Before launching into this post I’d like to apologize for taking so long to complete the promised post describing an approach that might speed up your recovery. It’s proving a difficult thing to explain, but I’m still working on it and will publish ASAP.

In my last but one post I talked about how long it was likely to be before you’d be cured of OA. I mentioned that one reader had left a review on Amazon to say that he was now pain free after working through the program in the book just once. That gentleman has since got in touch to let me know how he’s doing and to ask what he should do to keep his hips in great shape. He is a similar age to me with a similar active lifestyle.

My first thought is that it’s possible (perhaps probable) that the underlying imbalance is still present. Remember, in the book I talk about the difference between a ‘functional imbalance’ (symptom free) and a ‘pathological imbalance’ (symptomatic). Almost always you’ll live with a functional imbalance for a long time – maybe (as in my case) decades – blissfully unaware that anything is wrong. It will often seem that your osteoarthritis developed suddenly but it’s highly likely it’s been lurking, waiting to pounce, for years.  Many people live their whole lives with functional imbalances and never develop symptoms – even some highly active people. However, when you have a functional imbalance you are always at risk of it tipping over into a pathological imbalance. Knowing now how difficult it is to put right when your joints are tight and painful it’s worth thinking long and hard about whether you want to leave things to chance or strive to eliminate (or manage) the functional imbalance.  If as you read this you’re crippled with pain and unable to perform simple actions such as putting on socks or loading up the washing machine don’t you wish you could turn back the clock and correct your imbalance BEFORE it got to the point where it was symptomatic and difficult to treat? If you get back to that functional state again what will you do – the same as last time, or will you take the time to reduce your chances of getting into this state again?

In short, when you eliminate the troublesome symptoms you essentially have three options:

1. Get back to normal life and forget all about your hip OA episode. It’s possible that you’ll never have problems again.
2. Keep working at maintaining what you now have – take steps to prevent the imbalance tipping over from functional to pathological.
3. Continue working to eliminate the imbalance entirely.

I chose the third option, but I’ll share my thinking on options 1, 2 and 3.

Option 1 – Business as Usual

I have an acquaintance – a facebook friend – who is a keen cyclist and ultradistance runner. He’s a similar age to me – in his fifties. A few years ago he fell during a race and hurt his knee. When it wasn’t better after a period of rest he went to the doctor. The doctor sent him for x-rays and based on the findings diagnosed knee Osteoarthritis. My friend was told to stop running. He followed this advice for a year, throwing himself into cycling instead and in time his knee pain disappeared. However, he wasn’t happy; he missed running. Eventually – inspired by my story – he decided to give running another try. He tells me that at first he had a bit of knee pain but he pushed through it and in no time he was running pain free. Now I’m not talking about the odd 5k run. He was back to running up and down mountains, competing in triathlons and ultra-distance races. A year ago he told me that he’d completed his millionth foot of ascent since his OA diagnosis. He says he can tell his knee “doesn’t feel quite right”, but he never has pain.

He has never shown any interest in doing any rehab work to keep his knee in good shape or to address the underlying imbalances. He once said to me that he was happy just to enjoy life and keep doing what he loves ‘until the wheels fall off’. This is a perfectly reasonable and valid choice to make; it’s a question of performing your own personal risk/benefit analysis.

What I will say however is that there is a much better chance of permanently recovering from knee OA than from hip OA. Research shows that knee OA frequently gets better – less so with hip OA.  Additionally, the type of imbalance that accompanies hip OA is likely to put strain on feet, knees, spine and shoulders. In my opinion, the risk of a re-occurrence of hip symptoms, or symptoms in other joints, is likely to be higher in people that once suffered from hip OA – unless you manage or completely cure the underlying imbalance. That said, I know that I had my  imbalance for over 20 years before symptoms developed – it’s certainly possible that you could roll things back and get another 20 symptom free years – or longer.

Option 2 – Maintenance

If you understand your imbalance well enough to switch it from a pathological to functional state it stands to reason that you should be able to work out a quick and easy maintenance routine that will help ensure that it STAYS in a functional state.  Towards the end of the book I listed some exercises that should help to keep your sacrum and spine stable – this is the most important thing you can do to keep your hips functioning well.  However, most of these exercises require a level of functionality that many people won’t consider to be worth the effort required.  It’s a perfectly reasonable decision to settle for partial improvement and attempt to maintain things at that level.

In this case I would aim for something along the following lines at least once a week. You should be aware of your own personal weak points so you can add in any exercises from the treatment plan in the book that you consider to be particularly beneficial to you.  If you start to deteriorate you can increase the number of times each week that you do your maintenence routine, or do a cycle of the treatment plan in the book to ‘reset’ things.

Dead Bugs

Dead bugs work the anterior oblique sling. This  includes the internal oblique and opposite side external oblique muscles. You know from the treatment plan how important this chain of muscles are in keeping the sacrum stable. If you don’t have full hip range of motion simply use a platform to drop the arms and legs to. The important thing is to ensure that you lower both arms/legs the same amount – you want to keep both sides of the body working equally. Over time, range of motion may well improve simply from doing this exercise.

Bird Dogs

Bird Dogs work the posterior oblique sling. This includes the gluteus maximus and the opposite side latissimus dorsi. You know from the treatment plan how important this chain of muscles are in keeping the sacrum stable.  If this is too advanced for you, use some of the simpler versions that are described in the treatment plan; over time your ability to do the exercise should improve.

Hip Mobility / Pelvic Stability Drills

Do some of the hip mobility drills from week 2 of the treatment plan. Remember to keep your pelvis stable as you do them! The exercises shown in this video should work well. If the drills are too difficult, simplify them; it’s better to do a simpler exercise well than a difficult exercise badly! Providing you’re taking your joints through their current full range of motion it should do the trick.

Thoracic Mobility

Never underestimate the importance of retaining good thoracic (upper spine) mobility; if the top of your spine isn’t moving freely, the lower sections of the spine won’t either.

Glute Activation

Keeping the posterior chain muscles strong and active goes a long way to ensuring that all the muscles acting on the hips are free to do the job they’re meant to do rather than compensating for dysfunctional/lazy glutes.
Single Leg Bridge – YouTube

How Much and How Often?

It stands to reason that if you’re happy with your current state you’ll want to maintain it, and perhaps even improve on it a little.

If you are currently able to perform the above listed exercises then you need to do enough to make sure you retain that ability. If you do a sport or regular exercise one approach might be to include a couple of exercises into a warmup or cooldown. Alternatively, you could try running through a quick set of exercises once a week. If you are maintaining or improving your ability to perform the above exercises then keep doing what you’re doing; if that is eating up too much time, you could try dropping back to once fortnight. If you find that your ability to do the exercises is waning over time try doing them a little more regularly. If things slip back significantly, return to the treatment plan in the book for a few weeks until things come back under control.

NOTE: You may well be capable of doing some of these exercises whilst still suffering from hip OA symptoms. If you are able to do any of them correctly and with good form then I highly recommend incorporating them into your rehab program. However, it is likely that in the early stages you’ll find it impossible to do them using the correct muscles. Don’t be tempted to do them badly – it probably won’t help and could be counterproductive. The treatment plan will gradually get you to the point where you’re able to do them. Be patient; always remember that any exercise is likely to be ineffective if you are unable to fire up the correct muscles. However, you should try them periodically to gauge your progress.

Option 3 – Complete Resolution

For around 3 years I’ve been saying “I’m almost back to 100% – just this one last thing to fix!”. But always I find something else. Even once you start to feel fine, if you keep looking you discover all sorts of things that are wrong. Most people won’t have the time or inclination to address these lesser issues. In my case, I love fitness training – strength, athleticism etc. I enjoy working hard daily to get my body working perfectly – to reach my full potential. The point I’m trying to make is that if you commit to putting everything right it’s not just a simple case of running through a prescribed treatment plan once a day; you have to really work at uncovering all the little flaws and fixing them one by one. However, if you love fitness and sport and want to spend the rest of your life aiming high and competing then perhaps, like me, you can learn to enjoy this process as part of your regular training.

I’m now working with an awesome personal trainer. You’ll find that people like this start to get more helpful when you’ve eliminated the pain and the worse of your symptoms. The closer you get to ‘normal’ the better the health and fitness pros will be at helping you to improve. I plan to share some of the things that have worked well for me since becoming symptom free. Much of this could well be helpful to those still trying to eliminate their symptoms. Remember, my basic imbalance is still the same as yours (if you have sacrum bending and rotating in the same direction) – it’s just that I no longer have symptoms – my imbalance is functional.