According to the Arthritis Today website (www.arthritistoday.org), 225,900 hip replacement surgeries were performed in the U.S. in 2004; this was an increase of 37% from 2000. If trends continue, that number will reach 600,000 in the year 2015. In order to regain strength and mobility, many surgery patients may seek the guidance of qualified fitness professionals.
But are there special considerations when working with this population? Christian Thompson, PhD, chair of the department of exercise and sport science at the University of San Francisco, urges professionals to create thoughtful program design that will not compromise the new joint. Prior to the first session, it is important to make contact with the client’s doctor or physical therapist to learn about specific contraindications, says Thompson. Although each individual will be different, there are some general guidelines to adhere to:
Steer Clear of Frontal Plane Movements That Cause the Leg to Cross the Midline of the Body. During the hip replacement procedure, the thick ligamentous fibers that stabilize the joint are removed. Any cross-body movements may cause joint dislocation.
Avoid Hip Flexion Greater Than 90º. Examples include deep squats and knee-to-chest stretches.
Be Wary When Incorporating Exercises That Cause Internal Hip Rotation. Use caution particularly when combining such exercises with hip flexion and/or abduction or adduction.
Thompson also offers methods for helping improve strength, mobility and function in hip replacement patients:
Develop Leg Strength. Focus on multiplanar step-return and/or shallow lunge patterns. Ensure upper-body posture is tall and strong so the hip does not flex past 90º.
Improve Leg Proprioception. Proprioception is likely reduced owing to loss of sensory receptors in the hip. Mobilize the ankle joint through loaded and nonloaded flexibility exercises. In safe environments, encourage the client to walk barefoot for increased sensory reception.
Enhance Balance and Gait. Balance and gait training will be necessary to counter surgery-related compensatory walking patterns. Vary gait exercises to include narrow and wide patterns, and frontal plane and diagonal stepping.