Orthopaedic Hip Surgery

Prone Extension

October 12, 2018

Surgery is a daunting concept for anyone, regardless of the size or severity of the planned operation. With many things to consider including what to pack in your hospital bag, dreaded thoughts of complications, coping post-surgery or just simply undergoing an operation is a big deal for most people. Dealing with the after-effects of joint surgery is our specialty and the team at Bodyfit NT is here to help for all your pre and post surgery concerns. We’re going to delve a little further into life before and after orthopaedic hip surgery, more specifically total hip arthroplasty.

First things first, let’s take it back to the beginning. Why do you need surgery?

Was it because of a sustained injury that has stuck around for years leading to *drumroll, please* osteoarthritis (OA).  OA is a common degenerative joint condition, also referred to as “wear and tear”, which can affect a variety of joints – it does not discriminate.  Osteoarthritis symptoms include pain and stiffness in the affected joint/s, limping or joint deformity resulting in an inability to complete daily living tasks to full capacity. Often, this can impact on quality of life and psychological health.

Considering the level of pain and reduced function experienced on a daily basis by some sufferers’ surgery may be a relief for many. Over time our body adapts to the pain, stiffness and discomfort caused by OA continuing to compensate and manipulate our body to minimise the effect of painful and inflamed joints. This notion is often referred to as the ‘compensatory effect’.

The compensatory effect is a term used to explain the compensation of opposing joints and muscles taking excessive load away from pre-existing injuries or pain in the “bad hip”. With years of compensation our muscles and bones tire, degenerate and become weaker than they once were, leading to increased susceptibility of fracture and injury. For me, this story sounds way too familiar. Growing up I heard the legendary story of how Dad kicked 9 on the left and 8 on the right in a game against rivals Nandally Tigers during his stellar football career… but with Dad’s stardom came injuries and with injuries came knee surgery and, many years later, hip surgery.  Dad also claims to have retired after this game, hanging up the boots and going out on a high!

So, with my dear Dad ready to go under the knife, I thought why not prepare him for the after effects and post-surgery rehabilitation. How lucky is he to have these services for no cost? Just extra love and care. You’re welcome, Dad.

Before diving right into surgery, it is important to mention the significance of a regular exercise routine to assist in building muscle strength and mobility prior to surgery. It has been discussed numerous times through research, that ‘pre-hab’ assists in your recovery and success with rehabilitation post surgery. Exercise prior to surgery can also assist in reducing pain levels and maintaining joint range of motion. As Exercise Physiologists we are able to prescribe you correct, effective, safe and achievable exercises that are specific to your goals and needs leading into surgery. We are passionate about building rapport with our patients to ensure your rehabilitation journey is both successful and enjoyable!

Now, let’s talk more post-surgery.

Recommendations suggested from the ‘ESSA Post – Operative Management following Common Orthopedic Hip Surgeries Protocols’ include the below goals and precautions to be aware of after surgery. Additionally, we have included a timeline suggesting achievable goals and exercises that can be completed during the time-frames provided.

Early Post-Operative Goals:

  • Gain efficient patient education and understanding specific to precautions and recovery protocols;
  • Understanding of ambulation with assistive devices, independent stair ascent/descent, mobility and transfers throughout the recovery period;
  • Independence with active daily living tasks and functional activities.

Post- Operative Precautions (4 – 6 weeks):

  • Crutches as required;
  • Use of wedge cushions when in supine- avoiding adduction of the hip;
  • Avoid >90degrees flexion, internal and external rotation, twisting and adduction beyond the midline;
  • Do not cross your legs.

Rehabilitation timeline:

1 – 3 weeks:

Goal: Improve range of motion and isometric strengthening

Exercise:

Heel slides in supine – this requires you to lie on your back with knees bent and feet flat on the floor. Core is engaged and pelvic floor activated with a neutral spine. Slowly slide your foot away from your buttocks to a point that is comfortable, and then slowly guide your heel back to starting position. Do not bend the knee or hip greater then 90 degrees.

Bent knee Heel Slide

Heel slide- extension

4 – 6 weeks:

Goal: Progress strength and conditioning of surrounding musculature, improve range of motion and ensure weight bearing is comfortable and achievable

Exercise:

Hip Extension in Prone – Lying on your stomach with your head resting on the floor and one knee bent. Engage deep core musculature and actively squeeze the gluteals to lift the thigh off the mat or bed, pressing the heels toward the ceiling. Use the gluteals to lift the leg and not the lumbar spine.

Prone Resting

Prone Extension

6 + weeks:

Transition back toward functional movements for active daily living tasks with focus on functional movements and balance/proprioception for older populations.

Exercise:

Sit to Stand – Seated in a chair, activate your gluteals and stand – transferring your weight though your heels and into the quadriceps to lift the body into standing. Bring the hips forward and squeeze gluteals. Slowly begin to flex through the hips and knees, lowering your bottom toward the chair, ensuring the quadriceps are engaged and knees are tracking in line with the hips.

STS- Seated

STS- Standing