Everything You Need To Know About Bone On Bone Hip Arthritis Symptoms, Causes, And Treatment Options

In this video today I’m going to cover everything that you need to know about bone on bone, hip arthritis, also known as osteoarthritis of the hip. Now, what I’m not going to talk about is rheumatoid arthritis, a vascular necrosis and hip dysplasia, those will be videos that will do it another time.

Don’t forget to subscribe to our channel so that you don’t miss out on those videos when we release them. We don’t have set dates on those yet, so just watch out for them there, we’ve got a lot of things brewing in the pot. But today specifically, I’ll be covering the symptoms so that you can tell on yourself and confirm if you have hip arthritis.

And then we’ll also be talking about the causes so that you can have a better understanding of what led to this point that you can make the lifestyle changes needed to not make this worse. And then we’ll talk about the treatment options.

What will the doctor tell you if you haven’t been or if you had been to the doctor, what do they maybe forget to tell you that you need to know and you know when the option is going to put you in a position where you can take the next best step for your bone on bone hip arthritis situation.

Hey, my name is Dr. David Middaugh. And I’m a specialist physical therapist at El Paso manual physical therapy. This channel is dedicated to helping people stay healthy, active and mobile. While avoiding unnecessary surgery injections and pain medications. Please consider subscribing so you don’t miss out on any of the videos we post every single week.

So let’s get to it. How can you tell if you’ve got hip arthritis, the number one sign that people with hip arthritis have is hip stiffness. In the morning, especially those first few steps when getting up out of bed and going to the bathroom or going wherever they go in their home, wherever they stay. Those first few steps are just painful and stiff. And they feel it in this area right on the front of the hip. Usually this part right here, sometimes it will be more on the outside or the back.

But the classic symptom is right here. And people typically feel like they have to stay bent over a bit and kind of walk like this until they can straighten out their hip all the way. And then the discomfort reduces in this area. But if you have stiffness in the front of your hip like that first thing in the morning, and especially if it lasts for a while, like more than a few minutes, if we’re talking 5, 10, 20 minutes, or some people even have this for over an hour in the morning, that will give you an idea of the severity of the problem.

And especially this last every day, it happens to you every single morning that you have some stiffness and you’re talking a little bit more severe hip arthritis, a little bit more of a severe bone on bone situation. But if it is intermittent like if you if you have a busy day, the day before, and then you pay for it the next day, you get a lot of hip stiffness. And it’s probably more on the moderate to even mild side of bone-on-bone hip arthritis.

The next most common symptom that you can check on yourself is if you have a loss of motion in the hip that’s bothering you, the classic sign that will tell you if you’ve lost some motion is if you can’t cross your legs the same way if you go to cross your legs. And you might do this right here, your hip that feels okay might move just like so and or if you cross your legs this way, that might work for you too.

But if you just have trouble getting the other leg, the one that bothers you up and you can’t quite get it flat, it just stays up like this. Otherwise, it hurts or just doesn’t feel like you can go, then that’s a sign that you’ve got some hip arthritis. Now you can move it this way in that way and compare because that’s rotation typically rotation in this direction where your foot moves out and the top of your knee moves in, we call that internal rotation.

That’s the first motion that’s limited. But you can also have limitations going this way. And coming up this way to could be limited, you might find that if you pull your knee up towards your chest, on the side, this bothering you may just not come as easy. Especially if you come across your body like this, it might even pinch and bother you right at that hip joints. That’s another big sign that you’ve got some hip bone on bone arthritis.

But before I get too far in, I want to do a Debbie Downer for you, you know, the truth hurts, but you got to hear it so that you can know how to fix it. Nine out of 10 of these cases can improve. You’re not doomed to having surgery every single time. It’s actually one of the 10 cases that will actually need to have a hip replacement right away.

Most cases can flare down the pain and be able to tolerate doing quite a bit, be able to reduce that stiffness in the morning and increase our range of motion in improving the other symptoms that I’m going to talk about. But I got to tell you how to find it in yourself right now. So I’m sorry if you’re having all of these problems, comment below. That’s you.

Another sign that you’ve got hip arthritis is if you can’t tolerate standing or walking and basically being on your feet. If a short walk doesn’t for you like going to a small store. You got a more severe case of bone on bone hip arthritis. Now hopefully you can last go into the store and maybe you just have trouble with a big store like a Walmart or a wholesale store like a Sam’s Club or Costco then hopefully you can lean on the cart and get some relief.

Which by the way, is another sign that you can lean on the shopping cart, and you can actually make it to the grocery store, what you’re doing is you’re offloading your hips by putting weight on your arms. And that decrease pressure is helping you out. Versus if you have to stand up and you can’t lean on anything, and it starts to bother you right away, or after some time, after several minutes, your hip starts bothering you.

And the more you on your feet, the more you walk, the more your hip bothers you, that’s a classic sign that you’ve got hip arthritis, and it’s a bone on bone situation, possibly, if you go to the doctor’s office, what they’ll do for you is give you an x ray. That’s how both diagnose the hip arthritis. And they’re looking at where the ball meets the socket, there should be a little bit of space.

In the X ray, if you look at the x ray, where the socket is and where the ball is, there should be some space, but they’re going to tell you that it’s a bone on bone situation, if there isn’t much space for the space is closing down compared to your other hip. They ideally should X ray both hips so that you can compare, because it could just be your genetics that you don’t have a lot of space in your joints, people are just genetically different, some have a lot of space, so I’m not that much.

You have to compare both sides to definitively tell if it’s a hip arthritis situation, based on your genetics. Now in real severe cases of hip arthritis, especially where it’s a bone on bone situation, you’ll get a lot of popping, clicking and grinding noises in the hip. Now, it may happen from time to time where the hip pops loose, but I’m talking about a repeatable pop or click like every time you go to bring your leg up, or when the classic one is getting in and out of a vehicle.

If you move your leg to get in or out of a car like this, and you feel like a grinding or popping or discomfort, then that’s a sign that you probably have some severe hip arthritis, it’s a bone on bone situation. And it’s different on the other side to side moves just fine. No popping and clicking or grinding, but that one side does every time you go to move a certain way. And especially if it catches and it hurts, like it’s going to ratchet like it goes in, it hurts every time it does that.

You got to go to the doctor, maybe you know, do your due diligence and get a second or third opinion, get the X rays do everything you need to do. But you might be the type of person you might have the type of bone on bone, hip arthritis, that needs to have a hip replacement, and you’ll probably do a lot better. Once you have a hip replacement.

That popping and clicking ratcheting grinding sound if it’s consistent that you feel it day in and day out, your hip is far gone. Now everybody’s hip pops or clicks. At some point grinding is more of a severe situation. But if you get the occasional pop or click, and sometimes it is repeatable, like if you move your hip a certain way.

But if it’s not painful, if you just can make it pop and it doesn’t really slow you down, it doesn’t feel any different after it pops, then you’re in a good situation, it is a sign that the pressures are increased in the hip joint, and you are on the pathway to getting that severe ratchety grindy popping and clicking. So you need to make sure you intervene soon and solve this problem. But there is a chance that you can make this better.

And we’ve actually got videos that will help you out with exercises and guidance on what to do. I’ve linked those in the comments below here. So go check those out if you’re looking for exercises, and when we talking about exercises in this video. So if you’re looking for that, go check out those links, go get to those exercises and begin to do them right away so that you can get some relief and get on the right path to getting your hip healthy.

Now let’s talk about the causes of bone on bone hip arthritis. Now to help me in my explanation, I’ve got a drawing here of a hip joints. This is my masterpiece. Just kidding. So bone and bone hip arthritis, just to orient you and I’ll use the skeleton here in a second. But in brown here, we’ve got the spine, the bottom of the spine, and then the pelvis bones, which contain the sockets for the thigh bones which contain the balls to make the ball and socket joint.

Now I’ve exploded the left hip on this side, and in red, that indicates irritated hip joints. So in the ball and socket, you’ve got a lining of cartilage in the socket side and then you’ve got aligning cartilage on the ball side. And when there’s increased pressure inside that joint, usually because of muscle imbalances, that cartilage gets irritated. And now if he gets irritated for long enough and it usually we’re talking like years and decades there has to be a lot of pressure on that side.

There has to be a combination of the way you move the muscle balance the activities that you partake in on a regular basis, then that pressure can increase so much that that ball drifts into the socket further and the cartilage thins out. And then that is where you have a bone on bone situation where the two surfaces can touch and the cartilage is worn down. But I do want to emphasize that when doctors tell you that you have a bone on bone, knee or hip joint situation.

I mean the knee because it has happened to the knee where doctors say, Oh, your knee is bone on bone or your hip is bone on bone, they don’t mean that the entire surfaces of the cartilage are completely gone 100% They’re usually talking about a spot or two, sometimes three that are worn down. And that’s where you get that grinding, that popping and that clicking inside the joint as you move it, but there’s still cartilage left in the joint that can be salvaged and used, it can heal.

And if you offload the joints and take pressures off the spots that have that bone on bone surface, then you can put yourself in a position where your hip joint actually feels better, despite not having a hip replacement surgery. And despite having a bone on bone situation, you can take that pressure off and be okay, you can be on your feet again, you can reduce that stiffness in the morning when you get up and even gain some range of motion back.

Now I’m not saying you can heal 100%. But it might be enough for you to delay having a hip replacement surgery, and possibly even getting away with never having hip replacement surgery. Because you can do what you want to do pain free, or at least greatly reduced pain without having to rely on painkillers, you know, medications or having to get injections. And you can avoid that surgery. Let me show you what this looks like on the skeleton now. My skeleton here.

Now here’s the ball and socket joint on the left side. So kind of like I had the picture. And this ball and socket joints should be able to move forward and backwards to the five moves forward and back. And then there’s bits of rotation in there as well. Now, when there’s a muscle imbalance, which is the most common cause of bone on bone, hip arthritis, what’s usually happening is the butt muscles, the glute muscles, the gluteus maximus minimis and medius and there’s a bunch of other muscles in there, those muscles will get weak. And their job is to move the hip into external rotation this direction.

So if they’re weak, then your hips going to be settling in relative internal rotation, which closes the position of the ball onto the socket, by default to those muscles get weaker than the muscles in the front, the hip flexors and the quad muscles will become the dominant muscle, thus causing a muscle imbalance. And because those muscles are on the front, they’re going to pull the ball forward and inwards into the socket. And that’s what increases the pressure on the cartilage inside the hip joint and causes that wearing down over the years.

Now cartilage is very resilient tissue, it can heal given the right environment and nutrition and movements and all the stuff that it needs. But it also heals slowly, just like it becomes injured slowly, some secondary causes to this because I already said the muscle imbalance is the number one problem. But if you’re sedentary on top of this, like you, you have a desk job, or maybe you’ve retired and you just haven’t been very active, maybe you’ve got other aches and pains that have slowed you down.

Oftentimes a hip problem, you know, a low level of it will cause people to not be as active as they may, they may be otherwise. And it just feeds itself after that point. If you’re sedentary, your muscles just get weaker over time all around, and that pressure increases inside the hip joints. Now the other end of the spectrum is you might be way too active.

Now if you’re doing more activity than your muscles, and your body’s prepared for, like I’m talking about the people that are kind of sedentary and then they all of a sudden pick up an intense exercise program. You know, they decide to go walking a lot or maybe jogging or go to the gym or hiking. They can also aggravate the cartilage inside that hip joint. And over time, create an overuse injury, which can wear down the cartilage inside the hip joint.

So you have to have the right balance of not overdoing it but also not under doing it being sedentary. And most people find this balance fairly easy. You can tell when you overdo it, you know you just feel tired. And if you think back and look logically at the activity, it’s like oh yeah, I did step it up quite a bit. I went from zero to 100 with not that much time to adapt my body. And then if they’re sedentary, they’re like, Oh yeah, I haven’t done anything in months or years.

And that’s why my body’s feeling that way. You have to keep up some regular exercise for most people. That means anywhere from one to three, four or five times a week. And it doesn’t have to be a lot we’re talking 15 to 16 minutes of exercise should be sufficient based on your level. You know how fit you are and what you can take to more causes that can be contributing to your bone on bone hip arthritis is:

Number one, your movement, the way that you move, meaning, if you tend to move with your legs inwards, which closes that hip joint rather than your legs outwards, that’s going to aggravate the cartilage little by little over time.

And the way this looks, I noticed this all the time in patients whenever they come in, if they’re seated, and I look at their knees right before they stand up, and when they go to pressure to their legs, their legs just come in words like this as they stand up, and then when they go sit down, the same thing happens or knees just come in.

And the reason for that is because of that muscle imbalance, they’ve got strong quads weak glutes, because it takes good strength to keep your legs open the whole way up and down whenever you’re sitting. So if you’ve a little trick that you can use, when you’re going to go stand up, if you’ve got this hip problem, you’ve got to keep your legs kind of open, and it should open up the hip joint.

Now, if your hips just very, very irritated, it’s going to hurt no matter what. But for some people that are more on the moderate to mild side of this bone on bone hip arthritis situation, they might be able to get away with feeling a significant improvement if they simply keep their knees open, and use their glutes when they’re going to stand and sit. And the other thing that could be a contributing cause to your bone on bone hip arthritis is an inflammatory diet.

We have known this and research for some time, and there’s more and more diets coming out that are anti sugar, anti carbohydrates, we know that those types of substances, the carbohydrates, we’re talking sugar, flour, any sort of any sort of sugar, it could be even sucrose, which is or I’m sorry, fructose, which is in fruits, and lactose, which is in dairy, those can all create inflammation throughout our whole body.

If you’ve already got a sensitive hip joint, it might just be overly sensitive after having a high carbohydrate meal. So look at your diet as well. And you can think about supplements that might be beneficial to you. And the other videos that we’ve got talking about what to do, if you’ve got hip arthritis problems, we talked about which supplements are best, and what other nutritional advice you can take, as well as exercises.

So go check those out, find the links in the description below here. Now something that did not mention, because I don’t want you to believe this, because it’s told to people all the time, whenever they have a bone on bone, hip arthritis situation is age, I don’t think that age is a factor here. Now separate agent and time. Because time happens no matter what you’re we’re all moving forward in time.

And the more time a mechanical process has to affect a joint, like this muscle imbalance wearing down the cartilage inside that ball and socket joint, it’s going to wear down the cartilage it’s going to create that bone on bone situation. But this happens as we age, it’s separated out because it is possible for somebody in their 80s or 90s.

To have great muscles that are in balance and feel fantastic. So it’s not an age thing. Some people might be genetically predisposed. But if you can put your hip ball and socket joint in a good position by moving correctly, fix up muscle imbalance despite having a bone on bone situation you can heal the tissue and make it feel better. So it’s not really an age thing. Like this isn’t something that’s just going to happen.

No matter what you do have control over it. You can influence your strategy, you can influence the way you move, you can influence what you consume the way you know as far as your diet, your hydration, there’s a lot of factors that are under your control. Ages not age is not in your control, you can’t stop time. So I don’t think it’s an age thing. It is a time thing. Given enough time with all the other variables.

Then it begins to affect your joint and becomes a bone on bone situation. My friends, let’s talk about the treatment options for bone on bone hip arthritis. The number one thing that will be told to you as advice if you go to the doctor is to take pain medications, we’re talking oral pain medications, Tylenol, Advil, Motrin, you know your ibuprofen or naproxen or the NSAID family.

The non steroidal anti inflammatory drugs are the first go to pain medications for this. And they are typically effective and you see commercials on TV for these types of drugs, and they do a good job. But we all know that they’re just masking the pain and they’re not really fixing the root of the problem. They’re not making your muscle stronger.

They’re not making the joint healthier, they’re simply shutting the pain off for just a few hours, whatever the pill is dosed for the hours it’s going to affect your body. So it’s okay to take in a pinch, but it’s not a good idea to rely on that pain medication. So don’t have a plan of solving your bone on bone hip arthritis with enroll medication. And even if you take high power medications that doctors prescribe. Again, it’s not making your muscles stronger.

It’s not teaching you to move better. It’s not fixing the root of the problem. It’s simply masking the symptoms to buy you some time and make you feel better for a day or however long that drug is supposed to affect you. The second thing that a doctor might recommend is an injection. The number one injection that’s done is a cortisone injection, which is an anti inflammatory steroidal drug. And it’s it’s designed to bring down inflammation, but also it’s a relieve pain.

Now also just like the the pain that the pain medication, you can take my mouth same effect, it’s just local, it’s very specific to the joint because that’s where it’s being injected. This pain medication can last for longer than just a few hours. Typically, we’re looking at weeks to months, the longest I’ve heard that it’s lasted is a few months. And in some cases, it doesn’t have any effect.

Some people they feel the same afterwards. I haven’t seen any people that feel worse afterwards. But I’ve seen people that are frustrated, hoping to get some significant relief and felt the exact same afterwards. But you have to have the right expectation, it’s not fixing the root problem. It’s just designed to mask the pain. So people just don’t have a good effect with it.

There’s other types of injections out there that could help with beginning to heal the joint, we’re talking like PRP injections, there’s you know, prolotherapy, there’s a ton of other injection options, discuss with your doctor, if one of those is right for you. But again, they’re all not solving the root problem of depressurizing the joint that’s got to be done naturally with certain exercises and movements.

Typically, if a doctor doesn’t send you the physical therapy, do some sort of exercises, they might send you to an orthopedic surgeon, at which point they might recommend a hip replacement surgery. Now it’s major surgery, they are literally ripping out your joint cutting it is precise, you know, they’re doing it with very precise tools that resemble carpentry tools, and then replacing it with a metal prosthetic so that you don’t have your normal history anymore.

You have an artificial joints inside the hip. And this can reduce pain. But of course, it exposes you to a ton of risk or the risk for infection. That you’re you might lose some the hardware, there’s there’s a ton of risk, the doctor will probably warn you and all the risks that are possible with getting a hip replacement surgery.

So you know, I would think long and hard before you have a replacement surgery, there’s a lot of things that you might try, you can try to reduce the inflammation. As I said earlier, in this video, there’s just one at a 10 people or less than actually need to go get a hip replacement right now, more often than not over nine times out of 10, there’s things you can do to control that hip inflammation, and get the bone on bone situation healthier, so that you can get back to doing normal activities.

Some doctors will send their patients off to do pain management, they’ll go to a pain management specialist who does all kinds of other usually drugs and sometimes procedures. And they might even recommend something called a 10s unit or a transcutaneous electrical nerve stimulation unit, which is some sticky pads that you can put on your hip. And it’s connected to a little box that has batteries in it. And you can turn up some little tiny electrical impulses that go through those sticky pads. And it might feel better temporarily.

Theoretically, it can help you get stronger, but it’s not teaching you to move better necessarily. And the research only shows that the 10s treatment is only beneficial when you have the device on. So it’s not practical to have it on always. But it might get you by and might allow you to take avoid taking the pain medications or getting an injection, especially if you have allergies to those medications.

You don’t want to be taking that. And then the other option that a doctor might give you is physical therapy, they might tell you go to go to physical therapy, and you got to be careful of physical therapy as well. Most physical therapy clinics specialize in helping people after they’ve had surgery.

And if you’re somebody who has not had surgery before and you’re looking to avoid having a surgery, then you’ve got to look closely at which physical therapy clinic you’re going to in which physical therapist you’re going to see and ask questions, maybe even get a few different opinions go to two or three different physical therapists to get an idea for which specialist is going to be best for you. I can tell you here at our clinic, we literally tell people and we do it here in the office, that we specialize in helping people avoid surgery injections and medications. And it’s true we see just a couple of surgical cases a year.

The majority of the majority of our caseload is people that are looking to avoid surgery because it’s its own specialty. There’s a completely different set of exercises, a different mindset, a different approach that needs to be taken on somebody who’s looking to avoid surgery versus somebody who just had surgery. The approach the mindset with somebody who just had surgery is they’re working out individual muscles one at a time.

And they’re practicing a lot range of motion stuff and it might help but to get you to the point where you can be as active as you were before and really heal the body. cartilage inside the joint. It may only take you so far, because typical physical therapy, which does a great job, by the way, and helping people after surgery, they’re looking to just get them back to moving enough to where they were before.

Now that they have an artificial hip, they just been cut on it, they’ve had that surgery, getting motion back, being able to tolerate standing and walking, getting off a walker or a cane after surgery is the priority. Not necessarily being able to run, jump be on their feet for a long period of time.

And if you’re in that boat, if you’re if your desire is to avoid surgery and get back to exercising, be on your feet for a good while, and being healthy inside your hip joint, then you’ve got to take a different approach than what they would run you through.

He went to a place that specializes in people that just had surgery. So do your homework, do your due diligence and find the right type of help for your hip problem.

Guys, I hope this video was helpful. Give us a thumbs up if it was and don’t forget to subscribe so you don’t miss out on any of our future videos coming your way every single week. We’ll see in the next video friends bye