Physiotherapy Research and Reports

Commentary

ISSN: 2516-7081

Pericapsular soft tissue as a pain generator in hip
osteoarthritis: considerations for developing a new home
exercise to prevent surgery
Kazuo Hayashi1* and Toshiharu Tsunoda2Arthritis Center, Fukuoka Wajiro Hospital, Japan
Department of Orthopedic Surgery, Asama General Hospital, Japan

12In previous studies by Fernandes et al. [1] and Svege et al. [2],the inclusion criteria of exercise as a non-surgical treatment forosteoarthritis (OA) of the hip included a Harris Hip Score (HHS)
between 60 and 95 points, and total hip arthroplasty (THA) wasindicated for patients with an HHS below 60 points. A number ofstudies have examined participants with mild to moderate OA of thehip [1-5]. In a randomized clinical trial, Bennell et al. [6] implemented
a multimodal physical program for patients with OA of the hip [6].
Their results revealed that the physical therapy program conferred noadditional clinical benefit over a realistic sham condition for 51% ofpatients with moderate to severe OA of the hip, and it was reported
that the program was associated with relatively frequent but mild
adverse effects [6,7]. Most studies of exercise interventions for OA haveexamined muscle strength training, stretching, functional training, andaerobic fitness programs [8]. However, functioning of patients withmoderate to severe OA of the hip has not been reported to improveusing these exercise methods alone.
However, many patients with an HHS below 60 points wish to
postpone surgery for a range of reasons, including work, child-rearing,or caring for parents, when seen on an outpatient basis. We have foundthat many patients with OA of the hip complained of hip pain at standing
and at first step when starting to walk but decreased hip pain during
walking. Many patients experience motion pain with no walking painor mild walking pain. This phenomenon has been observed even inpatients with an HHS below 60 points. We speculate that motion pain
can be caused by contracture of the hip joint, whereas walking pain
can be caused by contact of the subchondral bone after the cartilage
has disappeared from the joint surface. This suggests that motion pain
could be decreased by exercise, whereas walking pain may be decreased
by surgery. An anterior pelvic tilt and elevation of the greater trochanterof patients with OA of the hip can cause apparent shortening of leg
length on the affected side. This apparent difference in leg length can
result in instability while walking. We considered that this instability
may cause repetitive pericapsular soft tissue (joint capsule, ligaments,inner muscles) injury, resulting in contracture of the affected hip. Thus,
correction of pelvic malalignment before a strengthening exercise isnecessary in addition to decontracture exercise of the affected hip todecrease motion pain. Decontracture may provide a useful method toease joint stiffness.
We developed a decontracture and pelvic realignment exercise
technique called the pericapsular soft tissue and realignment of thePhysiother Res Rep, 2018

doi: 10.15761/PRR.1000111

pelvis (PSTR) exercise [9]. In a retrospective study, PSTR exercise
induced significant improvement in patients with OA of the hip (Table
1 and Figure 1) [9]. In addition, PSTR exercise resulted in a significant
improvement even in patients with an HHS below 60 points (Figures 2and 3) [10]. We have begun a multicenter prospective single-arm study
to confirm the effects of PSTR exercise [11]. We plan to investigate thedecontracture test to differentiate between motion pain and walking
pain to determine surgical indications in future studies.

Acknowledgments
PSTR exercise is a part of the Yuki program developed by Teruo
Ooyati (Osaka, Japan). We thank Benjamin Knight, MSc., fromEdanz Group (www.edanzediting.com/ac) for editing a draft of thismanuscript.

Figure 1. HHS change after PSTR exercise in patients with an HHS above 60 and below
59 points at baseline
Unilateral: Group with unilateral OA of the hip (no pain in the opposite hip)Bilateral: Group with bilateral OA of the hip (pain in the opposite hip)*Correspondence to: K Hayashi, Arthritis Center, Fukuoka Wajiro Hospital,Fukuoka, Japan, E-mail: hayashis@giga.ocn.ne.jp
Received: July 03, 2018; Accepted: July 07, 2018; Published: July 26, 2018

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Hayashi K (2018) Pericapsular soft tissue as a pain generator in hip osteoarthritis: considerations for developing a new home exercise to prevent surgery

Figure 2. HHS change after PSTR exercise in patients with an HHS above 60 points at baseline
Unilateral: Group with unilateral OA of the hip (no pain in the opposite hip)Bilateral: Group with bilateral OA of the hip (pain in the opposite hip)Figure 3. HHS change after PSTR exercise in patients with an HHS below 59 points at baseline
Unilateral: Group with unilateral OA of the hip (no pain in the opposite hip)Bilateral: Group with bilateral OA of the hip (pain in the opposite hip)Table 1. Baseline characteristics
Mean ± S.D.

Unilateral Group(n=154)

Age (years)

56.4 ± 14.2

Bilateral Group(n=131)
54.2 ± 12.8

Women, no.(%)

133 (86.4%)

123 (93.9%)

BMI (kg/m2)

22.0 ± 3.3

22.1 ± 3.2

HHS (0-100)

74.14 ± 17.79

65.35 ± 17.24

No. (%) below 59

n=38 (25.0%)n=49(37.4 %)

No. (%) above 60

n=114 (75.0%)

n= 82 (62.6%)

Duration of pain (months)

30.8 ± 50.4

55.7 ± 98.7

Physiother Res Rep, 2018

doi: 10.15761/PRR.1000111

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Hayashi K (2018) Pericapsular soft tissue as a pain generator in hip osteoarthritis: considerations for developing a new home exercise to prevent surgery

Reference
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10. Hayashi K, Ooyati, T, Haruguti, K, Tobo Y (2017) Clinical trials of PSTR exercise(Yuki program) for hip osteoarthritis in patients with a Harris Hip Score below 60
points. Hip Joint 43: 1001-5 (in Japanese).

5. Kemp JL, Moore K, Fransen M, Russell TG, Crossley KM (2015) A phase II trial
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11. Hayashi K (2017) Investigation regarding effects of PSTR (pericapsular soft tissue andrealignment) exercises to improve function in patients with osteoarthritis of the hip anda Harris Hip Score (HHS) below 60 points. (UMIN000028277).

Copyright: ©2018 Hayashi K. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.

Physiother Res Rep, 2018

doi: 10.15761/PRR.1000111

Volume 1(2): 3-3