A combination of active principles

After the knee, the hips are most commonly affected by osteoarthritis. And this joint condition entails a wide field of non-surgical treatment options – or so one would think. For the first time, a multi-directional brace now dares to go where no brace has gone before. 

After all: conditions of the musculoskeletal system have become the leading cause for illness. Experts warn that case numbers for bone and joint conditions will double over the coming 20 years. To highlight the relevance for society, the World Health Organization declared the last decade as the “Bone and Joint Decade”. Surgeons already have their hands full: joint conditions, primarily osteoarthritis, are the most frequent reason for surgery. Even though osteoarthritis of the knee prevails slightly during clinical everyday work, more hip replacements are performed than knee replacements. According to data published by the German Federal Statistical Office in 2015, about five percent of the German population from the age of 60 suffered from osteoarthritis of the hip, a condition that can present very differently in each patient. 

Don’t do too much, don’t do too little 

Bauerfeind has advanced a treatment regimen for the hip that has been successful for decades: exercise therapy, also known as kinesiotherapy. The goal according to the Train principle is that problems are alleviated during walking, and joint replacement is at least delayed, if not made redundant. There are many causes of osteoarthritis of the hip: “Obesity, rheumatoid arthritis, accidents and one-sided strain can be responsible for damaging the hip joint,” explains Prof. Dr. med. Stefan Sell, Medical Director at Schwarzwald Joint Center at Neuenbürg Hospital, Germany. Too much strain is harmful, but the same applies to doing too little. Individuals who take less than 6,000 steps per day are at risk, says the expert. “However, 44 percent of patients suffering from osteoarthritis of the hip who undergo controlled kinesiotherapy,” the orthopedist quotes his favorite study, “were able to postpone the need for hip replacement by six years.”¹

A wave-shaped progression is followed by decompensation 

This means the hip also needs to be moved. But how when every step hurts? “Just like osteoarthritis of the knee, osteoarthritis of the hip initially shows a wave-shaped progression,” Prof. Sell explains. “There are good days and bad days. In the beginning, there are significantly more good days than bad. After that, it gets interesting. Decompensation is next.” While the condition of the knee continuously worsens over years, the hip may deteriorate so much in only two weeks that patients practically beg for surgery, reports the Director of Schwarzwald Joint Center. “I meet many patients whose quality of life hasn’t been right for a long time.” As opposed to osteoarthritis of the knee, the areas adjacent to the hip are also affected by radiating pain, probably via the fascia chain running toward the knee. Gait deteriorates and posture to help relieve pain becomes more pronounced during standing and walking. Eventually, the decompensation phase will set in almost abruptly. “It’s very difficult to help these acute patients with a brace,” Prof. Sell states. 

The overall pelvic structure

It helps to look at the anatomy of the hip to locate potential trigger points and modes of action for a brace. The origins of different symptoms can also be determined in this way. The hip is the largest and strongest joint in the human body. With its three-dimensional mobility, it supports an upright gait and straight posture. Walking and running have a direct impact on the movements of the upper body and pelvic tilt. The ball-and-socket joint is embedded in a large overall pelvic structure. 

Increased strain on the sacroiliac joints

“When we talk about hip pain, we refer to pain in the entire lumbar, pelvic and hip region,” explains Prof. Sell to clarify the situation. “All three regions influence each other, physiologically as well as pathologically. In cases of osteoarthritis, the hip increasingly loses its capacity for rotation. This must be compensated for by rotating the lumbar region, specifically from the sacroiliac joints (SI joints), which will cause increased strain and pain.” This is exactly where the new hip brace deploys one of its many active principles. Pads in the Coxa Train’s pelvic section exert a friction massage on the ligament structures and surrounding muscles of the SI joints. “It’s a good idea to use a support that’s similar to the SacroLoc in this sensitive area,” the orthopedist confirms. “Otherwise, established potential would be lost.”

Friction therapy with a proprioceptive effect

In addition to the friction massage of the SI joints, the pelvic section of the brace also exerts an intermittent friction massage on the hip muscles, which often suffer from hypertension. A roughly palm-sized, bow-shaped pad covers the lateral gluteal muscles that are often painful and tense. These muscles control hip extension, for example. The Gluteal Pad features three nubs and exerts a massage effect in a transverse direction to the muscle fibers during walking – with a positive proprioceptive and muscle-relaxing impact on the gluteus medius, which is often shortened. 

Innovative Trochanter Pad relaxes the hip muscles

Problems with the SI joints, muscular imbalances as well as intra-articular pain are the causes of multifaceted hip issues. A brace that claims it has an effect on all these symptoms must reflect this goal in its design as well. “To achieve its goals, the Coxa Train implements several active principles at the same time, originating from multi-directional approaches,” Prof. Sell explains. The crucial mechanisms are friction and proprioception. The Trochanter Pad is a real innovation. This pad is located on the eccentric hinge of the brace, and it is moved up and down above the greater trochanter during every step. The cyclical movement of the Trochanter Pad exerts friction massage on the local soft tissue, thus relaxing the muscles required for hip movement. “This mechanism not only reduces pain but also improves gait,” Prof. Sell says. “Examinations show that hip strain is reduced by a good percentage, thanks to the corrected rolling and rotational movements during walking.” 

Multi-directional approaches 

Reducing strain to return lost mobility to patients suffering from osteoarthritis of the hip is a prerequisite of kinesiotherapy. If there is no quick relief, not many of those affected will be easily convinced by this therapy. “The Coxa Train combines many active principles in one innovative product,” Prof. Sell summarizes. “This combination forms an additive therapeutic concept to delay hip joint replacement.” Furthermore, there are many patients who do not want surgery or for whom it is not possible. In general, the multi-directional approaches of the Coxa Train increase the chances of success of non-surgical treatment. “Including braces in the specialist’s non-surgical toolkit,” Prof. Sell says, “also always means having additional treatment alternatives. The Coxa Train provides me with another option.” 

Osteoarthritis of the hip and treatment using braces 

Prof. Sell and his research team from Karlsruhe, examine to what extent the Coxa Train represents an option for patients to regain mobility and also return to demanding everyday activities, such as taking the stairs or even exercise (see the interview on p. 20). The physician is also professor at the Institute of Sports and Sports Science (IfSS) at the Karlsruhe Institute of Technology (KIT), Germany. The connection between clinical work and the scientific research at the IfSS is a crucial aspect for him. When he is at the hospital, he can see which problems have not been solved yet, and he can easily recognize what impact research has on treatment. “The first Coxa Train wearing tests were really very promising,” the physician says. He even risks a prognosis: “Previously, there was no treatment using braces for osteoarthritis of the hip. This has now changed, thanks to the Coxa Train.”

1 Svege I, Nordsletten L, Fernandes L, Risberg MA. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial. Ann Rheum Dis., 2015 Jan; 74(1): 164–9. doi: 0.1136/annrheumdis-2013-203628. Epub, 2013 Nov 19.

Images: Bauerfeind, Udo Schönewald