Physical therapy amped up a bit again this week!

Monday started off with warming up on the stationary bike for the first time which made me feel pretty awesome! Then back in the main room my PT told me she was going to push my range of motion, which made me nervous because I had flashbacks to painful months of attempting to push flexion back into my knee post op (it healed stiff by surgeon’s design). Thankfully since this procedure didn’t require ligament immobilization/support for an extended period of time, my range of motion hasn’t suffered too badly.

I was able to comfortably flex my hip to about 120 degrees flexion on my own, which she said was “full range of motion”. I then demonstrated flexing/rotating my non-surgical hip to be able to put my leg behind my shoulder and she amended her declaration to “normal” range of motion. She did some passive range of motion work which included external rotation for the first time since surgery which felt pretty good, as did the abduction stretch she put me in. All around everything is coming along really well and my range of motion on all points is not requiring any aggressive intervention thankfully!

Up until this point I had been sticking to the post-op hip movement restrictions since I hadn’t been told otherwise, other than the end of last week when I was told I could start bending past 90 degrees if comfortable. So, she sat me down at the end of our session and clarified for me that those post op restrictions are pretty much lifted and now I’m at the phase where movements are allowed, provided that they are controlled, not excessively uncomfortable, and no impact. Still no aggressive isolated hip flexor engagement, single foot per stairs on ascent/descent, etc. Thursday we did start adding some shallow straight leg lifts to start strengthening my hip flexors again, and also added a band around my ankles for my standing hip extension/flexion/abduction reps.

My cane has been approved of although I have been 100% okayed to walk around without it. I am going to continue to carry it when out and about for two main purposes; to slow me down so I don’t do something stupid, and also to alert other people that I’m slow and to not run me over.

New Home Program

My therapist gave me an updated home program which I dove into for the first time on Tuesday – she also said I was free to do any additional exercises that we did in clinic as well. I got done with my first run through and it just seemed like it was more exhausting than doing the session in the clinic – probably because I had done PT the day before. It could also have something to do with the new mobility work of work of external rotation, and activating/opening up a bunch of muscles that haven’t really been targeted for a hot minute. After my discussing with my PT on Thursday she agreed it might have just been exhaustion from two days in a row and agreed I should do the stretching and mobility work every day and just do the strength work every other day while I’m rebuilding.

Some of the new exercises this week have been 45-degree wall sits, non-banded clamshells, standing leg extension, and bird dogs. I’m also now adding a butterfly stretch for external hip rotation. Additionally, a “bend knee, grab toe, straighten knee” hamstring stretch has been added to the stretches now that I can comfortably/safely bend far enough for that movement.

Since I was told my post-op movement restrictions are eased up, I decided to test myself and (with the support of my cane at first) discovered I was able to do box drill movements with my legs. I like to use my cane or a strap for support if I am trying a new movement so that I can bail on it easily if it starts feeling awkward. I showed my PT and she approved the movement since it feels smooth in my hips and I’m not leaning forward or putting any weight the joint yet. I’m able to control the full movement including extending my right foot in front of me and holding it off the ground while switching between internal and external rotation. I currently am moving my left leg first and using it to base but eventually will work back up to moving both sides at the same time.

My current weaknesses that I notice are definitely in any “step up” motions with my right leg and the clamshell actions are weak as well since it’s new. The first time I did them on Monday I was not able to comfortably bring my knees together again since I had still been observing “pillow between knees if lying on side” precautions as I hadn’t been told differently so I was stiff at that angle. Doing them on my own Tuesday I was already able to comfortably bring them together, so the stiffness was already worked out.

Week Recap

By the end of the week, I could already tell a huge difference in confidence/strength for my hip flexors. I went from barely moving to able to use the light resistance bands without any soreness afterwards. We are of course keeping an eye out to make sure nothing we are doing is causing any tenderness that might be a signal that we are progressing too quickly.

I’m a bit slow to post this update (I usually post it on a Friday but today is Sunday), but I wanted to wait and add on my Saturday adventure before posting. A friend came to visit and I was able to (slowly) walk all over our local farmers market. I brought my cane of course and it was exhausting, but I did it and had no pain – waking up this morning feeling just fine.

I’ve noticed with my home program that with some of the movements I will feel an occasional small pinch in my hip. If I pause the exercise and internally rotate my hip for a small stretch which relieves the pinch and then I can resume the movement without the sensation. I’m going to bring that up to my PT and also my surgeon when I see him at my follow up. My guess is it probably has something to do with scar tissue and/or my hypermobility – since it resolves easily I’m not too concerned at this point.

This coming week I will only have one session in the clinic of Physical Therapy since Thursday is Independance Day here in the US. So I will be in the office Mon/Wed, and have PT on Tuesday. Thursday the office will be closed and I’ll likely work from home on Friday as well. The following Monday is going to be a big news day – post-op visit with my surgeon. I’m writing out a whole bunch of questions to annoy him with!