Bilateral THR Aggressive PT (obsessed with one particular exercise and adding more weight)!

[BGH]

Hello All,
Previously I posted in the hip pre-op forum; just a refresher: I am a serious ballet dancer who had "lots of space" between the femoral head and acetabulum and was having a hard time being taken seriously with ortho surgeons regarding my hip pain.

Update: I did have a simultaneous, bilateral hip replacement- done at HSS. I am approximately 4 weeks post-op. He did it posterior-laterally. In addition to the arthritis, he also corrected my severe Coxa Valga (thus now my hips are a bit "wider" than they used to be) and anteversion. Basically, the grinding, popping, catching, and clicking between the femur and acetabulum (perceived anteriorly) has stopped, but now I have different issues.

I was an inpatient post-op for 3 days. On my discharge day I went to use the toilet in the room, for some reason my butt and muscles felt very "tight" upon descent and when I was about to sit on the toilet something in my left butt cheek/hip popped loudly! I was highly scared and refused to be discharged until an x-ray was taken to see if anything had dislocated. The x-ray showed nothing. The PA stated it could be just "soft tissue." I was discharged and flew back to Tennessee.

About a week and a half later, at home, I noticed a rubbing/ pulling/ "grisly" feeling underneath and around where my stitches are on my right hip/buttocks. It happens when I go from standing to sitting and vice versa, when I do lateral moves with Physical Therapy, and any movement where the butt is flexed and extended. I messaged my surgeon several times- the NP stated it is my "IT Band rubbing" and that this should "settle down overtime with physical therapy." I had my Physical Therapist to place his hand on my right buttocks as I did provocative moves and he said he thinks in the glute medius and/or minimus. He, too, stressed that I have been through a MAJOR operation and I need time for the muscles/ ligaments/ tendons/ etc. to "settle down."

When people tell me "don't worry," I WORRY! I had the clicking/ catching/ and grinding anteriorly since 2016 so of course I'm ultrasensitive now that there is popping/ moving/ rubbing posteriorly!!!! I am athletic, active, and progressing in PT except for this!

Has anyone else who had the posterior approach had anything similar to my symptoms?

Thanks!

 

[Mojo333]

Hi @BGH
Welcome to my fellow bilateral hippy pal.
So sorry you are stressed with the pain in the rearend issue while recovering from BTHR.

On my discharge day I went to use the toilet in the room, for some reason my butt and muscles felt very "tight" upon descent and when I was about to sit on the toilet something in my left butt cheek/hip popped loudly! I was highly scared and refused to be discharged until an x-ray was taken to see if anything had dislocated. The x-ray showed nothing. The PA stated it could be just "soft tissue." I was discharged and flew back to Tennessee

I'm glad your prosthesis is intact, and likely may be soft tissue trauma and the strain from your toilet incident, but honestly, from your description of the incident... I would insist on an MRI to rule out a gluteus medius/minimus tear...and is not entirely uncommon.

Hopefully this isn't the case, but erring on the side of caution isn't unwarranted.

Can you please share your surgery date so we can add it to your signature?

I hope you take things slow and easy... irrespective of your physical fitness prior to BTHR.
This IS a big surgery, and the next few months need more healing than PT.
You can get it back after healing is further along.

 

[BGH]

Hi Mojo,

Oh yes, I did tell the NP that on my 6 week follow-up, I may insist on an MRI! Thanks for your kind words.

BTW: surgery date 5/11/23

 

[Mojo333]

Thank you for the date... BGH (Bilateral Girl Hippy)
At 6 weeks out, I was beginning to get weary of recovery and had cabin fever and a bit of the post-op blues.

I am going to leave you our Recovery Guidelines.
You are through some of the first tough bits, but the articles are really helpful.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Hip Recovery: The 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​

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​

6. Access to these pages on the website​

Oral And Intravenous Pain Medications​

Wound Closure​

​

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.

 

[Eman85]

Maybe it's the TN thing? Clicking and noise on both hips early on. When I hurt my L IT band this year I had a little bit of it again. The injury was a lot like THR recovery again. On my R I had and still have a tightness in my butt/glute area. Early on I couldn't reach to my foot if my knee was bent at all. I could bend and touch the floor with my knees locked but if I sat I could not touch my foot. It took some time before it eased but I can still get a twinge from it today.
This whole operation recovery is all about the soft tissue, the damage is done during the procedure. We all have it in our minds that the implant will hurt but it is the trauma from the dislocation that is what the recovery is about. My rubber bands are old and I really don't think they will ever fully recover, for you I'd say time is on your side. One thing I think with my L is I pushed a little in recovery and did more harm than good. You're early on, let it heal and don't push despite your age and fitness.

 

[BGH]

Mojo and Eman, thank you both for your stories and warm encouragement! This is very helpful.

 

[benne68]

Happy one-month anniversary, @BGH. I hope you are doing better this weekend.

 

[BGH]

Hello All,
Tomorrow (9/11) will be exactly 4 months after my simultaneous bilateral hip replacement. My surgeon said I can go back to some "basic" ballet things and removed all restrictions, and I do continue with PT 2X per week. My problem is my PT! Granted, I had major anterior hip flexor pain before surgery and pretty much none of that pain while I was on Mobic immediately post-surgery (had to d/c Mobic because it was causing a GI bleed/issues), but since the PT has been ADAMANT about adding MORE weight to the single leg raises, I am having MORE of that pain. He tried to progress from 3 pounds to 7.5 pounds in a short amount of time and keeps harping on "getting to 10 pounds"! I don't know what his darn protocol is, but my hip flexors usually burn like crazy after his exercises and hurt the next day. Ballet does indeed require anterior hip strength, but NOT the brute weight lifting-type thing he is suggesting. I keep telling him the single leg raises hurt. When I go back to PT this Tuesday I'm tempted to tell him I am not doing ANYMORE single leg raises with him (he doesn't know a thing about ballet anyway and I pretty much think I can handle safely increasing hip flexor strength on my own) and that if he persists, I'm leaving therapy. What do you all think? (I am pretty much ready to d/c PT on my own at this point...)
Thanks a bunch for any advice.

 

[Pumpkin]

Hmmm, adding more weight to a hip that has a history of pain.

I am pretty much ready to d/c PT on my own at this point...)

I think this may be your best decision, your sore hip needs rest and appropriate painfree exercise. Suggest walking as the best thing you can do right now.
You can call and cancel your next appointment on Monday, and ask to be discharged.
Should you resume PT, ask your ballet teacher or other classmates for recommendations for someone who specializes in working with dancers.

Here is a reminder from the Hip Recovery Guidelines.

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.

 

[Pumpkin]

You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

Thanks,
Chris

 

[Jaycey]

You are not in training - you are healing. I agree this PT is not for you. Working on your own is the best approach. There is absolutely no need for weight training!

 

[Hippie Chick]

If you were working with a trainer who was not aligned with your goals, you would probably not overthink ending the training relationship. The same should apply to a PT. If insurance is paying for PT, it’s important to find the right PT. Hang in there, this sounds hard.

 

[Eman85]

Your life, your body, your decision just like the decision to have the surgeries. You're a dancer which means you know your body and how it feels. you have determine if straining it to attempt to build strength on damaged muscles from surgery is wise. You're young and have a long life to live and should heal really well from THR. I can say from my experience that these muscles weren't crazy about having my joints dislocated and mine seem to be a little more sensitive to being strained then they were before.