A Multimodal Approach for the Management of Moderate Hip Osteoarthritis in A Runner: A Case Report.

BACKGROUND AND PURPOSE Evidence concludes that aerobic exercise, exercise therapy, and manual therapy effectively improve pain and function in individuals with hip osteoarthritis (OA). The American College of Rheumatology (ACR) reports there is no consensus on which type of exercise elicits the greatest benefit for those with OA. The American Academy of Orthopedic Surgeons (AAOS) cites gaps in the physical therapy literature regarding failure to stratify severity of hip OA in the context of exercise interventions. The purpose of this case report was to examine the benefits of a stratified, tailored multimodal approach for an individual with moderate hip OA.

CASE DESCRIPTION A 75-year-old male and recreational runner of more than 40 years presented with an insidious onset of worsening hip pain. The Lower Extremity Functional Scale (LEFS) and Visual Analog Scale (VAS) at rest were utilized to stratify the subject's hip OA severity, and the subject was assessed as moderate severity. Long run mileage and total weekly running mileage were tracked as a measure of progress towards the subject's functional goals. The subject's therapeutic goals included decreasing pain and improving function to complete a half-marathon scheduled for four months after the initial evaluation. The subject completed a physical therapy plan of care spanning twice weekly for six weeks, twelve total visits. The multimodal approach consisted of manual therapy, supervised exercise therapy, and an unsupervised home exercise program (HEP).

OUTCOMES The subject improved in all primary outcomes. The LEFS improved from 32/80 to 50/80; the VAS improved from 61/100 to 52/100; and hip active range of motion improved for flexion 90° to 110°, IR 10° to 20°, and ER 30° to 35°. The subject's functional measures improved from long runs spanning 4.0 miles to 8.0 miles and total weekly running mileage from 10.0 miles to 28.0 miles without limitation.

DISCUSSION The six-week, multimodal approach effectively reduced pain and increased function in this recreational runner. Individualized exercise therapy and the use of a critical magnitude of force used during manual therapy were two important tenets of an effective multimodal program for this subject. Moreover, the severity of OA and contextual factors might be significant considerations to guide future interventions.

LEVEL OF EVIDENCE 5.