Re: Range of movement in new hip (long)

March 15, 2004

Jeff strikes again! Y'know sometimes I think we went to the same grade school

and had the same PE teacher.

Des Tuc

In a message dated 3/15/2004 1:53:55 PM Pacific Standard Time, jjg@...

writes:

Move and move lots. It took you years to get into a sad state and a quick

recovery shouldn't be expected. If you still aren't happy at a year, take

up conditioning the muscles with weights, (to reduce the risk of injury)

then go find a good yoga class

March 15, 2004

Yeah. Mine was Mr. Walshaw - a Yorkshireman with the warmth of a viper. I'll

never forget him.

In a message dated 3/15/2004 2:49:44 PM Pacific Standard Time, jjg@...

writes:

The one with the baseball bat and cattle prod? Seems like most folks had

him too...

March 15, 2004

Hi Sundog (jtinsley),

Your hip history and ROM issue strike a chord with me. I'm only 4 weeks post-

op but I can already see a similar pattern shaping up. In fact, my

physiotherapist discussed this with me just a few days ago. I (we) will be

facing

a steeper ROM challenge than most hip patients - because we went into

surgery so fit! It's counterintuitive, and in fact I have no regrets for having

been

somewhat muscle bound in the hip area due to extremely proactive exercise

therapy over the last few years. Like you, I'm recovering extremely well in

every

way - except ROM. Especially forward/back extension, which " sucks big time "

in my physio's words. Reason: as my OA worsened, I continued to strengthen

my increasingly shortened muscles and ligaments - especially the hip flexor. I

was walking strongly up to about 6 months pre-op, but with a bent, shortened

gate. The flexor remains very short and feels totally jammed up... " stopped " as

you say. Bringing my knee up past about 45% is really hard. My physio says

people who've been more sedentary often have an advantage with flexibility -

but that doesn't mean we can't get there. Your hip will loosen up eventually,

but

you'll have to really work hard on stretching it out. Do you have a good physio?

Massage therapy can be useful too.

a

Masri / Durom 17.02.04

> I am a little concerned about the range of movement (ROM) in my

> recently resurfaced hip. It's not that I expect to be fully flexible

> at this time, but rather that it feels like much further movement may

> not be possible. First a brief personal history:

>

> I am a 56 year old male (UK) who for the past few years had what I

> took to be a groin strain, or trapped nerve. I limped and did not like

> bending. 15 months ago it got to the stage where I could not stand for

> any length of time, or walk for more than a few hundred metres without

> severe pain. At this stage I sought specialist help, and it was

> revealed I had severe osteoarthritis with cysts and consequent joint

> space narrowing. I was sceptical, since for most of my life I had been

> active, playing squash, tennis and marathon running. This surely could

> not happen to me! So, I took a crash course of physiotherapy, started

> taking all the supplements and started on a course of exercise (for

> the previous few years I had become sedentary), and stretching. First

> I started walking around town increasing the distance until I could

> happily walk 5 or 6 miles. Next I took to the hills. I started walking

> with the local Rambler's group at weekends, walking 10 to 12 miles

> each week, and often the same midweek. I still struggled at stiles,

> but with the help of trekking poles I could apparently go anywhere. I

> sought an appointment with a hip consultant since I was still in

> denial about having osteoarthritis, but he confirmed I would probably

> need a replacement hip some time in the next 10 years. I was still

> sceptical, and prepared to accept the limited ROM in my left hip, and

> if at all possible avoid surgery. And the consultant did not mention

> resurfacing, merely saying I was too young for replacement.

>

> I got very fit, and at one point walked 22 miles over the hills. But

> there were warning signs. Occasionally I would feel a sharp twinge in

> my hip. This grew more frequent until I had to start taking

> painkillers and anti-inflammatories to continue walking. The sharp

> pain did not go away, but appeared for more extended periods. Now I

> could not put my full weight on my hip. I realised the game was up

> when by bending my left hip I could produce a series of quite audible

> clicks, and suspected I now had bone-on-bone contact. I had to give up

> walking the hills. I could still walk for a mile or 2 on the flat

> with increasing pain. By this time I had heard of resurfacing, so took

> a second consultation with a resurfacing consultant. The result was as

> I feared. My hip was now as good as it was ever going to be. I had 2

> choices - to accept the pain (now occurring at night as well) and

> limitations, or go for a resurfacing op. I was now walking around the

> house hanging on to things for support, and had constant joint pain. I

> was fortunate enough to be able to have a private operation, which was

> arranged for 12th January this year.

>

> The operation went well. I had no pain to speak of - the joint pain

> was gone. The only discomfort was when I panicked getting back into

> bed, and aggravated the hip joint. I was walking after 4 days with a

> stick, and was discharged after a week using only a stick. At week 3 I

> no longer needed pain killers, and at week 4 could walk without a

> stick. At week 7 I could comfortably walk on the flat for 5+ miles

> negotiating crowds, and at week 8 I walked 11 miles over the hills

> (with poles) with no pain or discomfort afterwards, (but still

> tentative on stiles.

>

> In fact, everything seems wonderful (week 9) - almost too good to be

> true. I do get occasional clunks (no pain) which others here have

> described, and I have to say I do not like them. However, I still

> cannot put on my left sock without using an aid. My problem (and I

> realise that in the scale of things it is very, very small) is that I

> feel I will not be able to recover much more movement in my left hip.

> When I try to stretch past the 90 degree position I can just about

> grasp my toes, but I feel that any more movement will *break*

> something. It feels like there is just no more movement available - as

> if I am up against some kind of stop. Should I just accept this

> limitation? Have others experience a similar feeling? I am just

> surprised that with my other progress I have (and may always have)

> less ROM that a year ago.

March 15, 2004

>In fact, everything seems wonderful (week 9) - almost too good to be

>true. I do get occasional clunks (no pain) which others here have

>described, and I have to say I do not like them. However, I still

>cannot put on my left sock without using an aid. My problem (and I

>realise that in the scale of things it is very, very small) is that I

>feel I will not be able to recover much more movement in my left hip.

>When I try to stretch past the 90 degree position I can just about

>grasp my toes, but I feel that any more movement will *break*

>something. It feels like there is just no more movement available - as

>if I am up against some kind of stop. Should I just accept this

>limitation? Have others experience a similar feeling? I am just

>surprised that with my other progress I have (and may always have)

>less ROM that a year ago.

?! At week 9 you are concerned about ROM?! You had your leg removed (oh yes

you did!) and put back on. Part of healing -- and this can take several

months -- is to let everything get nice and tight, then try to limber it

up. You don't want to stretch something that's still trying to heal, since

the structure of the hip might be long-term changed. Quick test is to look

at the scar. Skin heals much faster than just about anything else they cut

and if it is still pink/reddish then deep inside you are still healing.

This is not to say that you shouldn't move it and stretch it some, just

follow what your body says and let nature take its course. At about 4 - 6

months is when you can push it, I was positive at 6 months that I'd gotten

as limber as I was going to get, which was a bit better than post-surgical

restrictions (pre-op I was immobile). Much to my surprise, it all did

limber up just fine when it was ready and now I'm doing all sorts of

stretches. There are still a few stiff spots, but really at no point has

this negatively impacted my post-op conditioning and training (yes, I'm a

bit of an extreme athlete).

Move and move lots. It took you years to get into a sad state and a quick

recovery shouldn't be expected. If you still aren't happy at a year, take

up conditioning the muscles with weights, (to reduce the risk of injury)

then go find a good yoga class.

Cheers,

Jeff

rBHR Aug. 1, 2001

Mr. McMinn

March 15, 2004

>Jeff strikes again! Y'know sometimes I think we went to the same grade

school

>and had the same PE teacher.

>

>Des Tuc

>

The one with the baseball bat and cattle prod? Seems like most folks had

him too...

>

-- jeff

March 15, 2004

J Gaynor/jqhome wrote:

> ?! At week 9 you are concerned about ROM?! You had your leg removed

(oh yes you did!) and put back on. Part of healing -- and this can

take several months

Thanks for the feedback. Two things made me concerned:

First, at my 6 week checkup the OS seemed to think I had less ROM than

I should have. This surprised me, because for the previous 6 weeks I

had resolutely tried to avoid going near 90 degrees - so the fact I

could get around 90 degrees seemed pretty good going to me!

Second, as a (talltree992003) also mentioned, there seems to be

what I can only describe as a *stop*, rather than a stiffness or pain

preventing further movement, which leads me to wonder whether I will

ever achieve much more movement. It's like the feeling of trying to

bend the knee in the opposite direction.

However, don't get me wrong -- if I improve no more than I have

already I will still be very happy. I can do just about all the things

I want to do, and am pain free.

March 15, 2004

I remember mine - his favorite expression was " ooh, it hurts so good! "

> >Jeff strikes again! Y'know sometimes I think we went to the same

grade

> school

> >and had the same PE teacher.

> >

> >Des Tuc

> >

>

> The one with the baseball bat and cattle prod? Seems like most folks

had

> him too...

>

> >

>

> -- jeff

March 15, 2004

Hi,

I will only add here that 18 months out from the Resurface op that gave me a

hip for the first time in 35 years I am still getting my ROM

back............ I am around the same age and yes it is a nuisance it

doesn't happen overnight.......... apparently even for people who were

pretty fit before hand.............. However, it sounds like you are pretty

used to working on your body with all the things you did preop to keep

going........... so I guess in the end there will be little option than be

prepared to continue to do these and have the hip ligaments etc loosen

up/function properly in due course................

Personally, I am determined that even if it takes me another 10 years I will

in due course be able to tie my shoe laces............ there is no time

limit on getting more flexible etc. i.e. They take 80 year olds down to

gyms and get strength and condition back so I figure we can at our

age...........smile. There are specific exercises and things to do that will

enhance ROM but it may pay to be careful that the area has healed

sufficiently before you get too adventurous.............for pushing it too

hard only seems to cause pain and wasted time waiting for it to all heal

again.

Best of luck with it all and keep us posted on progress..........

Edith LBHR Dr. L Walter Sydney Aust 8/02

> I am a little concerned about the range of movement (ROM) in my

> recently resurfaced hip. It's not that I expect to be fully flexible

> at this time, but rather that it feels like much further movement may

> not be possible. First a brief personal history:

>

> I am a 56 year old male (UK) who for the past few years had what I

> took to be a groin strain, or trapped nerve. I limped and did not like

> bending. 15 months ago it got to the stage where I could not stand for

> any length of time, or walk for more than a few hundred metres without

> severe pain. At this stage I sought specialist help, and it was

> revealed I had severe osteoarthritis with cysts and consequent joint

> space narrowing. I was sceptical, since for most of my life I had been

ETC ...........

March 15, 2004

> I am a little concerned about the range of movement (ROM) in my

> recently resurfaced hip. It's not that I expect to be fully

flexible

> at this time, but rather that it feels like much further movement

may

> not be possible.

As others have said, this is fairly common for many hippies. You

need to start thinking long term, like Edith suggests. Also, I

second Jeff's advise to keep moving and do gentle stretching, etc.

but wait until 6-months post op before you start pushing it. I

started pushing it early and developed mild tendonitis that took

months to get rid of. Time heals all wounds!

For good stretching guidelines, check out:

www.exrx.net

from there, link to the Exercise and Muscle Directory to find hip

stretches and exercises.

Don't push it and use perfect form in every thing you do. It is much

more important to do it right than it is to do it hard or far. When

doing stretches, go to just before the " stop " and try to relax,

rather than trying to force it further... it's called " dying in the

pose " .

Remember, even while you managed to keep active, you did so by making

accomidations for your diseased joint. This unconsious activity

produced a pathological muscle memory over many years. It will take

many years to unwind and retrain your muscles, nerves and brain to re-

establish healthy mechanical function.

Clunking, clacking and clicking are all pretty normal for the first

year. Until you get your mechanics back, your joint will act more

like a cam, rather than a ball joint, causing the noises.

Bilat C+ July 2001, Dr. S at JRI

March 15, 2004

Hi,

Me back again.............. I know that feeling of a blank wall fairly

well............mine got hit around 85% bend........... but have found over

time it does give way if only in tiny increments - getting close to 90% now.

I think persistant pushing at the limits somehow stimulates the brain into

building the necessary bits......... Mine seems to go through cycles as if

it stretches, builds the strength into that and then demands a bit more

movement.........those days it is like an itch that needs scratching and I

find myself going around pushing at the limits in all directions i.e. on

steps, while sitting, needing to use my exercise ball to push on the hip,

getting a strap and hooking to the bottom of the foot etc........ it is a

facinating procedure........... then it goes quiet for days on end until it

gets the urge to go a bit further apparently............

I simply figure that the brain does unconsciously know what it is doing when

healing something like this and about all one consciously can do is take

part in

the process.........

You could perhaps ask the OS too how far he bent the hip on the day of the

op.......... mine told me right up to the chest so I figure one way or

another it finally will go that far........just a matter of building in the

necessary..........

Edith LBHR Dr. L Walter Syd Aust 8/02

> J Gaynor/jqhome wrote:

>

> > ?! At week 9 you are concerned about ROM?! You had your leg removed

> (oh yes you did!) and put back on. Part of healing -- and this can

> take several months

>

> Thanks for the feedback. Two things made me concerned:

>

> First, at my 6 week checkup the OS seemed to think I had less ROM than

> I should have. This surprised me, because for the previous 6 weeks I

> had resolutely tried to avoid going near 90 degrees - so the fact I

> could get around 90 degrees seemed pretty good going to me!

>

> Second, as a (talltree992003) also mentioned, there seems to be

> what I can only describe as a *stop*, rather than a stiffness or pain

> preventing further movement, which leads me to wonder whether I will

> ever achieve much more movement. It's like the feeling of trying to

> bend the knee in the opposite direction.

>

> However, don't get me wrong -- if I improve no more than I have

> already I will still be very happy. I can do just about all the things

> I want to do, and am pain free.

March 16, 2004

> J Gaynor/jqhome wrote:

>

>> ?! At week 9 you are concerned about ROM?! You had your leg removed

>(oh yes you did!) and put back on. Part of healing -- and this can

>take several months

>

>Thanks for the feedback. Two things made me concerned:

>

>First, at my 6 week checkup the OS seemed to think I had less ROM than

>I should have. This surprised me, because for the previous 6 weeks I

>had resolutely tried to avoid going near 90 degrees - so the fact I

>could get around 90 degrees seemed pretty good going to me!

>

Hmmm you avoided going to 90 degrees. Does your hip move freely within the

range you've been using? Is it possible that you've restricted your motion

unduly? Try moving within the 90 degree rule, but in all directions.

http://www.exrx.net as mentioned elsewhere is one of the best idea books

for stretching.

A possibility here is the agonist vs antagonist pairing of muscles. To move

you must have the primary muscle contract (agonist) and have the opposing

muscle (antagonist) relax. If you were walking ginky pre-op the muscles

were possibly splinting your hip to take load off the joint. It is possible

that these are still inhibiting motion. The way to get around this is to

just gently and slowly move around within the range of motion as best you

can for a minute or two and concentrate on relaxing the antagonists. Try

that and see if it helps. Be sure to use the muscles in the hip to move the

leg, rather than swinging it. Imagine having a weight attached at the knee

you are moving, rather than trying to move the whole leg.

>Second, as a (talltree992003) also mentioned, there seems to be

>what I can only describe as a *stop*, rather than a stiffness or pain

>preventing further movement, which leads me to wonder whether I will

>ever achieve much more movement. It's like the feeling of trying to

>bend the knee in the opposite direction.

>

Yup, I know the feeling. I still got this at the end of ROM for some

months. It was all soft tissue. As one poster pointed out, ligaments,

muscles and tendons have likely shortened over time. In my case, standing

" normally " the first few times post-op actually was stretching things

because I was so twisted up pre-op. I slightly pulled some back muscles

that first week because of it. Darn strange it was... Deep tissue massage

(such as seifukujutsu or rolfing) can break that up.

>However, don't get me wrong -- if I improve no more than I have

>already I will still be very happy. I can do just about all the things

>I want to do, and am pain free.

>

That's what's most important.

Best of Luck!

Jeff

rBHR Mr. McMinn

Aug. 1, 2001

March 16, 2004