Does your car need an MOT?
My youngest son, Marcus, drove his old Morris Minor across the Sahara desert down to the Gambia a few yrs ago. It’s an old car and is exempt from having an MOT. I always say to him: ‘I still think that having an MOT is a good idea’…..
Several years ago I was giving a talk to a group of GPs about chiropractic.
One of them questioned me about ‘maintenance care’: ‘What is it with chiropractors getting patients back for an ‘MOT’ when they are feeling fine? What’s the point of that’?
I said that if someone comes to us with right sacro-iliac pain, for instance, and the sacro-iliac joint is tender to palpation, it’s quite possible that it will respond favourably to some manipulative treatment [1, 2]. That may take a few treatments, everyone is different.
As chiropractors though, we attempt to find out WHY the sacro-iliac joint become painful in the first place. There will always be a reason. One common reason is that the ipsilateral hip joint will have some degenerative changes and limited movement [3, 4].
In a case like this there is no point discharging the patient, because the pain will keep recurring. We want to do everything that we can to keep that hip functioning as well as possible: hip rehab exercises [5], weight management [6] and manual therapy to improve and maintain hip function empirically makes sense [7], although it’s efficacy is low [8,9] . It’s going to be an ongoing process, a bit like swimming upstream. So a periodic MOT makes sense to me.
Eventually that hip joint may require surgical replacement. At that point the reason to see the patient evaporates [10]. Unless the other hip is following suit……
Marcus tells me that his Morris Minor does have an MOT, but I’m not convinced……
Questions:
What activities typically are difficult for a patient with unilateral hip OA?
When you examine a patient with hip OA, which movement normally becomes limited first: external rotation, or internal rotation?
How important is hip mobility in patients with spinal stenosis?
How do you mobilise a hip?
Do you think that vintage cars should be exempt from having an MOT?
I am a chiropractor and sonographer. I also mentor colleagues to help them become the clinicians that they want to become. Find out more here.
References:
1. Nejati, P., A. Safarcherati, and F. Karimi, Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician, 2019. 22(1): p. 53-61.
2. Shokri, E., et al., Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study. Chiropr Man Therap, 2018. 26: p. 16.
3. Weiner, D.K., et al., Deconstructing chronic low back pain in the older adult--step by step evidence and expert-based recommendations for evaluation and treatment: part I: Hip osteoarthritis. Pain Med, 2015. 16(5): p. 886-97.
4. Eguchi, Y., et al., Spinopelvic Alignment and Low Back Pain after Total Hip Replacement Arthroplasty in Patients with Severe Hip Osteoarthritis. Asian Spine J, 2018. 12(2): p. 325-334.
5. Miller, K.A., et al., Implementing an osteoarthritis management program to deliver guideline-driven care for knee and hip osteoarthritis in a U.S. academic health system. Osteoarthr Cartil Open, 2024. 6(2): p. 100452.
6. Tanaka, S., et al., Factors related to low back pain in patients with hip osteoarthritis. J Back Musculoskelet Rehabil, 2015. 28(2): p. 409-14.
7. Murphy, N.J., J.P. Eyles, and D.J. Hunter, Hip Osteoarthritis: Etiopathogenesis and Implications for Management.
8. Beumer, L., et al., Effects of exercise and manual therapy on pain associated with hip osteoarthritis: a systematic review and meta-analysis. Br J Sports Med, 2016. 50(8): p. 458-63.
9. Wang, Q., et al., Manual Therapy for Hip Osteoarthritis: A Systematic Review and Meta-analysis. Pain Physician, 2015. 18(6): p. E1005-20.
10. Ran, T.F., et al., Relieved Low Back Pain after Total Hip Arthroplasty in Patients with Both Hip Osteoarthritis and Lumbar Degenerative Disease. Orthop Surg, 2021. 13(6): p. 1882-1889.
