Thoughts on outpatient Physical therapy

10 weeks post op posterior hip replacement and doing very well. Walking very well with no pain...going up and down stairs with no pain , driving with no pain riding or getting in and out of car...sleeping on either side with no pain...getting really good sleep...taking absolutely no medication .oh yeah putting my socks on and tieing my shoes ... Using common sense in deciding what i should or should not do...Have no intention of running but walking and stationery bike will be my regime. My ortho doesnot do outpatient physical therapy until 3 month post op. My thinking is with how i have progressed and where i will be in two more weeks not sure PT outpatient is neccessary..i did the excercise that PT in home gave me initially but have been concentrating on walking more in the last three weeks and i know that some of the PT people have the "no pain no gain" mentality which i disagree with. Just wanted others thoughts...Thinking if my 3 month xray is good and all is well that my walking and hoping stationery bike after that will be good..Thoughts? Happy Monday

Most orthopedic surgeons I know don’t even suggest PT after THR, so if you’re doing well, I would say keep going, if you have problems, then do some PT?

Sounds like your doing wonderful.... I'm on hip replacement revisions now.... I'm 4 1/2 weeks in but only allowed to partial weight bare... I have been given exercises and doing them at home... we have no provision for physio ... so unless when i see surgeon at 3 mths check he feels a need then im on my own... but like you doing fine in the constraints of what im allowed... if you find when you get to that stage your dont need P then dont feel pushed into it... you know your body and sounds as if you very sensible.

Dear Thomas

Just keep on walking strongly and with a good balanced gait and forget any thoughts of physio m. After my primary twenty-one years ago I only needed or walking stick to leave hospital and was not offered any physio but I just walked and walked

I had the poly cup replaced last year as a revision and turned down the offer of physio and just walked and it worked fine again!

Good luck and keep walking! Cheers Richard

Totally agree with you...not to mention the out of pocket expense for the PT..

Thanks for your thoughts and advice. Definitely if all is well at 3 month checkup i feel no need to spend more money and let PT drag it out to make more...

Yes mam.. I agree...just dont see the need if things are still moving well like it is now..My wife says i am the perfect patient because i do exactly what dr says because i dont want to go backwards but also dont to do anything uneccessary such as the Outpatient Pt when not needed... Thanks for your thoughts and have a great week.

Wow!  I thought I did pretty good after my THR one year ago today!  But it sounds like you have done fantastic!  I can't imagine you needing PT.  I didn't do any PT except the exercises they gave me to do when I left the hospital.  I was as active as I could be early on (maybe even a little too much at times), but I was so anxious to resume my previous life as fast as I was able.  I'm 64, was in great health and had a hip replacement after falling off a ladder onto the concrete in my garage.  Glad to hear your success story! 

Thanks for your kind words Begonia...I have just done exactly what my ortho said to do because i donot want to go backwards. I am 61 and retired from a 30 year career as a public school teacher and coach. Taught physical education my entire career and think that has helped me in many ways in recovery.. Very competitve by nature and refuse to fail and that mindset has driven me everyday of my recovery..Definitely hoping PT is not neccessary. You have a great week and thanks for the encouragement.

Sounds like youre doing great Thomas, that’s great.

I’m  19 weeks post anterior thr and I was on the same track as you until week 11.

I did the first 6 weeks of home PT and after that felt I didn’t need any more, same as you.  In recent weeks I’ve learned that continuing pt might have prevented a problem.

At week 11 I was feeling nearly healed so I got out on one of my newly vacated rental properties to do some tree pruning and other yard cleanup.  

I apparently over did it even though I was was being careful on the new hip.

A day or two later I began having increasingly severe pain from my rear side, all around the new hip and down to the knee.  I mean the pain became nearly unbearable at times.  Every few seconds 24 hrs a day id get sharp stabbing pains all through that area. The stabs so sudden and severe it would cause my body to bolt and It was difficult to prevent verbalizing it, “OUCH!” And often more colorful language followed.

Then the constant burning pains made it feel as if I had a mean little gremlin in my hip with an ice pick in one hand and a blow torch in the other and he was trying to stab snd burn his way outta there.  

My surgeon did xrays each time I returned for help and assured me the prostheses were in their proper place and my problem was bursitis and that it might resolve in time.  He put me on steroids and ibuprofen 800 and it eased up maybe 25% for a few days, then the angry gremlin went back at it.

I saw another highly respected hip surgeon who did xrays and said all looks good but that I had tendinitis.

He recommended more PT.  I asked if ge coukd do an MRI to see exactly were an injury might be and he laughed.  He sais I can never have an MRI done in the hip area because the prosthetic implants reflect the imaging back so bright that nothing can be seen. It’s like looking directly at the sun, he said.

He also showed me what I had felt, that my leg with the new hip is now very slightly longer than before surgery, by about 1/4 inch or so.

He explained that because I had Avascular Necrosis (AVN) in the hip, the ball at the femural head had begun to slowly cave in, my muscles around the hip were slowly tightening up becomming shorter in direct correlation with the hip slowly caving in.  

Now that they’ve put in a new hip the hip is now back where it was when I was a healthy 30 year old, which pushes the leg making it appear about 1/4 inch longer. With this extension, all those muscles and tendons and a long thing that stretches from buttock to knee called the iliotopial band (spell?) were now much tighter around the hip because of the new length of my leg.

There it was, finally explained to me much better than I just did. These tightened tissues are more susceptible to injury until they stretch back to the proper length to match the longer leg.

Working with a chain saw that day likely caused some friction of the femur against the muscles and that ilitopial band.  Once injured it takes months to heal because there is very little blood flow to that band to speed healing.

At PT they work at stretching those that band and surrounding muscles  in several ways to try to lengthen them to reduce further friction caused from them being over tightened around the new hip joint.

I hope that makes sense somehow. lol

Now at week 19 those pains so far are reduced by 50%.  The gremlin is slowly wearing himself out in there I hope.

If you feel the outside of your leg midway from hip to knee, and compare the tightness you feel to your other leg, you’ll likely feel a big difference in the tightness.  It’s mostly from that iliotobial band, called a band because it’s not a muscle, tendon or ligament so they call it a band.

And it’s my least favorite band now.

So, that’s one argument for continuing PT.

Best of luck,

Thomas, if this link works, it shows how big that ilitibiol band is. It’s the long white thing stretching from aboue hip to knee.

https://www.google.com/search?q=iliotibial+band&client=safari&hl=en-us&prmd=ivsn&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiJoLjNr4vaAhUMv1MKHZ3gBG8Q_AUIESgB&biw=375&bih=537#imgrc=gXr2J5wRZyKNbM:

Sounds like you did have a rough time. Inam very familar with the iliotobial band as previous to being diagnosed with my hip problems my chiropractor thought that was my problem. I may need PT but i promise you I will not be using a chainsaw or pruning anything...Thats where my yardcman comes in..lol...my thought on the PT not being neccesary was assuming everything is still progressing very well.. Hope things continue to get better and thanks for your input.

You sound amazingly similar to me in mindset and "stubbornness" about refusing to fail. LOL  I've been a wallpaper hanger for 30 plus years so I was in great shape from all the exercise I got in my job.  I felt very fortunate that I was in good shape and recovered very well.  I did overdo it a few times and paid the price after going to bed at night with more aches and discomfort.  Breaking my hip was a curveball from *=@% and brought my life to almost a complete stop which I was anxious to put behind me.  It sounds like you just aren't gonna let anything take you down!  LOL  Me either, if I can help it!  Keep up the great attitude and forge on. 

Thank you Ms Begonia..yep sounds like we have the same mindset and the reason I love this site is that WE is better than me and together on this site we can encourage one another sharing our hope, strength and experience. Got to keep pressing on....A journey not a destination.

Did you walk previously?  If not, please don’t overdo it.  I was swimming and using my bike for transportation at eight weeks and continue with this.  I was a runner for many years followed by cycling for many more.  In bad weather I would use the stationary bike.  Later, when my spinal stenosis took hold I did just the stationary bike.  Now I swim an hour a day, normally five days a week. I have a routine of starting the week with easy swimming, going to much more effort towards the end of the week.  Oh, I also walk some but not too much because it messes with my back.  Exercise is important.  If it hurts though, don’t overdo it 

Oh, I never had PT ordered

I assume you are not in the U.K., as I think here you are offered physio therapy routinely for a while. Last night I had my almost 6 week review with my consultant and he gave me permission to do any exercise or activity I wanted, but told me to pay attention to my body. If it was causing me pain, then stop.

The first two weeks post-op I had to do the exercises I was given in hospital. Then at 2 weeks the physio checked my progress and added in a couple. At 4 weeks he told me I no longer had to do those but to concentrate on just four new ones. Squats, hip bridges, and two leg movement. He also said to get out walking every day but not to overdo it. So you are doing the right thing by walking,

The major thing the physio diesis to check your gait to ensure you are walking correctly. Most of us have developed a limp by the time we have a THR, and he can see  if you are still favouring your good leg and not putting your weight down evenly, or not stepping down with your heel first.

I’m due to see him again tomorrow so, I feel he gives me any new exercises, I’ll let you know. In my case I do feel the exercises have helped me build strength and walk better.

If you are walking well, can get up and down from a chair just using your legs, and don’t have any back problems, you are probably doing fine. You can always google exercises for post hip op if you want to do some.

About the ‘no pain no gain’ mentality, I have to say that is not at all what I’ve experienced from my physio. I was finding one of the exercises painful and he immediately told me to stop it and gave me a different exercise that worked the same muscles but without the pain.

I didnt saybthey were all that way but know from other people that they can be..no biggie..just going to listen to my body and if my ortho thinks it is neccessary we will see.

Hi, I’m in the UK, and I just had my exercise sheet from the hospital. I had a 6 week physio appointment, and I was doing fine so I was discharged. Just practised walking nicely, and was sent on my way. All fine so far. Biking, swimming, skiing, but I don’t run any more.

Good luck, Judith