THR Getting mixed messages on PT after THR<

[CricketHip]

If you can find a licensed massage therapist with good reviews, that would be worth trying, for sure.
My recoveries were helped so much by using them.
There’s a rather large muscle that runs from the ribs to the hip and maybe it’s still irritated and needs some soothing. I tend to have issues with it, myself.
Please update us on what you decide to do.

 

[Klassy]

Hi @Debru4 . My second, right, hip is doing brilliantly thanks. I’m really pleased with the pair of them. Just the other day it dawned on me that I had been living with nagging background pain for years, and now it was gone. Like when a fridge or something is churring away quietly so that we don’t notice it, but then it suddenly stops and the silence is like a weight being lifted. But I have to be careful not to do too much too soon and upset my left knee, which has always been troublesome. It was a reminder to read of your experience with your knee.

My physiotherapist massaged my right thigh muscle, which was very tight for a few months post-op, and it helped a lot. His touch was very gentle, none of that kneading and pummelling that some masseurs do, but he obviously knew just the spot to work on. I hope you can find someone with the magic touch and it helps you.

 

[Debru4]

I wanted to post an update about the hip concerns I shared here a few weeks ago. I made an appointment and saw my surgeon yesterday. It was the first time I'd seen him since a year after my hip replacement 4 years ago. The X-rays showed the replaced hip was "perfect" (doctor's words) and the other hip showed only a tiny bit of a bone spur, but great space. He said it was likely I would never need surgery on that hip, which was a great piece of news as well. He did a complete assessment, including range of motion and was pleased, saying my new hip had the same functionality as my own hip. That had been my sense as well, which is why I was concerned with the niggling hip pains over the past few months.

The X-rays did confirm continued issues with the back disc spaces, with considerable arthritis, which I have known all along, but it did not appear to be significantly worse when compared to previous views. Clearly an MRI would show more detail, but while he did think some of the pain could be from my back issues, he didn't think most of them were.

Instead, he felt most of my pain was related to the ice fall I had in January, since I‘d rolled onto the hip area after I hit my back. He said I’ve probably carried my body differently for a while and adjusted my gait to compensate for the pain of the broken ribs and internal bruising, and that there may also have been some overstretching and tearing of the ligaments in that area that are still healing.

But the main issue he identified was trochanteric (hip) bursitis, related to my fall. He though with my increase in activity this summer it has become even more inflamed. Since I'm unable to take NSAIDs for inflammation and pain due to an immune disorder, that has kept the bursa from settling down.

He suggested seeing my family practice doctor for a prescription of Celebrex, and icing and resting the hip. He agreed that if I could find someone who could do a good massage in that area that it could be helpful. I’ve had massages for fun occasionally, but haven’t done it for a specific therapeutic issue like this. Do any of you have advice about how to find someone with those particular skills?

I do think trochanteric bursitis is likely the cause of most of the pain, as I “cheated” and took a couple ibuprofen along with icing, and within a few hours my hip felt much better. (Sadly, my stomach reacted to the ibuprofen so I hope my regular doctor will prescribe the Celebrex.) Do any of you have additional advice or suggestions about dealing with trochanteric bursitis? I understand it can become an ongoing/ recurring problem and I’d like to avoid that. I plan to increase my tumeric curcumin for inflammation. Are there any other supplements or prescription medications any of you have found useful in reducing inflammation?

Needless to said, I’m relieved the replaced hip is in good shape, and to also have a diagnosis for the pain. Thanks to everyone here for the encouragement.

 

[myglasshalffull]

I'll be most interested in the massage info, I've been wanting to try it myself.
I developed bursitis as well and was told to use Voltaren which obviously you cannot use due to your immune issue. I didn't find it all that helpful in any case.
Following...

 

[Mojo333]

Hi @Debru4
Glad you got confirmation from your OS that all is well with your prosthesis.

He agreed that if I could find someone who could do a good massage in that area that it could be helpful. I’ve had massages for fun occasionally, but haven’t done it for a specific therapeutic issue like this. Do any of you have advice about how to find someone with those particular skills?

The first thing you will want to consider when you want to apply massage for hip bursitis is that your massage therapist should be very experienced, have a medical massage license, hopefully have experience with clients with bursitis, and use very light pressure massage.

Everything I've read says that you do not massage right over the bursa. This will make it worse. However, massage can be done to other areas of the body to address imbalances and decrease pressure on the bursa.

Ice is definitely useful when at rest and being mindful of your posture so that weight is balanced is also important as well as avoiding or restricting activities that seem to aggravate the condition.

I wish I had better advice regarding alternatives to NSAIDs ...
I hope this settles soon

 

[CricketHip]

He suggested seeing my family practice doctor for a prescription of Celebrex, and icing and resting the hip. He agreed that if I could find someone who could do a good massage in that area that it could be helpful. I’ve had massages for fun occasionally, but haven’t done it for a specific therapeutic issue like this. Do any of you have advice about how to find someone with those particular skills?

I recommend looking for a sole practitioner, or an office with just a few therapists working together. I'm not saying that the massage chains or spas aren't good, but it's usually a toss up whether you will get someone competent enough to help. The chains/spas also tend to have a set game plan and you get a full body session when sometimes you want a specific session, as in your case where you want the hip, back and legs thoroughly addressed. There's nothing more frustrating than going for something specific and have your therapist spend 15 minutes on scalp and face massage.
Then you want to look at their reviews, confirm that they are a licensed massage therapist. Most states require that they show their license # on their other information.
As for massage over the affected area, I actually believe it is very beneficial. There's more than bursitis going on and it's good to relieve the tightness and inflammation around the supporting soft tissue. Sometimes one or two muscles are more toned than others and can cause an imbalance, which irritates and can create bursitis. Mojo is correct in that they shouldn't be pressing deeply right on top of the inflamed bursa.
It would be hard for you to distinguish though, but if they are using fingertips, thumb or elbow then ask them to ease off a bit. I would want it to be administered with a flat hand in the area.
Most therapeutic or neuromuscular massage sessions should take into consideration your level of pain, to not try to "fix" everything in one session and explain what they are doing during the session.
I would recommend going once a week for several weeks and see how you are doing.

The other option that could be very helpful would be acupuncture. The combination of them both could be very beneficial for you and also for @myglasshalffull

 

[CricketHip]

Here is an article that could be helpful..

Chronic inflammation and fatty acids

Chronic inflammation and fatty acids Chronic inflammation is a major factor in a wide range of health issues in the body. Medical research demonstrates this from arthritis to cardiovascular disease. This article concentrates on the topic of chronic inflammation in regard to arthritis, a topic...

bonesmart.org

 

[Flowerfloosey69]

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.

My opinion on PT is my own and I don't pretend to have professional knowledge.
I have had one two total hips posterior done years ago and within last 9 months two revisions on one side. I believe an uncomplicated anterior approach does not need any PT. Walking is the best exercise. It sounds like you are well on your way in that, and I would discuss it at your 2 week appt. As you well know, they don't cut thru the muscle in Anterior approach so walking for rehab is the best ticket back to normalcy! Listen to your surgeon and take his/ her advice.

 

[Flowerfloosey69]

I was told at my 2 week followup to use Vytorin and rub that into area around my hip. It's an anti inflammatory. I can't take the pill form due to stomach issues.

 

[Jamie]

I was told at my 2 week followup to use Vytorin and rub that into area around my hip. It's an anti inflammatory. I can't take the pill form due to stomach issues.

Vytorin is a cholesterol lowering medication taken orally.

I think you may have meant Voltaren which is an NSAID cream Or gel for arthritis pain. Although in past years it was believed that using an NSAID in cream form eliminated the possibility of stomach problems, current guidance cautions people about using it if you do have stomach issues. It is possible to have problems with the cream or gel. They can be quite serious and come on suddenly With no warning. Your surgeon can (and probably should) prescribe a medication to help protect your stomach if you are to continue using Voltaren. If he won’t, contact your GP.

 

[Jamie]

Also, since you are only a little over 2 weeks out from your surgery, be sure you keep any creams, oils, or gels well away from your incision.

 

[Debru4]

@CricketHip and @Mojo333 --Thanks for the advice. To be honest, the places where I feel a massage might help the most are my lower back, waist, and bottom. I had the same concern, Mojo, about massaging on top of the bursa, but it sounds like there are plenty of other areas around it that likely could use some loosening.

Cricket---I agree completely about not going to a chain and really want to research to find someone who understands anatomy and won't do any harm. Your suggestions relative to this are helpful.

I do have a good friend who is a licensed acupuncturist. I had seen her prior to my back surgery 12 years ago, and to my hip surgery 4 years ago, and didn't get any pain relief from it at the time so I didn't really think about it this time. If things don't clear up I may check back into it.

 

[Debru4]

@Jamie and @Flowerfloosey69 ---For some reason you both seem to be responding to my original post from 4 years ago. (Or thinking my recent post is about a recent hip surgery rather than that one years ago?)

My recent posts are related to some hip pain that started following a bad fall on the ice in January. I checked back in here to get some support and ideas, and ended up going back to my surgeon last week for X-rays and an exam.

The title of my original post obviously no longer applies----@Jamie, do people just leave the original one or change it if it's no longer pertinent? Thanks.

 

[Jaycey]

@Debru4 We can certainly change your thread title for you. What would you like as the new title?

 

[Flowerfloosey69]

I was told at my 2 week followup to use Vytorin and rub that into area around my hip. It's an anti inflammatory. I can't take the pill form due to stomach issues.

Vytorin is a cholesterol lowering medication taken orally.

I think you may have meant Voltaren which is an NSAID cream Or gel for arthritis pain. Although in past years it was believed that using an NSAID in cream form eliminated the possibility of stomach problems, current guidance cautions people about using it if you do have stomach issues. It is possible to have problems with the cream or gel. They can be quite serious and come on suddenly With no warning. Your surgeon can (and probably should) prescribe a medication to help protect your stomach if you are to continue using Voltaren. If he won’t, contact your GP.

Thank you Jamie.. I'm sorry for that mistake.. you are completely right about the wrong med name.

I had some Voltaren that was suggested by my husbands OS but we never used it. When the PA from new OS office suggested it, I got it out and read the precautions on it and decided I didn't want to use it for a couple of reasons, one being the increased risk for heart attack or stroke!

 

[myglasshalffull]

Yes, the precautions on the Voltaren are scary. I did use it a couple of times but found it to not be useful in my case.
I use Arnica gel and find it very soothing. Not necessarily a cure all by any means but it's cooling and just feels good.

 

[Jamie]

@Debru4 … sorry for any confusion. I was actually responding to Flowerfloosey69’s post to ensure that people understood the risks with using even the cream or gel. As Jaycey indicated, we can change your thread title to reflect your current concerns. All you need to do is post what you want the new title to be.

Your thread got a bit off track and we’ll get the focus back on your questions about Celebrex and massage for your trochanter bursitis. If you do use the Celebrex, you might still take something for any potential stomach problems. Ceebrex is supposed to be less likely to cause stomach problems, but you may want to play it safe with the additional medicine.

 

[Hip4life]

@Debru4 I had trochanteric bursitis on my left hip a year ago July after a fall. Tripped over an uneven sidewalk seam. I mainly iced and took ibuprofen or Aleve but icing and not overdoing seemed to help the most in lieu of OTC NSAIDS. I also had the sitting on a ball discomfort. I used a PT-style foam roller on the area. After several sessions, the muscle (I decided it was the piriformis based on my doc's description of said syndrome) relaxed and the ball sensation and discomfort was eliminated. It was pretty sore at first to start but one of those "good" sorenesses. I'm also a fan of a good therapeutic massage from an experienced therapist be that a massage or a PT. Just sharing in case something might help and to let you know you're not alone even this far out. I hope you get some relief soon.

 

[Elf1]

@Debru4 good to see you but sorry you're having pain and possibly the dreaded trochanteric bursitis! That is the bane of my existence!

First off, celebrex is also an NSAID, pretty much any arthritis type med seems to be. I can't take them either as I have kidney disease from over prescribed NSAIDS over the years.

I hope the massage helps, definitely try some ice, even heat to see if it works. I had a cortisone injection in both hips a while back as I was diagnosed with it in both hips. Yeah, I have to be special! I did experience some relief for a little while.

Don't know if you've ever tried acupuncture or not but if you can afford it and are willing I'd definitely give it a try. I used to see an acupuncturist before my hip surgery and she about put me to sleep every time I saw her! And that's from someone who hates needles.

Keep us posted, hope you find something that works as it can be quite annoying. And, like you, I have previous back issues that just add to the fun so I definitely feel what you're going through.

 

[Doglover7]

I am at 9 weeks post op on weds and I did not do any physical therapy other than the home health 2 days after surgery and he only showed me exercises I never did them. I am back to work, managing 7 dogs at home and pretty much doing everything I want within reason.
Honestly I think physical therapy is over rated and can do more harm than good.