Hip replacement exercise therapy
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Exercise can reduce joint pain and stiffness and increase flexibility and muscle strength after hip surgery.
People who have an artificial hip usually participate in classes and exercise programs both before as well as after surgery.
Warning... Do not do these exercises before checking with your surgeon and physical therapist
Most exercise programs begin with safe range-of-motion activities and muscle strengthening exercises. Patients should avoid high-impact activities, such as basketball, running, and tennis. These activities can damage the replacement or cause loosening of its parts.
Some recommended exercises are low impact such as cross-country skiing, swimming, walking, and stationary bicycling. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip.
Early postoperative exercises are important for increasing circulation to the legs and feet to prevent blood clots. They also are important to strengthen muscles and to improve hip movement. These are started in the recovery room shortly after surgery.
Ankle Pumps - Slowly push the foot up and down. Do this exercise several times as often as every 5 or 10 minutes. This exercise can begin immediately after surgery and continue until recovery.
Ankle Rotations - Move the ankle inward toward the other foot and then outward away from the other foot. Repeat 5 times in each direction 3 or 4 times a day.
Repeat the following three exercises 10 times 3 or 4 times a day
Bed-Supported Knee Bends - Slide the heel toward the buttocks, bending the knee and keeping the heel on the bed. Do not let the knee roll inward.
Buttock Contractions - Tighten buttock muscles and hold to
a count of 5.
Abduction Exercise - Slide the leg out to the side as far as possible and then back.
Quad Set - Tighten the thigh muscle. Try to straighten the knee. Hold for 5 to 10 seconds. Repeat this exercise 10 times during a 10-minute period. Continue until the thigh feels fatigued.
Straight Leg Raises - Tighten the thigh muscle with the knee fully extended on the bed. As the thigh muscle tightens, lift the leg several inches off the bed. Hold for 5 to 10 seconds. Slowly lower. Repeat until the thigh feels fatigued.
The following exercises are started soon after surgery.
Repeat the following exercises 10 times 3 or 4 times a day
Standing Knee Raises - Lift the leg toward the chest. Do not lift
the knee higher than the waist. Hold for 2 or 3 counts and put the leg down.
Standing Hip Abduction - Be sure the hip, knee and foot are pointing straight forward. Keep the body straight. With the knee straight, lift the leg out to the side. Slowly lower the leg so the foot is back on the floor.
Standing Hip Extensions - Lift the leg backward slowly. Try to
keep the back straight. Hold for 2 or 3 counts. Return the foot to the floor.
Walking with a walker and then a cane is the progression patients will follow after hip surgery. The physical therapist will provide the tempo.
Stair climbing will then follow. Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than those of the standard height of seven inches and always use the handrail for balance.
A full recovery will take many months. The pain and swelling after surgery have weakened the hip muscles.
The physical therapist will advance exercises as tolerated. The focus will be on strengthening the weakened muscles.
Using an exercise bike is an excellent activity to help regain muscle strength and hip mobility. Adjust the seat height so that the bottom of your foot just touches the pedal with the knee extended. Pedal backwards at first. Pedal forward only after comfortable cycling motion backwards is routine. Slowly increase the tension on the exercise bike.
Walking is also a good exercise.
Endurance exercises will progress so the muscles may function effectively over longer periods of time. These may include walking, swimming, upper body exercises, and any other activity, which maintains your hip precautions at this time.
Postural Exercises: Postural exercises will be incorporated into the program to keep the back and head well aligned and preclude unnecessary stresses on the back as a result of the surgery.
Balance and coordination exercises may be incorporated.
Retraining of gait may be needed if there was a limp, as a result of pain prior to the surgery, apprehension, or simply a habit developed over time. The goal is to develop a normal walking pattern.
Eventually, patients progress to a final home program.
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