Avascular necrosis, or osteonecrosis, is a condition in which your bone tissue dies due to a lack of sufficient blood supply. This can happen for several reasons including use of high-dose corticosteroids, injury, excessive consumption of alcohol, chemotherapy, radiation and sickle cell disease. Osteonecrosis can affect any bone, but most commonly occurs in the hip joint. Exercise is often recommended as part of the initial treatment plan to heal the bone or delay surgery.
Exercise promotes the flow of blood to the joint. This provides nutrients to the bone to allow it to heal, as well as alleviates pain. In "Physical Therapy Alone Compared with Core Decompression and Physical Therapy for Femoral Head Osteonecrosis in Sickle Cell Disease," Heumayr et al. report that physical therapy alone was equally effective as surgery and physical therapy combined for patients with osteonecrosis of the femoral head. Eighty-two percent of the cohort treated with core decompression and physical therapy reported no collapse of the femoral head after three years, compared with 86 percent of the cohort treated with physical therapy alone. The researchers noted that 90 percent of patients will experience collapse of the femoral head in the five years succeeding diagnosis. This suggests that physical therapy may be an effective way to stave off surgery.
Increase Your Range
The goal of range of motion exercises is to maintain or increase joint flexibility. Avascular necrosis can cause your joints to become stiff and difficult to move. Sometimes, this can go unnoticed for some time so it is imperative that these exercises are initiated as soon as the diagnosis is made.
Strengthen Against Injury
Strengthening exercises are aimed at building the muscles surrounding the joint to help to protect it from injury. This may include weight lifting or resistance band exercises.
Don't Do This
Avoidance of weight-bearing exercise on the affected joint is one of the most vital things you can do to delay damage to the joint, notes the University of California Davis Cancer Center. By avoiding weight-bearing exercise, the amount of pressure put on your bone is reduced and the bone is allowed to heal. Your doctor may recommend using devices, such as crutches, to limit the amount of weight put on the affected joint. He may also recommend reducing involvement in certain weight-bearing activities or switching to a different activity.
The Last Word
Your doctor will determine if exercises are appropriate for you. Exercises are usually recommended as part of an initial treatment plan if the diagnosis is made early and it is possible to curtail further joint damage. Unfortunately, for most individuals, exercise will only delay the need for surgery and relieve pain temporarily. Surgery is eventually necessary for most people to repair the bone.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: Osteonecrosis
- University of California Davis Cancer Center: Avascular Necrosis
- Journal of Bone and Joint Surgery: Physical Therapy Alone Compared With Core Decompression and Physical Therapy for Femoral Head Osteonecrosis in Sickle Cell Disease; LD Neumayr, et al.