I'm back for another year! Hope yours is off to a good start. In my previous column (A Postoperative Story: Part 2 of the Hip Replacement) I described the incision made for my posterior approach hip replacement surgery.

If working with a joint replacement patient, be sure you know the rehabilitation protocols of the particular appliance. If you don't, with permission, consult with the surgeon to learn them. Otherwise, stay away. Most have range of motion (ROM) and direction of pressure limitations. Remember, do no harm.

The Surgery

Once the incision is made, the hip joint is then dislocated and positioned to remove a portion of the femur. A hole is then drilled down the center of that bone, and the appliance is inserted. The lateral aspect of the greater trochanter is undisturbed, and the rest of the deep six external rotators (medius and minimus) are not cut.

Then the acetabulum is routed out and the new socket is installed. Now the femur is repositioned, forced into the new socket and moved around to check appliance tightness and overall fit. Mine was too tight, so it was again dislocated and a different sized appliance was installed. The surgeon was then satisfied with the fit and function and "sewed me up." Just think about the stretch and strain that puts on the muscles and fascia of the hip and thigh. Yikes!

Sadly, medical establishments don't see any need for soft-tissue therapy after these manipulations. All they give, unless one knows enough to ask for more, is ROM exercises and recommend walking. These are very necessary, but in my opinion inadequate for optimal results.

After the Surgery

They had me walking two hours post -op. At about six hours post-op they gave me my initial exercises. These consisted of bent-knee hip flexion, straight leg hip abduction, and bent knee hip extension.

I suggested straight leg hip extension and flexion, and was told I could do them as long as there was no pain. Ha, every-thing was painful initially, but those movements did not cause additional pain.

The physical therapist (PT) was concerned that straight leg extensions could cause back pain, and suggested not to do them if they caused any pain in my back. No problem for me. These exercises need to be done religiously multiple times a day. They recommended three times a day, but instead I did three sets of twelve reps three times a day, plus three reps of each every time I got up.

Secret #1

As soon as I awoke from the anesthesia, I started tensing and relaxing my hip extensors, as well as my internal and external rotators. I just tensed and relaxed the muscles slightly to get them firing and to cause micro movement around the new joint and incision. I continued with this as healing progressed until I was actually contracting against the resistance of the bed and a pillow between my knees with full strength. Now there was some movement allowed but only about 5 degrees. However, working up to three sets of twelve reps was building strength without getting out of bed.

I love exercises I can do in bed.

Secret #2

Once I could stand on my new hip relatively comfortably, using a counter top for balance, I started doing the ROM exercises with the non-surgical hip first, three sets of six reps each, then exercising the surgical side, working up to three sets of twelve reps. Again, these were bent knee hip flexion and extension; straight leg hip flexion and extension; and straight leg abduction. After three weeks I added reaching back and grabbing my ankle during the bent knee hip extension and pulling the ankle towards the hip (knee flexion) to stretch the quadriceps during the third set.

Secret #3

Walking – this may be the most important thing one can do. Every time I got up, even in the middle of the night, I did three laps around the kitchen and three reps each of the ROM movements. Keep those tissues moving as much as possible. Also, walk as much as you reasonably can post-op.

Secret #4

We typically adapt our gait to avoid pain when joint degeneration occurs. These incorrect patterns need to be replaced with proper, functional patterns. As this is a dysfunction unique to each individual, I recommend consulting with a PT or a provider good with gait re-patterning skills at about six-weeks post-op. Precise strengthening exercises will be a part of this. My PT recommended TheraBand resistance bands and ankle weights. From my estimation, hip abductors and extensors need the most work as they take the biggest trauma from the surgery. My surgeon did not offer this aspect of rehab, but when I asked for it he gladly wrote the PT referral.

Massage for Recovery

Remember, there is no longer any pain in the joint as it is not innervated, but the surrounding soft tissue and fascia are. Properly trained massage therapists are the ideal providers to address these traumatized tissues. As I wrote last month, Neural Reset Therapy (NRT) and manual lymph drainage (MLD) rapidly normalized the soft tissues and eliminated the pain. The scar tissue and traumatized muscle was easily treated early on, and therefore I do not have any pain or movement restrictions post–op.

That's my story and I'm sticking to it. I hope you have found it interesting and useful. I'll be back in the March issue—see you then for therapy tips that are painless for both the patient and provider, along with updates and opinions on the politics of the profession.