09 December 2006

Pre-Op Physical Therapy

Bonnie Kurth is a physical therapist who specializes in hips. I went to her for three months, and I learned several things from her: less is more, walk with a cane to minimize pain, and the key muscle for gaiting is the gluteus medius.

Because my hip joint had been collapsed for a long time already,my gluteus medius had gone to sleep, along with a bunch of other muscles that work with it. Before I could strengthen them, I had to stretch them, and Bonnie and I spent a month stretching, which did a lot to relieve my pain. I refused to take drugs, so I was always in pain.

But the anti-inflammatories didn't really do much (and Celebrex carried an increased risk of heart attack) and the idea of taking pain killers and messing with my mind didn't appeal to me. So no drugs.

Bonnie convinced me, while I was laying on her table and she was trying to do trigger point release on me, that I should walk with a cane because she was going to hurt me in order to help me. While I didn't like it, I found a web site called Fashionablecanes.com and ordered a couple of great canes -- one was a replica of an 18th century Royal French walking stick, and the other a spring floral pattern. They made a fashion statement that I wanted to make.

Like me, Bonnie had two dogs, and we were drawn to each other by our understanding of how dogs think (or how we think they think). Because of this, I let Bonnie do some really strange things: for example, she would put a belt around her own waist, and around my leg, and try to dislodge the femur from the acetabulum to give me more range of motion. She was pretty successful in doing that, and I regained much of the range of motion I had lost.

I also switched from painfully walking the canal with my girlfriends in the morning for exercise to water aerobics and walking with the Aquajogger belt. And Bonnie made me aware that I was causing myself more problems by exercising through my pain, because I was compensating too much, This meant I was using all the wrong muscles to do things, and letting the "right" muscles, the ones I'd need after surgery if I had it, atrophy.

Not a big surprise; I've always been partial to outcomes rather than process. I had never studied the process of walking and running, just gone for the outcome. Now, I got to learn what goes into walking--all the little muscles that influence gaiting, like the ilio-psoas, the gluteus medius and miminus, the adductors and abductors. Throw into all of that the functions of the spinal erectors and the core, and you get to realize how complicated this process of walking on our hind legs truly is.



Dear Francine ,
I appriciate the Idea of walking with a cane and the Trigger point release on you by Bonnie. It was also good to avoid anti inflamatory drugs & pain killers and for that matter any Drugs, because all Drugs have their own negative side effects.
My Son and Daughter-in-law are doing the same here treating patients without medicine.
Paddu Hyderabad India
Mobile 91 9247568970

Toni said...

Amazing - no one (including me) thought to refer me to a PT PRE-op. Which would have made sense, because I had put off surgery for more than 3 years and was ALL atrophied and misaligned. Do you by chance have a link to any good info on the mechanics of walking? (I found your blog because, a year and a half post-op, I am trying to determine what it is safe for me to do in the way of exercise and especially stretching. Didn't get too many good answers from my surgeon, and the PT basically said hip precautions are forever...)

Francine Hardaway, Ph.D said...

What you need is a kinesthesiologist to teach you about walking, although I also used a good personal trainer. Anyone who knows anatomy and physiology can help. As for hip precautions being forever, don't you believe it. I don't obey ANY of them anymore. I'm 2.5 years post-op. But will say I have spent a lot of time observing myself walking and fine tuning the muscles used. Get to know your gluteus medius.