Nono's Hip Replacement - Part 1

My dad has had quite a few injuries to recover from in the past two years of his retirement. I talked a bit on social media about how we rehabbed him after a motorcycle accident and we can do a blog and podcast about that later. 

My dad had his left hip (same side as my bad hip) replaced a week ago. He is actually really flexible for a guy and as a kid I remember practicing for cheerleading tryouts when he came home from work and he said a toe touch didn’t look too hard.  He proceeded to do a jaw dropping toe touch in his khakis and dress shoes and floored me. I think I get my innate flexibility from him. I don’t think he ever pushed his joint laxity limits like I did for dance, gymnastics, cheerleading and yoga.  He was more of a basketball, baseball, football, skiing, and motocross kind of guy in his youth.  I can only speculate as to why his hip degenerated.  

He had a posterior hip replacement. That’s when they cut through the glute max and ITband and remove and reattach the external rotators of the hip. 

Because of my hip injury and my dad’s hip replacement, I wanted to talk about a little bit about the hip and all the things that contribute to the stabilization of the hip, how the hip moves, and the outside of the box things that what we plan to do with my dad’s recovery to help it be the best that it can be.

The Hip

The hip is a ball and socket joint. The femur (long leg bone) has a ball at the top of it that fits into the pelvis perfectly at the acetabulum or nicely shaped pocket.  The ball of the femur should be lined up and centrated in the socket and if it stays there, it will move smoothly and not degenerate as quickly. When it is not centrated the edges rub awkwardly and create friction and eventually degeneration.

People often come in the office and tell me that their hips hurt, they grab their SI joint. When we say your hip joint, it’s your femoroacetabular joint. It is that ball and socket joint that should have nice flexion, extension, abduction, adduction, and circumduction. It should run smoothly.

In a hip replacement, they take the ball off and create an artificial joint. There are a ton of muscles in and around that act on that joint.  A lot of times, or at least in my case, because of my ligament laxity, the ball on my femur is not sitting centrated within the acetabulum.  I try to do rehab and prehab exercises that encourage centration of that joint to stabilize it and hopefully prevent a hip replacement. This is something we will focus on for my dad in his recovery as well. 

Some of the muscles that actually cross the hip joint are the Psoas, Iliacus, Sartorius, Tensor Fasciae Latae (TFL), and rectus femoris. Your Psoas is a hip flexor. It attaches from the spine, crosses over the ligament on the top of the pelvis, and attaches down onto the femur or the leg bone. It is very difficult to palpate or feel.  It is very deep and very difficult to access. It crosses over the hip joint and does not attach to it. When it contracts, it flexes the leg up. There are also new research that says that when you are standing and you flex your knee up to your chest the opposite psoas is also activating to stabilize the spine.

The other interesting thing about the Psoas is that it attaches to the spine and it goes under a a fascial arch called the medial arcuate ligament.  That’s the tendinous fascia that arches over that muscle and it is coming from the diaphragm. The diaphragm and the Psoas have a fascial connection that links breathing and hip flexion. Another hip flexor that also crosses over the front of the hip is the Iliacus muscle. This attaches from the Illium down onto the leg itself where psoas attaches. It is also a major player in drawing your knee up and doing that hip flexion action. Sartorius or the tailor’s muscle attaches from the pelvis and crosses over the front of the femur down to the knee. It crosses two joints. It brings the knee up and out because of that diagonal pattern and it’s also crossing over that hip joint.  TFL has a little role in hip flexion and it feeds right into the IT band.

The last hip flexor is the rectus femoris. It is one part of your quad muscle. Your quad has four parts called the vastus lateralis, vastus medialis, vastus intermedius, and the rectus femoris. The rectus femoris is the only one that attaches up onto the pelvis. All the other three quad muscles extend only the knee, but rectus femoris also flexes the hip because it crosses that joint.

The other muscles I wanted to write about are your groin muscles. The groin is usually referring to the adductors. Relating it to motion, abduction takes your leg away from the midline. Adduction brings your leg towards the midline. The midline is that groin area.

For the adductors, there are a few of them, including the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus. Pectineus is really short and it actually helps to stabilize the hip joint because it takes the femur and brings it midline. It’s helping with centrating the ball of the femur into that joint. Stability happens with all of the adductors for the pelvis and they are the very key in the stability of the hip joints.  It is very important to work on those and tap into those when you’re working on a hip injury or rehabbing your hip replacement later on.

There are also external rotators that will be cut through in hip replacement surgery and are going to need attention as well. External rotators also help centrate the hip joint. They stabilize the hip joint dynamically.  Glute max is more superficial than these and attaches onto the femur, but it also feeds into the IT band. 

What Things I Plan On Doing Early On With My Dad For Outside Of The Box Thinking

Right now, my dad is getting some physical therapy to work on some very easy and basic muscle engagement kind of things. 

What we will be starting with is some breath work.  Remember psoas and diaphragm are intimately tied together. The other thing about breath work is it helps to down regulate your nervous system and help regulate that pain response as you are recovering.

I have not written about or talked about diaphragm vacuums in my online content, but I am planning to do that with my dad. The diaphragm vacuum is when you take an inhale and you exhale all of the air out. Without inhaling air in, you take a false inhale in and expand the rib cage. Basically, you are not inhaling, but you are letting the rib cage pop open without taking the breath in. This tractions the diaphragm up and creates a vacuum in your abdomen. The diaphragm is getting pulled up like a little parachute and I want you to imagine the Psoas sliding easily under that medial arcuate ligament. We want that ease of movement of the Psoas under the ligament. You want to have a completely relaxed and soft abdomen when you do this. 

Another thing that we’re going to dive into is Kinesio taping, rockblades, and cupping. I like to facilitate better lymph flow. As I’ve said in my blogs and other content in the past, a stagnant lymph system leads to inflammation. We want as much healing to take place as quickly as possible with my dad’s hip rehabilitation.  We want to keep the lymph system moving and filtered as well as we can.

I will also have him try dry brushing twice a day for better lymph movement. Dry brushing uses that light stimulation of the skin, which helps get your lymph system moving. I have all my pregnant patients do it, anyone with a chronic autoimmune issue, and more.  I will also do manual muscle work for where my dad might be tight or is compensating for using a cane.

Once his incision is healed, we will also use rock blades or any other type of tool assisted myofascial release on the scar. He also has a coregeous ball and we will use it to work on the scar tissue mobilization and structuring.

Once he is a little further out, we will also do balance work and then we will start having him do some single leg movement, split squat, adductor engagement, external rotator integration for joint centration, hip hikes, and more because it’s going to be very easy to lose a lot of strength. This is especially true because you might have been altering how we do things and babying it without knowing it prior to surgery. That is why we want to keep that strength equal side to side.

I also really like vibration tools when we are trying to reconnect with the tissue and bring awareness to an area that has been cut into. We will start with soft vibration around the areas that need more connection and integration. 

Nono has big goals for golf soon and wants to be skiing next season.

If you have any questions, you can drop it in the comment section or you can send me a message through Facebook or Instagram. I’d be happy to do another podcast about your questions. Also, if you want me to talk about something specific, let me know!

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