Date: April 3, 1956
Occasion: The Milton Berle Show
Location: USS Hancock, an aircraft carrier at San Diego’s Naval Air Station
Significance: 21-year-old Elvis Aaron Presley performs “Heartbreak Hotel” and “Blue Suede Shoes,” his hip gyrations earning the burgeoning superstar the sobriquet, “Elvis the Pelvis”
However, certain conditions produce pain and disability with such movements, or even while walking or at rest. In reviewing some of these causes and their treatments, we are going to weave in the songs of Mr. Pelvis – see how many you can spot; there are 35 and a checklist is available!
Any hip disease or damage may induce discomfort, impair movement, and, possibly, generalized symptoms including fever. Pain evolved to warn us of damage meriting attention, a hand too close to the fire prompting withdrawal or joint pain necessitating rest. My way of categorizing causation is to look at conditions present at birth or acquired by accident, infection, environment and so on.
Elvis had a stillborn twin brother, Jessie Garon Presley, hence some people spell Elvis’ middle name Aron. Sometimes a child comes into our wonderful world with a hip deformity, or dysplasia, predisposing to problems later in life. For instance, a shallow socket or poorly angled femoral head ball causing pain, a limp or significant leg length difference.
While something rarely seen nowadays, rickets, triggered by insufficient vitamin D and calcium, produces osteomalacia, or “soft weak bones” leading to painful deformity. Adults can also suffer, sometimes from underlying kidney, liver or metabolic disease. If unvaccinated, tuberculosis can infect joints, leading to degeneration, a common occurrence in some countries.
Smoking interferes with blood vessel and cell health, and the hip, like everywhere in our body, needs a good supply of oxygen and food. Without this, the bone may deteriorate from puffing tobacco, another reason to quit! Bone can be killed from diminished blood supply in avascular necrosis, which literally means “dead from lack of blood.” This can present at any age, but most commonly between 30 and 50 years from sickle cell anemia, the rare Gaucher’s disease or, for the gym rats out there, steroids – just a little bit, even one dose, can do it. You will really understand what beach boy blues means if your hip crumbles as you aim to get buff!
If you get all shook up in a motor vehicle accident, the force of collision might be transmitted through your leg and terminate with a broken hip. Similarly, alcohol, age or other circumstances mean you can’t help falling over, thereby fracturing a hip. One may have double trouble when osteoporosis, or bone thinning, occurs with age. Although women are more commonly afflicted, men can develop this, making even minor trauma raise the fracture risk. Good diet, high impact exercise, such as running, and avoiding smoking help head it off. Name me anything that’s part of you that smoking does not damage! Maybe you have seen those TV commercials “help me, I’ve fallen, and I can’t get up”? Tumbles in the elderly are sadly very common, and emergency service alert systems might ensure your aged relative receives rapid treatment for a hip fracture which could otherwise prove fatal. Just a little bit of prevention can have a huge impact. Or prevent one.
Hip fractures usually occur at the neck where the femur angles to the head, as this area has an inherently poor blood supply. Surgery is required to replace either the top of the femur alone or maybe in conjunction with the “cup” it sits in with metal, plastic or ceramic components.
Acute hip pain provoked by specific movements may imply a tear of ligaments or muscles around the joint. Be sure to recount your memories of how this happened to your doctor, whether it be a fall on a snowy Christmas night or by some other means. One specific structure, the tensor fascia lata, found on the front side of the joint, can be damaged by repetitive actions such as playing golf. And if you want to give up golf, that’s all right, just don’t give up flying! Rest, anti-inflammatory medications, icing, physiotherapy and specific exercises may resolve these problems, but it may take time to patch it up and in the interim, undue joint strain from sitting awkwardly or carrying heavy loads should be avoided.
Come what may, the most common reason for hip pain and disability is osteoarthritis due to wear and tear, a function of age and obesity. About 58 million Americans have osteoarthritis and in roughly half, their activities are limited by disease. This diagnosis is always on my mind when I see an older person with hip pain, although the source may be in the spine, being referred to the hip, and likewise, hip pain can be referred to the knee. Once diagnosed by clinical examination and radiographs, treatment will initially address pain, exercises to strengthen muscles, occupational therapy to teach new ways to deal with activities of daily living and hip replacement, when the patient asks themselves “am I ready” to have this operation. A hundred years from now – and hopefully much sooner – we will have regenerative medicine technologies with stem cells, drugs and tissue scaffolds to repair diseased or traumatized joints.
Another form of joint inflammation is rheumatoid arthritis, which commonly commences with smaller joints such as fingers and elsewhere in your arms and legs. In addition to pain, early morning stiff joints and generalized symptoms affecting skin, liver and other organs may be present. After a thorough examination, the doctor will confirm the causation with specialized blood tests, and often symptoms can be controlled with advanced medicines that target the immune process at the root of the problem.
Years ago, I got stung by an insect on my palm and developed a swollen wrist. If you get stung or bitten on your leg by a hound dog, you might develop a high temperature, feel shivery, notice red skin with lines and a tender feeling in your hip. Such septic arthritis is a medical emergency, as infections from bites can be very nasty and merit aggressive treatment with antibiotics and maybe even surgery to remove infected tissue
If hurt is never-ending, even at rest, and maybe in several bony areas, doctors will have suspicious minds that a cancer has spread to these locations. This most commonly happens with prostate, lung and breast tumors, and although this spells trouble, symptomatic improvement can be achieved with radiotherapy
Once in a blue moon there is a more esoteric cause that might arouse the doctor’s suspicion such as Paget’s disease, where bone is replaced in a disorderly manner and the pelvis ends up thick and deformed. If the cause of pain is not obvious, it is critical to find out what’s happening as soon as possible to direct appropriate treatment.
As we age, it is common to develop aches and pains in places you didn’t even know you had. If your hip hurts, see your physician if it has come on suddenly, is constant, worsening or interferes with ambulation – or flying, of course. Should there be other symptoms, then set aside a little less conversation and get thee to a doctor because it’s potentially now or never! Treatment, and the effect on your time in the left seat, will vary with cause, but as always, if you want a happy ending, deal with your health first, then the flying.
A song made famous by The Beatles and The Swinging Blue Jeans was originally a hit for Chan Romero in 1959, and although obscure in the US, it was a hit in Australia. “The Hippy Hippy Shake” was one of many songs said to be about “...dancing in an uncontrolled manner,” and maybe it was Presley’s mobile hips that started the craze. Regardless, if your hips are not up to shaking to the left, shaking to the right and shaking with all your might, consider gyrating to your doctor so you can continue to fly well! Happy Holidays and New Year!
You can send your questions and comments to Dr. Sackier via email: [email protected] and listen to his weekly podcasts at: https://www.emjreviews.com/type/podcasts/?page_from=1&page_to=3
And if you want to check if you found all the Elvis references, email me and I shall send a checklist!