Myths of hip fractures

First of all, I am done with my flare. Lasted solid three weeks and also meant three weeks of rest and no workouts. At the moment I am in the process of trying to work myself up again to what I could do “pre-flare”.

 

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In my last year, recovering from hip surgery No. 3, a complete hip fracture, I came across many comments and wanted to debunk some myths.

 

1.) “Hip fracture is not hip fracture.”

An incomplete fracture is a totally different story than a complete fracture or a stress fracture.

Also the location, angle and severity of the fracture takes a big role in how the surgery or recovery will be approached. Some fractures need surgery, some don’t. Some need pins, some rods while others just require rest and crutches.

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2.) “Once you are done with crutches, you just walk again.”

Nope. First of all, you will start “weaning off” crutches, which will take another few weeks and is a gradual process, you don’t just “drop” your crutches and go.

And second, nobody walks normal right away again. You are dealing with muscle atrophy, the bone is still weaker and your gait will be off.

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3.) “Physical therapy is overrated.”

Most certainly not. I can only speak of my own experience but I know 1000% I could not have done it and would not be where I am at right now, without physical therapy.

If you end up being on crutches for five months like I was, there is  TONS  to work on. Build up strength and endurance, isolating muscles to start firing again, range of motion needs to be worked on, gait, walking sideways/ backwards… an endless program.

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4.) “Once you are done with PT, you are done with rehab.”

I wish. After surgery to your hips, your hips will never be the same again and to keep your hips happy, you better get used to the idea that is a lifetime commitment from now on.

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5.) “You can speed things up by taking shortcuts.” 

This is a serious injury and requires medical expertise, good guiding at PT, following instructions from your OS and PT; dedication, time and effort.

You can not shorten up the time on crutches. Either your bone is not strong enough yet for bearing weight or your muscles mass is not there yet. Most likely both but if you still push for it, you  WILL  PAY  for it. With pain, a huge setback and you are at risk of refracturing the bone.

Also, the “no pain, no gain” attitude in the gym does not work. You can not bulldoze your way through this recovery, that’s just not the way this recovery works.

 

 

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6.) “It’s just a broken hip. Everything else still works.”

Initially yes, but once you are on crutches for a long period of time, it will create a domino effect on the entire body.

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7.) “Only old people break their hip.” Definitely less common in young adults but still possible, I can assure you.

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8.)  As read in Google “Recovery from a broken hip takes three months.”  Obviously a statement written by somebody who never had to go through it. A minimum of one year recovery for a complete fracture is more likely.

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9.) “It’s just a broken bone.”

Wrong on so many levels. It is first of all a major weight bearing bone and second, the surgery/ recovery comes with many risks and can take many bad turns, even death in the cases of older people.

It also is not just an injury that affects you physically but also mentally. It’s not easy to go from a busy and active lifestyle to basically being disabled for a while, being dependant on others and staying put. It gets to you and it is also pretty demanding on your partner.

~~~

10.) “Hip pinning is an easier recovery than THR.”

Two complete different surgeries and therefore different approaches for recovery. THR means replacement, hip pinning means fixing the bone.

It just can not be compared. It’s apples and oranges.

 

 

That’s all.

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Putting the hip to the test

 

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7.5 months  PO,  R hip pinning.

 

We just came back from vacation and it was a good test to see where I am at. It was a  pretty active few days, nothing too crazy but still, challenging enough for somebody in my situation.

What I learnt was, “speed walking” is not my friend, nor are many “uneven, high” steps, uneven ground or long distance walking. (All in one day…)

 

The mentioned uneven and challenging ground.

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For example – we did a day trip and first thing – a pretty long walk on uneven ground. I thought I was smart by walking behind some senior citizens (they had the perfect pace for me, as pathetic as that is…) but we were told by the tour guide to speed it up and put “a bit more passion into it”.

I did the walk but on the way back my knees were really shaking.

The day was pretty challenging and in the evening I had  NOTHING  left. Zero. I was limping heavily; walking very, very slowly and was exhausted. Once home, I fell onto my bed and slept for two hours like in a coma, only to wake up in the exact same position, pretty much like this guy…

 

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What I learnt this vacation was, 10.000 steps are not 10.000 steps.

I can do 10.000 steps/ day now again but it is a  h-u-g-e  difference if I accumulate this with many, many short distances (grocery shopping, household chores, doing the Elliptical etc.)  OR  if I have to crank it out in several long distance marches. Definitely not the same thing.

~~~

Was I surprised by it? Not really, since this is hip surgery recovery No. 3 and it was a more severe injury, more invasive surgery and yep, more time on crutches than after the first or second surgery ( FAI & labral tear).

I have lost  A LOT  of muscle mass during my time on crutches (20 weeks) and it takes forever to get it back. Probably around two years for me, but I was happy about what I could do.

 

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We had to take one day off, to recover and give my hip some rest but otherwise I did everything. Walked over lots of gravel and uneven ground, climbed up to see waterfalls and iceberg lagoons, hiked around the crater of a vulcano and did a good amount of sitting in busses too.

 

Hiking around the vulcano crater and taking a well deserved break. 

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I had to do the activities my own speed and choose my walking paths more careful than others but I did it. Most of the times my op hip and surrounding muscles started aching in the evening which was okay. That’s why I brought the icepack along.

~~~

So I know now I can walk in an airport without wheelchair assistance and I can do a whole vacation again. Endurance on vacation was at about 40 % to where I was before I broke my hip.

I still need more overall strength and endurance in my op hip, glutes and quads, strengthen the knees as well and work on muscle imbalance. Unfortunately this will take its sweet time.

Some people can just go ahead and really crank it up in the gym to see faster results. Good for them but it does not work for me. My body heals slowly and what I have going for myself is persistence and consistency with my hip friendly, PT based workouts, patience and time will work for in my favour.

 

But the good news is, even though I am not as strong yet as I want to be,  I see improvement to a few months ago and considering where I am at in my recovery, I did really good.

I am happy. The trend is still going uphill.

 

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Things are going according to plan

6.5 months PO

 

I am doing good. My hips like my new PT/ workout routine much better than physical therapy which turned into bootcamp in the end.

 

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I still get achey with my op hip, on “very special” days it’s both hips, but in general they are much calmer. Compared to two months ago I feel much stronger too. Of course that will be put to the test at some point and I probably still can’t keep up with others over longer distances but I am getting there.

For example, I can walk a bit more than a mile now and I even can pass people, so I am officially not the slowest one in the park anymore. Ha!

~~~

  • My Elliptical is up to 11 minutes on level 1,
  • the stationary bike I can do 16 minutes on level 1 and
  • walking on the treadmill is also okay for 16 minutes, medium fast walking speed. I guess adding a minute every two weeks is safe. Of course it’d be nice to go for more but what’s the result? Two pissed off hips.

 

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At my 6 month follow up with my orthopedic surgeon X-rays were taken and everything is healing nicely. There is continued bone healing and bone remodeling taking place and no complications.

 

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He reminded me again, that this is a recovery that can take up to a year. I believe it but I do feel like I have, for the most part, my life back already.

I can take care of my family again, run the household & errands and except for doing sports, I am the same as before I so geniusly kissed the snow. Now it’s all about fine tuning.

~~~

He examined my hip and it is gliding smoothly and its mechanics work well. It is not completely anatomic anymore since the fracture was impacted and I might have aches here and there from now on, but when do I not? I expect things to get even better with time and I am already very happy with the healing process.

 

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I should “keep doing what I am doing” with my exercises and should be able to go skiing again early next year. Music to my ears!

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My daily steps are also improving. I am now doing 10,000 steps several times a week but I also learnt two lessons the hard way last week.

a) I went too fast on my stationary bike and was limping and hurting the whole next day.

b) I have to watch my walking speed and gait. For one of my walks I walked too fast and my stride was too long, was hurting the whole night. So back to walking a bit slower again and making smaller steps.

 

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Trying to figure things out

5 months/ 3 weeks PO

 

Since both my hips were seriously not happy last week, I took about five days off and did no  PT  exercises at all. My hips needed a much deserved break.

 

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My op hip is still recovering and the other one has been majorly working overtime for the last six months and has had it too. If I keep plowing through this with my PT’s  “no pain, no gain” attitude, I am setting myself up for a nice stress fracture in either or both hips and that’s not part of the plan.

I kept following my PT’s instructions to the “T” and did everything he asked of me but at some point it became too much.

 

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I am more of the “slow and steady wins the race” kind of girl and like slow approaches, but my PT just kept on piling on, one exercise after the other.

The days off felt so good, like a breath of fresh air to my hips and muscles. Less is more.

~~~

Now I started again with my exercises at home. I made up a workout plan that involves the Elliptical, walking outdoors, the stationary bike; planks, free weights, stretches and of course my PT exercises. Every day a different mix but less.

 

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My muscles need to be confused, if I do the same old, same old – day in, day out, I will build up muscle memory and won’t improve my situation.

~~~

Last week I tried walking a mile on my treadmile. What I know now is, “a mile in the park is not the same as a mile on the TM”. (Again, a lesson learnt the hard way…)

The  TM  pulls too much on my hip. I have to get used to that again and build it up gradually.

~~~

This week I noticed my glutes are starting to fire again. Finally! I am glad they snapped out of it and start doing their share. The gluteus maximus is a huge muscle and if it hangs out in lala land, others muscle have to compensate and muscle compensation is never a good thing. So – welcome back!!

 

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I still have not found the ideal rhythm of being active, challenging my hips & muscles and “pushing myself” but not overdoing it. That will take a while, years probably, but I am used to it from my previous hip surgery recoveries.

My new plan is a hit or miss with countless adjustments coming up and an even bigger need of patience. I am aching again, op hip/ good hip, seperate or together. They are flexible like that.

 

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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.

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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.

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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.