THR Severe Pain

[Rick Burr]

11 weeks post op, right hip, posterior approach. All was well until 3 weeks ago when I started to struggle getting my leg into bed. It's now agony when lying in bed and trying to get up. Physio says my psoas is tight and has me doing the Thomas Stretch. I'm starting to get really worried. Surely there can't be this much pain from a tight muscle? I see physio again on Wednesday.

 

[Jaycey]

Physio says my psoas is tight and has me doing the Thomas Stretch.

Welcome to BoneSmart! What was the date of your surgery and which hip? We will put the information in your signature for you.

Way too early for any strengthening exercises. You need to let muscles, soft tissues and tendons recover from all the trauma of the procedure before attempting this. In addition, it sounds like this PT has no experience with hip replacements as this exercise is not wise for any newbie.

I suggest rest, ice and elevation - and I would find a more compassionate PT. If you read the big tip at the bottom of the guidelines below, you will see that walking is the best exercise for hips post THR.

Here are your recovery guidelines:

Hip Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

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 this BoneSmart philosophy for sensible post op therapy
5. Here is a week-by-week guide for Activity progression for THRs
6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Rick Burr]

Jaycey, surgery was 7th November, right hip, posterior approach in the U.K. I had a really good initial recovery with hardly any pain whatsoever. This just came out of the blue. Like I said, it's only when the leg is stretched out in bed. I've tried putting a pillow under knees/thighs but no difference. The physio is a hospital one attached to the orthopedic department so deal with hips and knees.

 

[CricketHip]

The Thomas Stretch is done on a table, which gives a fairly deep stretch. I am wondering if it's too much for an already irritated psoas? It's just a thought but I also wonder if there's a trigger point there. Has your PT palpated and possibly treated for that?

A trigger point is when a muscle spasm is sitting directly on top of a nerve ending and can be painful- which then causes the muscle spasm to spasm even more- it can become a very irritating cycle.

They are easy enough to treat by just gently pressing on the tender area until you illicit the pain response, then holding until the pain eases. So, feel free to blame it on me, when asking your PT.
Icing the psoas could be helpful too. Just be sure to have a thin cloth between the ice pack and your skin. No ice burns allowed.
It is sometimes what happens when you are healing post op and begin increasing your activity levels.
In fact, I just remembered that we have a great article to illustrate the psoas and some ways to help and I will leave it HERE for you to read.