Due to changes in our NHS service more & more Pilates teachers are being referred clients following hip replacement surgery. Once, patients would have been on a hospital ward for at least a week receiving Physiotherapy daily. This ensured that they could confidently perform their post op exercise regime and climb stairs safely. However, these patients are now discharged after 2 – 3 days with an exercise booklet and a quick mobility check.
As a result many patients turn to Pilates looking for an alternative rehab programme to enable them to restore normal hip function and mobility. So what does the Pilates teacher need to know? There are several hip replacement procedures, the most common of which is the total hip replacement (THR).This involves the removal & replacement of the femoral head with a prosthesis and the acetabulum is deepened and resurfaced. These prosthesis’s are commonly made from metals such as titanium, stainless steel & polyethylene.
During surgery the hip is dislocated to enable the prosthesis to be fitted and as a result post operatively the hip joint will be more unstable. Therefore the main objective is to strengthen the muscles around the posterior & lateral region of the hip to help regain stability. As the muscles start to gain strength the clients balance and mobility also need to be restored.
Due to the invasive nature of this surgery you often find post op that the gluteas maximus & medius as well as the external rotators and abductors will be weak, and that you will also be presented with a protective shortening pattern of the anterior element of the hip around the TFL, rectus femoris and even the psoas. This tends to gives the impression of the ilium hitching and the head of femur sitting forward of the joint. This can often be observed if the client is lying supine with knees flexed, feet on floor & you will also be able to palpate this shortening.
Therefore, as well as strengthening the effected posterior and lateral element of the hip we also need to rebalance the pelvic and femur placement by careful positioning and cueing.
The biggest fear that many patients have is will their hip will dislocate after surgery. This is very rare and with the correct rehabilitation exercises over 6 – 9 months the hip will be as strong as it was before. However, like any recovery process it must be paced. Initially there will be vast improvements but then the pace will slow down as it reaches its potential. So it is important that the client be guided to reach progressive goals.
There are a few contraindications that need to be given attention initially after surgery to prevent dislocation, they are:
• Hip flexion > 90 degrees • Leg adduction
• Hip rotation
• Crossing legs
As a Pilates teacher it is necessary to be aware of these contraindications during the early stages of rehab. However, due to our deep understanding of movement, we are well equipped to take the client through a gradual rehab programme that will address the weaknesses that have arisen during surgery.
As I mentioned earlier the THR is the most common hip replacement available but in the instance of trauma or congenital abnormalities the procedure and contraindications may differ. It is extremely important in this instance that the Pilates teacher liaises with the patients Physiotherapist to check the safely precautions with that specific situation.
To learn more about the steps to follow after hip & knee surgery see Maryʼs workshop; hip & knee post op workshop. www.theclinicalpilatesstudio.co.uk