Introduction
Developmental Dysplasia of Hip (DDH) is a congenital anomaly in which the hip joint develops defective. The baby may present with abnormal twisting or movements of the hip joint. The parents might notice a slight difference in the length of baby’s both legs that become evident once the child starts walking. Though it is an anomaly by birth, very early diagnosis and proper management can help correct the condition almost completely. Most cases of DDH are identifies in infancy or early childhood with difficulty in walking or an abnormal gait.
Signs and symptoms of DDH
- Hip joint that is stiff
- Lower limbs with different length
- While in standing position, the patient leans to the side affected
- The affected side foot tends to tilt towards the outside
- Thick and uneven folds of skin in groin or upper part of thigh
Causes of DDH
Exact cause of DDH is not known yet but some risk factors are found with increased risk, as follows:
- First born child as they are more tightly packed inside the uterus
- Breech presentation in the last phase of pregnancy
- Family history with similar condition
- Female children are affected more than male ones
Pathophysiology of DDH
DDH starts with genetic alterations and is mostly established from birth or early infancy. DDH is a wide spectrum of disorders associated with an abnormality of development of acetabulum and proximal femur, resulting in mechanical instability of the hip joint. It can develop with or without the dislocation of the hip joint.
Diagnosis of DDH
- Physical examination-the Ortolani test and Barlow manoeuvre
- Proper history taking with special reference to the family history
- Ultrasound scan
Treatments for DDH
A very early diagnosis of DDH can be managed by a fabric splint named as Pavlik harness, that keeps the hip of the baby with stability, enabling normal development to an extent.
Other treatment options include braces, hip spica (plaster cast), rehabilitation procedures and surgery. Surgical corrections to the ligaments in and around the hip help in DDH. In children below two years, a non-surgical procedure known as closed reduction is found beneficial. Though non-surgical, this procedure is done under anaesthesia.
Prognosis of DDH
The result of the treatment depends upon the time of diagnosis and intervention. If diagnosed and treated in the early infancy, most children get cured almost completely. But if not properly managed, DDH can lead to many complications including osteoarthritis.
Complications of DDH
- Difference in length of the limbs
- Painless limp
- Osteoarthritis
- Hip labral tear
DDH and Ayurveda
Sandhigatavaata
Sahaja Vaataroga
Nidana-Ayurvedic causes
Dhaatukshaya(degeneration)
Aavarana(obstruction to channels in the body)
Poorvarupa- Ayurvedic premonitory signs and symptoms
Not mentioned
Samprapti-Ayurvedic pathogenesis
In SandhigataVaata, the Vaata dosha gets vitiated due to the causative factors and gets lodged in the joints causing pain and swelling. It can happen at the hip joint also especially when it becomes sahaja or a birth defect.
Lakshana – Ayurvedic signs and symptoms
Vaatapoornadrutisparsam – Feel of an air-filled bag on touch
Sopham – Swelling
Prasaaranaakunchanayo: savedanaam pravrthim- Painful movements of joints like flexion and extension
Sadhyasadhyata-Ayurvedic prognosis
Yaapya(manageable with medicines, therapies and Pathya)
It is saadhya/krichrasadhya if it is new and involves only singe joint.
Chikitsa-Ayurvedic treatment
Samana
Lepana or herbal paste with soolaharadravyas (herbal medicines that reduce pain)
Parisheka or herbal wash with soolaha-sothahara dravyas (herbal medicines that reduce pain and swelling)
Upanaha or bandage with herbal paste inside it on the joint with Vaataharadravyas(herbal medicines that pacify Vaata dosha)
Sodhana
Sneha (Abhyanga)-medicated oil massage
Sweda (Potalisweda)-bolus therapy with herbs
Vasti-herbal enema
Virechana-herbal therapeutically induced purgation
Raktamokshana-blood letting
Commonly used Ayurvedic medicines
Maharasnadi kashayam
Amruthotharam kashayam
Kaisoraguggulu
Guggulutiktakaghrutam
Home remedies
Pain medications to manage the pain.
The RICE mnemonic is helpful, especially when the pain if injury happens:
Rest: Rest the joint, take a break from activities involving the affected joint.
Ice: Applying ice pack locally
Compress: A compression bandage can help prevent swelling and help alignment. It should not be too tight and should be removed at night.
Elevate: Elevation while helping can help with blood flow and remove any swelling
Diet and behaviour suitable for DDH
- To be avoided
Heavy meals and difficult to digest foods that cause indigestion.
Junk foods that cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks making the stomach more acidic and disturbed digestion
Refrigerated and frozen foods that cause weak and sluggish digestion by weakening Agni (digestive fire)
Curd causing vidaaha and thereby many other diseases.
- To be added
Light meals, warm and easily digestible foods
Green gram, veg soups, sesame oil.
Ragi products
If having good digestive power, have milk and milk products except curd
Freshly cooked and warm food processed with spices like cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Avoid excess physical exercise, continued sitting and a sedentary lifestyle
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid climbing of stairs.
Yoga and Pranayama
Vigorous exercises are not allowed in very painful conditions.
Only stretching, moderate walking, and mild cardio exercises are advised
Children with DDH can be allowed to do Sookshma Vyayama involving all the joints especially hip
Adults with DDH can perform Vrikshasan, Taadasana, Pascimotthanasana etc to improve the mobility of the hip joint.
Research papers
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192282/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850778/
The Food and Drug Administration, United States has not evaluated these statements. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
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Writer:
Consultant,
Ayurveda Medicine, India
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
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