Massage & Bodywork

MAY | JUNE 2019

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94 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 9 technique MYOSKELETAL ALIGNMENT TECHNIQUES Tale of a Falling Star Hip Osteoarthrosis May Force Tennis Legend to Retire By Erik Dalton, PhD 1 Femoroacetabular impingement syndrome (FAI). Whether you're a tennis fan or not, it's sad to see a superstar like Andy Murray face the prospect of early retirement due to injury (Image 1). Considered the greatest British men's player ever, Murray has been one of the four best in the world this decade. Recently, an emotional Murray admitted his time as a professional tennis player is nearly up due to osteoarthritic hip pain. Murray's orthopedic surgeon, the legendary John O'Donnell, MD, believes the only hope for relieving the tennis star's sharp groin pain is a total hip replacement or hip resurfacing surgery, the latter of which Murray underwent in late January. "It's like the brake linings of your car," O'Donnell says. "If you rag them too hard, they wear out earlier, particularly if the hip has suffered previous injury." joints of women in their 50s and 60s. Conversely, in secondary OA, the factor or event is known. In Murray's case, repetitive movements, recurring injuries, and abnormal joint loading during his teenage growth spurts are suspected causes. Joint alignment, muscle strength, and nutritional status also seem to contribute to the development of secondary OA, and the most frequently affected areas are the neck, low back, hips, knees, acromioclavicular joints, wrists, and fingers. Although OA is considered a natural part of the human aging process, most bodyworkers have seen how articular cartilage damage and joint compression can cause the brain to lock down an area with protective muscle guarding. Digging on the spasm does little good until proper joint mobility, neurology, and hydration are restored. During a typical history intake, OA clients presenting with hip pain often describe a lifetime of overuse, underuse, or plain old abuse, leading to disruption of the delicate mobility-stability balance around their affected femoroacetabular joint. This is where massage and mobilization may help. According to recent research, a number of manual therapy modalities have shown promise in treating those with mild to moderate hip OA, including soft- tissue manipulation and joint stretching techniques. 1 Given the close kinetic link between the hips, lumbar spine, sacroiliac joint, and In Murray's case, degenerative joint disease damaged the articular cartilage of his right femoral head, resulting in repetitive grinding of the femur on the rim of the acetabulum, a condition known as femoroacetabular impingement syndrome, or FAI (Image 2). Murray's doctors have diagnosed him with hip osteoarthritis, but there is not enough evidence to validate an inflammatory process in these "wear- and-tear" degenerative joint disease cases. Therefore, I will refer to his condition with the more appropriate term osteoarthrosis (OA). For Murray, the severity of his hip OA, coupled with a history of related issues and injuries, landed him in the operating room for relief from OA pain. However, for our clients with more moderate OA, manual therapy can play a key role in recovery. PRIMARY AND SECONDARY OSTEOARTHROSIS For a better understanding of this condition, let's take a look at the two types of OA— primary and secondary. In primary OA, the initiating factor is unknown, and it's commonly seen in weight-bearing Andy Murray. ©Reuters with permission. 2

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