Your response to my previous article, "Training for a Hip Replacement" (August 2018) was overwhelming. Many wanted more so this column will provide the first part of my postoperative story.

Proteolytic Enzymes

One thing I did not include in the previous article is the use of proteolytic enzymes. These have all sorts of health benefits if taken on an empty stomach so they can be easily absorbed through the small intestine into the bloodstream. (If taken with food they help digestion but do not make it out of the gut in therapeutic concentrations.)

In the case of post-surgical healing, they greatly reduce inflammation and fibrin production. A very common product, available in most health food stores, is Wobenzyme. However, I found two products by Arthur Andrew Medical (arthurandrew.com) to be superior: Serretia and Neprinol AFD. They are plant and bacteria based products with greater potency than animal based ones.

Serrapeptase is the active ingredient in Serretia. It is an enzyme which has been shown by research to support the normal and healthy ability to suppress the production of pain-producing amines known as bradykinins. Bradykinins are peptides which bind to areas of injury and cause them to become inflamed.

While low levels of inflammation allow injuries (surgical incisions are significant injuries) to heal, chronic inflammation causes irritation, pain, and can slow the recovery process. Serrapeptase has also been shown to reduce post-exercise soreness by 50 percent over the placebo group.

Neprinol AFD contains Serrapeptase but also has other enzymes (nattokinase, papain, bromelain, etc.) that work synergistically to provide even more effectiveness. I took therapeutic doses of both for three months, then tapering to maintenance doses. The protocol is to start the enzymes three to four days prior to surgery. Stop the day of surgery and begin again as soon as it is safe for you to ingest them, with doctor's permission of course, or once you get home and are stable.

Everyone is amazed at how well my incision healed and it has no pain or adhesions. I highly recommend systemic enzymes as part of any post-surgical rehab protocol. Our body produces a number of proteolytic enzymes not only for digestion but also for body maintenance. This production decreases over our lifetime. Most people getting hip replacements are well along in their aging process, so supplementing our proteolytic enzymes is a very good idea in general, but especially in times of tissue healing, like surgeries.

Post-Surgical Massage Modalities

There are lots of exercises and massage modalities that have been helpful to me during the rehab process. I was able to teach a seminar (on my feet the entire weekend) at five weeks post surgery, much to the surprise of my surgeon. I was seeing patients at four weeks post-op. I credit the enzymes, manual lymph drainage (MLD), dedication to the rehab exercises, and NRT for my rapid recovery. At four-and-a-half months post-op, I was fully functional and pain-free.

The first hands-on therapy I received was MLD four days after surgery. That is the earliest it is recommended to receive MLD. It is not recommended sooner because if the lymph is moved too much too soon it will drain off the anesthetic they pack the new joint and incision with and one will be in much more pain than need be. I continued with MLD once a week for six weeks. The sooner one can get the swelling down the faster the tissues can heal.

I started receiving NRT six days post-op. Of course, not on the surgery side, but be aware that with NRT, using the "Twin Reset" – a unique aspect of the NRT system - I could receive manual therapy on the non-surgical side that directly and precisely affected the painful and restricted areas on the surgical side. Because of the relief from pain I could begin treating patients much sooner.

The Posterior Approach

As I related in my previous column, I had the "posterior approach" surgery. The surgeon made the incision just posterior to the iliotibial tract, cutting through the gluteus maximus and bisecting the piriformis, retracting half of it, leaving the other half attached at both ends. No other muscles were cut. Of course, this weakened my hip external rotators, extensors and abductors, creating major imbalances between them and the internal rotators, adductors, and extensors.

Darn, I am out of space again. I will continue with greater explanations of the surgery processes and relate the rehab protocols for the posterior total hip replacement surgery in my next column, coming up in the January 2019 issue of Massage Today. Happy Holidaze!