5 things to help you get the most out of your hip replacement

We've seen several patients in clinic recently who were either waiting to have a hip replacement or who have recently had surgery and have come in for rehabilitation post operation. A relative of mine has also recently been told that he needs a hip replacement which has prompted me to share with you some information on what you can expect before, during and after hip replacement surgery and what what you can do to help speed up your recovery.

1. Do some strengthening exercises prior to your surgery

Even though your hip may be painful at the minute there will be some positions we can get you exercising in which won't aggravate your hip but can start to strengthen your muscles. Following your hip surgery your muscles will get weaker however if we have built up some strength prior to the operation this won't affect you as much.

2. Try exercising in water

Exercising in a pool can be a useful way to strengthen your hip muscles as the support from the water reduces the load through your hip allowing you to move with less pain. This doesn't have to involve swimming, walking through the water holding a float out in front of you can make it harder allowing you to strengthen your hip muscles.

3. Progress your exercises as your hip heals

You will often be shown some exercises to do whilst you are in hospital and for the first week or two after your surgery. The aim of these exercises is to help get you walking with crutches and to help stimulate blood flow. A problem we often see is that patients then don't progress these exercises and can be left with significant hip muscle weakness that prevents them from recovering fully.

4. Gradually increase your walking distance

Muscle wasting and weakness happens very quickly whilst lying in bed after surgery, which will make your rehabilitation harder, so the sooner you get started the better. Getting moving sooner also reduces your risk of experiencing a clot which can lead to a stroke or embolism in your lungs or heart.

5. Relearn how to walk

Many people we see after hip surgery may have lived with a painful hip for several years. This often means they have learnt to walk with a limp and even though the surgery has taken away the pain we still find most people still walk with the same learnt pattern even though they have no pain. After your surgery as well as strengthening the muscles it's important to learn how to walk without a limp. Seeing a therapist who can help retrain your walking pattern means you get the most out of your hip surgery.

Below are some links to further handouts that you can click on and download for free:

Preparing for hip replacement surgery

The hip replacement procedure before and after

Rehabilitation after hip surgery

Please feel free to share this post with any friends or family who you feel may benefit from it.

Kind regards

The Kendal Physio team

What to do after an ankle sprain? Call the P.OL.I.C.E

I was starting to get a bit cocky, I’d managed to increase my long run up to 14 miles and everything was feeling ok, my 10k time was improving and I was feeling strong then two weeks out from the Langdale half marathon I managed to twist my ankle whilst out for a run.

I felt an initial sharp pain but then after walking for a minute or two it felt ok, I still had 5 miles to get home so after trying a tentative jog with minimal discomfort I set off again.

It coped with the rest of the run but I knew that evening and the next day I could feel some pain around the outside of left ankle and up into the outside of my calf.

I followed the advice I give to a lot of my patients after an acute injury and followed the P.OL.I.C.E protocol which stands for:

Protect – Try and avoid further overloading the damaged tissue

Optimally Load – Complete rest is often unnecessary you just need to find a level of exercise/loading that the tissue can cope with

Ice – Stick an ice pack on it for 10-15 minutes (Ice and water in a plastic bag wrapped in a tea towel to protect your skin

Compression – Wrapping the injured area in an elasticated bandage or tubigrip this helps to minimize swelling which can lead to secondary tissue damage due to the increased hydrostatic pressure in the injured area.

Elevation – Place the injured area above the level of your heart to allow gravity to help drain any swelling.

After approximately 48hrs I started trying some single leg balance exercises to help improve my ankle proprioception which was significantly worse after the injury. This initially consisted with just balancing on the affected ankle and then over the next week progressing to moving my other leg in different directions and standing on a pillow and eventually hopping in multiple directions.

I also started doing some elastic resisted exercises for the muscles on the indie and outside of my shin (see video below).

I avoided any running for the next 9 days which was harder than I thought it would be, I could feel myself getting more and more grumpy due to lack of running and although I was still cycling to and from work it didn’t give me the same stress relief that I get from running.

On the positive side it did force me to taper my running prior to the Langdale half marathon on Saturday and the two 4 mile runs I’ve managed this week have felt fine lets see how it copes with those all those hills.

What causes shin splints and tips on how to run pain free

When I started to increase my running in preparation for next years Brathay Windermere marathon (read blog here) I had an old and unwelcome friend return once more, shin splints.  

Shin splints is a term often overused in connection with any pain in or around the shin and is a poorly understood term. In the physio world we call shin splints medial tibial stress syndrome (MTSS) doesn't exactly roll off the tongue and so probably not surprisingly shin splints is still used more commonly.   

The problem arises when a chronic repetitive bending force is applied to the shin bone (tibia) and is very common in runners especially those that have rapidly increased their mileage, speed or running frequency. This causes a stress reaction within the outer layer of the bone and can be very painful.  

Other causes of medial shin pain can also include overload of a muscle/tendon on the inside of your shin (Tibialis Posterior).   

Both of these conditions are usually triggered by a rapid increase in training load however certain characteristics of your running technique are thought to increase your risk of developing medial shin pain.  

So I decided to turn the analytical spotlight on myself (something physios are notoriously reluctant to do) and did some filming of my running technique on the treadmill and whilst running overground.

So the most noticeable thing from looking at me from behind was that I had a tendency to land quite far on the outside of my heel on both feet. This means my foot has got a long way to travel in order for my foot to get flat (in physio speak we would call this an increased pronation excursion angle). Now over pronation has long been unfairly demonized as the cause of most running related injuries however my foot is not rolling in excessively it's just it's got a long way to travel in a short space of time. This can cause increased force to be applied to the inside of the shin bone and means the muscles on the inside if the shin work a lot harder both of which can lead to medial shin pain.

The other noticeable thing from the video is that I start to roll my foot outwards before I have fully pushed off through my foot.

In fact it looks like I don't push off through my big toe at all, this leads to a less efficient push off part of my running cycle (in physio speak we call this low gear propulsion). This might also help to explain why my calf muscles feel so tight and fatigued after a run.

The fix in the end was rather simple I used the running cue of thinking about pushing off through my big toe. This helped reduce my shin pain really quickly and after practising this cue over the last 3 weeks it feels much more natural, my 5 km and 10 km times have dropped and my calf feel much more comfortable even after longer runs. 

If your struggling with medial shin pain the 1st thing you need to do is get it checked out by a qualified health professional who has experience of treating runners. Call our reception on 01539 725220 or ​book online here.  

If you want to read more about our RunFit running assessment and retraining packages and how they can help you run pain free or improve your performance click here. 

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