18.104.22.168 CAM Education
Anatomy and Pathogenesis & Understanding Symptoms:
a. Your hip joint is a ball-and-socket joint that connects the top of your thighbone (femur) to the socket in your pelvis (acetabulum). It allows for smooth movement and stability. Additionally, there is a ring of cartilage called the labrum that lines the rim of the acetabulum, providing cushioning and stability to the joint.
b. In femoral acetabular impingement (FAI), there can be abnormal bone growth or alignment in your hip joint. This can happen due to factors like genetics, repeated hip movements, or certain sports activities. As a result, the bones of the hip joint can come into contact with each other in ways they normally shouldn’t, causing impingement. This repetitive rubbing or pinching motion can potentially damage the labrum and the smooth cartilage that covers the ends of the bones.
c. The symptoms of FAI can vary from person to person. Some common symptoms include groin pain, which is usually felt deep in the front of your hip. You may also experience hip stiffness, making it difficult to move your hip freely. Clicking or catching sensations in the hip joint can occur when the bones rub against each other or the labrum gets caught. Additionally, FAI can limit your range of motion, making it challenging to perform certain activities or movements without discomfort.
Physical Activity & Rest
a. Encourage the patient to maintain an active lifestyle while modifying activities that aggravate their symptoms.
b. Suggest low-impact exercises such as swimming, cycling, or walking to maintain cardiovascular fitness and overall health.
c. Promote regular, adequate sleep as it plays a crucial role in pain modulation and overall well-being.
Nutrition & Supplementation
- Avoid irritating the gut: Irritation of the gut can contribute to inflammation and dysregulation of the immune system, which can worsen central sensitization pain. To reduce gut irritation, it’s important to identify and avoid any foods or substances that may trigger inflammation or aggravate existing gut issues (such as irritable bowel syndrome). This may involve working with a healthcare practitioner to identify potential triggers and develop a personalized dietary plan.
- Support a healthy gut microbiome: The gut microbiome plays an important role in regulating immune function and inflammation, and imbalances in gut bacteria can contribute to central sensitization pain. To support a healthy gut microbiome, it’s important to consume a diverse range of fiber-rich plant foods (such as fruits, vegetables, legumes, and whole grains), as well as fermented foods like kimchi, sauerkraut, and kefir. Probiotic supplements may also be helpful in some cases.
- Consider dietary neurotransmitters: Some neurotransmitters (such as serotonin and GABA) are produced in the gut, and imbalances in these neurotransmitters can contribute to central sensitization pain. Consuming foods that are high in precursors to these neurotransmitters (such as tryptophan and glutamine) may help support healthy neurotransmitter production. Foods that are high in glutamine include caviar, fermented beans (such as tempeh), meats, mushrooms, seafood, seaweeds, soy products (such as miso), spinach, tomato, and tamari and oyster sauces.
- Consume omega-3 fatty acids: Omega-3 fatty acids have anti-inflammatory properties and may help reduce central sensitization pain. The current best guess for optimal omega-3 intake is around 2 grams per day for a healthy adult weighing 70kg. Good sources of omega-3s include fatty fish like salmon and mackerel (eating 50g of either will provide 1g of omega-3s), as well as chia seeds and flax seeds.
- Typically I recommend a mediterranean style diet. The Mediterranean diet emphasises whole, nutrient-dense foods such as fruits, vegetables, whole grains, legumes, nuts, and fish, while limiting processed and refined foods. This can help to reduce inflammation in the body, which is a key factor in central sensitization pain.
- The diet is high in anti-inflammatory nutrients such as omega-3 fatty acids, antioxidants, and polyphenols, which can help to decrease inflammation and oxidative stress in the body.
- The Mediterranean diet also includes healthy fats such as olive oil, which has been shown to have anti-inflammatory effects and may help to reduce pain and inflammation.
- The diet is low in processed and refined carbohydrates, which can contribute to inflammation and insulin resistance. By reducing these foods, the Mediterranean diet can help to regulate blood sugar levels and decrease inflammation.
- The diet is rich in fiber, which can help to improve gut health and support a healthy gut-brain axis. This is important for those with central sensitization as gut health can affect pain and inflammation in the body.
- The Mediterranean diet emphasizes moderate consumption of alcohol, primarily red wine, which has been shown to have anti-inflammatory and antioxidant effects. However, it is important to note that excessive alcohol consumption can have negative effects on health and should be avoided.
- Overall, the Mediterranean diet can help to improve overall health and reduce inflammation in the body, which may help to reduce central sensitization pain.
- Generally I would recommend a more mediterranean diet however it may be worth trying a ketogenic diet and seeing how you feel. The ketogenic diet is a high-fat, low-carbohydrate, and moderate-protein diet that has been shown to have a variety of health benefits, including potentially reducing central sensitization pain. Here are some possible mechanisms by which the ketogenic diet may help with pain:
- Reduced inflammation: The ketogenic diet has been shown to reduce inflammation throughout the body. Inflammation is a major contributor to pain and can increase the sensitivity of the nervous system. By reducing inflammation, the ketogenic diet may help to decrease pain sensitivity.
- Improved mitochondrial function: The ketogenic diet may improve mitochondrial function, which is important for energy production in cells. By improving mitochondrial function, the ketogenic diet may help to reduce oxidative stress, which is another contributor to pain.
- Reduced glucose metabolism: The ketogenic diet shifts the body’s metabolism away from glucose and toward ketones. This may be beneficial for people with central sensitization pain because glucose metabolism can lead to the production of advanced glycation end products (AGEs), which are known to contribute to pain.
- Increased GABA: The ketogenic diet may increase the production of gamma-aminobutyric acid (GABA), a neurotransmitter that has been shown to have a calming effect on the nervous system. By increasing GABA production, the ketogenic diet may help to reduce pain sensitivity.
- Improved gut health: The ketogenic diet may improve gut health by reducing inflammation and improving the balance of gut bacteria. This is important because gut health is closely linked to overall health, and poor gut health has been linked to a variety of chronic pain conditions.
- It’s important to note that the ketogenic diet is not for everyone and should be approached with caution. It’s best to work with a healthcare practitioner who is knowledgeable about the ketogenic diet before making any major changes to your diet. Additionally, it’s important to make sure that you’re getting all the necessary nutrients on a ketogenic diet, as it can be easy to miss out on certain vitamins and minerals.
- Prioritize Gut Health: Irritation of the gut can worsen hip impingement pain by contributing to inflammation and immune system dysregulation. To alleviate gut irritation, it’s crucial to identify and avoid foods or substances that trigger inflammation or aggravate existing gut issues, such as irritable bowel syndrome. Collaborating with a healthcare practitioner to pinpoint potential triggers and develop a personalized dietary plan is recommended.
- Support a Healthy Gut Microbiome: The gut microbiome plays a vital role in regulating inflammation and immune function, both of which impact hip impingement pain. To foster a healthy gut microbiome, ensure your diet includes a diverse range of fiber-rich plant foods like fruits, vegetables, legumes, and whole grains. Incorporating fermented foods such as kimchi, sauerkraut, and kefir can also be beneficial. In some cases, probiotic supplements may provide additional support.
- Consider Dietary Neurotransmitters: Imbalances in neurotransmitters produced in the gut, like serotonin and GABA, can contribute to hip impingement pain. Including foods rich in precursors to these neurotransmitters, such as tryptophan and glutamine, may aid in promoting healthy neurotransmitter production. Glutamine-rich foods include caviar, fermented beans (like tempeh), meats, mushrooms, seafood, seaweeds, soy products (such as miso), spinach, tomato, and tamari and oyster sauces.
- Consume Omega-3 Fatty Acids: Omega-3 fatty acids possess anti-inflammatory properties that can help reduce hip impingement pain. The recommended daily intake of omega-3s for a healthy adult weighing 70kg is around 2 grams. Good sources of omega-3s include fatty fish like salmon and mackerel (eating 50g of either provides 1g of omega-3s), as well as chia seeds and flax seeds.
- Mediterranean Diet Approach: Generally, a Mediterranean-style diet is recommended for hip impingement pain. This diet focuses on whole, nutrient-dense foods such as fruits, vegetables, whole grains, legumes, nuts, and fish, while limiting processed and refined foods. The Mediterranean diet helps reduce inflammation in the body, a key factor in hip impingement pain. Its anti-inflammatory nutrients like omega-3 fatty acids, antioxidants, and polyphenols can decrease inflammation and oxidative stress. Additionally, healthy fats such as olive oil, which has anti-inflammatory effects, may help alleviate pain and inflammation.
- Consider Ketogenic Diet: Although a Mediterranean diet is often advised, it may be worth exploring a ketogenic diet to assess its impact on hip impingement pain. The ketogenic diet is a high-fat, low-carbohydrate, and moderate-protein diet associated with various health benefits, including the potential reduction of hip impingement pain. Here are some mechanisms by which the ketogenic diet may help with pain:
- Reduced Inflammation: The ketogenic diet has demonstrated an ability to reduce inflammation throughout the body, which is a major contributor to pain and can heighten nervous system sensitivity.
- Improved Mitochondrial Function: The ketogenic diet may enhance mitochondrial function, crucial for cellular energy production. By improving mitochondrial function, the diet can help reduce oxidative stress, which contributes to pain.
- Reduced Glucose Metabolism: Shifting away from glucose metabolism, the ketogenic diet can mitigate the production of advanced glycation end products (AGEs), known contributors to pain.
- Increased GABA: The ketogenic diet may stimulate the production of GABA, a neurotransmitter with calming effects on the nervous system. By increasing GABA production, the diet may help reduce pain sensitivity.
- Improved Gut Health: The ketogenic diet has the potential to improve gut health by reducing inflammation and rebalancing gut bacteria, which is significant as gut health correlates with overall well-being and is linked to various chronic pain conditions.
Note: The ketogenic diet is not suitable for everyone and should be approached cautiously. It is advisable to work with a knowledgeable healthcare practitioner before making significant dietary changes. Additionally, it’s important to ensure you receive all necessary nutrients on a ketogenic diet, as certain vitamins and minerals may be easily overlooked.
- Limit Caffeine Intake: Caffeine, a stimulant, can worsen hip impingement pain by activating the stress response and increasing cortisol levels. The recommended daily limit for caffeine is 400mg for a healthy weight individual (70kg). Keep in mind that one cup of coffee contains approximately 100mg of caffeine, while Moka coffee contains around 200mg. Black tea has about 47mg of caffeine, and green tea has approximately 30mg. It’s advisable to limit caffeine intake, particularly in the afternoon and evening.
- Restrict Alcohol Intake: Alcohol can disrupt sleep and increase inflammation, potentially exacerbating hip impingement pain. Moderate alcohol consumption is recommended, defined as up to one drink per day for women and up to two drinks per day for men.
- Avoid Sugary Drinks: Sugary drinks can heighten inflammation and disrupt the balance of gut bacteria, leading to gut dysbiosis associated with hip impingement pain. It’s advisable to avoid sugary drinks and instead opt for water, herbal teas, and low-sugar alternatives.
- Consider Impact on Histamine and Glutamate Levels: Certain drinks, like fermented beverages, may contain elevated levels of histamine and glutamate, which can worsen hip impingement pain. It’s essential to be mindful of the impact of drinks on histamine and glutamate levels, limiting intake if necessary.
Remember that personalized nutrition and lifestyle plans are crucial for effectively managing hip impingement pain, as individual responses can vary. Collaborate with a healthcare professional to develop a plan tailored to your specific needs and condition.
Stress Management & Psychology
- Practice relaxation techniques: Relaxation techniques such as deep breathing, meditation, and yoga can help to reduce stress and anxiety, which in turn can help to reduce central sensitization pain.
- Develop a positive mindset: Focusing on positive thoughts and feelings can help to shift your attention away from pain and reduce stress. It can also help to cultivate resilience and reduce the risk of developing depression and anxiety.
- Exercise regularly: Exercise can help to reduce stress and improve mood, which can be beneficial for people with central sensitization pain. However, it’s important to start with low-impact exercises and gradually increase intensity to avoid triggering pain.
- Get enough sleep: Sleep is essential for the body to repair and regenerate, and getting enough sleep can help to reduce stress and improve mood. Aim for 7-9 hours of sleep per night and establish a regular sleep routine.
- Practice mindfulness: Mindfulness involves being present and fully engaged in the moment, and can help to reduce stress and improve mood. Consider practicing mindfulness meditation or other mindfulness-based activities.
- Seek support: It can be helpful to seek support from friends, family, or a support group. You may also consider talking to a mental health professional who can provide additional support and guidance.
- Identify and modify negative behaviors: Negative behaviors such as procrastination, avoidance, and negative self-talk can increase stress and exacerbate pain. Identifying and modifying these behaviors can help to reduce stress and improve overall well-being.
- Aim to get at least 15 minutes of sunlight a day where possible, preferably first thing in the morning
- Exposure to moonlight before bed may also be beneficial
- Take 1000 IU of vitamin D when not getting good sun exposure
Time in Nature:
- Get a 10-15 minute walk in nature daily where possible, even if it’s just a park in the city
- Spending time in nature decreases levels of pro-inflammatory cells that increase our sensitivity to painful stimuli
- Positive social interactions are very beneficial for reducing systemic inflammation
- The quality of our relationships directly affects our levels of inflammation
- If you have a pet you enjoy spending time with, prioritize this! It increases oxytocin levels in both you and your pet, improving stress handling and psychological health, which is closely associated with outcomes in chronic pain
- A cold shower first thing in the morning appears to improve testosterone levels, pain tolerance, immune markers, and maybe longevity. Even as little as 30 seconds can help.
- Do not use a cold shower post-exercise as it may diminish the immune response
Baths or Hot Showers:
- A 10-20 minute bath before bed is ideal
- Adding 4 cups of Epsom salts may aid relaxation
- Long-term sauna usage is associated with lower levels of systemic inflammation
- Music you enjoy can improve pain tolerance and immune function
- London tap water may contain antibiotic-resistant bacteria, so avoid it where possible
- Poorer air quality increases levels of inflammation in the brain
- If you live in an area of poor air quality, get away as often as you can
- Preliminary research suggests WiFi signals may influence our immune cells and skin bacteria
- Limit exposure to WiFi where possible, e.g. turn it off at night
- Paints, in particular, can contain toxic substances that increase cancer risk, respiratory symptoms, and “sick building syndrome”
- Mold can cause fatigue, brain fog, and musculoskeletal symptoms
- Avoid damp environments and get assessed if you have these symptoms for no obvious cause.