Is Phyical Therapy really necessary?

[oxley]

I am 4 mths post op. I went to p.therapy a few times. I really didnt see the purpose of having someone press so hard on my incission area all the way down to my knee. It is so painful. I quit going and now wondering if it is really important or not. My doctor said I could go to therapy if I "wanted" to. He didn't make out that it was necessary. What does everyone else think?
My hip is still sore. Just feels very bruised and that muscle that was cut is tender still. I am terrified of slipping on the ice here in Canada so I try to avoid those situations. Getting in and out of my low car is still not comfortable. Other than that, doing pretty good. 

[wayne-0]

You should try pool therapy. It doesn't hurt and it really helped me get some Rom back.
Good luck.

Wayne

[gazza]

Oxley
Just for info.  I am from UK and had my hip done Nov 09. I was not given any PT (not even anything to do at home).  I have read all sorts of stuff on PT and did some leg exercises that I found on the McMinn site. Other than that I have been trying to walk as much as possible. I had my 1st check up with my consultant’s office on Monday this week (8 wks out). He was very pleased with my progress and told me to carry on walking and to try cycling.  I also asked about doing some stretching to increase mobility, he told me that gentle stretching is ok, but to stop before it hurts to much. I was told not to go swimming (breast stroke) for another month as he thought it could possibly cause damage to the capsule as could leg crossing. But if I wanted to try swimming I could but not to put to much effort into the legs (I’ll wait another month then give it a go).
Non impact stuff in the gym is also ok, cycling, cross trainer, stepper etc.
I think you should do what you are comfortable with and if it hurts ease off.
We are also having some bad weather in UK, and like you I’ll very scared of falling and damaging my hip….
All the best
Garry

[pashley]

gazza Mr Mcminn says to swim for 20 mins every day especially breast stroke from 6 -12 weeks, its certainly helping me + non impact stuff in gym ie cross trainer, bike all really helps to prevent internal scaring and permanant stiffness

[obxpelican]

IMHO, walking as per Dr. Gross is the best therapy, if you have access to a pool that is great as it takes the weight off your hip and offers resistance. 

Dr. Gross has plenty of satisfied patients and he almost never prescribes PT unless you ask for it, my ROM came back better than my unoperated hip without PT.

I am not saying that some problem cases don't require PT, follow your doctors orders.


Chuck

[halfdone]

Hi Oxley
Here's my 2cents, as a non-medical 2006 vintage LBHR surfacehippy. (age 50ish)
I think people use the term PT to include both specific exercise and massage therapies.  You seem to be having trouble with the latter so I think you are wise to stop.
I did a lot of exercise PT (including walking, cycling, swimming - ie conventional exercise - as well as a specific program of hip strengthening, proprioception type stuff) but no massage therapy.  I worked with a therapist who helped me along a program of progressively more challenging exercises.  I am convinced that this PT was key to a (relatively) rapid rehab and good long term post op hip performance.  
IMHO, the focus on PT depends on your ambitions for how hard you expect to push things.  Walking diligently might be just great for regular life, but I think if you are a "play hard" type, more focus and variety on exercise PT will pay dividends, particularly in the longer term.  But as others have noted, it can be hard work to regain lost strength and flexibility and entail a fair amount of post exercise stiffness and soreness along the way.  The hip has a very large number of muscles surrounding it!  PS I think good muscle strength also helps keep the joint in place (less clunking) and reduces the chance of dislocation.
Good luck!

PS I totally agree with everything above on pool based exercise (preferably hot tub!).  (I had my surgeon refer me to a therapist I knew already and she corresponded with him on limitations/recovery progress.)

[moe]

 Oxley, I agree with halfdone, I don't see the purpose of someone pressing so hard on your incision that it's painful. Just walking is ok if that's all you want to do but if you want to be more active later you might need to step it up with stretching and resistance exercises with thera-bands and or weights. Just use common sense and don't do anything that hurts or doesn't feel right. I often wonder if some docs don't recommend PT because some patients or clueless therapists may cause injury or damage. moe

[obxpelican]

Moe,

Very good point that I failed to mention, Dr. Gross does not like his patients using PT because he has no control over what a therapist might or might not do, although Dr. Gross does prescribe Phase I and Phase II excercises.


Chuck

[Pamela P]

Wow...after reading all the experienced people's views on the PT, I am ready to move on and challenge myself more and more.  I go to dr. appt tomorrow for 8 wk post op.  I hope he will give me the 'go ahead' for range of of motion exercises.  I am ready!    The stiffness in the morning is tough and I am hoping this next phase of my recovery will give me the confidence that I am headed back to working out like I used to.  It wasn't elaborate...just spinning, yoga, pilates and zumba. 

[Clydascope]

I am a firm believer in PT.  I had to request a 'script from my surgeon and his advice was to take it easy at first, listen to my body and don't do anything that felt wrong.  There were many range of motion restrictions to begin - 90°, inward rotation, crossing legs etc. 

Starting with home visits, I soon was given the green light to advance.  At around 6 week post op I began pool training at our local Sports Medicine & Orthopedic Center.  These guys regularly work on Olympic athletes, US Ski Team members and really know their stuff.  They were excited to have me there for they don't see many hip resurfacings. 

I moved to the dry land stuff a few weeks after getting in the pool.  I would spend a couple hours a day, three days a week on strength, range of motion and massage routines.  This was followed by 15 minutes in their new ice rig that completely wrapped the joint and circulated ice water in the device.

In total I must have had 35+ sessions for each hip with lots of "homework," which included many miles of walking.  I loved it and think it helped get me back in shape for the things I want to do; hiking, biking, skiing, climbing, motorcycling etc.   

[B.I.L.L.]

Remember the story about the guy in the dr's office who says "It hurts when I do this"  and the dr says "Then don't do that" , there ya go.

IMHO (I am a poolman not a doctor) I would take it easy early on (up to 6 months) and then gradually increase to as intense as you want. For me the strengthening exercises helped ALOT after the 6 month mark, I still do strengthening and stretching exercises almost nightly and I feel like I am still improving at almost 16 months out.
  I'm not doing anything fancy, just simple things like butt and thigh crunches, leg lifts, clamshells with rubber tension bands, squats(cheater ones in the jacuzzi) toe raises, "invisible chairs" where you get to 90 degrees and lean against the wall for awhile, bicycling etc.
If I'm sitting on the couch wasting my life straring at tv I'll extend my legs out until my thighs start to burn and vibrate haha. Sit ups and "core" strengthening seems to help too. Anyway thats my advice, take it easy in the beginning but at some point stronger is better, it's all held in place by muscles.  Anyway for me it seems like the stronger I get all those muscles they hacked through the better it feels.
Listen to your doc and your body though, thats just My Opinion

[moe]

Moe,

Very good point that I failed to mention, Dr. Gross does not like his patients using PT because he has no control over what a therapist might or might not do, although Dr. Gross does prescribe Phase I and Phase II excercises.


Chuck

Thanks Chuck.

One other thing, even if someone is not interested in sports or activities after surgery, I still think strength training is important. You could slip on ice, trip on something, fall in the shower, things happen, the extra strength built up in muscles around the hip could be really important at that point.

moe

[tedroberts]

It is my opinion that PT after hip resurfacing is a must.  Even though I was not in great pain when I went in for my resurfacings, for example I could walk 3 miles with out pain medication, it was amazing how much strength and flexibility I had lost in my hips and legs over the years.  It just creeps up on you.  I was characterized by my therapists as having an "interesting gate". 

I had bilateral hip resurfacing a year ago.  After 6 weeks I started outpatient PT with a therapist recommended by my surgeon.  I was evaluated (I think I was the first bi-lat they had seen) and started therapy two times a week, first in the pool then on dry land.  In my case my therapists did a lot of manual loosening up of my hip capsules - something you can't do to yourself.  When my therapists massaged my scars it felt great.  In fact I had no pain or discomfort in any of my PT (unlike some PT I have had in the past).  After about two months we went to once a week, and in another two months they cut me free. 

I was given PT exercises to do on my own in between sessions along with being told to up my intensity and length of my
exercise bike sessions (which helped both my legs and hips as well as increased my endurance in day to day living.

This fall I enrolled in a dry land training class for recreational ski racers.  It took my PT to the next level.  We worked on a lot of hip strength and flexibility and I now see how much stronger and flexible I can get.

If I had it to do over again I would have started the out patient PT at two weeks.  The PT exercises I was given when I left the hospital were not enough and one of them was actually hindering my recovery.

Ted Roberts, Bi-Lateral BHR 1-7-09 Minneapolis, MN, Dr. Nelson

[Foosball]

At 3 months my doc sent me to PT.  That was 3 weeks ago.  I'm surprised at how much it's helped my range of motion.  I only go twice a week but I do all of the stretches and exercises in between appointments.

In one way it is a little disappointing because I was just getting over the initial soreness of the surgery and now I'm sore again.  But I know I just have to work through it and get those muscles going again.

My range of motion is now better than before I had surgery.  I recommend it to anyone having range of motion problems.

[pashley]

personally I don't think you need professional physio, just get to the gym regularly, make sure you stretch after workouts and in between, swim and walk lots !

[resurface]

I have rehabed after two previous injuries successfully that required surgical intervention: (1) right shoulder seperation and (2) a left knee ACL.  The support of PT was critical.  Most of us are highly motivated, young and want to get back into a more normal activity level, which could lead to "over doing it," due to good intentions. Your surgeon should have a PT plan and work with a few specialists to see that it is implemented [IMHO].  That has been my past experience.  Following my expected hip resurfacing on May 6, the hospital / surgeon sends a PT to my home for two weeks.  Admitidly, I actually need to find out what happens thereafter.  In any case, I will be interviewing PTs just as I did in selecting a surgeon.  I view this aspect as making a decision to INVEST in my future health, and hopefully, a better outcome.  I think that the surgical outcome will only be as good or maximized with appropriate rehab.  So if insurance does not pay, I would consider paying out-of-pocket.  Good luck.

[obxpelican]

PT is good if you feel you need it, some doctors do not push PT because it's easy to mess up the good work of your doctor if the therapist is not knowledgeable with the do's and don't of hip resurfacing.  There have been documented cases where a PT cause problems.  Moral of the story, be careful who you choose.

Walking is good threrapy, pool therapy is probably the best. 


Chuck

personally I don't think you need professional physio, just get to the gym regularly, make sure you stretch after workouts and in between, swim and walk lots !

[bothdone]

Hi

I thought I’d describe how my first six weeks went after my second BHR in 2008.

First, a bit of background.     Before both ops I maintained a high level of physical activity using exercise bikes and rowing machines.  However, in my last six months before each operation I was walking with a severe limp and in a lot of pain.  Walking was not enjoyable – I could only manage about half a mile at a time.  Even then, sometimes I would have to stop and let the pain wash over me while I took a breath.

After my second BHR in March 2008 I kept a record of all my physical activity so I can look back at what I did.

After both operations I had very little contact with physiotherapists.  In both cases it was really a case of showing me how to use walking sticks (canes) and crutches, and how to go up and down stairs, with some monitoring of progress before I left hospital.  I was also given a pamphlet with a few exercise diagrams and information about lifestyle management during recovery.    Once I left hospital I had no more contact with physiotherapy personnel.

Throughout the first six weeks I just concentrated on two simple exercises:
1.   swinging both legs (one at a time!) to the front and back 20 times.
2.   swinging both legs to the side at right angles 20 times.

Basically that was just keeping the joint mobile and giving some gentle stretching to the leg muscles.     I still do 10 of these to each leg every day.

The only physical exercise I did in the first six weeks was walking.    Building up to about 3 or 4 short walks each day (short equals quarter to half a mile)

Here’s my first six weeks walks:
Week 1   Nil.  In hospital
Week 2   Total miles for the week 3.0 (yep, just 3 miles) Longest walk 0.9m (19 mins)
Week 3   Total 8.5 miles     Longest 1100 yds
Week 4   Total 13.3 mile.    Longest 1400 yds
Week 5   Total 20 miles      Longest 2650yds (1.64 miles)
Week 6   Total 23.6 miles   Longest 2460 yds (1.52 miles)

As is often said on here, everyone is different.   This is just what I did.   

After six weeks I kept increasing distance and speed of walks.   Day 56 (8 weeks) was my first time on an exercise bike ( 3 miles).  Day 62 first time on a road bike (6 miles).  At the six months stage I started some very gentle jogging and this has progressed to five mile road runs.   I now do two minute stretching exercises and 10 minute yoga exercises on alternate days though flexibility was never my strong suit and getting older doesn’t help!

[Pat Walter]

Many of the expeirnced surgeons don't recommend any special PT after leaving the hospital or their facility.  My surgeon was Dr. De Smet of Belgium that has done over 3000 resurfacings and he suggests walking, walking and walking.  Normal folks that are not trying to run a marathon at 3 months or 6 months post op heal and recovery quite nicely without any special PT.  There have been a number post that they have just lived their lives and returned to work.  They all end up in the same place at 6 months to 1 year post op - out of pain and active.  If you had very diffiuclt problems with your muscles before your surgery, then your surgeon might suggest special PT.

I just wanted to make sure people realize that for most folks - many surgeons just recommend walking. I know most athletes and many people want to make their bodies heal faster and get on with life - but all the PT and positive thoughts won't make your body heal faster.  It takes time to heal and sometimes being agressive in your activities or PT can actually hinder your recovery.  I like my surgeons recommendation - if it hurts, don't do it.   Be cautious because you are going to be healed and have the rest of your life to do the aggressive, crazy things you have dreamed of.

Give your bodies a chance to heal.  Be kind to them and they will be kind to you.

Pat