THR Reclaiming my Future after THR

[proffrench]

@Eman85 PT yesterday wants me to do 2x a day:
15 reps bridges
15 heel slides to side
15 heel raises (lifting the heel up and holding for 3)
15 sliding heel and knee up
Ankle pumps frequently
She says it will "break up" the swelling and tightness.

 

[Eman85]

It will break up something, nothing I'd want to be doing. How about we all give you a pass, take a couple of days off from the PT, ice and enjoy yourself, we won't tell anyone, and see how you feel. All I can say is with my second all I did was ankle pumps and a couple of heel slides in bed. I walked around the house and to the bathroom and it all worked out great.

 

[benne68]

Your PT is being unreasonable, @proffrench. That's way too much exercise for someone who is 3 days post-op! Some ankle pumps, a few heel slides, and some walking around the house are really all you need for the first two weeks out of this surgery.

Hospital for Special Surgery, which is the #1 orthopedic hospital in the world, studies the recoveries of their hip replacement patients (of which there are thousands) and found this:

- When it comes to patient satisfaction with their recoveries, the vast majority of those who say they are unhappy with their THR outcomes pushed themselves hard with too much exercise early in recovery.

- On the other hand, patients who took things slowly during the first six weeks, and focus just on walking, are generally the most satisfied with their outcomes.

So, please don't push yourself (or let a PT push you). Go slowly and let your body recover from the trauma of surgery before you try to build strength.

Wishing you an easy recovery.

 

[AlanInAZ]

If you had an anterior approach bridges this early are not a good idea and contraindicated. I have done modified bridges in my second week being careful not to arch my back.

 

[Layla]

Please understand that Bridges can cause tendinitis, particularly in glutes, quads and hamstrings.

I would really reconsider doing all of those exercises. I understand it's difficult to go against the recommendations of your physician. After all, we usually research our OS and put our trust him as the medical professional. However, I think you'll find reading other's accounts here that time and again those that engaged in overly aggressive therapy struggled through recovery with pain and discomfort. It's not necessary.

Hugs for all of the loss you've suffered. Your mom wasn't the only one that lost the loved ones mentioned...you did also.

 

[proffrench]

@AlanInAZ
I have a lateral incision-- SuperPath. But I am in agreement with everyone that this is too much too soon. I did more walking around the house today and on my patio in the backyard, but I'm lots more swollen above my knee today. Planning on sleeping with my Lounge Doctor tonight and see what happens. I just took 2 arthritis strength tylenol, but I'm worried about too much tylenol and liver damage. I hate taking drugs, but I need some help with the pain at the bottom of my butt along the upper thigh.

 

[mendogal]

Re Tylenol: I spoke with my primary care doc, who stays very current on research and best practices. She said that the liver toxicity isn't dose related in the sense of accumulation over time. As long as you stay within the recommended limit of (depending on the source) 3,000 - 4,000 mg in 24 hours it should be fine. I'm still prudent, and small, so limit it to 3,000.

 

[proffrench]

@mendogal Thanks for checking on that for me! It's one of my major worries! My pain isn't horrendous, but by the end of the day I'm not looking forward to getting up from my chair. Lots of swelling starting last evening, even a little below the knee. Sleeping with my lounge doctor took a lot of that away and I did manage a little more restful sleep. But yes, the tylenol helps a great deal.

 

[Freyagirl]

@proffrench I’m day 20 with hip #2. For sleeping try putting pillows along both sides to stabilize your hips and rest your arms. It is a “pillow fort” and takes some work to get into, but it actually helped me sleep on my back for the first time in my life. Also, take heart, you are getting quickly past the worst part of the recovery, and every day should be feeling a little better a little stronger and able to sleep better.

 

[proffrench]

Day 5. Yesterday I think I overdid it with walking, some laundry. As evening wore on, I had bad pain and lots of swelling, even below the knee. I followed everyone's advice and didn't do my regimen of PT exercises, aside from ankle pumps and some gluteal squeezes. But last night was really bad-- straining my rotator cuff sure hasn't helped. PT is coming today at 10:30 and I'm telling her I can't overdo it. I sure could use some reassurance that this darned swelling will start to abate soon along with some of the pain. I'm really starting to feel like I'll never be ok again.

 

[mendogal]

Day 5 laundry?!?
Bridges before the 6-8 weeks it takes for basic muscle healing after a minor strain? (I can't imagine a PT honestly thinking this is appropriate)

It's no wonder you're having tremendous swelling.

PLEASE give yourself permission to just heal now. You need to rest and walk. Doing housekeeping chores and these PT exercises is sabotaging your recovery.

Activity progression for THR

 

[Layla]

Please imagine I am relaying this message as I give you a consoling hug.
I understand your anxiety and frustration and I mean no disrespect, but you will need to readjust your expectations as everything you are dealing with, while difficult, is normal at less than one week post op. The swelling may take awhile. My OS said some have swelling for up until one full year post op, normally easing over time. Rest, Ice, Elevate, take meds on schedule and take your hourly walks. Beyond that, you don’t need to be doing much more in these early days.

I will share an exercise that you may try, if interested. First understand that it is
our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

BoneSmart FA, CricketHip, involved in Therapeutic Massage, has shared this exercise to assist in manual lymph drainage. This gentle, yet effective therapy will help prime your lymphatic system to move fluid and inflammation away from your leg, which in turn will help your range of motion and pain - you may want to give it a try and tag her if you have any questions.

While lying supine, take deep breaths...deep, as in breathing in to a count of 5, 4, or 3 seconds, whatever is most comfortable for you. Hold that breath for another count of 5, 4, 3 then blow out completely, still using the count that's comfortable for you. A series of at least 6 reps may help get the excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up. Repeat this whenever you feel up to it during the day or night. Lying flat (supine) is best as the lymph nodes seated in your groin are less restricted, allowing for better lymph flow.

In addition, after the breathing exercise, place your hands lightly on your upper thigh, at the crease in your groin and lightly stroke upwards towards your naval.
Be patient because it can take the body time to respond.

I hope you had a good session with your PT and she did not force you to do anything you were feeling apprehensive about. Get some rest, use ice liberally and keep us posted. Happy Monday!
@proffrench

 

[Eman85]

Day 5. Yesterday I think I overdid it with walking, some laundry. As evening wore on, I had bad pain and lots of swelling, even below the knee.

If you reach the point of pain you passed overdid by a lot. Most overdids don't show up until the next day after THR. Only thing you should do with PT is have coffee if the PT makes it while you sit and rest and ice. Day 5 is too early on for overdids as it just takes you backwards in recovery.

 

[Layla]

Only thing you should do with PT is have coffee if the PT makes it while you sit and rest and ice

Eman!
Gotta luv him.

 

[proffrench]

sitting with my feet up now and icing my side. It's HARD as a Type A overachiever to not want to blow by the competition and say "woohoo! See ya later folks!" I know what I sound like. Back in the day, I rode horses, skiied and raced sailboats. I wasn't the best, but I did it. It is truly humbling and heartbreaking to watch your body slowly disintegrate thanks to familial arthritis and all those things you loved to do are taken away from you. You turn into your mother, who spends her days sitting at the kitchen table, drinking her tea and doing crossword puzzles. So many situations in my life were out of control-- my daughter dying of cancer at 16, my brother and sister young from cancer too, my elderly father with dementia burning to death at the stove 1 year ago today-- so the few things I could control, I did. And so while it's hard to rest and let nature take control of my body to heal slowly, I realize that I must... and tell myself that this is temporary and in a few weeks to months it will all be in the rear view mirror. I thank God for a husband who is my rock, unlike the first one who checked out after our daughter died, and I will try to take it down a notch. You have all walked this path before me and I DO listen and absorb the advice. So thank you for your patience and understanding.

 

[benne68]

It's HARD as a Type A overachiever to not want to blow by the competition and say "woohoo! See ya later folks!"

The problem is, when it comes to this surgery, if you try to "blow by" the competition now, you will suffer the consequences later. Please be gentle with that new hip!

 

[raylo]

The thing I worry about with Tylenol dosing is that these recommendations don't seem to address or account for other common medications a patient may be taking that may stress the liver, statins for instance. I am on a strong statin for which blood testing for effects on the liver were necessary when I started the meds. So, I am skeptical that I should simultaneously be taking 3000 mg of Tylenol. And statins are just one example. I am sure there are plenty of other folks here in a similar situation. Curious to know what folks think...

Re Tylenol: I spoke with my primary care doc, who stays very current on research and best practices. She said that the liver toxicity isn't dose related in the sense of accumulation over time. As long as you stay within the recommended limit of (depending on the source) 3,000 - 4,000 mg in 24 hours it should be fine. I'm still prudent, and small, so limit it to 3,000.

 

[Eman85]

Look at it this way, once you pay your dues of sitting and icing you will reap the rewards of a new hip. I had both of my THR's in the winter because there are too many things I want to do when the weather is nice. Not fun to face father time but I think it was Clint Eastwood said some thing about don't let the old man in.
After this pep talk I hate to bust your bubble but it's going to be more than a few weeks before you look in that rearview mirror.

 

[mendogal]

@raylo re meds and liver - that's totally for you to discuss with your primary care doc!

 

[raylo]

Yeah, I know. I just think it's crazy the way the OS's toss around the 3000 mg and other meds/interactions and the need to coordinate with your PC or other care providers never gets discussed. Especially when there are many very common meds with potential adverse liver effects that a lot of us of a certain age are taking. I see that here a lot, too. I'll just say that personally I am not comfortable taking 3000 mg day after day for several weeks especially for the minimal pain relief effect.

@raylo re meds and liver - that's totally for you to discuss with your primary care doc!