Rehab Before Riding after Hip Replacement

The transition from hip replacement to riding again is not a quick one and requires rehabilitation and patience.

Part 3 in our series on hip replacement and the rider.

by Deidre Rennick

Rehab Before Riding Recovery after your hip operation is the highest priority, as is following your hip precautions carefully and your rehab exercises religiously. Do not expect to get straight back into caring for your horse and doing all the general ‘around the stable’ chores that you were doing before your operation.

You will be on crutches or a walking frame initially but your physiotherapist will teach you how to safely use these. Hopefully, you have a fridge and freezer already stocked with meals to minimise long periods of standing preparing food. Bath, shower and toilet may need adaptation for this period.

Perhaps the hardest part of the recovery is the last thing you would expect – and that is having to sleep on your back for up to six weeks, usually with a large rectangular pillow between your legs.

There are a couple of things often not discussed that can be an issue. Leg waxing and shaving the operated leg is discouraged for some time after your replacement in case any nicks, cuts or superficial traumas get infected.

Also, if you have any dental work in the first twelve months you are usually advised to take a course of antibiotics as a prevention. Infection in the artificial joint can lead to failure and revision surgery.

Once you get mobile you may find other bits can start to hurt. Many people experience back, knee or sciatic pain once they start moving as there may have been a long period of abnormal alignment, gait and posture.

Tony Golder (our bilateral replacement rider in the previous issue), found that after his hip replacement his second hip deteriorated rapidly once it started to carry the additional load.

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Thigh pain is also common in a full hip replacement due to the rod settling into the long femur bone, and areas of numbness in the leg. The most important thing is to keep your surgeon and physiotherapist informed of any issues, particularly if something is new or gets worse. Calf pain and new swelling can be an indicator of a blood clot, so should be reported to your doctor straight away. Chest pain, chest tightness and/ or sudden shortness of breath can also be a sign of a clot and urgent medical assessment and treatment is required.

Driving

You will probably be unable to drive for four-to-six weeks, depending on which side was replaced, and if you have a manual or automatic car. Get medical and insurance company clearance before driving as the issue of insurance cover can be tricky if you have an accident.

Rehabilitation

Your surgeon and physiotherapist will usually have a set schedule of exercises and milestones for you to reach before you go onto the next level of exercises. These exercises, and the safe progression to gradually increasing the use of your new hip, will be the cornerstone of your recovery.

Make sure your physiotherapist knows you are a horse rider, as the strengthening of your abduction (moving away from the midline) and adduction (moving towards the midline) muscles are critical for mounting and riding.

Generally you will be on crutches for six-to-eight weeks, usually the last three weeks will be with a single crutch or walking stick. Don’t rush to get rid of your crutches. You need to be strong and balanced before you do as you are still vulnerable to trips and falls.

Bringing your horse back into work

Exercises and Rehabilitation Your surgeon and physiotherapist will usually have a set schedule of exercises and milestones for you to reach before you go onto the next level of exercises. These exercises, and the safe progression to gradually increasing the use of your new hip, will be the cornerstone of your recovery.

Make sure your physiotherapist knows you are a horse rider, as the strengthening of your abduction (moving away from the midline) and adduction (moving towards the midline) muscles are critical for mounting and riding.

Generally you will be on crutches for six-to-eight weeks, usually the last three weeks will be with a single crutch or walking stick. Don’t rush to get rid of your crutches. You need to be strong and balanced before you do as you are still vulnerable to trips and falls.

Common Rehabilitation Exercises If you have not sent your horse elsewhere for agistment or training during your downtime, consider investing in a professional to spend a week or so with your horse to get any kinks out before you ride. Towards the end of your initial rehab program you may be strong enough to walk your horse in-hand, lunge or round pen (being mindful not to work in soft conditions where you could fall or pivot on your leg!).

Look at creating a rehab plan for your horse. There are loads of groundwork and strengthening options to get your horse and his brain back into work.

If you have not already done so, now is the time to train your horse to stand at the mounting block. Coach, Sandi Simons has a very simple training method to establish this, so look up her videos through her website or YouTube.

Back in the saddle When you return to riding will depend on a wide range of factors, so no definitive answer can be given. A lot depends on how well you are rehabilitating and also the horse you are going to get on!

A quiet plodder with soft paces who will stand patiently while you slowly mount will be easier to start on than a responsive, anxious horse with quick and jarring movements. Realistically, you should expect it to be a minimum of eight weeks after a straight forward replacement with no complications, before you ride.

Tony used his stationary cycle to practice the swinging action of mounting and finding the best technique to reduce stress on the joint. He is also using this as his guide for when he will be ready to progress to mounting a horse. Cindy knew she was

These exercises, and the frequency and number of repeats you will do for each exercise, are usually prescribed by your surgeon and physiotherapist. For those not recovering from a hip replacement they are also good for strengthening normal or early arthritic hips.

SUPINE EXERCISES (LYING DOWN) In the early post op stage you should keep your hip flexion between 45 and 70 degrees. Once you have clearance from your rehab provider the flexion can up go to 90 degrees.

Calf Pumps - with your knees bent, slightly flex your toes towards and away from you using a pumping action. This stimulates the calf muscles and keeps the blood returning to your heart and can assist in the prevention of clots and a reduction in swelling.

Heel Slides – slide your heel up towards your bottom and back down again in a smooth motion.

Leg Abduction-Adduction Slides – with your knees straight, slide your leg away from the midline of your body and back again.

Bridging – with knees slightly bent, lift your bottom off the bed and hold before gently lowering down.

STANDING EXERCISES If you can access a pool, exercises in water are excellent due to the gentle resistance and buoyancy of the water. As you get stronger you can exercise in more shallow water to increase the workload on the hip.

Knee Lifts – lift your knee (but remember hip flexion limits, so not too high!).

Abduction/Adduction Leg Swings – swing the straight leg away from and back to your midline Hip Extension – move your straight leg slowly back and forward again.

Heel to Bottom – slowly bring your heel up to your bottom.

Weight Shifting – whilst standing gradually increase the weight on your operated hip though a slight tilt of the upper body then shift back again.

Walking within your tolerance levels and using stairs are also additional activities that will aid your rehab program. If you do choose to stationary cycle like Tony, make sure you start with your leg almost straight when the pedal is at its lowest point to avoid too much flexion on the upstroke of the pedal. Initially you should sit upright and pedal backwards with little resistance until you are stronger, and your backward pedalling motion is smooth. Then you can progress to forwards and backwards pedalling and increasing resistance.

STAYING MOTIVATED DURING REHAB You will have good and bad days – recovery is never a straightforward process.

You would not expect your horse to perform Grand Prix movements three weeks after an operation, so don’t set your own goals too high.

Stay motivated by watching videos, reading books, planning rehab for you and your horse, goal setting or planning next year’s calendar of events. Learn a new skill through online learning, such as massage and stretching. Try not and be disheartened if you don’t hit the goals right on time. Sometimes taking more time in the basic strengthening stage can give you better long term results.

Rehab before riding continued... you will be unlikely to be able to dismount unassisted should this occur. Realistically, it can be anywhere up to twelve months before you can expect your hip to be fully stable and supported by the surrounding muscles, particularly with a Classic hip replacement, so plan how you will slowly increase activity.

Joint Life

Even with the quietest of mounts it is a good idea for your first few rides to be on a lead or lunge, so that if anything goes wrong you have someone else in control of the horse. ready when she could get on and sit comfortably on her quad bike.

You can also sit on a large Fit Ball (remembering to maintain your open hip angle, so not too soft a ball) and rock your pelvis back and forth to simulate riding movement. Following your precautions will help to keep your hip safe when preparing to ride – so you will need a mounting block that allows you to mount without overflexing your hip, or mount using your non-affected leg (even if only while your affected leg gets stronger). If you have to mount on the affected leg, be very careful not to pivot on it as you do – the stirrup needs to freely rotate as you pivot to mount.

The next step is to ride in an enclosed area with a soft fall surface and someone around to keep an eye on you. Your main risk in the early post-operative stage is dislocation, which is very painful, and

Cindy’s First Ride Cindy Francis was our Pre-Hip Replacement Rider in the last issue.

It is now three months after Cindy’s operation and we caught up with her to celebrate her first ride and discuss her journey.

Being on a farm Cindy did not have access to a gym or pool, so she spent a lot of time gradually increasing her walk distances and getting back to farm work. Cindy decided the time was right to ride when she realised that she was already doing so many things – riding the quad bike, gardening, crawling on the floor with her new granddaughter, carting fire wood, getting up and down at work, walking and driving – all without pain.

It was a month sooner than she expected, as she had set her goal to be riding at four months, but she felt ready. She had some lingering thigh pain from the rod settling into the femur bone, but the rest of her hip was pain-free.

To prepare for her first ride, Cindy organised her husband to be present. King had only October/November 2019 - Page 58

Everyone wants their hip replacement to last a lifetime, but unfortunately the average lifespan of a hip prosthesis is 20-30 years and depends on a range of factors, such as the rate of bone thinning (particularly for post-menopausal women) and the wear and tear the replacement is subjected to over time. Generally, your new hip will be stronger than your original diseased hip, and can survive the impact of a fall from a horse. You need to understand that hip replacements do fail and revisions can be required, but this is your best chance at resuming a pain-free horse riding life.

Continue to follow your hip precautions, maintain your rehab exercises, take your time, listen to your body, avoid putting on weight and in 12 months’ time you will probably forget you have even had a hip replacement! Good luck and happy riding!

This article provides general information only and may not apply to your circumstances. Always be guided by your health professionals for your individual recovery program.

About The Author: Deidre Rennick Deidre is an older rider who has suffered from osteoarthritis for the last 15 years. She had one hip replacement ten years ago and is heading towards another. Deidre was the Project Lead in the development of the resource for general practice nurses “Osteoarthritis Nurse Clinics: A Resource for Primary Health Care Nurses”.

done a couple of lunge sessions leading up to the day, but as she knows him so well she was comfortable that he was fine to get on. She approached it step-by-step, thinking “if it hurts or doesn’t feel right, I can stop”. Importantly, it was telling herself that if she didn’t get on and ride it wasn’t a failure – she broke everything into little steps and as each little step didn’t hurt or feel strange, she kept going until she was there – sitting in the saddle without pain! Cindy normally rides in spurs but didn’t use spurs for her first ride in case they made King too sharp.

In retrospect she feels she could have worn spurs to minimise her leg movement, as she did pull up with a bit of muscular soreness.

“Getting on was very nerve wracking, as at any moment I was expecting there to be pain”, she said, “And then I got on and it was WOW, WOW, WOW – no pain!” After eight years of riding in severe pain, Cindy could not believe the difference.

“I was really nervous to trot, and suddenly I was doing rising trot!

Then I popped into a canter!

It was amazing.”

She is planning to gradually increase her ride times – keeping it to ten minutes was enough for her first two rides.

Cindy has been able to get off all her strong pain and anti-inflammatory medications with now just some maintenance paracetamol and ibuprofen when she has done a lot in a day. There has been a huge difference in her mental state and ability to think. “The fog has lifted!” she says. We look forward to seeing Cindy and King returning to the competition arena in the future.

Cindy Francis and King - on their way back to competition after the operation.

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