Hey everybody it's Doctor Jo, and today
I'm going to show you some stretches and
exercises for a total hip replacement
posterior approach. So let's get started.
So let's start off by reviewing the precautions that
you're not supposed to do. This, you
should not do. So hip flexion past 90
degrees which is about right here, is a
no-no. So no bending down to tie your
shoes. No bringing your knee up to make
that hip bend. You don't want to go past
that 90 degrees because that puts a lot
of pressure on that incision site and
all those muscles they have to go
through to put that replacement in. And you
also don't want to cross your leg over
the other leg, so that takes out crossing
your legs this way.
However a lot of people think that
you're not supposed to do that either,
but that's okay.
You're not going to be able to do that
in the beginning, but you're just not
supposed to cross the leg over. That
rotating outward is ok, the rotating
inwards, that internal rotation this way, is
another no-no. That one's bad as well
because again as you can see when I
rotate in, it puts pressure that incision.
It's usually about right there, and it's a
big one, so no hip flexion past 90, no
adduction across your body, and no
internal rotation. Those are the ones
that you shouldn't do. You should wait
until you're clear by your doctor,
usually that's at six to eight weeks, but
I would say just don't do until your
doctor says it's okay. Alright, so I'm
going to show you some exercises that
are early on some isometric type
exercises.
These are just to get the muscles
activated, but not doing big motions yet.
So the first one is just going to be a
quad set. For the quad set, you're
activating that quad muscle, squeezing
that muscle, but not really making a
movement. I like to have a little roll
underneath the knee because i feel like
it gives you a target.
So what you're trying to do is push that
knee down in
that roll where you're squeezing these
muscles as tight as you comfortably
can for about three to five seconds. If
you see my foot, I kind of pulled that up
to that activates the calf muscle as
well as the quad muscle, just to get
those muscles moving. So you might not
have that much bend in the knee yet
because I think people often forget to,
that even though they're working the hip,
all those muscles come down into the
knee too, so a lot of times you're going
to have some knee tightness and some
knee pain as well. So even if it's up
here, that's okay just make sure you have
a nice squishy rolls so you can push
down into it.
The next one is going to be a hamstring
set. So again make sure that you're not
breaking that hip flexion of 90 degrees,
but just prop your knee up a little bit, put
your heel down, and what you're doing is
pushing the heel down into the floor, and
that's activating that hamstring muscle.
So push down, hold about as much as you
can, or as hard as you can for three to
five seconds, and then relax. So do about
10 of each of these and then you can
start working up your sets and your times
holding, but just three to five seconds
out there and then relax. After that then
you're going to do glute sets or glutes
squeezes, and that's activating those
butt muscles because again that's right
where they could do a lot of that
surgery in there, so you want to be able
to squeeze those butt muscles. You can do
them lying on your stomach or you can
just do them sitting down like this, but
you're squeezing in, kinda like you have to
go to the bathroom really badly and
you're trying to hold it, three to five
seconds, and then relax. Sometimes those
muscles don't want to activate so you, if
you want to tap it a little bit when you
squeeze, sometimes that helps, but again
holding three to five seconds, doing that
10 times. The next one is going to be
squeezing into a ball for adduction
strengthening. Again make sure you if you
want to sit in a chair that might be
easier so you don't break your
precautions, but you can do it here as
long as it's comfortable. Take a ball or
something,
but it's going to give a little bit but
just so your knees are slamming together,
and then squeeze in. Give that three to
five seconds and then relax, doing about
10 of those. Squeeze, squeeze, and hold and
relax. Okay now don't squeeze to where
is painful because these muscles are
pretty tender right now, but just squeeze
til you feel some tension, and then
relax, and then the more you do, then the
easier it'll get, and then you can
squeeze a little bit longer. And then the
next one is going to be pushing out into
abduction. So if you've got a belt or
some kind of tight rope,
this is not those bands, you don't want
it to be a resistive band where it
gives way, but you want to be something
tight, and then you're going to push out
into the belt with both legs. Almost like
you're opening up like a clamshell or a
butterfly, and then three to five seconds
for those as well, so just pushing out,
and then relaxing. Then you're gonna do some
ankle pumps. Ankle pumps are always good.
I like to prop my foot up on something
so that heel has room to bend. If you
just have it flat, it's a little bit
harder to pump that ankle, but I would
say if you only do one exercise the
ankle pumps pushing down and pulling up
is the most important because what that
does is it makes that calf muscle work
like a pump and get that fluid out of
your leg because even though your
surgery's up here, a lot of times that
fluid has nowhere to go when you're up
and moving, and so it goes down into your
leg, knee, foot, and then you get that
swelling in there. Sometimes that
swelling is painful,
so just ankle pumps. You can do a lot of
these several times a day just pumping
up and down, and pumping up and down, and
that's working those muscles helping to
work that fluid out there and getting
those muscles strong again as well, so
again I don't think you can do too many
of these. You don't wanna
make your muscles were they're so sore you
can't do anything, but you can definitely
do a lot more of these throughout the
day. And then that also helps make sure
you don't get a blood clot, so very very
very important. And the last thing in
general is some gate training, and so the
important part of that is to make sure
that you're walking with equal weight on
both sides, and sometimes that's really
really hard.
So what's important is don't get off
your walker or cane if you can't walk
normally because then that's going to
give you bad habits along the way, so
I'll show you standing up. So for the
gait training, when you're walking
normally, your heel hits first and then
you roll through on your toes. After a
surgery, hip surgery, knee surgery, a lot
of times our calf muscle becomes tight
and we kind of hit like this, and we
don't hit our heel first and then what
that does is that it makes us kind of
limp on that leg. So if you're limping on
the leg,
you still need an assistive device
because if you're walking around like
this, then your muscles are going to get
that bad habit. You're gonna have a
really hard time walking normally again. So
it's really hitting the heel first,
rolling through the toes, squeeze those
butt muscles to keep your hip from
popping out, and then step through. If
you're stepping and going over like that,
that means those muscles aren't quite
ready yet, so really concentrate on
squeezing those hips and butt muscles as
you put weight through that leg, so heel
toe, step and step through. So even if you
have to say "heel, toe, step through," that's
important because that gait training,
that walking normally, is one of the most
important parts. So there you have it,
those are your stretches and exercises
for a total hip replacement posterior
approach. If you have any questions, leave them in the
comments section. If you'd like check out
some other videos, go to askdoctorjo.com
And remember, be safe (make sure you follow all those
precautions), have fun, and I hope you feel better soon.