Movement Precautions: What No One Tells You!

As many of you know, I recently had surgery on my hip to repair a torn labrum. Thankfully, at this point I am walking, lifting, and starting to get back on my bike….but for the first four weeks post-op, I had quite a few movement restrictions. My surgeon provided me with my movement restrictions almost two months prior to my surgery, but it wasn’t until I got home from the hospital that I realized what these restrictions and precautions really meant for my everyday life. Despite being a physical therapy student, I hadn’t thought about all the things I would no longer be able to do, all the things I would need help with.

Movement precautions will differ depending on the location of the operation and the severity of damage. Here, I’ll take you through my own movement precautions (which are very similar to total hip precautions) and several things that I was unable to do/needed help with. Patients: If you’re heading for surgery, I would suggest a pre-op consult with a physical therapist to talk about the practical implications of precautions ahead of time! And PTs: TALK ABOUT THIS STUFF WITH YOUR PATIENTS. Better understanding of protocols/precautions = greater adherence  = you get your patients better faster!

My hip arthroscopy precautions were:

-Toe-touch weight bearing (20% of my body weight or 20 pounds which ended up being about the same thing for me) – make sure to do the math and practice what this feels like BEFORE surgery

-No hip flexion past 90, passively or actively

-No hip extension past 0

(I was given a brace to wear at all times which prevented these movements.  It’s especially important to wear in social situations/crowds, when you may be distracted from your movement, and during sleeping, when you have no control over what your body does. Same for slings if your shoulder is the involved limb.)

-No abduction, adduction, internal rotation or external rotation

…….Ok so basically no active movement of that leg. Pretend like it’s dead. No movement means no movement, but it also means…..

1.Getting into and out of a car

I was unable to do this without help, despite the fact that I was technically allowed to drive a car at 5 days post-op. No active flexion = I needed someone to lift my leg into the car for me (My classmates got a huge kick out of this. Shoutout to everyone who drove me home from class). Also – since you cannot flex past 90 degrees, you might have trouble seeing over the steering wheel (oh wait, just me? #shortpeopleproblems) and if you need to twist around in the seat at all, you’ll be in trouble. You also need to be comfortable with reactive/defensive driving and stuff like slamming on the breaks and swerving out of the way in order to get behind the wheel.  And I think it goes without saying that you need to be OFF the opioids before you drive! (#GetPT1st #ChoosePT).

Side note: If it’s your right leg that’s involved, you will most likely not be driving at all until you can fully bear weight on that leg.

(this is what it’s like trying to transition positions by yourself…it ain’t happening)

2.Picking things up off the floor

Clothes, pens, notebooks, your phone….and your crutches! Unless your single leg deadlift game is on point (most likely this will be too painful during the first week), you will need someone to do this for you, OR you can purchase a “grabber”. I guarantee your crutches will fall at least once. Probably while you’re on the toilet. Fun times! It’s SO important to have someone you trust close by at all times for these awkward situations to ensure that you’re not breaking your movement precautions and/or not stuck on the toilet.

  1. Personal Hygeine

Showering, brushing your teeth, doing your hair and makeup…..that’s a lot of standing on one leg. In order to prevent overuse fatigue of your unaffected leg, I highly recommend putting a chair in the shower and in front of your bathroom sink/mirror so that you can spend as much time primping as you like. It sounds lazy, yes, but you can use that energy to let your body heal and to make bigger gainz in physical therapy. I fully admit to using my shower chair up until six weeks post op ONLY because sitting down in a hot shower after a long day of class is every bit as awesome as it sounds. No shame.

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  1. Getting dressed

pants and underwear. You will not be able to put them on by yourself because you can’t flex past 90 or actively lift your leg at all. Unless you have the aforementioned “grabber” tool, you’ll likely need some help with this. And shoes…if I had to go back and do one thing differently, I would absolutely buy some slip-on sneakers. This is also a good time to invest in some more supportive shoes (your unaffected leg is doing a LOT of work), or at least something that’s non-slip.

  1. Getting into and out of bed.

Again, you will need someone to lift your leg for you. This goes for transitioning to and from the couch as well, especially if you are spending time in a continuous passive motion machine. If no one is around to do this for you, you can sling a towel or theraband under your leg and lift it passively – but avoid pain and pinching in the joint!

Side note: when you wake up to get out of bed in the middle of the night, so does everyone else. Maybe take a pass on that second glass of wine, and reduce your fluid intake two hours before bedtime if you know what I mean….

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6.Eating and Drinking?

It’s difficult to prepare food while on crutches – again, standing on one leg for long periods of time can lead to foot pain, knee pain, and both anterior and lateral hip pain. Whatever you do, DO NOT lean on your crutches or put weight through your armpits – the brachial plexus (aka every single nerve in your arms and hands) passes through there. At best, your arm will go numb for a bit – at worst, if you do this too often and for too long, you could end up with lasting damage. If your surgery is elective, and you have time to plan and prep for it, I suggest preparing pre-portioned meals and freezing them; having lots of hand-held fruits and veggies; and enlisting the help of friends and family to bring you Chipotle UMMM i mean cook for you.

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As for carrying food and drink from kitchen to table….I worked really hard on this because I love me some snacks, but I never did quite figure it out. Carry around a water bottle (with a loop handle) when you are alone, and don’t be afraid to ask your family for help carrying food to where you are. Or, if you REALLY love food, you could get a minifridge to put next to the couch. (That would be epic. If I ever have another surgery I am totally doing that).

And finally, while we’re on the subject, a note on nutrition and activity changes: yes,  your activity level will diminish exponentially, but the healing process can burn some serious calories, and at the very least, you still need to fuel your basal metabolic rate – that’s normally not less that 1000kcal/day for most people.  Listen to your body, eat when you’re hungry, and focus on high quality (nutrient dense) real, whole foods.  It’s especially important to focus on protein – your body will be in a bit of a catabolic state with the inflammatory/healing process, and because you will not be able to work out, you’re more susceptible to muscle atrophy.  Increasing your protein intake will help combat those losses (and will help with physical therapy GAINZ). I know athletes and females and female athletes ESPECIALLY will be worried about weight gain during this period of inactivity – I promise you will be fine.  I joke to my friends a lot about feeling like a sloth/whale/elephant/insert-really-large-animal-here, but in reality I weigh three pounds less than I did pre-op. Remember, healing burns calories,  and crutching is a LOT harder than walking (the more inefficient you are at things, the more calories you burn). Weight gain is the LAST thing you should be concerning yourself with.  Focus on sharp nutrition and killing it in PT, and the fitness will come back.

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If you have any further questions about surgery recovery, movement precautions, and the implications for your daily life, please don’t hesitate to contact me! I am more than willing to talk you through any concerns you may have, either for yourself or for your patients.

 

 

 

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