Post-Op Days 19-27: Hip Labrum Rehab Milestones (Post 8)
This post is dedicated to Barbara Rabin PT, ATC, PYT-C. I could not have made it through this third week without her (more than) full-time assistance.
If you have missed the other posts in the series, catch them here:
- Post 1: Day 1 Post-Op Recovery
- Post 2: Day 2 Post-Op Recovery
- Post 3: Days 4-5 Post-Op Recovery
- Post 4: Day 6 HLI Rehab
- Post 5: Day 7 HLI Rehab: Mantras and Edema Management
- Post 6: Day 10 Slow & Steady: The Yoga of Hip Labral Rehab
- Post 7: Days 11-19: A Turning Point Hip Preservation Post-Op
Day 19: How will I return to work so (too) soon at barely 3 weeks post-op?
Work equals lecturing 8-10 hours daily, most of those standing, 6 days with heavy manual labor, like manual therapy, moving equipment, etc.
As for returning to work (I have no choice), I am honestly not sure how I’m going to do it. I can’t even dress myself yet, nor take care of my house or children alone. I still have ROM (range of motion) and weight bearing precautions to protect the repairs, and should spend, per surgical recommendations, no more than 30 minutes of upright sitting daily. In addition to that, I must maintain my regular physical therapy regimen and spend 2 hours in prone-lying and 4 hours on the CPM – daily.
Not to mention standing any length of time makes my entire leg swell, for multiple reasons, mostly vascular and post-op edema, and my left hip has now joined in the pain circus (with bursitis and tendonitis) from carrying all my body weight. It’s a hilarious catastrophe, actually.
Giving 8-10 hours of lecture a day for 6 days will be interesting to say the least. The only way I can do it is to have a round the clock assistant. Even then, it’s frankly silly to go back to work. However, the key factor in all of this is I have no choice. And I know many other folks are in the same situation. They MUST return to work to support themselves and their families.
Therefore, any success I achieve will be a miracle – a God thing, because I know full well it’s too early for me to be working. I can’t do it on my own steam. I’ll be meditating and praying for success this week, to be sure.
Day 20: First day on the bike
Now you may say, wait a minute, most folks are on the bike at day 1 of therapy! Not this PT “hippie” patient, I say. The bike was totally counterproductive for me, and here’s why.
Note: We (both my PT and me) hesitated to use the bike because of chronic psoas tendinopathy. Frankly, the psoas was ALWAYS on. The tendon was thick, congested, and VERY angry. So when I tried the bike at first, of course the psoas fired immediately and automatically and in all phases of bike use – it was COMPLETELY misbehaving. BUT, after the acute phase, I was able to compress the distal psoas proximal to crossing the hip joint – and inhibit it/turn it off.
Also, I have loads of extra-articular hip snapping of the ITB (iliotibial band) over the greater trochanter – so much that it makes my hip unstable and creates lots of pain (And I have a high pain threshold. Three babies with big heads, all birthed naturally. Enough said.). It is mostly provoked by hip external rotation plus loading and/or GMAX (gluteus maximus) firing in almost any position except prone.
Take home message: The bike isn’t for everyone, and as I move forward in PT, it will not be a mainstay of rehabilitation. However, today was a milestone because I could (finally) inhibit the psoas to allow for some bike riding.
Day 21: Three Week Post-Op Milestones
- I made it to three weeks post-op!
- MEDS – Hallalejuh. Today is my first day with no meds whatsoever, day or night, other than the required Naproxen, which is a prophylactic NSAID to prevent chondral/bondy growth. For the NSAID, I am okay with it. I have seen and heard of too many folks with regrowth or excessive bony growth in the post-op period. So if the NSAID prevents it, it’s worth any side effects for the short term.
- SLEEP – I had to get creative, but I finally slept all night by allowing myself to lay on my left side in strict spinal and hip neutral. I had no real pain, but I had plenty of apprehension trying to get, and maintain, that position, even though I woke up often to assist my leg into supine or hook-lying. I also had to continuously talk my psoas out of behaving badly through using yogic breathing and relaxation techniques.
Now I have a new use for my CPM at night, supporting my operative leg in sidelying hook-lying. I am I sleeping better than ever now that I am not stuck in a single position all night long, an impossible task for almost anyone.
- FIRST GLIMMER OF HIP HOPE TODAY. I will be better.
Life Lesson: A singular less-than-stellar milestone (in hindsight)
My rehab is now officially combined with doctoral work and administrative work for my organization, not to mention my upcoming (premature) return to work/lecturing. My daily schedule looks something like this:
- 6:30 AM – Awake and start the laborious process of self-care to get ready. What usually takes me 15 minutes now takes me at least an hour, typically more.
- 7:30 AM – Breakfast so I can take NSAIDS and off to PT (not driving yet, so I’m chauffeured by family)
- 9:30 AM – Return from PT and dive into work (not one of my smarter ideas) for example: Finish literature review and evaluate evidence quality and statistical design while on CPM.
- 4:30 PM – Make the long trip downstairs to join the family for dinner. Typically I can only sit for 30′ before the pain lets me know I’m done, then I head back up to lie down and ice.
That makes me want to laugh out loud, but in hindsight, starting back to work this soon and this heavily was not the best option, however, it was my only option for the given workload. This, in combination, with parenting three young children.
What’s more is next week – I will have to figure on a way to teach from supine and partial supine-lying. This will be VERY interesting indeed.
I am doing okay. I am hooked up to the CPM – and have just barely eked past 90 degrees hip flexion today. Today is 3 weeks – and I am officially “allowed” to try and get past 90, albeit with no pain, impingement symptoms, etc.
It’s exciting – but I’m being smartly cautious. I don’t want to flare up the synovitis or tendinopathies that have been there for so many months/years. Steady goes it, in other words.
Aquatic therapy (in a spa tub) is enormously beneficial now since my incisions have (finally) closed. I’m doing:
- 1 hour aquatic therapy (in spa tub)
- 3-4 hours in the CPM
- a minimum of 1 hour prone lying
- 1 hour physical therapy
- 3 cycles of compressive icing daily.
Day 22: Clinical Pearl “Firsts”
Clinical Pearl “Firsts” in Home PT
- Day 22: Today’s CPM = -5 to 85 with 20 degrees of trunk elevation/wedge (per tilt meter app). Today I cheated a bit on ROM and carefully and gingerly managed to partially sit in thunderbolt (vajrasana) – on the actual floor. I couldn’t bear weight on the right hip at all, but I did eek past 90 degrees flexion without pain, which I haven’t been able to do. Happy tears.
- Day 23: CPM: -5 to 102 with 20 degrees trunk elevation/wedge
- Day 27: 4 pt./quadruped hip flexion to 107 degrees today in PWB (partial weightbearing); Windshield wipers/Lateral articulation (from Medical Therapeutic Yoga practice) at 50% ROM today (watch video here).
Clinical Pearl “Firsts” in PT
- Quadruped without weight bearing in left lower extremity (watch video here).
- Light hip posterior/inferior glides helped gain 100 degrees PAIN-FREE (essential) PROM. Without glides, 100 degrees would not be possible and would be painful (which is a no-no).
- Kinesiotape has been a benefit so far – starting as early as the first week of PT.
- Don’t feel obligated to get on the bike for ROM assist. It does not work for everyone. Good thing is, there are alternatives.
Clinical Pearl “Firsts” in ADL’s (activities of daily living)
- Sit-to-stand with assist of my 3 year old’s (yes the one pictured above) toddler table
- Floor-to-standing transfer attempted and conquered!
- Long-sitting/staff pose (dandasana) on land – sort of conquered! Unable to achieve spinal neutral (Little did I know but this would take almost a year to regain)
Day 27: Foreshadowing for the Work Ahead
When I palpate the iliopsoas both proximately and distally, my suture lines/scars are pulled superiorly and pucker significantly. Scar formation needs to be addressed more deeply. This scarring is complicated by a 40-year old vertical abdominal paramedian incisional scar and 3 newer horizontal laproscopic incisions. More work to come…
Follow Up on Work
I did end up making it through the week, but not without paying the price. By the end of the week I had more swelling, more pain, and increased frequent psoas spasming (which if you’ve ever felt that on a postsurgical repaired hip labrum on a shallow acetabulum, the pain is terrific) and general muscle motor fatigue (resulting in muscle trembling and less motor control than usual).
However, I had the amazing support of a bevy of world class physical therapists, acupuncturists, occupational therapists, and athletic trainers. I even had the US Track and Field’s therapist there that week (as a student) helping me through.
I want to give a BIG thanks to Barbara Rabin for being my sidekick and doing everything from teaching meditations for me (there’s no way I could make a 5:30 AM call) to driving me to therapy to helping me put my pants on. You are a true friend, a stellar colleague, and a real gem.
Need help finding a good hip PT?
JOIN THE JOURNEY via Email
If you want to get these posts automatically, you can sign up for my Blogroll. It puts a single email in your inbox once weekly. No more, and with total privacy and respect for your personal information. I never share it with anyone, no third parties. Notta.
JOIN THE JOURNEY via Facebook
This page is private and CLOSED. You will have to request membership, which I have to approve. I have been fielding questions and growing a network of international HIP LABRAL physical and physiotherapists experts who can help direct you to the who’s who of hip preservation so you can have the best chance for recovery. Join the HIP LABRAL PHYSIOTHERAPY & PHYSICAL THERAPY NETWORK