Sunday, June 29, 2014

Summertime fun

We had a pretty cool spring and now the summer seems to be following in a similar path.  Typical weather for end of June/fourth of July is hot, humid, sticky weather.  It's been in the 80s with tolerable humidity and the nights are staying cool.  Amazing!  I know this won't stick around but I'm enjoying it while it lasts.

Today I went for my first bike ride post-surgery.  I'd been holding off because biking definitely had been irritating my hip flexors.  I managed 12 miles in about an hour, just a real easy pace on a flat rail trail.   No pains or aches while I was biking but yeah... the hip flexors, particularly my TFL, are cranky.  I iced afterwards and foam rolled a bit, we'll see how it feels in the morning.

After the bike ride, I still wanted to get my daily walk in, so I went for a few miles in the woods near our house.   The trail follows the river and it's so pretty.

The river runs along the right.

Some busy beavers!

Over the last 30 days, I've walked just about 32 miles.  I try to get out at least for a mile every day.  As I mentioned, the weather has really cooperated and it's been great outdoor weather.  My walking schedule from the last week:
Saturday - 3.4 mi
Thursday - 3.3 mi
Wednesday - 3.3 mi
Tuesday - 2.6 mi
Monday - 1.5 mi
Sunday - 2.5 mi

I had my two month check-in with the surgeon this week.   It wasn't much of anything, really.  I first met with the PA and he tested my range of motion, then I waited for an hour to see the surgeon and he basically tested the same things and also checked to make sure my psoas was firing ok.  Everything checked out fine and so my next appointment will be in mid-August.  

Friday, June 20, 2014

I would walk five hundred miles

I hope the Proclaimers song is now in your head. :)

Today is the 7 week mark.

Over the last 5 days, I've walked 7 miles.  That doesn't really sound like much, does it?  But it's something.  My longest walk has been 2.2 miles and I could have done more but I've been playing it conservative, trying to get a little walking in each day before I go for longer mileage.  

Physical therapy continues to be tough but I got less muscle soreness/DOMS this week than last week (don't get me wrong, I'm still SORE but relatively speaking, it's less.)  Today I walked for 1.6 miles, then I lifted upper body stuff and then I did 30 minutes in the pool doing squats and lunges and what not.  The pool has better than trying to do my land strength work on the day after PT when things are still pretty angry.

This last week or so the psoas/iliacus had been really acting up.  Like deep, sharp pains in my abdomen, near the "wing" of the hip (the iliac crest, specifically).  The physical therpaist noticed that I am way too tight through the front of my hip.  A few assessments later... and we're at the "you're using your hip flexors too much and your glutes are not firing" diagnosis.  My poor hip flexors were just getting too much of a workout!
I also notice that when my hip flexors are tight my groin/joint hurts more - like the tight muscles are squashing my poor hip joint or something, so along with the psoas pain came some increased groin pain.   This week was probably the most uncomfortable I've been in a while, but in the grand scheme of things I have to remember I am still in the early stages and the pain wasn't that bad.  Though being in any sort of pain during rehab just screws with your head.

So anyway, the therapist wants me to get up and first thing in the morning run through my set of "glute" exercises to "wake up" the muscles.   Right.  Because I am SUPER organized in the morning and totally NOT rushing out the door grabbing things as I go.  Uh huh, we'll see how this goes!

As far as the exercises at PT, here is the sheet I am currently working off of for my homework:

From the top left going clockwise:
Split squats
Side lunges
Step downs - stand on a step, drop the leg not on the step behind you, stand back up (this one really gets the glutes good)
Bird dips or Statue of Liberty
Squats (I'm doing them on the Bosu)
Hip drops - stand on a step, drop the leg not on the step (keeping the hips level, so the other leg bends a bit), stand

Things not on the sheet but still on my list for homework:
Core work - planks, side planks
Monster band lateral walks
Walking, biking, elliptical - I have been doing mostly walking because the weather has been so nice!  But I am cleared to use the indoor bike and elliptical as I can tolerate.

The next milestone will be... two months.  That seems huge!  Closer to the end than the beginning.  Hooray!

Thursday, June 12, 2014

42 days

Six weeks!

I feel like the six week mark has been a milestone of sorts.  Six weeks was the longest I might have been on crutches.  Six weeks marks a significant portion of healing and with that, more freedom to do various things as well.

At six weeks:
- I can go up and down a flight of stairs without too much issue.  The psoas is still unhappy about lifting the leg going up, but nothing terrible.
- I can walk for exercise and I can add resistance on the bike (but not yet cleared to ride outside).  We also did the elliptical at therapy today.
- I sometimes find myself forgetting I had surgery.   I sat quickly the other day, not thinking about my hip, and had a nice, sharp reminder that I'm not healed enough to do things like that.  Oops.
- Standing and sitting for periods of time isn't dreadful.  Some chairs are still uncomfortable, but overall, I can get comfortable.
- I am still having some nerve issues while sleeping on my side, so I haven't yet been able to move off of sleeping on my back (which I don't like).
- My range of motion is just about perfect, except for internal and external rotation - but even those are improving daily.

Physical therapy has jumped from regaining motion and flexibility to pretty much all about strength and balance.  We've now added:

One-legged squats on a stair

Bird dips with weight

Bosu planks

Monster walks/lateral band walks

Today I felt like all my pre-op work was finally starting to pay off.  I can get though almost a full hour of leg work, and while they are still total mush by the end, the fact that I can get through it all without needing to modify anything was promising.   She's also increased the weight/resistance every session and it hasn't caused me any trouble.

And the best is - NO hip pain doing any of the exercises.

Saturday, June 7, 2014

Post-surgery depression

If you're on the hip forums or chat rooms, you'll see the post-surgery blues mentioned.  Some claim it happens around week 6, some say anywhere in the 4-8 week range after surgery.   It's not surprising that a total change in your lifestyle - one that is generally difficult, isolating and with many restrictions on what you can do - would be met with sadness, frustration and depression.   People generally value their independence and now for weeks or months, you are highly dependent on others... it's tough.

That said though, it is important to try to find ways to keep your spirits up post-surgery.   There is a good amount of evidence out there that people who are happier will fare better in rehab and healing.  For example:

Depressive symptoms are a major driver of reduced immunity after hip fracture.

Depression following hip fracture is associated with greater physical frailty and poorer long term recovery post-injury.

Major depression is accompanied by immune dysregulation and activation of the inflammatory response system (IRS). 

I think staying socially connected - for me at least - helps combat the feeling of isolation after surgery.  Try to find events or social gathering that you can handle while on crutches and that won't increase your pain.   If you are missing your daily workouts, ask your therapist if there are things that you can do without causing problems - the arm bike was something I figured out would help get my heart rate up a bit without impacting my hip at all.

It's also important to ask for help if you are feeling depressed.  Don't bottle up those feelings.  It is a normal part of surgery but you don't want it to consume you in a way that will impact your healing.

How do you keep your spirits up during tough times?  

Edit - I wanted to add this recent FAI blog post, as it touches on some of the mental aspects of surgery: Hip Athroscopy Rehab - a Psychological Perspective.

Tuesday, June 3, 2014

We must learn to walk before we can run

Week 5 - I am cleared to ditch the crutches and walk for exericse!   Tonight's walk was just up to the corner and back, maybe 10 minutes.   Felt great!  I'll try to extend the walk each night.

Today was my first real "land" physical therapy session (Thursday is my last pool session! :sad face:).  Hoooollllleeeeee shaky legs, Batman!

Here's what we did:
Assisted leg press/hack squat with no weight

Wall ball squats

One legged bridges

Walking forward/backward/lateral with resistance

Quad "presses" 

One leg balancing on a trampoline


I am pretty sure I am going to be really sore tomorrow!