rich plasma therapy. There are three stages of healing after platelet-rich plasma Prolotherapy injection and different types of growth factors are involved in driving different stages.

• Inflammation phase: It lasts for 2-3 days. In this phase, growth factors are released.
• Proliferation phase: It lasts for 2-4 weeks. It is vital for musculoskeletal regeneration.
• Remodeling phase: It lasts over a year. In this phase, collagen is matured and strengthened and the injury is healed

20-30 mL of blood is used to make platelet-rich plasma. The blood is spun for 15 minutes at 3,200 rpm in a centrifuge machine. This step separates platelet-rich plasma from platelet-poor plasma. 3 mL of platelet-rich plasma is obtained from 20 mL of blood. The platelet-rich plasma is combined with half mL of sodium bicarbonate to neutralize its pH. The injection is administered with the help of a dynamic musculoskeletal ultrasound with a transducer of 6–13 Hz to maximize the location accuracy for the injection. The injection is administered directly at the site of injury.

As the platelet-rich plasma Prolotherapy technique uses the patient's own blood, the chances of immunogenic reaction or the transfer of blood borne diseases are completely eliminated.

The growth factors attach to the cell surface and not the nucleus of the cell, thus the chances of tumor growth are also eliminated. As the platelet-rich plasma Prolotherapy is an injection-based procedure, the risks involved in the procedure are:

• Anaesthesia allergy
• Infection
• Neural trauma
• Organ trauma
• Needle breakage

PRP prolotherapy cannot prevent or repair the outgrowth in the hip, but it can be very helpful in repairing the damage caused by hip impingement. To treat the cartilage degeneration, the most suitable treatment option is the one that increases the chondrocytes activity and cartilage repair and regulates cytokine production. This can be achieved by platelet-rich plasma (PRP) Prolotherapy. A chronic knee pain study published in the Journal of Prolotherapy showed amazing pain-relieving effects of PRP Prolotherapy in patients with knee cartilage degeneration. This study shows that PRP prolotherapy can also be effective in treating the damaged articular cartilage.

The data available on prolotherapy shows that PRP prolotherapy is safe and has fewer to no side effects. A combination of arthroscopy and PRP prolotherapy can be an efficient approach to treat the hip impingement and repair the damaged structure.

CONSERVATIVE TREATMENTS TO COMBINE WITH PRP

While PRP and stem cell treatments are enhancing the tissue repair and regeneration, conservative treatments can enhance healing, strengthen the muscles, and stabilize joint movements to maximize your recovery.

COLD LASER THERAPY TREATMENTS

1. Accelerated tissue repair and cell growth


Photons of light from lasers penetrate into tissue and accelerate cellular growth and reproduction. Laser therapy increases the energy available to the cell so it can work faster, better, and quickly get rid of waste products. When cells of tendons, ligaments, and muscles are exposed to laser light they repair and heal faster.

2. Faster wound healing

Laser light increases collagen production by stimulating fibroblasts. Collagen is the building block of tissue repair and healing. Laser therapy increases fibroblast activity and therefore collagen production to speed healing.

3. Reduced fibrous tissue formation

Low-level laser therapy decreases scar tissue formation. Scar tissue can be a source of chronic pain and poor healing. By eliminating excessive scar tissue and encouraging proper collagen production, painful scars and chronic pain is reduced.

4. Anti-inflammation

Laser therapy causes vasodilatation (increases the size of capillaries) which increases blood flow. The treatments also increases lymphatic drainage to decrease swelling or edema. Therefore, laser therapy reduces swelling caused by bruising or inflammation while speeding the recovery process.

5. Pain relief

Cold laser therapy decreases pain by blocking pain signals to the brain. Some nerve cells sense pain and send signals to the brain. Chronic pain can be caused by overly active pain nerves. Specific wavelengths help "shut off" the pain signals, thereby eliminating your pain.

Low-level lasers are excellent at decreasing inflammation, which also increases pain nerve activity. Cold laser therapy also increases endorphins and enkephalins, which block pain signals and decrease pain sensation. Overall laser therapy reduces painful nerve signals and reduces your perceived pain.

6. Increased blood flow

Blood carries nutrients and building blocks to the tissue, and carries waste products away. Increased blood flow to tissues increases and enhances cellular healing. Cold laser therapy increases the formation of capillaries in damaged tissue. Specific laser frequency also increases blood flow to the area treated to enhance injury repair.

7. Increased repair and regeneration

Low-level lasers increases enzyme activity to improve metabolic activity that affects cell repair and regeneration. The enzymes are turned on "high" to speed the healing.

8. Nerve function and repair

Nerves heal very slowly. Lasers speed up this process. Damage to nerves causes numbness, pain, muscle weakness, and altered sensations. Laser therapy treatments enhance nerve function, healing, and reduce pain.

9. Increased energy production- ATP

ATP is like gasoline for cells, it is the energy source that cells operate. Injured cells often have low levels of ATP, which decreases their ability to heal and repair. By increasing ATP and "gasoline storage levels," cells have the ability to heal and repair. More on cold laser therapy for hip pain.

SOFT TISSUE TREATMENTS

Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.

When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercises and flexibility programs.

Many leg injuries are associated with radiating pain. The two legs function as a system for movement. Injuries in one area of the system are commonly associated with poor joint stabilization in the foot, knee, or hip. This leads to poor alignment and excessive forces being placed onto muscles and tendons. Knee injuries are common because of weakness and poor stabilization of the leg and hip muscles. The combination of muscle weakness, poor coordination, and altered gait mechanics produce excessive strain on the soft tissues.

The lower extremities work as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.

Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for hip, knee, and ankle; flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, exercise balls, and BOSU balls can be performed on the floor. The more unstable of the surface the more effort and stabilization is required of all the lower extremity muscles.

Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments foot pain and exercises.

BIBLIOGRAPHY

Hauser, R. A., & Orlofsky, A. (2014). Regenerative Injection Therapy (Prolotherapy) for Hip Labrum Lesions: Rationale and Retrospective Study. The Open Rehabilitation Journal , 59-68.