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News Letter

Physical Therapy Treatment Following Hip Replacement Surgery Print E-mail

Once the physical therapist has completed an examination, he/she will put together a treatment plan. The treatment plan lists the types of treatments that will be used for your condition. It gives an indication of how many visits you will need and how long you may need therapy. The plan also lists the goals that you and your therapist think will be the most helpful for getting your activities done safely and with the least amount of soreness. Finally, it will include a prognosis, which is how your therapist feels the treatment will help you improve.


Using Physical Therapy to Ease Pain

Your therapist may choose from one or more of the following tools, or modalities, to help control the symptoms you may have from your hip surgery:


    Rest: Rest is an important part of treatment after surgery. If you are having pain with an activity or movement, it should be a signal that there is still irritation going on. You should try to avoid all movements and activities that increase your pain. Be sure to use your crutches as assigned by your doctor, and put only the amount of weight on your leg as approved by your doctor.

    Ice: Ice makes the blood vessels in the sore area become narrower, called vasoconstriction. This helps control inflammation that is causing pain and can easily be done as part of a home program. Some ways to put ice on include cold packs, ice bags, or ice massage. Cold packs or ice bags are generally put on the sore area for 10 to 15 minutes.

    Heat: Heat makes blood vessels get larger, called vasodilation. This action helps to flush away chemicals that are making your hip hurt. It also helps to bring in nutrients and oxygen, which help the area heal. True heat in the form of a moist hot pack, a heating pad, or warm shower or bath is more beneficial than creams that merely give the feeling of heat. Hot packs are usually placed on the sore area for 15 to 20 minutes. Special care must be taken to make sure your skin doesn't overheat and burn. It's also not a good idea to sleep with an electric hot pad at night.

    Electrical stimulation: This treatment stimulates nerves by sending an electrical current gently through your skin. In the acute treatment after meniscal surgery, the stimulation can ease pain and help remove swelling. It is often used in combination with ice in the early stages and heat in the later stages of recovery. This treatment stimulates nerves by sending an electrical current gently through your skin. Some people say it feels like a massage on their skin. Electrical stimulation can ease pain by sending impulses that are felt instead of pain. Once the pain eases, muscles that are in spasm begin to relax, letting you move and exercise with less discomfort.

    Improving range of motion (ROM): To improve your ROM, your therapist can use graded joint mobilization, manual stretching, and select exercises. Active movement and stretching as part of a home program can also help restore movement.

    Gait training: Once you are safe to put full weight through your operated leg, your therapist will work with you to "fine tune" your gait. Retraining may be needed if you've developed a limp, which may be due to apprehension of pain or simply from a habit you've developed since your injury or surgery. Getting a normal walking pattern starts with shifting your weight when you walk. If you can visualize the way competitive speed skaters sway their hips when they skate, you'll get the picture of what it means to shift your weight. When you place your sore-side foot down and prepare to step through with the opposite foot, you may be hesitant to shift the weight of your hip over your planted foot. This leads to an antalic gait; better known as a limp. Practicing this part of the walking cycle may be all that is needed to help you "remember" how to walk without a limp. Your therapist will also make sure that your steps are equal in width and length.


Aquatic therapy: By doing exercise in a pool, the properties of buoyancy and warmth to let you exercise with ease of movement. The buoyancy of the pool can be used to make exercise easier, to give resistance with some of the exercise, and to help you begin walking with less stress on your new hip. The warmth can help muscles relax, improve circulation, and ease soreness letting you move more easily. If your therapist works with you in the pool, only a few visits are usually necessary before you get into a regular program on land. If you are getting good benefits in the pool, you will probably want to get a membership to the pool so your other visits can be used to work on strengthening, walking, and getting you back to doing the activities you enjoy.

Strengthening: After a hip surgery, you can expect that your leg muscles will be weak. When muscles weaken from pain or disuse, other muscles overpower the weaker ones. This leads to an imbalance where the weaker muscles become longer and the stronger muscles become shorter. These imbalances change the way the joints usually work. The swelling and pain from your hip pain and surgery can lead to weakened muscles around the hip and knee. The quadriceps muscle usually is affected. Exercises can be chosen to help regain the strength in the muscles around the hip.

Biofeedback: Muscle control is the basis for strength. Using biofeedback can help you get back the control of the quadriceps muscle. The biofeedback unit has surface electrodes that are put on the skin over the muscle that needs help. As you practice working the muscle, the machine will give you "feedback" to let you see and hear how the weak muscle is performing. The biofeedback unit can also be set to alert you if other muscles are overpowering the weak muscle. Biofeedback can be used while you do your exercise program so you'll know if you're actually working the right muscle.

Functional Electrical Stimulation (FES): This is a way to use electrical stimulation to help retrain a weakened or deconditioned muscle. Electrodes are placed over the muscle that is to be retrained. The electrical current passes through the skin and stimulates the motor nerve of the muscle causing it to tighten for a set time without your conscious effort. The machine is usually set to go on for about 10 to 15 seconds and then off for 15 to 30 seconds. Once you get the idea of how the muscle feels when it tightens, you can begin tightening the muscle when the current comes on again. After you get a good contraction going, you should be able to successfully tighten the muscle without the use of the current.

Progressive resistive exercises (PREs): Many choices of PREs are now used in rehabilitation. Some of these choices include pulley systems, free weights, rubber tubing, manual resistance, and computerized exercise devices. Using PREs is a way to apply graded resistance to muscle groups to gradually help them gain endurance and strength. These exercises typically start with lighter weights with lots of repetitions, and as endurance increases, more weight is gradually used with fewer repetitions.

Exercise precautions: First, avoid "overdoing" it. If you find that you are getting swelling late in the day, it may be a sign you may doing too much too quickly. Second, avoid pain. Pain is an indicator that something isn't right. You may feel some discomfort with your exercises, but this should be "reasonable" discomfort. If pain is excessive or lasts more than one hour after exercise, inform your therapist at your next visit. You may need to change the number of repetitions, the amount of pressure, or the how often you are doing the exercises.

Progressive exercise: Exercises will be given to help improve motion, strength, and endurance in the hip muscles. Your program will also address key muscle groups of the buttocks, thigh, and calf. Other exercises can be used to simulate day-to-day activities like stair climbing, pivoting, and squatting, depending on which phase you have completed. Following are some types of exercises that may be used to help your condition.

Proprioceptive exercises: These are exercises that help retrain your position sense, also called "joint sense". If you close your eyes and hold up your hand, you know what your hand is doing, even though you don't "see" it. We get position sense by way of our vision, middle ear balance, and from tiny receptors in the ligaments and joints. When we close our eyes, we rely on middle ear balance and these special receptors to keep us upright. If there has been swelling or injury in or around a joint, these tiny receptors get injured and do not recover. You can do certain exercises to get the other receptors to do more, regaining what was lost with the damaged receptors. The loss of position sense puts the joint at further risk of injury because the joint loses stability, like having loose lug nuts on a wheel of a car. Special exercises, called proprioceptive or neuromuscular exercises, help protect the hip by "tightening the lug nuts." You can think of these exercises like balance training. Examples include balancing on one leg with your eyes open/closed, walking on uneven or soft surfaces, or practicing on a special balance board. Some therapists use special manual exercises to get the other receptors working better.

Closed kinetic chain (CKC) exercises: These are exercises in which the foot is kept on the ground while movement and resistance take place in the joints and muscles above. These types of exercises are important because they are so much like the activities we do every day. For example, a partial squat exercise is the same action as lowering yourself onto a chair or couch. A leg press is a lot like the action of going up a stair or step. These exercises add strength and stability around the muscles and joints of the hip and leg.

Stabilization exercises: Muscles that are closer into the "core" of the body act as stabilizers. The job of these stabilizers is to put your joints in the right position and to steady them while you squat, walk, or jump. These muscles form a stable platform, letting you move your leg and foot with precision. If these muscles aren't doing their job, your hip loses some of its control, keeping it from working its best. The stabilization exercises you'll be working on can be thought of in the way you take care of the tires on your car. If you had a wear spot on one of your newer tires, you'd be pretty upset with a tire dealer who simply wanted to replace it. You would first want to be sure the car was checked for alignment, that the wheels were balanced, and that the lug nuts were tightened. Otherwise, your new tire would end up getting worn like the last one. Treating your new hip takes more than just pain control (new tire). It requires training the stabilizers to assist with posture (alignment) and to guide the joint in the right placement (lug nuts) while you go about your daily tasks.


Home program: As your condition keeps getting better, you will be given advanced exercises to do at home, a pool, or in a gym setting. You may be scheduled to recheck with your therapist at regular intervals to make sure you are doing these exercises routinely and safely. During these rechecks, you may be given additional exercises to work on over the next few weeks. Eventually, you will be progressed to a final home program. Once you've been released to full activity, you may be instructed to follow up with a few visits over the next few months. This will give a comparison of strength and function of the operated hip and to make sure you are performing at peak levels. Before you are completely done with therapy, more measurements will be taken to see how well you're doing now compared to when you first started in therapy

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