And… more PT!

Same week, more of the same.

Had physical therapy twice and my PT is really pushing me. The second I am not looking he sneaks another plate of weight on the leg press and exercises that are tough already are  REAL  tough now. Just when I think “this exercise is monstrous”, he tops it with something.

I have made my peace with “clams” by now but two exercises just got more advanced and are killers.

  1. walking sideways 8x with a super tough elastic band around my ankles. It takes everything out of me and burns my gluteus medius muscles to a point that’s beyond funny.
  2. getting up and sitting down from a chair 20x with a 4 lbs./ 2 kg ball in my outstretched arms  AND  an elastic band around my thighs, while the feet are wider than my shoulders.

They are both tough exercises but I really do hate the first one. That band is so incredibly tight, it hardly gives. I swear it’s the elastic band from hell.

 

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I am doing my exercises but I certainly have an opinion about them.

~~~

Did I mention already I almost fell at PT?? I was done with the elastic band from hell, which by the way is so tight it left my skin bloody as I noticed afterwards (!), and hobbled that one meter over to the bench to take it off, when I tripped and almost fell. That could have been catastrophic!!

~~~

Also, my PT thinks it’s a splendid idea to start doing incline on the treadmill. (I personally  KNOW  it’s not a great idea. Already before I broke my hip and I was “just” dealing with two recoveries from FAI & labral tears, incline was a baaaad idea.)

For the moment it is on the lowest level and only a few minutes at a time but I know my PT by now. Very soon it will get steeper and the minutes longer and then I will put my foot down.

 

Coming home from PT I was completely exhausted. So many exercises in a relatively short time, a few were made even tougher and to top it off – incline. I fell asleep immediately,  with my lower body feeling like dead weight. That’s the best I can describe it.

 

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~~~

Last week I tried walking a tiny bit more than a mile (2 km). I needed about 5 breaks and my op hip was not happy afterwards. So back to my mile. Obviously my hip needs more time.

 

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Why does it take so long?

 

5,5 months PO

Recently I got asked over and over again “why is your recovery taking so long?” Well, here it is….

The hip is not “just” a broken bone. The femoral neck is one of  THE  major weight bearing bones in the entire body and neither the fracture nor the recovery is a joke. It is considered a life threatening injury to have and can have many devastating complications, not just during surgery but also in the recovery.

My recovery is slow yes, but everything is going smooth and according to plan. What more could I wish for??

 

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People who ask “how much longer is this going to take?/ Is this ever going to end?/ Geez, this is going on forever!/ Why are you still in physical therapy?” and other charming questions don’t realize just how serious of an injury this is and how incredibly complex the recovery is.

Recovering from hip pinning is way harder than recovering from a  THR. Only young, healthy and active people will be given this kind of surgery, because it’s too tough for older people and they have a higher risks of complications, such as AVN.

~~~

I started off with “toe touching only” for six weeks, to really give the fractured bone a rest and was full time on crutches for 14 weeks, weaning off for another six weeks. So basically I spent the whole month of January, February, March and April on crutches and did not get far.

The recovery is very very delicate since you can not put “too much weight – too soon” on the hip, otherwise it re-breaks and then “the shit has hit the fan”, to be very blunt.

 

Everything has to be learnt all over again over the course of many months and hundreds of hours of physical therapy.

Simple things like “standing” on two legs for example, with the weight equally spread out, is not easy at the beginning and one has to learn to stand for “longer periods” of time, 5 minutes, 10 minutes ect. again.

Might not seem important but it is. How many times a day does one “just” stand? Brushing your teeth, putting make up on, cooking, prepping meals, ironing, standing in line  somewhere…, leave alone learning how to stand on “one” leg again.

 

Other tasks I can think of that everybody takes for granted but I had to learn again:

  • getting up from a chair/ low seated couch
  • unassisted showering
  • putting on socks & shoes by myself
  • getting in and out of a car
  • eventually drive myself again, whereas my op leg is the right
  • doing stairs
  • shifting weight forward and sideways
  • walking without crutches and walking altogether

 

The hip is a very complex joint and lays super deep within the body. It is surrounded by 17 muscles and being on crutches for such a long time will do a serious number on them.

Atrophy begins after 11 days not using muscles, imagine what the muscles look like after 140 days on crutches! Not much left.

 

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Muscle mass is disappearing very fast and it takes forever to build it up again. My OS told me “per week on crutches the body will need six weeks to rebuild the lost muscle mass”. So in my situation I am looking at 120 weeks. This will keep me occupied for over two years and I am working hard at PT.

~~~

Things one has to work on is getting your range of motion (ROM) back, get rid of the limp when walking and find your proper gait again; one must work on balance, the leg (and knee) is very weak because of missing muscle mass and needs to regain strength. With strength will come endurance as well and of course one has major muscle imbalance to deal with.

Not only the front to the back in the op leg but also from the good leg to the op side leg. While the op hip is still healing, my good hip has to take over and do overtime and being an operated hip itself, there will be the point when even that hip has had it and needs extra love.

 

One must also not forget that some muscles need more attention than others. The glutes for example, so important for basically everything but mine don’t fire properly which throws off everything. The muscles have to be “trained” again to fire  when needed. Another task that takes months.

I am not even getting started about soft tissue issues with scar tissue & adhesion build ups and issues with the pesky hip flexor which by itself can make life miserable already. (Soft tissue issues are very real and can take years to go away).

 

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And since everything is off balance and not working properly, SI dysfunction is never far away either.

 

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The bone will take up to a year to completely heal and till  ALL  of this has settled, calmed down, is strong enough again and balanced, it will be a while. I am not too concerned about the timeline. It will take what it will take.

I could go on and on with this, but my point is, this is a very complex and intense recovery. I am not dragging it on because it’s “oh so much fun”.

I am following instructions from my orthopedic surgeon and my physical therapist and between them and me; time, dedication and  A  LOT  of hard work I am getting it done. Maybe not tomorrow or the day after tomorrow but I know there is a light at the end of the tunnel.

 

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Working like a dog at PT

5 months, 1 week PO.

~~~

Back to PT twice a week, 1.5 hours each time and hard work. (If I am not in the best shape of my life after all this then I don’t know.)

~~~

Here is a summary of what it takes at 5 months + PO into the recovery from hip pinning.

 

  • 30x hip flexion on the table to warm up the hip
  • 30x rolling the big ball towards me, for  ROM
  • 30x hands free bridges on the big ball
  • 30x clams with a heavy resistance band around the knees
  • 30x sideways kicks for the adductors

 

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  • 20x walking sideways with second toughest resistance band around ankles
  • 20x walking “ ice scater” style with second toughest resistance band around the ankles (# burn baby burn)
  • 20x sitting down and getting up from a chair while holding a 4lbs./ 2 kg ball in my outstretched arms
  • 20x exercise with resistance band for the adductors
  • 20x exercises with resistance band for the abductors

 

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  • 20x hip flexion machine for adductors, 15 lbs./ 7 kg
  • 20x hip flexion machine for abductors, 15 lbs./ 7 kg
  • 20x hip flexion machine for flexion, 15 lbs./ 7 kg
  • 20x hip flexion machine for extension, 15 lbs./ 7 kg
  • and  REPEAT  with the other leg

 

  • 40x leg press with 70 lbs./ 35 kg with both legs
  • 30x leg extension, op leg  ONLY  with 30 lbs./ 15 kg
  • 20x walking the balance beam
  • 3x 30 seconds the wobbly board for balancing the body for- and backwards
  • 3x 30 seconds the wobbly board for balancing the body sideways

 

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  • 10x forward lunges
  • 10x sideways lunges
  • 10 minutes slow pace, walking on the treadmill

And in the end my PT stretches me out and gives my hip flexor some love.

 

I am pretty burned out after all this and both my hips need a rest. Most of the times I collapse on my couch and ice the night away but feel okay again the next morning.

 

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It was also good news to hear I have not lost range of motion over vacation time.

~~~

My daily pensum of home PT takes a good hour and I take turns doing the stationary bike, the TM and Elliptical, each twice  week, usually to warm up.

Stationary bike I can do 15 minutes/ level 1; Elliptical 8 minutes/ level 1 and the TM 10 minutes but it all adds up. One day per week I take off from PT, to give my body rest.

~~~

This week I added going back to  ART  treatment to the mix. I wanted to go sooner but I did not want to cross a busy road while still being on crutches. I wanted to be off them and be able to cross the road safely.

I saw this woman before, after my labral tear surgeries, she helped me where nobody else could. ART stands for active release therapy and is basically a deep tissue massage.

And not one of those “nice relaxing” massages either. ART is  w-o-r-k.

My therapist put me in various pretzel positions on her massage table and while she stretched my hip or leg, she dug her fingers into trigger points, manually broke up scar tissue & adhesions and found entrapped nerves.

I will see her now regularely again. Getting rid of scar tissue etc. takes time.

~~~

My therapist asked me which hip it was I broke. “The right.” “So, did they do the other one too?”

( Hmm?? It’s not like the surgeon pinned my hip and once she was done she said to her medical team “well, since we have her on the table… flip her over! Might as well pound some screws in the other one too. Just in case.”)

I try to only have one hip drama at a time.

 

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To finish off with some good news:

  1. stairs work much better now. Almost like normal and naturally “best” in the morning when I am fresh and my hip is rested. I am still sticking to smaller stair cases. If longer ones are present I choose the elevator.
  2. my PT said my gait does not look robotic anymore.
  3. (a little mean but…) I was not the slowest one in the park anymore. I passed one guy with a cane.

 

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Reality check at 5 months PO

I am back from vacation.

Had a great time and it was my first “sightseeing” vacation since my ski accident/ hip pinning surgery and I know now where I am at in my recovery (5 months PO).

The good news – I could do more than expected but I also learnt a few tough lessons.

At the airport I could walk to gates which where nearby, longer distances I still used the wheelchair assistance. Carrying my backpack not only slowed my walking down, it made me limp and used up more energy, faster.

~~~

I had my crutches along and would have actually used them but at the time of need I was stuck nowhere near our hotel (where my crutches were) and had to deal with the situation, without them.

One time in particular I completely misjudged the walking distance and not only ran out of energy but went into pure survival mode. Sights which I usually would have enjoyed and taken photographs of did not matter to me anymore; I shuffled away in slow motion, tiny steps and with a big limp, till the next bench. It was brutal. I would have given something to have access to my crutches at this point.

It was not that the hip itself was hurting, it was the missing muscle mass, on my op side. Atrophy is a real bitch.

~~~

Most days I stayed around 8,000 steps which is all I can do right now and not be aching. I overdid it a few times and paid for it, every single time.

 

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  • Pulling a heavy suitcase? Pain level 5/10 in the hip throughout the entire night and the whole hip joint felt bruised on the inside.
  • Walking up and down hills results in an aching hip.
  • Walking over cobblestone and uneven ground – hip is not very forgiving.
  • Hip flexor on my op side joined the party pretty much every day and gave a lot of  additional “joy”.

 

On the bright side, I was able to walk behind a waterfall; sitting in trains, cars & planes was not a problem and my icepack was a lifesaver several times.

~~~

I certainly had my moments in which I thought “this is so lame” – for example, trying to take part in a 90 minute walking tour.  Brilliant idea!

The group took off and I was always the last one and never heard a word of what was being said.

At some point I called it quits and left the tour. I could not keep up and nobody cared or asked if I was okay either. So, another one for the list, “guided city walking tours” – not happening at the moment.

I was slow to begin with but the longer the vacation went on, the more aching my hip became and the slower I walked. My good hip was aching off and on as well.

~~~

Overall I could do many things though and had quality time with the hubby. Things went better than expected but still lots of work ahead.

Endurance and strength I have to continue working on. But I am sure my PT will have some good exercises up his sleeve when I see him next week. No rest for the weary.

 

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Little big milestone

21 weeks PO

I finally reached walking one mile in the park, at 21 weeks PO hip fracture! I was very proud of it, did it quite well and when I told my PT, his very first question was “did you time yourself?” Huh? I am happy I could walk it, I could seriously not care less in what time. Weird.

In the past week I walked my precious mile three times. It goes a bit better each time but still takes a lot out of me.

At PT we increased the height for practicing doing steps. Now it’s an 8 inch height, which is pretty much the standard height for stairs.  I can manage my staircase twice a day now – the “normal” way. But twice is  MORE  than enough. I feel it in both hips pretty much right away and it takes a tremendous effort.

~~~

Tomorrow we are going on vacation. My PT told me to take the crutches along. Just in case my hips get angry. Makes sense but I was kinda hoping I was done with them, but I am a good patient and take them along.

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~~~

The Elliptical is up to 8 minutes on level 1, medium speed. I am happy with that. Lots of little improvements happening.

Pain is almost gone, the hips take turns in being achey and it of course depends on how much I do. Overall I feel pretty good and if it wasn’t for the lacking strength and endurance in my R op hip/ muscles; doing sports and moving faster on the staircases, I’d say I feel almost normal.

Girl drawing smiley face on to a wall

~~~

So now I can pack my suitcase.

Forget the cute shoes, it’s comfy sneakers with good support, icepack, Ibuprofen and crutches. Hooray. But I will make the best of it. I will have to choose wisely what I can do, judge walking distances and I will probably make friends with every single bench in sight. Hopefully this will be the last vacation with crutches.

As I said to my OS already, last time I saw him “the subject hips is not just getting old – it  WAS  old already five years ago” (when this “oh so fun journey” began).

See ya.

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20 weeks PO after hip pinning

Wow, 20 weeks already – so theoretically I am almost at half time till I can go skiing again! Yep, you read that right. I have full intentions on going on the slopes again. I loooove winter!

I am actually a really good skier, I do blues and blacks, have good balance and don’t fall. Well, except that one time but that was just an incredibly super freak accident. My surgeon said it will take one year to do sports again, so… something to look forward to.

 

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All together I really must say, if there ever is something like “perfect timing” for a hip fracture, it’s probably in the winter. I was laying low for the last few months but now that spring has finally found its way here and I am learning to walk again, it’s perfect to do it outside when everything is blooming.

 

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~~~

Last week was a little bit of everything, hip wise.

I was really aching in both hips after my first mini walk in the park without crutches, but had big improvements only three days later and no problems at all and eventually I made it around the whole pond without crutches. (Walking really slow and limping towards the end.)

PT was going well, so well in fact I thought I still can go grocery shopping afterwards.     BAD  IDEA! I moved around like a 95 year old afterwards. Aching in both hips quite a bit and a miserable night as a bonus. Ergo – lesson learnt. PT and grocery shopping on the same day is still a big no no at 5 months PO.

~~~

PT itself was fine. We worked on balance, some exercises were okay, others very challenging.

 

Walking on a medium soft beam.

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Two different exercises on a wobbly board. Keeping balance while it tips forth and back and keeping balance while it moves left to right.

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Otherwise the same exercises as last week, which are about 15. The leg press, hip extension machine, leg extension machine, exercises with the big ball, clams, bridges, squats, exercises with a resistance band around my ankles, treadmill and so on.

We are also still trying to make my muscles fire correctly. My glutes are still hanging out in lala – land and refuse to fire when needed.

My PT did said I am doing a great job though but I still need finetuning.

~~~

I also saw my OS for a follow up appointment. Three X-rays with different views were taken and everything looks good.

 

  • No  AVN  but we have to monitor it closely from now on
  • No malunion or nonunion
  • The three screws are still in position
  • Bone healing and remodeling is taking place
  • Bone fragments that were floating around are gone
  • Major atrophy is visible on my op side

 

He was happy with my progress and told me again, it was a major fracture and does take time to heal. I am within the timeline of the recovery and got another script for 6 weeks of PT for range of motion & strengthening.
I asked about my good hip being cranky and was told, it is normal and expected for the circumstances. My R is still not healed yet and my L (which is an operated hip as well) is working overtime since five months. Once everything is balanced, things will calm down again.

In the end I was sent on my merry way with the recommendation “push yourself a little bit but don’t overdo it.”

~~~

Summary of what I “can” do at this stage:

  • I am doing my household at about 80% of my usual self
  • 8,000 steps a day, spread out over the whole day
  • Stairs – still Granny style. (L foot up, R foot on the same step. Left foot up, R on the same step; going down – R foot down, L foot on the same step. Ect.)
  • TM 10 minutes slow walking, Elliptical 6 minutes slow walking, stationary bike 10 minutes, no resistance
  • An hour PT every day
  • 700 yards/ meters in the park, crutch free, several times a week

 

And here is a list of what I can not do yet:

  • walk long distance
  • do stairs properly
  • sports that is anything beyond PT
  • carry something medium heavy or heavy

 

~~~

Things are looking good and I am heading in the right direction.

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19 weeks PO

I am 19 weeks post operative and doing really good. Particularly the past week.

In general, I am less aching after physical therapy, and I can tell my efforts with doing hours and hours of home exercises since many months are paying off and for the first time I really thought “things are coming together”.

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My PT gave the green light for the treadmill and the Elliptical, only to “try it” and see how it feels.

I tried 10 minutes very slow walking on the TM and really focused on proper gait and good walking technique and the Elliptical was 5 minutes, also slow. Was okay, apart from things clicking in the back of the hip (probably the hamstring tendon snapping) but those five minutes sucked the life out of me. Wow!

I am not pushing it on the TM or the Elliptical, I am happy with 10 and 5 minutes for the moment. Those are new exercises and things have to get used to it again.

~~~

My exercises at PT are going well and I am now done with them in an hour.

I really see big improvement and last week there was a significant push in my recovery. My “slow and steady”approach is paying off.

There is still lots of work ahead but I feel really optimistic about my future and healing up.

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My PT told me to try going to the park “without” crutches and see how far I get. He suggested going for 800 yards/ meters (once around the pond) but that is only happening in his little fantasy world.

I went for half of it. It felt okay, I was not in pain but on the way back I walked significantly slower and with more of a limp. A few hours afterwards both hips were aching, was not great but still tolerable.

Even though I did not go that far, it was a gorgeous day to be out. The trees were blooming, it was in the low 70’s and a picture perfect evening and I was one of the crowd.

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Next up? My follow up appointment with my orthopedic surgeon. Let’s see what the X-rays will tell.