Avascular Necrosis (Osteonecrosis)

Explanation of Diagnosis

Avascular necrosis, also called osteonecrosis, means bone tissue loses its blood supply and starts to weaken. It most often affects the hip, but it can involve other bones such as the knee or shoulder. Common symptoms include deep aching pain in the joint, stiffness, and pain with weight-bearing or movement. It can happen after joint injuries, heavy or long-term alcohol use, high-dose steroid medicines, or other medical factors that affect blood supply and bone health.

Specific Work Modifications

• If your job involves standing or walking, alternate short bouts of standing with sitting breaks.
• Use a stool or sit-stand workstation for tasks that don’t require walking.
• Avoid heavy lifting or carrying, especially with bent hips or twisting through the affected side.
• Take micro-breaks every 30 to 60 minutes to change positions and reduce joint loading.
• Use supportive footwear and consider an insole or cushioned shoe to reduce impact on the affected joint.
• If possible, limit stairs, ladders, and uneven surfaces during flares.

Specific Activity Modifications

• Avoid running, jumping, and high-impact sports because they increase stress on weakened bone.
• Limit deep squats, lunges, and aggressive stretching into pain.
• Choose low-impact cardio such as stationary cycling, swimming, or water walking if they stay comfortable.
• Avoid long sessions of standing sports and replace them with shorter, more frequent intervals.
• Stop activities that cause sharp, escalating pain during or after use of the affected joint.
• If you like sports, plan a gradual return after symptom stability and clinician guidance.

Recommended Supplements

• Vitamin D3 1,000 to 2,000 IU daily with food, since adequate vitamin D supports bone health (have your level checked when possible).
• Calcium (aim for about 1,000 to 1,200 mg per day total from diet plus supplements), because bone requires calcium to maintain strength.
• Omega-3 fish oil (about 1 to 2 g per day combined EPA and DHA), which may help some people with inflammatory-type pain and overall recovery support.

Recommended Nutrition and Hydration

Diet Recommendations

• Focus on a balanced diet with adequate protein at each meal to support tissue repair (examples include eggs, fish, poultry, beans, tofu, and dairy if tolerated).
• Choose a variety of colorful fruits and vegetables for antioxidants and general inflammation support.
• Limit alcohol, especially if alcohol was a contributing factor or you are taking medications that affect bone.
• Maintain a steady calorie intake; crash dieting can reduce muscle support and worsen recovery.

Hydration Tips

• Drink enough fluids to keep urine pale yellow, especially if you are reducing activity and sweating less.
• Consider adding fluids with electrolytes during hot days or longer low-impact exercise sessions.

Home Exercise Prescription

Perform these exercises 4 to 6 days per week, keeping them within a comfortable, mild-stretch or mild-work range.

1. Heel slides (if your hip or knee is affected): Lie on your back, gently slide the heel toward you until you feel mild discomfort, then slide back. Do 8 to 12 reps.
2. Glute sets (hip-focused strengthening): Tense your buttock muscles while keeping your hips level, hold the squeeze, then relax. Hold 5 to 10 seconds, repeat 8 to 12 times.
3. Supported standing weight shifts (only if safe and comfortable): Hold a counter for balance and gently shift your weight from side to side without forcing pain. Do 10 to 20 gentle shifts.
4. Seated or lying range-of-motion for the affected joint: Move slowly through your pain-free range (no aggressive stretching). Do 1 to 2 minutes total.
5. Calf and hamstring gentle stretching: Use a towel or support to stretch lightly without sharp pain. Hold 20 to 30 seconds, repeat 2 to 3 times.

Stop and reassess if you get sharp pain, new significant limping, or symptoms that noticeably worsen during the same day.

Helpful Books

• "Explain Pain" written by David Butler and Lorimer Moseley
• "The Hip Owner’s Manual" written by Brett Sears