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Feldenkrais Method
Hip Dysfunction, Degenerative Joint Disease (DJG), Conservative Management

The hip itself is a very sturdy joint, protected by large buttock muscles, and covered by strong ligaments. It is however vulnerable to groin pulls. Although the hip is a relatively simple joint, it bears the burden of bearing significant weight on fairly small cartilaginous surfaces. Cartilage on the end of the thigh bone should make even continuous contact with the cartilage of the socket. (See ill. 1) When these two surfaces are properly aligned or "well seated", the load is distributed evenly and friction minimized. Cartilage can wear unevenly with high-pressure spots when the hip is not well seated

or if there is asymmetrical weight bearing through the legs. (See ill. 2) Carrying an excess load with heavy activity can lead to early wear of the joint surfaces as well.

Causes of Hip Degenerative Joint Disease (DJD)

Simple Overuse:

When there is excess weight borne on one leg, the cartilage of that hip wears away more quickly. Have you ever seen workmen who carry heavy buckets and equipment walk with a limp? Imagine yourself holding a heavy bucket with your strong hand. You would either lean way over to the other side if it was very heavy or take the full weight directly over your strong hand side.

In either case, this adds excess weight over one hip joint and day after day can cause the degeneration of the cartilage. This is true of any prolonged one-sided standing or asymmetrical walking done day after day. Vigorous sporting activity, done without rest, can also create excess wear to the joint. As degeneration of the hip progresses, a lurching motion over the sore side develops. Interestingly enough this occurs because of an unconscious attempt to shift weight off the painful spot of the hip by lurching more over to that side.

Structural Causes of early cartilage degeneration are:

Hip dysplasia is a poorly formed, hence poorly seated hip joint.

It is usually congenital and the poorly formed cup and ball of the hip joint are not stable so often require surgical reconstruction. (See ill. 3)

Compensatory asymmetry through out the skeleton causing a poorly seated and subsequent subluxing hip joint. Any poor alignment throughout the body can result in one hip joint becoming overstretched and unstable.

Weakness around the hip can cause the joint surfaces to be poorly seated and wear unevenly. A short leg, whether it is a true bony shortness or a "functional" shortness (due to musculoskeletal imbalances) can cause excess weight bearing on one leg and excess wear over time.

Conservative Management Approaches:

Dietary Changes

For anyone experiencing degenerative changes in a joint, I recommend consulting a nutritionist who can make dietary recommendations and provide high quality supplements. Calcium and Magnesium citrates are easily absorbed forms of both calcium and magnesium. Getting 20 minutes of morning or late afternoon sun will also help give you the vitamin D needed to keep bones healthy. In the winter in areas above the 40th latitude the sun does not provide UV, so dietary supplementation may be required.

Glucosamine/Chondroitin/MSM are recommended by many doctors to help reduce inflammation as well as build cartilage. (See Dr. Williams link for more nutritional approaches to bone and joint health, Whenever a woman 40 or older has degenerative joint problems, having a baseline bone density scan can be helpful in monitoring bone health.


Making sure that you get 8-10 glasses of pure water each day is very important for maintaining healthy cartilage. When the body is well hydrated, the cartilage has a protective layer of moisture that makes it more resistant to wear. Unfortunately the body can become accustomed to low hydration,

so the normal thirst mechanism doesn't alert you like it should. I have observed that if I am well hydrated and drink 8 ounces of water it goes through me in about an hour or two. Good times to drink water are between meals but no sooner than an hour after eating and no less than a half hour before eating. The lining of your digestive system is also more protected from irritating acids when better hydrated; however following the above rule prevents over diluting the digestive juices.

Have pain? Check shoes... With any back, hip, knee or foot pain it is important to notice undue wear on the bottom of the shoes. Worn shoes can cause strain up the entire linkage of the lower extremity and back.

Inspect and replace worn heels and/or soles. Normal wear is on the outside of the heel and under the fall of the big toe. Replace when this wear is between1/8 and 1/4 inch.

Arch Supports

If your arches are low, consider getting arch supports not only to support your arches but also to support your knees and hips. Excess flattening of the arches is a common cause of medial knee strain and can cause excess internal rotation of the hip. It can be tricky to get just the right amount of support using the right materials for your feet but don't give up. Often several adjustments to the orthotics are needed to get you pain-free. (See Arches)

Structural Balance

A person having a "short leg" (whether the leg itself is truly short or whether it is short due to a musculoskeletal imbalance) will stand and walk with excess weight on one leg. This excess weight bearing on one side can cause uneven, excess wear of the hip or knee over time.

A truly short leg is called a "structurally short leg". Common causes are: having a broken or injured leg as a child, childhood growthplate problems, scoliosis, injury or surgery that leaves the hip or knee permanently bent. Sometimes there is no discernable reason.

More commonly people have a "functionally short leg". It can be caused by imbalances either in their skeletal alignment or weakness in ligaments and muscles. Poor standing habits, hyperextension of the knee, a fallen arch, misalignment of the first cervical vertebra, pelvic torsion problems or a sprained sacroiliac joint can all contribute to a functionally short leg. Not only the hip can suffer but knee and foot problems all may also result from imbalanced forces acting down through the weight bearing joints. (See ill. 5)

It is commonly thought that most people have some asymmetry and that a short leg of 1/8 to 1/4 inch is no big deal.

If a person is having symptomatic neck, back, hip, knee or foot pain, structural alignment needs to be evaluated. If left uncorrected it may cause considerable problems over a lifetime. The Leaning Tower of Pisa may have started out with a small structural fault but over the years the result has become very obvious.

Assessing and Attaining Structural Balance

When I see a patient I evaluate them for structural imbalance. Are the shoulders level? Is the pelvis level? Hips, knees are they level? Is the head to one side? Is there a visible Scoliosis? Is the person standing with one knee slightly bent, the other straight? How high are the arches?

When lying down are the leg lengths equal?

If the history indicates any injury-related reason for an asymmetry, then that is treated first. If there is no obvious cause, I begin by teaching a procedure for balancing the pelvis (see On the Level), along with some gentle stretches. I let these work over a period of about month and keep checking the pelvis, re-balancing it again if needed and this is accompanied by work to neck and cranium. Most often the imbalance can be corrected or partially corrected. If some imbalance remains then I refer my clients to a NUCCA practitioner for evaluation of their first cervical vertebra (C1).

I would not have believed it if I had not experienced myself the instant effect of a C1 adjustment. Legs become equal length, the pelvis is level and weight becomes balanced through both legs as soon as the first cervical is put back into correct alignment. Read more about NUCCA at Find a practitioner in your area

Occasionally I do recommend a shoe lift, but only if a person has had a C1 correction and they still show a true shortness in their leg. Then, it is best to start with half the shortness and then increase it incrementally as tolerated.


Re-education of habit is a hallmark of the Alexander Technique. Learning to stand in ways making more solid connections with the ground instead of collapsing into the ground is essential to sustaining structural balance and/or using a shoe lift. Some people have a habit of twisting and dropping weight down the inside of one knee and arch. A fallen arch can shorten a leg functionally by as much as a 1/4 inch. In instances where a person has weak arches, orthotics are indicated to help bring the legs into correct standing length. (See ill. 4)

Habits that strain the hip in sitting and standing are also addressed.

Current research is finding that the angle at which the thigh is aimed during walking, stair climbing and exercise can influence the strength of hip muscles. This angle is consistent with the direction of the hip and knees that F.M. Alexander recommended in his teaching.

Asymmetries in the cranium and top cervical vertebrae are also treated using Crainio-sacral work, positional release and Kurashova Tissue Re-education techniques. I often refer my hip patients to a NUCCA practitioner after I have gotten them stable and out of pain, this way they can maintain their structural balance, even more precisely, from the first cervical down.

Kurashova Tissue Re-education Techniques work to improve the circulation to the hip area, help tissues repair and normalize the elasticity of ligaments, muscles and bursae.

Strengthening of hip and buttock muscles and stretching out tight muscles is the final step once pain is greatly reduced. Skeletal imbalances are accompanied by muscular imbalances. Because muscles take shape around the skeleton, some become shortened and some become over lengthened. If one hip is overstretched (hypermobile) with weakened ligaments and muscles, the other hip is usually tight. For the overstretched hip, stability is emphasized and the opposite side usually requires stretching.

Stretching should be gentle and pain-free. I usually recommend isometric strengthening at first so as to reduce friction and wear of a painful hip. There are effective Feldenkrais lessons that address core muscle tightness in and around the hip and back.

Water Walking

Once pain is reduced, walking in the pool can help a person keep fit. It strengthens the legs using water as a resistance and is low impact due to the buoyancy of the water.


Stationary bicycling can help warm the hip, improve circulation and mobilize the hip joint.

It is best to ride without resistance and you should be pain-free during and afterwards.

Prolo (proliferative) Therapy injections can help firm up the hip joint as well as the SI (sacroiliac) joint, which is often also overstretched. This involves multiple injections of an irritant into ligaments, which help stimulate the formation of new collagen fiber. These injection plus nutritional supplementation helps grow new stronger tissue. A series of injections are generally given about a month apart and may involve 3-6 months of treatment. See link to Dr. Hauser web site:

Synvisc, Artificial Synovial Joint Fluid Injections

Synvisc is an artificial joint lubricant similar to that found in young healthy joints. It has been injected in knees to help reduce pain and friction related arthritis for many years. Research has shown that it may be effective in reducing early DJD in the hip as well.

If there is still irretractable hip pain and/or considerable degeneration, a hip replacement may be indicated. The technology and surgical procedures for hip replacement keep getting better and better. Most surgeons prefer that patients wait as long as they can before surgery, because joint replacements break down over time and require revision.

Don't wait until there is visible muscle weakness and marked limping. The jolting from this only sends further abnormal pressure up the spine and down to the knee leading to other joint wear. After hip replacements I usually recommend a NUCCA practitioner evaluate leg length/C1 balance to see if a shoe lift is needed.

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MovementWise Christine Inserra P.T.
Certified Teacher of the Alexander Technique & Feldenkrais Method
Physical Therapy serving Chicago and the Greater Chicagoland Area