Definition

What is hip osteoarthritis?

The hip joint is the articulated connection between the pelvis and the thigh bone. The femoral head (femoral head) is embedded in the acetabulum. The cartilage layer between these two structures ensures a low-friction sliding surface. Hip osteoarthritis (coxarthrosis) is a degenerative disease of the hip joint. It is the most common form of osteoarthritis in humans, even before knee osteoarthritis. It is caused by wear and tear of the cartilage surface in the hip socket and the femoral head. The disease often develops over many years and goes unnoticed for a long time. It usually occurs in older adults, typically after the age of 50 to 60. The cartilage damage is divided into four stages:

• Stage/grade I: Soft cartilage

• Stage/grade II: Rough surface with cracks

• Stage/grade III: Deep tears in the cartilage that extend to the bone

• Stage/grade IV: Complete wear of the cartilage with exposed bone. This is also referred to as bony baldness.

1. Pelvis
2. Healthy joint cartilage
3. Damaged joint cartilage
4. Bone outgrowths
5. Thigh bone

From where does the pain in hip osteoarthritis originate?

The intensity and frequency of pain caused by hip osteoarthritis (coxarthrosis) can vary greatly from person to person. Even in the same person, hip osteoarthritis pain can vary in intensity and frequency. Many people mistakenly believe that it is only the worn cartilage that causes the pain. However, the variability of hip joint osteoarthritis pain shows that cartilage degradation is not solely responsible for the pain. If this were the case, the pain would be constant and noticeable with every movement of the hip joint. However, those affected often report phases of complete pain-free periods through to severe pain around the hip joint. This proves that cartilage health and thickness should not be the only basis for further measures. X-rays and other imaging techniques should therefore not be used solely to assess the severity of osteoarthritis and treatment. As with all structures in the body, cartilage also undergoes a continuous process of formation and degradation. The aim in everyday life must be to ensure that the degradation processes do not outweigh the build-up processes.
The variability in the intensity and frequency of pain is also related to various internal processes that take place in osteoarthritis of the hip. Here are the most common causes that lead to pain in the hip:

• Cartilage degradation
  The articular cartilage acts as a shock absorber between the femoral head and the acetabulum. If the cartilage breaks down, additional pressure can be exerted on the periosteum, which is very sensitive to pain due to the blood vessels and nerves involved.

• Joint inflammation (synovitis)
  Cartilage wear can trigger inflammatory processes in the synovial membrane. The associated increase in the production of joint fluid leads to swelling, overheating and pain.

• Joint effusions
  The increased formation of joint fluid as a reaction to cartilage degradation exerts additional pressure on the joint, which can cause pain and feelings of tension.

• Irritation of the surrounding tissue
  Changes in the joint can also irritate surrounding structures such as ligaments, tendons, muscles and fascia, leading to pain and increased joint stiffness.

• Bone changes (osteophytes)
  As osteoarthritis progresses in the hip, bony growths form which can press on nerves or soft tissue, causing additional pain and restricted movement.

• Microcracks in the bone (subchondral changes)
  The increasing loss of cartilage puts more strain on the underlying bone, which can lead to small cracks and bone thickening, which also cause pain in the hip.

• Myofascial tension
  The musculoskeletal system senses the incorrect and excessive strain on the hip joint and tries to protect the joint and cartilage by tensing the muscles and fasciae, as the hip can no longer be moved to the maximum possible extent. This tension in the myofascial structures can lead to pain during movement, as the muscles are working against this tension.

Cause of hip osteoarthritis

The causes of cartilage degradation and the associated pain in hip osteoarthritis (coxarthrosis) are closely linked to our modern lifestyle and changing environmental conditions. In the past, our ancestors had to move a lot more and in a more holistic way in order to obtain food, be it by hunting, picking berries or farming. These activities were often carried out barefoot and on natural surfaces, which led to well-developed foot and leg muscles.
Over the millennia, our lifestyle has changed considerably. Today, modern civilization is often characterized by a lack of exercise and a sedentary lifestyle. When we move, we usually do so on hard, flat surfaces such as concrete or asphalt and in supportive, immobile shoes. These changes in movement habits and conditions lead to physical adaptations that can contribute to the development of osteoarthritis in the hip. The effects of this on the development of osteoarthritis of the hip joint (coxarthrosis) are described below.

Physical inactivity and a sedentary lifestyle

The modern way of life, which is characterized by a lack of exercise and a sedentary lifestyle, places incorrect strain on the musculoskeletal system. The lack of exercise and sedentary lifestyle lead to physical adaptations that can result in the degeneration of the hip joint cartilage. The following changes play a significant role in the development of osteoarthritis of the hip joint:

• Weakened muscles
  Lack of exercise and a sedentary lifestyle cause essential muscles to atrophy. The foot, leg and hip muscles play a decisive role in the cartilage health of the hip joint. On the one hand, functional foot muscles support the longitudinal arch of the foot, which is the first instance of reducing the force exerted on the hip joint and thus its cartilage when standing and walking. On the other hand, the foot and leg muscles ensure that the foot rolls naturally and thus protects against uncontrolled foot drop after heel strike. Due to uncontrolled rolling of the foot, the hip is hit with every step instead of being guided physiologically. This incorrect and excessive strain leads to overuse and can therefore lead to osteoarthritis in the hip joint. The leg and hip muscles stabilize the hip joint and keep it in the correct position. Active and tense muscles around the hip joint also protect the cartilage from the forces exerted during each individual movement. The importance of functioning muscles is therefore essential for the health of the joint cartilage.

• Foot misalignments
  The weakened musculature can also lead to foot deformities. The muscles responsible are no longer able to support the longitudinal arch, which leads to flat feet. The collapse of the longitudinal arch deprives the foot of its shock-absorbing function when walking and standing. The force exerted is therefore transmitted via the feet and knees to the hips and their cartilage with every step. The increased load can damage the cartilage over time, leading to osteoarthritis in the hip and hip pain.
  Foot misalignments can also lead to an uneven distribution of body weight, which puts excessive strain on the hip joints and can accelerate cartilage degradation. Furthermore, the leg axis can be displaced by a bowed foot and pronation and supination, which leads to a change in the position of the femoral head in the hip socket. This puts increased strain on a corresponding area of the hip cartilage and promotes osteoarthritis in the hip joint.

• Restricted supply to the cartilage
  The cartilage in the hip is not supplied directly by blood vessels. Instead, it receives its nutrients from the synovial fluid that is pumped into the joint through movement. This process is disrupted by a lack of movement and a sedentary lifestyle. As a result, the cartilage is not supplied with sufficient nutrients and oxygen. As a result, the cartilage loses elasticity and resilience, which increases friction and wear and tear. In the long term, this can lead to the development of osteoarthritis in the hip.

• Fascia dysfunction
  Fasciae change their original structure and can become brittle if they are subjected to irregular and unphysiological stress. As a result, the fascial network loses its elasticity and leads to increased tension around the hip joint. The increased tension pushes the femoral head and acetabulum closer together. This additional pressure from the adjacent bones wears down the cartilage layer excessively. This can lead to osteoarthritis in the hip joint. The altered fascia structure can also impair the mobility of the joint, causing it to stiffen. More on this in the following section.

• Joint stiffness
  Due to a lack of exercise and a sedentary lifestyle, the joints are not moved to the maximum possible range of motion. The hip joint is barely moved, especially when sitting every day. Excessive sitting also shortens the hip flexor, among other things, which changes the pelvic position and thus leads to a change in the load on the hip joint cartilage. The shortening also reduces the hip joint's range of motion. The lack of movement and sedentary lifestyle results in a natural stiffening of the joints, which leads to increased wear and tear in the still possible range of movement. The hip joints also suffer when the foot joints become stiff. The lack of foot mobility prevents a natural rolling movement and thus increases the force exerted on the hip joint.

Hard, flat floors and immobile, supportive shoes

Hard, flat floors and immobile, supportive shoes have a significant impact on the hip joints and can cause or exacerbate osteoarthritis of the hip. The following factors play a significant role in the development of osteoarthritis of the hip joint.

• Reduced shock absorption and increased force impact
  When walking on hard, flat floors and in immobile, supportive shoes, higher forces act on the musculoskeletal system, especially during heel strike. The firmness of industrial floors and the stiffness of conventional shoe soles prevent the absorption of these forces, which leads to increased strain on the body. This increased force first hits the feet and is then transferred to the hips via the knees. The less well the feet can absorb the forces, the greater the strain on the hips. The cartilage in the hip joint is therefore subjected to greater stress with every step.
  
  The increased and early application of force during heel strike shortens the possible reaction time of the responsible muscles. If the muscles cannot tense in time, the corresponding joint is insufficiently stabilized, which leads to incorrect and excessive strain. Insufficient muscular tension in the feet results in uncontrolled folding of the midfoot after heel strike. This results in the so-called "hinged foot" and leads to an additional impact on the hip joint, which further damages the cartilage. The hip-stabilizing leg and pelvic muscles are also unable to react quickly enough due to the early and increased force. The reduced muscular tension leads to an unstable hip joint, which increases the strain on the cartilage and can lead to osteoarthritis in the hip in the long term.

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  1. Maximum load after time 1 during heel strike in conventional shoes
  2. Maximum load after time 2 during heel strike in kybun shoes
  3. Force in Newton
  4. Time in seconds
  5. Walking on flat, hard ground in kybun shoes
  6. Walking on flat, hard ground in other shoes

• Restricted foot function and muscle weakness
  The hard, flat floors and immobile, supportive shoes reduce foot movement with every single step. The restricted foot function therefore also limits the movement of the overlying structures. The less movement is generated in the lower extremities, the more inactive the relevant muscles are, which leads to muscle weakening. Studies show that immobile, supportive shoes are often associated with reduced muscle activity in the calf and thigh muscles. Reduced muscle function, particularly in the foot, leg and pelvic muscles, results in insufficient stabilization of the hip joint, which promotes increased cartilage degradation.

• Unnatural sequence of movements
  Natural movement sequences are designed to react dynamically to changing surfaces. Hard, flat floors and immobile, supportive shoes make a physiological sequence of movements much more difficult. On the one hand, the lack of muscle activation during heel strike causes the foot to fold downwards in an uncontrolled manner. The folding foot and its consequences for the hip joint were described in the previous section. On the other hand, the hardness and inflexibility of industrial floors and the stiffness of conventional shoe soles prevent the foot from rolling naturally. This restricted foot movement limits the distance covered by each individual step. In order to move forward, the required movement must now be taken from the hips, resulting in a hip-oriented gait. This puts significantly more strain on the hip joint with each individual step, which accelerates the deterioration of the hip joint cartilage. Furthermore, immobile, supportive shoes reduce the sensory feedback from the foot, which leads to a reduction in the exchange of information and therefore a reduction in adaptability. This results in a monotonous load, which is particularly harmful to the hip joint. The lack of variation and constant pressure on certain parts of the hip can cause microtraumas in the joint, which can develop into osteoarthritis in the hip joint over time.

Symptoms of hip osteoarthritis

It is important to note that the following are the most common symptoms of hip osteoarthritis. However, the list of hip osteoarthritis (coxarthrosis) symptoms is not complete and exhaustive. Atypical hip osteoarthritis symptoms are also possible, which are not listed here either. Hip joint arthrosis symptoms often depend on various factors such as pain sensation, cause of injury, degree of injury, physical constitution, etc. A doctor should be consulted in order to obtain a clear diagnosis.

• Pain in the hip: Pain often occurs in the hip region and can radiate to different regions. Pain in the groin or radiating to the legs is not uncommon with hip osteoarthritis. The hip joint arthrosis pain is often load-dependent and can worsen during the course of the day. At a later stage, hip osteoarthritis pain can occur at night or even at rest.

• Stiffness: The hip can be stiff and immobile, especially after periods of rest, such as after getting up in the morning or after sitting for a long time. This can be the onset of hip osteoarthritis symptoms as well as long-term hip joint osteoarthritis symptoms.

• Restricted mobility: Mobility of the hip may be restricted, making walking, bending or climbing stairs difficult.

• Muscle weakness: The surrounding muscles around the hip joint can become weaker, leading to noticeable instability of the hip joint.

• Swelling and inflammation: In some cases, swelling and inflammation can occur in the hip area, causing additional pain.

• Altered gait pattern: Affected individuals may develop a limping gait to compensate for the pain in the hip and reduce the load on the affected hip.

• Weather-sensitive hip problems in osteoarthritis: Heightened pain and stiffness in wet or cold weather are characteristic symptoms of hip osteoarthritis.

• Crunching or grinding noises: With severe osteoarthritis, crunching or grinding noises may occur when moving the hip, indicating that the cartilage is wearing away.

• Varying pain sensation: From no hip joint osteoarthritis pain to extreme pain, the pain can vary accordingly in the same person within the same day. This is a strong indication that it is not the degenerated cartilage but the myofascial structures that are the cause of the pain. Reason: Cartilage damage is consistent, but tension and blockages are not.

What helps with hip osteoarthritis? Conventional therapy

There are several approaches to treating hip osteoarthritis pain. Some hip osteoarthritis therapies are listed below. The list of these therapies is not exhaustive. Various measures can also be combined to treat hip osteoarthritis. A medical consultation is recommended to determine the appropriate therapy for osteoarthritis of the hip joint.

• Physiotherapy: Special hip osteoarthritis exercises and forms of therapy are designed to improve mobility, strengthen the muscles and relieve the joint. This can reduce the symptoms of osteoarthritis of the hip joint after just a short time.

• Exercise therapy: Gentle exercise (e.g. swimming, cycling or yoga) promotes mobility and musculature without overloading. It also promotes blood circulation, which is useful for hip osteoarthritis treatment.

• Weight Loss: Extra weight puts more pressure on the joints. Therefore, losing weight can significantly alleviate the symptoms of hip osteoarthritis. By lowering body weight, the pressure on the hip joint is reduced, which eases the strain on the cartilage.

• Orthopedic supports: Bandages or orthotics for the support and stabilization of the hip joint. Shoe inserts for the correction of misalignments and relief of certain joint areas.

• Change in diet: A balanced diet rich in omega-3 fatty acids and antioxidants can have an anti-inflammatory effect and positively influence the course of the disease.

• Acupuncture: Relieving pain by targeting specific points.

• Heat or cold applications: Heat to relax tense structures, cold to relieve inflammation. The right temperature must be tested during hip osteoarthritis treatment.

• Magnetic field or electrotherapy: Promotes blood circulation and pain relief.

• Medication Therapy: Painkillers and anti-inflammatory drugs. This option only addresses hip osteoarthritis symptoms without eliminating the causes of hip osteoarthritis development. Cartilage-building medications can help promote the healing of cartilage tissue.

• Joint injections: In hip joint osteoarthritis, hyaluronic acid can help to improve joint lubrication and relieve hip osteoarthritis pain. Cortisone to reduce inflammation in acute flare-ups and relieve pain in osteoarthritis of the hip joint.

• Self-Blood Therapy: This approach utilizes the healing properties of the body's own blood to regenerate joint cartilage and ease hip osteoarthritis pain.

• Surgical interventions: If conservative measures are no longer sufficient, surgical procedures such as a hip arthroscopy or the insertion of a hip prosthesis may be necessary. This measure should always come at the end of various conservative coxarthrosis therapies if these have not produced the desired results.

What helps with hip osteoarthritis? the kybun working principle

The range of kybun products aim to eliminate the harmful effects of hard, flat floors and immobile, supportive shoes and actively tackle the lack of exercise and sedentary lifestyle. The elastic, springy properties of kybun products relieve and activate the musculoskeletal system. The relief ensures that the load on the hip joint cartilage is reduced as a first step. Activation is intended to tackle the causes of hip osteoarthritis so that hip complaints caused by osteoarthritis become a thing of the past in the long term. This makes kybun shoes ideal for osteoarthritis of the hips, as they help treat hip osteoarthritis through the following modes of action:

• Natural foot roll and increased range of motion thanks to elastic-springy material
  Thanks to the compression capability of the kybun sole, the heels can slowly sink into the elastic-springy material during heel strike. This slow sinking allows the foot muscles to prepare for the upcoming load. The tensed muscles prevent the uncontrolled and cartilage-degrading folding foot and allow the foot to roll naturally by pushing off via the toes. By using the full range of motion of the feet, a considerable distance is covered without having to transfer this movement via the hip joint. Instead of a hip-oriented gait, a foot-oriented gait is initiated, which relieves the cartilage of the hip joint and thus reduces the risk of hip arthrosis. Furthermore, the impact on the hip joint is reduced by the natural rolling of the foot, as the force exerted is converted into forward movement. In addition, active rolling on the elastic, springy kybun material utilizes the entire range of movement of the foot. This automatically generates more movement in the knee and hip joints. As a result, the hip joint is not always moved in the same range, which promotes cartilage degradation, but is used over the entire range of possible movement. The result is a reduction in the point load intensity. Furthermore, several studies have shown that cartilage can be rebuilt through natural and physiological loading.

• Walking without foot roll

  Walking with foot roll

• Muscle activation and stabilization of the hip joint
  When walking in kybun shoes, the heels sink deep into the elastic, springy material thanks to the compression soles. As a result, the full load is built up slowly and in a controlled manner, giving the body more time to tense the relevant muscles. The tensed leg muscles stabilize the hip joint and stress the cartilage in a natural way. In contrast, when walking on hard, flat floors and in immobile, supportive shoes, the load is applied to the body in an undamped manner. The increased force and reduced reaction time prevent the relevant muscles from tensing in time. This leads to insufficient stabilization of the hip joint and thus to incorrect and excessive strain on the cartilage.

• 1. Conventional shoes (left): Delayed, uncontrolled reaction of the muscles prevents hip stabilization.
  2. kybun shoes (right): Tense muscles lead to hip stabilization.

• Reduction of the force exerted by hard, flat floors thanks to the cushioning effect
  When the heel strikes the kybun shoes, the elastic, springy material is compressed. Thanks to the compression capacity of the kybun sole, the rear foot can sink deep into the material. This slow and controlled sinking reduces the force and therefore the load on the hip joint and cartilage. Similar to an airbag in a car, the cushioning effect of the kybun sole minimizes the impact of force.

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  1. Force effect 1 during heel strike in conventional shoes
  2. Force effect 2 during heel strike in kybun shoes
  3. Force in Newton
  4. Time in seconds
  5. Walking on flat, hard ground in kybun shoes
  6. Walking on flat, hard ground in other shoes

• Activates and strengthens the muscles thanks to its elastic, springy properties
  When walking and standing on the elastic-springy kybun surface, the body must constantly make small compensatory movements to maintain balance. The deliberate instability of kybun products challenges the balance system and specifically activates the stabilizing deep muscles, which are responsible for stability and posture. As a result, the hip joint is better stabilized and protected by the surrounding muscles. At the same time, coordination skills are trained as the interaction between the nervous system and muscles is improved. This leads to better body awareness and more precise movements, which ultimately protects the hip joint from osteoarthritis.

• Balance and EMG
  The ability to balance was measured with a force plate by moving the body's center of gravity from front to back (ant-post) and sideways (med-lat) while standing. In parallel, electromyography (EMG) recorded muscular activity.

  With ordinary shoes

  1. Reduced muscular activity
  2. Reduced range of movement of the body's centre of gravity

  With kybun shoes

  1. Increased muscular activity
  2. Increased range of movement of the body's centre of gravity

• Promoting blood circulation through increased movement activity
  The knee joint also requires numerous nutrients to nourish, maintain and regenerate the cartilage. These nutrients are transported to the corresponding tissue via the blood and synovial fluid. In addition, anti-inflammatory substances are transported to the knee joint via the blood, while harmful and inflammation-promoting messenger substances are transported away. This constant exchange of fluids thus supplies the cartilage and keeps it elastic and resistant. The elastic, springy kybun materials promote movement and thus activate the muscles around the knee joint. This increases blood circulation, which in turn promotes the benefits mentioned above.

• Promoting movement and reducing sedentary activity
  The elastic-springy kybun products promote the joy of movement, as walking and standing on the unique material relieves pressure on the knee joints. The movement activates and strengthens the muscles and promotes blood circulation. The benefits of these two processes have already been described in the previous sections. As the use of kybun products can also reduce the duration of sedentary activity, harmful shortening and blockages of the myofascial structures can be avoided. Increased walking and standing stretches and lengthens the often shortened hip flexor muscles and the posterior chain of calf and thigh muscles, which has a positive effect on the angular position of the knee joint and the pressure on the knee joint cartilage.

• Care and protection of the fasciae
  The fasciae stabilize the knee joint and distribute the load evenly with every single step, which protects against cartilage wear. Healthy and functional fasciae are elastic and therefore free from adhesions and tension. Elastic fascia promotes the mobility of the knee joint and supports good blood circulation, which is important for the nutrient supply and regeneration of the cartilage. Thanks to the kybun shoes, a natural sequence of movements is made possible, which keeps the fasciae elastic.

• Optimised pressure distribution thanks to the reduction of pressure points
  The entire sole of the foot is surrounded by this unique elastic, springy material. This leads to optimised pressure distribution in the feet. As a result, the punctual load on the back (e.g. intervertebral discs) and the surrounding soft tissue can be reduced. In addition, the constant slight movement on the kybun products increases the load-bearing surface, which can also reduce individual pressure points. This can protect the back from overloading and injuries.

Application tips for hip osteoarthritis

Before you wear kybun shoes for the first time, you should consider a few tips on how to use them. Correct use can help to relieve hip osteoarthritis pain. You can also treat hip osteoarthritis with targeted hip osteoarthritis therapy, which is explained in the next section.

• To begin with, only wear the kybun shoes for as long as your body allows. Take breaks from wearing the shoes if the hip pain caused by osteoarthritis increases or the musculoskeletal system becomes tired. Hip osteoarthritis treatment takes time. The activating properties of kybun products train the muscles, which can lead to so-called initial reactions, especially at the beginning.

• If you have hip joint arthritis pain, you should walk more often than stand. When standing, the constant pressure can put more strain on the joint cartilage and lead to further tension and blockages. Movement promotes blood circulation, loosens tense muscles and fascia and distributes the load over the entire hip joint.

• Press your heel into the elastic, springy material. Try to find a load point at which the pain in the hip joint is reduced or does not occur.

• Try to roll as actively as possible over the forefoot and toes. An increased range of motion in the feet already generates a greater distance via the foot roll, which relieves the hips. The goal is a foot-oriented gait instead of a hip-oriented gait.

• After a certain period of time, try changing your walking speed. Switch from walking to trotting and back again. Stay at one speed for about 15 seconds. Changing speeds can help to relieve tension in and around the hip joint. Test at which speed you have the least or no pain.

• Try the following exercises to boost the effectiveness of kybun shoes and increase the chances of recovery. These are intended as a complementary therapy for back pain and should form part of the treatment for back pain.

How to manage hip osteoarthritis? Beneficial exercises

To increase the effectiveness of kybun shoes and reduce the likelihood of hip osteoarthritis pain, we recommend performing the following exercises for hip osteoarthritis. The selection of exercises is not exhaustive and can be supplemented by other exercises. The basic rule for all exercises is that the pain in the hip joint must not increase. If one of the exercises increases the osteoarthritis pain in the hip, it must be discontinued. Soothing and relieving "pain" outside the pain point in the hip joint (e.g. in the thigh) and a reduction in the symptoms of osteoarthritis of the hip joint are desirable.

The exercises are divided into the following areas: "Correct walking in kybun shoes", "Muscle length training", "Fascia rolling" and "Strengthening". Ideally, the different areas should be used as complementary therapy for hip osteoarthritis.

Walking the right way in kybun shoes

The quality of each individual step is crucial in the treatment of coxarthrosis in order to reduce hip pain caused by osteoarthritis and to eliminate incorrect and excessive strain. The kybun shoes therefore offer an ideal therapy for osteoarthritis of the hip joint and can be worn for both incipient hip osteoarthritis symptoms and severe hip osteoarthritis.

Controlled foot movement

• Gently press the heel into the elastic-springy material to find the load pressure and point at which it is possible to step without experiencing pain.

• Lower your midfoot and forefoot slowly and in a controlled manner.

• Controlled foot position so that the foot does not tilt inwards or outwards.

• Roll slowly and in a controlled manner with the forefoot.

• Slow exercises help to rebuild the stabilizing muscles.

• Consciously carry out daily exercises when using kybun products.

Quick Step Frequency

• Movement sequence identical to exercise 1.

• Now incorporate short steps with a high step frequency that lead to movement in the hip joint. However, always use the full range of motion of the feet.

• If you have pain in the hip joint, increase the stride length and reduce the frequency.

• Important! Maintain an upright posture when standing and walking. Do this consciously every day when using kybun products.

Muscle length training

Muscle length training is of crucial importance in the treatment of coxarthrosis, as the hip complaints associated with osteoarthritis are often caused by shortening, tension and blockages in the myofascial structures. Targeted stretching exercises can actively tackle the shortening, tension and blockages and are therefore an ideal therapy for osteoarthritis of the hip.

Hip opener

• Begin in an all-fours position.

• Place left foot forward next to arms.

• Stretch your right leg back and place your foot flat on the floor. Make sure that your hips and spine are in line.

• To increase the stretch, push the hips forwards and downwards. Depending on your individual mobility.

• Perform 1-2 times daily.

• Hold the exercise for 3 x 30 seconds.

Buttocks

• Start lying on your back.

• Stretch both arms out to the side at a 90-degree angle and place your left leg bent on your right side.

• Press the bent knee down with your right hand.

• Make sure that both shoulder blades remain on the floor.

• Perform 1-2 times daily.

• Hold the exercise for 3 x 30 seconds.

Fascia roller

Fascia training with the fascia roller is important in the treatment of coxarthrosis, as this is often caused by shortening, tension and blockages in the myofascial structures. By regularly rolling out the shortened and tense myofascial chains, the fascia roller is suitable as an active therapy for osteoarthritis of the hip joint.

Gluteal muscles

• Start in a seated position with both legs bent.

• Roll out the corresponding half of the buttock with the fascia ball. Increase the pressure by placing the leg on one side. If pain occurs in the wrist, the exercise can also be performed on the forearms.

• Perform the exercise slowly and in a controlled manner.

• Adjust pressure to personal feeling, but go up to the tolerable pain threshold.

• Roll out any localised adhesions or hold the position at this point.

• 3 minutes each side.

• Perform 1-2 times daily.

Lateral thigh muscles

• Starting position in side-lying position.

• Place a large roller between the outer thigh area and the floor.

• Position the upper leg at a right angle for stabilisation and to guide the movement.

• Actively roll out the lateral thigh from the hip to above the knee joint.

• Perform exercises slowly and controlled.

• Adjust pressure to personal feeling, but go up to the tolerable pain threshold.

• Roll out any localised adhesions or hold the position at this point.

• Exercise can be strengthened by straightening the upper leg.

• 3 minutes each side.

• Carry out 1 - 2 × daily.

Strengthening

Targeted strength training helps to strengthen the muscles around the hips, thereby relieving the strain on the hip joints and their cartilage and eliminating typical hip joint arthrosis symptoms. The strengthened muscles can better absorb the forces acting on the hip joints with every movement. Furthermore, the muscles stabilize the hip joints and thus protect them from incorrect and excessive strain. Strengthening exercises are an effective therapy for osteoarthritis of the hip joint and help to alleviate hip osteoarthritis pain in the long term.

Hip thrust

• Starting position: lying on your back with your legs bent (hip-width apart). Arms are stretched shoulder-width apart at the feet.

• Actively lift your hips off the floor and move them towards the ceiling (hips should be fully extended at the top of the exercise).

• Hold the position at the highest point for 4 seconds.

• Make sure that the force comes from the buttocks (not from the heels or the back of the thighs).

• Slowly lower your hips again without your buttocks touching the floor.

• 3 sets of 8 - 12 repetitions.

• Perform 2 - 3 × weekly.

Squats

• Starting position: standing, feet slightly wider than hip width and slightly rotated outwards.

• Squat down slowly and in a controlled manner. Push your buttocks back and shift your weight onto your heels.

• Ensure that strength comes from the buttocks. Stabilise your knees so that they do not bend inwards or outwards.

• Stand up again slowly and in a controlled manner. If you have balance problems, you can hold on to a stable object with your hands.

• 3 sets of 8 - 12 repetitions.

• Perform 2 - 3 × weekly.