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Chapter 7 – Slice Or Dice: What Are The Nonsurgical Treatment Options For Hip Pain?

Slice Or Dice: What Are The Nonsurgical Treatment  Options For Hip Pain?

Hip Replacement Book

Hip Replacement Book

Slice Or Dice – This is the ‘dice’ in slice or dice, meaning you are rolling the dice that one of the nonsurgical treatments will work for you. In case you didn’t know…

 “God does not play dice.”
Albert Einstein

Diet and Exercise? Diet and exercise (gosh, have you ever heard that before?) are frequently cited as ways to decrease your risk of a hip fracture. Weight bearing exercise help keep your bones strong.

Hip Tip – The Two Vitamins To Include In Your Diet: Your diet (check with your physician) should include calcium and vitamin D. The National Osteoporosis Foundation states that men and women require 1,000 to 1,200 mg of Calcium per day. The recommended daily dosage for vitamin D is 400 to 1,000 IU. You can achieve this via a supplement, by walking (or sitting) in the sun and from food. You will find vitamin D in fatty fish and products like milk.

Conservative Treatment First – As you are aware by now, I wrote this book to alert you that your hip will not get better. I wandered in and out of various self treatments, denial, hoping my hip would improve. Most of the nonsurgical treatments, also referred to as ‘conservative treatments’ are below.

Hip Tip – Which Conservative Solutions Worked? I tested most ‘conservative,’ ‘alternative’ and over-the-counter solutions. In retrospect, most of it was fruitless and a waste of money. The conservative treatment plans for curing the pain for my arthritic hip are akin to non-dental treatments for an abscessed tooth. Sure you can buy a dental numbing agent, but the tooth will not get better – same with your hip. Even though I wasn’t getting better…

I Believed I Could Get Better – I spent over two years of stretching and massage therapy.

Vibration Therapy For $20 – Vibration therapy is exactly what you think it is – a strong steady vibrating pulse against your body. I spent over two years of stretching and massage therapy. Vibration therapy probably worked best on my hip.  (Yeah, that is where I bought the cheapest sander, a Factory-Reconditioned Ryobi, that I could find and applied the machine to my hip, ran it for 3 minutes – and my hip did feel better).

Hip Tip – Optimize The Sander: Remove the sandpaper before applying to your hip. Also find out how many minutes my massage therapist recommends using the sander before you are at risk of nerve damage.

 Hip Tip – Nerve Damage? My massage therapist told me not use the sander for over three minutes straight or I could cause nerve damage. Consult with your healthcare professional for advice.

“I’ve Seen Fire And I’ve Seen Rain”
James Taylor

Pestilence Of Disease – I also tried heat, ice, light exercise, leg strengthening, a lot of Tylenol and a Jacuzzi all to relieve pain. These various items provided some relief, but it was always short lived. I believed I would/could get better. Later I came to wonder if there were any beliefs that were true…

“In Iran we don’t have homosexuals like in your country.”
Former Iranian President Mahmoud Ahmadinejad
(Howls and boos immediately broke out among the Columbia University audience)

Hip Tip – Believe What You Want, But Your Hip Pain Is Not Going To Get Better: I repeat, your hip pain will not get better. You can say what you want, say what you believe, say what you hope for, but like Ahmadinejad’s misplaced belief, your hip is not going to get better. Take actions sooner, rather than later. Any nonsurgical treatments are only temporarily making your hip feel better, but once it is arthritic and your cartilage is gone, hip replacement surgery is the best option for 99% of all people. My hip was hurting so much, I thought there couldn’t be any silver lining to pain…

“Pain is your friend; it is your ally.
Pain reminds you to finish the job and get the hell home.
Pain tells you when you have been seriously wounded.
And you know what the best thing about pain is?
It tells you you’re not dead yet!”
G.I Jane – Master Chief John Urgayle

Here are a few things I bought to combat my hip page:

Drawn And Quartered – I bought a Teeter Hang Ups Back Stretcher– Imagine a modern day, self-inflicted drawn and quartered device. It was essentially y-shaped with each end available for hands or ankles. I would lock my ankles into two holsters, then each arm would push down on hand grips, lengthening my body, stretching my back and hip.

 

Here are the nonsurgical treatments available to you, most of which I tried:

Stretching  – I start to stretch more, and I had my therapist do more forcible hip stretching. A word of warning, if your hip is shot, this technique is probably not good for you. Below is a representative video on stretching your hip by a professional.

Yoga – I found numerous stretching videos at YouTube.com and a couple free yoga apps for my iPad. My body determined that stretching and yoga wasn’t really enough, so as a penalty for not seeking professional medical treatment, I soon developed muscle knots and super tight muscles. Of course, at that time, the muscle tightness only confirmed to me that my ‘groin pull’ was getting worse.

Yoga poses

Yoga poses and stretches

Hip Tip – Free Yoga Apps: I tried quite a few free yoga apps on my iPad. The program I ended up using was Yoga Free for iPad: Asanas and Exercises by Arawella. I liked that it offered many poses and that I could sequence the order according to my needs. I am sure that by the time you are reading this that are even better programs. Good paid apps include Yoga Studio and Pocket Yoga. Free apps also include Daily Yoga. Here are a few yoga app links Simply Yoga FREE   Daily Yoga  Yoga Studio

Drawn And Quartered – I bought a Teeter Portable Back Stretcher. Imagine a modern day, self-inflicted drawn and quartered device. It was essentially y-shaped with each end available for hands or ankles. I would lock my ankles into two holsters, then each arm would push down on hand grips, lengthening my body, stretching my back and hip.

What Goes Up… – I found relief as it probably created some space for my bone-on-bone contact, but relief was short lived once I stood back up and gravity sealed the gap between my hip and femur head.

Hip Tip – Prehabbing Your Hip: I did extensive stretching and leg exercises and it did slightly lessen the pain I experienced, but the real advantage I received via the exercises is that it shortened my recovery period.

“Hope is the feeling you have that
the feeling you have isn’t permanent.”
Jean Kerr

What Kind Of Massage Do You Need? (Not The Kind You Find On In The ‘Personals’ Section Of Craigslist). I discuss the type of massage you need for your hip. Below is a video about deep tissue massage.

Of course, a loved one maybe able to provide you with a free massage.

The Goo Massage

My cat, The Goo, provided frequent deep-tissue massages for me.

What Kind Of Massage Do You Need? (Not The Kind You Find On In The ‘Personals’ Section Of Craigslist) – I had a great deal of massage before I realized that my hip was arthritic and needed replacing. I was receiving deep tissue massage on my thighs and hips. I envisioned finding a perky blond on Yelp, but ended up with a big, burly Bulgarian guy with hairy arms, and exceptionally big hands. I needed someone who could reach the depths of my muscular thighs.

Hurts So Good – John Mellencamp

Good Pain – After each massage I felt better, especially when those strong thumbs found one of those ‘hurts so good’ trigger points. While I found relief, that relief was temporary. Most insurance plans do not pay for massage.

Acupuncture: Stick It To Me – Acupuncture is an ancient Chinese art practice that may prove to relieve your pain. A trained acupuncturist will gently insert very thin needles into your skin to create healing opportunities. You will barely feel the needle as they are inserted (ha ha).

And Then Add Electricity – Some needles may be hooked up to a low electrical pulse device. You will feel a tingling, but not uncomfortable sensation. Most insurance plans do not pay for acupuncture.  Below is a video discussing acupuncture.

Chiropractors Bend More Than Backs – Of course I did several chiropractic sessions. The chiropractor manipulated my hip to reduce pain. The only benefit I received there was having my ear bent and learning, at length, at how bad the chiropractic industry is and how underpaid for their services chiropractors really are. Below is a sample chiropractic manipulation for hip pain.

 

Hip Tip – Chiropractic Motivations: Since chiropractors are paid by the visit, not the minute, you will find many chiropractic visits highly efficient as they are short and to the point. This is not an indictment on chiropractors as everyone is paid for their work that they perform. My comment is merely to alert you to ask questions and make sure your needs are met during your visit. Plus, I did not understand that my body could be pushed, pressed and stretched and then making weird popping sounds.

I tried several visits with my chiropractor and experienced mild, temporary relief. Most insurance plans do not pay for your chiropractor.

‘FrankenKreis’ – Next, I started Feldenkrais treatments. The Feldenkrais Method uses gentle movement and directed attention to improve body movement and enhance human functioning. Feldenkrais is based upon principles of physics, biomechanics and body movement sequences to help the body heal. I would lie on the therapist table while she sat at my head, slowly pulling and tugging as if she wanted to replace it. Below is a video discussing the Feldenkrais method.

Hip Tip – My Feldenkrais Assessment: I found some relief, but not enough to get return to a pain free state. I think if I had a less severe ‘pain’ problem it would have been very effective. I was just too far gone for Feldenkrais treatment to heal me. Most insurance plans do not pay for your Feldenkrais therapist.

Rolfing: Like Pounding A Cheap Cut Of Beef – I got even got ‘Rolfed.’ Rolfing is deep massage and pressure that focuses on the vertical realignment of your body. To achieve that alignment the massage must be deep enough to release muscular tension at skeletal level by manipulating your body’s deep connective tissues. It attempts to separate the muscle fascia (that clear plastic-like film covering you might see on a large cut of beef).

Roll With It – Imagine the end of rolling pin being assertively driven into your muscles, then swirled around until you squirm in pain – you get the idea. I found some relief, but not enough to get return to a pain free state. Most insurance plans do not pay for your body to Rolfed.. Below is a video about Rolfing.

Let’s

Let’s Talk About Weed: Yeah, that kind… marijuana.

Purple Haze – Jimi Hendrix

Weed By Any Other Name – I was watching the painfully funny Ali G Show (bottom of the web page) where street-wise Ali G goes in as reporter to meet with a DEA agent about marijuana. Ali G is supposedly unsuspecting of this world and the DEA agent is painstakingly explaining to Ali G some of the phrases associated with marijuana. Ali G then asks, with his hatcheted British manner, “What is (sic) the different types of hash out there? We all know that it’s called the bionic, the bomb, the puff, the blow, the black, the herb, the sensie, the chronic, the sweet Mary Jane, ganja, split, reefa, the bad, the Buddha, the home grown, the ill, the Maui-Maui, the method, pot, lethal turbo, Thai, shake, skunk, stress, whacky, weed, glaze, the boot, dime-bag, Scooby Doo, bob, bogey, back yard boogie.” Ali G then pauses and asks, “But what is (sic) the other terms for it?”

You can watch the whole five minutes or fast-forward to 4:18 where he naively guesses all the names for marijuana.

Ali G – The various names for weed.

Or, if you prefer a softer version, Peter, Paul and Mary below.

Puff The Magic Dragon – Peter Paul And Mary

Not Like Bill – I secured (‘scored’ if you use street terminology) a medical marijuana license, but, unlike Bill Clinton, not to smoke.

“I’ve never broken a state law, but when I was in England
I experimented with marijuana a time or two,
and I didn’t like it. I didn’t inhale it, and never tried it again.”
Former President Bill Clinton

Reefer Gladness – I used my prescription for a cannabis based pain lotion (yeah, that is marijuana). The topical crème containing cannabis sativa oil has been demonstrated to be effective for pain relief. Interestingly enough, when I applied the lotion directly to my hip, the pain relief was noticeable within 10 minutes and lasted hours.

Hip Tip – Dope Crème: For me, the dope crème (that is what my wife calls it) was a very good option. If you are in a state that offers medical marijuana, or where marijuana is legal, ask for a sativa oil-infused lotion to provide pain relief.

Hip Tip – Don’t Make Your Own Dope Crème: You can watch numerous YouTube videos on how to make your own dope crème. In order to make the lotion, whole marijuana plants are immersed in a solvent like butane or alcohol to extract the active ingredient, THC. Then the solvent is evaporated leaving the pain-reducing product. The problem is that the solvent is so volatile that it easily can ignite. So, it is safer to buy the product already manufactured.

Along Comes Mary
The Association

Sweet As The Punch – Note that the lotion induced no Lucy In The Sky With Diamonds hallucinations, did not make me want to sing along to Brewer & Shipley’s One Toke Over The Line, did not have me humming along to Rick James’ Mary Jane, did not create an excess (higher than already exists) desire for chocolate brownie ice cream, did not cause any loss of daily functioning skills, did not make me want to search for the ‘number’ in Rikki, Don’t Lose That Number nor make my mother in-law funny, or even more tolerable.

Lifestyle Changes – This is a politically correct phrase for meaning, ‘lose weight.’ There are varying medical perspectives as to how much weight loss will really reduce your pain.

Hip Tip – Is It Too Late For Lifestyle Changes? For me, and for most people who now have a totally incapacitated hip, it is too late. The other reality is that when you hip really hurts, it is hard to exercise.

Diet – Some healthcare practitioners may declare you are allergic to gluten or dairy or in-laws. They may prescribe or recommend various food regimens to minimize your discomfort.

Hip Tip – Is It Too Late For Diet Changes? For me, my hip was too far gone. You may find some relief, but in my experience, once your hip is gone, no diet will improve your hip. Enjoy your gluten-laden morning toast, with butter, guilt free. For others, there may hope, but at best it is temporary.

Activity Modification – This is a politically correct word for meaning, ‘get off your duff and work out.’ You can, and should, strengthen the muscles around your damaged hip, but the cartilage degradation and bone damage will not improve.

Common Sense – If it hurts, try not to do it, no matter how tough you think you are or should be.

Physical Therapy – Learning proper body mechanics can help, but this option only slightly delays the inevitable.

Assistive Mobility Aids – You can use a cane, walker, crutches or a wheelchair, but, if you have the means to pay for the expense of a hip replacement, assistive aids will not improve your condition. As you are aware, if you are reasonably healthy and using mobility aids, you should already have had hip replacement surgery.

Corticosteroid Injections – Corticosteroid injections have been used to help knee arthritis, but due to the shape of the hip joint it is difficult to place the needle in the optimal location. I had an injection and did not experience any relief.

White Rabbit – Jefferson Airplane

One Pill Doesn’t Cut It – I have tried various vitamins and ‘nutritional supplements’ such as glucosamine, chondroiten and MSM (methylsulfatemethane). I bought so many supplements I at least paid for the salesclerk’s annual salary. I did not experience any relief.

OTC Pain Medications – Options such as NSAIDs (non-steroidal anti-inflammatory drugs) or acetaminophen (Tylenol) will provide some pain relief. As your hip gets worse, the effectiveness of OTC medications seems to dwindle. There is a risk to taking too much Tylenol as well and while some physicians will approve high dosages of pain medications for a short period of time, it is not a good idea to overuse any medication.

Hooked On A Feeling – I probably had taken 10 Tylenol tablets in my entire life. Then, almost two years before my surgery (yeah, I am a slow learner) my wife and I were hiking near Lake Hodges in San Diego and upon getting back to the car I said that we were stopping at the first pharmacy or grocery store we see as I have to buy some Tylenol. My wife knew my groin pull was now something more severe because I don’t take pain pills. We bought the Tylenol and before we started the engine I had swallowed the first two tablets and soon I was hooked.

“Too Much Weed, Man…” After my primary care evaluation my doctor provided an orthopedic referral for me and told me I could, short term, use up to eight Tylenol tablets a day. Soon, I was consuming Tylenol tablets like a 13 year-old wolfing down Halloween scored bags of M&Ms. After five days I contacted my primary care physician and wrote, “When I hit seven tabs in a day, I get a, “Too much Tylenol” feeling. The sensation is reminiscent of what my college roommate said once as he laid on his bed staring at the ceiling, not moving, ‘Too much weed, man… I smoked too much weed.’ While not as dramatic, I got the feeling of ‘too much’ Tylenol and physically noticed it.” Not surprisingly my doctor told to take ‘less Tylenol’. I went down to ‘just’ five Tylenol tablets a day, and, as you might suspect, less Tylenol equals less pain relief. Maybe if the tabs had been chocolate coated cannabis sativa oil I would have fared better.

I found some relief, but not enough to get return to a pain free state. Most insurance plans do not pay for your body to Rolfed.Your physician may prescribe a medication to relieve your pain, but the underlying condition is still present and not improving. These are the medications I received:

  • Meloxicam – Initially I found relief using Meloxicam (Mobic) daily, but I had an adverse reaction my blood pressure spiked. Unfortunately I had a second adverse reaction – minor heart palpitations during this treatment which resulted in a two day stress test at the local hospital. My EKG and related test results were in the normal range and the palpitations went away when I stopped taking the Meloxicam. The pain returned and, for the most part, was barely managed.
  • Norco – I have tried various regimens up through Hydrocodone-Acetaminophen. I quit taking these stronger medications after less than a week due to ineffectiveness and side effects (constipation).

Elastic Bandages – I would take three six-inch elastic bandages and tightly, just short of constricting blood flow, wrap my upper thigh. This technique allowed me to work-out with reduced pain.

“When things are bad, we take comfort in the thought
that they could always get worse.
And when they are, we find hope
in the thought that things are so bad they have to get better.”

Malcolm S. Forbes (Easy to say when you are rich)

 Could I Get Any Worse? – Stop me if you have read this before. I still thought I would get better – even over two years after the onset of my ‘groin pull.’ My thigh muscles continued to get worse. It was as if my muscles were turning into a Gordian Knot made of solidified beef jerky. I spent hours on Amazon.com researching, reading reviews and buying various muscle treatment devices such as a Rumbleroller, a hard foam yoga roller, below.

Drive The Spike – I bought an Acuforce Massage Chisel Tool (seven pounds). It was a cross between a railroad spike, a weighted police baton and something you might find at an adult store. You hold this seven pound stake that has both a chiseled end and rounded end and drive that into your muscle for deep tissue massage and, hopefully, relief. I later bought the smaller, more manageable, Acuforce Star massage tool. It was easier for my wife to manipulate for me.  The good news was I did get some relief, the bad news was that the relief I received caused me to prolong an orthopedic evaluation. I just kept thinking it must get better…

It Just Doesn’t Get Better – This certainly isn’t the last time I will say this, but in retrospect there was a problem with my self diagnosis – it was wrong. I had an arthritic hip and no matter what I would do, it just won’t get better. Not only that, but…

Even The Pain In My Wallet Got Worse – From yoga to massage to Rolfing to supplements to chiropractic manipulations to Feldenkrais treatments to massage therapy tools, neither I, nor my wallet, found any ultimate relief.

It was time to visit the orthopod.

I guess better late than never.

Alrighty… that concludes Chapter 7.