Progressing through the rehabilitation stages correctly is a major part of the success of Total Hip Replacement (THR) surgery.
If you have yet to read my article on your first three weeks recovery following your hip surgery, you should read this first: How to Recover for Total Hip Replacement Surgery First 3 Weeks
Everyone’s recovery journey is different, but at this, the 4 week stage of recovery, there are several milestones that we are looking to hit. Firstly let’s remind you of the precautions that you still need to be aware of.
Precautions
Thankfully, these do not change from your first few weeks post surgery, but they remain important nonetheless.
- Do not cross your legs
- Do not swivel on the affected leg
- Do not lie on the affected side
- Do not bend your hip beyond 90 degrees
Milestones
Within the 4-8 week stage we are looking to make sure that we are achieving the following milestones:
- Improved Mobility: This means walking short distances indoors with reduced reliance or no reliance on your walking aids. We are also looking to increase our walking distances generally.
- Reduced Pain and Swelling: Pain is managed well, with little or no pain relief at all, if possible. Your wound scar should be moisturised and managed well to prevent the buildup of scar adhesions. Please note that some pain/discomfort at night is still normal at this stage of recovery.
- Improved Hip Range of Motion: You should be able to sit comfortably in a chair and perform basic activities of daily living, such as getting in and out of bed comfortably. Getting in and out of a bath should still be avoided at this stage.
Weeks 4-8 Changes
During this rehabilitation stage, the focus changes onto more robust strengthening exercises as well as progressing walking distances and improving gait patterns.
Each persons progression time scale is different and factors such as pre-surgical mobility levels and any other health complications can affect this.
It is always vital to check with your Physiotherapist to see how quickly to progress through the stages of rehabilitation. As a rough rule of thumb, let pain be your guide. Working into mild discomfort with exercises and walking is fine, whereas sharp stabbing pain on exertion should be avoided.
Walking Progression
You will have been issued with walking aids after your surgery. Most commonly these are elbow crutches but it could also be a walking frame.
Our goal during this next phase of recovery is to start to challenge your walking and gait patterns in particular. It also means walking more generally.
This involves starting to reduce reliance on walking aids and, when ready, to remove them altogether.
Start by removing one crutch first and spend some time getting used to this by walking short distances only indoors. As you begin to feel more confident, you can progress this to walking with one walking aid outside, too.
Look to incorporate a daily walk (or two) into your rehabilitation programme. Again, be sensible here. Start with a few minutes at a time and build up slowly by adding a minute every day.
Start by performing 5-10 minute gentle walks.
The Exercises
You can add the following five exercises to your plan. I encourage my patients to add these to the current set of exercises from the first 3 weeks plan which you can watch here:
Ball Squeeze
In lying, with knees bent, place a ball, pillow or cushion between your knees.
Gently squeeze the knees together onto the ball, pillow or cushion.
Hold for 2 seconds.
Repeat 10 times. 3 times a day.
Straight Leg Raise
In lying, bend the unaffected leg and keep the affected leg straight.
Making sure that you keep the knee facing up to the sky, push the back of the knee down to engage the thigh muscles.
Lift the leg off the bed about 30 degrees.
Hold for 1-2 seconds.
Slowly lower the leg down to the bed.
Repeat 10 times. 3 times a day.
Bridge
In lying, with both knees bent comfortably and the feet placed on the floor.
Start the movement by tilting your pelvis towards you as if you are peeling the lower portion of your spine of the floor, each vertebrae at a time.
Push through the feet to drive your bottom up. You are aiming to lift your bottom up so that it forms a straight line with your body. But don’t worry if you can’t achieve this at first. Just lift as high as comfort allows.
Hold the position at the top for 1 second.
Slowly lower your bottom back down.
Repeat 10 times. 3 times a day.
Hip Hike
In standing, using a wall or table for support.
Lift the affected hip up whilst keeping the leg straight. The sensation or feel should be that you are drawing your leg into your pelvis.
Hold for 1 second.
Try not to bend your upper body as you complete the movement.
Repeat 10 times. 3 times a day.
Hip Abduction
In standing, using a wall or table for support.
Take the affected leg away from the side. Try not to turn the foot out too much; a little is fine.
Take the leg out as far as comfort allows.
Hold for 1 second and slowly return to the starting position.
Repeat 10 times. 3 times a day.
Progressions
To start with, performing 10 repetitions of each exercise, 3 times a day, is the right place to start. The exercises should feel challenging but easily achievable. After a week or so, you can progress the difficulty by adding more repetitions, so increase from 10 to 15, and when that becomes easy, you can add an extra set.
Conclusion
Working hard with these exercises is the key to getting the most from your new hip.
Be diligent and more importantly, be consistent. Do not miss a single day of exercise unless pain absolutely restricts your ability to exercise.
Good luck with your recovery!
