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. 

Richard’s case of festival shoulder

Spending a weekend in a tent, ankle deep in mud, in a field somewhere in North Yorkshire left me with several things.

  • a strong desire to buy a camper-van
  • a debilitating lack of sleep
  • a very sore and painful shoulder

Now this could have been brought on by some over-energetic dad dancing whilst raving into the early hours of the morning. But instead I think it was caused by a combination of lifting and carrying all our camping gear from the car to the campsite, holding my sleeping 3.5 yr old daughter for an hour whilst watching a band and then carrying all our gear back through thick mud to the car.

I woke up on Monday with a really painful and stiff shoulder wondering whether I’d be able to ride my bike to work never mind spend all day treating patients. I knew I needed to get my shoulder moving and after some Ibuprofen and paracetamol I could start to exercise and move it which helped to further reduce the pain.

I continue to be amazed at the ability of the human body to heal itself as long as we put it in the right environment to allow it to do so. Fortunately the following week I was on holiday camping with my family and a combination of early nights, being able to run every other day and relaxing on the beach not having to worry about work in combination with a few strengthening exercises allowed it completely settle.

We see a lot of people with shoulder pain with a similar story, instead of a festival shoulder it might be a 1st good gardening weekend of the year shoulder or a I’ve been painting ceilings for 3 days shoulder. Basically if we expose our shoulders to a level of activity and strain that they are not used to too quickly and don’t give the muscles and soft tissues time to adapt to this new level of load it’s going to get sore.

So the take home message is to try an pace yourself and introduce any new activities at a gradual rate to allow your body to adapt and in my case make sure we pack a lot less stuff next time we’re camping at a festival!

If your suffering from a painful shoulder and don’t know what to do about it call our reception team on 01539 725220 and find out how we can help. You an also book online by clicking here

Lisa’s hurting hamstring

Some of you will already know Lisa our practice manager. A few months ago Lisa completed the Keswick to Barrow walk along with Kerry one of our physios. They did amazing raising loads of money for some worthwhile causes as well as being the fastest all female team to finish.  

During her training for the walk Lisa had increased her walking mileage a lot in a short period of time and started to get some pain in the back of her knee. This got worse after the walk and was starting to be painful during and after a run.   

Now Lisa identifies herself as a runner it's part of who she is, part of her DNA. She loves running, and I mean really loves it, so much so she just carried on despite the pain. Sound Familiar? 

She even did the Grasmere gallop a 10km trail run a few weeks after the walk but found her knee pain was worse than ever after. It got so bad she even had to stop running, now. Now what do you call a runner who can't run?

A "ner"!!  

Now the funny thing is Lisa works in a physio clinic, she is surrounded every day by expert physios with loads of experience treating injured runners. We even have a RunFit service that that analyses and retrains running technique. And to top it all off Lisa gets free treatment as an employee.  

So it might surprise you to hear that Lisa didn't mention her injured knee to any of us. Not one little peep!  

Why I hear you cry!  

The reason is something we hear all the time from our clients.  

She was scared we would tell her to stop doing the thing she loves, running. This is despite the fact that she had already stopped running because she was worried about the pain and doing more damage.  

Lisa finally fessed up and told us her tale of woe. We listened to her story including what she wanted to achieve with her running (a sub 2hr half marathon). We assessed her and found a sore hamstring tendon inserting into the back of her knee (hamstring tendinopathy). Lisa was given some exercises to help calm down her pain followed by strengthening exercises to help build strength in her hamstring. We explained her problem and told her she could even start running again as long as the pain stayed at a low level and wasn't worse the following day.  

Lisa is now gradually increasing her running and strengthening exercises. She has a lot less pain and we have analysed her running technique and identified some areas she can work on to help reduce her risk of injury, improve her running and smash her 1/2 marathon personal best.   

Lisa has very kindly agreed for us to share her story and some of her RunFit analysis videos and we will be catching up with her over the next few months to see how she gets on.  


Richard’s mid life crisis marathon

It's that time of year again!  My 39th birthday is rapidly approaching and I realised that time is running out (no pun intended) on me achieving my goal of running a marathon before I turn the big four zero.

Is it a mid life crisis type of thing? Possibly but it's certainly cheaper than buying a sports car! Now which one to enter London, Paris, New York? Well actually none of the above, instead I've decided to enter the Brathay Windermere marathon described as one of the most scenic road marathons in the UK as well as one of the most challenging courses.

Having chosen which marathon, it's time to get serious about my training and I've enlisted the help of Wayne Singleton from Jogging Pals to help me devise and stick to a training plan. Wayne is a top bloke as well as a UK Athletics Coach, seasoned marathon and ultra runner. Jogging pals is an amazing running group that is all about making running fun and inclusive go check out their programmes at https://www.joggingpals.co.uk/

I'm really interested to see how my body is going to cope with the increased training load and I will be writing a monthly blog to track my progress and giving you my insights as a physio and a runner along the way.

To follow my journey you can check out our blog, or like and follow the clinic Facebook page. You can also follow me on Strava by searching for Rich the physio.

4 ways to reduce your risk of injury

By Kris Baldock

It's that time of year again, whether you've started a new year fitness regime or are planning to hit the slopes for that ski holiday, a sudden change in physical activity can lead to injury.  A large number of people embark on a new exercise regime, and others increase their activity levels or intensity of an already established routine. As with any new activity or increase in training, there  is an increased amount of load being put through your tissues and this can lead to a higher risk of injury.

As prevention is better than cure, could you try incorporating some of the points below  which will help reduce your risk of injury.

1. Always include a warm up. Follow a specific warm up that recreates the movements of the exercise your are about to perform, once warm your muscles have a greater tolerance to loading and increased elasticity. This is what we call a dynamic warm up and is very different from the type of static stretching that many of you may be used to. Static stretching has been shown to have no effect on preventing injuries and in some studies has been shown to reduce your muscle ability to produce force, not something you want to do before a workout.

2. If your new to exercise, gradually increase your activity level. Recent research suggests an increase risk of injury is brought about by not only an increase of training load, but also too little training load. This therefore suggests that a sharp increase or excessive variation in training load may increase the risk of injury. Gradually increase and maintain your activity level and if you have time off for illness or injury, do not return to your
previous activity level too quickly. 

If you are used to exercise, don't increase your training by more than 10% per week. This could be an increase in the length of time you are exercising, the intensity of your workout or an increase in the weight you are lifting.

3. Take a rest day. Research has shown that if you load tissues above your current tissue capacity everyday, this can lead to a breakdown of collagen tissue. Collagen makes up a large part of our muscles, tendons and ligaments. We need periods of rest to allow our bodies to regenerate and repair. Loading your tissues everyday without rest over time can lead to weakness and structural changes in these tissues, and they can't cope with the demand of load and this can lead to pain.

4. Mix up your training. This changes the type of loading through your tissues.For runners this could be a change in footwear, running pace or mixing road running with trail running.  Doing some form of cross training (different type of exercise) e.g. cycling, swimming or gym based exercise can allow you to strengthen different muscle groups whilst helping you maintain your cardiovascular fitness.

5 easy tips to help reduce your Back Pain

“Is your back pain taking over your life, does it stop you enjoying an active outdoor lifestyle or prevent you from playing with your kids/grandkids? If this sounds like you or a friend or loved one you know you need to keep reading”.

1.Avoid bedrest, stay in work and gradually resume normal activities

Prolonged rest and avoidance of activity for people with low back pain actually leads to higher levels of pain, greater disability, poorer recovery and longer absence from work. In the first few days of a new episode of low back pain, avoiding aggravating activities may help to relieve pain. However, staying as active as possible and returning to all usual activities gradually is actually important in aiding recovery. While it is normal to move differently and more slowly in the first few days of having back pain, this can be unhealthy if continued in the long-term.

2.You should not fear bending or lifting 

Bending and lifting are often portrayed as causes of back pain and while an injury can occur if something is picked up in an awkward or unaccustomed way, it’s most likely to just be a sprain or strain.

3.Exercise and activity reduce and prevent back pain

Exercise is shown to be very helpful for tackling back pain and is also the most effective strategy to prevent future episodes.Start slowly and build up both the amount and intensity of what you do and don’t worry if it’s sore to begin with – you won’t be damaging your spine.

4.Painkillers will not speed up your recovery 

There is no strong evidence on the benefits of painkillers and they do not speed up recovery.They should only be used in conjunction with other measures, such as exercise, and even then just as a short-term option as they can have side effects.

5.Get good quality sleep

The importance of sleep in tackling back pain has become increasingly clear in recent years. This is because it reduces stress and improves your overall feeling of wellbeing, making you less susceptible to the triggers of pain in the first instance and helping you to cope when it does occur.

Need more help with your back problem? Why not request our free back pain report (worth £40).

Our 10 page report is packed full of more information that will help you get back to living an active outdoor lifestyle without having to rely on painkillers or having to bother your GP.

Call Us!