Introduction

Hip osteoarthritis is a condition characterized by pain and limited range of motion caused by joint wear and deformation. However, recent research has revealed that “chronic inflammation” and “circulatory insufficiency” are fundamentally involved in its underlying mechanisms.

As a physical therapist working with many patients with hip osteoarthritis, I have experienced the complexity of symptoms that cannot be explained solely by “cartilage wear” or “joint deformation.”

From an osteopathic perspective, based on the fundamental principle that “the body is a unit,” hip joint symptoms can be understood as phenomena closely related to the systemic circulatory system.

“Why do joints hurt?” “Why is recovery difficult?” The answers to these questions lie in the inflammation and blood flow problems occurring in the hip joint and inside the bone (bone marrow), as well as in systemic circulatory dynamics.

Today, I will organize the relationship between chronic inflammation and circulation in hip osteoarthritis based on anatomical and physiological evidence, and discuss the approaches to enhance natural healing capacity that osteopathy can provide.

1. Chronic Inflammation and Circulatory Insufficiency: Understanding Pathology at the Bone Marrow Level

Pathological Recognition Beyond Conventional Understanding

When discussing joint inflammation, “synovitis” and “articular cartilage wear” tend to receive attention. However, from my anatomical knowledge as a physical therapist, I understand that more profound and complex phenomena are actually occurring.

Bone Marrow Level Inflammation (Bone Marrow Lesions: BMLs) Recent MRI studies have shown that in hip osteoarthritis pain manifestation, inflammation at the bone level = bone marrow level plays an important role as a source of chronic pain.

Particularly, edema (bone marrow inflammation) occurs within the cancellous bone of the femoral head and acetabulum, and these areas are believed to function as pain sensors.

Osteopathic Understanding: Relationship with Primary Respiratory Mechanism

In osteopathy, we consider that craniosacral rhythm affects systemic body fluid circulation.

Relationship Between Central Nervous System and Bone Marrow Circulation

• Cerebrospinal fluid circulation abnormalities
• Dysfunction of vascular regulation through autonomic nerves
• Disruption of inflammatory regulation mechanisms through endocrine systems

Integration of Bone Marrow Circulation and Systemic Circulation Bone marrow is an important organ with hematopoietic function, and its circulatory insufficiency is not simply a local problem but is closely related to systemic circulatory dynamics.

Chronic Inflammation Vicious Circle Mechanism

Inflammation Persistence Due to Circulatory Insufficiency The background to persistent bone marrow level inflammation is “circulatory stagnation”:

1. Microcirculatory Disorders
   • Decreased blood flow at capillary level
   • Increased vascular permeability due to endothelial dysfunction
   • Increased blood viscosity
2. Metabolic Environment Deterioration
   • Decreased oxygen partial pressure (hypoxia)
   • Decreased pH value (acidosis)
   • Insufficient nutrient supply
3. Inflammatory Cytokine Accumulation
   • Excessive production of IL-1β, TNF-α, IL-6
   • Relative insufficiency of anti-inflammatory cytokines
   • Self-amplifying cycle of inflammation
4. Tissue Repair Inhibition
   • Decreased stem cell function
   • Impaired collagen synthesis
   • Progression of fibrosis

2. Vascular Anatomy of the Hip Joint and Osteopathic Approach

Major Vascular Systems Nourishing the Hip Joint

From my anatomical knowledge as a physical therapist, I understand that the vascular supply to the hip joint has a very specialized and vulnerable structure.

Medial Circumflex Femoral Artery

• Most important vessel nourishing the posterosuperior part of the femoral head
• Branches from the deep femoral artery
• Characteristic course within the hip joint capsule
• Easily compressed or occluded by trauma or inflammation

Lateral Circumflex Femoral Artery

• Blood supply to the anterior neck and anterior joint capsule
• Nutrient artery to rectus femoris and vastus intermedius
• Affects blood flow to hip flexor groups

Obturator Artery System

• Artery of Ligamentum Teres
• Important in childhood but regresses in adults
• Functions as reserve pathway for angiogenesis

Superior & Inferior Gluteal Arteries

• Blood supply to hip periarticular muscles
• Nutrition to posterior joint capsule
• Communication with intrapelvic circulation

What Our Clinic Can Offer

1. Structural Adjustment

Integrated Pelvic Ring Adjustment Improvement of structural misalignment in hip osteoarthritis:

Sacroiliac Joint Mobilization

• Recovery of sacral nutation and counternutation
• Improvement of physiological iliac mobility
• Mechanical integration of pelvic ring

Intra-articular Hip Joint Adjustment

• Improvement of acetabular-femoral head compatibility
• Normalization of intra-articular pressure
• Recovery of labral function

Lumbosacral Junction Adjustment

• Improvement of L5-S1 functional connection
• Optimization of lumbosacral angle
• Improvement of mobility around nerve roots

Through these approaches, we aim to achieve physical decompression of vascular pathways and functional recovery of neurovascular bundles.

2. Release of Adhesions

Release of Perivascular Tissues

• Release of adhesions around medial circumflex femoral artery
• Improvement of mobility at deep femoral artery bifurcation
• Decompression at nutrient artery entry points

Integrated Myofascial Approach

• Deep Front Line tension release
• Lateral Line balance adjustment
• Release of intermuscular septal adhesions

Visceral Manipulation

• Positional adjustment of pelvic organs
• Improvement of iliac vascular system mobility
• Indirect approach to autonomic nervous system

In Conclusion

The essence of pain in hip osteoarthritis has been revealed to lie not in simple “joint wear” but in the vicious cycle of chronic inflammation and circulatory insufficiency beginning from inside the bone.

In osteopathy, we understand these symptoms not as localized problems but as integrative dysfunction of systemic circulatory and structural systems.

“The healing power lies within you”

Based on this belief, we help maximize the natural healing capacity that awakens with proper blood flow.

Our clinic integrates specialized knowledge as physical therapists with osteopathy’s holistic approach, providing individualized treatment programs according to each person’s circulatory dynamics and structural characteristics.

For those seeking fundamental improvement of hip osteoarthritis and those wanting to review health from a circulatory perspective, please feel free to consult with us.

By examining the essence of pain and providing comprehensive support based on scientific evidence, we will help support your health recovery.

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For Those in Japan with Physical Discomfort

Are you unsure where to get care for pain or tension?
Worried about language barriers?

We offer gentle, hands-on osteopathy to support your body’s natural healing.

– Neck/shoulder stiffness from desk work

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I’m still learning English,
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My English isn’t perfect, but I’ll listen carefully and respond with care.
I often use Google Translate—please don’t hesitate to contact me.

Sota Omura,
Qualifications: Licensed Physical Therapist / Master of Health Science

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