Table 4

Suggested alternative health messages when communicating with people with persistent hip pain

Health messages reported by participants in the study linked with unhelpful health behavioursAlternative evidence-based health messages that aim to promote positive health behaviours for people with hip pain
Your hip pain is due to damaged structures in your hip joint (eg, labral tears and arthritis)‘Pathoanatomical’ changes such as labral tears and hip joint arthritis are common in pain-free populations.30 This means that other factors are also important to explain hip pain.
Pain in the hip structures is influenced by multiple factors such as sleep, fatigue, mood, strength, physical activity and body weight.40 Many of these factors are influenced by things you can do for yourself. We can make a plan to address these.
Hip tendons spontaneously break down in people over 50 years… loading them will damage them further‘Pathoanatomical’ changes relating to the hip tendons are common in pain-free populations. Tendon health is influenced by lots of factors such as muscle strength, engagement in physical activity, psychological health and levels of obesity.54 55 Addressing these factors can keep tendons healthy with ageing. It is important to know that it is safe and helpful to engage in graduated exercise with tendon tears—rest and activity avoidance is unhelpful.43
Your hip is unstable and needs controlling and stabilisingHip joints are very stable structures.56 Maintaining muscle strength and mobility around the hip is important for joint health, while guarding and holding muscles tense can be unhelpful.
Being too lordotic can lead to wear/arthritis on your hipsThere is no evidence that spine and pelvis posture predicts hip arthritis. People have a range of postures and body shapes and the body can learn to adapt to movement and load.
Engaging in weight bearing and loaded exercise will damage the hip structures moreEngaging in graduated weight bearing exercise is safe and does not damage the hip structures in people with osteoarthritis. In fact exercise is important to maintain the health of your joint.57
With your damaged/arthritic hip structures a joint replacement is inevitableDeveloping an understanding of your hip pain, building confidence to move, getting strong and active, as well as maintaining a healthy body weight, can reduce pain, disability, need for medication and in many cases the need for surgery.43
I think we better get you on some antidepressants to manage your mental health, as exercising vigorously like you used to in order to manage your mental health is not safe for you nowPhysical activity is important for mental health.58 Exercise is safe as long as it is graduated and has huge health benefits.57
You need a cortisone injection for your hip painWhile cortisone injections can provide short-term pain relief for some people, the effects do not last59 60 and may increase osteoarthritis progression especially when repeated.61
Understanding the factors linked to your pain, building confidence to strengthen your hip, becoming active and managing your weight is a more effective way to manage your pain in the long run.43