When a PT Rehabs

So you want to know how long it will take you to recover from hip arthroscopy, huh? Quite a while, that’s all I can tell you. Each person, each hip, each surgery is different. You need to talk to your surgeon and your physical therapist to know what you are allowed to do and when, because it will depend on what surgery you had, what your surgeon’s protocol is, and how your recovery is going.

However, if all you want is an example of what to expect, here is a hip arthroscopy recovery timeline for one person:

How I’m Doing

Pretty good. There is a little up and down with the soreness, because when you start to do more, it can be a little more sore. But, I’m pretty cautious with adding new things, so the only day that it really got sore was the day that I ended up having a lot going on. Just gave myself a rest day the next day and used the crutches more. Settled right down. After 4 weeks of very little changing, there has been a lot of progress this week!

Progress

• Using crutches less is going well. Almost too well. What I mean is, it feels pretty good to not use the crutches in that it doesn’t hurt and it feels pretty stable, and I’m not lurching to one side. However, if I’m not really careful, my hip wants to stay slightly flexed and my back wants to extend (arch into a sway back position) instead so that my hip doesn’t have to straighten out or extend. It’s better to use at least one crutch and not get that compensation than to rush off the crutches!
• Got into the pool a couple of times. It feels so good to move with the added buoyancy! Not only that, but it felt great to move for about 40 minutes at a time. Hard to get that when crutching around.
• I have added a couple new exercises, including bridging on a ball. Being able to do my exercises on the floor also means that I am able to gradually start adding a little more gentle stretching and soft tissue work.
• I’m loving my walks. Walking for 5 minutes or so may not be the same as walking for 5 miles, but it’s how you start. Also easy to do inside since it’s single digits and snowing here today.

Precautions

• Careful with walking to avoid twisting or rotating while standing on that hip.
• Avoid movements that cause pinching.
• Be careful lifting my left leg, but letting it do a little more.

What I’m Working On:

• Not letting my impatience to be off crutches get the best of me and really making sure my walking is the best I can make it. At this point that is sometimes no crutch when in the house, one crutch or occasionally two crutches.
• Hip flexor stretches- probably one of the biggest things I can do to help my biggest walking issue.
• Lying on my stomach for at least 2 hours per day.
• Ice as needed.

Exercises

• Psoas stretches
• Iliacus stretches
• Rectus femoris stretches
• Hands and knees rocking (being on my hands and knees with my back flat and moving my hips back toward my feet)
• Cat/cow
• Tall kneeling- some balance with turning my head, some moving the pelvis and shifting weight.
• Bridges.
• Bridging on a ball.
• Hip hinge.
• Standing “skaters” (hate the name of this one, because I don’t really think it’s very descriptive of the exercise, but I didn’t pick the name and it’s a good exercise).
• Core activation. (Not technically one particular exercise, but rather being sure to engage during walking, pool, and yes, a few exercises where it is a little more of a focus.)
• Bike (upright stationary)
• Pool- Aiming for 2 times per week, walking forward, backward sideways, some standing hip movements and core activation, a little stretching. No hot tub due to COVID, so that’s about all I can take before I have to go warm up!
• Isometrics (so, tightening the muscles and holding them for about 5 seconds) for my glutes (butt), quads (thighs), abs and pelvic floor. Yep, still occasionally do these. They are not glamorous and are a lot less needed now as I can do more, but I still do them some when I have a little extra time.
• Starting to work some on calf stretches, toe extension stretches, foot strengthening (I know, foot and calf don’t SEEM like they would make a big difference to the hip, but they do. They really do.)
• Also starting a little more upper body work. Things like wall push ups. Super simple and nothing to strain the hip, but everything is deconditioned after this year, so again, nothing wrong with starting small.

Notes

• Physical therapists and surgeons and pretty much everyone talking about hip flexors get lazy and refer to 3 main muscles as “hip flexors”. I’ve been guilty, but it’s time to change. These muscles are the psoas, the iliacus and the rectus femoris. These muscles all do have a part in flexing the hip, but they are different in where they attach, how they are stretched, how they function and how they pull on things when they’re tight. After surgery, all of them are tight, but one thing I realized after only 7 years of managing my symptoms (yes, there is sarcasm there) is that I was doing a lot to stretch and work on my psoas and iliacus, but not my rectus femoris. And let me tell you, my rectus femoris was causing ALL kinds of problems. I now very much cringe to lump them all in a group and, no, I will not try to make the psoas and the iliacus into one muscle (commonly called the iliopsoas). They are also different in their attachments and functions.
• As you might notice, this is the part where there is a lot to do, and it takes all kinds of time, but it can be tedious and not very exciting. Hang in there! This part is really important. Doing these things consistently and well is one of the best things that you can do to set yourself up for the best results. I’m lucky. As something of a rehab nerd, I see where this is heading, so I get excited enough that it helps me through the tedium.
• It’s true that I am not being terribly specific on what a lot of the exercises actually are. There’s a reason for that. At this time and with how I’m currently progressing, these are the exercises that my physical therapist and I have determined are right for me. They are NOT necessarily what you should be doing if you are 5 weeks out from surgery. Let your PT explain exactly which exercises you should be doing and how to do them.