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)….

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…

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 !

Waiting for my new hip……

Friday 4th My

Hi I’m Nicky Turner. I am a 41-year-old physiotherapist and I am having my hip replaced in two weeks – 21st May 2012. For me this whole process has been devastating. I know there are much worse health issues out there to have to deal with and as my friends and fellow colleagues say, well it could be worse, at least you haven’t got cancer and haven’t had your legs blown off in Afghanistan. I know that, but for me it is still hard to sink in and get round my head. I think I should have done more to help my poor little hip but didn’t. I tried but it wasn’t enough. But to have massive surgery to cure the pain isn’t me. My job as a physiotherapist was to avoid surgery at all costs and now I am at the end of the road (and tether) and have no choice but to go ahead with it. Marcus Bankes my surgeon assures me it will only get worse and well, there is little choice. Great.

Anyhow as a result I feel I need to get my experience across to all other pending arthritic hips, whatever the age, and see, as a physio what I can do to help. I have worked as a health professional assessing, treating and rehabilitating hips post injury and post operation for 17 years and I want to offer some advice and help to those out there who are struggling along. For some, you may be excited about the fact you will walk without pain, get in and out of a car, put your shoes on and get your leg over a bike! For some reason I feel more of a dread and constantly worry about how long the new hip will last, 2,5, 10 or 20 years??!! I think if it lasts 20 years then my next one will be at 61 and then one more and well perhaps that would be it….?? A consultant orthopaedic surgeon friend of mine, tells me how strong the latest prostheses are and that they can last for years. He is so animated in his description I hold onto to his words for ages and hope that mine is one of them.

So, for me, going from climbing icefalls and cycling over the Alps to barely being able to walk down the road with my 18 month old baby due to extreme pain is simply awful. How did I get to this? How did it get so bad? Why didn’t I do more exercises? Why me? I watch mothers walk with their babies on their back or chest and I envy them, as I cannot do that without causing sharp pain in my groin and outer hip. The pushchair is my crutch and on rainy days I use my umbrella as a walking stick to try and disguise my limp which now is so apparent. In fact cycling to work to treat my patients is easier than walking!

Anyway this is the start of my journey….