Wondering whether it's safe to be returning to the gym after hip replacement? We asked one of our most experienced hip physiotherapists, Eric Huang, who also has a special interest in strength and conditioning, and sport, to write on this topic for you. Eric has worked for over a decade here at PhysioTec in Tarragindi, Brisbane, with our practice principal and physiotherapy hip expert, Dr. Alison Grimaldi. Eric has also worked for many years with Associate Professor Patrick Weinrauch, Brisbane hip surgeon, where they have collaborated to optimise activity and sporting outcomes for patients following total hip replacement surgery. Take it away Eric!
With modern technological advances with prosthetic material, the capabilities of modern total hip replacement (total hip arthroplasty) are much greater than what they once were. We have all heard at some stage from someone who has had a hip replacement, and had been told by their surgeon explicitly that they were to never do any impact activities like running and jumping. Most people then naturally assume that this is the case with all hip replacements, and that the gym might also be out of the question.
While some prostheses (hardware components of the hip replacement) may not be appropriate for impact activities, most modern-day prosthetics are more than capable of tolerating impact, provided the muscular structures around the hip and the lower limb are tolerant to absorbing the load.
This brings me to the topic of returning to the gym following hip replacement. If you are considering running, playing sport, or returning to the gym after hip replacement, it is important to reach out to the treating hip surgeon who performed your surgery, to see if it these activities are appropriate for your personal situation.
This blog will cover the following points on Rehab and Returning to the Gym after Hip Replacement:
- Post Total Hip Replacement Recovery Timeline
- Total Hip Replacement Recovery: Strength and Conditioning
- Total Hip Replacement Recovery: Gym Loading Patterns
- Getting Help for your Total Hip Replacement/Arthroplasty
- Total Hip Replacement FAQ
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Are you planning on having a Total Hip Replacement? Or have you recently had one? Book in with one of our friendly, experienced Hip Physios, and let us help guide you through pre-operative and/or post-operative recovery after hip replacement surgery.
While you might have been waiting for a long time to have your hip surgery and finally running again, or returning to the gym after hip replacement, it is important to respect the healing timeframe and stages of rehabilitation. Hip replacement is one of the most successful operations performed on the human body, but it is still a big surgery and there is quite a lot of healing and recovery that needs to occur - not only from the surgery but also from the years of functioning with an arthritic hip.
Following a high-quality rehabilitation program with the guidance of an experienced hip physiotherapist, will provide the most rapid recovery while reducing chances of setbacks or injury.
Post Total Hip Replacement Recovery Timeline
Below you will find a general outline of a typical post-operative recovery timeline, and guidance towards returning to the gym after hip replacement (for those with goals to return to the gym after their hip surgery - this might not be your goal).
The timeline will vary depending on a number of factors, including the complexity of the surgery, type and stability of the prosthesis, type of surgical approach (anterior, lateral or posterior approach arthroplasty), early response to surgery, pre-operative level of physical conditioning (muscle strength, health, endurance and co-ordination, range of motion, movement patterns), and other additional musculoskeletal or general health conditions.
0-6 Weeks Post Total Hip Replacement Recovery
- 'Dust settling down' phase - recovery from immediate surgical effect.
- The primary goal at this stage is to get plenty of rest, nutrition and hydration, while gradually returning to activities of daily living.
- Exercise is focused on encouraging gentle loading of deep hip muscles and restoration of good movement patterns and everyday functional tasks.
- Restore good walking habits, adequately supported by 1-2 crutches. Gradually build up tolerance to nonstop movement (steadily increases daily). Don’t be in a hurry to get off the mobility aid as stamina will not return immediately. Walking well is a far higher priority, than walking without a crutch or stick.
6-12 Weeks Post Total Hip Replacement Recovery
- Continue to work on further hip-specific muscle strengthening and optimise the lower limb kinetic chain by incorporating gym-based loading, or strength work in the home.
- Avoid hinge type work (deadlift etc), where the body leans forward and hands reach below the level of the knees. This is especially important for posterior approach hip surgeries (scar in the back). For anterior approach total hip replacement (scar in the front), introduction may be earlier but the load and depth of the movement still needs to be carefully controlled in the early phases. This is best done under the guidance of an experienced hip physiotherapist.
Are you having/have had a Total Hip Replacement?
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3-6 Months Post Total Hip Replacement Recovery
- Continue to optimise the lower limb kinetic chain - functioning of the whole leg.
- Introduce hip-hinge type work like deadlift starting from Romanian Deadlift ->Rack lift ->Trapbar deadlift -> Gradual lengthening of posterior cuff and hamstrings - under the guidance of a physiotherapist experienced in hip rehabilitation and gym technique.
- Stretches particularly for hamstrings and posterior hip musculature no earlier than 3-4months.
6 Months + Post Total Hip Replacement Recovery
- If the treating surgeon is happy with the x-ray at the 6-month review mark and the prosthesis (components of the hip replacement) is appropriate for impact activities, we can gradually guide you towards introducing impact loading like a return to run program, and plyometric skills (jumping, landing).
Total Hip Replacement Recovery: Strength and Conditioning in the Gym
(Remember, returning to the gym after hip replacement is always safest under the guidance of an experienced hip physiotherapist, with knowledge or strength and conditioning technique).
Type of exercises to consider after surgery
For gym-based exercises, I tend to favour compound double-sided loading to teach the movement initially and then progress to offset/single-sided loading to encourage the surgical side to load and develop control with the lower leg.
Range of motion considerations after hip replacement surgery
Start with the range of motion that you can control but be mindful, especially in the early phase (<3 months), not to overly push the range. This ensures you don’t overstress the surgically repaired capsule.
Contraction mode for gym exercises
Using an eccentric focused tempo in your lift is also a really good way to develop good control and build strength.
For example, you can try a tempo with 3second down; 1second pause; 1second up; and 0second pause at the top. This will ensure you develop a good sense of control and body positioning by slowing down the lowering phase and increasing the time your muscles are under tension, which will help to build strength.
Exercise sets and repetitions
Repetition and set prescription can be as simple as 8x3 sets for double-sided movements and 6x3 sets for unilateral movements (offset/single leg). The earlier you are in the post-surgical phase, I would be conservative about how much weight you use and the number of reps/sets you do initially. Observe your response after the workout especially at night as you have to remember your ability to recover from the gym stress is now hindered by the fact that the body has other higher priorities around healing the effects of the surgery.
Aim to give the lower body a rest from the weighted loading - at least a day in between to allow recovery. As you progress further and you are recovering well after a gym session, you can aim to use a weight that will work you hard enough to achieve 2-3 RIR (reps in reserve) within a 6-8 reps set i.e when you aim to do 6 reps, you feel like after the 6 reps with a certain weight, you can do an extra 2-3 at the most. This ensures you can work yourself hard enough to get gains but at the same time not too hard that you might be too sore which may take longer to recover.
Working into excessive fatigue may also reduce safety for the prosthesis, so always progress within reasonable limits, and get good advice and guidance to achieve best outcomes safely.
Total Hip Replacement Recovery: Gym Loading Patterns
Below you will find an inforgraphic of some of my favourites gym loading patterns - types of lifts that really help encourage good hip loading after total hip replacement.
Hip and Back Dominant Lifts:
- Weighted offset bridge
- Romanian deadlift / Romanian offset deadlift (2 hand hold or opposite arm hold to challenge hip rotation control)
- Landmine offset romanian deadlift / Landmine single leg Romanian deadlift
- Trapbar deadlift / trapper offset deadlift
Hip and Knee Dominant Lifts:
- Goblet offset squat
- Front squat / Offset front squat
- Landmine offset goblet squat
- Bulgarian split squat (start bodyweight, goblet hold, 2 arm dumbbell hold, opposite side hold)
Getting Help for Total Hip Replacement/ Arthroplasty
Hopefully the above information has been helpful as you embark a fulfilling journey of getting full usage out of your new hip.
This blog is informational in nature and should not be taken as personalised medical advice. As always, consult with a physiotherapist to assist with mapping out your optimal post surgery work out plan.
You can make a booking with me, or one of the other friendly physiotherapists here at PhysioTec, and we will help guide you towards a positive recovery.
Total Hip Replacement FAQ
Have you, or someone you know recently had a Total Hip Replacement? Planning on having one? Visit us at PhysioTec, and let one of our Hip Physios assess you and provide you with a personalised recovery program to help you jump-start your post-THR recovery, helping you get back to doing the things you love!
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