In June 2012 my left hip was replaced and I knew there was a good chance my right one would have to be done at some point too. This time instead of ignoring the signs, I decided to be more proactive.
I was a runner and taught hard core classes up to the day of my first surgery in 2012, so I was in good shape. But since then, I had gained a much deeper insight and appreciation of the importance of anatomy, biomechanics and how optimal alignment is important to support the body when recovering from a hip replacement (or any surgery for that matter).
Organizing the body before and after a hip replacement
Being a Pilates instructor, I know it’s important to strengthen the muscles that support the hip and knee, be able to alleviate cranky SI joints, work internal rotation of the lower leg bones while externally rotating the femur and understand the significance of developing the muscles that spiral and crisscross throughout the body.
For instance, there’s a rotation that occurs in the pelvis at the head of the femur. It literally makes the femur feel stuck ‘stuck’ – this is what’s referred to as bone on bone and can be very painful. After my own movement practice and trial and error with clients, I noticed that working upper spinal extension and rotation while keeping the pelvis neutral helped minimize the pain and discomfort in my hip by regaining more neutrality in the lower back muscles and pelvis.
Being more proactive for round two
Early in 2017 small indicators began to manifest. This time instead of ignoring the signs: joint stiffness after sitting for prolonged periods; some discomfort during and after exercising; disruption in sleep due to dull aching in my hip; I decided to be more proactive.
Similarities and differences of my first and second surgery
As I recover from my most recent surgery it has allowed me the opportunity to reflect on the differences and similarities of the surgeries.
In both instances I had a total hip replacement which entailed the hip joint being replaced with an artificial socket and a metal ball and stem. Both were done laterally; the incision runs along the side of my thigh which meant the major hip rotators had to be aggressively manipulated and some nerves impacted due to the incising. It also meant that for the first 6 weeks there is no forward flexion. As a result of this procedure exercises both pre and post that focused on balance as well as strengthening these muscles was and is imperative.
When I met with my surgeon in 2012 I was given a binder which detailed everything from pre-surgery preparation, what to expect while in the hospital, post -surgery activity, discharge and follow-up. Almost 5 years later that information has expanded and now includes websites and you tube videos for educating on the procedure, your stay in the hospital, healthy eating tips, exercises and information on publicly funded rehab facilities as in home visits by therapists are no longer in existence. In both instances there was a preadmission clinic visit approximately 4 weeks before my surgery. Although the visits were over 5 hours it was another opportunity to review in more detail all that was in the binder but more importantly to actually meet with the anesthetist, the nursing team and physio therapist and ask questions.
What I found intriguing in 2012 and now is their focus on pain and pain management. I had been taking extra strength Advil three times a day for a few months leading up to my surgery but after both surgeries I had absolutely no pain and thus no need for opioids. Having worked with a wide variety of clients over the years I know everyone’s perception of pain is different. It was therefore refreshing to see how the surgical team recognized and addressed this. In 2017 the binder has been updated with more information and websites that discuss the pros and cons of opioids, the how’s and whys to manage pain and how to safely wean off pain medication. Their goal is to make sure that there is as little pain as possible and to manage pain early so that people can return to normal activities as soon as possible.
Although everyone’s speed of recovery will vary, by making your body and mind stronger prior to surgery will not only make your recovery faster and smoother, you will also feel more confident.
- Learn how to differentiate between pain and muscle tightness
- Find balance between moving and resting. Use ice it helps with the initial swelling.
- If your surgery is in the winter you can still get outdoors but use Nordic Walking poles. You’ll stay more erect and have a more even gait.
- Do your exercises every day 3-4 times a day.
Here are a few Pilates based exercises that start easy and get a little more challenging
Lying or sitting:
- Use a Theraband for foot & ankle work.
- Heel slides works both knee and hip and you can engage core muscles
- Hip abduction and adduction – slide leg away from midline and back
- Hip flexion – bend knee and lift leg aiming for 90 degrees
- Hip abduction – similar to standing – move leg to side
- Hip extension – works erectors and gluts
More challenging for thigh
- VMO – a squishy ball under the knee – slight external rotation of leg, foot flexed, press back of knee into the ball
- Rec Femoris +hip flexor – side lying, hips stacked, small squishy ball between bent knees press knee down into ball. More advance straight legs.
- Glut med-Theraband above knees, side lying, hips stacked – lift top leg hold. More advanced, theraband around ankles legs straight, lift top leg, hold