After 15 years helping people prepare for and recover from their hip replacement surgery with exercises, I have learned which ones are essential for a strong return to function. You probably are reading this with many questions you want answers for and to be guided with knowledge and expertise. The exciting news is that by deciding to do some stretches, cardiovascular training, and a handful of strength exercises, you can have a valuable impact on the speed of your recovery, how you feel, and how much you are able to do post surgery. Below I am going to give you the top tips you need to know about exercise and your hip replacement. Imagine we are sitting down for an hour consultation and I am answering all your questions with the goal to give you a solid framework from which to build your own exercise program.
What is the best type of cardiovascular exercise I can do for my hip replacement?
That is a great question and I am going to answer it in two parts depending on if you are pre operation or post surgery. Prior to surgery often the upright bicycle in a weight room is best because there is no load or weight bearing so it will not aggravate pain or cause inflammation. However, it is very important to keep up walking and some weight bearing activity with walking whether that be outside or on a treadmill. The key with walking is to let pain be your guide; you will need to monitor the pain both during and after and then adjust the volume of walking accordingly. Post surgery again, the combination can be stationary cycling on the upright bike and the treadmill, but post surgery the emphasis will be on increasing your walking volume as the weight bearing will build your endurance and strength back up. Please note that the Elliptical trainer is not nearly as good as the treadmill because you never have to transfer weight or load unilaterally on one leg; therefore the operated leg will not gain as much strength back as you can when using the treadmill.
What are the stretches I need most for my hip replacement?
Again, I will answer this question in two parts for what stretches are best pre operation and which ones will be required post hip surgery.
Best stretches pre hip replacement surgey & precautions:
- Hip Flexor (seated, kneeling, lying one leg off bench/bed)
- Quadricep (standing, side lying)
- Hamstring (supine)
- Groin (supine)
- Calf stretch
- IT band / Illiotibial band (standing, supine)
Please note that all stretches should always and only be done in your pain free range of motion, so it is imperative you listen to your body.
Best stretches post hip replacement surgery & precautions:
- Hamstring (supine or seated on chair) *hip bend must be no more than 90 degrees and this stretch should be supervised by physiotherapist in the first 6 weeks and only gradually implemented in range after the 6 week mark as there is always a risk of dislocation if you go past the 90 degree bend
- Hip Flexor ( seated or supine) *If your incision is anterior at the front of your hip, please wait the full 6 weeks post surgery to do this one unless advised by your doctor or physiotherapist before then and under their direct supervision.
- Quadricep (prone) * you may want or need a pillow under pelvis
- IT Band / Illiotibial Band *avoid this stretch if you have a lateral incision for at least the first 6-8 weeks; however you can roll it and massage it as long as you stay clear of the hip bone and the incision site if painful
- Calf stretch standing
- **Avoid the groin stretch for potentially up to 3 months or longer because it is external rotation of the hip which is a contraindication, ask to be shown gentle groin stretches you can do that will not externally rotate the hip
- Gluteals ***again the traditional gluteal stretches involve external rotation of the hip which is a contraindication after hip replacement surgery; however you can do some gentle massaging, small ball rolling away from your tailbone, surgery site, and always only where it feels good after the 3 month mark unless otherwise advise by your medical team
- Abdominals to correct posture and open you up
What are the most important strength exercises I need for hip replacement surgery?
Pre Hip Replacement strength exercises:
Often prior to surgery depending on how advanced the osteoarthritis is and your pain level, there are two key exercises that are a must for a strong recovery:
1. Gluteus medius doing the clam shell or side leg raise (non weight bearing)
2. Gluteus maximus prone from the floor, bench, bed or in 4 point stance
The squat can be a good exercise for some people, but I often see clients take all the load in their good leg which can create more imbalance.
Best strength exercises to do post hip replacement surgery:
Your strength exercises for post hip replacement surgery should be done in progressions from non weight bearing to weight bearing and are dependent on time from surgery date with 6-8 weeks being a rule of thumb to gradually add in more weight bearing as tolerated.
- Clam Shell and / or progress to side leg raise
- Prone hip extension
- Standing lateral side step with band or crab walk with band
- One leg balance and hold starting at 5-10 seconds
- Bridge lift, bridge marching with short pause/hold up
- Standing band/cable hip extension
- Shuttle 1 leg press
- Step ups single riser to start (low step height)
- Squats watching and feeling for equal weight bearing
This is just a quick summary of the major points on the best exercises you need to do prior to and post hip replacement surgery to have a good recovery and function. For more in depth details on receiving a complete hip replacement exercise program you can follow visit here: Hip Replacement Exercise Progam