Pain With Resistance

[kimberly52]

I have a question about PT.  Yesterday was my 13th day out of surgery and up to that point I was doing great.  Stairs up and down were no problem, walking no problem, etc., etc.  pain has been minimal at best until my therapist introduced new exercises yesterday.

He started me on a few with a band for resistance.  Wrapped the band around my knees in a seated position and had me lift the affected leg 30 times.  Then the other new one was while the band was still in place, do hip adduction (?) I can never get adduction/abduction right.  Anyway, I had to pull against the force of the band where the tension was on the outside of my legs, 30 times.

Late yesterday and now today bearing weight is painful and I almost feel like things became unseated in there.  Obviously I did not dislocate because if I had I would be in writhing pain.

I don't want to be a wimp and call the doc unnecessarily and ask if any of you veterans had experienced a similar setback when introduced with new exercises.  My PT guy only has experience  with one other resurface so I am being very cautious about pushing through this new pain.  I am wondering if it was too early to introduce resistance.

Until I can be assured that something like this is normal, I will resign myself to only walking to be on the safe side. Thanks in advance for all input on this.  I don't know what I would do without this site, the information here has been invaluable and comforting to me as I progress through my recovery.

Kim

[packman]

I am certainly not a veteran - only at 4 weeks post-op myself and I too am feeling quite strong, and reining my desire to do more in.  I am following the advice of my Doctor - Dr. Gross. Quite simply from grossortho.com the prescribed exercises for the first 6 weeks are walking, walking, walking, and some very simple leg slides, knee supported lifts. The exercises you are talking about, are after 6 weeks x-ray clearance and not 13 days post-op. Very few PT's that I have heard of, that are familiar with HR and are more familiar with THR.
I am in pretty good shape with a very high threshold to pain and perhaps you are one phenomenal athlete but I am choosing to go "turtle power" - slow and easy does it.
My thoughts are you are pushing your expectations with a junior "PT" in the world of HR too soon, but that is just my opinion to which I invite the other veterans to challenge.

[kimberly52]

Thanks for weighing in on this Packman. I will say that he was pretty amazed at how quickly I can get around for an extended period of time and that the prescribed non resistant exercises for me were quite simple. However, I think you are right in that junior is pushing me too hard possibly thinking I can/should be doing resistance since the leg slides, marching etc. are coming easy to me.

I have my doc's protocol and it says at 2- weeks I can do the elliptical, stationary bike but nothing about resistance. 

I think I will take today off from any form of exercise to give my body a rest.  I certainly do not want to have a relapse and slow down recovery. 

I agree, slow and steady will win this race and it needs to be treated like a marathon and hold back until the final few miles.

Kim

[Marco Polo]

Kim:

I am no expert either, but agree with Packman - 13 days is pretty early to introduce resistance.  I am at 3 weeks and doing simple stand up stretches, walking, and stationary bike with no resistance.  I will start outpatient physical therapy next week, and they may introduce some resistance at that point;  we'll see.  In any event, I would follow the adage of listen to your body.  If the exercise causes pain, back off until your body is ready for it. 

I am still just early days.  I assume others who have completed the recovery process will add their thoughts about when to introduce resistance.

The good news is that I am quite certain that you simply stressed the muscles around the hip that were impacted by the surgery.  Ice and rest should get you back on track!

Good luck!

[kimberly52]

Thanks Marco.  I hope you are right about just stressed muscles.  Today is an ice and rest day.  It's cold and windy out so a good day to lay low.

If this continues through Monday I will call the doc.

Kim

[hernanu]

Hi Kim, I had PT both in house and outpatient. Although I did do clamshells with resistance like you describe, I didn't get to those until about five or six weeks along.

I did clamshells first without resistance, then with at about five weeks. I started with 3 sets of 3 reps each, increasing until I could do thirty reps.

Your body is recovering, and doing so well, but my PT introduced things gradually. Starting with 30 is pushing it a bit, I think.

The thing you can trust is your body. If you are having pain from something, scale that back. I started doing the elliptical at eight or nine weeks, had pain from that and stopped it for a bit. Others have no problems at all with the elliptical and it was fine later, but my body was telling me to stop a bit, so did.

I would also touch base with your surgeon and just get their take. I had no problem calling in about my recovery.

[kimberly52]

Hi Hernanu,

Yeah my body is screaming at me today and it is hard not to listen to it.  I found a second copy of my doc's protocol in the folder that home care leaves here.  Nothing in there about resistance, just basically work on strength/stretching and my gait.

I have been icing all day but don't feel a heck of a lot better.  Hope this clears up by tomorrow.

I'll call Clarke on Monday.

Thanks,

Kim

[chuckm]

Kim, I remember when I was only two weeks post op and no way was I going to do any of those exercises. And 30 times - wow. I waited 5 weeks before starting anything close to that and it never went beyond 10 or 15 reps for any exercises. My surgeon was very adamant about regaining range of motion in the first 4-6 weeks because he said you can build strength at any point but you need to restore the range of motion while the soft tissues are still pliable.

I think you should ask your surgeon to write a new prescription for PT and have very him put very precise instructions about what and when so the therapist does not cause problems.

Chuckm

[kimberly52]

Good morning,

After a horrible day and night last night, not to mention very concerned, things have settled down considerably.   I started taking naproxen, iced, and much rest yesterday which I believe helped calm things down.

Today I have reverted back to the former exercises that work on ROM only and will tell junior tomorrow that from here on I will be the boss of this job and we will stick to those phase I exercises from the McMinn Centre on Vicki's site

Thank you all for your feedback.  It is very helpful to tap into others who are going through this now and also you veterans who have much experience/knowledge to share.

I will continue to take it easy today and be very gentle on myself with more ice and rest.

Kim

[Marco Polo]

Kim:  Glad to hear you are doing better today.  Your decision to take charge of your physical therapy is wise, and a good reminder to me as I start my outpatient physical therapy this week.

Best wishes for a week of continued progress!

[kimberly52]

Good luck to you too Marco!

Kim

[John C]

Hi Kimberly,
When working with a PT who is familiar with THR but not HR, there are a couple of things to keep in mind. In a HR surgery, there is a lot more trauma to the soft tissue, and more soft tissue that has often been cut or detached than in a THR surgery in order to allow the dislocation, and then stitched back together. This means that this traumatized soft tissue needs more time to heal before it is over-stressed. The other is that there is more potential for impingement of the femoral neck against the edge of the cup in an HR during extreme range of motion, which does not happen with a THR where the neck has been replaced with a thin metal part. No pain, no gain, does not apply to the early stages of healing. Unless we are lucky enough to have a PT who is very well trained in working with HR cases, we need to be have specific guidelines from our surgeons to guide that PT.
It sounds like you are on the right track now.

John

[kimberly52]

I think I am on the right track now too. Thanks for your input John.  I will be calling my doc tomorrow for those specific instructions that both you and Chuck suggested. 

My husband took me to Planet Fitness today and I was able to ride the stationary bike with no resistance very slowly and with no pain.  There was a bit of clunking but from reading my doc's post op protocol, that is normal. I did 5 minutes for each of the 2 times I got on. Some upper body circuit and about 2 minutes on the treadmill very slowly.

It felt so good to get out and back to the gym.  Although it was kind of hilarious that I normally can spin the bike at like 110 rpm no problem and now can't even get it to turn on. haha!  All is well though and I will learn patience through this for certain.

Best,

Kim

[RobinK]

Kim,
I'm not really a veteran, but I recently went through something very similar. I went gung-ho on the new exercise given to me at my 6-week follow-up. Although I did exactly as I was told, it was too much, too soon, and I set myself back about a week. My pain was back at the same level it had been pre-surgery.
I stopped the exercises, started icing and taking prednisone, NSAIDs, and Vicodin. 1+ week later, I'm feeling much better.
The great advice I got from everyone here was to listen to my own body and be gentle with myself.
Hope you continue to improve!