by Lesley Powell, Director of Movements Afoot
When teaching clients with hip replacements, it is important to find out what kind of hip replacement did they have. At the moment, there are 2 different type of surgeries: the incisions are in front of the hip or in the back. Because of the incisions, this leaves the hip vulnerable to displacement due to weakness and the incision. I highly recommend that you and the client talk with their Doctor about their surgery and contraindications for training. With new advances in hip replacement, things are changing.
For instance, surgery from the back, movements of deep hip flexion is contraindicated. That means not to push hamstring flexibility by trying to bring the leg close to the body. Training the posterior hip is very important. Building strength of all the muscles of the hip and legs is important. In Pilates, diminished range of leg circles are great. Full short spine is not recommended. (Some of range of motion depends on their fitness before the surgery. Dancers have a unique range of motion.)
The most important thing to remember with hip replacements is not to push extreme range in the hip. Building dynamic strength is essential. Some clients, who tried to avoid surgery, developed compensation habits around the painful hip. Part of your teaching might be teaching your clients better function of using their legs.
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Excellent post and I agree with your comments. Not only is the surgical approach important in the re-education of the movement after total hip surgery but also the type of surgical fixation is also. The porous or cement fixation will determine the degree of weight bearing and movement in the early stages of rehabilitation. The incision itself doesn’t limit the movement after the total hip replacement (THR) but the surgical approach and the tissue that is resected or removed determines the limits of movement post surgical. The resection of the iliofemoral and iliopubic ligaments are the primary reasons for precautions with hip movement after THR. Usually the limitation is no flexion beyond 90 degrees, hip adduction across the midline of the body and hip internal rotation. These three movements together are usually prohibited as well as any one of these movements taken to an extreme. These combinations may result in dislocation of the prosthesis requiring surgical intervention to reduce the dislocation. The anterior surgical approach is most common. The posterior approach is usually but not always, reserved for hip replacement revisions or unusual situations. Its great to have someone writing on medical exercise guidelines. There is certainly a need.
After 40 years of yoga I had a hip replacement four years ago. Maybe I did too much yoga. The surgery is a very wonderful thing, my husband has had three of them, he never did any yoga. Now he needs to have a re-revision which is a complicated rebuilding of the pelvis, I wonder what he will be able to do in rehab. Any advice?
Hip replacements do not last. Just as the hip wears down, the mechanical new hip wears down. Because of the pain in the hip prior to the surgery, many avoid certain movements. This could lead to weakness. In rehab, he should work on building strength all all the muscles of the hip, legs and torso.