Leg strength and recovery 'issues'

[Minniemuis]

Hello,

Posting another question for my husband who is now 7 weeks post left hip resurfacing by Dr De Smet.

It is hard to judge how well recovery is going.  When he went in for the 5 week checkup, both Dr De Smet and his assistant said my husband was way ahead of schedule.  However, an athlete is never satisfied and keeps pushing the limits. Also, we have no one to talk to for specific athlete recovery, not even the physical therapist has experience with hip resurfacing.

Im am hoping the experience on this forum can give some feedback regarding some issues:

1. I sometimes feel my husband may be pushing a bit too hard. He is walking on a treadmill for over 1 hour with up to 15% incline, cycling 1h at 180 watts on a stationary bike. During activity sensations are not painful although sometimes uncomfortable.  This is probably the reason why he feels a certain level of pain at/under the incision area most of the time. When should you be more or less pain free in daily life? Is there any danger doing too much?  I know professional athletes also push limits (thru pain) when rehabbing from injury, so how do you know when to push and when to hold back?

2. my husband did a walking assessment - 1h treadmill walk today and the result showed 8% more impact on his operated side, less on incline, more on flat. The muscles on his left side are not strong enough to lift his leg as fast as on the good side. He was a bit worried but I feel this is normal at 7 weeks post op.  Am I wrong? Will this resolve in time? If running is the goals, than there should definitely be more balance... (he hopes to start easy running at 12 weeks as approved by Dr De Smet)

3. I am not a therapist but I give my husband frequent massages. I notice that a certain area under the lower side of his scar feels really hard, almost like  I am feeling the bone of his greater trochanter. He is skinny but on his other side it is not the same. Can this be scar tissue? Or can it be fat loss that  leaves his bone more to the surface?  It does not hurt him but it is a strange feeling.

Thank you so much

[imgetinold]

I'm not a doctor, so this is just my personal experience.  Also, my resurfacing is uncemented, so the bone grows into the femoral component, which is different than what Dr. De Smet does.  So, that might be a difference between recommended recovery activities.

Dr. Gross, my surgeon, says no weighting of the hip for six months.  No impact exercises (running) for six months.  I went to the gym after six weeks to start using weight machines (where I don't have to pick up and carry weights).  At 3 months I started spin class, and Dr. Gross said no to that until six months.


So, in MY opinion he's doing way too much, too soon.  This SHOULD be a marathon recovery, not a sprint.  I wasn't back to "full speed" until one year post-op.  He could actually set himself back, or - God forbid - compromise the joint by pushing it too much. 

His body will tell him when he's done too much in general, but if he has a high pain tolerance he could be doing damage and continuing on anyway.  I would have him (or you) contact Dr. De Smet's office and ask them to be VERY SPECIFIC as to what he can and cannot do, and when he's allowed to do those things.

As for the hard part under the scar......that is very likely just scar tissue.  My scar and the area around it were unnaturally hard for months.  10 years later it's barely visible and no residual firmness.  So, I wouldn't worry about that part.

[Minniemuis]

Thank you for your insight... that is exactly the problem - they do not/cannot give specific instructions. They say 'listen to your body'.
When in pain, don't do it. But that is useless for people with high pain treshholds... (i.e. most athletes) They are used to working hard in order to get results.

As a personal trainer, my husband knows very well which exercises are good for him. As an athlete, however, he wants to be able to sweat ...
I am curious how Andy Murray and Isaiah Thomas did their rehab, this would help to put things into perspective.

He is definitely not doing any jumping, running nor weights. The only thing that I fear may be overkill is the cycling resistance... can this really be harmful? If so, in what way? I saw martial artists doing leg kicks on a boxing bag at six weeks... it is not easy to know what to do.

[imgetinold]

Because my surgeon is notoriously conservative when it comes to recovery, I tend to fall on that continuum.  It may very well be that the cemented implant can be worked out much sooner than my non-cemented one.

I guess if his surgeon isn't worried about it, then you shouldn't be either.  He is one of the most experienced surgeons in the world.

[stevel]

What the experienced surgeons dance around with recovery is to prevent femoral neck fracture.  Some surgeons say 3 months but Mr. McMinn says 1 yr for impact activities such as running, jogging, downhill skiing, martial arts, etc.  My soft tissue had healed by 2 months but I waited until 3 months to phase in downhill skiing, per Dr Su's parameters.  Bob Bryan returned to pro doubles tennis in 5 months by rehabbing on an antigravity treadmill per Dr Su's guidance.