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My View From Here

By Ralph Stephens, BS, LMT, NCBTMB

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Training for a Hip Replacement

I had been dragging a degenerating left hip joint around for several years (from sitting/driving disease), finally realizing that replacement was the only way to get out of the pain. I am not a big fan of surgeries. They are a last resort in my wellness paradigm. However, two of my teachers set me straight on this. The first said, "when the hip starts making decisions for you, it's time." The second said, "paradigms are for youth." Got it! Come to find out, it is one of the most successful surgeries orthopedics perform. Everyone I talked to that had the procedure was delighted. At this point in my recovery, I am too.

The 3 Approaches to Hip Replacement Surgery

There are three common surgical hip replacement approaches. They are: the anterior, side, and posterior approaches. Each has its advantages and limitations.  The statistics show that the long-term outcomes are statistically about the same. Depending on the patient's particular condition, one approach may be better than the others. Get several opinions from different surgeons. Often a surgeon will recommend the approach he/she is most experienced with. This does not mean it is the best for you.

My recommendation is to listen carefully, as to why a particular approach is recommended by a particular surgeon and decide for yourself. In my case, due to the type and degree of degeneration, including a loose chip, the posterior approach was recommended by several surgeons - even one who normally does the anterior approach; he referred me to his colleague in the practice who mostly does the posterior approach.

I ultimately went with the surgeon in my area who is known for being the best for revising hip replacements by other surgeons when they have failed or dislocated. Not only did I like him personally, but thought if he fixes the failures he must be good. Maybe a good rationale, maybe not, but so far I am very pleased with the outcome at six-weeks post-surgery as I write this.

Training for a Hip Replacement - Copyright – Stock Photo / Register Mark Training for a Hip Replacement

When one is favoring a painful joint, one often becomes de-conditioned. It is not good to be in this state going into a total hip replacement surgery. As hip replacements are becoming more and more common, I thought many of you might be interested in a training strategy for pre-surgery, either for yourself or your patients. Believe me, it is worth the time and effort - and not that much is required!

Note: Before you begin any physical fitness or training protocols, check with your physician regarding what is appropriate for you. Physicians are, after all, known as the recognized experts in physical fitness and training. The following is not medical advice, it is for information only and is non-evidence based, (totally anecdotal), and only based on the real experiences of going through a real hip replacement, not on any double-blind study. It is your responsibility to determine what is safe and appropriate for you or another's particular situation. There—that should satisfy the lawyers and the evidence based crowd.

Areas to Strengthen

There are three primary areas one needs strength in after hip surgery—knees, upper body (especially arms and shoulders), and hip muscles.

The opposite knee is going to have to stand you up and sit you down post-surgery pretty much all by itself for awhile. However, the surgical side's knee will become deconditioned post-surgery, so strengthen both. Doing squats to your ability, plus knee extensions – full and short arc – will be very valuable.

Your upper body, especially arms and shoulders, are going to have to do a lot of work raising you up, moving in bed, getting up and down from supine to sitting to standing, back to sitting, using walkers, crutches, and canes, etc. This turned out to be very important immediately post-surgery as almost any movement required support and strength from my upper body. I used a TheraBand arm/shoulder routine and was very glad I did. No one suggested upper body training to me, but it seemed logical to me to do it. It paid off in spades.

The better condition the hip muscles are in pre-surgery, the faster they can be rehabbed to functional strength. You need to train both sides as one side will likely be "chopped up" (although not in the anterior approach) and the other side will be doing lots of extra work until the repaired side is re-conditioned. The most important action to strengthen is abduction. Second, is extensions (gluteus maximus). Then rotations and adduction. Most patient's hip flexors are adequately strong and usually tight/shortened. Get professional advice regarding a particular individual's needs for hip flexor conditioning.

In addition, it is usually a good idea to strengthen one's "core" muscles. Variations of the classic bridge posture, some Pilates exercises, modified sit-ups, and lower rectus abdominis exercises worked well for this.

Respiratory Health

Something seldom thought about is that general anesthetic is hard on the lungs. I practiced breathing exercises from the Yoga Pranayama system daily. If you are not familiar with Pranayama, just do deep breathing. Work to lengthen your inhale to as many seconds as you can and your exhale twice as long. Also, try some vigorous inhaling/exhaling. Immediately post-surgery they require deep breathing exercise to prevent pneumonia. The better shape your respiratory muscles are in pre-surgery, the less likely respiratory complications will develop.

Finally, I highly recommend manual lymphatic drainage (MLD) one to two days pre-surgery. Then again three to four days after. If possible, continue once a week or so as needed. This really helps manage the excess fluids from the irritated/inflamed joint pre-surgery and the swelling/bleeding post.

Of course I received very regular Neural Reset Therapy (NRT) both pre-and post-surgery. It helped me put off the surgery and has greatly helped with recovery. With NRT the therapist can work on the opposite side of the injury/surgery and have positive results on the target side.

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