THR Wonkyhipoy Recovery<<

[wonkyhipoy]

Hi all, time for an update. It is a bit of a good news bad news update unfortunately... would prefer all good news, but issues crop up of course.

Okay, so here we go. Have been increasing my walking distance quite a bit. Did to walks of 1 mild on Friday... going 600 meters before needing a break for a minute. Felt strong, but tired and sore as I approached the 600 meter mark.

Took the weekend to rest and recover, with only short walks, and had no ill effects. On Monday I had my six week OS follow up (a couple days shy of six weeks as I am officially six weeks today). OS said the xray couldn’t look better. Restrictions were removed other than flexing past 90 and bending backwards while leg is bent and externally rotated (that last one, and hyper flexion are lifetime restrictions... which I knew going in).

OS said ROM is decent and should continue to improve with time and the soft tissues heal and swelling reduces (no timeline was given for this, but then, I never asked). Was cleared to drive and go in a pool, and start my return to work. OS said the next follow up is in one year unless I experience any issues, in which case come see him.

After the appointment, wife and I went to the beach and again did another 1.3 mile walk... this time without using my waking poles... though I did carry them just in case... taking many sit breaks along the way. Again no ill effects other than some next day soreness and stiffness.

So to that point, all good.

My return to wok began Tuesday, with a 3 days a week, 4 hours a day schedule, with the ability to increase after the first week as tolerated. The first day back was great. I was definitely sore in the evening, but not too bad. Iced and rested in the evening.

The next day did not go so well. At work, everything was fine, but after the drive home I had sharp burning pain on the outside of the hip, basically where the bottom part of the incision is. When walking (about a 5-6). Nothing while resting. Iced all evening; however, pain was still present this morning.

Also, there is a lot of stiffness making hip extension difficult and my my stride limited. So, a setback unfortunately. I am not sure if this pain is from the sitting (I got up every hour and walked a little bit and stretched) or the driving... but I am leaning towards the driving. I have a standard (clutch in the left), and it was after the 40 minute drive that the pain set it. I am off today (though I do have PT), so resting for the most part. I find it I walk slow, with a smaller stride and no rotation I am fine. Tomorrow I will use transit to get to and from work to see if the driving is causing the irritation.

All in all recovery is still going well I think. Like I said, not all good news.. but nothing terrible either... so I am pretty positive at the moment. I fully expected more soreness, stiffness and pain with returning to work, though not the pain at the outside of the hip. Wouldn’t mind some feedback from all of you if you experienced something similar at some point in your recovery.

@Josephine, just wanted to ask you if my thinking is correct, the the pain is likely coming from the muscles/tendons that where stretched and/or cut.

Cheers

 

[lovesstars]

 

[Mojo333]

Sorry you have some things aggravating you.
@WendyP648 was discussing, I believe, this particular pain site with Josephine so she might want to check out her thread with charts and potential issues.
Hope you spend the weekend DOING NOTHING!!!!

 

[Josephine]

@Josephine, just wanted to ask you if my thinking is correct, the the pain is likely coming from the muscles/tendons that where stretched and/or cut.

I think not! You've described pretty clearly what's causing it

Did to walks of 1 mild on Friday... going 600 meters
and start my return to work
went to the beach and again did another 1.3 mile walk.
When walking (about a 5-6)
a lot of stiffness making hip extension difficult and my my stride limited
40 minute drive

And 40 minutes each way, no doubt?

after the drive home I had sharp burning pain on the outside of the hip, basically where the bottom part of the incision is.

And this, not doubt is our old friend Trochanteric bursitis. Or it might just be an ITB (ilio-tibial band) issue.

So I'm going to ask you some questions - hope you don't mind!

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.

 

[wonkyhipoy]

Hi all,

Thanks for your responses. Saw the PT today (no exercises) and he thinks it is a bit of both bursitis and IT Band. He said that clearly my hip pointer is inflamed, but also, the IT Band is very very tight (he pushed on it and it was soooo tender). So when I walk, the IT Band is rubbing against the inflamed area, irritating if even more. He wants be to continue icing the outside of the hip, but use lots of heat on the lower portion of the IT band (mid way down the leg, and stretch the IT band gently. Also suggested I go back to the walking poles until it settles down.

@Josephine... it appears my PT landed on the same diagnosis as you... which is reassuring. As for your questions, here are the answers. Hope so got the format right.

1. Surgeon said it was posterior lateral... but the scar looks like the lateral picture.

2. Resting pain, almost none... just occasional zips and zaps here and there (level 1-2). Walking, sharp burning pain on stepping down/pushing back (level 2-5) with certain movements and none with others (meaning in a 6 step walk, some of the steps trigger pain, others don’t. Lot of stiffness with hip extension behind, and very mild occasional pain (level 1).

3. Prescribed Tramadol. Have not taken it since week one. Mostly take Tylenol 500mg every 4 hours or 1000 mg every 6 hours (mostly the latter). Occasional Advil (1 x 400mg once every three days or so... though this is not on a schedule or anything).

4. I use the ice machine, so I ice all morning (moving the pad around every 40 minutes... hip, groin sometimes butt, repeat) and evening (3-4 hours each session). I do a third 1.5 hour session after lunch when not working.

5. Evenings only and when when sleeping if it was a work day (like yesterday)... on non work days, when icing.

6. Not much really. Prep little one’s lunch in the morning, prep breaky. Help with making dinner. Help with dishes or put little one to bed. Try to do at least one 20 minute walk every day (though resting completely today). Strive for two walks on days I am not working. Stairs, both legs going down normally; up only good leg leading.

7. Not really doing much. At this point only two:

- ball knee raise (lying on back, legs resting on big exercise ball, bring both knees to 80 degrees). 15 reps twice per day
- ball sided to side (same position as previous exercise to start, rotate legs side to side about 20 degrees) 10 reps twice a day.

 

[Josephine]

1. Surgeon said it was posterior lateral... but the scar looks like the lateral picture.

Well, I suppose he thinks it's a posterio-lateral! I can tell you this, though. I've been doing hips since I was a teenager and no two surgeons ever did an incision the same! Sometimes, even one surgeon never did an incision the same, be it lateral, posterior or posterio-lateral! They don't cut to a pattern like in dressmaking!

2. Resting pain, almost none... just occasional zips and zaps here and there (level 1-2). Walking, sharp burning pain on stepping down/pushing back (level 2-5) with certain movements and none with others (meaning in a 6 step walk, some of the steps trigger pain, others don’t. Lot of stiffness with hip extension behind, and very mild occasional pain (level 1).

Stiffness is also pain - you did factor that into your pain score, yes?

3. Prescribed Tramadol. Have not taken it since week one. Mostly take Tylenol 500mg every 4 hours or 1000 mg every 6 hours (mostly the latter). Occasional Advil (1 x 400mg once every three days or so... though this is not on a schedule or anything).

Okay, not bad

4. I use the ice machine, so I ice all morning (moving the pad around every 40 minutes... hip, groin sometimes butt, repeat) and evening (3-4 hours each session). I do a third 1.5 hour session after lunch when not working.

Very good!

5. Evenings only and when when sleeping if it was a work day (like yesterday)... on non work days, when icing.

Excellent

6. Not much really. Prep little one’s lunch in the morning, prep breaky. Help with making dinner. Help with dishes or put little one to bed. Try to do at least one 20 minute walk every day (though resting completely today). Strive for two walks on days I am not working. Stairs, both legs going down normally; up only good leg leading.

Good

7. Not really doing much. At this point only two:
ball knee raise (lying on back, legs resting on big exercise ball, bring both knees to 80 degrees). 15 reps twice per day
ball sided to side (same position as previous exercise to start, rotate legs side to side about 20 degrees) 10 reps twice a day.

NO! No exercises for hips!

Remember this?
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.

Stop the exercises and I'll guarantee that it 4-6 weeks, your pain will be down to zero!

 

[wonkyhipoy]

Hi @Josephine,

Thanks for the reply. You mentioned previously that Iveas walking too much. At six weeks now, can you provide some guidance as to how far I should be walking? I tried using the activity progression guide, but I can get pretty far in the 30 minutes it suggests at this stage.

Cheers

 

[Josephine]

Well, not wishing to be trite, but less than you are now. Sorry I can't be more specific!

 

[wonkyhipoy]

Hi @Josephine,

Regarding the exercises, I think my description was misleading. They are not really exercises, but rather stretches. The ball is used so that I do no need to lift my leg to stretch it. Given that, should these still be avoided?

Cheers

 

[Josephine]

I get it but it's still unnecessary activity which is causing the pain you complained of.

 

[wonkyhipoy]

Hi @Josephine .. Okay, thanks for the helpful advice. Much appreciated.

Cheers

 

[Layla]

Hi @wonkyhipoy
I hope in taking Jo's advice you see a continual decrease in pain.
Some of the setbacks we suffer from overactivity take longer to ease than we'd imagine.
We sure need to practice patience in recovery
I hope your pain eases soon.
A great weekend to you!

 

[wonkyhipoy]

Saturday night for a Daddy at six weeks post op. The pad on the leg is the ice machine. Nacho’s would have been better, but fishy crackers are readily available.

 

[Mojo333]

That's what we like to see..good nutrition!
Hope today is a Good Day!

 

[JoeKnows]

Saturday night for a Daddy at six weeks post op. The pad on the leg is the ice machine. Nacho’s would have been better, but fishy crackers are readily available.

This is very familiar.

Hmm... Goldfish nachos? Seems reasonable, maybe I'll try it someday and report back.

 

[wonkyhipoy]

Here is an absolutely fantastic video (3 minutes total) that explains the “basic science of tendons and tendinitis”. I highly recommend watching.

Fascinating!

 

[Mojo333]

Great video....

 

[wonkyhipoy]

Hi all,

Time for an update. Again it seems to be a two steps toward one step back kind of update.. more good then bad of course.

Anyways, I am seven and a half weeks out and seem to be progressing, though not as fast as I would like. I am doing stairs normally (up and down) though weak in my op leg. Trying to walk outside at least once a day, sometimes twice. The weekend went well with a Costco run, a couple of walks outside of about a mile (part of it on a pretty steep hill) with only minor walking pains, all resolved with Tylenol. Iced regularly. And I almost went to the pool... I have been cleared by my surgeon and GP, but at the last minute I chickened out. The incision is fully healed, but how “fully” is fully... that is what got stuck in my head. I read a couple articles online suggesting it is better to wait 3 months... couldn’t tell if the reason was infection risk or dislocation risk. In any event, my resolve to go to the pool melted like a kid’s dropped ice cream on hot summer pavement . Perhaps Friday I will go. It was probably a good thing I didn’t go, for reasons I am about to explain.

So all was going well, and the today happened. At 12:30 I walked from my work to the Starbucks in the mall, which is about 1.2 km round trip (under a mile). Got tired and sore on the way back, with no place to rest. Got back to my office and my hip flexor area was mildly painful on walking when the leg strike the ground (it seems this is always the pattern... pain when leg strikes ground). So, strapped myself into my ice machine (have it at work with me... god I love that thing), and rested for most of the afternoon, getting up only to go to various meetings. Anyway, was a bit tender until I got home, and themn whammy! Sharp pain with walking in the hip flexor. Not sure how I aggravated my muscles this time as I did not seem to do too much... but here I am. Very frustrating.

It’s funny because the pattern is always the same it seems (pain when leg strikes the ground, or pain if I shake the leg out while extended) but the location is always different. It is like someone is playing a “guess where you will hurt this time” game at my expense.

I must admit, I am somewhat disappointed with my recovery at this point, from the perspective of walking. I thought I would be walking further before my muscles get tired. Haven’t seen much progress in terms of distance in the last few weeks, and can only go about 600 meters without stopping to rest for a couple of minutes. And when I have a good day where I can go further, two days later I have pulled this, or irritated that. Very frustrating. Also very normal it seems. But I have never been a patient man... when the lord was handing out patience, I got impatient with the wait and got out of the line it would seem .

All in all though, I am happy with my progress on the days where I don’t have a setback. My strength is getting g better, and my ROM is increasing (albeit very slowly). I am quite surprised at the amount of swelling around the lateral side of the hip that is still there. Still have a faint bruise too, just above the incision... though bruises seem to take forever to disappear with me.

Fortunately I have tomorrow off, so the plan is for complete rest, which will include no walking at all (it is supposed to rain 20 mm tomorrow, so the no walking thing won’t seem like such a burden... plus I can drive now, so if I feel couped up, I can just drive to get a coffee or something). I also need to get a chair for my office tomorrow. The one I have does not recline, making it impossible to elevate the leg, and keeping my hip and 90 for too long of a time. So I plan on spending the money to get a really good chair that has a reclining function. I will use it at home in the future, so it seems a worthy investment.

Speaking of chairs, I had to laugh today. A colleague of mine broke his back in September... that is not the funny part... he is okay by the way. What is funny is HR offered the same thing to him as they offered me when he mentioned his chair won’t work for him. Their response... “would you like us to install one of our sit stand desks for you?”. I felt like telling them “this isn’t the kind of situation where standing is better than sitting... it’s more like laying is better than sitting... if you want to help, offer me a couch and some pillows”...lol. Good times.

Oh, before I forget. I bought a book from Amazon called “your nerves are having hip surgery”. It is written by one of the world’s leading pain experts, Adriaan Louw. I stumbled accross it on day two of my recovery, but forgot about it. I have always been fascinated with pain and nerves, in terms of how they work. It amazes me that pain is quite literally all in our heads. Not meaning that it isn’t real, but that it is not actually felt by muscles and bones... but felt by the brain... all sensory feelings for that matter. Mind blowing . Anyway, he has some interesting you tube videos, but I will post a little review of the book once I read it. It won’t be delivered until the 18th though.

That’s all for now.

Cheers

 

[Mojo333]

I remember that game..hard to know why certain places act up at certain times...

It is like someone is playing a “guess where you will hurt this time” game at my expense

I know you are ready to get on with it...but two months out things were much the same for me.
I sometimes wonder if someone had given us a more conservative timeline..."you will have extreme pain while walking for three months" we would think we were doing splendidly.
I know my legs were so easily aggravated I wondered would this be permanent!? It wasn't but it does make you wonder if it will ever just disappear.
Things never just disappeared, they eventually dissipated.

. when the lord was handing out patience, I got impatient with the wait and got out of the line it would seem

That's funny!

Love to know what the author of the book has in there about pain management. No lobotomies allowed.
I'm glad you are just going to relax today.
I think it is just still early days for your poor leg. There was significant trauma done that just will take more time, I think.
Sometimes I try to remember how much recovery discomfort at how far along...I must admit I'm getting more foggy on that.
Will have to go back and look at my recovery thread!
Still remember very well the pre-op hip pain. Terrible.

Hope today is a Good Day!

 

[wonkyhipoy]

@Mojo333, thanks for the words of encouragement. Much appreciated. I love the people on this forum... supportive and understanding. I myself hope to continue to be a regular contributor long past my recovery.

Regarding the pain management from the authors perspective, if is really interesting. His focus is more around chronic pain (not the hip book, but his research). They have done some really neat studies that have shown when people understand pain, meaning they have learned about it, there pain levels are dramatically reduced. There is nothing about “don’t take pain meds” or anything. It is all about calming the nervous system down... which of course pain meds assist with. I am not really doing it justice in my explanation. I will put a couple of links to some of his You Tube videos (well, he is in them, but they are actually from a pain clinic).

By the way, I hope I have not given anyone the impression that my mood is in the dumps or anything. I am actually feeling quite positive about my journey thus far. While I am not as far along as I would like, I am further than I probably should given the severe level of ROM restriction I had prior to surgery. My current theory (I have a new one every day ) is that my muscles are not just upset because of the surgery, but also from years of under and improper use. It’s like my muscles are a grumpy teenager who I just woken up at 6:00 AM... and then I told them to mow the lawn (or took away their phone.... or whatever else makes grumpy teenagers more grumpy).

Mojo, perhaps you can send me a link to your recovery thread. I tried to find it, but thus far no luck.

On another note, I have a question for the lovely people if this forum. About when did every stop needing regular non narcotic pain killers (i.e. Tylenol) on a regular basis. I myself don’t take them at night (haven’t for sometime now) as I have no pain when resting (unless sitting for too long). But I still take Tylenol (1000 mg, every 6 hours) during the day when I have pain walking (like right now for example). So, just wondering when everyone switch from regular use to “as needed” semi-regular use, to “as needed” occasional use? I would really like to know the stats on this (I am an IT guy, do I love numbers... no no, I need numbers ).

Also, something some of you may find funny (because you can relate). I was lamenting (and laughing) to my wife last night about how “imprecise” everyone (OSs, PAs, PTs, websites, etc.) is about recovery timelines and the journey in gerneral. For example, “complete recovery takes anywhere between 4 months to two years”... or, “walk as much as tolerated, but not too much”... etc. Basically, recovery is not black and white... there is a lot of grey. Well, Wonkyhipoy doesn’t do grey. He wants precision. “Walk exactly this far and no farther”, “full recovery in 5 months, 3 days, 15 hours, 32 minutes, and 28 seconds”. That’s what Wonkyhipoy wants... lol.

Alas, Wonkyhipoy will not get his wish. Recovery is not precise.... it’s not like a very specific step by step instruction manual on how to build a nuclear reactor... it is more like instructions from Ikea. I just hope I don’t have left over pieces once I am done.

Cheers