THR Feeling discouraged

[Victorialast]

I’m a day past 4 weeks anterior LTHR. I used a walker for about 3 weeks (my doctor said 2 weeks were required for me) and then moved to a cane.

Now I’m still using the cane and my physical therapists are telling me I should have already been off it at this point.
I’ve been walking with the cane about 4-5000 steps a day and just trying to slowly increase if it felt good.

I guess I’m questioning myself now.. I felt like I’ve been improving decently since surgery, I could feel my walking was improving pretty well and I felt really positive but they’re saying I’m not locking out my left knee when I walk and that’s my issue causing me to still use the cane - I felt that I still had a limp, so I didn’t want to rush myself off the cane.

I also feel like some of the therapists are pressuring me to do exercises I’m not comfortable with and now I’m questioning if I should have just been sucking it up and doing it despite the pain and swelling it would cause? They’re saying I’m where I’m at with the recovery because I’ve not been pushing myself enough since I’ve been focusing more on walking and not some of the exercises they’ve been prescribing. I don’t know, I have been doing the exercises that weren’t too hard, like the glute and thigh squeezes for instance.

I’m feeling very discouraged about my recovery now.

Extra information:

I was quite weak prior to the surgery because my hip had started to cause severe back pain so I was less mobile than ever along with my hip not being able to handle long walks anymore.

I’ve been going to therapy once or twice a week and my hip usually swells up and it’s painful to walk afterwards.

Gonna add this in case it’s relevant:
33F, had a traumatic hip dislocation and fracture about 14 years ago which resulted in my first surgery, then a hip arthroscopy about 7 years after that. Now about 7 years later (present) I had my hip replaced. I have significant weakness and nerve damage in my left knee and ankle (my entire left leg, really) stemming from the original break/dislocation that never went away.

I don’t know if this is a rant, or a request for advice, idk.. am I wrong for not having pushed past the pain?

I was already having a rough day before my therapy today and it was just the last straw to totally ruin my day.

 

[mendogal]

Welcome to BoneSmart.

You are CORRECT to use an adaptive aid like a cane in order to avoid limping. It's important to slowly improve your heel to toe walking until you're doing smooth weight shifts without a limp.

To rush off the cane while limping will reinforce faulty structural patterns throughout your body. Your hip replacement was an opportunity to regain good structure. I'm sorry your PT doesn't recognize this.

Pain is your hip's only way to tell you that you're overdoing things. Four weeks is barely healing! Most ortho surgeons will say walking as you are is the only "therapy" you need this early in recovery, when it's too early to address strengthening.

You would benefit from icing 45-60 minutes at a time. And consider deferring PT until later in your recovery, or finding one who actually understands the needs of brand new hips.

 

[mendogal]

If you give us the exact date of your anterior LTHR we will create a custom signature for you. That lets members see at a glance how far out you are from surgery, and your peers will find you.


HIP RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.

4. PT or exercise can be useful BUT take note of these
BoneSmart philosophy for sensible post op therapy

5. At week 4 and after you should follow this
Activity progression for THRs

The recovery articles
Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Hip4life]

Hello @Victorialast and welcome to BoneSmart. Don't let over-aggressive PT people ruin your day or what was a satisfactory recovery. 4 weeks out is still early in this recovery especially with your history. Hips don't need anything more than walking (and NOT to excess) to recover. Aggressive PT now could hamper or set back your recovery. You know your own body and this is not your first rodeo. Your age may be playing with the PT minds but hips are hips and they will recover on their own timeline. You are not in training, you are recovering. Strength training is WAY down the road, if at all.

There is no timeline for getting rid of your assistive devices, either. If you are limping or feel unsteady, then you still need them. I used mine for at least 6 weeks and then the cane off and on for several more, especially with longer walks. They are tools not crutches (unless, of course, they actually ARE crutches. Lol.) If you were having that much pain before your surgery, it's very likely that will equate to a bit longer recovery. That is where I was at, as well. You are the captain of this ship. You get to decide what happens with your body.

My recommendation would be to back off of PT. See how you respond with just moderate walking. Try elevating and icing after walking. Give those soft tissues a real chance to heal. The gait will come back if given half a chance. Sometimes we get into some bad patterns/habits to avoid pain before surgery. Try walking concentrating on a heel to toe movement through your foot, as shown below. You can always add PT back in down the road if you feel you need it. Most of us did just fine without it. Follow your instincts and steer your course with lots of TLC and patience. We'll be here for you whether you need to vent, get advice, or just update. Hang in there. Sending you hugs and healing blessings.

Here’s a tip -
Try heel-toe walking when you're limping.
This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.
It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.

Here is a visual on heel-toe walking -

 

[myglasshalffull]

I have nothing to add because you have already received great advice & I would only be repeating it, but welcome, don't beat yourself up & remember this is your personal journey so don't compare it to anyone else.
All my best.

 

[Nini]

I’m still on this journey at 12 weeks post op. What I’m learning is give yourself time. I was off the walker at a week and in looking back I don’t think I did myself any favors by pushing myself like that.

 

[Eman85]

You'll find that the majority of us on this board will tell you to skip PT altogether. In the early months doing anything more than walking usually causes pain and setbacks and possible problems later. That said just sitting feels good but you do need to move. It's hard to find the balance of positive recovery and doing too much and causing pain and swelling. Are you icing for the pain and swelling?
For the limp here's what worked for me after the walker. I found that the shopping cart at the big retail stores was a great walking aid. Not much flat ground near me to walk on so the store and it's parking lot worked great especially on bad weather days. I could walk very slowly and concentrate on not limping and not be obvious while having the support of the cart.

 

[raylo]

That is my pre-surgery mode, too. Drive to the grocery store, get one of the small carts, and that support is enough to allow me to walk pretty well. Definitely will be part of my post-surgery routine.

For the limp here's what worked for me after the walker. I found that the shopping cart at the big retail stores was a great walking aid. Not much flat ground near me to walk on so the store and it's parking lot worked great especially on bad weather days. I could walk very slowly and concentrate on not limping and not be obvious while having the support of the cart.

 

[djklaugh]

@Victorialast Welcome to BoneSmart! You have already received lots of excellent advice from the ones who posted above. I can only add one thing - and if you've already done this just ignore this. Are you still wearing shoes that you wore frequently BEFORE your surgery? If yes, look at the bottoms of those shoes. See the wear pattern on soles and heels? That is the old limping pattern and that is NOT good for new hips!! That old pattern can keep you walking in the old limping manner and that can interfere with your muscles and gait returning to the way they are supposed to be! If you have not gotten new shoes either just before or since your surgery, get them ASAP!!!

 

[Victorialast]

Welcome to BoneSmart.

You are CORRECT to use an adaptive aid like a cane in order to avoid limping. It's important to slowly improve your heel to toe walking until you're doing smooth weight shifts without a limp.

To rush off the cane while limping will reinforce faulty structural patterns throughout your body. Your hip replacement was an opportunity to regain good structure. I'm sorry your PT doesn't recognize this.

Pain is your hip's only way to tell you that you're overdoing things. Four weeks is barely healing! Most ortho surgeons will say walking as you are is the only "therapy" you need this early in recovery, when it's too early to address strengthening.

You would benefit from icing 45-60 minutes at a time. And consider deferring PT until later in your recovery, or finding one who actually understands the needs of brand new hips.

I think I will put off going to pt until later on! I always feel negative after a session with them.
I do worry about my surgeon getting a negative report from pt, though. I’ve worked with the same surgeon for almost 10 years now and I don't want our doctor-patient relationship to take a hit from their reports.

 

[Victorialast]

Hello @Victorialast and welcome to BoneSmart. Don't let over-aggressive PT people ruin your day or what was a satisfactory recovery. 4 weeks out is still early in this recovery especially with your history. Hips don't need anything more than walking (and NOT to excess) to recover. Aggressive PT now could hamper or set back your recovery. You know your own body and this is not your first rodeo. Your age may be playing with the PT minds but hips are hips and they will recover on their own timeline. You are not in training, you are recovering. Strength training is WAY down the road, if at all.

There is no timeline for getting rid of your assistive devices, either. If you are limping or feel unsteady, then you still need them. I used mine for at least 6 weeks and then the cane off and on for several more, especially with longer walks. They are tools not crutches (unless, of course, they actually ARE crutches. Lol.) If you were having that much pain before your surgery, it's very likely that will equate to a bit longer recovery. That is where I was at, as well. You are the captain of this ship. You get to decide what happens with your body.

My recommendation would be to back off of PT. See how you respond with just moderate walking. Try elevating and icing after walking. Give those soft tissues a real chance to heal. The gait will come back if given half a chance. Sometimes we get into some bad patterns/habits to avoid pain before surgery. Try walking concentrating on a heel to toe movement through your foot, as shown below. You can always add PT back in down the road if you feel you need it. Most of us did just fine without it. Follow your instincts and steer your course with lots of TLC and patience. We'll be here for you whether you need to vent, get advice, or just update. Hang in there. Sending you hugs and healing blessings.

Here’s a tip -
Try heel-toe walking when you're limping.
This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.
It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.

Here is a visual on heel-toe walking -

You know, I thought I was being really mindful while walking to achieve this gait, but I think I started not paying as much attention at one point.

Prior to the surgery, my left foot was pointed very far inward while I walked, so I know I had a really bad gait at that point :(
I notice I’m walking with my feet aiming more forward now !

 

[Victorialast]

You'll find that the majority of us on this board will tell you to skip PT altogether. In the early months doing anything more than walking usually causes pain and setbacks and possible problems later. That said just sitting feels good but you do need to move. It's hard to find the balance of positive recovery and doing too much and causing pain and swelling. Are you icing for the pain and swelling?
For the limp here's what worked for me after the walker. I found that the shopping cart at the big retail stores was a great walking aid. Not much flat ground near me to walk on so the store and it's parking lot worked great especially on bad weather days. I could walk very slowly and concentrate on not limping and not be obvious while having the support of the cart.

I do ice when I have swelling, but I typically only have swelling after pt. since I was going pretty infrequently, I wasn’t experiencing much swelling at all.
I’m lucky I live next to a tract neighborhood with nice flat sidewalks! I will try the shipping cart, I tried it not long after I moved to a cane and I didn’t feel enough support at the time from it but it may be better now because I feel my hip is much stronger now!

 

[Victorialast]

@Victorialast Welcome to BoneSmart! You have already received lots of excellent advice from the ones who posted above. I can only add one thing - and if you've already done this just ignore this. Are you still wearing shoes that you wore frequently BEFORE your surgery? If yes, look at the bottoms of those shoes. See the wear pattern on soles and heels? That is the old limping pattern and that is NOT good for new hips!! That old pattern can keep you walking in the old limping manner and that can interfere with your muscles and gait returning to the way they are supposed to be! If you have not gotten new shoes either just before or since your surgery, get them ASAP!!!

I actually bought some new shoes right before surgery and those are the only ones I’ve been wearing so far!
I did have a really bad gait prior to surgery, like pigeon-toed really pronounced on the left side. I’ve noticed it’s much less severe now. I will look at all my other shoes and see if they have a bad wear pattern that could affect my walking!

 

[benne68]

@Victorialast Please give us the exact date of your surgery so we complete your signature for you and add you to the correct team thread. It will help staff give you appropriate and timely guidance as your recovery progresses.

I'm assuming it was sometime in early March?

 

[Victorialast]

@Victorialast Please give us the exact date of your surgery so we complete your signature for you and add you to the correct team thread. It will help staff give you appropriate and timely guidance as your recovery progresses.

I'm assuming it was sometime in early March?

March 7th!

 

[benne68]

Thanks, @Victorialast. I've updated your signature and asked the admin to add you to our March Hippie team!

 

[Abbylayla]

@Victorialast Don't let anyone tell you where you should be when in your recovery. Everyone is different. Some, like yourself & me too have additional challenges that make rehab harder than the "norm". Don't let their negativity get to you because that will absolutely prolong your healing. Work at your own pace, no one else's. I quit PT on my knee after 3 sessions and had none for my hip. I won't for my second hip either. And I'm fine.
Listen to your body. Take your time. Work at your own pace. It's a marathon not a sprint. You'll get there. Dosen't matter if it take you a little longer. So what. Took me longer too. You will get there! Don't get discouraged. There's lots of people here to talk to & cheer you along!!

 

[Layla]

Happy One Month Anniversary!
Cheers to great progress and a wonderful Summer 2024!
@Victorialast

 

[Going4fun]

OMG, you're walking 4,500 steps a day with the cane at four weeks. That's wonderful!

Your PT who said you "should" be off the cane--I'm just going to be polite and say they were ill-informed. My real language would be more insulting. That's so wildly wrong.

My first hip, I think I got off the cane at 9 weeks or so, my second hip ... maybe 7 or 8 weeks. You are seeing the progress, big progress. And you started with a real point of disability with the old injury. You're doing fabulous at four weeks. Fabulous!

Cancel the PT and keep walking and getting stronger--yes with the cane! You will naturally transition off of it.

Keep tuning into YOUR OWN sense of progress. Your assessment is correct! And, let yourself enjoy the progress. Some weeks there will be less than others. That's fine. But over time you'll get there. Let yourself celebrate your new freedom!

 

[Eman85]

If you're counting steps don't use that as any type of gauge or goal. 4,000 bad steps aren't as useful as 400 good ones. I had to learn to slow down and not try to push distance, once I figured that out my walking got a lot better.