THR Hitch & Get Along<

[Josephine]

Yesterday I had a PT session, did everything I had been doing with the addition of upright cycling, leg press on a machine and some wicked side leg lifts. This morning I woke up and I have pain in my hip.

You know, @NanaKP I had to go back and check that you'd actually been left our recovery guidelines because it sounded like you hadn't seen them! But there they are, in post #5, just where Jaycey left them! Do me a favour and go back and read them again, will you? Because you are missing some very important information there. Not least of which is this one

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.

You're right, I think I have been sabotaging my progress because I get stuck in that mindset of "more is better" and I should be further along.

You said this yourself - you've been sabotaging your recovery big time! And the sooner you get back on track and stop doing all this exercising, the better you will be!

 

[NanaKP]

So I guess I tell my OS that I'm going to ignore his request that I follow up with PT after each surgery? Pretty sure he wouldn't do my second one if I didn't follow through with his request after the first. Yes, I DID read the recovery tips and said my husband I were surprised by the information that many of you didn't believe in PT after THR. It was contrary to everything we were told by my surgeon, surgical team, GP, etc.

I apologize for asking for advice about the popping. Please just disregard and I'll figure it out. Thanks.

 

[Mojo333]

@NanaKP
No apology for asking question. It's confusing ...but all I can say is I went to PT one week out for three sessions and it was obvious it was actually causing my poor legs, which weren't ready for that sort of activity yet, distress and problems. My PT was rather strenuous where I've read of others where the therapist is more sensitive to the fact there is a lot of healing going on.

I told my OS I was going to hold off and do walking and simple stretching and he had no qualms as I was doing very well without it.
It can't hurt to slack off and see if it resolves some of your issues maybe.
I also figured out that the good advice I was getting was from those who have been there, done that!
My physical therapist never had a Hip replaced.
They are trained to deal with all problems by Doing something physical.
Sometimes, we just need to stay active, but REST those already aggravated muscles and soft tissues.
They are trying to recover from a major surgery..
The mixed messages we get are confusing, but your body should be your guide.
We just don't want to see folks create chronic problems especially early in recovery...which you are.
Hope tomorrow is a Better Day!

 

[Bone-obo]

This is a pretty touchy subject around here for exactly the reasons you lay out: most (not all!) surgeons recommend PT, and PT's are personal coaches at heart - they have your best interests in mind, but they vary a lot in terms of how much intensity they think is "correct". When working out a muscle, it's natural for it to tire and start to ache - that's when trainers want you to push through the pain. But post-surgery, there may be little twinges and pains that aren't muscle-related, and if you annoy them, these bad boys will snap at your heels for days or even weeks if you don't watch out.

Suggestion: train your PT to give you what you want. What I did was ask a lot of questions of the PT - what does this exercise do? How can you tell my abductors are weak? (They love to work abductors - it's a fetish or something.) And I give them problems to solve - PT's love those! "Can you check how I'm walking - I think I have a limp." "Stairs are a problem around the house - anything you can do to help?" "My operated leg feels longer than the other one - is it?" (Use this one for distraction only! They can't really tell, as Josephine will tell you, but it makes them happy to think they can!) And of course, "did you enjoy the chocolates I gave you last week?"

And don't let us push you around. We're really horrible bullies who think we know stuff, but only you know how your body feels and what your situation is!

And in another month or so, you'll know stuff, too!

 

[Layla]

Wait, Wait...Whether you engage in PT is entirely up to you.
Many do so successfully without any set backs. It's discussed here daily.

I've yet to hear of a surgeon who wouldn't perform a THR due to a patient mentioning pre-op that they had no intention of engaging in physical therapy during their recovery. In my experience, PT was never even mentioned in the meeting with my OS before scheduling surgery. It's a matter of preference and I don't believe your OS can dictate you partake in PT.

It does seem though that you are suffering some pain / a setback directly related to PT. You mentioned the side leg lifts were very painful and that you should have said, No, and stopped, but instead you did thirty of them. You referred to them as "wicked" which sounds as though you suspected you may be suffering afterward. Or, hoping you weren't hurting yourself.

I think it's a safe bet that if you lay off PT for a time and rest, ice and elevate as often as possible you will improve. That would include using your cane until you're no longer limping. Once you're feeling better, re-visit the idea of PT without doing anything that hurts. If a movement hurts, I'd stop and request your therapist come up with exercises that don't cause pain while you're engaging, or have you suffering in misery hours later.

Please don't walk away from the valuable advice, support and encouragement offered here over a difference of opinion in regard to PT. It's your recovery and you are allowed to heal in the way you choose. However, you did express frustration and worry in regard the pain you're suffering and it seemed clear you were relating it to your latest PT session.

I hope your pain eases soon and wish you well as you move forward in recovery.

 

[Mojo333]

And I give them problems to solve - PT's love those! "Can you check how I'm walking - I think I have a limp." "Stairs are a problem around the house - anything you can do to help?" "My operated leg feels longer than the other one - is it?" (Use this one for distraction only! They can't really tell, as Josephine will tell you, but it makes them happy to think they can!) And of course, "did you enjoy the chocolates I gave you last week?"

And don't let us push you around. We're really horrible bullies who think we know stuff, but only you know how your body feels and what your situation is!

Perfect advice! And so true...I used some of those diversionary tactics when I resumed PT for gait training purposes approximately two months out!

 

[Layla]

The best thing I took away from my PT was her emphasis on heel-toe walking which was new to me and felt foreign for a time....until I realized it worked and I was no longer limping.....Yay!
I blab about it here constantly because I'm a believer...it really works!

 

[NanaKP]

It's been quite awhile since I've been on to post. It has been quite a ride between then and now. After going through 12 weeks of rehabbing and PT on my left THR (popping that happened when I lifted my leg, pain in my hip, inability to walk without a limp that was worsening), I was told that I had a greater trochanter fracture on the operated side. My husband and I wanted it fixed before proceeding with the 2nd hip. On August 1st, I underwent surgery to fix that fracture and have a lovely metal clamp on the side of my femur and cerclage wiring. Approximately 3 weeks into the recovery from that surgery, the wound opened up and I developed an infection. We learned how to pack the wound and after 2 weeks of oral antibiotics, the infection was cleared up. This week, the wound is pretty much closed up.

The problem that I am having at (now) week 7 from the repair (week 20 from the THR) is that I struggle walking up the stairs leading with the operated leg. I have some pretty wicked pain in my left butt cheek and I am unable to go up even one stair without a good grip on the railing (not just for balance but to assist me in lifting myself up). I am not doing ANY PT, I have taken some short walks, always using the cane.

I have had some very dark days in the last 7 weeks, only sharing with my husband how down and frustrated I have been feeling. I miss being able to be on the floor with our grandsons, I miss going up to our cabin, I miss enjoying life - period. My right hip is deteriorating quickly, originally that hip was scheduled for August 6 but is obviously off the table with the repair and then the wound dihiscence. I see my surgeon on Tuesday and he wants more X-rays (especially after I have told him that I am still struggling with the stairs, going up, not down).

Anyone else go through anything similar with stair climbing?

 

[Mojo333]

Oh my stars, @NanaKP ! What an awful thing to have gone through. Hate to hear it, but am glad the infection is under control and hopefully this is going to move forward and get well quickly.

The problem that I am having at (now) week 7 from the repair (week 20 from the THR) is that I struggle walking up the stairs leading with the operated leg.

Why are you trying to do that? It is too early to even be trying it, in my opinion.
Up with the good (i know your other needs replacing, but lets make this be your non-op leg) down with the bad.
Lead with your non op leg going up and lead with your op leg to walk down stairs.
Hopefully you have railings to help pull up with so not so much weight on it.
If you are using a cane, hold onto the railing with one hand and place the crutch or cane on the opposite side of your repaired hip.
Please do try to not have to do more stairs right now than absolutely necessary.

 

[Josephine]

@NanaKP I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[NanaKP]

@Mojo333 - we live in a house that is on 4 levels so going up and down the stairs is pretty much inevitable. I really believe that 7 weeks out of the repair of the fracture, I SHOULD be able to do the steps with much more ease. There's no way I can even consider getting that second hip done if the first one isn't pulling its weight.

My husband and I are self-employed and there has already been considerable strain put on him with my missing so many days. I can't help but wonder if it's the cerclage wiring that is irritating the muscles when I go up? The surgeon said that some people do really well with that hardware and some people find it very irritating and want it removed once the fracture is healed. I'm not sure if that is the problem or not. I will definitely ask him when I go in on Tuesday, he's doing another xray then too.

I know that I could be in a much worse situation that anything I have experienced up to this point but it does feel like it has been anything BUT 'par for the course'. I have been really trying to stay upbeat through it all but those dark days have crept in and reared their ugly head more than a few times. Thank goodness my husband is my rock.

We celebrated one grandson's birthday, both of our daughters and son-in-laws birthday's and our anniversary since the fracture repair. We now have the other two grandsons' birthdays coming AND the holidays, I want . . . no I NEED. to be back to my normal self before I lose the rest of my mind.

 

[NanaKP]

Ooops sorry, meant to reply to @Josephine -- yes that's fine.

 

[NanaKP]

When I say "celebrating" the above birthdays, I did nothing for any of these celebrations - we had one get together for the birthdays (BBQ at one daughter's house); we attended the grandson's party for approx 1 hour where I stayed in the recliner (I was still NWB on crutches) and we went out to our favorite restaurant for anniversary dinner. My activity level is pretty much zero - we go visit the grandsons usually once a week (though I am unable to do much of anything other than read to them or sit with them while having a treat). I limit trips other than work M-F (30-35 hours) to one or two each weekend day. (Getting in/out of the car is pretty tiring).

 

[NanaKP]

Sorry to be answering now in "chunks" - I don't mean to turn this into a long, sordid, woe is me tale. As much as I expected some down time through the THR, I feel like I have had the rug yanked out from under me as far as participating in life. I was able to make it to our cabin one time this summer (we had family visiting) but have not attempted it since. My husband goes hunting for one week every October, something he looks forward to for the full year.

I am usually "manning" our business in his absence and really do not want him to miss out on that because of me. I know everyone works or has things in life that are important to them, I am no different. I need to go see my aging Mom and that requires a 4 hour flight plus a one hour drive once I land. I have no idea if I can even think about taking such a trip in 2018 with all of these issues.

On top of that, there are the financial logistics of already meeting that substantial out of pocket/deductible amount so getting that 2nd hip done in the same calendar year would be to our benefit.

Like I said, I apologize for rambling on so and for being so melodramatic. I actually have a very good life with a great (supportive) family but I, like many here, have been sidelined for way longer than I had ever anticipated. The hope of feeling 100% again anytime in the foreseeable future is pretty dim.

 

[Josephine]

I really believe that 7 weeks out of the repair of the fracture, I SHOULD be able to do the steps with much more ease.

Not likely. 7 weeks is no time in the life of a fracture, let along a hip replacement. It's a bit like expecting a 6 month old to walk and talk already! It needs time.

I want . . . no I NEED. to be back to my normal self before I lose the rest of my mind.

It's not your needs that are paramount here. It's the healing in your hip.


Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[NanaKP]

@Josephine - this is what I'm currently doing (probably been the last two weeks).

1. Anterior

2. 0 most of the time, 1 upon first standing or getting in/out of car, 8 when I attempt operated leg leading up the stairs

3. Tramadol 50mg as needed (not to exceed 1 every 6 hours) last took 1 approx 2 weeks ago
Aleve 220mgs (2 as needed, not to exceed 4 per 24 hours) last took 2 tablets today
Tylenol Extra Strength 500mg. (2 caplets as needed not more than 2 x per day) - last took 2 caplets at bedtime approx 5 days ago

4. Icing: minimum 2 x per day for at least 90 minutes each time up to 2 hours; weekends I ice 3-4 times a day for 90-120 minutes each time

5. Elevate leg several hours in the afternoons/evenings while icing and also in bed

6. Light housework, cooking dinner, laundry for spouse and myself, grocery shop with spouse. *Note - we have a 4 level house that literally requires going to different levels for the kitchen, bathroom, garage, laundry.

7. 5-10 heel slides while lying in bed in the morning
arm raises (stretching)
slow stretching in mornings (mostly so that I am able to get dressed and put my shoes on to go to work)

 

[Josephine]

2. 0 most of the time, 1 upon first standing or getting in/out of car, 8 when I attempt operated leg leading up the stairs

I think this is what prompted me to leave these questions. What you have there is this Piriformis syndrome - a pain in the butt!. I've had it and it's horrible!

3. Tramadol 50mg as needed (not to exceed 1 every 6 hours) last took 1 approx 2 weeks ago
Aleve 220mgs (2 as needed, not to exceed 4 per 24 hours) last took 2 tablets today
Tylenol Extra Strength 500mg. (2 caplets as needed not more than 2 x per day) - last took 2 caplets at bedtime approx 5 days ago

Well if your pain is normally 0, then certainly you don't need any pain meds!

4. Icing: minimum 2 x per day for at least 90 minutes each time up to 2 hours; weekends I ice 3-4 times a day for 90-120 minutes each time

Follow the suggestions in the article i left you before.

5. Elevate leg several hours in the afternoons/evenings while icing and also in bed

okay

6. Light housework, cooking dinner, laundry for spouse and myself, grocery shop with spouse. *Note - we have a 4 level house that literally requires going to different levels for the kitchen, bathroom, garage, laundry.

Okay

7. 5-10 heel slides while lying in bed in the morning
arm raises (stretching)
slow stretching in mornings (mostly so that I am able to get dressed and put my shoes on to go to work)

You don't need to do heel slides - they're not even appropriate for a hip! They're a knee exercise!

 

[NanaKP]

I do the heel slides because I am stiff in the morning - I sleep with a bunch of pillows (elevate operated leg) and those seem to loosen up my thigh. I am stiff upon standing as well so I stand for several seconds until everything feels 'in place' and ready to go. I have been so ultra careful to avoid any kind of falls up to this point and now, living in a place that can get MAJOR snowfall, I'm really dreading winter coming. I had originally been thinking both hips would be done and I'd be recovering during the late summer, early Fall but you know what they say . . . the best laid plans . . . ugh.

Thank you for your help. I'll look up that piriformis syndrome to see what to do about it. I'll also review the icing. I'm pretty maxed out during the week with the time I can ice because of work but I do go to bed every night with a very large ice (gel) pack and it usually stays in place for several hours.

Just read the exercises to do for the piriformis syndrome - have to say, they scare me a bit after the fracture repair I've been through. I'll talk to Dr Hipster on Tuesday to see if he thinks I'm good to go at 7 weeks post-repair.

 

[Mojo333]

I'm so sorry you are frustrated, and I do get it.
You certainly weren't expecting the fracture so you're timeline has been derailed.
I also seriously underestimated the time I would need to give my hip in order to get back to life!
I thought I could get back to work without any of the really physical stuff in three weeks after bilateral hip replacement
Someone mentioned that this recovery is an investment in our future and it is true.
On top of all of it, prime time for post-op blues so all can seem so much more frustrating.
Giving your leg all the time you can, all the time it needs...will actually Speed Up the process.

We can try it out...but if it isn't ready...it just isn't.
I had a serious whine-fest on my recovery thread...missed son's graduation and large event at work ...
You will get through this and we are rooting for you!
Wishing you a peaceful day...

 

[Josephine]

I do the heel slides because I am stiff in the morning

That's okay. As long as you're not doing them because you've been told to!

I'm pretty maxed out during the week with the time I can ice because of work but I do go to bed every night with a very large ice (gel) pack and it usually stays in place for several hours.

That'll do!