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!

 

 

 

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.

Hip Rehabilitation – 3 months

13- 19th August – pretty good week..

Had a good week with exercise. It really helps to do something every day and you certainly feel it if you don’t.

13th – Pool exercises and 10 lengths

14th Aug – Hydrotherapy at guys hospital to help improve hip range and power

15th – 30 min turbo trainer with 30 sec intervals x 4. Floor exercises lunges, bridges, ab work

16th Aug – Met my brother Rob who is a personal trainer at Starsgym http://www.starsgym.co.uk in Battersea. Session consisted of a sustained 30 minutes on the watt bike. The Watt bike was great for seeing how much pressure you put through the pedal comparing left and right. Also it improved your pedal stroke so you concentrated on the pulling up motion which in effect is using the hamstring muscles. It was a tough session and I did sweat! I also did 3 sets of lunges, squats with swiss ball, ab work in kneeling and bridging on ball.

17th – Brockwell lido pool swim – sunny swim in the outdoor pool. I cycled to and from the lido and I managed a 1000m swim with a few stops. Temperature was 20.6 degrees c. Quite chilly but after my friend Garith Brown said I was a wimp at not ever getting into lido (as it is too cold) I thought bugger this I’II show him! I felt my cardiovascular fitness was pretty good.  Hip is feeling comfortable and less achy. Worse time is after sitting for a while and then standing and walking. I feel quite stiff around the groin and my limping is more pronounced.

19th – Turbo trainer – 30 mins, 5 x 1 min intervals – sweating. It is boiling outside and as I leave it until after Lily is in bed I get attacked by mosses! Did my floor exercises also which consisted of the usual bum, tum and stretches

Hip Rehabilitation – Week 10-11

July 30th – 10 weeks post operation!

What I can do – I can do a lot now. Driving is comfortable, put my sock and shoe on in lying on the bed, squat down, walk without a crutch, get into and out of the bath.

What is still difficult – Still painful slightly mid thigh going up stairs, flexion of the hip stills feels awkward although the range is coming. In the morning my lower lumbar spine and sacroiliac joint (SIJ) on the right is really stiff and my hip movement is only 90 degrees (eases as the day progresses). Still difficult picking my daughter off the floor and worse when she is playing up kicking and screaming and worse still if she chucks her food everywhere (usually at my head) and I have to get on the floor and clean up, I really don’t like doing this.

Went to the gym and did bike for 18 minutes, walking 12 mins. Lots of stretching lower back and hip. Clam exercises x 120, plank x 1 20 secs, core abs, squats 12 x 3, lateral squats 12 x 3.

July 31st – Went to work for the first time! Had 3 patients. Was enough. Managed to walk to and from the train station and felt normal! What was interesting was, pre op I would catch the C10 bus from Elephant and Castle to the north side of Lambeth Bridge in order to get as close to Millbank Medical Centre to see my patients as possible. I did this to avoid my hip pain. Today I thought about walking from Elephant and Castle to Millbank (but actually didn’t have enough time) but instead, for the first time, was able to walk from the south side of Lambeth bridge without limping badly and suffering with pain. It was quite a moment. The simple tasks that I couldn’t do, I now could! Even before my operation I would even avoid the kerbs on the pavement to prevent pain. Mad eh?

August 1st – Felt really tired today. Probably a mix of working the previous day and doing a lot of walking, getting up in the night for Lily and having a bit of wine…. probably the wine?? Anyway we went to the Olympic park to watch the hockey. My thigh was achy slightly mid shaft so I thought I would take my crutch use in case. Glad I did as we had to walk for a 40 minutes to get to the stadium! I am sure the mid thigh ache will ease but it is sometimes a little disconcerting to have these niggles.

Exercise – walked 2 hours. Got on my road bike and cycled 30 minutes easy. I went to the Herne Hill velodrome where they had the 1948 Olympics. Good to be on the bike. Hip range exercises. No clams or bridges : (

Bradley Wiggins won the gold in the Olympic time trial!! Woohoo!

August 2nd – generally feel a little more sore in the leg and hip. Khilen the lead physio at fit8physiorooms videoed my walking in the gym. It was interesting as I still collapse in the lumbar spine over the right hip and my leg was rotating inwards. Perhaps this is why I hurt more. Looking at this video I feel there is a need to go back on the crutch for a while longer just to steady up the walking and level me off. Also there is a need to ‘up’ the hip strengthening exercises – abduction (clams) and extension (bridging).

Just did 20 minutes on the cross trainer.

August 3rd – did my exercises at Dulwich pool and felt really good afterwards. The discomfort before this session in my thigh has eased. Always feel relaxed after exercising in water. Clams x 100

August 4th – Nic’s dad and sister are flying over from South Africa for Nic’s 40th. Still have a slight discomfort in the thigh which makes weight bearing on the leg harder.

Went to the gym and did cross trainer f0r 30 minutes, stretches for back and hip, clams x 100, bridge on swiss ball x 3 20 secs holds, reverse wood chop really trying to weight more over the right foot which is slightly difficult, core exercises for abs, squats without weights, lateral squats. Got in the hydrotherapy pool at the gym which was soothing

Hip Rehabilitation – Week 9-10

24th July – I had my first bath with my daughter since the operation! It felt good to be sharing this with her and another hurdle I have overcome. Perhaps I could have got into the bath sooner but I only felt ready to do this now.

25th July – I managed for the first time to cycle on my road bike from home to Brockwell Park. It took me 20 minutes and I felt comfortable in the hip. My biggest worry was falling off but knew that was more irrational than anything else. It was lovely being back on the bike. I did not use my cleats, just trainers so i could walk with my bike if necessary. I also had a good gym session. 10 minutes warm upon the cross trainer and strengthen work for the hamstring and gluteals.

26th July – Khilen at fit8physiorooms mobilized my right facet joints and QL (quadrates lumborum a muscle that attaches from the pelvis to the lower ribs). He said my midline was towards the left and my pelvis on the right elevated but corrected once weight bearing evenly. When he corrected my posture it felt really wrong. Still a long way to go!

27th July – Olympics began today!

My leg does ache below my knee, around my shin. It feels like it is my back causing this

Swim session – pool exercises – heel raises, balance, squats right leg, hip flexion, abdustion, extension, cycling legs in the water – all exercises last 2 mins. Leg kick with float 8 lengths.

28th July – gym session – x trainer 20 mins, treadmill backwards walking 5 minutes on 5-8% incline, sideways walking 2 mins each way, hamstring curls with swiss ball, roll outs with ball for abs, press ups, kettle bell squats, leg press 15 kgs – 12-15 x 3 sets.

Nic massaged my leg which felt better. My back feels stiff this evening and  i am still not properly weight bearing on the right leg. My natural midline is definitely towards my left.

29th July – no real exercise routine today apart from stretching my lower back and flexing my hip. It is still really stiff in the morning and I can only manage 90 degrees. It does loosen but takes some time. My back generally feels out of balance and sitting on the right hip/buttock is foreign to say the least. You would have thought at 10 weeks post operation this would be better. Perhaps being a physio with a new hip I can see that there is still a long way to go in terms of weight bearing properly over my new hip and normalizing my gait. I was after all moving so badly pre operation it is to be expected I suppose.

Hip Rehabilitation – Week 7-8

10th July – Hydrotherapy at Guy’s hospital. Good workout as quite controlled. Spent 2 minutes on each exercise – hip flexion, heel raises, squats one leg, hip extension, hip abduction, knee flexion, balancing, lunges and step ups. Felt relaxed afterwards. The water really is key to hip rehabilitation.

13th July – Pool exercises as per Guy’s hospital routine. Swam a few lengths concentrating on leg kick.

14th July – drove to Southwark park and walked with Lily in the rain without a crutch. Felt good. No aches. Went to the gym later for a 20 mins cardio vascular session on the cross trainer and leg strengthening exercises as per Stef’s program.

15th July Sunday – felt good today in terms of my hip. Felt equal on my legs. Still have a slight weakness on right leg and this is more noticeable when standing on that leg. I can walk independently (no crutches) with a mild limp that does not really require an aid. Even so my walking is so much better than pre op it is quite remarkable.

Good week with hip. Progressing well.

Hip Rehabilitation – Week 8-9

Sunday – felt good today in terms of my hip. Felt equal on my legs. Still have a slight weakness on right leg and this is more noticeable when standing on that leg. I can walk independently (no crutches) without limping or with a mild limp that does not require an aid. Even so my walking is so much better than pre op it is quite remarkable.

16th July – Felt ill today. First day with no exercises!

17th July – gym weights – kettle bell squats 4kg 12 x 3, hip flexion using ball 10 x 3, dead lift with 10 kg 12 x 3, clams x 150, bridge with feet on ball x 3 20 secs hold, plank x 3 30 secs, press ups x 12 x3, abdominal bracing x 10 sec x 3. My core abs feel really weak and difficult to recruit, need to work harder on this.

18th July – pool exercises. Working more on hip extension, abduction and hamstring cycles in the water. Swam 10 lengths.

21st, 22nd July – Did not do much exercise apart from the odd clam and bum exercises plus trying to encourage more hip flexion. I did do more crouching down and cleaning floors plus a bit of gardening. Also did more stairs as we were refurbishing our house which has too many stairs! This did ache my thigh more especially going up stairs.

Not such a great end to the week probably because I have taken my eye off the ball and not quite as good with my exercises.