Designed by Nicole Sheldon and Joseph M. Keating, UQ-Ochsner Clinical School, Class of 2014 You are about to undergo hip surgery. After your successful surgery, you will play a very important role and have great influence in your progress during recovery. This guide will help you with the stretching and exercises that will be the tools you will use to strengthen your hips, improve your balance and to live as full of a life as you can. Remember, this is a guideline only and is not intended to replace the recommendations and plan you have made with your health-care team. Every patient’s situation and surgery recovery is unique, so it is important that you not perform tasks that could impede your progress. Discuss these exercises with your doctor and be sure you are doing only the exercises most appropriate for your path on recovery. Most importantly, remember the distinction between discomfort and pain. While you can expect much discomfort during your exercises, if there is too much pain in your hip to exercise or any pain, swelling or bruising worsened by exercise, you should stop immediately and tell your physical therapist or doctor. Before beginning, you first have to learn one new term we will be using during your exercise – Core Muscles. Core Muscles Deep muscles that support your spine and pelvis. These muscles provide stability, control and good posture when you move. When your hip hurts too much to stand or walk, these muscles become weak and don’t work well. This can causes problems with your back or hips, as well as poor balance. Later we will request that you “turn on” these core muscles, which is to request you to consciously, gently flex and contract these core muscles. With practice and as you progress in your recovery, these muscles will turn on without conscious effort. Learn to turn on these muscles before and during each exercise. In addition to helping you recover and regain movement and strength in your hip, theses exercises will also help to reduce swelling, improve sleep, prevent clots, improve balance, control pain, increase activity tolerance and prevent constipation. Things you can’t do DO NOT bend your hip past 90 degrees DO NOT cross your legs at the ankles or knees DO NOT twist your body or legs Things you SHOULD do: Use long-handled aids, such as a shoehorn and reacher, to help you dress and pick up items. Sleep with pillows between your legs for the first 3 months after your surgery. If you need assistance placing the pillows, please ask for it. If there is no assistance available, try buying a longer pillow Your nurse will teach you how to use the pain scale below, in which, “0” means you have no pain and “10” means it’s the worst possible pain. A number of medicines will be available to help you control your pain, starting with acetaminophen, e.g. Tylenol, and sometimes an anti-inflammatory, i.e. NSAID and/or a narcotic like morphine. This combination will be determined with the recommendation of your doctor. For some people, the combination can cause an array of side effects, including nausea, vomiting, drowsiness, itchiness and/or constipation. If you notice any of these changes, be sure to tell your nurse or other healthcare provider. If your pain becomes increasingly worse or if you have pain in a new part of your body, seek medical attention immediately. Here’s what you can do to play your part in pain management at home: Take your pain medication as directed by your doctor. If you’re experiencing pain before or during physical activity, try taking a dose of the pain medication 1-2 hours before engaging in these activities. Ice: Ice can reduce pain and inflammation. Place an ice pack wrapped in a towel on your joint as directed by your physiotherapist. Pace yourself: do not push yourself. Regular rest is an integral part of your recovery. Relax: use relaxation techniques like breathing exercises or progressive muscle relaxation. Distract yourself: Listen to music, visit with friends, write letters, watch tv, or anything else that is interesting and allows you to forget your pain. Think Positively: You have a lot of excellent resources with highly trained professionals at your disposal to support and guide your recovery. They have played their role in many people’s recovery and have the experience you need to succeed. They will help you achieve your goals. You can do it. You can achieve your goals. Even when it gets hard, you will achieve your goals if you keep pushing forward. You will become more and more comfortable as you progress through your recovery. Immediate Post Surgical Phase (Day 1-4): Occurs while in the hospital. Patients are generally in the Hospital 2-4 days post-operatively if no medical complications occur Criteria for progression to the next phase: Motion Phase (week 1-6): Occurs at home with outpatient rehabilitation appointments Goals: • Muscle strengthening of the entire hip girdle of the operative leg with emphasis on hip abductor and extensor muscle groups • Attention should also be directed toward any weakness present in the operative leg as well as any generalized weakness in the upper extremities, trunk or contralateral lower extremity • Improve body/spatial awareness of the operative leg in functional activities (Proprioception) • Endurance training to increase cardiovascular fitness. • Functional training to promote independence in activities of daily living and mobility Ankle Pumps While lying down with the knee extended: Place a small rolled towel under your ankle for support. 1. Slowly point the toes as far as possible, hold 5 seconds 2. Pull the toes back towards you as far as possible. Hold 5 seconds. 1 set = Repeat 10 times Complete 1 set 3x daily Isometric Quad Sets Sit with leg out straight in front of you. 1. Place small towel roll under ankle. 2. Tighten the muscles around your knee and press towel into the mat. Hold for 5 seconds, then relax. 1 set = Repeat 10 times, hold for 5 seconds each. Complete 1 set 3x daily Isometric Glute Sets Lie on your back with your legs extended 1. Squeeze your buttocks together 1 set = Repeat 10 times, hold for 5 seconds each. Complete 1 set 3x daily Isometric Hamstrings Sets Lie on your stomach with your legs extended 1. Slowly bend your knee as you bring your foot towards your buttock 2. Hold for 1 second 3. Lower back to mat 1 set = Repeat 10 times Complete 1 set 3x daily Heel Slides Lie on your back with your legs extended 1. Slide the heel of your operated leg toward your buttock so that your knee and hip bend 2. Hold for 10 seconds 3. Slide your heel back so that your leg is flat * Keep the opposite leg flat 1 set = Repeat 10 times Complete 1 set 3x daily Hip Abduction Lie on your back and keep your knee straight 1. Slide your leg out to the side (away from your body) then back to the starting position • Do NOT allow your leg to cross the midline of your body • Make sure your feet are always pointed up • Do NOT let your leg roll in or out while sliding it 1 set = Repeat 10 times Complete 1 set 3x daily Hip Stretches Lie on your back with both knees bent 1. Turn on core muscles to keep back and pelvis still 2. Use towel to bring one thigh up no more than 90⁰ 3. Slide the other leg down the bed, until you feel a stretch at front of hip, keeping core muscles on and not arching your lower back. 4. Slide straight leg back to bent position, lower the supported leg 5. Repeat other side Hold stretch for 30 seconds Repeat 3-4 times, once a day Hamstring Stretch Sit with your back, thighs and feet supported 1. Turn on core muscles 2. Squeeze a rolled towel between your thighs 3. Lift one foot up to straighten knee 4. Stop when you feel a stretch at the back of your thigh even if knee is not straight. 5. Repeat other side Hold stretch for 30 seconds Repeat 3 – 4 times, once a day Calf Stretch Stand beside a support 1. Turn on core and lower buttock muscles 2. Bring hips forward, feel a stretch along back of calf. Note: You may also feel a stretch at the front of your hip Hold stretch for 30 seconds Repeat 3 – 4 times, once a day Hip Lift Lie on your back with knees bent 1. Turn on core muscles and engage lower buttocks muscles to lift hips up while keeping back relaxed. 2. Slowly lower hips. 1 set = 8 – 15 times 3 times a week Hip Extension: Straight Leg Lift Stand supported over counter 1. Tilt tail bone up to form a small curve in back. Turn on core muscles 2. Stand on non-operated leg and lift your operated leg up and back without twisting the pelvis or the hips 3. Lower leg while maintaining a curve in your lower back using your core muscles. 1 set = repeat 8-15 times 3 times a week Standing Knee Bend Stand with support 1. Turn on core and lower buttock muscles 2. Bend knee by lifting heel toward buttock 1 set = repeat 8-15 times 3 times a week Weight Shift Stand with feet shoulder-width apart 1. Turn on core and lower buttock muscles 2. Shift body weight form one leg to the other through your lower buttocks 3. Keep pressing other foot into the floor Note: Imagine using only one buttock and leg to support all of your weight 1 set = 6-8 times 3 Times/Day Criteria for progression to the next phase: • Active hip range of motion 0-110’ • Good voluntary quadriceps control • Independent ambulation 800ft without assistive device, deviations or antalgia Progression to driving is per surgeon recommendations By three weeks after surgery, your hip should start to feel better and move easier. Accordingly, progress with your exercises means to gain more flexibility, strength and control of your new hip joints. Goals by end of week 6: Bend your hip to 90⁰ Slide your leg out (abduct) to 25⁰ Straighten y our hip fully to 0⁰ Walk several blocks with a cane in the opposite hand Ride an upright stationary bike with seat raised so your hip does not bend more than 90 degrees. Front Step Ups While standing with both feet on the floor: 1. Step up a step with operated leg 3. Return backward towards the floor leading with the same leg. Lateral Step Up While standing next to a box or raised surface: 1. Step up and to the side on to the surface with your operated leg 2. Both feet should touch the raised surface. 3. Then step down and onto the floor towards the same side that you started from. Core Bent Knee Turn Out Begin on back with legs bent and feet shoulder-width apart. Tie exercise band around thighs to provide resistance 1. Turn on core muscles to keep back and pelvis still 2. Turn one knee out no more than 6 inches and slowly bring it back. 3. Repeat 1 set = 6-8 times 3 tiimes/day Thigh Stretch on Belly Lie face-down (optional pillow under belly-button) 1. Turn on core and lower buttock muscles 2. Bend one knee until you feel a stretch at front of thigh. Be sure to keep foot in-line with same buttock 3. Lower leg slowly while keeping core and buttock muscles on 4. Hold stretch for 30 seconds 5. Repeat with other leg 1 set = 3-4 times daily Heel Squeeze Lie face-down (optional pillow under belly-button) and legs apart 1. Bend knees with heels together 2. Turn on core muscles 3. Press heels together to turn on your lower buttock muscles 4. Relax buttock muscles without relaxing core muscles 5. Hold for 6 seconds Note: Do not due this exercise if surgical cut is on the front of the hip. 1 set = 8-15 times 3 times a week Hip Bend Stand tall with operated side against wall 1. Support other side with chair 2. Slide operated thigh up and down along the wall, while not bending past 90° 3. Keep lower buttock turned on and hip straight on standing leg 1 set = 8-15 times 3 times/week Original article and pictures take http://www.exercisemenu.com/ultimate-home-exercise-program-total-hip-replacement/ site
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