Hip Rehabilitation – Days 0-21

REHABILITATION DIARY

Day 0 – Operation day.

Nic, Lily and I arrived at Guy’s hospital entrance at 7am after a bad night sleep and waking up a 4am. We looked terrible, well I did anyway. My parents were there waiting for us, both worried about their middle child about to have major surgery. They equally looked knackered and hadn’t slept. Both were worried and my dad seemed particularly worried. They were there to look after Lily for us. I felt strangely calm now I was here but having the chance to speak with my surgeon Marcus Bankes and his fellowman Mike before the operation was extremely reassuring. I needed this conversation badly. What it did was completely aligned me so I was ready for the operation and was aware of all the pros and cons of the operation.

I said my goodbye to Nic and walked with a nurse to theatre. No trolley to get me there just my limping gait in my ted stockings. I had a spinal, general anaesthetic and psoas block. The operation took about one hour.

I did not get out of bed on the operation day (occasionally you can get out of bed of the day of the operation) as could not move my right leg due to the psoas block which lasted nearly 24 hours. Managed to do ankle pump exercises and left leg knee and hip bends and buttock squeezes. Surreal.  As I was unable to move, there was no going to the loo. I had to use a bed pan. Not a nice experience and to lift my bum on this thing was so hard and painful and without the help of a nurse I am not sure if I could have done it. I had to do it twice on this day and the first time managed to get stuck on it as I waited for the nurse to come back and get me off it! I did it myself after putting loads of pressure through my operated leg. God I hope I didn’t damage it I thought!

Day 1 – Hospital. Felt crap, sick in the morning and generally rubbish. I had more pain as the psoas block wore off. At 4am my right quads/thigh muscle was coming back to life and could manage both static quads, inner range quads was sore on the right around the right hip, ankle pumps. Right knee flexion was about 5 degrees and no more. I had to use my hands to get this working and then only got another few degrees. Physio came and got me moving and trying to flex and abduct my hip which were both really hard to do. Next was getting out of bed for the first time (slightly daunting…). It took me ages to shift my bottom to the edge of the bed, it was really painful in the hip and felt like it/the hip was falling out! I got there and then what a mission to sit up on the edge of the bed. I had to move my right leg to the edge and the move the body keeping it in line with the leg trying not to adduct my hip. I finally sat  on the edge of the bed and felt a bit woosey. I then stood with the help of a zimmer frame and had an awful biting pain around my groin. I felt faint and had to lie back down again. Pathetic! This is quite normal said my physio and is usually worse with the young ‘uns. I managed some weight transference exercises onto the right leg in standing but it was sore and not great.

Stef Brennan my friend and physio came to see me and how I was doing. I said not much and that I had had a pretty pathetic morning of dizziness and fainting. He gave me ice packs and ice bag to and told me to ice my hip 4 times a day. Just keep it iced he said, it’ll help with the swelling. The physios do not seem to emphasis ice to reduce inflammation, swelling and bruising for the hip. Strange as it is easy to apply if ice is readily available. Anyway as i had not yet peed in a toilet i said to Stef i needed the bed pan. He promptly legged it.

The afternoon was a result and i managed to get to the loo with the frame and walk back on my own. The hip felt much less painful, just a bit odd and although a bit woosey i managed it. I then sat out in the chair for 60 minutes (not too comfortable) and got too tired and back to bed as slow as I had got in. I did it all myself.

That evening I managed to knock a cup of hot tea onto my bed with made me lurch and move my operated leg across my midline which felt like I had put it in a position that it didn’t like (they say avoid crossing your legs!). The nurse came, had to change me and then bed. What a plonker.

Day 2 – Hospital. Slept so well! Ear plug was good. Less pain in the hip. Managed to walk to the toilet with the zimmer and wash my essentials (what a joy!) Notice a clicking around the hip but knew this was quite normal. The physio assistant came round with crutches and got me out of bed. Walked with crutches around the room.

Standing exercises – abduction, Extension and flexion. All movements felt awkward and painful with hardly any movement! Heel raises and weight transference exercises and mini squats x 10 each. In standing squeezed gluts, walked backwards and side to side. Bed exercises gluts squeeze, static quads, active assisted (with plastic apron on the bed) hip abduction and flexion exercises. Knee extension edge of bed.

Felt like I could have had some passive movement help from physio for hip abduction and flexion.

Walked x 5 today with the crutches. Managed mini stairs! Physio discharged me!

What was really interesting was as a physiotherapist myself when I taught the standing and bed exercises to patients years ago I always thought the exercises I was giving out were not that useful and rather lame and were easy to do incorrectly such as the standing extension or abduction exercise, therefore the patient would not benefit from doing them. However as a patient and physiotherapist I see how massively important they are and how difficult it is to do them properly without using your spine or other joint to compensate for the movement. And it is the job of the physio to really watch how the patient moves the hip in order to ensure correct movement patterns.

Day 3 – Hospital/Home. Miserable start. Felt tearful. Hip feels stiff and sore and struggling to move my leg to get in and out of bed. So difficult! My new hip aches. I real need to wash as haven’t done so properly since the operation. Walked to shower room with 2 crutches – washed hair and body apart from right below knee. Put my clothes on using my grabber to pull trouser leg up. Feel normal with clothes on. so important to get out if your hospital gown when you can. Interesting psychology.

Exercises – sit to stand edge of bed x 10, Hip abduction, extension, flexion, heel raises, mini squats, weight transference right leg, hip flexion/abduction in lying, gait re-ed heel strike to toe off, sitting exercise abducting hip. iced hip x 3 20 mins.

Stef visited me at Guy’s again and checked my gait and gave me other exercises and tips to improve function.

Home this afternoon at 4.30pm. My brother Rob Turner wheeled me out in a pink porter’s chair. What a good brother. We did have a laugh as he dragged my down to the entrance where other fellow patients were sitting out in their chairs sunning themselves. Walking to the entrance was too much on day 3.

Generally I was weight bearing more on the right leg and needed 2 crutches. What would have been helpful in hospital was to have passive hip abduction by a physiotherapy and hamstring stretches.

Day 4 – Home. Living in a small ground floor flat isn’t the greatest but at least it is on one level. Woke up at 4am feeling weird and wanting the toilet. Got out of bed slowly and put on the light so not to trip and fall over. Felt rough at 7am when Nic gets up to feed Lily. My sister Becky is arriving to help us for 2 days at 2pm. I cannot wait to see her and have a catch up! She is a great with Lily which will be a massive help for Nic and I. Rob and Deepy also came around to help for support. We had a bbq in the garden as the weather is great. I managed to sit out in a garden chair with a cushion for 1 hour but had to go in for a lie down. Sitting isn’t my favourite activity at the moment.

Land exercises – hip flexion and abduction in lying. Hip abduction with the knee straight and knees flexed. Standing exercises. Walked down the road with Becky and Lily. Timed it when schools came out and felt quite vulnerable and wobbly. Wanted to get home quirky. Had a BBQ and was able to sit for 1 hour but needed to walk and move around. Sitting was uncomfortable.

Day 5 – Hydrotherapy at Parkside Hospital Wimbledon was wonderful. My sister drove me there with Lily. I was able to move the hip more freely due to the buoyancy of the water. I could abduct, extend and flex the hip although it felt weird especially into flexion. After, Bec drove to Dulwich Park and Bec, Lily and I walked from the carpark to the cafe. Managed well with two crutches. Exercises standing and lying flexion and abduction, heel raises, mini squats, hip extension. Iced hip 20 minutes x 3 day.

Day 6 – Easier this morning. The hip feels less stiff. Can get leg on and off the bed with using my hands. I can now straight leg raise! Pelvis feels awkward being tilted forward/anteriorly. Leg swing flexion/extension and abduction in the kitchen holding onto both work top surfaces. This exercise feels good, no pain. The hip felt more swollen towards end of the day. Iced hip x 4 20 mins. Rob came over for a bbq in the garden. He took Becky to the station so she could get home to her family. It was really good having her for both sisterly chats and help.

Day 7 – One week post op, amazing! Walking with one crutch.

My great friend Bones (aka John Hart, Sofaman, milker) turned up this afternoon to stay for 4 nights and help look after Lily for us.

Exercises hip flexion, extension and abduction swings of hip in standing. Press ups against work top surface at a 45 degree angle x 10, heel strike to toe off practice operated leg, active knee flexion. Iced hip x 4 as felt hot and swollen. Walked with my brother for 10 minutes which included a small slope (slow going up but normal down) – overall felt good. No nasty pain. Able to hip extend normally. Hip extension pre operation was impossible. It was so painful.

Day 8 – Dr Lindsay visited me and was surprised more by the fact I did not look to bad and noted I had skinny legs. Well better than big. She was also impressed that I had 3 men at my disposal! Rob was also here feeding me poached egg on toast and telling me you must eat well so you heal well. Bones was just bothering me and Nic was keeping out the way..

Exercises – Active Hip/knee flexion x 20 – can do 90 degrees and have full knee flexion. Hip abduction x 20 in lying and x 20 standing. Still hard to abduct my hip in standing. Hip flexion in standing about 80 degrees and feels awkward still. Tried sit to stand from chair x 20 and this helped hip flexion in standing, felt smoother. Heel raises x 20. Weight transference onto right leg x 10. Bridging x 10. Pelvic tilts x 10. Abdominal bracing x 5 20 second holds. Iced hip x 3 20 mins.

Compex – muscle stimulator over gluts and hamstring for 20 mins with bridging

Gait – Able to walk outside for 10 minutes with one crutch and felt good. Two crutches definitely not needed now.

Day 9 – Had a slow start. I do not like getting out of bed in a hurry. Slow motion. Do my hip flex/abduction, gluts squeeze exercises before I get out of bed. Nic brings in a coffee. I swing my legs out of the bed. This movement feels more normal now.

Stef came to see me. He was pleased with how I looked and moved. I told him the hip did not like flexion and was still hard to abduct. He thought both hip movements were much better than 1 week ago (I had forgotten a week had past). I said my pelvis did not like anteriorly tilting especially if the hip was flexed.

My physio session consisted of – lateral hip and gluteal gentle massage for swelling (in left side lying). This was the first time I had laid on my left side  and I was quite nervous as the hip feels very odd and very weak. I also did hip extension in prone, IR/ER in prone with knee flexion (5 degrees and under physio control as have no IR control). Very positive session. The hands on manila therapy really helped unblock the hip!

My friend Anita came over to visit. I left both Bones and Anita to look after Lily for us whilst Nic took me to hydrotherapy.

Hydrotherapy – Brilliant. Water based exercises with Becky physiotherapist at Parkside Hospital. She reassured me of the clicking sounds I felt around the hip and said they were more likely to be flicking of the soft tissue and tendons as the body adjusts. She also said hip flexion will come so not to force it and hurt yourself. This also helped and reassured me.

Day 10 – Easier to flex knee/hip this morning and get out of bed. This is a first time it was easier to move and get out of bed. I did my exercises as DAy 9 but only twice. I felt generally tired after hydrotherapy yesterday and my legs weak. My friend Bones, Lily and I went to the Horniman Museum in London and I took 2 crutches as I felt tired. I will have a better day tomorrow. Still using primarily one crutch. Can lift leg in and out the bath whilst sitting on the bath seat. Sitting in a chair is still awkward and I feel i am on my left hip (unoperated hip) too much. Trying to stand from sitting using both legs. Sitting with right leg tucked under chair instead of out straight.

Day 11 – Feeling slightly more aching in the hip and more pinching pain on weight bearing and walking. Not really comfortable. I am sure this is normal but of a bit disconcerting. Doing my exercises but nothing seems to help today. Compex gluts and hamstrings. Felt tired most today and did little walking. Went to bed at 10pm and slept like a log.

Day 12 – Woke up feeling stiff in the back and right pelvis. Stef Brennan came round today to check me out and do some physio. It was a helpful session and I felt more mobile afterwards. He mobilised my lumbar spine and gluts. Massage gluts and ITB and quads. The tissues are tender but it felt good. We did some control work in prone with knee flexed to 90 degrees for internal and external rotation. Also had a go at the clam. This was very difficult and I could barely do it against gravity. This is very weak indeed. This is so hard to do and I am not confident to do this alone yet as the proprioception of the joint is not good. It is odd as I do not know where my leg is in space if I cannot see it. Managed the plank for 10 seconds on the physio couch!!

I managed one walk for 10 minutes again with one crutch and did ok. Perhaps not as good as 3 days ago. I feel some discomfort in the bum and slightly in the groin but more in the buttock where the sitting bone is (ischial tuberosity). I am sure it is all to do with the surgery and healing. However I did feel a bit down about it as of course you want to feel nothing. My old nasty pain is not there so that is good. I think I have a tight psoas (hip flexor) muscle which was tight pre op.

Able to stand and externally rotate and abduct the thigh/femur. Feet are just about together when I do this.

Will concentrate on hip abduction range and strength in sitting and standing. See if I can gain some improvement by Thurs when i see Stef again.

Day 13 – Lazy start this morning. Knee and hip flex better so not quite as stiff. The whole thigh feels tender to touch especially on the outside thigh over the ITB and the inside over the adductors. I managed to walk for 21 minutes lunchtime and then a further 11 minutes in the evening. The longer walk was more tiring towards the end of the walk and I notice when I looked side on at myself in the shop window I could see I was still walking like I did before the operation. I was walking very badly pre operation and my limping was pronounced. I was unable to extend my hip and therefore developed patterns of abnormal movement to cope with the pain. Also I was unable to stand on the leg without pain in the groin and outer hip so my abductors weakened significantly. Where I need to concentrate the most – hip extension, abduction strengthening and gait re-education. I think it’ll take some time to get this right. I think video feedback will be helpful.

Other exercises – managed to do 45 degree angle press ups x 20 and triceps dips on the edge of the bed x 20.

Day 14 – Worked on the exercises as above. Nothing new to note apart from it was the Jubilee weekend.

Day 15 – Went to Jose’s for lunch which was nice. Sitting was not easy mainly due to coccyx pain. My coccyx pain was there after the birth hot my daughter and gradually got worse as my hip got worse. I must have been rotating so much and tightening the ligaments lateral coccyx. I hope this improves as I walk better and strengthen my muscles especially the hip abductors.

Day 16 – Had my hydrotherapy session today at Parkside. It was a self help group so you had a exercise program and got on with it. Did a lot of hip abduction and extension. Less of the hip flexion but I know this will come with time. Felt tired after but that is usually the way. I did manage to remove my dressing and reveal my scar to the world after hydro. My incision is completely healed but I still wanted to cover it and protect it. I did massage my scar for the first time with bio oil which good.

Managed to go for  a sneaky lunch with Nic as our friend Vonney looked after Lily for the afternoon. It was hard to sit in the Rocca restaurant in Dulwich Village for more than a few minutes. My coccyx is also painful here aswell as my hip feeling awkward in sitting.

I walked twice for about 15 minutes really concentrating on the gait and weight bearing through the right hip. It is so hard as I haven’t been on this leg for so long as pre op I was in so much pain. My left leg does feel tired but its not really surprising.

Day 17 – Stef came over again today and we really concentrated on my gait and abduction. I still need to use the crutch to weight bear on the leg as I do have a trendelenberg gait pattern. Weight bearing on the leg is really hard to do. Stef massage around the scar and gluts for 25 minutes and then doing the clam after this felt a lot looser and easier to do. I managed 80 clams in the session. However we agreed in order to get rid of the trendelenberg gait I need to do about 200 of these a day! Also did prone hip extension, weight transference with knee flexion. Walked 15 minutes and worked on heel strike and toe off, increasing weight through the leg.

Day 18 – Had a few helpers (Marion and Ginty) come over this morning to assist me with Lily as Nic had to go to work. I am doing this to avoid lifting and bending to get her from the floor or into the cot or high chair. I managed to get out of bed at 6.45am the earliest so far. Felt rough but ok. I didn’t manage my normal routine of exercises really until Nic came home at 2pm and took me to the Dulwich pool so I could exercise my hip. It feels really good after this session and still does 4 hours later. It actually feels better in a cooler pool than when I come out of the warmer hydro pool at Parkside hospital, perhaps it is because the water is cooler???

Pool session – hip abduction x 60 – extension x 60 – running action in the water (flex/ext of hip) x 60 – front crawl leg kick holding onto the side 4 sets of 40 kicks – walking forwards and backwards in the pool – squats x 40 – balancing on right leg.

Land exercises – 200 clams – 50 x hip extension lying on front – plank x 2 20 sec hold – hip flexion and abduction standing x 20 – quads stretch x 2 20 sec holds – 45 degree press ups 20 x 2 – triceps dips 20 x 2. walked 15 minutes concentrating on gait – heel to toe off practice.

Day 19 – A hard ‘head’ day today. Cabin fever and boredom and lethargy. Been coming on for a few days. I think I am driving Nic mad. I know I am driving him mad. However we managed to get out for my longest walk yet to the park in West Dulwich. I was pretty much on my feet for 1.5 hours walking and standing with one crutch. I was tired walking home as was Lily who was rolling around at the traffic lights. My lateral calf ached and lateral hip but more over the scar. I iced it like mad and then gave up for the evening.

Sleeping better at night and able to lie on my side now with a pillow between my knees. This helps in the morning when I wake up and my thigh does not feel as stiff lying on my back.

Land exercises – 200 clams – posterior pelvic tilt and glut squeeze – psoas stretches – plank x 2 20 secs – bridge x 5 10 sec holds – heel strike to toe off phase practice – prone gluts squeezes and extension x 50 – hip flexion and abduction.

Day 20 – Got up after playing with Lily on the bed and hiding under the covers. We went to Dulwich pool early for the women’s only session and I did a really good 30 minute program of exercises plus about 8 lengths of crawl leg kick with my float. I feel I could swim a little more next time. My plan is to get in the pool every other day. The water is by far my favourite place as it is so easy to move then leg. Walking is still hard but good with one crutch. My hip abductors are very weak still and slow at strengthening but until I can stand on one leg and keep my pelvis level then I cannot lose the crutch! It does feel slightly easier moving around the house without crutches but the right hip is weak and I do limp not due to pain, just weakness.

Land exercises – 200 clams – 20 hip extensions – bridge x 3 10 seconds holds – walked 20 minutes – quads stretch – heel strike to toe off practice – walking sideways and backwards – plank x 320 second holds.

Day 21 – 3 weeks post op! Amazing the speed of recovery! I can walk for 20 minutes easily and at a good pace. Getting in and out of the bath to show is also good. I still walk with one crutch as my hip abductors are still weak. I can use a kick board in the pool. I can get my sock on by bending me knee and hip (better doing this on the bed). I can do 200 clams. Up and down stairs with one crutch normally (just a bit slow). I can kneel on my knees. Can do the plank for 20 secs x 3!

I can’t quite walk without a limp and I do not pick up my daughter from the floor. I haven’t gotten on the floor yet.

Mum and dad came to visit today 3 weeks since the op. They said they were not sure how they would find me and were quite frankly worried about seeing me. However they were relieved and had nothing but phrase. To them I was more upright, taller, slimmer and my walking was no longer a rock. They said I was better than them, the geriatrics (they said it not me). It is good to hear this as my old hip plagued me for years.

Land exercises – walked x 2 for 20 minutes – hip flex and abduction mobility exercises – hip extension in prone x 40 – clams x 200 – quads stretch – standing abduction with feet together. I do this twice a day.

Author: nickyturnerphysio

Mother, Physiotherapist, Traveller, Cyclist & Hip Replacement

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