Avascular Necrosis and Exercise: Unlocking Hip Mobility

INTRODUCTION:

Avascular Necrosis (AVN), also known as osteonecrosis, is a debilitating condition that occurs when the blood supply to bone tissue is disrupted, leading to the death of bone cells. The hip joint is one of the most commonly affected areas, causing pain, reduced mobility, and eventually joint collapse if untreated. While medical interventions such as medications or surgery are often necessary, exercise plays a pivotal role in preserving and improving hip mobility, reducing pain, and enhancing quality of life.

Understanding Avascular Necrosis.

AVN develops when the blood flow to the femoral head (the ball part of the hip joint) is compromised. Common causes include:

• Trauma: Fractures or dislocations that disrupt blood vessels.

• Steroid Use: High doses or prolonged use of corticosteroids.

• Alcohol Consumption: Chronic use can interfere with bone health.

• Medical Conditions: Such as sickle cell anaemia or lupus.

  
  

Symptoms of AVN.

• Gradual onset of pain in the groin, thigh, or buttocks.

• Stiffness and reduced range of motion in the hip.

• Pain that worsens with weight-bearing activities.

If untreated, AVN can progress to arthritis, making early diagnosis and a structured rehabilitation plan crucial.

How Exercise Can Help.

While AVN is a serious condition, carefully planned exercises can:

1. Improve Mobility: Restore the range of motion in the hip.

2. Strengthen Muscles: Support the joint and reduce stress on the femoral head.

3. Alleviate Pain: Promote joint lubrication and reduce stiffness.

4. Delay Progression: Prevent joint degeneration by improving circulation and muscle balance.

   
   

Types of Exercises for Hip Mobility.

1. Low-impact aerobic Exercises

• Swimming: Reduces joint stress while improving cardiovascular health.

• Cycling: Promotes hip motion without heavy weight-bearing.

  
  

2. Range of Motion (ROM) Exercises

• Hip Flexor Stretch:

  • Lie on your back and pull one knee toward your chest.

  • Hold for 20–30 seconds and repeat on the other side.

• Hip Abduction:

  • Lie on your side and slowly lift your top leg upward, keeping it straight.

  • Lower gently and repeat 10–12 times per side.

    
    

3. Strengthening Exercises

• Bridges:

  • Lie on your back, knees bent, and feet flat on the ground.

  • Lift your hips toward the ceiling, engaging your glutes.

  • Hold for 5 seconds and lower. Repeat 10–12 times.

• Clamshells:

  • Lie on your side with your knees bent and feet together.

  • Open your top knee upward while keeping your feet in contact.

  • Repeat 10–12 times.

    
    

4. Core Stability Exercises

A strong core supports overall hip function.

• Plank:

  • Hold a forearm plank for 15–20 seconds, gradually increasing the duration as tolerated.

    
    

5. Stretching and Flexibility

• Pigeon Pose:

  • From a kneeling position, bring one leg forward and extend the other behind you.

  • Lower your hips gently toward the ground.

• Seated Forward Fold:

  • Sit with your legs extended and reach forward toward your toes.

    
    

Precautions While Exercising

• Avoid high-impact activities such as running or jumping, which can worsen joint damage.

• Always consult a healthcare provider or physical therapist before starting any exercise regimen.

• Stop immediately if you experience sharp pain or discomfort during an activity.

  
  

Role of Physiotherapy in AVN Management.

Physiotherapy combines personalized exercises with techniques such as manual therapy, ultrasound, and electrical stimulation to improve hip function and reduce pain. Therapists focus on:

• Strengthening the muscles around the hip.

• Enhancing joint mobility and alignment.

• Designing weight-bearing progression plans to protect the femoral head.

  
  

Lifestyle Changes to Support Recovery.

1. Weight Management: Reduces pressure on the hip joint.

2. Balanced Diet: Ensures bone health with calcium, vitamin D, and essential nutrients.

3. Limiting Alcohol and Smoking: Improves blood circulation to the bones.

4. Assistive Devices: Use of crutches or canes to reduce stress during weight-bearing activities.

   
   

When Surgery is Necessary.

In advanced stages of AVN, surgical interventions such as core decompression, bone grafting, or total hip replacement may be required. Post-surgical rehabilitation is vital for restoring hip mobility and strength, and exercises remain integral to recovery.

Conclusion.

Avascular Necrosis is a challenging condition, but incorporating targeted exercises into a comprehensive treatment plan can significantly improve hip mobility and quality of life. By strengthening muscles, enhancing flexibility, and optimizing joint function, individuals with AVN can maintain active and fulfilling lives. Always work closely with a healthcare provider or physiotherapist to design an exercise program tailored to your condition and goals.

REFERENCE AND RESEARCH ARTICLE :

1.Effect of physiotherapy rehabilitation on stage 4 avascular necrosis of femur following pyogenic arthritis: a case reporthttps://pmc.ncbi.nlm.nih.gov/articles/PMC8895557/

2.Conservative Treatment in Avascular Necrosis of the Femoral Head: A Systematic Reviewhttps://doi.org/10.3390/medsci12030032