20 weeks post hip surgery

Friday 1st January, 2016

20 weeks since my hip surgery!

Friday 14^th August – Labral tear repaired, 3 anchors, acetabulum shaved, ligaments tightened and ligamentum teres tear repaired.

Weeks 0-8:

Protocol (0-2 weeks) – limited hip flexion, gentle exercises; internal rotation, knee flexion and foot peddling. No external rotation. Numbness and pain in hip/back/abs and movement was difficult.

Day 10, stitches removed and pain medication decreased significantly.

Walking without crutches but small distance with small stride, by 2-4 weeks. 

Protocol (2-4 weeks) – exercise bike with no resistance, limited hip flexion, isometric glute activation standing, bridging, hamstring and adductor stretches, internal rotation. No external rotation.

Returned to work after 2.5 weeks; started driving and off crutches by 3 weeks.

Groin pain on flexion and still struggling to actively hip flex.

Physio (2-4 weeks) 4 point QF activation, resistance band abduction and extension, rolling and gentle hip flexion stretching. Introduced bridges. Strength work for upper body and compliant with rehab exercises for hip. Increase bike work to 30 minutes most days with low resistance.

Need to do more rolling and stretches. Hip flexors feel locked up and glutes, ITB, adductor are tender.

Good days and bad days, possibly overdone it a few times, but trying to be careful.

* Week 4-5, I had a big set back. I was in pain most of the time. I returned to work and I was generally doing too much. As I began doing more exercise, my lower leg issues - calf, flexor hallucis longus - began to hurt again. I had medial knee pain (worked on VMO activation and calf raises). My right hip also started hurting (suspected labral tear) and presented with Psoas pain. I started to feel overwhelmed by the amount of rehab however the physio helped to prioritise. 

Protocol (4-6 weeks) – exercise bike with low resistance, hip flexion 90 degrees, glute activation standing and walking, bridging, hamstring and adductor stretches, internal rotation, leg circles. No external rotation. Still tired and some pain relief especially when walking too much.

Groin stiffness on flexion greater than 90 degrees. Still struggling to actively hip flex.

Physio (4-6 weeks) 4 point QF activation, resistance band abduction and extension, rolling and gentle hip flexor stretches. Strength work for upper body. Bike work 30+ minutes everyday with resistance. Need to do more work on rolling and gentle stretches.

Good days and bad days; hormonal issues making life difficult.

Physio exercises (6-8 weeks) TRX half squat, hip flexor stretches, bridges (attempted single leg bridges), lunge stance but hurt hip flexor, 4 point QF activation, resistance band abduction and extension, rolling and gentle hip flexor stretches, calf raises, single leg extension (VMO activation)

Gradual external rotation. Strength work for upper body and core/abs (no rotation).

Weeks 8-12:  

* I began setting 2-weekly goals. Ankle dorsiflexion and foot pain was prominent. Hip slowly progressing (some groin pain). My right hip began to settle. I changed my focus to mobilising thoraco-lumbar junction. At 11-weeks post-op, I began small amounts of running however I increased too quickly. I pulled up achy in the hips and tight in the thoraco-lumbar spine, the following day. I decided to stop running for a further 2-3 weeks.

ROLLING! Thoracic spine rotation stretches.
Chiropractic adjustment everyday for thoracic spine and foot!

Protocol and physio (8-12 weeks) – TRX half squat and get ups, hip flexor stretches, bridges (attempted single leg bridges), 4 point QF activation, resistance band abduction and extension, calf raises. Strength work for upper body and core/abs (no rotation).

11-weeks - started running small amounts. Initially I could only last 60 seconds before significant groin pain. Then, I progressed to 1-2km, 3km, 5-6km. 
I attempted 8km and pulled up very sore - my entire leg and back ached. 
I stopped running completely for 2-3 weeks.

Weeks 12-18:  

* I was hoping to be running by 12-14 weeks but instead I'd had a setback because I'd tried running too early (11-weeks) and I increased too quickly. I took 2-3 weeks off and tried again around 16-weeks post-op. I began clinical pilates, which helped significantly! I started running weekly on an AlterG treadmill (anti-gravity). It was amazing! I loved being able to run, sweat and increase my heart rate without the same impact on the joints. I ran at 65% of my body weight. I continued with strength progressing to integrated exercises, more single-leg exercises and thoracic mobility. I noticed a pattern of focusing on cross-training and strength, but not enough mobility for my hip.

ROLLING! Thoracic spine rotation stretches.
Chiropractic adjustment everyday for thoracic spine and foot!

Protocol and physio exercises – Squat and get ups, hip flexor stretches, bridges, calf raises, leg press, deadlift, single-leg deadlifts, torsonator exercises, Lat Pulldown, Chin ups, core work
Clinical Pilates

No running after pulling up sore between 11-12 weeks. 
Began running on an AlterG treadmill at 65% of my body weight - Amazing!
Around 16-weeks, I tried running again. Small amounts. Sometimes I would feel ok, other times I pulled up very sore (hormones seemed to be a significant factor in pain levels!)

Weeks 18-20:     NOW!

* I started running weekly on an AlterG treadmill (anti-gravity). I increased from 65-70% of my body weight. I began focusing more on mobility, specifically Limber 11 (2-3 times per day), cross-training and strength work. I continued clinical pilates. I could run 5-6km outside and 5-8km on a treadmill. Any further would result in significant pain the following day.

LIMBER 11! (https://www.defrancostraining.com/joe-ds-qlimber-11q-flexibility-routine/)
You Tube Limber 11 (It became part of my daily routine from approximately 16-weeks post-op).
Chiropractic adjustment every second day for thoracic spine and foot!

Protocol and physio exercises – Squat and get ups, hip flexor stretches, bridges, calf raises, leg press, deadlift, single-leg deadlifts, torsonator exercises, Lat Pulldown, Chin ups, core work
Clinical Pilates
I decreased my physio but started booking regularly myotherapy appointments for massage and dry needling. As mentioned, I'm exercise-compliant regarding strength but I need to work on mobility and treatments. 
AlterG treadmill at 70% of my body weight - Amazing! Treadmill runs at approximately 10km/hr for 5-8km. Outside runs (5-6km maximum)
* I tried running 8-10km outside a couple of times and pulled up very sore! It lasted for days!
I'd entered Great Ocean Road 45km in May 2016 however after being so sore, I decreased to 23km event. (Hormones still a significant factor in pain levels!)

* Goals for the next few weeks:
- Cardio and strength training daily
- Limber 11, 2-3 times per day 
- Yoga/Pilates weekly
- Myotherapy treatments weekly
- Chiropractic adjustments

Note: People ask if I'm happy I had surgery. My biomechanics are better. I can squat better, sit cross-legged on the floor and run with a neutral gait. I still sleep with a cushion in between my legs and have some limited movement (flexion and rotation). However, pain levels are still higher than pre-op. One reason it took me so long to have surgery was my pain levels were low. Most days it didn't bother me (I'd adapted). Most runs it didn't bother me (I'd learnt to externally rotate my hip). But I lost power, speed and most of all, I had foot pain (which refused to go away because I couldn't put my hip in a neutral position). 2016, I've entered 2 half-marathons (6 months post-op) and aim to run a marathon (12 months post-op). My goal is to mobilise daily, adhere to weekly treatments and regular pilates/yoga. I have years of poor function to correct. It will take dedication. 
Thanks for following my story :)