Hip & Knee Pain

Joint pains, including hip and knee pain from osteoarthritis, and arthritic pain generally are among the conditions osteopaths commonly help with. These are weight-bearing joints, so even mild pain tends to show up in walking, stairs, getting out of a chair and sleeping, and people often put up with it for a long time before seeking help.

What causes hip pain?

Hip pain can come from the joint itself, from the muscles and tendons around it, or be referred from the lower back. The NHS lists osteoarthritis as a common cause in people over 45, with tendon strain or inflammation after intense or repetitive exercise another frequent one. Pain felt in the groin or the front of the thigh tends to come from the joint; pain on the outside of the hip is more often the tendons and bursa there. Hip stiffness lasting more than 30 minutes after waking is a sign the NHS suggests discussing with a GP.

What causes knee pain?

Knee pain without an injury is commonly osteoarthritis, bursitis or a problem with how the kneecap tracks. After an injury it may be a sprain, a strain, or a torn ligament or cartilage, which need a medical assessment. The NHS says most knee pain should start to feel better within a few days of self-care, and advises seeing a GP if it has not improved within a few weeks.

What is osteoarthritis?

Osteoarthritis is the most common type of arthritis in the UK and most often affects the knees, hips and the small joints of the hands. It causes joint pain, stiffness and sometimes swelling, tenderness or a grating feeling on movement, and symptoms vary a great deal between people. The NHS management plan is regular physical activity, keeping to a healthy weight, suitable footwear, painkillers where needed, and structured exercise, with surgery considered only when these have not worked.

How can osteopathy help with hip and knee pain?

Abdul examines the painful joint along with the back, pelvis and the other leg, because hip and knee pain is often influenced by how the whole lower limb is loading. Treatment may include gentle mobilisation of the hip or knee, soft tissue work on the muscles around the joint, and attention to the lower back and pelvis where they are contributing. The most important part is the exercise plan. NICE guideline NG226 on osteoarthritis recommends therapeutic exercise as a core treatment and says manual therapy should only be considered alongside it, so hands-on treatment here is there to make the exercise easier to do, not to replace it. For some persistent tendon problems around the hip and knee, shock wave therapy is available at the clinic.

What can I do while I wait for an appointment?

The NHS advises:

• staying active, but avoiding putting too much strain on the joint, such as standing for long periods
• an ice pack wrapped in a towel for up to 20 minutes every two to three hours after a flare-up
• paracetamol or ibuprofen gel if they suit you
• comfortable, shock-absorbing shoes with a soft sole
• losing weight if you are overweight, which reduces the load on both joints

When should I see a GP or get urgent help?

See a GP if hip or knee pain is stopping you doing normal activities or affecting your sleep, if it is getting worse or has not improved after two weeks of self-care, or if a joint is stiff for more than 30 minutes after waking. Get urgent help for severe pain that started suddenly, pain after a fall with inability to walk, a joint that has changed shape or locked, or a hot, swollen joint with a high temperature.

Sources

• NHS: Hip pain in adults
• NHS: Knee pain
• NHS: Osteoarthritis
• NICE guideline NG226: Osteoarthritis in over 16s
• Institute of Osteopathy: Muscle and joint conditions