THR 4.5 Weeks Post... New Pain with increase in cycling activity

[Tabbycat44]

I am a lifelong competitive athlete and endurance cyclist. My surgeon cleared me to no resistance spin at 2 weeks post op anterior replacement. I was told I can gradually increase time, resistance etc. everything was going well until yesterday and today. I got caught up in feeling good and getting better and now have a random pain when walking in my lateral glute area. I rested all day today with my friend ice but just stressing a bit. Any other cyclists here?

 

[Axx72]

If you can tell us which hip you had replace, and the date of your procedure, one of the Bonesmart administrators will create a signature for you

I am also a lifelong cycling enthusiast with many years of endurance competition as well. The difference is that I had a knee replaced instead of a hip.

Remember, when you had your hip replacement done, you underwent a lot of internal trauma to that area. Lots of traction on your knee and muscle/connective tissue displacement in your hip area. Remember you have to differentiate your hip replacement being akin to a sports injury.

The differences between a THR and TKR recoverys are not that much, except for the expected healing duration differences and specific physiotherapy programs. However in both cases, the information given by the surgeon is a very generalized set of guidelines. In the end, everyone is going to heal at different rates and those rates can also differ on the same person with two different THRs or TKRs.

Healing gains in our journeys are never consistent. There will be ups and downs all the way through. The best thing you can do is listen to your body, if your hip tells you it’s hurting then you should take a step back from what you’re doing and use the RICE method. Sounds like you may have some compensation strains, especially when you increase your spinning effort quickly. Maybe consult your PT for advice or surgeon if it is an extreme pain management problem. Too much effort too quickly can actually set you back in your recovery.

Like you mentioned, you sat back and tried to relax about it but ended feeling stressed. Maybe try to look at your recovery in smaller steps. Look at those little wins, how far you have come and celebrate your achievements. We would all love to get back to normal life in one shot but that’s not reality. You will get there with small steps and consistency.

Unless your hip hurts, keep spinning


Welcome to Bonesmart.

I have left you some hip recovery guidelines below. There are some good articles and information there. Keep us updated on your progress.

 

[Axx72]

HIP RECOVERY GUIDELINES

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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

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 these
BoneSmart philosophy for sensible post op therapy

5. At week 4 and after you should follow this
Activity progression for THRs

The recovery articles
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.

 

[mendogal]

Hi @Tabbycat44 ! If you tell us which side and the date, we can create a custom signature for you that lets other members see at a glance where you are in your recovery.

Welcome to the OverDid It Club (ODIC)... every one of us has spent time on that bench, some of us more often than others!

Advancing too quickly (either in time, distance, reps, or resistance) aggravates healing soft tissue. Pain and swelling is your hip's only way to tell you.

It helps to track your workout, and increase by small percentages a couple of times weekly.

 

[Tabbycat44]

Wow thank you. I am so pleased to have found this community!!

I had my left hip done on Jan 25th. I am 5 weeks post op tomorrow. I had the anterior approach done.

 

[Tabbycat44]

If you can tell us which hip you had replace, and the date of your procedure, one of the Bonesmart administrators will create a signature for you

I am also a lifelong cycling enthusiast with many years of endurance competition as well. The difference is that I had a knee replaced instead of a hip.

Remember, when you had your hip replacement done, you underwent a lot of internal trauma to that area. Lots of traction on your knee and muscle/connective tissue displacement in your hip area. Remember you have to differentiate your hip replacement being akin to a sports injury.

The differences between a THR and TKR recoverys are not that much, except for the expected healing duration differences and specific physiotherapy programs. However in both cases, the information given by the surgeon is a very generalized set of guidelines. In the end, everyone is going to heal at different rates and those rates can also differ on the same person with two different THRs or TKRs.

Healing gains in our journeys are never consistent. There will be ups and downs all the way through. The best thing you can do is listen to your body, if your hip tells you it’s hurting then you should take a step back from what you’re doing and use the RICE method. Sounds like you may have some compensation strains, especially when you increase your spinning effort quickly. Maybe consult your PT for advice or surgeon if it is an extreme pain management problem. Too much effort too quickly can actually set you back in your recovery.

Like you mentioned, you sat back and tried to relax about it but ended feeling stressed. Maybe try to look at your recovery in smaller steps. Look at those little wins, how far you have come and celebrate your achievements. We would all love to get back to normal life in one shot but that’s not reality. You will get there with small steps and consistency.

Unless your hip hurts, keep spinning


Welcome to Bonesmart.

I have left you some hip recovery guidelines below. There are some good articles and information there. Keep us updated on your progress.

Thank you. It helps to speak with other athletes. My surgeons exact words "I have no idea what you can do. You are an anomaly. You can spin (I use my indoor trainer on Zwift) but no 2 hour spin class, no standing on the pedals and no weighted squats" On Sunday, I was feeling good... I had ridden 2.5 hours on Saturday (yes 2.5 hours at a very easy pace with a bit of climbing but always seated and absolutely no issues during). Also did some single leg extensions with light 10lbs, 3 sets. Still felt fab on Monday... did a 1 hour spin, flat. I can do all of my ROM exercises from PT. What is worrying me is that I have this new tweak pain in the lateral glute, some back pain when I woke and I can feel some joint discomfort when standing. These are all new pains (not extreme at all) but of course because I am nuts thinking I am invincible, I am thinking I have loosened the hip and surely destined for revision.. lol

 

[Axx72]

After my six month surgeon visit, he didn’t know what to expect either. His advice was, ride as much as your knee, will let you. Pain like you described can often be developed from connective tissues, adjusting to your new joint. I if you actually had a loosening of the prosthesis, there would likely be fairly extreme joint effusion and pretty good pain along with that.

I can also mirror your comments on during exercise there is rarely and discomfort. It’s usually 24+ hours later that my joint starts to react.To be honest, I had the same revision thoughts around the six week period as well with my knee. Even though your hip may be feeling good, perhaps, breaking up your sessions into shorter lengths with a bit of recovery RICE in between could help. There have been times when forcing myself to take some days off, have made a huge difference. I understand very much about not being able to turn it off…. Welcome to the ODIC(overdoit club). Of which, we will probably a regular members for as long as we can manage it.

Is your hip cemented or non-cemented? The reason I ask is recovery for a non-cemented prosthesis version, like my knee, can take up to twice as long because there is bone/prosthesis integration regrowth in play. Your bones have to biologically connect with the prosthesis and re-create a new blood supply in the area, not to mention healing from damage done during the procedure.

As hard as it is, maybe try to take a few days off and see if that helps with the lateral glute pain

 

[cold_brew]

Patience, you will get there. I’d look at it as, first make 100% sure you are healing right, then get strong. At 3 weeks I hadn’t even gone upstairs in my house yet, and at a year I could ride a bike 50 miles. So there’s a long road ahead, don’t rush too much and listen to your body!

- former runner and newly minted road biker

 

[cold_brew]

We need to print up some “Team Titanium” cycling jerseys for all us bionic folks

 

[Going4fun]

You are doing way too much, not even close. It's a miracle you haven't had excruciating pain before this. Your surgeon cut from the front, the very muscles you use in biking. No judgement but seems to me your surgeon might have given you too much confidence in what you can do at five weeks.


On the radiating pain, the nerves all connect with each other. I had knee pain, severe knee pain at times, though my knees were fine. The nerves in my hip were stressed and they passed on pain to the knees. You really want to pause fully until the pain completely goes away. You can't speed up recovery by exercising aggressively. One more time, you cannot speed up recovery by exercising aggressively. You cannot speed up recovery. You can basically go along with the pace at which your body is naturally recovering--by walking over time and paying attention to pain, backing off when you have pain.

Your soft tissue is still recovering and if you overload that still-recovering tissue, other body parts will try to pick up the load and the pain will spread. That's my non-science understanding of things.

So chill and lots of icing, and then start again with walking. Now if you stop activity and you still feel radiating pain or if the pain worsens, I recommend you call your surgeon's office to report what you're feeling.

Once more: you cannot speed up your recovery by exercising aggressively, though lots of athletes certainly try. Then they come onto this board and report their struggles. Oh, and undoubtedly you read stories of people with super amazing recoveries. Ignore those. Many of us fall into that trap (I certainly did). Your brain remembers more of those stories and minimizes all the stories of normal recoveries.

One more point: going more slowly means you have to manage your anxiety. I could sense myself pushing both of my recoveries because I wanted to escape that anxiety-fear zone where recovery gradually occurs. (I also wanted to be one of the “special” ones who recovered super fast.) But when you overdo things, you end up having that fear and anxiety anyway---because you can't help but think, "maybe something is wrong!"

A rule I found helpful was this: don't try to top a personal best every day. You have a personal best, then the next day back off. It can take a day or two before the pain registers. Trying to top a personal record (recovery record) day after day--that don't work for folks recovering from this surgery.

Good luck.

 

[mendogal]

Thank you @Going4fun for such an excellent post!!!

I want to fully support and emphasize that in order to heal we MUST accept spending more time on plateaus than on continual measurable progress.

As a martial artist I learned that plateaus are inevitable, and not to be feared, because they are periods in which neuroplastic learning and "muscle memory" are happening subconsciously even as we feel stuck, and once that integration has happened, we progress.

Same thing here except there is essential physical healing going on at the very same time that our nerves and soft tissues are adjusting to the new structure imposed in the OR.

Breathe. Give yourself permission to be kind to your new hip so it will serve you well.

 

[myglasshalffull]

Totally agree with above posts, I think you are being way too aggressive way too early in recovery.
Many folks figure if they are in great shape prior to their surgery that means they should recover sooner. Unfortunately not the case. Yes, some people have miraculous recoveries & I applaud them but majority of us need time.
Even though I was 70 when my hip needed to be replaced I was also in "great shape" for my age. Walking at least 3 miles a day as well as volunteering at dog shelter, plus 3 days a week working as a server in a very busy restaurant. I was told by PT in hospital "in 30 days you will be doing what you were doing before surgery." Great to hear but unfortunately wasn't the case. Of course I'm not a workout junkie, just enjoy moving.
Had to take the big "patience" pill & let my body heal.
Now at 72 & 2 years after surgery recently returned from 2 week Virgin Island vacation where I hiked up sides of mountains and down rugged terrain. Rock scrambles & all. Walked every AM up big hills in neighborhood we were staying & I felt great. I'm back dogsitting & doing rescue & averaging about 4 miles a day. Not all at once, I split it up in 2-3 walks over course of the day. I tried going back to restaurant last spring but my body said NO, so I listened, had no choice! I have a wonderful partner & he has seen me through a broken ankle (4 years ago), and fractured hip (2 years ago). It's so important to have someone who doesn't "rush" your recovery.
I'm sure if you take it easy for couple days you will be back biking in not time.
I wish you the best.

 

[newguy]

Way too much too soon. Chill guy. This is not a good way to heal. It is a car WRECK!!. Do you get that?? Do you know the type of saw that was used to remove your femur head? Probably not. But it is kinda Frankientienish. 20 years ago you spent almost a week in the hospital and the first few days in ICU.

 

[Layla]

Happy Two Month Anniversary!
You haven't posted in awhile. How is your recovery going? I hope all is well.
Hope to hear from you soon!
@Tabbycat44

 

[Tabbycat44]

Whew. I have not been on here in some time... today marks 13 weeks post op! I am happy to report I am exactly where I was competitively pre op. I have done some 100mile/162km rides and I am back to racing. My first outdoor race is in 16 days! I have finally been able to stretch the area more and get more mobility. yes, it still gets angry when I do too much. I ice, ice ice and rest for a day or so then I am back in business. Am I doing too much? Probably and I am fully aware of that. I am getting stronger every day and I am so excited to see what the next 3 months brings!

 

[cold_brew]

That’s awesome, have fun and stay safe out there!

 

[raylo]

That is a fantastic recovery and I am glad to see that a return to serious cycling is attainable in a reasonable time. I am at 3 weeks post op and have done some easy no resistance pedaling but am reluctant to go further lest I irritate my hip flexors. I came into this in decent shape and I could probably jump on my bike now and ride 40 miles... but then I probably wouldn't be able to walk for a couple of months. ;-). I'll be consulting my doc Monday to try to get a feel about what might be a reasonable return to activity in my particular case. But for now, I am jealous!