Hip Replacement Exercises
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Post-operative therapy after hip replacement is mostly performed by the patient getting on with normal life but in most cases it's useful to quickly analyse their progress and suggest avenues for improvement. It is important to assess any deficiencies in the patient's performance and correct them early as arthritis of the hip causes several problems to develop. Muscle power drops around a painful joint, reducing the stability and support for the joint as the pain inhibits natural movement and activity. Lack of normal full movement allows joint restrictions to develop, leading to an abnormal walking pattern.
Pre-operative education and rehabilitation is important so the person knows what they are trying to achieve with their exercises and gait practice. Range of motion and strengthening exercises can be given along with gait correction. If the gait cannot be easily corrected by instruction, consideration should be given to using a walking aid. Either a stick or a crutch can be used depending on the degree of support needed, held in the opposite hand to the arthritic joint. If the patient walks with a good pattern this is sufficient, but if they still walk poorly they may need two sticks or crutches to achieve a reasonable gait pattern.
On the first post-operative day the physiotherapist assesses and treats the patient both in the bed and up mobilising. Quadriceps and buttock muscle contractions performed hourly allow the leg to regain muscle control to enable movement. Repeated gentle hip flexions by sliding the heel up and down in the bed can help the patient regain control of the leg and restore this functional activity which they need to master bed mobility. Circulatory improvement is also encouraged by pumping movements of the ankles routinely but the size of this effect may not be very great.
Hourly contractions and gentle movements of the hip will get the joint moving and restore some confidence in the patient that they can independently move their leg around, which initially feels very heavy. The physiotherapist and an assistant will mobilise the patient as their condition allows, using crutches or a frame. Early sitting out in a chair is encouraged with a seat high enough to prevent too much hip flexion. As the side of the thigh has been operated this can limit the amount of knee bend so patients are encouraged to regularly slide their feet back towards themselves in sitting.
Initial mobilisation concentrates on getting the person going with an acceptable gait pattern for their confidence and safety. Once they are more mobile then it is important to teach a natural gait, moving on from the step-to gait to the step-through gait. When the patient is skilled at this they should look like they are walking entirely normally but just happen to have a pair of crutches with them. A natural gait pattern promotes the natural rhythms of muscle activation which reinforces the correct muscle patterns and contributes towards strengthening the muscles and reducing the work of walking by promoting an efficient gait.
If a patient does not gain in muscle strength which is required then specific exercises can be performed. Initially the patient can be in standing and holding on to a high table or back of chair for balance. The operated leg is bent up gently with the knee coming up forwards for five repetitions, increasing as it gets easier with time. The second movement is to move the straight leg out to the side which strengthens the stabilising muscles of the buttock. The third movement is to move the straight leg backwards and behind without bending the body forwards to activate the large hip muscles.
If these are not sufficient then the patient can be instructed in exercises on the bed or prescribed hydrotherapy. Hydrotherapy is a very good method for strengthening joint replacements as the water gives good levels of resistance but supports and controls the joints as they move. Floats can be used to strengthen muscles against resistance and gait practiced against the water, giving resistance to the whole process of walking and strengthening the entire pattern. Excessive exercise is not recommended for hip replacements as this can compromise the interface between the cement and the bone inside and shorten the life of the implant.
Article Source: Articlelogy.com
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