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Hip pain has several common causes including:

1. Falls Related Hip Fracture or Hip Injury
2. Activity Related Hip Injury (e.g., sports, or dancing)
3. Osteoarthritis of the Hip
4. Pinched Nerves of the Hip or Low Back
5. Hip Sprains and Inflammation 
6. Cancer

Regardless of the cause of your hip pain, when you hurt and you have reduced mobility in your hip, you want it fixed. Hip pain and injury reduce your mobility, which can lead to impairments in completing your daily functions, it can impact your social life, and it can have a negative impact on your psychological health.¹ If you are living with hip pain, then you are looking for solutions.

What are my Treatment Options for Hip Pain?

When it comes to dealing with hip pain you have a few different options

• Do nothing
• Take Medication
• Receive Injections
• Surgery (Including Total Hip Replacement)
• Physical Therapy

What can Physical Therapy Prior to Total Hip Replacement Offer Me?

If you have spoken with your doctor about the possibility of a Total Hip Replacement (or Hip Arthroscopy), there are several reasons you might want to consider physical therapy prior to your Hip Replacement.

Reduce Hip Pain 

Physical Therapy is considered conservative care because when performed properly, you can relieve a lot of the symptoms you are having safely. One of the biggest benefits of Physical Therapy is reduced hip pain through improved muscle health. Healthy muscles are strong and flexible. A physical therapist will help you strengthen the muscles in and around the joint of your hip. This is going to help support the hip bones and lead to reduced pain

Improved Hip Mobility (ex. Internal rotation)

Beyond strength, an added benefit of healthy muscles is that they are flexible. This is going to allow for great mobility, or movement, of your hip. With great mobility comes improvement in your ability to complete daily activities.

Improved Hip Functioning

When your hip muscles are both strong and flexible, they can be optimized so that you can safely complete the daily activities you need to. Improved Hip Function means that you will see improvements in your

Daily Functioning

With improved hip function, you will better be able to navigate stairs and ramps, you will be able to properly bend or pick things up, and you will improve your ability to sit and stand.

Social Life

With improved daily functioning, you are going to be able to travel to see friends and family. It will make your life richer and you will get more pleasure out of the things you love to do.

Psychological Health

When you are in pain or lack mobility, it can be isolating. By addressing your hip pain through Physical Therapy, you improve strength and flexibility, which leads to better mobility, and more opportunities to do the things you love doing. An added benefit or doing the things you love doing, is improved psychological health; it just makes you happier.^1,2

Even the best surgeries come with some risks that Physical Therapy doesn’t. So, if Total Hip Replacement surgery might be in your future, you should consider Physical Therapy a great treatment option to start with. Total Hip Replacement surgery is a really successful surgery for many patients, but it is not something you want to rush into or have to do more than once. As such, physical therapy may delay your need for surgery by improving your hip pain and function.³ 

Why should I consider a Total Hip Replacement?

When pain, mobility, and loss of function are too severe, it is probably time to consider Hip Surgery. For most that means Total Hip Replacement, but if you are looking for less invasive alternatives, Hip Preservation (or Hip Arthroscopy) may be a better alternative. 

Dr. Johnson at the Hip Clinic here in Oklahoma City, is an expert in Hip Arthroscopy and we had the chance to talk with his Nurse Practitioner, Sarah Higginbotham. You can check out that interview here: "Hip, Hip Hooray," on the Love Your Life Podcast.

Regardless of Hip Arthroplasty or Hip Arthroscopy are right for you, hip surgery should be followed up with Physical Therapy.

What Can Physical Therapy do after Total Hip Replacement?

Following total hip replacement, Physical Therapy has been shown to generate significant improvement in patient function and walking speed. This is important because functioning is assessed across a variety of daily activities including climbing stairs, walking, getting in and out of your car, getting on and off the toilet, and more. Walking speed has previously been linked to falls risk. So by addressing these issues through Physical Therapy after hip surgery, you improve the likely long-term outcomes while reducing long-term challenges and complications.⁴

There have been some sources that suggest that Physical Therapy is unnecessary after a total hip replacement. But the scope of these studies is often low intensity or delayed onset. We know that if you want the best possible outcomes from your total hip replacement, you need a high dose (i.e., high intensity) of physical therapy soon after your hip surgery is completed.⁵ 

Going back to the benefits of physical therapy after surgery, your physical therapist should be focused on functional improvements. A good example of a high intensity activity that leads to more function improvement is the Sit-to-Stand. The name describes the activity pretty well, but your hips are vitally important in your ability to go from a seated position to standing and from standing to seated. Following surgery, your muscles are likely to have atrophied, or gotten weaker; by focusing on strengthening the muscles in and around your hip joint, you are going to get the most out of your physical therapy while recovering from hip surgery.⁶

Using Enhanced Recovery after Surgery, ERAS, principles have been shown to be highly effective for positive post-surgical outcomes following Total Hip Replacement. To summarize, ERAS suggests a high-intensity dosage of physical therapy soon after Total Hip Replacement and is becoming a recommendation for best practice.⁷ 

Risk Factors for Falls after Total Hip Replacement

Following Total Hip Replacement, you are at a higher risk for falling, and unfortunately, falling is a  high risk activity for hip fractures. When you have had one hip replacement, you do not want to have to undergo another hip surgery any time soon. As such, one area of improvement that a physical therapist can help with is balance rehabilitation.⁸

As a physical therapist, specializing in balance rehabilitation means having both the know-how and the equipment to safely support your patients. FYZICAL Oklahoma City has the only Level III Certified Balance Retrainers in Oklahoma City. If you are worried about falling after hip surgery, our Safety Overhead System ensures your safety while pushing you to get the results you want.

Can Telehealth Physical Therapy be used for Total Hip Replacement Physical Therapy?

Telemedicine and Telehealth Physical Therapy are becoming common components of treatment for a variety of conditions. One area that already has good support for using telehealth is Physical Therapy following Total Hip Replacement. If you are worried about COVID-19, the Flu, or just having difficulty traveling to see us, FYZICAL Oklahoma City is prepared to deliver Telehealth Physical Therapy following your Total Hip Replacement.^9,10,11 

No matter the reason for your hip pain, if you are ready to Love Your Life, then you're ready to start physical therapy today! Give us a call or schedule your appointment.

-FYZICAL Therapy & Balance Centers of Oklahoma City 

FYZICAL Therapy & Balance Centers of Oklahoma City provides orthopedic physical therapy in Lakeside, The Village, Nichols Hills and surrounding NW Oklahoma City. Our physical therapists are specially trained to treat all types of pain, movement disorders, and musculoskeletal dysfunction including post-surgical recovery from Total Hip Replacment. Our practitioners take a patient-centered individualized approach that focuses on your health needs. If you are unsure about your pain, or you want to see the FYZICAL Difference for yourself, schedule a free consultation today.

References

1. Czyzewska, A., et al. (2014). Effects of preoperative physiotherapy in hip osteoarthritis patients awaiting total hip replacement. Archives of Medical Science, 10, 985-991.  
2. Gill, S.D., & McBurney, H. (2012). Does exercise reduce pain and improve physical function before hip or knee replacement surgery? A systematic review and meta-analysis of randomized controlled trials. Archives of Physical Medicine and Rehabilitation, 94, 164-176.
3. Svege, I., et al. (2013). Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis:A long-term follow-up of a randomised trial. Annals of the Rheumatic Diseases, 74, 164-169.
4. Monaghan, B., et al. (2017). Randomised controlled trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement. Physiotherapy, 103, 283-288.
5. Bandholm, T., & Kehlet, H. (2012). Physiotherapy exercise after fast-track total hip and knee arthroplasty: Time for reconsideration? Archives of Physical Medicine and Rehabilitation, 93, 1292-1294.
6. Gavin, J., et al. (2018). Functional sit-to-stands evoke greater neuromuscular activation than orthopaedic bed exercises in healthy older adults. Isokinetics and Exercise Science, 26, 139-148.
7. Wainwright, T. W., & Burgess, L. C. (2018). To what extent do current total hip and knee replacement patient information resources adhere to enhanced recovery after surgery principles? Physiotherapy, 104, 327-337.
8. Lo, C. W. T., et al. (2019). Risk factors for falls in patients with total hip arthroplasty and total knee arthroplasty: A systematic review and meta-analysis. Osteoarthritis and Cartilage, 27, 979-993.
9. Anton, D., et al. (20XX ). Validation of a Kinect-based telerehabilitation system with total hip replacement patients. Journal of Telemedicine and Telecare, 22,  192-197.
10. Hoogland, J. H., et al. (2019). Feasibility and patient experience of a home-based rehabilitation program driven by a tablet app and mobility monitoring for patients after a total hip arthroplasty. JMIR Mhealth Uhealth, 7, e10342. 
11. Wijnen, A., et al. (2020). Effectiveness of a home-based rehabilitation program after total hip arthroplasty driven by a tablet app and remote coaching: Nonrandomized controlled trial combining a single-arm intervention cohort with historical controls. 
    JMIR Rehabil Assist Technol, 7, e14139.