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[THR] Getting mixed messages on PT after THR<

Discussion in 'Hip Replacement Recovery Area' started by Debru4, Aug 15, 2018.

  1. Debru4

    Debru4 graduate
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    This is my first time asking a question on this forum, but I have read comments on it often since learning I needed THR.

    I will be going in for my 2 week follow up in two days, after having anterior approach right THR. I am doing well, have been off of heavy duty pain meds since day 4, able to walk unassisted in my home, and am walking about 2400 steps each day.

    My ortho originally said most likely he wouldn’t suggest PT after surgery unless I was having problems because daily movement and being active would suffice. However I have been cautioned by three people who had THR that I should take advantage of this chance for early PT that would be covered by insurance. They said they wouldn’t have progressed as well without it. None live in my city.

    My adult children also are encouraging me to do PT if I want to get back my mobility and strength. I am ambivalent as the PT I did following back surgery was helpful, but I’ve read many comments warning about how it can be detrimental after THR.

    I’m not sure I’d know which exercises to decline or which would be OK. I feel like I need to be prepared for my Dr apptointment. Has anyone consulted with a PT first and told them they wanted a very pain free, conservative approach? Any ideas that would help me decide are much appreciated. I don't want to set myself back since I’m doing so well, but have a trip planned in 2 months that I want to be ready for. Thank you.
     
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  2. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @Debru4 Welcome to BoneSmart! If you have been around this forum for any length of time you will know that we agree with your surgeon's approach. Hips really don't need PT. What works is walking. You will gain strength and mobility just be moving around on your own.

    Unfortunately most physios have a checklist of exercises that they prescribe. Most do not even address the hip. Patients just end up sore and frustrated.
    Interesting - who do they know they would not have progressed. They didn't try recovering without PT.

    You won't set yourself back in any way. Just keep up the walking.

    Here is some reading for you. Note the Big Tip at the end of the list.
    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
    5. At week 4 and after you should follow this

    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.
     
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  3. EmEm

    EmEm member

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    Hi @Debru4. I am 10 months post-op and the only physio (PT) I had was 3 very short sessions in the hospital to mobilise.

    I went from a walker to 2 canes within the first post-op day and down to one cane after about 3 weeks when I had a 20 minute assessment to make sure I was moving well. The only exercise I was shown then was how to prepare to walk upstairs normally. It involved standing sideways to the bottom stair with my operated leg on the first stair and then taking my weight on my new hip whilst lifting my good leg off the floor.

    By my 5 week check-up I was walking unaided. By 7 weeks I could walk for 20 minutes. By 5 months I went to London by train, walked to the theatre and sat through a 2 hour performance. By 7 months I could sightsee around a city for most of the day and my proudest moment - climb every staircase in a French castle. My pre-op pain was always associated with climbing stairs or walking uphill so I noticed a huge difference.

    By 9 months I walked in the Swiss Alps. Exactly a year before that, I couldn't walk over a bridge without pain.

    I set myself the target of walking at least once a day and was hugely supported by my husband when some of the early walks involved being driven to a shopping mall because the weather was bad.

    I think you can succeed without PT if you are motivated to keep moving. Good luck with your recovery.
     
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  4. Bionic

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    Hi @Debru4
    This is a difficult one as there seems to be some many conflicting views. From what I can see in the US physio is covered by insurance and maybe they feel that they need to justify their presence by giving people a good workout. In the UK there often seems to be a more gentle approach. Having said that I did pay for my surgery and physio, rather than wait on the NHS list, and my physio was also on the less is more side.

    He said that he has been doing this for 25 years, and unless there is a specific issue that needs to be overcome, then walking is as good as anything else and not as hard on the body.

    My op was on 13th July, so 5 weeks on Friday and, as far as I can tell, I seem to be recovering as well as anyone else, but what I haven't had is the soreness that some people say they are having after their physio. I have been off all meds too since 2 weeks post op.

    I am not sure if this post helps as only you can make the decision

    Best wishes for your op
     
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  5. Bchbum4evr

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    THIS! I have been doing PT 2 times a week but so far it's basically been stretches. I've been conflicted as well but as long as it stays with these stretches, I'll finish out. I've also refused to do bridges. This said if I quit tomorrow, I'd be ok as long as I did as @EmEm said.
     
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  6. bickypeg

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    After really hurting my non operated arthritic leg by doing some of the standing stretches on it about 10 days ago I'll never do any more physio. I tighten glutes and quads on and off all the time as you can do it sitting or on the move. But otherwise I just do little walks around the house (amounting to .9 of a mile one day according to the fitbit !) I couldn't raise my operated leg when sitting off the floor or off the bed at one point, now I can. This just happened naturally it seemed. Physios are so lovely but a bit one track minded. They have a tick list which is fine but they seemed unable to cater for the fact that my other hip was bone on bone the same as the operated leg. Was nice having them coming in as I felt very unsure of myself those first few days after such a short hospital stay but to be honest I've learned more of use on here. And it wasn't helpful being told they had a 90 year old using only one stick when I was still clinging for dear life to the zimmer! So what? I should have said. We're all different and heal at different times.
     
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  7. Eman85

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    My OS had an extremely complete program for THR and it had no outside PT in it. His handbook specified doing any and all PT at home by yourself and gave illustrations and it was demonstrated to us the day after the operation before we left the hospital. It was mostly muscle contractions and movements to keep muscles loose. If you look at the sites of the companies that manufacture the replacements they show and recommend the same movements. You'll see repeated posts on this forum where outside PT hurt them.
     
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  8. skigirl

    skigirl FORUM ADVISOR Forum Advisor

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    I am going to suggest a middle ground. You could consider a PT appt. If it helps and you feel positive, then continue. If it does not help and you did not like it, then cancel the rest of them. I am an athlete and enjoy PT. I like to be sure that I am moving my body in the proper way to maximize performance. My PT (I had a TKR) did mostly stretches in the beginning and also helped me to mobilize my sleeping muscles by showing me how to do quad sets and to use E-stym.

    But do not do anything to hurt yourself, I cannot imagine doing "bridges" early in recovery for a hip, that is just plain silly. You could ask for someone who has been trained for THR in the last five years---that person does not bring the baggage of the "no pain, no gain" philosophy which existed early on with hip and knee recoveries. Now, most PT are trained to have easy and gentle recoveries.
     
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  9. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Hi, Thanks for joining us! It's nice to read you're doing well.
    Please provide your exact surgery date and which hip was replaced. The info will be applied as your signature. Thanks in advance.

    If you're feeling conflicted in regard to PT, try it and make a decision based on "your" feelings. Personally, I don't feel PT is necessary. I did attend three sessions, didn't like what the therapist was asking me to do. So I stopped going.

    IF you go, don't do anything that hurts. If it hurts, STOP. It's not a "no pain, no gain" type of situation.

    Something to consider.....if you sustained traumatic injuries the equivilant of your THR, through a car accident would you feel your leg needed to be exercised? No answer necessary, just something to ponder.

    A great rest of the week to you.
    @Debru4
     
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  10. Going4fun

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    Your friends are trying to be helpful ... but really .... Why not listen to your surgeon? Your surgeon's reputation is on the line. Your surgeon wants his/her patients to thrive and move and recover. Don't you think your surgeon has talked to a ton of other surgeons and gone to a ton of conferences and been exposed to a ton of research on PT? Don't you think he'd recommend PT if he thought it helped people recover?

    I have noticed that there is this "fantasy" out there about PT. Everyone I tell that I'm gonna have hip surgery will mention PT. I tell them that the Rothman Institute, where I am having my surgery, conducted a major and influential study that found that formal PT conveys no advantage over gentle exercises and walking after hip replacement. And Rothman isn't alone.

    One of the top hip surgeons I know once told a patient that if he could guarantee that the patient got to a super gentle PT practitioner, he might be in favor of PT ... But the problem, according to this surgeon, is that there were too many "PT idiots" who prescribed aggressive activity that ended up hurting patients. And too many patients have the erroneous view that "pain equals gain." So this surgeon does not want patients to do PT.

    BS has example after example of PT not only NOT helping but actually harming people in their recovery.

    I think people have this magical view of PT that if you just think about it a second ... is misplaced. Someone breaks a leg. There is no immediate PT. There is a cast and time to allow the bone to heal ... then later, the person will gradually walk and use the leg. If there are problems, you might try PT, but ... if there are major problems, most likely the bone didn't heal correctly. PT cannot heal bones.

    In the aftermath of hip surgery, you've got this new device that has to fuse with bone. That takes several months, as I understand it. PT cannot speed up the fusing of the device with the bone.

    You also have a ton of sore and stressed and traumatized soft issue that was cut--and yes gets stretched and pulled-- even with "anterior" surgery. Stressing those tissues in the the process of healing ... doesn't help anything ... anymore than running on a broken leg helps anything or lifting heavy objects with a broken arm helps anything.

    The soft tissue has to heal ... Just as any cut has to heal ... and unfortunately hip replacement is a deep, MAJOR cut.

    One of the best interviews I read with a PT person about hip replacement said the following. The real role of PT after hip replacement was in the hospital before patients are released ... The PT person accompanies the patient up and down the hallway and up and down the stairs, shows you how to dress and so forth. And here was the gimmick: the real role of this PT in the hospital, according to this particular practitioner, was simply to instill confidence, to get people to trust that they could put weight on the new hip. People are terrified after surgery, and the PT in hospital is simply a way to get them to trust their hip enough to walk.

    Let yourself heal ... if a year later, you find some problem, ask for PT then--after your bones and soft tissue have healed. At that point the PT can be well-researched and specifically targeted to stimulating muscles and tissues that are not in a state of trauma. But again ... if there is a real problem after a year, there's a good chance the issue is with the fusing or lack of fusing of the device with bone. Ain't nothing PT can do about that.

    Trust your surgeon. He's the one (besides you) whose backside and reputation is on the line with the results.
     
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  11. wonkyhipoy

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    Gonna chime in here... but be forewarned, this is just my opinion. When my hip was scoped I did PT right away. At first it helped; however, it became clear after my own research the the therapist had little if any knowledge of the PT protocol for my operation. For clarity, I had a femoroacetabular impingement repair surgery where they shaved down the bone, resected the labrum and debridged the torn cartilage. Anyway, like with the hip replacement, you are not supposed to bend past 90 or risk a fracture of the femoral head, or possible dislocation. The PT however consistently forced my knee to my chest. I don’t want to even talk about the rotation stuff.

    Basically I feel that it all depends on the knowledge of the therapist. The guy (therapist) in the hospital (for my hip replacement) really knew his stuff. He basically said the job of the therapist is to ensure you are doing the exercises that the hospital therapist gave you correctly... that is all. He said to not let any therapist deviate from or get you to do different exercises until the OS has removed your restrictions. After that, it is all about getting lost ROM back (both from the surgery and years of limited mobility). His words.

    So I would stick with only the exercises the hospital gave you, and use the PT to ensure you are doing them correctly. But that is just my opinion.

    Cheers
     
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  12. dlp

    dlp senior

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    I'm a fan of PT, if done right. I did PT after both of my surgeries (am going for a session today, in fact) and found it to be helpful. They key is finding good folks who know how to work with you after a THR. As with surgeons, there are good ones and bad ones.

    The basic exercises given seem to not cover all possible outcomes for sore and angry muscles. I found my PTs to be very helpful in making sure I didn't overdo it, and to also make sure that I was performing exercises correctly. (Bad form can be worse for you than not doing anything.) PTs can also perform gentle massage, which can help loosen up muscles to make doing any exercises easier.

    I don't think anyone should rush to PT, but I also think that it shouldn't discounted as a way to make sure that you are staying on track, not overdoing it, but also not under doing it. Granted, I will say that I had a lot of issues pre-THR (back problems, quad issues, etc - all stemming from the bad hips) that needed to be looked into, so I might be an outlier.
     
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  13. Debru4

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    Thank you all so much! I am so grateful for your prompt and thoughtful responses. You have given me lots to think about. (Layla....My surgery was on August 3, 2018. It was a right anterior approach total hip replacement.) I am doing so well that at this point it is hard to imagine starting PT and possibly irritating/straining muscles that still feel compromised from the surgery, but are improving gradually every day. I really like the comments about how we don’t rush into PT for other injuries immediately. I am still sore in many different areas and my hip/leg still feel very “alien” to me. But I am walking about a mile unassisted each day (not all at once,but over the day) and I am able to take care of myself, my pets, and basic household tasks. I don’t want to introduce more pain if it may not benefit me in the long run. I am thinking that after my dr. assesses me on Friday I will follow his advice, which is my first inclination. If he suggests seeing a PT, I will be clear with them that I won’t allow excessive exercises or painful moves. (Thanks for your advice on that!). If he says no PT is needed now, I’ll see if I can keep that option open for the future. I know this is a process, and I have a long way to go——it’s nice to have a support group!
     
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  14. bickypeg

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    How I wish I'd read this when I came out of hospital! It would have saved me a lot of pain and what was a real setback in my recovery. But it's a time when you feel vulnerable and it's hard telling experts that their exercises are too difficult and hurt bits you're already having trouble with. You're quite right about the physios in hospital - their advice on just basically getting about and washing and dressing was invaluable. But no one should be made to feel they aren't progressing according to some ideal recovery rate. I'll continue my little walks around the house and doing a few easy jobs, but I shan't go in the car or go outside until I feel confident. I've spent years in pain. I'm not going to throw that away.
     
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  15. Mojo333

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    Splendid decision!:ok:
    Bonesmart was a wonderful tool for recovery for me as there's nothing better than hearing support and advice from those who know.
    You really are in such early days...and resting, icing and short walks are all you need to do right now as your body is in major healing mode after a big surgery.

    Hope today is a good day:SUNsmile:
     
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  16. Eman85

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    @Debru4 I would ask the OS for his recommended exercises. I would think if he does a lot of THR's he has a system which he has seen work. Why go to a PT? It's not like you need any equipment more than a bed and a chair for equipment.
     
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  17. Layla

    Layla FORUM ADVISOR Forum Advisor

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    :hi:
    Good luck with your appointment tomorrow on your Two Week Anniversary! :happydance:
    Let us know how it goes, if you feel like sharing.
    Keep the Big Tip from the Recovery Guidelines in mind when contemplating PT.

    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.

    Hope your day is great!
    @Debru4
     
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  18. Debru4

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    I wanted to update you all on my first follow up appointment with my surgeon following my right total hip replacement on August 3. I had asked the group for advice in advance of this appointment in terms of whether I should push for PT or not.

    My doctor felt I was doing very well and repeated that he did not feel there was any need for physical therapy at this time. He restated what several of you on this forum had said about the need for the hip to have time to heal on its own first, through walking and daily movements.

    He mentioned that hips are totally different than backs, knees, and shoulders, which often do need some guided exercise in order to improve, and that many people assume all surgeries and repairs need the same post op treatment, which isn’t correct.

    My surgeon also agreed with all of you that anything that caused true pain needed tp be avoided. I was mentioning how sore I was at the end of the day if I didn’t take some acetaminophen for pain relief. His comment was to be sure the pain relief was for existing pain, and not for pain I was creating by pushing myself too hard. That made me stop and think.

    I will return to see him in 4 weeks. He said at that time if there are things I feel I need support with, I can always consult with a PT then, and that I could also do that at ANY point in the future if I felt I needed it, so there was no need to rush into it. This sounds very different than what some people have said about their physician pushing them right into it.

    I am feeling incredibly reassured about my progress, and about the surgeon who did my THR. I also feel that the support from the members of this forum has already been invaluable—it helped me go into this appointment with good questions, a clearer picture, and more confidence than I would have had without your feedback! Thanks so much! I’m sure I will have more questions, and need more support as the process goes on—nice to know you are all here to help me out! Debbie
     
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  19. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    I love love love your OS.:loveshwr:
    He really seems like he has been attentive to what works for hippys.

    Wonder if he's ever heard of Bonesmart?
    Two weeks yesterday for you:ok:
    Hope your weekend is wonderful!:SUNsmile:
     
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  20. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Sounds like a nice surgeon. My advice on the pain killers+exercise/PT has always been that it's dangerous to mask pain when doing anything like this. That's because pain has a function which is to warn you when you are doing it wrong or just doing too much. Without that warning, we could risk causing us serious damage like torn ligaments or muscles and chronic pain. I've seen it happen any number of times.
     
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