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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

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    Hi @Small1014 ---the post of mine you responded to this evening was one I wrote almost a year ago after my hip replacement. I opted not to do any PT but kept as active as I could comfortably by doing a lot of walking, and resuming of daily activities. For me, it was the right decision, as I was in pretty good shape prior to the surgery and am active by nature, so those things helped me recover without PT.

    You make a good point that those who have had previous hip replacement experience may have a different perspective/approach than first timers:) I also have noticed here on the forum that many people do not wait as long for their second replacement as their first, most likely because they realize how manageable the recovery typically is, and because they see how much the replacement improves their quality of life. I also have observed what a huge range of things people are asked to do in PT---some of the exercises appear to be closer to Olympic training that hip recovery. There are people like you as well, who feel they are able to do PT without overdoing. I'll be you are relieved to have hip #2 done and be moving along so well in your recovery!:flwrysmile:
     
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  2. Fit4Family

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    Good morning @Debru4

    You neighborhood sounds lovely. I had same images of trekking poles but, when I was using them last month was really impressed with the upper body workout they provide. Our area has quite a few hills. So they were very helpful for balancing around lakes here. I am so glad you are able to work and walk in your yard. That is on my can’t wait to do list. I had hoped that Fall would be possible. My husband has been doing the yard, but the shrubs, garden have kinda been ignored. My turf. Lol.

    I only went to PT three times this go around. The last day, I was lifting my leg forward with the lightest resistance band they had. It hurt. Should have stopped. I had also practiced going up and down stairs the normal way just prior, so either could have been what irritated the Gluteous minimus tendon. Surgeon wants me to give it a few weeks before getting an MRI, as I’ve already had so much surgery. It’s been quite a year. I took the freedom of movement for granted before this happened. It’s been a very illuminating experience. I hadn’t realized what so many dealt with. Really hoping this heals without more surgery. We have a son in high school and a daughter in college. Lots on the calendar this month as my hip continues causing pain. Trying to remain hopeful.

    Thank you so much for sharing your journey. I do agree that slow, natural recovery is the best path. It’s a wonderful thing to read that you have gotten your life back. Very hopeful to read. Hope you have a great week. ❤️ Sarah
     
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  3. Debru4

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    Wanted to give an update since it's been awhile since I did so:) I had my one year follow up a couple of weeks ago. It was a good appointment—they x-rayed both my operated hip, and my other one, and both were found to be in good condition. :yahoo:

    I also had both knees x-rayed because I have been having some knee pain in my non-operated leg, and the doctor wanted to see if I was developing osteoarthritis or if the pain was from something else. My knees had plenty of joint space and minimal arthritis, which also was great news. :)

    The backstory: My knee pain came on about 1 1/2 months ago following my first challenging mountain hike where there was quite a bit of elevation gain, and a pretty rough trail. As I’d mentioned in an earlier post, I was thrilled that the hike gave my hip no trouble at all, but what I neglected to think about was that I hadn’t really done any hiking in almost 2 years, and my knees were not ready for the downhill race that I felt compelled to do. I had a trekking pole which helped, but I still had considerable pain the next day——new pain, in my left knee. I didn’t consider that our whole bodies are affected by a non functioning hip, by hip surgery, and by the subsequent recovery, and that effects can last longer than the actual hip recovery.

    I was diagnosed with patellar malalignment in both knees, but much more serious in my left knee. My kneecaps are not tracking properly, The surgeon said it is common in women, and in those who have had hip/leg/knee issues and who moved with an altered gait for a period of time. The compensation/overcompensation often result in weak tendons/muscles around the knees. Fortunately the doctor said it responds well to PT. This was completely unexpected for me, as I had no idea that once the hip was replaced I would continue to deal with aftereffects of the damaged hip.

    I’m not particularly worried about it, as a couple of PT sessions where I’ve learned a handful of targeted exercises, coupled with my regular activities already seem to be having a positive effect. My therapist is excellent. He has adapted exercises based on my feedback—he does not want me to have pain. He also has modified some to take into account my previous back surgery and my hip replacement——all this without my having to ask, or to get assertive. As a result, I have more confidence and less stress associated with going to PT, and doing the activities. However, thanks to the Bone Smart coaching, if I had any concerns, I would know to speak up and not push through pain. For that, I am grateful!:loveshwr:
     
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  4. Jamie

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    This is a great report! I'm glad you've found a wonderful therapist who can help you with your knee issues. Doing this proactively could very well slow down any arthritis development. You were wise not to ignore it.
     
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  5. Carmen2348

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    Just joined the forum - much useful information. Wish I knew about it before my hip surgery about 3 weeks ago.

    I feel I must take an issue about the importance of PT to recovery following joint replacement or other orthopedic surgery. I started PT, coupled with Ocuupational Therapy (OT) at a post acute rehab i day post my THR surgery. I found it extremely helpful and it truly did much to raise my spirits follwing a surgery I neither expected nor really wanted (but had no choice). Prior to surgery I was very active - going 3/week to the Gym and doing long bike rides through country roads at least 2/week plus, of course, walking as much as i could (my knees won't let me do more than light jogging, alas). So my concern was getting back to being active ASAP, since to me physical activity is essential, both to maintaining a healthy weight and keeping a positive attitude to life.

    My Orthpaedic surgeon generally believes in aggressive post surgery PT. When i had to have a rotator cuff repair follwing a dislocated shoulder due to an accident, I started moving the shoulder a day later, and continued with PT fror over 12 weeks (my insurance kindly agreed!). Within 3 months my shoulder was just about as good as new with the same range of motion I had before my accident and all pain gone. Heck, I could even try for a pull-up over the bar, something I could never do!

    With the hip, the exercises are not too taxing at all. In fact I keep asking for harder ones so they have to hold me back. Ar rehab I was able to graduate to a crutch from a walker after 4 days, and could walk with almost no limp using a cane after 2 weeks. I am now - at not quite 4 weeks - practicing walking unaided for increasing distances (not very aggressively. There is that fear factor....am not free of it after reading way too much about potential complications). Yes, there's still some pain now and then and swelling below the surgery site. But it's manageable with Tylenol.

    On the bright side, through this entire ordeal (which for me started 2 months before the surgery), I have lost 20lbs, so everything seems somehow lighter.

    From my experience I do recommend light PT post surgery - not just for the hip but for the mind as well. Naturally one must have competent PT who is fun to work with too, so the time goes by fast.

    Anyways, I aof course agree that walking is great. It's just not enough for some of us who are both used to and need more rigorous workout, and can't imagine life without it.
     
  6. Debru4

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    Hi @Carmen2348---welcome to the forum! If you have a chance, you can start a thread and list your surgery date and then some of the forum advisors will welcome you and share some info:) This is a great place to get info and connect with others.

    I had focused PT following my back surgery as recommended by my surgeon, and got moving again quite well, really soon. My surgeon this time did not recommend PT--he said hips are completely different from backs, knees, and shoulders, and that he had seen many people suffer setbacks from doing PT. I followed his advice, and didn't do any PT. The PT I am doing now for a few sessions is related to my knee, which is a part of the body that responds well to rehab.

    It's interesting that with no PT, I too was walking with no aids and driving at 2-3 weeks post op. I just walked, did daily activities, and started going up my steps as I was able. So it seems we had the same result early on. . For me, it was the right decision, but I am pretty active, so was able to incorporate plenty of movement as soon as my body could handle it. My progress was steady, with no setbacks.

    It obviously is an individual thing, and I have noticed for people like yourself who are accustomed to structured exercise---going to the gym, biking, running, that it is especially hard to take the time off. And for the mental aspect, I've heard others say PT helps them. It seems like your PT is working fine for you at this point, and that you are being careful and not pushing things:) A good therapist makes a big difference. After spending nearly a year on the forum, I have seen far too many people suffer an injury, or a setback from aggressive, or incorrect PT, so do keep monitoring it. Good luck to you as you continue your journey.
     
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  7. Mojo333

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    Oh my stars...your one year hipversary slid past me.
     
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  8. Mojo333

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    images (1).jpeg

    Hope the therapy for your knee gets it "back on track"
    I've had some targeted therapy for my lower back/SI joint the past month and it has been very helpful.

    Thanks for sharing your hip recovery and uplifting others.
    Hope you have a great Labor Day Holiday @Debru4
     
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  9. Calgal

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    Your posts everywhere are always honest informative and insightful. :thankyou:
    Thanks for sharing your experience with all of us and wishing you happy 1 year hipaversay (a bit late) and good luck getting those knees stronger and fitter to carry your bionic bod even further! :walking:
     
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  10. SurreyGirl

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    @Debru4 congratulations on your year’s anniversary! Glad you are doing well.
     
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  11. Layla

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    A belated Happy One Year Anniversary!
    I hope you have a great holiday weekend and beautiful weather to enjoy it.
    Good to read the targeted knee exercises are helping, may it only get better! :)
    @Debru4
     
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  12. Barbaraj

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    Wow, one year @Debru4! Great report, and I'm sure you're relieved that knee pain can be dealt with through targeted exercises rather than facing the trauma of surgery yet again. Glad the exercises are working for you. I can't wait to start PT shortly myself and agree with you that while it's hard for some of us (uh...like me) not to immediately after surgery to get back into regular exercise we did before surgery, waiting to return to that and just focusing on walking and balance early on is a smart approach.
     
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  13. swimmer77

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    So much valuable information in this thread. My problem with PT is that every patient is different so I don't understand how they know the limitations or strengths of each individual patient to get maximum benefit.

    I was given a booklet pre-op that had exercises to do before and after. I haven't had a "formal" PT session. I'm on my own. And I do the exercises if I feel like it but I'm spending most of my allowed "up" time walking and doing some steps. I'm focusing on practicing my gait by using crutches and the walker.
     
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  14. Debru4

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    Thanks @Mojo333! I too have some lower back pain that was not addressed in my surgery 10 years ago, as we did not want to do a fusion, and the doctor was able to isolate the disk and area that was causing my sciatica symptoms and most of my pain. That surgery was a huge success, and maintaining my core and staying pretty active kept the other bulging disks in check. With this hip situation, which started in Oct. 2018, through now, my decreased activity for part of it, coupled with my compensation have resulting in a bit of an increase in my back pain.

    However, the current PT is not just working on my knees, but rather is having me do core exercises as well as all the leg/hip muscles around the knees, so I hope that addressing this, and getting bak into better habits will help ward off more back issues. I'm glad to hear the targeted PT has been helping your back. With your job you must put a lot of strain on your back, even when you are living properly and doing everything right. But isn't it exciting, that even when other body parts are trying to give us fits, our new hips are working so well?!?!? I still marvel at that each and every day.:loveshwr:
     
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  15. Debru4

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    Thanks @Calgal---I appreciate your kind words. I am glad I have continued checking in on the forum, even at one year out, as it's been nice to share some of my experiences with others, as well as continue to get support as new things pop up. I've learned that a replacement of a major body part is far more than a single surgery, but rather more of a process that lasts much longer than the original recovery period. Plus there are so many lovely people here on the forum, like you, and @SurreyGirl and @Layla who I enjoy staying in touch with. :flwrysmile:

    Beautiful, albeit HOT weather here in Colorado this weekend---95+ degrees out, but the dry heat isn't too bad. I'll take that over the cold frigid temps of the deep of winter any day. Am having a gathering tomorrow and plan to set up my collection of wading pools for the kids to play in----suspect I'll be joining them!:heehee:
     
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  16. Debru4

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    @Barbaraj----You'll be proud of me--- I actually enjoyed spending time on the exercise bike when I had my last PT session for my warm up. :egypdance:
    I was thinking about that and believe part of my aversion to formal workouts is the actual act of having to drive to the gym, as well as the highly competitive, super fit people I always seem to end up next to, which has an intimidation effect on me. At PT, everyone there is struggling with something. In my past I have taken lots of different exercise classes, and often (not always) enjoyed them. I need to do some research and see if there is something that looks fun and motivating to get me back into that, for some variety. As I approach winter, when I can't be out in the yard, or walking as much, I think it would be good. My self discipline to do consistent exercise in my home, on my own has gotten to be hit and miss the past few years. I'm hoping this round of PT will help me get back in a better routine!!

    When I last talked to you, I didn't feel like the knee exercises were helping, but when I met with him after my first session and told him about it, he adapted the exercises and now things are much better! Great therapist:)

    Kudos to you for your self control in NOT going with your heart of hearts desire to go for broke. Just as not being out in my garden/yard literally kills me when the weather is bad, I know not getting into your gym does the same thing to you. :cheers: (Pretend like these are wine glasses!:heehee:)
     
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  17. Debru4

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    @swimmer77--I also did the slides and simple exercises they sent me home from the hospital with, and I think they were good---helped me with range of motion and the beginning stages of recovery, but like you, I did no formal PT for my hip. I was concerned about that---in fact my first post on here (hence my now unnecessary thread title---"Mixed messages on PT" was asking the forum members if I should follow my doctor's advice and do no PT, since I always thought it was necessary after a major surgery. I kept hearing that it wasn't necessary/good for hips and even got online and researched what muscles were used with the daily life activities I was doing---reaching, getting in and out of bed/shower, climbing steps, walking, standing, and so forth. And lo and behold, I was activating everything I needed to be to recover. :yahoo:

    I think that people underestimate what you can accomplish by being active and moving. For some of us, that includes a gym, or PT. For others, we can do it other ways. I also believe that a good PT, like the one I have now for my knee, can figure out what you need by studying your records/test data/xrays, AND by talking to you and LISTENING. I think that is how they can differentiate and figure out what would help you move forward safely, just as a good teacher does with their students. With that said, it seems there are far too many tales of PTs who follow the same, prescribed, and often too intense program for everyone following a hip (knee, back, substitute the body part here) surgery and that's where I believe people end up hurt. I had one of those myself for an elbow issue many years ago, and after 6 weeks I quit, in worse shape than I started. I did not like the PT I had personally following my back surgery, and she was not a good communicator---more of a drill sergeant, but the assessment and exercises did match my needs, and she did monitor me closely, so it was a successful, if not fun experience.

    I think you are doing exactly what you should be, and I believe your common sense approach is going to pay off for you in the long run. :yes!: Keep checking in to the forum and utilize the vast experiences of the members on here to help you in your recovery!:loveshwr:
     
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  18. Going4fun

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    @Debru4 ... glad to hear of the positive PT experience for your knees. Sorry to hear of the knee pain after the hike.

    I just finished a kind of delayed PT for my hip and back ... and I totally loved my therapist. I seriously think having the right therapist, one you feel really comfortable with, who you trust, is part of the healing. I turned off my worry-figure-it-out-what's-going-on-panic brain and just followed my PT's suggestions, focusing on telling her what exercises felt good and which didn't feel so good.

    Good luck ... Congratulations on your first year.
     
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  19. lotusbuds

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    @Debru4 Congratulations on your one year anniversary! so glad to hear the PT is helping with your knees.
    I am going to try Feldenkrais classes in 2 weeks. I did them years ago and it was great. Just finally found a class about 30 minutes drive away. Have you ever tried them? google it and see if that is something you want to add in the winter months.
    I have appreciated your posts on the forum so thank you.
     
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  20. Debru4

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    @Going4fun--Curious about your "delayed PT for hip and back"---what prompted you to do it? How many sessions did you have? Your surgery was a little over a month after mine---how are YOU doing at this point overall?

    I agree 100% about the value of a good PT. And the trust factor is huge---as I mentioned in an earlier post, I had a PT who not only gave me crazy inappropriate exercises for my elbow (I later learned) but was rude and didn't pay the least bit of attention to my feedback or concerns. This was many years ago, and I did not have the confidence at that point to challenge him as soon as I should have. I just kept going. Eventually he "fired" me, as in ----my insurance ran out. Lucky for me---elbow now is fine, but no thanks to the PT. I would not let that happen to me at this point in my life, especially with the coaching from those on this forum, but it isn't easy to self advocate and question a medical professional for any of us.

    I have such a positive feeling about my current therapist. So wish me luck on this round of PT---I am eager to get hiking at elevation a bit more before the snows hit the mountains and I have to wait another year. I walk a fair amount so I'll keep doing that, but would love another shot at the mountains:) If the knee acts up again, I'll have the winter to rest up.
     
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