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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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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Mini progress!

7 weeks PO and two physical therapy sessions down.

That place is hopping! A constant flow of patients coming and going, whereas I am by far the youngest. The average age there is 65 and somehow I always get stuck with some old guys who work out right behind me, making weird noises. Eeeeeek!

To warm up I was told to do the stationary bike for 10 minutes without resistance. I swear, among all the high tech equipment they have, this was the wimpiest bike there.

 

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I was there for almost 1.5 hours and did all of my home exercises. My PT also did passive movement with my hip, to gain ROM.

He also did massage the scar tissue and the hip flexor. That needs major attention and I need to see an ART therapist for that, when I am more mobil again. It seems like I have quite a bit of really hard scar tissue in my thigh and of course adhesions.

He rolled out the TFL band too since it’s tight and I still have swelling in my upper thigh from surgery.

~~~

The only movement I should avoid is deep flexion with internal roation. Also, still no green light for going in the bathtub. Requires too much flexion of the hip.

 

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My PT was happy with my exercises and we both could already see improvement. He gave me very specific exercises to target different muscles. Muscles that were in the sleeping mode for the last seven weeks and they need to be woken up again.

The home exercise program I was given takes me a good hour right now.

~~~

I am definitely walking better than last week too. I had people with walkers pass me in the hallway, but better is better.

 

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I do get the feeling though that my PT rushes things a bit. Already at my first visit he told me about doing the anti gravity treadmill “ next time”. I am not a fan of the idea of doing it so incredibly early on.

 

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After all, I have not formed bone or even reached 25% weight bearing yet. So when he suggested it at my last visit,  I told him no.

 

Maybe later on, when I am more weight bearing and stronger but at the moment my fracture is still there and is only being held together by three screws, and the middle one is “too short” as it is, according to my local OS.

In his opinion it should reach more/ longer into the femoral head and even though I am not a radiologist, looking at the Xray, I see what he means.

~~~

I asked my PT if he had patients my age with this kind of fracture before and was told “not too many”, which could also translate to “none”…. Hm.

He suggested to “put weights on the ankles” next time I do prone hip extension with a bent knee. (What part of me telling him that “I am a slow healer” did he not get??)

 

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There won’t be any weights on my ankles next time!! It is plenty to work with my own body weight, especially so early on.

 

I have read one should avoid “too much too soon” since it’s a very delicate recovery. If one pushes things one can end up with a stress fracture in the femoral neck and that on top of the still fractured hip would have me headed straight to a THR. I need that as much as a hole in my head.

Already from the exercises we did I was in pain afterwards. My night was miserable and my hip was very angry. It also did not help to have me double my time on the stationary bike within two visits.

 

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~~~

The verdict for this week is a good one. I am walking better, pain is in general low and PT is already paying off.

 

The next big hurdle is my 12 week PO follow up appointment. In a perfect world, the Xray should show hard callus and ideally, some new bone already. If not, then it means I am taking the scenic route in this recovery again and more quality time with my mobil legs.

 

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The next chapter in my story

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6 weeks PO and doing good. Pain is pretty low during the day, nights have gotten much better too. I am not sleeping on my op side yet but with the help of many pillows, I am halfway there. Progress!

My op hip still gets upset easily and then all I can do is rest, ice and wait it out.

Putting on socks is getting easier too but it also takes its sweet time.

 

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I have done more research on my injury and those are the sentences I read over and over again…

 

  • Femoral neck fractures in young adults are uncommon and often the result of high-energy trauma.
  • These fractures typically occur after a slip and fall. In a healthy, young adult it would be very unusual for the type of fall to cause a broken hip.
  • Hip fractures in young adults comprise a small proportion of the total hip fracture population. However they form a distinct and important sub-group, often presenting as a result of high-energy trauma.
  • Femoral neck fractures in physiologically young adults are less common than intracapsular femoral neck fractures in elderly patients.
  • Hip fractures in young patients are rare.
  • Femoral neck fractures in young adults are difficult to treat. There are substantial gaps in our knowledge regarding treatment and prevention of young adult femoral neck fractures.

 

Article like these are always a confidence booster and make me feel real special.

 

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Sarcasm aside, the absolutely  BEST  article on the whole subject I found so far is this one:  https://juniperpublishers.com/oroaj/pdf/OROAJ.MS.ID.555693.pdf

~~~

United airlines really cracked me up last week with an E-mail too. This was their advertisement…

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Ha! I sure had my little adventure “beyond the slopes” when I ended up in the hospital. Not exactly how I had our week of ski vacation pictured.

~~~

The most important event of this week was for sure my six week follow up appointment with my OS.

After changing into those weird paper shorts, I could really see the atrophy in my R  op leg. It’s scary, the whole quads on my R side seem to be gone.

 

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New X-rays were taken.

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Thank goodness it was good news! My fracture has not completely healed yet, we still could see the fracture line, but the healing process has gotten started and things are moving in the right direction.

According to my OS it can take up to 12 months for the bone to heal. So far no bone has formed, only soft callus, which is the step “before” bone formation as explained very nicely here…

 

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No sign of AVN, malunion or nonunion either, which is fantastic news!

~~~

I am allowed to add a bit of bodyweight, about 25% for two weeks. After that I should try to bear 50% of my bodyweight for two weeks and work towards WBAT (weight bearing as tolerated) after that. I am also supposed to start physical therapy.

When I asked about aqua training as part of my physical therapy, I was told it is still too aggressive since it is an acute fracture. Maybe down the road we can consider it but not now.

 

Driving my car also has to wait unfortunately since it’s my R hip/ leg and going on the break would be too much weight on the hip. I either risk re-injurying the still fragil hip or causing an accident.

~~~

The whole recovery should take between 3-4 months, meaning till “I can walk without assistance” (crutches or a cane). Returning back to sports takes a minimum of one year. Those are guidelines, knowing myself things will take longer as I am a very slow healer and of course one has to adjust along the way.

I know there will be lots to work on, like finding my gait and balance again, working on endurance, strength and building up muscle mass, getting rid of muscle imbalance and addressing soft tissue problems like scar tissue and adhesions. Lots of work ahead.

Besides, my OS said, the fracture I have is usually for 70 and 80 year olds. And of course I got the  THR  speech again, just in case something does not go according to plan.

 

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The increase in body weight from 10% to 25% should add compression to the fracture and stimulate bone growth by aggravating the cells a bit. So basically, those guys need a good smack on the back of their heads!

I asked how I can tell how much 25% of my body weight is in my foot and was told, to put my op foot on a scale at home till I hit the right weight. In my case it would be 46 lbs/ 23 kg.

 

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I tried it very gently but can not reach it. The most I reached was a bit over 20 lbs. Bummer since this is less than half what I should be doing but this is all I have so far. I have no strength in the op leg. Zero.

~~~

My first walking experience with adding some weight to it was interesting and sloooooow. (I am turning into a sloth, I swear.)

 

I did some mini walks in our home and the op hip felt fine. The other hip was not happy about it, whysoever, but that’s the thing with hips – never a dull moment!

Walking with more body weight takes more energy and makes very tired. Those are my first impressions. But it sure felt good using both feet, especially since those were my very first steps of 2018, since my accident happened on December 31 last year. Happy New Years to myself!

 

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All together I am very happy how things are progressing and very relieved about the good diagnosis. I made appointments for PT and next week I am getting started. Let’s see what my new PT has up his sleeve.

Off to better things. ❤

 

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