Diaphragmatic or belly breathing

With all the fear surrounding the coronavirus, it occurred to me that people may not be breathing properly at all.

The worry about getting or dying from COVID-19, losing a loved one, losing our jobs, being unable to pay your bills and support your family, is huge.

Usually when we are worried or stressed we breathe using our upper chest, when actually we should be breathing with our abdomen or belly. This breathing technique can also be done post operation to avoid any respiratory complication that may occur after any surgery.

So, I have put together a simple video which will improve your breathing technique and hopefully calm you down.

The benefits of diaphragmatic or belly breathing are;

Increase lung capacity, relaxation, improve sleep, lowers blood pressure and lowers heart rate.

Breathing exercise procedure;

  • Lie flat on the floor, your bed or sit in a comfortable supportive position.
  • Put a hand on your chest and a hand on your belly.
  • Relax your shoulders.
  • Breathe in through your nose for 4 seconds and you want feel the air go into your abdomen/belly which in turn makes your stomach blow outwards.
  • Make sure your chest remains fairly still and the belly area is moving outwards.
  • Hold your breath for 4 seconds if possible.
  • Breathe out through your mouth for 4 seconds and let your belly flatten.
  • Repeat this 4 times and then repeat this sequence another 2 or 3 times

You can also try this breathing in sitting or standing, whichever works best for you.

Good luck!


Skiing 7 years post ceramic hip replacement

I am 7 years post hip replacement in May 2019. I cannot quite believe how quickly it has  gone and generally how good the hip has felt.  The operation has removed 99% of pain and I’ve had no or very few issues with the hip. Occasionally you get the odd ache outer hip, groin or mid thigh but it is something that never really lasts and changes with exercise especially strength work around the gluteals. The only real physical issues I have are discomfort with my lower back. but that is manageable.

My 5 year hip review at Guy’s Hospital summer of 2017 with my surgeon Marcus Bankes was good. He told me that Guy’s Hospital do not routinely do the 5 year review for the ceramic hips as their outcome has been good that its no longer necessary. Good news all round!

I had a total ceramic hip replacement in May 2012 after sustaining a hockey injury in 1995 where l landed hard on my great trochanter or lateral/side of hip and develop a deep groin pain thereafter. I recovered after 3 months and managed to get back into my normal activities. In general I was really good at throwing myself around and injuring myself during sport and exercise. However, it was probably not just the sports I did, but also a possible congenital problem called hip dysplasia. I never knew I had hip dysplasia until Mr Warwick Radford Orthopaedic surgeon at the Lister hospital, London told me this in 2002. He kindly said i would need a hip replacement in the future, which of course I barked at! But, I guess the seed was sown.

Hip dysplasia means you have shallow hip sockets and the head of femur (ball) is not fully covered by the acetabulum (socket). Interestingly, I always had groin tightness and snapping pain from time to time during my twenties so whether this was my first signs of hip issues I will never know.

In the end and what finished my hip off, was the weight gain during pregnancy. Its funny because I truly thought that as soon as I lost the pregnancy weight, the pain would go.  Sadly, it didn’t and in fact the pain just got worse. I developed a really bad limp and my pain levels were a biting 9/10 whilst walking. I had a dull ache in the hip at night which would wake me up. My limp was unavoidable and frankly terrible. I could not even run after my toddler. My hip movement was becoming more limited especially into flexion and adduction. But I was also losing hip abduction and external rotation and could not to sit cross legged on the floor. Doing the breaststroke leg kick became impossible or even lifting my leg over my bike cross bar was becoming very hard to do.

7 years post THR, I can do everything, rock climb, ski, hike, cycle and swim. However, jogging or running isn’t particularly comfortable. I still feel my leg is weak especially around the hip and thigh. I know a lot of people re-start running post hip replacement but I have accepted running is no longer on my list of things to do. The fact I do not run anymore is ok and I have found a lot of enjoyment from other sports and activities.

Next stop – off piste skiing the Haute Route…. (perhaps hiking it first)….

Skiing after a new hip

Lily & mummy skiing in Val d'isere 2014

I managed to ski for the first time since my hip replacement at 22 months post operation (April 2014). I know some people who have undergone a hip replacement have managed to ski just a few months after their operation and I even know a physiotherapist who was skiing 3 months after a knee replacement!  I just did not feel ready, confident or even strong enough on the new hip to ski in the first 12 months post surgery.

I had managed to lose so much leg muscle mass in the 2 years before the hip operation it took me a considerable amount of time to feel I had regained the power in the leg again. Skiing has been a pretty big hurdle for me as the thought of falling over and hurting myself on the slope was not appealing in the slightest. My surgeon Marcus Bankes, had ensured me that skiing was absolutely fine post hip however we never actually discussed the falling over aspect. For me it felt rather risky and a bit stupid really doing it but as I love the sport, the thought of not ever skiing again would be a real shame.

At the time, Nic, Lily and I drove from London to Val d’Isere France to meet our friends for 1 week in the Easter snow April 2014. I was definitely keen to be out in the Alps again especially after having so much fun there between 2000-2010, climbing , skiing, mountaineering. I loved the mountains and it was great being back. I was equally excited to introduce our daughter Lily who is 3’5 years old to skiing, hoping secretly she would love it.

Lily tried a mini ski school but she didn’t like it. I think the thought of queuing with other toddlers just didn’t appeal and the fact she was only tiny. After encouraging her she became more frustrated, started to cry and was somewhat rude to the ski teachers we decided enough was enough. That was the end of the ski for now.

I decided she should then stick with mum and ski with me in between my skis. Now for me this was going to be a challenge. I didn’t feel at all confident on my skis so how was I going to do this?? It takes a lot of snowing ploughing and power through the downhill leg and much harder on the turns even on a gentle green slope. However the biggest challenge for me was getting on and off the chair lift. I ask my friends what other parents were doing with their children and watched and learned. Best way on was to get the chair lift to slow right down at both ends and then when getting off grab Lily around her waist under one arm as you stand off the chair and carry her to safety. The next part was setting myself up for the downhill part, bending down to tighten my boots which was a bit of a strain on the hip, then getting Lily in between my skis, making sure her gloves were securely on and then off we went down the slope snow ploughing with her singing ‘if your happy and you know it clap your hands’!!! She did really well and wasn’t scared in the slightest.  As we got lower down on the slope she shouted ‘let me go, let me go’! so when ready I did and off she went trying to lean forwards and after 30 metres would stop by falling backwards and laughing.

It took me 3 days of skiing to start feeling excited about it again. The first two days I just didn’t enjoy it. However, from a rehab perspective, I found skiing was really good for forcing the weight through the operated leg and strengthening the quadriceps and hip abductors. I was much more effective than doing clams or mini dips. So I will preserve and continue this much loved activity!




2 years after my total hip replacement

Looking back 2 years since my operation with Marcus Bankes at Guy’s Hospital London UK, I have to say it certainly was the right thing and best thing I could have done. At the time, I felt far too young (41 years old – not that young but young for a joint replacement) and too ‘sporty’ to have this operation and frequently questioned why me?? However, I was literally disabled, with the most horrendous limp lurching from side to side. I used to try and disguise my limp by walking with a large umbrella or using Lily’s push chair as a rollator frame. I mean how bad was I? I was in complete denial about my condition trying to continue on as normal. Nic and fellow physiotherapy colleagues often demonstrated how badly I used to walk!

I often thought once Lily was born (in October 2010) and after losing my pregnancy weight my pain would improve. It didn’t improve. It just deteriorated and my limp became slowly more and more pronounced and my muscles wasted. I could barely walk 50 metres down the road before the operation in May 2012.

Now at nearly 24 months post total ceramic hip replacement I am doing really well and for a physiotherapists expectations I am very happy with my progress. I would say I have 100% pain relief when comparing the pain before the operation and now. Of course there are a few things I have to still work on and that is continuing with the exercises to strengthen my hip abductors, gluteal maximus (buttocks) and the deep abdominals or core and quite frankly these exercises are ongoing for me. My physiotherapy colleagues say my walking is normal now and you would not know there was a new hip lurking underneath the surface. I can walk with speed which is an important part of rehabilitation especially concentrating on extending my hip and pushing off through my big toe during walking.

Running is more of a challenge. I lost so much leg strength pre operation it has been really hard learning how to run for a bus again or chase Lily on the scooter. Even 2 years later I am still gradually gaining strength to be able to do this. Lily said to in April 2014, ‘mummy jog with me’ as she scootered. I say to her ‘I can’t’ which is rubbish because I can (but it is still with a slight limp) but I find it still really hard to switch my brain on and do this action. It is like I have completely forgotten how to run or jog, it is coming back slowly but it is really slow.

All in all though I am happy. I will continue to exercise and strengthen my body regularly and practice being able to run equally on both legs. Having said that although I will work on improving my running, since my total hip replacement my actual running days are over. This is not negative as I have dealt with it and find lots of satisfaction keeping fit through cycling, strength work, swimming, hiking and now skiing. It really is not the end of the world when you realize running is not the be all and end all. Off to the gym later…

Traveling through Africa with my new hip – www.familyinafrica.wordpress.com

We started our overland journey from London to Johannesburg in January 2013 – seven months after my total hip replacement. It was at this point I felt my hip and leg were mobile and strong enough to make the trip as I had a good few months of rehabilitation under my belt. However I was a little concerned about the lack of movement and sitting for long periods which could tighten up my hip flexors and weaken my gluteals.

Interestingly, I was half contemplating taking a mountain bike and my turbo trainer! I remember my brother saying I should take your bike and just do some awesome cycles through Europe and at the same time keep fit. I thought it would be bonkers for me to take a bike on such a long journey and become some rehab junky! If we were traveling alone and not with Nic’s dad in his car then possibly I may have brought the bike and Nic also and we would have then taken it in turns to cycle whilst the other drove with Lily. Instead I took my exercise mat, my trainers and a 5kg kettle bell.

Looking back I think the trip and the rest (not going mad in a UK gym) did my hip some good. Although we sat for long periods, climbed into a raised suspension Land cruiser, put up tents, made fires, collected wood, climbed up the ladder into the roof tent, pulled luggage and water containers out of the vehicle and ran after our 2 year old, my hip generally felt good. One other interesting point to mention was having to start squatting down for a wee. The toilets in Greece turned into a ‘hole in the floor’ which initially was quite challenging to do especially as the position requires a lot of hip flexion and there is always a possible risk of dislocation in the back of your mind. In Africa the toilets were mostly dirty ‘holes in the ground’ or behind a bush! However the squatting practice certainly seemed to make my hip more flexible and strengthen my leg considerably without seemingly doing any harm to my new joint. The more I practiced the better I became!

I managed to exercise well in Europe and Israel (3 x a week) by walking, swimming, doing my hip stretches and gluteal strength work. However, my plan for Africa would be to do at least one cardiovascular exercise a week which would be a mile swim (if I found a pool!), 30 minutes on a bike (if I found a gym!!??) or a 30 minute walk. Egypt was a bit more challenging. I managed to find a swimming pool in Nuweiba and we snorkelled in the Blue Hole in Dahab, Sinai Desert. Walking the filthy streets in Cairo with Lily in her push chair dodging the burnt out cars and puddles from the water cannons in Tahrir Square the night before, was all we could manage. Aswan, Egypt was a good base as we were there for a week waiting for the Lake Nasser crossing and we found the pool at the Old Cataract to be perfect! Once we were in Sudan exercising became much harder as at 45 degrees it was just too hot to do anything. Surprisingly I did do my exercise regime at least once a week through the rest of Africa – Ethiopia, Kenya, Tanzania, Malawi and Mozambique which was just enough to maintain and keep ticking over.

Overall I would say driving from the UK to South Africa with a total hip replacement was definitely manageable and worth doing!

TrampolineSplitDead Sea Israel CampingPyramids Egypt Busy ferry across the Nile

Hip Rehabilitation – 15 weeks

I am now 3 months and 3 weeks post new hip. All seems to be doing pretty well apart from what I thought was a set back a few weeks ago (around 11 weeks post op) when my mid thigh started aching and I had difficulty going up and down the stairs without holding on to something. I then released that I was still very weak especially in my quadriceps. It was my friend and physiotherapist colleague Jose Marcelino who said perhaps you are not strong enough. Strangely I hadn’t thought of that. I think you get so caught up in your post op recovery and noting every sensation or discomfort with the new prothesis you forget somehow that perhaps you are just not strong enough and you need to step up the exercises. I was doing squats but thought I would try lunges aswell. Now I have increased the number of thigh strengthening exercises (lunges) I do not feel my thigh pain and walking up stairs feels stronger.

Life for me really started to improve at around 3 months post surgery but even more so at 3.5 months. The recovery was quite amazing. Since getting back on my bike again to cycle to work (16th August was the first time – 3 months) I have felt stronger and certainly more able. I have done this commute now 3 times and tomorrow I am thinking of cycling to Kingston which will take around 1 hour, as long as it is not raining…. I only got back on my bike when I felt confident enough and able.

My relationship now with Lily is quite normal now and I can lift her and hold her where by for the first 6-8 weeks I was not really able. You worry as a mother that if you cannot do the basic things with your baby it may affect them. There was a period after surgery where she did go to daddy a lot more. Now she holds her arms out to me more and I am able to hold her for longer. I was in Battersea Park today with our friends Ginty and Stuart who adore Lily. I was able to hold and carry her for much longer with out pain in my hip! Amazing. This was something I could not do before my operation and if I did it was literally for a few steps and then I would have to hand her over to Nic due to the biting pain in my groin and outer hip.

Hip Rehabilitation – 10 months

March 2013

Since January 20th 2013 I began traveling from London UK to Johannesburg South Africa with my husband and 2 year old daughter. We are currently in Aswan in Egypt waiting to board a ferry across Lake Nasser to Wadi Halfa in Sudan. Apparently Wadi Halfa used to be a lovely town but it no longer exists in its true sense as it was flooded by the creation of the dam in the early 20th century.

We are traveling in a Toyota land cruiser with a raised suspension. I remember first time getting into the 4×4 after my operation at Guy’s hospital London at the end of May 2012 with great difficulty and transferring my weight in order to not to twist or knock my operated leg. It must have taken me a few minutes (about 10 actually!) to make this maneuver and get into the car onto a raised seat with cushion.

Now 10 months later I am traveling and able to get into the car quickly and also climb onto the roof of the car but needed some help getting down. I am certainly not gazelle like doing this but it makes me feel more like myself again.  Our tent is on the roof of the car which means you have to climb a ladder to crawl into the tent. Our 2 year old loves this especially when she keeps both parents awake as she kicks us in the head all night!

Exercising and traveling like I am doing now is proving very challenging and requires massive amounts of discipline and motivation especially when it is so hot and you have a toddler to mind. When I find a pool I’m like an addict and jump in at every opportunity to do some cardiovascular work and hip exercises even if it costs 10 pounds at the Movenpick Hotel in Aswan (which was a rip off!) and then when I have a hotel with space i.e. a roof terrace or a large bedroom then I will get on the floor and do a sequence of 10 exercises or a tabata as my personal trainer brother Rob Turner would say, http://www.mountainmanpt.co.uk. The tabata worked well for me as it lasted for about 20 minutes and combined of a cardio workout and strengthening.

As a woman in her 40’s it is even more important to do some sort of resistance exercise ie Pilates, yoga, weights or floor exercises using your own body weight (press ups, tricep dips, squats etc), in order to maintain strength. The reality is as we grow older we lose muscle mass and in addition our metabolic rate declines. If you are over 40 years and you are aerobically active (run, cycle, swim), this will not prevent the loss of muscles and if you continue to do exactly the same thing, you will lose muscle and gain fat!! Not great. Strength training is the only way to increase or preserve muscle mass and I have found after having a big operation, being 42 years and traveling for 5 months a big challenge to get the strength back in the operated leg (let alone the rest of your body) and it takes a lot of discipline and dedication.

Needless to say I will persevere !

Hip Rehabilitation – 8 months

I am now just over 8 months post hip replacement and I would say now that although I am a lot better, I am not in my opinion right yet.

I am probably 75% better. The other 25% would consist of continuing to strengthen the leg, balancing on the leg, running after my 2 year old and being able to walk up and down stairs comfortably. I still am not able to hill walk (properly yet) or ski as I am not confident enough on the leg as it just continues to feel weaker. I definitely have strength issues my operated leg and I really do not know why. Perhaps as my friend said things take longer especially when you are a younger and a higher performance person and have higher expectations. This could be true but I am still unsure why I find it hard to do a mini dip/squat on the operated leg 8 months post op.

One of the thoughts I have for this are my hip abductors. They are still incredibly weak and slow to fully engage. If this muscle group is not functioning correctly then you will not be able to stand on the operated leg and squat properly. Also running will be a problem. However I feel I am doing a lot of exercises to strengthen this muscle group but still I am struggling. Admittedly I am not doing these exercises daily and it is possible if I do I may be able to make the muscle ‘remember’ again and have some carry over. It is frustrating for me as I expected that at 8 months I would be pretty good and near 100% back to normal.

At my request, Nic has begun to massage the scar. Being a doctor himself and doing a lot of orthopedics in South Africa, he could see I had a lot of scar tissue and tethering over the greater trochanter (outer hip bone) and that it needed a lot massage to break the scar down. This is most likely what is the clicking sound I feel when I shake the leg, flex or abduct it.

Also pre-op my limp was pretty bad and my hip abductors completely inhibited i.e. not working at all so I clinically reason that it will take a while for the strengthen to return to as near as normal as possible.

I will focus on regular scar tissue massage, lots of hip abductor, buttock and abdominal work for the next 2-4 months and reassess.

Hip Rehabilitation – 6 months

Hello all,

My blog posting has not been so good over the past few months, probably because I am getting back to normal life and activities which starts to take over and as we always say, I have no time. Rubbish really because you do, just need to manage it better.

Well, I am now 6 months post hip replacement. All is pretty good and I would say I am so much better than before surgery. I am not perfect by all means. I still have a slight limp and I do have pain from time to time in my thigh, over the scar, in my lower back and pelvis. My back is particularly bad and first thing in the morning I find getting out of bed, flexing my hip and moving a real struggle. Bending over is a real problem and my back kills, not sure why, perhaps it has something to do with picking up Lily my 2 year old daughter or years of walking badly and compressing my spine on the right side???

However, I am better. My pain has gone. I can walk but it still does not feel natural and after going to Coniston Water in the Lake district for 4 nights I felt, will I ever be able to hike the fells again!!? I probably will but right now it feels I won’t ever be able to. My leg is still very weak but this is an accumulation of the 2-3 years of pain and limping before I even had the surgery. Despite trying to get strong before my op my pain was so severe my muscles were inhibited due to the pain i.e. they just wouldn’t work! My friend Dr Lindsay did say the other day, I wasn’t quite smooth walking but at least I was not lurching around with a positive trendelenburg (or massive waddle!). Nice GP friend she is!! I know it will take time, about 18-24 months before I feel the leg has returned to me, if it ever will….

I manage to exercise 4-5 times a week which is a mixture of buttock, thigh and abdominal strength work, cross trainer, bike, swimming, water exercises, hip flexor, hamstring, quad and lower back stretches. The creche at Dulwich Leisure Centre http://www.fusion-lifestyle.com/centres/Dulwich_Leisure_Centre has really saved me and now I can let Lily have a hour of playing whilst I do my cardio and strengthening exercises.

I do have some clicking during bending over and flexing the hip and also and more weirdly my hip/bum area knocks a little when I shake my leg, as if you were nervous. I do not like this sensation and I hope it will decrease as I get stronger. I have spoken to my surgeon and he says he is not worried.

I would have thought by now it would have been easier (hip stronger, full movement and able to run  little) but in some ways it feels harder and my walking is not quite as good as it was, mainly due to funny painful weird sensations in the leg and knee. If I miss a few days of not doing any strength work then I feel slightly more discomfort and thigh pain. However I realized yesterday that my quadriceps are still very weak and perhaps this is the reason for not feeling as though the leg is working properly whilst walking. Additionally my hip rotator muscles are weak and that is another area I need to work on which even as a physiotherapist is hard.

So on reflection I will spend more time in the pool to strengthen hip rotators and then concentrate on my quadriceps. Lets see if that works. Will keep you posted.