Hooray for Hips

A person’s hips are typically not a body part that we think much about. 

They are just there on our bodies. They don’t require any unusual care. They work when they are needed. However, let’s take just a moment to think about them as special as they are.

The hips, one on each side of the body, are considered differently by people. Some think about their hips as an area of skin, others think about the hip’s bones and muscles. Indeed, the hips are all these things. The hips are the starting point to the legs. Engaging the hip joint can keep us from falling when alerted by the brain. They are quite important.

After spinal cord injury, the hips movements are typically unaffected. The bones still move, muscles still work, circulation is still pumping. The issue is messages cannot get through the area of the injury to or from the brain. The body below the level of injury still works, even if brain engagement of the hips is challenged.

Therefore, a person might neglect this part of their body. The hip joint can develop issues if attention is not paid to it. This is not a massive job but one that should not be neglected. You can care for your hips in your usual daily routine without much additional effort.

Hip Bones
The hip bones are a ball and socket joint which means the top of the femur or long bone of the thigh, has a ball end which fits into a cup like area of the pelvis, the socket. Thinking about a socket wrench, the hips move mostly forward, less backwards and sideways. This flexibility allows our bodies to move in a variety of directions.

Good positioning in bed or when seated is important to maintain the structure of the hips. Most people with SCI sit in their chairs and when in bed, use the incline feature. This puts the hip in a flexed position most of the day and night. If you are able, try to lay flat or occasionally, extend your hip a tiny bit toward the back when on your side in bed or straight if you are able to be positioned on your stomach. This will stretch out your flexor hip muscles to avoid a muscle contraction. When doing range of motion exercises, be sure to stretch the hip back just a tiny a bit when on your side in bed. This will help to keep the flexing hip muscles longer and pliable.

When anyone is positioned on their back in bed, their feet will start to turn out from their body due to gravity. You can see this as the feet each point to the outer side instead of correct back positioning when the toes point straight up. This slow droop of the toes affects all of the leg muscles right up to the hips. The weight of the pull of the feet will start to affect the hip joint.

To avoid this, many individuals with SCI will have positioning boots to keep their feet in alignment at night and sometimes in the day as well. The same positioning can be done when on the back by rolling a bath towel and placing it along the length of the leg, from the upper thigh to just above the ankle. The towel should not be placed under the hip bone or ankle to avoid pressure injury. Others might use a pair of high-top athletic shoes to keep their feet upright which protects both the foot position as well as the hips.

Other diseases can affect your hip joints as well. This includes arthritis, an inflammation of the joints, and bursitis, an inflammation between the tissues of the hips or other body joints. Both of these inflammations can develop at anytime but after SCI, they usually appear when the limbs have been consistently tossed instead of carefully placed when changing positions or during transfers.

Hip fractures can occur after SCI, either from mishandling the body or from loss of bone density, an all too common issue. A hip fracture may not be accompanied by pain if your sensation is challenged. You may have symptoms of autonomic dysreflexia, or when positioned on your back in bed, you might notice one of your legs being a bit longer than the other and the foot turned out on the side of the hip fracture. Swelling can also occur in the area of the hip.

Bone density tests are very important to assess the health of your bone health. Early detection can help you get treatment to avoid a hip and other bone fractures. If your bones are healthy, ask your healthcare professional about obtaining a standing frame. In the standing frame, your body has some tension on the tendons that attach to the bones which will assist in keeping your bones in shape. Also, performing range of motion exercises will cause the tendons to pull on the bones. Be sure to follow the explicit instructions of your healthcare professional and physical therapist so as not to overwork your body.

Another revealing outcome of bone density testing is if you have too much bone growth. A complication of spinal cord injury can be Heterotophic Ossification (H.O.) Sometimes, the bone grows too thickly and out into muscle tissue. This can cause the joint to be unable to articulate or move. If H.O. is in the hip, it can prevent you from sitting. Sometimes H.O. is confused with a contracture so you need to have a CT scan, MRI or X-ray for diagnosis. This condition is treatable with medication if caught early. Surgery to remove the bone overgrowth is needed in extreme situations.