How Pat Avoided a Hip Replacement Surgery

      Meet Pat. Pat is one of our clients who was able to go from being a candidate for a hip replacement surgery to thinking he may be able to avoid it. This transformation happened in just an 8-week period.

           But first, a little background: Pat is a lifelong athlete. In university, he was on the rowing team, he has a black belt in karate, he competed in a number of triathlons, and he was a high-level kayaker. In a nutshell: he’s no slouch.

           Being an active guy, over time, he started to feel his left hip wearing out. He pushed through the pain, until it was unbearable, at which point, he went to his doctor. The diagnosis: a very predictable arthritis. He went to a number of doctors, and they all concluded the same thing: it’s arthritis. It’s irreversible. Let’s “watch it”, until there’s no cartilage whatsoever, and then, let’s do a hip replacement surgery.

           Pat didn’t like that (who would?). So after a while, he decided to hire us to help him get his hip back on track. Nowadays, only about 8 weeks since he started working with us, he feels like he may be able to prevent the surgery altogether.

           In this article, we’ll cover:

• How the arthritis was affecting his life
• What he’s tried before to help him deal with the hip pain
• Why he decided to start working with us
• What we found during his assessment
• The exercise program that his trainer, Justin put him on
• The results of the program, and how his life is different now that his hip feels better

But remember – the strategies used here are specific to Pat. Two people with hip arthritis may follow the exact same program, and one will make progress, but the other will get worse (hence the need for assessment, which is covered later in this article). So if you want something made specific to you, we have a program called “Happy Hips.” If you’re interested in learning more about this, just email me, with the words “Happy Hips” in the subject line.

Anyways, without further ado, let’s talk about Pat. If you’d like to hear Pat tell his own story, check it out in this video:

Why He Started Working with Us

           As mentioned earlier, Pat is a lifelong athlete. And there’s a saying: “if you do everything wrong, you end up in the cardiologist’s office. If you do everything right, you end up in the orthopedist’s office.” You’re damned if you do, and you’re damned if you don’t. Well, Pat’s heart was quite healthy, but his left hip had worn out from decades of athletic activity.

           It was deteriorating badly. At first, it was just pain now and then, but he pushed through it. Eventually, the pain became worse, and it was affecting him in other ways:

• He was limping more and more
• His hip hurt when he had to bear weight
• He couldn’t walk for long distances (over 20 minutes) without hip pain
• He couldn’t do the exercises that he liked to do. An active guy likes to be active, and when his activity has to be limited, well… he doesn’t like that
• He couldn’t squat all the way down (I know, I know… my readers in their 50s, 60s and 70s are thinking “I’m not a kid, I shouldn’t be able to squat all the way down.” Well, my stiff friend, not being able to squat all the way down is exclusively a Western problem. After all, the elderly – even those that aren’t athletic - in other countries have no problem squatting all the way down. They’re either going to the washroom in the ground, so the necessity is there, or they’re picking fruits and veggies off the ground. Here’s an example.).

As you can imagine, for a very active guy like Pat, hip pain was severely limiting his life. And it was deteriorating even further, so the future wasn’t looking good. It was just going to be filled by more activities that he’d have to give up.

What He’s Tried to Help Him Deal with the Hip Pain

           Not being one to go down without a fight, he decided to take matters into his own hands, and try to make his hip feel better. He thought to himself that he’s a former athlete, and a smart guy all around. He’ll create his own program, to help his hip feel better.

           He tried his own program. And although he got stronger, his hip didn’t feel any better. The deterioration continued. Why? Because exercise for strength is different than exercise for hip arthritis. Use the right tool for the right job. A hammer is a good tool if you’re trying to hammer nails, but a hammer is a bad tool if you’re trying to saw a piece of wood. Same with strength training – there’s no universally good program. Just the right program, for the right person, at the right time.

           Anyways, strength training wasn’t working (at least not the way he was doing it). So he tried yoga. After all, yoga is all about the joints, right? So he did try yoga for a while, and his flexibility improved. But again, his hip wasn’t any better. To re-state from earlier – flexibility training is good – if you do it right. Yoga is another tool in the toolbox. Though in this case, it was the wrong tool for his hip. Didn’t make it worse, but didn’t make it better either.

Why He Decided to Start Working with Us

           After trying the “do-it-yourself” approach, and it didn’t work, Pat decided to get some professional help. But it was a long process. Our “Happy Hips” program isn’t cheap, so he wanted to see if he could do it himself before turning to professional help. He couldn’t.

           Having been reading my newsletters for several years, and seeing stories of our other clients who’ve gone through the “Happy Hips” program with great success, like Anne. Carole, and others, he decided to try it himself.

           He also liked the fact that the Happy Hips program is not generic, that every client gets, but is personalized for each client, based on the results of their assessment.

           So with a combination of scepticism and hope, he decided to give it a shot.

What We Found During His Initial Assessment

           We paired up Pat with one of my trainers, Justin. Justin is an expert at musculoskeletal (try using that word in Scrabble 😉) assessment, and rebalancing muscles. On his first session, Justin did a complete, full-body assessment of Pat’s joints, not just his hip (because joints other than the hip can affect the hip).

           Here were the results of Justin’s assessment:

• Most joints were fine – shoulders, elbows, wrists and ankles
• Pat had a tight left IT band (it’s a thick band of connective tissue that runs from the hip to just below the knee)
• He also had tight adductors, rectus femoris and gluteus maximus muscles. All on the left side, compared to his right.
• His left hamstrings were too weak compared to his left quadriceps
• His left adductors were also too weak

The whole “so what?” of all this is this: the combination of these muscle imbalances was pulling the “ball” out of the “socket” (the thigh bone out of the hip bone), which was grinding down his cartilage.

As mentioned earlier, the importance of the assessment is because there’s no generic “hip arthritis exercises.” These exercises done by one person with hip arthritis may work, but for another person, they may do more damage. Assessment gives us much more precision in exercise prescription.

After all, when you go to a doctor, they don’t just give you a medication without running some tests on you. Blood work and radiographic studies (X-rays, MRIs, etc.) are their diagnostic tool of choice. Musculoskeletal testing is our “diagnostic” tool of choice, given what clients come to us for.

Pat’s Exercise Program

           After Justin figured out what’s going on with Pat’s hip, it was time to devise an exercise program.

           Although the program was fairly extensive (13 exercises per workout), I’ll just give the highlights, along with the thought process behind them.

Foam Rolling and Stretching

           Remember the muscles that Justin found tight during the initial assessment? During the warm-up, Justin used foam rolling and stretching to loosen them up. What these two groups of exercises do is they release how strongly they (the muscles) pull on the hip joint. Remember – if muscles pull harder than they should, it throws things out of alignment. So we wanted to decrease the force with which those muscles pulled on the hip.

Controlled Articular Rotations

Controlled articular rotations (CARs) for the hip are not a stretch or a strength exercise. Rather, they are a motor control exercise. They also go by names like “fire hydrants” or “hip circles”, and others.

The goal here is to improve motor control, as indicated. But what is motor control? Motor control is:

• Which muscle fires
• With what force
• At what time

Notice that force is only one third of the motor control equation. Firing the right muscle, and relaxing the right muscle is just as important as using the right amount of force (read: strength). After all, if you strengthen muscles that are already too strong, you’ll actually make arthritis worse, not better. Hence the importance to doing an assessment to figure out which muscles are too strong.

So motor control exercises should improve which muscles fire, and the timing.

Justin recommended that these exercises be done 3 times per week. But Pat, being a keener ended up doing this 6 times per week, which probably has something to do with how good his results were.

Negative Box Squats

           One of the biggest limitations of hip arthritis is the inability to get all the way down. So when Pat first started, he could only squat to an 18-inch step.

           The idea behind negative box squats is to develop strength in unfamiliar/lost ranges of motion. As he did the previous exercises (foam rolling and stretching), he gained new ranges of motion. However, unless he added strength in those new ranges, this newly-gained range would only be temporary and last for just an hour or two after a workout. Adding strength to new ranges makes those ranges more permanent.

           As Pat’s range improved, the height to which he squatted got lower and lower. He went from 18 inches, to 12 inches, and over time, all the way down – butt to heels. With weight.

Strengthening Exercises for the Hamstrings and Adductors

           Since Justin found weakness in those muscles during the assessment, he needed to strengthen them. Strengthening these muscles would give Pat greater control in those deeper ranges of motion, of the squat.

           Again, these are just a few of the 13 exercises that Justin used in Pat’s program, and the program also changed as Pat’s body changed, but these are the highlights.

The Results

           In many of my articles, I emphasize the importance of progression. The exercise routine can’t be static, where you’re doing the same weights, repetitions, etc. workout to workout, or else, you don’t make progress (duh!). So over the 8 weeks that Pat has been with us so far, he’s seen:

• Improvements in his flexibility: as mentioned earlier, when he first started working with us, he was only able to squat to an 18-inch box. Now, he’s squatting all the way down, butt to heels, pain-free.
• His flexibility is 70-80% better
• He is stronger

Now, that’s all nice, but we don’t want to leave all that progress in the gym. The idea behind exercise is to enrich your life outside the gym, and that, we’ve certainly done with Pat.

In 6:47 of his video, he describes that now, when he squats, he feels euphoria (and you can really hear the elation in his voice). He compares it to having a drink of water on a hot day.

And once he was able to do hip CARs pain-free for the first time, he felt like “my body said to me ‘where have you been? Why haven’t you done this before? Thank God you’re doing it now.”

Also, other small things throughout the day that used to bother him no longer do:

• He can now sleep on his left side, whereas before, the pain would wake him up
• He can ride his bike
• On his recent trip to Mexico, he was able to walk for 20 minutes, pain-free, limp-free. Seems like no big deal, but when your hip used to ache badly with that simple activity, you start to really appreciate when it doesn’t.
• His family has said that he looks different, and moves different.

Overall, we’re very proud of Pat, and the results he’s been able to achieve. It’s case studies like these that make us love our job. If you or someone you know also has bad hips, and wants to see whether we can do something to improve them, we do have a program specific for that, called “Happy Hips.” If you want to find out more, just email me with the words “Happy Hips” in the subject line.