In the UK, NSAIDs such as Ibuprofen and Naproxen are routinely prescribed for the management of the symptoms of Hip Osteoarthritis (OA).
The National Institute for Health and Care Excellence (NICE) which provides national clinical guidelines recommend providing pharmacological support ALONGSIDE therapeutic exercise.
The recommendations are for the lowest effective dose of oral or topical NSAIDs. The prescription of paracetamol or weak opioids is discouraged unless pain is not well controlled.
Alongside this, the NICE guidelines recommend prescribing therapeutic exercises such as cardiovascular movement and strengthening regimes.
But is this correct and how does Exercise vs Ibuprofen and Paracetamol stack up?
Hip OA
Hip OA is a degenerative joint disease characterised by the breakdown of the articular cartilage which lines the joint surfaces. This leads to pain (typically, but not exclusively groin pain), stiffness and decreased mobility.
It develops slowly as the cartilage wears down over time. This is Primary OA. Hip OA can also be triggered by a traumatic incident causing damage to the joint. This is Secondary OA.
The deterioration results in the bones rubbing on each other causing pain, inflammation and bone degradation.
Conservative Management of Hip OA
Exercise
The management of Hip OA focuses on pain management, improving joint function and enhancing the quality of life without resorting to surgical interventions.
One of the cornerstone approaches is Physiotherapy. A skilled Physiotherapist will identify the specific symptoms and design a management programme which is personalised and progressive. Exercises such as swimming, cycling and walking as well as strength training to improve the muscles of the legs, hips, gluteals and core will be provided and progressed.
Often group exercises such as Hydrotherapy or swimming pool-based exercises, low-impact aerobic classes or strength training are highly encouraged.
Exercise has been shown to help with the management of pain and improve the symptoms of Hip OA. It also has a great secondary effect of improving cardiovascular function, lowering blood pressure and improving the metabolic factors that can lead to the development and worsening of Hip OA.
You can read more about how metabolic factors impact Hip OA here.
NSAIDs and Paracetomol
Pain management is often addressed through pharmacological means. Non-steroidal anti-inflammatory drugs such as Ibuprofen or Naproxen are commonly used to reduce pain and inflammation.
Paracetamol is an over-the-counter medication that can be used to manage symptoms.
They can be effective at managing short-term pain.
Long-term use of NSAIDs is discouraged due to the potential for long-term side effects such as gastrointestinal issues, cardiovascular problems and renal impairment.
Exercise vs Ibuprofen and Paracetomol for Hip OA
Exercise offers a more sustainable and holistic approach to managing Hip OA. It addresses not only the symptoms but also the mechanical aspects of the disease. It can be seen as a proactive measure that enhances overall health and functional capacity.
Ibuprofen and paracetamol are quick and effective symptom controllers, which can be crucial for acute symptom control and also to facilitate engagement in exercise and other activities.
In a Systematic Review published in the British Journal of Sports Medicine, the comparative efficacy of Exercise vs Ibuprofen and paracetamol was explored. It concluded that Exercise has similar effects on pain and function to that of oral NSAIDs and Paracetamol. It goes on to recommend exercise over pharmacological management due to its low safety profile when compared to the potential side effects of medication.
Practical Application
How do we apply this in real life?
The most successful management programmes for Hip OA incorporate a multimodal approach. By this, I mean incorporating various techniques to make up a holistic strategy for managing the symptoms and preventing the condition’s acceleration.
Exercise represents an important strategy as already seen, but by also addressing factors such as obesity, diet and hydration, we can compound the beneficial effects.
When pain is significant and preventing the fulfilment of exercise or restricting your activities of daily living, Ibuprofen and Paracetamol should be considered as a short-term option.
Consider using pain relief such as Ibuprofen or Paracetomol when in OA flare or when the pain is preventing you from completing exercise programmes designed to help with OA management.
It can also be used alongside heat or Ice, using walking aids and modifying the load placed on the Hip.
Lifestyle changes are the most effective way of managing OA. Make these the most important strategies for managing your OA symptoms for the best results.
If you’ve enjoyed this article, take a look at my other articles here.
