Recovery Timeline

This is a summary of the timeline for my recovery.  My passions have always been running and hiking.  For some people their big thing is biking, other people judge milestones by golf, others do their milestones by judging swimming.  The timeline that follows focuses on walking and  running, as I’m not much into golf, biking, or swimming (it was suggested following surgery I do triathlons for variety instead of just running – time to take an interest in biking and swimming). 

Week one

I actually went into mild shock (chills, cold sweats, thready pulse)  the first time my caregiver and I tried to do physical therapy.  There’s a difference between knowing the meaning of a term and understanding the meaning of a term.  I understand the meaning of the word shock now.  Not that my caregiver was doing anything wrong, it was because my hip had been distracted less than twenty four hours earlier and it was having nothing to do with any additional movement. 

Physical therapy three times a week (surgery was on Monday).  I also learned the physical therapy definition for ‘visceral response’.  I’d start gasping or shaking or tearing up during therapy sessions, even though what we were doing didn’t actually hurt.  Apparently my body was reacting, even though I didn’t actually feel any pain.  This had nothing to do with the plexus block as my ‘visceral responses’ continued in various forms until around week eight.

It is absolutely crucial to have someone assist with passive exercises during the first few weeks of recovery.  This will help to keep the scar tissue from forming in areas where it’s not supposed to be.  This continues for the first two to three weeks.   

I wore sweatpants everywhere for the first week (not that I got out alot, but when I did, sweat pants ruled the day).

Lumbar plexus block (pain pump) came out on day 4.  It was suggested I take an oxycodone that night by the sugeon, as the nerve that had been bathed in ropivacaine woke up.   That was a good suggestion, as that nerve definitely had something to say when the ropivacaine finally wore off.  Fortunately, it never started throbbing, but it definitely got my attention.

The first week after surgery, I was essentially bed ridden.  This continued for around two weeks.  One thing that made it worse (yes, it got worse) was that during the first week I noticed an amazing decline in my physical stamina.  By the end of the first week, I was exhausted just going up a flight of stairs.  I had hiked over four miles just five days earlier.   When I mentioned that to the physical therapist, I was informed that was entirely normal and to be expected.  To help combat this, my physical therapist recommended that I do upper body exercises to attempt to maintain some semblance of physical conditioning and stamina.  I used the Upper Body Ergometer (UBE) at the gym to get me through the next two months.

The absolute worst was one week after surgery, I went to the grocery store for minor shopping (read: I was going crazy and needed to get out of the house).  I had to stop and rest in the grocery store because I couldn’t go down the aisles.

Additionally, during this period, I spent at least six hours a day in the CPM machine.  In order to keep myself occupied, I had brought work related material home to work on so that I at least was able to keep my mind somewhat active. 

Essentially, the only therapy exercises allowed during this time are passive range of motion (PROM) stretches and isometrics (flex glutes for 30 seconds, flex quads for 30 seconds, etc).  I questioned the physical therapist why everything hurt when I moved and why couldn’t I start work on my other leg muscles, the answer was that my hip was ‘distracted’ (essentially a lite version of dislocation) during surgery and they want all of the muscles to be on the same playing field during recovery. 

Completely off work.

Week Two

Lose the sweatpants in public.

Get stitches removed.

Towards the end of week one, I was able to dump one crutch.  That was my first legitimate milestone.  NOTE: I did not have the microfracture process done on my hip.  If this had occurred, I would have been non-weight bearing on crutches for 6 weeks.

Continue with passive exercises with caregiver and physical therapist.

All exercises were still basic stretches and isometrics.  I got to ride a stationary bicycle for 5 minutes on zero resistance.

Completely off work

Week 3

Towards the end of week 3, I was able to drop the second crutch, though I did have a bit of a limp.  In a perfect world, I should not have dropped the second crutch until my limp was entirely gone. 

Lose the CPM machine.  

Continue with passive exercises with caregiver and physical therapist.

During this time, I started minimal exercises to begin to restore hip strength.  I mean MINIMAL – like walking in a pool in waist deep water.  Riding a stationary bicycle with no resistance.

Work from home part time.

Week 4

Continue exercises from previous week.  During this time, my gait continued to improve.  Towards the end of this week, I took my first few pain free steps.  Believe me, that was quite a milestone. 

During one of the physical therapy sessions at this point, the physical therapist did one particular distraction (yep, they do it too, only not as intense) technique, which fortunately did not elicit a visceral response.  I found out later that this one in particular causes a relaxing of the bladder muscles in some people.  I could have had it so much worse.

Continue exercises from previous weeks.  Add a few new ones. 

Work from home part time.

Week 5

Continue all stretching and exercises from before.  During this time, I was released to go back to work part time.  This involved walking a quarter mile at a time.  I was absolutely amazed at how far a quarter mile is after a month with hardly walking. 

Additionally, though I was going stir crazy from being home for essentially the last four straight weeks (I knew it was bad when my idea of a big day was going to the physical therapist), going back into the stress of work was significantly more difficult than I had anticipated.  Though I was only working part time, work was still more of a challenge than I had expected.  The issue with my hip had essentially taken over my life and throwing my mind back into work was unexpectedly difficult. 

At this point exercises took at least three hours a day.  That is not including physical therapy days. On physical therapy days, I would put in close to four hours a day on rehab, stretching, and exercising. 

Go to work (place of employment)  part time.

Week 6

Reduce physical therapy visits to once a week.

Able to take stairs normally (step over step) rather than one step at a time. 

I mentioned to the physical therapist around this time that I was surprised I still hurt from the surgery, she reminded me that I had undergone a psoas tenotomy, femoral neck osteoplasty, labral debridement and the big one: significant femoral ‘distraction’ – remember, distraction is a polite word for partial dislocation. 

Continue exercises from previous weeks, begin actually walking distance again (distance in this case defined as more than a quarter of a mile).   Still putting in 3 plus hours a day on rehab exercise.

This was the first time since the surgery my hip actually hurt.  Prior to that point, all aches and pains had been muscle related.  I hadn’t even mentioned this to the physical therapist.  She mentioned offhandedly, “I wouldn’t be surprised at all if your hip joint starts to hurt, because you haven’t loaded it significantly since the surgery”.  She definitely knows her stuff.

According to normal protocol, I was released to drive a clutch at this point, but in reality, I probably should have waited two more weeks because the ‘sting’ of the tenotomy was still fairly pronounced. 

It was at this point I learned the meaning of the term benign fasciculation (muscle twitching after exercise).  At this point I was walking maybe a mile to a mile and a half at a time.  Six months earlier, I had been able to run ten to twelve miles no problem.  I had never even heard of benign fasciculations before this.  I handled this with prodigious amounts of Gatorade.  I was quite stunned actually,  I had always thought Gatorade was basically an ad campaign.  Gatorade (or something along those lines) actually took care of the benign fasciculations on several occasions during my recovery. 

Go to work (place of employment)  part time.

Week 7

At this point I went back to work full time,  on the whole it was a good thing, but it was still difficult to get reengaged intellectually full time.  Needless to say, the level of investment in rehab took a hit.  This actually worked out quite well as at this week, stretching exercises are supplanted with more active strengthening exercises. 

Additionally, somewhere between weeks six and eight, most of the trauma from the surgery and the tenotomy resolved themselves.  I still had a ‘sting’ in the tenotomy site on my psoas, but it wasn’t as pronounced.  It was during this timeframe that my range of motion ROM significantly increased as did all other aspects of my recovery.  Exercise took around 2 to 2 1/2 hours a day.

Week 8

My daily exercise leveled out to around two to two and a half hours a day.  My walking program increased significantly and I could now walk for extended time durations without a noticable limp.  At this point in the recovery, the running program starts for some patients.  I had to wait a week due to the fact that my psoas still ‘stung’ when stretching, or under load, that it wasn’t yet strong enough to begin running.  As far as I was concerned, that was fine.  I’d rather wait a week and do additional rehab than show up with a case of tendonitis.  It is my understanding that in this type of situation, once tendonitis starts, it is difficult to get it under control without intervention (coritsone shot to the affected area).  I’ve had enough people poking things into me to last the rest of my life.  I wasn’t risking another round with the Dr because I couldn’t wait a week. 

At this point though, I had to begin pushing exercise for the first time.  Up until this point in the recovery, the mantra was ‘if it hurts, stop’.  At this point, I had to begin to push my psoas a bit.  In many ways this was the toughest part of the protocol.  I had to push through the discomfort.  The entire time, I was still worried about tendonitis, as I had also been warned by many people that between weeks six and eight were the time when people got tendonitis in the psoas.  I never pushed my way in to actual pain, but I certainly pushed the envelope with discomfort. 

Week 9

Begin running (yay!).  This is little stuff at this point, run two minutes, walk three minutes, no more than 8 minutes total four times a week.  Of course one could argue that’s what got me into this mess, I would counter that statement by saying there are alot of people out there that ran harder and farther and longer than me who never got this and my other hip is just fine.  So even though I’ll never be able to run without wondering if I’m doing damage to my hip, I will still run on some level.

I was able to mow the lawn for the first time in months.

Week 10

Reduce physical therapy visits to every other week.  Significant ROM improvement.

The ‘sting’ in the area of the tenotomy finally resolved (I’m not sure if this resolves sooner on some people or if it took longer for me than others, I don’t know.  But it was REALLY nice when that finally resolved itself).

Increase running to 3 minutes running, 2 minutes walking 20 minutes total.

Walked same 4.5 mile hike I walked the morning before my surgery.

Week 11

Increase running to 25 minutes total, 3 min running, 2 min walking.

Increase stairs

increase weights.

Week 12

Follow up appointment with the surgeon.   The surgeon came into the exam room with four or five fresh faced residents in tow, all filled with hope and conviction (I was at one of those  University hospitals).  The surgeon and I start talking about the surgery, recovery, questions I had, etc.   The residents were all nodding and scribbling on their notepads.  I’ll never know if the surgeon was setting this up for the residents or not, but she threw this next one out there, so I responded.  She said, “How was the recovery so far since the surgery?”  I said, “It’s been a bitch, I had no idea what I was in for.  It hasn’t been anything you didn’t warn me about, I just had no idea how traumatic something like this would be”.  I heard a couple of the residents actually gasp.  I’m not sure if it was because I swore about the recovery or maybe they were surprised that a patient would be that blunt.  The surgeon smiled and basically said, “I hear that alot”.   

Apparently though, things were progressing quite well: I was at the level of strength and flexibility for where I supposed to be in the recovery timeline.  Once it became apparent that I didn’t have any pressing acute issues, most of the residents wandered off.  I’ve never been so happy in my life to be uninteresting.

Continue running program, walk more stairs, walk greater distances.  Gradually begin to increase weight resistant exercises. 

Run four minutes, walk one minute, total of 25 minutes

Still spend around 2 hours a day simply stretching, walking and doing ‘core’ rehab exercises.

Week 13

Up running program, walk more stairs (5 flights, one step at a time, slowly – no problem), walk greater distances (basically as much as I want).  Gradually begin to increase weight resistant exercises. 

Run four minutes, walk one minute, total of 30 minutes

Still spend around 2 hours a day simply stretching, walking/running  and doing ‘core’ rehab exercises.

Week 14

The phrase of the week for me on this week was ‘neuro-muscular reeducation’.  I had seen this phrase in countless areas of the rehab protocol.  You would think by at this point, I would have stopped thinking, ‘Oh that only applies to other people’.  It took until week 14, but I found that phrase does indeed apply to my recovery. 

By this point, I could pretty much walk as far as I wanted and do 5 flights of steps and I had started running (little) hills.  The physical therapist said, “Today you’re working on ‘power ups'”.  What are those?  “Basically, glorified hops on your bad leg”.  I figured, sure, that sounds like fun, let’s get to it – how hard can it be?  I started out on my right foot, no problem.  When it came time to work on my left (bad) leg, it took at least five minutes to force myself to hop up on my left leg.  It didn’t hurt, I just couldn’t make my body hop on my left foot.  I had been compensating for so long by protecting my hip on that side, I had basically forgotton how to hop on my left leg.  Oh, THAT neuro-muscular reeducation.  

I also started on lateral movements at this time as well.  This was another action that I had a tough time with, as I had been guarding against that action for so long that I had to work to actually perform the task.  It didn’t hurt, I just had a tough time actually doing it. 

This was the first week that I realized just how bad my hip had gotten over the last year.  I had subconciously modified my stance and activities in ways I had not even realized.  I had not allowed myself to do lateral movements to the left for at least a full year prior to the surgery.  Up until this period, I just wanted to get back to where I was prior to surgery, I finally saw how this could work out to be better than before the surgery.  

Still spend around 2 hours a day simply stretching, walking/running and doing ‘core’ rehab exercises.

Week 15

Continue lateral moves, ‘neuro-muscular re-education’, power ups, etc.   During this week I had to go back over nearly all my exercises from the first few weeks on.  This was because I was starting to activate muscles that I hadn’t used for several months (possibly a year) prior to surgery.  It really started to become apparent at this time all of the little compromises I had made in the last year or two without even realizing.

Still spend around 2 hours a day simply stretching, walking/running and doing ‘core’ rehab exercises.

Week 16

Extend endurance and add additional strength exercises.   Up to this point, my goal had been to get where I was presurgery.  On week 16, I surpassed my capabilities presurgery.  At that point  I realized I could do things that I hadn’t been able to do for at least the past year.   Physical actions that most people wouldn’t even notice, but for me were incredibly telling.  This was the week that for the first time, I woke up in the morning, did my exercises, went about my morning and it was late in the morning before I even realized that NOTHING hurt.  My hip didn’t quite feel ‘normal’ (compared to my other hip), but for the first time in ages, no aches and pains. 

Still spend around 2 hours a day simply stretching, walking/running and doing ‘core’ rehab exercises.

Week 17

Continue basic stretch and strengthen exercises.  Around this point, most of my aches and pains resolved, though I still had to work through continued weakness in my psoas and surrounding muscles.  This was a result of not having really started to load those muscles until fairly recently. 

Still spend around 2 hours a day simply stretching, walking/running and doing ‘core’ rehab exercises.

Week 18

I was down to once every two weeks for  physical therapy.  I’ve since realized that a person can get themselves into alot of trouble in the two weeks between appointments with the physical therapist.   I was still doing basic stretch and strengthen exercises, but I could see daylight at the end of the tunnel so I really started to push the envelope.  Naturally, I overdid the strengthening portion of the rehab protocol and pushed my TFL, rectus femoris, quadriceps and psoas (of course) muscles almost to the point of  collapse in my left hip.  In my defense, when I was working those muscles, they felt fine, a few hours later, the tightness/soreness feeling would set in.  That got me into a vicious cycle of trying to exercise out the soreness.  At my next physical therapy appointment the physical therapist spotted pretty quick how I’d gotten myself into the cycle I was in and set me straight.  I had to stop all strengthening exercises for the front of my hip for a couple of weeks.  Fortunately, I didn’t get tendonitis as a result of my lack of patience .  This was another reminder that this type of recovery cannot be hurried.  I also got put back on weekly physical therapy visits. 

I stopped running for a week and I backed off  all psoas loading exercises.  However, I still spent around 2 hours a day simply stretching, walking and doing ‘core’ rehab exercises. 

Week 19

Start reintroducing strengthening exercises – very slowly.    I also modified my diet to include more protein, that really helped me get back my strength and stamina, though I wasn’t nearly as agressive as I had been.  I decided I would rather go a bit slower than have any more setbacks.  This part was particularly tough because it was the most significant setback to date.  As a result, I missed my self imposed 6 month timeline.  The most significant portion of the strain injury itself was to one of the quadriceps, which apparently is fairly common at this point in a patient’s recovery. 

6 month followup

Meet w/the surgeon for my six month followup.  I started out with an apology for swearing at the 3 month meeting about the trauma immediately following the surgery.  The surgeon said that it was probably good for the resident physicians on hand to hear that because it let them get a glimpse at what to expect if they go down that particular medical track.  Hearing that, I’m thinking I probably shouldn’t have held back as much as I did. 

Also, I mentioned to the surgeon that I was still working through some overuse issues with my quadriceps, she had no trouble at all pinpointing exactly where the issue was occurring.  She mentioned that the symptoms I was showing were fairly minor, another 6 weeks or so and I’d be good as new.  6 weeks?!?!?!?!

Aside from the quadriceps issue, my progress was right in line with expectations.  Apparently, the 6 month estimate is for bones and cartilage.  Anything to do with muscles and any damage done during recovery just adds to the recovery timeline.

Onward

At some point daily physical therapy resolves to a maintenance regimen of stretching and strengthening certain muscle groups in their hip that need attention.  Everyone is slightly different in this respect based on their needs.

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