Pilates Guidelines for Hip Replacement Patients
Whilst Pilates itself causes no problem, what precautions should be followed to assist in the best rehabilitation for your client?
A hip replacement is a common operation given to those who have pain in their hip resulting in reduced range of movement affecting their quality of life. This can be due to osteoarthritis, rheumatoid arthritis, bone tumours, childhood complications, a fracture or a fall. The surgery itself takes around 60-90 minutes and some patients are able to get up and walk with support the same day. There is a very structured rehabilitation programme with specific precautions that patients must follow to aid their initial recovery. These are to reduce the risk of dislocating the new hip and are in place for the first 6 weeks.
- Do not bend the hip beyond a right angle – so avoid sitting on a low chair or toilet seat (raised toilet seats are recommended for these weeks)
- Do not bring your affected leg across the centre line of your body – so avoid crossing your leg, or lying on your good side
- Do not twist your leg in or out – so avoid swivelling and lift your feet to twist from your torso
If a client has recently had surgery or is going to have surgery, it would be advisable for them to refrain from Pilates classes for 8-12 weeks depending on how quickly they recover. Pilates itself causes no problem and the precautions given can be easily followed but the client may initially become tired very quickly. They will also be unable to drive and will be walking with crutches or a stick. A class usually lasts an hours and this is a long time. They may not be able to participate fully and could feel demotivated by this. If it is an existing client and you are able to adapt around the precautions listed, then they will benefit from exercises such as One Leg Stretch at the heel slide layer in these early weeks. If you would be more comfortable with them attending further through their recovery, ask them to come back when they feel able to drive. This is usually around 8 weeks, and will be a good measure of their physical ability at this stage. If they are physically able to drive they will have more confidence coming to the floor for exercises.
After 6 weeks it is no longer necessary to follow the initial precautions and if your client is 8 weeks or more post-surgery they should be getting used to moving around without walking aids and feeling more confident in themselves. They will be working towards walking up and down stairs normally and core strength from your classes will aid this. Any standing mobility moves where all joints are in line and general posture correction will benefit at this point, as will standing on one leg, leg slide and lift or half squats. Be aware of twisting until your client is 12 weeks post op. At this stage, although physically able to do side kick, they may prefer to do it lying supine and abducting then adducting alternate legs.
After 12 weeks your client should be back to their daily living activities. No impact sports are advised yet and your client may still be working towards going up and down stairs independently. They should still be following the rehab programme of exercises and progress should still be evident.
After 6 months your client should be back to all activities excluding high impact sports. They may tell you that they think the muscles around the hip feel weaker and this is something you can work on together. Exercises such as swimming, prone or on all fours, Side Kick, One Leg Stretch, the One Hundred legs only and Shoulder Bridge are all fantastic to work towards pelvic strength and stability and would be part of your class anyway. This client should be encouraged not to progress through your layers too quickly as the main benefit for them will come from performing the lower levels really well.
After a year they should be fully recovered and the hip should not be the limiting factor in their ability to do anything. They will be able to progress through the layers in your class to a level they would have reached previously and participate fully with no special considerations.