Horse Riders and Hip Pain - Hoofbeats

Hip and knee problems are a common topic of discussion with those involved with equestrian sports or riding for pleasure. As their joints react to the wear and tear from years of use and conditions such as osteoarthritis, it does have a large impact on the comfort and ability of riders to continue enjoying their sport. It is not only the act of riding that is affected by joint pain; as we all know, that owning horses generally means a lot of bending, lifting, carrying and general hard work to maintain your horse and its environment.

hIP PaIN hIP PaIN

Part 1 will explore the condition of osteoarthritis of the hip and provide some hints and tips to get you more comfortable with your riding. Part 2 will look at preparing for a hip replacement, tips for success and post-operative management and rehabilitation back to riding and we’ll chat with riders who have had, or are preparing for, hip replacements, to learn first hand their experiences with managing the hip.

Tips for rider comfort

Tips for rider comfort

Tips for rider comfort

by Deidre Rennick

her knowledge as a nurse to ensure her remaining hip will last as long as possible whilst still enjoying riding. Deidre was the Project Lead in the development of the resource for general practice nurses “Osteoarthritis Nurse Clinics: A Resource for Primary Health Care Nurses”.

Deidre shares her knowledge with all riders, not just those who are experiencing problems through age, but also for those starting their riding career. Early, preventative measures to ensure their riding can be pain free for many years to come may be dismissed by the young rider as ‘old fogey stuff’. No one wants to think that age and its associated problems will ever affect them.

Riders need to consider their own bodies in the same light as the care they take of their horse. No one with any horse knowledge asks their young horses to perform without warming-up and appropriate muscle-building exercises, while also ensuring a work and maintenance regime that will care for their joints so they can be ridden pain-free for many years. The same concept applies to the rider’s own body.

Those who ignore information on joint care and maintenance usually find their horse’s use-by-date will come a lot quicker, and the same principles also apply to riders.

Hip Osteoarthritis

Osteoarthritis is a chronic and progressive condition that mostly affects the hands, spine and joints such as hips, knees and ankles. It is commonly referred to as the ‘wear and tear’ of ageing and affects the whole joint. It is the most common form of arthritis and the predominant condition leading to knee and hip replacement surgery in Australia. Statistically, 1 in 11 Australians (9%) have osteoarthritis, which is approximately 2.1 million people. Two out of three people who have osteoarthritis are female, and given the high percentage of female older riders there are many of us riding with this condition.

Early Signs

The early signs of hip osteoarthritis (HOA) can be very subtle. Perhaps one of the earliest signs is groin pain. When we think of the ‘hip’ we may look to the wing of bone below our waist. This is the pelvis, not the hip. The hip joint itself is a ball and socket joint and if you were to x-ray yourself standing upright you would clearly see its location in the groin. That is why early signs of groin pain can be dismissed as a strain, as many people are not aware of the joint location. Loss of range of motion is also an early sign, so when you dismount you may catch your leg on the cantle of the saddle as you swing it over. Loss of limb strength may also see you start to struggle mounting (if it is your mounting leg), and you may notice your leg aids are less effective on one side.

When pain is present the body automatically compensates to protect that area and this may change the way you move. This

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gait abnormality can lead to pain and discomfort in other areas of your body, such as back and knee pain.

People may comment that you are limping, without you being aware your gait has changed. Other indicators are ‘rain pain’ and ‘night pain’. ‘Rain pain’ is often felt as a deep nerve pain and really does indicate the coming of rain in many instances. The theory is that the drop in barometric pressure that precedes a low front causes changes in the vasculature (arrangement of blood vessels) in the joint capsule, causing pain. It has not been definitively proven, but those of us who experience it know it to be true! ‘Night pain’ is just that – you are pain-free during the day but the minute you lie down you get a dull ache in the affected area, and discomfort.

Diagnosis

Diagnosis of HOA is very straightforward with a plain x-ray. There usually is no need for any further investigations, like MRI or CT scans, until you are approaching the replacement stage. Based on your history, physical examination and x-rays your GP will be able to confirm the diagnosis. Once HOA is confirmed your challenge is to reduce the rate of deterioration of the hip joint, maintain functionality, manage pain and continue to enjoy your riding. The longer you can avoid hip replacement the better!

Management

Now you know you have hip osteoarthritis you are able to develop your management plan in consultation with your GP and other health care professionals.

YOUR HIPS

Medication – pain management is the cornerstone of strategies to keep you going. Pain can be very debilitating and pain at night will leave you exhausted and irritable. There are a large number of options to get the pain under control. A good pain medication program can be very effective, but an ad hoc or sledge hammer approach can have far-reaching consequences, with many drugs having undesirable side effects. Once again, your GP should be consulted to help design your medication plan. There are many Over The Counter (OTC) medications that are effective. The most commonly used first-line medications for HOA are paracetamol and Non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen. Combination medications of these are very common on the shelf but should be avoided. Instead, use single agents so you only use the medication you need at the time. For example, sustained-release (SR) paracetamol is very effective, but it has to be taken regularly so that the level of drug is maintained. NSAIDs can be very effective but can be hard on the stomach and kidneys, so should always be taken with food and make sure you keep yourself hydrated. Long-term daily use of NSAIDs should be avoided.

A good daily management plan is to take regular, sustained-release paracetamol and NSAIDs half an hour prior to riding or other physical activity.

There is a whole suite of prescription drugs available to help when the OTC medications are not enough, but these should only be used as part of a careful pain management plan – sometimes a pain management specialist is required to ensure a safe and successful outcome.

Weight Management – if your Body Mass Index (BMI) has started creeping up it will be impacting your HOA. Get your BMI down into the healthy zone. Unfortunately, as your body start to lose function, your tolerance for vigorous physical activity gets lower so you will be less effective at burning kilojoules. A Very Low Calorie Diet (VLCD) will get your weight down quickly, but should be done in consultation with a health care professional. A healthy BMI will stand you in good stead when the time comes for

your hip replacement and of course will make the work associated with horses, the getting on and off and the actual riding, so much easier if you are not carrying around those extra kilos.

Diet – eat a wide range of different foods. Eat plenty of wholegrain products, vegetables and fruits. Decrease fat intake, particularly trans fats (unsaturated fats such as doughnuts, cookies, crackers, muffins, pies and cakes are examples of foods that may contain trans fat) and saturated fat (dairy foods – such as butter, milk and cheese; meat – such as fatty cuts of beef, pork and lamb, processed meats like salami, sausages and the skin on chicken). Moderate sugar intake. Include appropriate amounts of omega-3 fatty acids (oily fish, flaxseed, walnuts), vitamin D (salmon, tuna, orange juice, soy milk, cereal and egg yolk), vitamin K (such as broccoli, cauliflower and green leafy vegetables) and calcium (green leafy vegetables, soya beans, nuts, bread with fortified flour, sardines and pilchards).

Physical Therapies and Activities – there is a whole world of therapies and activities out there that can help. Take the time to discover activities that you enjoy, so they are not a chore and you will be more likely to do them. Avoid all high impact activities such as running. Explore swimming, water aerobics, bike riding, and static machines in the gym that gently take your hip through a range of motion (ask a physio to suggest some exercises). Pilates, Tai Chi and Yoga are all excellent activities. Consult a physiotherapist, osteopath, myotherapist, acupuncturist – the list is quite extensive. Each modality may have something that works for you, or only one. You won’t know until you try.

Supplements – there is moderate scientific evidence to support the effectiveness of rosehips, ginger, green-lipped mussel extract (MSM), Indian frankincense (Boswellia serrata), phytodolor (ash bark extract/aspen leaf), pine bark extracts and Sadenosyl methionine (SAMe). Whilst glucosamine and chondroitin, fish oils and turmeric have all been promoted as supplements, the scientific evidence is not as strong for these products.

Private Health Insurance – if you don’t have it, consider getting it! While a hip replacement through the public health system may not cost you anything the public waiting lists are long and getting longer. A hip replacement can cost between $3050,000 with surgery, hospital stay and recovery. Explore waiting times with your private health provider – two years may seem a long time to wait but if you can get a good management plan going in the interim you will hopefully not be a hobbling, sleep-deprived wreck when your waiting period has finished, or you finally get to the top of the public queue.

One of the major benefits of private health insurance is being able to choose your surgeon. In Part 2 there will be a few tips on finding the right surgeon for you, but without private insurance you may not be able to choose who does your replacement when the time comes. Another advantage to private health insurance (apart from the Extras options that may help with your other therapies) is that many insurers offer a range of free support, from health coaching consultations to subsidised weight loss programs, as it is in their financial interest to keep you from needing the hip replacement.

In the Saddle – start to take care of your hip when you ride. As already mentioned, taking pain medication half an hour before you ride can set you up for a more comfortable experience. Invest in a mounting block that is stable and at a height where you don’t have to flex your hip more than 45 degrees when mounting. Train your horse to stand at the mounting block so you can gently ease yourself into the saddle. Sit for a moment with your legs out of the stirrups to allow the joint to settle (if it is safe to do so!).

Play around with stirrup leather length - you may find shorter or longer works better and is more

Trial ergonomic stirrups – some people have found a significant

– as horse riders we spend time and considerable money ensuring that the saddle fits the horse so it can perform at its optimum level without pinching or pain but our comfort needs to be considered too! There are a few saddle manufacturers that make female-specific seats to reduce the load on the pelvis and hip. Try and find one that suits you and your horse.

Stretch Regularly During Your Ride – stand in the stirrups, hang your legs out of the stirrups, swing your legs back and forth – anything you can do safely that loosens up the joint. Hopefully this information will set you on the right track to managing your symptoms and allow you more time in the saddle.

Whilst you may never be pain free, you can certainly reduce the severity and dysfunction through a whole systems approach.

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