Total Hip Replacement (Posterior Approach) Recovery Exercises – Ask Doctor Jo


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.