THR DonnieP's Hip Recovery

[Bone-obo]

“While caution is necessary to avoid further injury, the belief that rehabilitation can occur in the absence of overload represents a failure to comprehend the basic tenets of the physiology and mechanics of the living human body.”

"Caution" is the key. Injuries need rest - you wouldn't overload a strained tendon, or a sprained ankle, would you? (Would you? I seriously don't know.) The knock against many therapists is that they have a standard book of exercises they use mechanically with every patient, without evaluating them beforehand. If the goal of PT is to get people walking, why not let the clearly fit just ... walk?

Just like choosing a surgeon, you need to audition all of your providers to find the right one.

Word!

So many, many, many variables. (like everything else that has to do with humans). It's a tricky one.

Agreed. But you're working with a limited population of people, and surely it wouldn't be that hard to find a PT-agnostic set of doctors who'd be okay assigning some patients to PT and others to go it on their own. The real problem is probably funding.

 

[Bone-obo]

What an interesting thread this has become! You guys rock!

 

[InkedMarie]

I had my first THR in 2014. I had PT but it wasn’t til I was almost three months out and it was to help me walk. I was left with a 7/8” leg length difference and my surgeon didn’t want lifts on my shoes yet.

My other THR was 8/27. I went to PT at the 6 week mark but it was more for walking and getting that hip strong for the TKR that I had at the 8 week mark

Had I not had any issues or another upcoming surgery, I wouldn’t have needed to go. By the way, *I* chose to go, doctors didn’t send me. I didn’t need a referral

 

[Clipper]

PT helped me after both hip replacements. The hips didn't need PT to heal, it was all my other muscles that had weakened from sedentary living with OA. Our rehab center with all the machines and great staff were very helpful for the first 6 weeks after each surgery. Now I walk every day and exercise and I can say I haven't felt this good in years. It was a slow process for 6 months or so after the second surgery with steady improvement. Simple things like trimming toenails, putting on socks, tying shoes, picking objects up off the floor were all mile stones in my recovery helped by PT.

Good luck!

 

[Alitm]

I know I won't get back to riding without PT but will approach it as an informed consumer. Luckily I have a great PT and he helped me get core and upper body fit pre-surgery. We have spoken at length about the healing time for soft tissue and also what PT is needed to help the repairing tissues lay down fibers in uniform fashion vs. in disarray (very much layman's terms!).

I believe I'll get back to the fitness level I had just before pre-op without too much issue but will have to take a slow and steady approach to getting my fitness back up to be able to train my horse again. My OS supports this. I am also having my left THR done in 8 weeks so need to work with my physio to condition core and upper body while recovering from right THR. However, if I took the booklet I was handed post op and went off and did all those exercises as directed, I would end up in the ODIC.

Someone commented somewhere on the hip forum that their OS said to be cautious, almost afraid, if that helped with listening to one's body. I liked what @Layla's surgeon had to say about post op precautions and being careful. It was so much like common sense to me! Perhaps Layla will stop by to repeat again! My OS asks me to watch the precautions, but he also said my body will tell me to stop, long before I really push the envelope....as long as I listen!

 

[Bone-obo]

We have spoken at length about the healing time for soft tissue, and also what PT is needed to help the repairing tissues lay down fibers in uniform fashion, vs. in disarray (very much layman's terms!).

I like your therapist. Can I have your therapist for my next hip? You can use my FedEx account# to ship her - just use lots of bubble wrap and poke holes in the box.

 

[Going4fun]

On the morning after surgery visit from my surgeon, he repeated the BS advice: "Walk," he said. "Just walk."

His other loud advice is for me not to "test" the hip for the first 8 weeks ... and to stop doing anything if it hurts (that goes even when there's full healing, he said).

Here's the thing. I live on the second floor of a house I share with friends. Between just going to the bathroom down the hall (same floor) ... standing up and getting a book off a bookshelf ... or taking meds every few hours ... and going downstairs to the kitchen to cook and eat ... I'm getting a ton of exercise ... even before we get to the ankle pumps and the gentle stuff that my surgeon recommends.

About an hour ago, I had to go to my car across the street to get something. Here's the thing. I'm on this cocktail of nerve block and a muscle relaxer and an anti-inflammatory (that is not an NSAID). Tylenol and Oxy as needed ... and my pain has been minimal. I can tie my shoes ... and raise myself from the toilet seat ...

Long story short: I'm in minimal pain and stiffness and just going around the house provides an astonishingly high amount of movement. I'll try my first formal walk outside when a friend comes over later this week. But if you have more pain and stiffness than I do, I can see the impulse to want to do "something" (PT) and I can see where doing something might be too much.

I do have the advantage of not being deconditioned--at least not severely so. I could still walk up and down stairs before surgery. Twice a week I got on the treadmill and did a mix of walking and running--I could run for 5 minutes before the pain really kicked in big time.

Anyway, right now, PT would be overwhelming I feel ... But ... (there we go again) ... I can get it if someone who is out of shape thinks PT will help them move more confidently.

But please be careful ... I'm reminded of going to PT a few years back (yes for hip) and my PT person would just google various exercises right in front of me. He didn't have any particular insight or program for my condition.

 

[Hipster63]

I've had good and bad experiences with PT. About 6 weeks after my emergency hip replacement the OS sent me to PT. I was getting in-home PT but that was a joke. The therapy center I was sent to was only a little better. Basically - do 10 of these and they walked away to tend to another patient. And I was actually assigned to an intern my first few weeks!

I could see I was put through the basic hip rehab program. The fall I suffered left me with a lot of soft tissue damage but the PT just ignored that fact. I did complain about certain exercises, I just could not do them. Eventually, after 5-6 months I left, I sought another OS opinion and was told how far behind rehab I was.

So he sent me home with 3 pages of exercises that I did 3 times a day! Exhausting. Then I sought another surgeon's opinion and he sent me to his PT. Finally, a competent, knowledgeable PT. I had irritated my psoas so much that he ordered me to stop most exercises. I saw him 3 times a week - we worked on gait (still limp) and very basic strengthening. It helped But after all the reading here, my views on PT have changed some. Rest up

 

[Alitm]

@Bone-obo I hated on my PT at first, three years ago, as he was the one who told me I was bone on bone in my hips, although I was still riding and competing at that point.

My quad muscles were ALL knotted up though, so he tried what I call "needling" (myofacial release with dry needles) to release them. In hind site the underlying arthritis was worse than we though and the "needling" just put the muscles in a worse state.

Anyhow, he changed approaches and bless him, kept me together and functional at home and in the barn (although I literally could not swing my leg over the horse and settle in a saddle from about two years ago) just about up to surgery.

I got myself into a real emotional twist and could not move my right shoulder a couple of weeks ago, and out came the needles and he got that shoulder loose again. Anyhow, if I could clone him and send him to you as a permanent fixture, I would! He is full of common sense to start with, and he doesn't mind if one swears...I swore during the needling!

Like with the upper body strengthening he wanted me to do (I'm pretty strong with my biceps, but not my triceps), he had me do exercises that I could just do when in the barn or the house and didn't need special straps etc. I will see him in two weeks from now to discuss what I can do for the second hip surgery. It may just be lying down on the bed and turning on my transverse abdominals etc., and maybe some other than triceps arm work. Who knows, but he'll be sensible and practical and won't overdo anything.

When I told him I had final decided to have THR, he shook my hand and said congratulations! We laughed at it all, as I said, "You told me three years ago that I needed to get on a list, but I didn't want to listen!". I asked him why there are such differences in physio approaches, and he just shook his head and asked how long is a piece of string?! I have NO idea!!

@Going4fun I realized after abdominal surgery a few years back how much we do when we get home from hospital. I've just realized that with good medication on board, I almost overdid the walking around the house yesterday. I love my new recliner so much that I'm spending all my days there, and it is a longer walk back to our master bathroom, where the raised toilet seat is (we have a bungalow and all but one of the kids have gone, so it is planned for hubs, me and the dogs really on one level).

When I walked back to the open plan living, kitchen, dining area, I thought, well I'll just do one extra lap around the kitchen island before heading to the recliner.....and was a little stiff this AM. Being more mindful today. I was amazed (yesterday) how much the fluidity of my gait, on the walker, improved.

 

[Layla]

Hi @Alitm
It seems you're doing well. You wondered if I'd repeat my surgeon's advice upon discharge...
I didn't have any restrictions. I was advised to move slowly and thoughtfully and if anything hurt, STOP.
The approach my surgeon used was posterior. I'm thinking yours was also? I was an icing fanatic, was cautious and had a good recovery. I can't complain. Try not to overdo just because you're feeling better than the day before. I did that on the day I first started practicing with the cane and was sore the next day. Icing quickly helped though.
Hope you have a good night!

 

[Alitm]

@Layla Thank you for the repeat! That is such great advice IMO. Common sense prevails it seems! No, I have no intention of over doing it, as I've seen what happens to the soft tissues in the ODIC...I so don't want to go there!

 

[JoeKnows]

Yes you would. In the article quoted, the author gives an example of a heart attack. Essentially, normal load is an overload for damaged tissue. This overload is the requisite stress required to trigger an adaptive response by the tissue. At some point normal load is no longer an overload because the tissues adapt, and to continue getting stronger additional load must be used.

I suspect you're either misinterpreting the author's point, or the book is BS (and I don't mean Bonesmart). The way you're trying to apply the example stated would mean that someone who suffered a heart attack should put their cardiovascular system under stress. I don't think anyone will argue that's a bad idea.

Of course it's necessary to stress your muscles to make them stronger. I'm not sure the same applies to tendons, but let's assume it does. The question then becomes one of timing, and I seriously doubt even the author of this book advocates for working through a traumatic injury (whether it's surgical or otherwise). Big difference between strength training otherwise healthy muscle groups and prematurely stressing an injured part of your body. It's the difference between "hurt," which can be good in the context of working out, and "injured," which is just going to be exacerbated by stress.

That's a long winded way of saying that I don't think PT is necessarily bad, but if you think adding stress to strained soft tissue before the tissue heals, that book might as well be selling snake oil.

Directly exercising tissue that has just been operated on is literally like telling someone to walk off a stab wound.

 

[MrDIY]

I suspect you're either misinterpreting the author's point,

I’m guessing you haven’t read the article quoted and perhaps are missing the point.

The way you're trying to apply the example stated would mean that someone who suffered a heart attack should put their cardiovascular system under stress.

Someone that has suffered a heart attack has no choice but to put stress on their heart if they are going to keep living. Continuing to circulate blood after part of the muscle has died is a great stress on the heart.

I'm not sure the same applies to tendons,

It does. Tendons, ligaments and bone don’t adapt as quickly as muscle but they adapt to stress.

and I seriously doubt even the author of this book advocates for working through a traumatic injury

Again, I’m guessing you have not read the article and are missing the point.

prematurely stressing an injured part of your body.

I think this is the crux of the discussion. What is premature? How do you know?

if you think adding stress to strained soft tissue before the tissue heals,

Stress is what drives the tissue to heal.

Directly exercising tissue that has just been operated on is literally like telling someone to walk off a stab wound.

Getting you to get up and walk the same day of operation is precisely directly exercising the affected tissue. The BS suggestions are to walk several times a day (starting at short 5 minute or so walks), which is also directly exercising the tissue that has been operated on. Early on this is overloading, even with a walker. As walking becomes easier it becomes less of an overload event because the stress of it has been adapted to. Many people, including BS, prescribe walking for longer periods of time at this point. This is a way of increasing volume to add stress. The only difference I really have is that I believe at this point it’s more effective to add loaded movement than adding volume to walking to cause further adaptation.

 

[MrDIY]

For clarity,

Let me apologize and say I don’t not wish to escalate anything to an internet argument. I do not intend any disrespect to Bone Smart or any of its members so hopefully none will be offended.

I posit that fundamentally all here would actually agree that “stress” of the tissue drives recovery. Before you jump in to disagree please consider this. Do you believe that the best and fastest way to recover is to completely avoid any and all movement? Would someone in an induced coma for 3 months be the ideal recovery model?


I think if you distill the PT debate down, at the root of the debate lay the following questions, “What is the appropriate stress to drive recovery and what is a detrimental stress? Further, what is an appropriate progression for the stress to optimize recovery? Is the optimal stress for one individual optimal for all individuals?”


Of course I agree that inappropriate application of stress could hinder recovery. Like @dlp alluded to earlier, I think optimum is highly individual. Is that controversial?

 

[An54]

..., “What is the appropriate stress to drive recovery and what is a detrimental stress? ...

Nailed it.

 

[JoeKnows]

I think if you distill the PT debate down, at the root of the debate lay the following questions, “What is the appropriate stress to drive recovery and what is a detrimental stress? Further, what is an appropriate progression for the stress to optimize recovery? Is the optimal stress for one individual optimal for all individuals?”

I can agree with this, so I'll leave it alone on that common ground (as much as I love argument of all sort, internet or otherwise, haha).

 

[MrDIY]

I can agree with this, so I'll leave it alone on that common ground (as much as I love argument of all sort, internet or otherwise, haha).

Let it be known. On this; the 17th day of September in the year of our lord 2018, an internet argument was averted. ROFL!

 

[dlp]

Let it be known. On this; the 17th day of September in the year of our lord 2018, an internet argument was averted. ROFL!

What just happened here? Did I actually witness this?

 

[JoeKnows]

@MrDIY and I are patiently awaiting our Nobel Peace Prizes (internet division).

 

[Mojo333]

Yes you would. In the article quoted, the author gives an example of a heart attack.

YOU would .I wouldn't!
The example is not hip replacement...or sprained ankle.
Moderation is key.