Author Topic: ROM  (Read 6739 times)

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Anna

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ROM
« on: October 09, 2013, 03:45:16 PM »
Hi all,

I have a question. When you were recovering from your op, once your 90 degree restriction was lifted, could you actually move your leg past 90 degrees?? I am 9 weeks post op now and I cannot get my get anywhere near 90 degrees, never mind past it. I know things take time but the thing that worries me is that it doesn't feel like it is tight bum muscles stopping it, it feels like slight pain or pinching in the front of the joint. Anyone any idea what this could be? I feel like its my new joint stopping me from bringing my knee up and not my muscles. I will ask my physio tomorrow but I'm a little worried. Has anyone else had anything similar or is this just a normal feeling?

Thanks in advance, Anna  :-[
RTHR - 08/08/2013 -Mr johan witt, London

hernanu

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Re: ROM
« Reply #1 on: October 09, 2013, 04:35:10 PM »
Hi Anna...

I didn't have the 90 degree restriction, so my PT at home started me on stretching the muscles in that area from one week on.

Very lightly and only to any resistance. At the beginning (3-6 weeks), no progress at all. After that, it began to loosen, so I actually got it to about 90 degrees after about three months and outpatient PT.

Just overall, when I went into outpatient PT at five weeks, they measured my ROM and felt I was at about 50-60% of normal. I worked on it with a PT that had experience with THRs for eight weeks two to three times per week.

A big part was stretching (LIGHTLY!) and strengthening both the core and the hip muscles. Not the big ones, but the small supporting muscles. When I graduated from PT (got a t-shirt and everything), my final measurements were either normal or above normal.

This wasn't normal for me, but it satisfied me nevertheless. I still felt tight, by six months, I started my old stretching routine, always careful not to push it past any resistance.

There are several things that play into ROM, in my opinion (and non-medically qualified it is...)

  • The flexibility of the big muscles.
  • Scar tissue buildup and breakdown.
  • Small muscle strength and healing.

I figure if the device has been put in correctly, you should be good structurally (as long as you don't push it too much).

One thing I've found in teaching stretching to new martial arts students is that it is an unusual thing in modern society. Most people don't do work that requires it, so if you are at a desk job or have suffered from a debilitating condition which made your muscles tighter over the years (  ::)  ), then it will take time to release the tightness and relax your muscles enough to increase your flexibility.

It is also counterintuitive. People tend to stretch at the beginning of a workout, but that is the worst time to do your big stretches.

The muscles are tight and cold from disuse, so if you try to stretch, they will fight you.

The best approach IMO is to do light motion to get your body moving (I would tell students to shadow box, easy movements to get the heart rate going and the joints moving), then when you've broken a light sweat from this, do light stretches (move your neck slowly, arms across your chest, windmill, bend body forward, light kicks).

Then start your workout once you feel a bit limber. 

Once the workout is through and your body is fully warmed up, launch into your heavy stretches (usually on the floor, forward bends, pulling knees up to chest or high stretching kicks in my case).

In all cases, I never pushed past resistance. If you feel resistance, that's as far as your body wants you to go. Any stretch in my mind is a complex process, involving several to many muscles.

To go beyond, something has to give. In the case of pulling your knee up, there are several candidates. One is the hamstring and buttocks - those are very large muscles and are not going to give easily. So physics tells you that the best candidate for the stress to go to is the weaker muscles in the link. That would be your newly healing smaller muscles  which are weaker than those big muscles even when healthy.

So if you are patiend and only stretch the joint (any joint) to resistance, then hold it patiently and without pushing for a time, you may feel frustrated, but you are making headway that will tell in time. I usually hold the stretch for (any stretch) 20 seconds, then release.  If you bring the knee up again to resistance, you may notice that it is slightly more flexible.

It took me a bit of time, probably in the order of a few months, but by gradually stretching this way, I brought the knee to a respectable stretch - probably about 120 degrees.  I can now (long time after) rest my thigh on my chest, so am getting to my kind of stretching.

I think it's normal, I think the pinching sensation is either scar tissue working itself out, or you smaller muscles feeling the stress that the bigger muscles are resisting. Just bring it to slight resistance, hold it there and repeat once the leg has relaxed.

Hope this helps...
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

Dannywayoflife

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Re: ROM
« Reply #2 on: October 09, 2013, 05:01:43 PM »
Anna I was the same had that same sharp pinnchy pain. Honestly it will come give it time ;)
Train hard fight easy
LBHR 10/11/2011 Mr Ronan Treacy Birmingham England
60mm cup 54mm head
Rbhr 54mm head 60mm cup 12/02/15 Ronan Treacy ROH Birmingham England
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Mike D

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Re: ROM
« Reply #3 on: October 09, 2013, 05:04:36 PM »
Hi Anna,
I was nowhere near 90 degrees for over 6 months, and then it was a struggle sometimes.
It's only within the last few weeks after over a year of gentle stretching and strengthening exercises that I've got a range of movement I'm happy with.
I've just got back from my delayed 12 month check at Birmingham today and the flexion movement was the first thing I asked about as I wanted to know how far I could push it.
The answer was don't push it at all past anything that feels uncomfortable but this may be advice to suit me rather than general THR advice.
Mr Treacy has lengthened my ligaments when he fixed my leg length difference so to push too hard to regain full flexion movement could lead to a tear if I go too far.
I can get my knee to my chin (just) and maybe that will have to do for me, I'll just keep up the stretches to that point.
My guess for you Anna, is that with your young age and the level of cycling you do, you will get a much better ROM than me-but it will take time.
Like me, you've had a lot put right-to use one of Mr Treacy's phrases-"you're not a slam-dunk, you're awkward"!
I think a 'standard' THR case can be compared fairly equally to a resurfacing regarding recovery and I read  a lot of cases on here and remember that I was nowhere near the same level in my recovery but the main thing is it feels great.
Hern and Tim Bratten among others have told me that things get even better in the second year  so I'm trying not to put a time on anything and just keep slowly but surely improving.
I've got a copy of my X-ray so I'll post a pic up very soon, like yours its a decent looking bit of kit!
That movement will definitely get betterhttp://surfacehippy.info/hiptalk/Smileys/default/smiley.gif
Right Ceramic THR
Ronan Treacy   Birmingham R.O.H
8 August 2012

Juno

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Re: ROM
« Reply #4 on: October 09, 2013, 10:56:26 PM »
Anna--- I am 13 weeks post HR and my ROM is no where near where it was pre OA. I was always very flexible, able to sit easily with soles of feet together (butterfly position) and had wide hip opening of the legs (splits and straddles) and stretched to the point that I could sit open legged and put my whole chest on the floor. My ROM definitely was decreased over the last year.

Since surgery I can just now lift my knee to 90 degrees, but it is still tight. I am no where near getting my thigh toward my chest when laying down. Just two weeks ago I was able to start sitting criss-cross on the floor with a pillow supporting my backside!! I think it's going to take lots of time. My big muscles are good, but it's all the smaller muscles that need to be stretched and loosened. I'm just now being able to slowly step into a lunge and balance and hold it. Yoga has been so challenging and the hardest of all the workouts I've tried over the last few weeks.

Give yourself more time. I think it's going to take a year to return to "normal" ROM.
Right resurfacing, Dr. Gross, 7/11/13
Left resurfacing, Dr. Gross, 12/11/13

Anna

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Re: ROM
« Reply #5 on: October 10, 2013, 11:44:44 AM »
Wow! Thanks guys. What a great response!  ;D

I was worried that the pinching was a sign that it would never get better. Thanks for putting my mind at ease. Basically, I need to again, find some patience. This is not my strongest asset I must admit. I would like my graduated from PT t-shirt sooner rather than later :)

I'm at a treatment centre this week and next with one to one physio everyday so I spoke about it today. My physio doesn't seem to think it is such a big issue either. I have been doing lots of pilates classes working on those core muscles and have lots of stretching exercises to be getting on with so I guess I just keep chipping away. Little by little and slowly.

Other than my ROM issues I am very happy with my new hip. I even got outside on my bike the other day!

Glad to hear you are all doing well and still making progress. Mike, get those x rays up. I'd love to see Mr T's handy work.

Anna
RTHR - 08/08/2013 -Mr johan witt, London

Reno

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Re: ROM
« Reply #6 on: October 10, 2013, 08:03:27 PM »
Hi Anna-

First, thank you for your encouraging message the other day!  It really helped lift my spirit.

Regarding the 90 degree bend, I too feel that pinch and as well like there is some "thing" blocking me from bending my knee toward my chest while laying down.  However, today my Phys Therapist measured the bend and it was 109 degree, so it is getting better, just as your will continue to do!!!  I am glad you have been able to bike.  It must have been exhilarating.  My biggest news is my F/U visit went well and the doc is pleased. I had to ask for pics, which they did email to me.  I will share them soon.  I was told that I could start water aerobics by the doc, but the Phys Therapist told me today that my muscles are not strong enough yet and that at best I can spend 15 mins in the water, walking slowly...  :-(  Oh well.  Progress...

After your two weeks at the treatment center you will likely be much further along.  Although the hour I spend with my Phys Therapist 2x weekly is excruciating...  I can't imagine the amount of work you are doing!  YIKES!  But, what a wonderful opportunity. 

Looking forward to hearing about your experience.
Take care.
Reno

Anna

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Re: ROM
« Reply #7 on: October 13, 2013, 08:29:07 AM »
Thanks Reno,

I can now get my leg to about 90 degrees. Any progress is good progress I guess!! You will love the pool, even if it is just walking around. It made a huge difference for me just to have something to do and it was so nice just to float around in water!! Have fun!  ;D
RTHR - 08/08/2013 -Mr johan witt, London