Self-Directed Physiotherapy for Persistent Limping. 16th April 2018

Four weeks on from my surgery means that a protective capsule should have formed by now around my hip. Dislocation should be much less likely because of this capsule, so I guess that clears me to be a bit more adventurous.

I would be if I could be, but I’m still on one crutch, and just can’t shake the limp when I take the crutch away. So I decided this week to get more concerted about strengthening my hip and my leg muscles, since I don’t think I’ll overcome my limp any other way. Many movements that are disallowed for the more commonly used posterior surgical approach are fine for the anterior approach, so I’ve had to try to avoid being unnecessarily bogged down.

I scared myself (again), this time by reading forums with posts from people who were still limping years on from their surgery, even when some of them had no limp beforehand!

It seems very incongruous to have walked 320 miles this time last year, granted with sticks, and for my right leg to be as wasted as it clearly is now. The quad is so puny that my right leg is a very different shape to my left (which looks rather good having done all the work for so long).

19 West Highland Way

 

I’m a bit depressed and downbeat, alternating with determination to exercise myself off the crutch and get rid of the limp, so it’s a bit of a dangerous time. I’ve lost the sentiment of just being kind to myself and coasting towards health, replacing it with a more urgent imperative to make a breakthrough. It makes me less patient with myself, which I suppose is one form of motivation. But if I don’t see results, things could go bad!

These are the exercises that I’ve put together from various sources to repair the gait through strengthening the hip flexors, the glutes and the quads, as well as an exercise to look after the femoral nerve.

 

Hip and Leg Exercises after Anterior Hip Replacement Operation

Femoral Nerve Flossing

The femoral nerve can be stretched, compressed or damaged in the anterior approach, so I thought it might benefit from ‘nerve flossing’:

hanging the lower leg over the edge of the bed and retracting it backwards while stretching the head back (chin up as far as possible), then raising the leg straight up and looking up to the foot. This moves the nerve up and down through its full range of motion.

I don’t do this anymore and I’m not sure how much it benefited me, but I used it while trying to get control of my leg enough to raise it upwards, which I can now do quite easily, though I might have become able to do it anyhow just with unassisted healing.

Current Exercises

1.Adductor Stretch

Adductor Stretch 2

Stretch the adductors by lying flat on your back with knee of operated leg bent. Let the operated leg drop out to the side as far as comfortable.

2. Quad Stretch

Adductor Stretch
Stretch the quads by lying with the operated leg bent over the edge of the bed or similar and bend the opposite leg up to the chest. (Jack knife stretch)

3. Hip Flexor Engagement

clamshell
Engage the hip flexors by lying in a straight line on your unoperated side and bending both legs at the knee to a right angle. Keep the feet in contact with each other and raise the knee of the operated leg up to the ceiling without moving the hip. (Clamshell). (similar to number 3 but this time not lying on your back)

4. Glute and Adductor Strengthening

Knee Brace
Glute and adductor strengthening. Lying on your back with knees bent put a rolled pillow between the knees and squeeze, tightening the glutes at the same time.

5. Illiopsoas and Glute Strengthening

Bum raise
Iliopsoas and glute strengthening. Lying in the same position as 4. Squeeze the pelvis up (a curling movement in the lower back), whilst squeezing the glutes.

6. Standing March

Standing March
Engaging the hip muscles while weight bearing. Performing a standing march, lifting the knee as high as possible with each leg lift, making sure to engage the glutes. I am doing this with one crutch still, but sometimes I take it away and do reps on one leg and then the other so that I can practice standing unsupported on my operated leg and develop my balance. One of the difficult things about doing this exercise unsupported is stopping the operated hip from dropping down and disengaging all the weak muscles.

7. Quad Strengthening

Back against Wall
Quad strengthening. I push my back against a wall and lower myself into a sitting position. Hold.

8. Quad and Anterior Hip Strengthening

Straight Leg Raise
Quads and anterior hip strengthening. Lie with straight legs and raise the operated leg up. Hold.

With all the exercises I concentrate on what feels difficult and try to work the weak muscles. I also try to engage them consciously, tensing and relaxing as I do the movements.

My physio in France, who helped get me walking on crutches, advised me to ‘lay off’ anything that was painful until I could manage it without pain, so I don’t push the exercises beyond what feels okay. That doesn’t, of course, mean that the aftermath of the routine is pain free.

The consequence of more exercise feels like a set-back since I’m less comfortable again, with the DOMS (delayed onset muscle soreness) that is so familiar from my more athletic days. I’m back on painkillers to keep me mobile, although I’ve decided not to take opiates any more. Usually I take paracetamol, and make limited use of topical or oral ibuprofen.

As well as medication I’m also icing the muscles after every exercise routine (twice a day), and use taping to deal with IT (iliotibial) band soreness (a band running from the hip down the outside edge of the leg and connecting around the knee).

IT Band

This area was the only place where I had bruising from the operation: the bruise ran in a distinct line over the IT band, so it obviously took quite a hammering. I want to look after it since IT band syndrome is a chronic and debilitating injury that stops many runners in their tracks. After a bit of reading around I’ve learned that the IT band emerges from the fascia lata, which was cut into to gain access to the hip joint, so the bruising and soreness makes sense. I’ll keep going with the ice packs!

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