HIP

If you are scheduled to have hip surgery, now is the perfect time to start doing Pilates. Even if it seems counterintuitive to start this joint, doing so with the guidance of a skilled and experienced Pilates instructor will strengthen the joint muscles safely. This is just one of the many benefits of participating in Pilates before hip surgery.Pilates before surgery will also help strengthen the tissue surrounding the hip joint and maintain its range of motion. The exercises are gentle and have little or no impact, which means they can be performed even when there is femoral deterioration in the hip. In addition, Pilates helps to break down the compensation habits you may have formed. These are movements or adjustments that you have developed in your body while trying to avoid pain in your hip joint.

“They’re normal,” says Ron Jegadeesh, a Pilates instructor, physiotherapist and owner of Southfield’s Pilates Fitness & Physical Therapy Center, “but they also throw the body out of alignment and further exacerbate their condition.”

Another consideration is the fact that some atrophy will occur after surgery, during the postoperative rest period. By strengthening the hip area before surgery, you will begin the process from a stronger place than if you had not performed any Pilates. In addition, you will also improve your balance by strengthening the core, which will help you after surgery. Maintaining balance will be important once you start rehabilitating this joint; you will be less likely to fall and feel more confident about re-exercising as needed. This is where Pilates comes into play after surgery.

Once you start rehabilitating the hip joint, logic would rule that you will only work the affected side, but there is an imbalance between the two sides of the body that has been exacerbated by the aforementioned compensatory habits you probably developed before surgery. In addition, when it is reached, although there is a clear imbalance around the hip joint and the incision point, the whole body experiences the consequences of the surgery. For example, the brain has to recover from the effects of anesthesia and the body’s immune system is weakened. All of these factors make Pilates a unique qualification for rehabilitation after hip surgery.

Pilates largely avoids high impact, high power output, and heavy muscular and skeletal loading. With the Pilates system, individual units work together in an organized scheme or method. In other words, while working to strengthen the area around the hip joint and increase its range of motion, the rest of the body is oriented as an integrated system.

This is done with an emphasis on core strength and two-way stretching. During hip surgery rehabilitation, you will learn to use the core muscles to support every movement of your body. Under the attention of the instructor, you will perform these exercises with proper alignment to make sure that the muscles establish new fibers in the most beneficial way for the joint. Pilates largely avoids high impact, high power output, and heavy muscular and skeletal loading.

The amount of time you need to recover before participating in Pilates after surgery will depend on many factors. For some patients, particularly those involved in preoperative Pilates, it could take as little as six weeks after surgery. For others, it can take two to three months. Obviously, you first want to get permission from your surgeon.

If available, look for a center that offers both Pilates and physical therapy. Physiotherapists in these settings are also trained in Pilates and use Pilates equipment and machines to further facilitate the recovery of their patients. After the initial physical therapy sessions, patients can be effectively transferred to Pilates with the guidance of their physiotherapist. If this place does not exist near the place where you live, be sure to work only with highly trained Pilates instructors who are able to approach your mobility safely, both before and after surgery.

Operating room robots aren’t just things from science fiction movies. In fact, many orthopedic surgeons already use them to increase their accuracy and precision. Total hip replacements are now being performed with the help of Mako, a robotic arm, and a three-dimensional modeling software system. Dr. David Cheong at Orthopedic Associates in West Florida, located in Clearwater, is one of the few surgeons in the state who uses MAKO to replace hip instead of just knee. Explain its benefits.

What is a macoplasty?

“Mako is the name of the robot used in makoplasty procedures. It’s basically robot-assisted arthroplasty or joint replacement surgery,” says Cheong. “Makoplastys begins with a computed tomography of the hip, which is then used to plan the placement of the implant. Not only planning, but execution can be done with significant accuracy because of this technology.” .

The procedure takes a few hours in an outpatient center. It starts with computed tomography (or CT), which becomes a 3D model of your natural anatomy, thanks to Mako software. The robotic arm is then directed by the surgeon to help place the hip implant at the correct point. Cheong says the Mako gives him auditory, visual, and tactile cues to help guide him in the right direction. Once completed, patients can leave the operation on the same day, without the need for hospitalization.

How long is the recovery time?

“Recovery lasts two to six weeks, which is also typical of traditional hip replacements,” says Cheong. “The only difference is the way the procedure is performed.”

In a matter of weeks, patients usually return to normal daily activities, but physical therapy is required to regain strength and make sure the implant is working properly. From here, follow-up appointments with the surgeon will be required. Implants can last from 10 to 25 years, depending on weight, activity level and general health.

How much does a macoplasty cost? Medicare and private insurers will cover the cost of a macoplasty because it is still considered a joint replacement surgery. Out-of-pocket costs will be the same as for traditional surgeries: $ 17,000 to $ 20,000. The cost of the robotic arm is expensive for doctors ’offices, so many hospitals don’t have it, just orthopedic practices.

Why don’t more surgeons use Mako’s robotic arms?

“A lot of doctors use this machine just for knee replacement, but the technology is a constantly evolving process. I think we’re going to start seeing more doctors implementing it,” Cheong says. “As surgeons, we are creatures of habit and it all depends on the type of doctor and the style they prefer, traditional or technological.” Cheong has been using the Mako arm for five years and believes it helps him place implants more accurately while eliminating other variables.

Who is a good candidate for a Makoplasty? According to Beaumont Health, makoplasties are for anyone suffering from non-inflammatory or inflammatory degenerative joint disease. Forms of degenerative joint disease include osteoarthritis, post-traumatic arthritis, rheumatoid arthritis, avascular necrosis, and hip dysplasia. Cheong adds that patients who prefer not to receive surgery may apply cortisone injections or anti-inflammatory medications as alternative treatments.

“Ultimately, it’s up to the patient to decide what they’d like to do,” Cheong says. “But for many, this type of surgery greatly improves their quality of life.”

Tips for Chiropractors and Care Providers to Avoid Arthroscopic Hip Surgery or Hip Replacement

In the United States, 3-7% of older adults will have some type of hip osteoarthritis during his lifetime. “Osteoarthritis” or “OA” is the appropriate term for overuse or age-related degenerative conditions. While there are other types of hip problems, such as fractures or soft tissue injuries, most people will be diagnosed and seek care for the degenerative type, eventually trying to avoid arthroscopic hip surgery.

Hip replacements and alternative methods

These degenerative hip problems result in nearly 200,000 hip replacements each year in our country. These surgeries are not only expensive, but involve intensive and time-consuming rehabilitation, as well as the potential for various post-surgical problems.

While some people may actually need arthroscopic hip surgery, many others are borderline surgical candidates or are not prepared to go under the knife without first exhausting other treatment options. In these cases, a combination of proper exercise and chiropractic care can significantly delay the need for surgery or even help prevent it altogether.

Exercise to support the muscles

Exercise and physical activity are known to have a positive effect on joint health and condition. When we look at the hip, we find a large “ball and socket” joint between the femur and pelvis that supports much of our weight when we do any “vertical” activity such as walking, running, or stopping.

Surrounding this joint and providing dynamic support is a complex arrangement of muscles, including the glutes, hip flexors, quads, hamstrings and adductors, to name just a few. Weakness in these muscle groups can cause unwanted additional load on the hips and cause excessive wear. By exercising regularly, especially in resistance exercise, we can make sure that the support muscles around the hip are strong and have the ability to support the hip during our daily activities.

Another added benefit of physical activity is that exercise can stimulate chondrocyte activity in the joints. Chondrocytes are the small cellular structures that hold and produce cushion-like connective tissue that surrounds and coats most of the joints in our body. If we can stimulate chondrocyte activity, we can aid in the physical process of repairing damaged tissue and creating new healthy tissue.

The good news is that if you don’t feel comfortable in a gym setting or your degeneration is too advanced to participate in “traditional” weight lifting, even the simplest bodyweight exercises can be extremely effective. Movements such as aerial positions, lunges, hip pushes / bridges, etc., are safe and efficient methods to improve endurance and muscle strength. If patients have the strength and ability to perform even more demanding exercises, encourage them to do so.

Strength exercises vs. cardio

If endurance exercise is good, what about cardio? Do you like walking or running? The answer is a bit complex.

Many studies show that, in the context of hip health, it is possible to overdo certain types of cardiovascular activity. A 2015 study, which measured the amount of load our hips experience when moving, showed that when walking, an average adult will experience hip contact forces approximately 4 to 5.5 times their body weight. This load can increase our body weight by up to 10 times when running 12 km / h (approximately the rate of one mile in 8 minutes).

For example, a 180-pound individual will experience hip contact forces of nearly 1,000 pounds when walking and more than 1,800 pounds when running. Does this mean that cardiovascular exercise is necessarily bad for the hip? No, but we must understand that these forces of contact with the hips create a cumulative effect over time. Several studies show a positive relationship between a runner’s age, running pace, total mileage, and degenerative hip disease, probably due to the increased hip contact forces that occur during the race. .

What does this mean for patients? While we can’t make specific recommendations for cardiovascular exercise, we know that extremely high mileage combined with a fast running pace can lead to an increased risk of degenerative hip problems, and the more degeneration there is, the more likely you are to encounter problems. . In the context of hip health, this means that a regular walking routine can greatly benefit patients, while running should be carefully monitored.

If you want to practice more vigorous cardiovascular exercise, try something like swimming or an elliptical shape that removes some of the load from the joints.

When adding exercise to a “surgical prevention routine,” the chiropractor or physiotherapist should determine what types of movements and loads are appropriate and make sure patients follow a proper and safe manner. When used correctly, exercise can play a valuable role in delaying the need for hip arthroscopic surgery or other surgery.

Research and the role of the chiropractor

Numerous studies have focused on the relationship between chiropractic / manual therapy and degenerative hip disease, but one highlights the benefits very well.

A 2004 study compared “manual therapy” with “exercise therapy” in 109 individuals who had previously been diagnosed with hip osteoarthritis. The exercise group focused on active exercises to improve muscle function and joint movement. Manual treatments (also known as chiropractic care) include: identification and stretching of short / tense muscles within the hip complex, traction of the hip joint, and manipulation of the joint in “each appropriate limited position.”

Participants were divided into two groups and treated for a period of five weeks, and the results were very impressive:

• Success rates of primary outcomes were 81% for manual therapy, compared with only 50% for exercise therapy;
• The manual therapy group had significantly better outcomes to improve range of motion, hip function, stiffness, and pain;
• The positive results experienced by the manual therapy group lasted after 29 weeks.

In addition to manipulating the hip joint, another consideration should be the difference in leg length (LLD), a sign of biomechanical problems with the pelvis, SI joints, and / or lumbar spine. Interestingly, research shows a potentially strong relationship between LLD and the onset of degenerative hip disorders, probably because weight alteration in a joint could be a contributing factor to osteoarthritis. Although there are other methods for analyzing pelvic / lower back function and alignment, research focuses on LLD because it is easily quantifiable and reliable.

LLD and stressful

The researchers propose that pelvic tilt or torsion, visible through the measured difference in leg length, puts uneven load and tension on the hips and can reduce the area of ​​contact of cartilage in the joint.

The combination of these tensions can increase the pressure on the cartilage and bone of the joint, causing degenerative hip conditions. We see evidence of this in a survey of 100 patients who were diagnosed with hip osteoarthritis. The researchers measured each person’s LLD just before hip surgery and found that their hip osteoarthritis was next to the longest limb 84% of the time. Other studies have shown very similar findings regarding knee osteoarthritis.

For chiropractors treating patients with degenerative hip problems, the focus is on restoring normal movement of the joints to the hips, as well as eliminating or reducing the amount of measured difference in leg length. Regardless of what methods or techniques are used to achieve this, attending to these areas can significantly reduce the need for surgery and have a positive impact on patients ’overall function and pain levels.

Arthroscopic hip surgery and variable options

While some patients really need surgery or arthroscopic hip replacement to protect their quality of life, many others have options when it comes to degenerative hip problems.

Proper exercise scheduling, combined with specific chiropractic care, can dramatically improve an individual’s function and mobility, significantly reduce their pain levels, and delay or avoid the need for surgery.