♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- (claps) Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapists
on the internet.
- In our opinion of course. (laughs)
- Today we're gonna talk about hip pain, arthritis.
We got eight strongly recommended treatments by experts.
And who are these experts?
I'm gonna reveal this right away, Brad.
- Okay.
- It's physicians from
the American College of Rheumatology and Arthritis.
So all these doctors get together
and in 2019, they did this.
They've been doing it for years.
They re-update it every so often.
- Okay.
- And they looked through the research.
They scanned all the research that's out there-
- Mhm.
- And they figure out what is working
and what is not working.
- Sure.
- And they kind of hedge their bet
by they'll say, they strongly recommend,
or they just recommend, or strongly recommend against.
- Okay, so the pros,
- Yeah.
- What's gonna make it better?
What's going to make it worse?
And in between.
- So I picked out only the stuff
that they strongly recommended for hip arthritis.
- Okay.
To make it better?
- Yeah, to make it better.
- Okay.
- By the way, - Oh, wow.
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- Blood pressure cuff. - Yeah.
- Excellent.
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if you want a 60 second version of our program
where we don't ramble and what else, Brad?
- We also now have podcasts out there
interviewing outstanding authors,
people with PhDs, a lot of smart people,
and we have some of our own stuff in there as well.
- Yeah well, this one's probably gonna be a podcast.
- Okay good.
- All right, number one, no surprise here.
Hip exercise is strongly recommended
for patients with hip osteoarthritis.
Now when I think of hip exercise,
I think of stretching.
- Mhm.
- Cause we wanna make sure
the hip has as much motion as possible.
- Right, maintain the motion.
- And we've got lots of videos on that, right Brad?
- We do.
- And what else?
- We have a program section on that already.
- No, I know, but hip strengthening.
That's what I'm talking-
- Strength, well yeah, range of motion,
stretching and strengthening.
You know, oftentimes, we're therapists,
those are cousins or tightly locked.
- Yeah, there we go. Just the cousins.
So the thing is, as you get pain in a joint
you stop using it as much and it becomes weak.
So it's really important
that you do some strengthening exercises.
So look up Bob and Brad for hip exercises,
stretches for pain, and also,
hip strengthening, yep. - Strengthening, yep.
Yep. So again, do these anyways, talk about this.
You're not gonna do 'em if they create pain,
particularly sharp pain,
you're gonna find out which exercises are tolerated
and stretches are tolerated well and make it feel better.
And then go from there.
- Let me just say this too.
It can make a huge difference.
- Oh, yeah.
- It can take people from having pain to no pain,
- Mhm.
- Even though they have are osteoarthritis
doesn't mean you're gonna live with pain.
- Mhm.
- I mean, so yeah, definitely give this one a try.
Number one.
Number two is again, probably blatantly obvious
but weight loss is strongly recommended for patients
with hip osteoarthritis if they're overweight or obese.
Now I know this is daunting for many of you,
but even a loss of 5% of body weight,
they found can make a big clinical or mechanist?
Mechan-ist-ic? Mechanistic! There we go!
- Ooh yeah.
- Mechanistic outcomes.
- So yeah, it doesn't take, you don't have to lose a lot.
- About 50 pounds.
- Part of it and it's gonna help you out.
- Right. So give it a shot.
- We know that's difficult.
It can be a real challenge for anyone to lose weight.
But you know, it can help.
- I'm not sure what this one means
but I'm gonna give you my interpretation.
So they found,
they strongly recommend self-management programs.
- Mhm.
- And I think the idea behind this,
and Brad and I have talked about this a lot with patients,
you've gotta feel like you're in control,
- Mhm.
- And that you're in charge of getting this better.
If you're waiting for somebody else to give you a pill
or something or, you know, to take care of it,
no, you gotta take it under the bull by the horns. Right?
- Well, a good example is the first two you just mentioned.
- The first two, right.
- You gotta get your exercise,
your strengthening, your range of motion,
and then change your diet
and see if that can help lose some weight.
And those two things,
that's all under your own self-management.
You're in control of it.
- Right. And I think this is a good time to mention, Brad,
you know, they didn't include this,
but physicians are a little bit slow to embrace this,
I think, but there's definitely anti-inflammatory foods.
- Right. I agree.
- You may wanna, you know,
I would check that out
because you might be able to knock things down,
the pain down, just by partaking in some of those.
- You're definitely gonna lose some weight,
if you happen to have not such a good diet,
if you eat a lot of carbs and sugars and that kind of thing,
it's just all part of the problem.
- Right. All right, number four.
Tai Chi is strongly recommended-
- Mm!
- And not surprisingly,
because when you have knee or hip arthritis
it's not only slow gentle movements, graceful,
- Mhm.
- It's also good breathing and relaxation,
- Right.
- But you're getting strength
and it's also helping your balance.
- Right.
- And so you're gonna prevent falls.
- I'm kinda surprised they didn't have yoga in there too.
Cause they're so much similar.
I've never taken either one.
- Right.
- I'm more familiar with some of the Tai Chi
but one way or another
it's part of one, you know, range of motion.
- You gotta be careful with yoga sometimes.
Some of them are really good
and some of the exercises may not be good for your hip.
- In our opinion, of course! (laughs)
- In our opinion, of course. Yeah, sorry yoga people!
- Yoga people get mad at us! (laughs)
- All right, number five.
I was glad they had this one, Brad.
Cause in one study I saw where they didn't recommend it
and they recommended use of a cane.
- Mhm.
- I always say to people,
I'm not saying that you have to use a cane forever.
- Mhm.
- But sometimes the hip kind of flares up.
And if you can actually use the cane to let it calm down
- Yep.
- And maybe do some strengthening while you use the cane-
- Mhm.
- I think it makes a big difference.
Because if you start, for example,
you're not using the cane and you're waddling along-
- Because of the pain? Mhm.
- Because of the pain.
That actually makes things worse.
- Right.
- And people go, "Well, I'm not gonna use a cane.
I'm not that old."
And end up, they'd rather than waddle along
and really draw attention to themselves
as opposed to if they used a cane and walk normally.
- Right. It is one of those things
you just kind of have to, you know,
just think of cane giving you some dignity.
- Right. - There you go.
- Or use a single crutch or a walking stick or something,
- (laughs) Yeah.
- That you know, it's a little less obvious.
All right, number six.
Oral NSAIDs, non-steroidal anti-inflammatory drugs.
They're strongly recommended for people with hip OA, so-
- So we're talking like Ibuprofen, Aleve, Tylenol.
Those types of-
- Right. No, Tylenol don't-
- That's right. I get,
I'm glad you picked that out
but also make sure you are aware of,
if you're taking other medications,
you should talk to your doctor
and find out if there's any precautions with an NSAID-
- Well even with Ibuprofen, you're only supposed to take,
you know, it can be hard on your stomach.
- Yep. Yep.
- You gotta take it with food.
We're not doctors, we're not pharmacists.
So, you know, get advice from them, people.
- We do have two outstanding videos
with a pharmacist talking about these.
If you Google Bob and Brad Tylenol and Ibuprofen.
- Sure.
- They'll both come up and you'll get some good,
excellent information on that, details.
- Yep. Number seven, number eight are kinda similar, Brad.
They're both talking about glucocorticoid injections
in other words, steroid injections.
And they're both recommended.
The one basically says for the hip,
they recommend that you use the ultrasound guided version.
- And you don't have to worry about this.
A doctor makes a decision for you.
- Well you wanna make sure the doctor's doing it.
You know that he's not gonna just stick in there blindly.
He's gonna have, you know, cause they used to do that.
(Brad laughs)
They used to never use ultrasound to guide it.
- Yeah.
- And they did it in the back too
which I would never get a cortisone shot in my back
without it being guided.
- In other words, if the doctor doesn't do it
you may wanna go to a doctor that does use,
so they can actually see the needle go in.
- Right. Right.
- And it goes to the joint of the specific area
without near as much guessing.
It's much more accurate.
So if a doctor says, "Well, I don't do that.
Cause I don't feel I need it."
You could say,
"Well, maybe I'll go to someone else who does have it."
- Right. Now they did say it's okay to, in your knee,
to not use the ultrasound.
Apparently, it's just pretty easy to find the spot.
- It's more superficial. Sure. Right.
- And the same with your hands.
But for the hip, they think you should be guided by that.
And you know, this is something that you can't do
too much of because you can't take too much steroids.
- Right.
- But they'll know that.
I think they can usually do two shots a year,
maybe three shots a year, so.
- Yeah, I've had patients.
Yeah, so actually putting that needle with the steroid,
and they try to get it, I believe, right into the capsule.
- Sure. Makes sense.
- It is, you know, how are you gonna see it?
Because it's, you know,
there's a lot of soft tissue around that joint.
- Right.
I just have had people that have really done well with it.
And I've had people
that didn't know at all that it'd even helped.
- That it'd made a difference, so.
- Right, right, yep.
- But it's enough that the research has shown
that it's definitely worth a try.
- Sure. Yep.
- Strongly recommended.
So there they are.
You can actually look these up yourself.
Just look up 2019,
the American College of Rheumatology Arthritis guidelines.
- Mhm.
- I think for hip, for osteoarthritis and it'll pop up.
- And then you don't have to listen to us
babble on about it.
- That's right! Good for you!
- It's a bonus! (laughs)
All right, take care,
and we hope your hips last a long time.
- Yeah, there we go.
(upbeat music chimes)