In “past, present, future”, we ask clinical or academic experts to reflect on selected Sports & Exercise Medicine topics. Today Joshua Heerey is on Hip Osteoarthritis.
Tell us more about yourself.
I am a physiotherapist and research fellow (the Hip Osteoarthritis Research and Development Lead) at La Trobe University Sport and Exercise Medicine Research Centre in Melbourne, Australia.
I completed my undergraduate physiotherapy degree at La Trobe University, Melbourne, in 2008, my PhD at La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, in 2021 and are currently completing my Masters of Sports Physiotherapy at La Trobe University. My research and clinical interests focus on the diagnosis and management of hip and groin conditions, with a particular focus on intra-articular hip conditions that contribute to the development of hip osteoarthritis. I work clinically at Lifecare Prahran Sports Medicine Clinic. Outside of clinical and research work, I am married to Rachel and have two young children, Charlie (5) and Rose (3).
What was hip and happening 10 years ago?
Hip osteoarthritis (OA) was a common condition encountered by all physiotherapists. Yet, the evidence supporting our treatment approaches (which included education, exercise, and manual therapy) was still emerging. Surgical procedures (mostly total joint arthroplasty but increasingly also hip arthroscopy) and/or pharmacological therapies were heavily favoured treatments for hip OA at that time. There was growing interest in the role that intra-articular conditions (e.g., femoroacetabular impingement syndrome, acetabular dysplasia and labral tears) played in developing early hip OA and physiotherapy-led treatment approaches were starting to be developed.
What are we doing now?
Consistent with other common musculoskeletal conditions, we now consider hip OA a ‘whole person condition’. Structural, psychological and social factors interact and influence a person’s symptom severity and reported disability. Education, exercise and weight loss (if required) are now the recommended first-line treatments for people living with painful hip OA. However, ongoing work is needed to ensure the uptake of these recommended treatments in clinical practice. The development and dissemination of physiotherapist-led programs such as Good Life with osteoArthritis in Denmark have aided in delivering recommended first-line treatments for hip OA. Some studies report the efficacy of passive treatments such as manual therapy, but there has been a shift away from these for the management of hip OA. Physiotherapy-led treatment for intra-articular conditions, particularly exercise therapy, has evolved and is now considered a viable approach for reducing pain and improving function. Despite this, we still need further research to determine the best practice physiotherapy for such conditions.
Where do you think we will be 10 years from now?
First-line treatment interventions will be adopted by most physiotherapists who manage painful hip OA. Further studies to understand which people with hip OA benefit from physiotherapy-led treatments and how to optimise them may improve outcomes and reduce health spending. Currently, studies are looking at modifiable risk factors (e.g., muscle strength, movement biomechanics, functional performance) for early hip OA development. If identified, treatments to address these modifiable factors could be used by physiotherapists to slow or even reverse a person’s disease trajectory. There will be further refinement of physiotherapy-led treatments for intra-articular conditions. The optimal goal is to develop criteria-driven programs that are easily implemented in routine clinical practice.