Hello Gentlemen,
I was hoping to get your opinion on something. In April of last year, my wife had a total hip replacement on her right side. It’s been 9 months, and she’s lifting slightly heavier weights post-surgery vs pre-surgery. (Current 1RM’s: SQ=200 / DL=255 / BP=125 / OP=85…in lbs)
The problem is she still has significant pain and tightness when she lifts her right leg straight up while standing or while doing leg lifts. This has been the case ever since the surgery.
She recently had an MRI which showed an atrophied gluteus medius and trochanteric bursitis. We saw a different PT today with lots of letters after his name (PT, DPT, MTC, FAAOMPT). He confirmed the weak gluteus medius and said her iliopsoas(?) was very tight. He also measured a leg length discrepancy of just under 0.5 cm (surgical side shorter)
Her homework is to do clamshells and standing one-leg thigh stretches. He’ll be working with her 2x/wk. He says it will take some time, but once he strengthens the gluteus medius and stretches out the thigh….it SHOULD stabilize the hip and help to significantly reduce her limp and pain.
He also said that she should discontinue the ‘heavy’ barbell training for now (at least below the waist). He claims eliminating the barbell training should help reduce inflammation in the joints caused by working out the primary movers.
I only have a BS degree in Biology, which basically allows me to understand some of the fancy words he uses. Don’t get me wrong, the PT is very personable and confident….but his diagnosis and treatment moving forward sounds suspect.
Any thoughts you could share on this matter would be greatly appreciated! Thank you!!
PS—my wife is 5’07/ about 175 / and is 60yrs old.
Hey Ghostrider, first it’s awesome that your wife continues to train. Depending on the approach for the total hip (anterior vs. posterior) it is not uncommon to have some long term weakness side to side. The posterior approach actually reflects (pulls back) most of your gluteal muscles in order to access the joint. As far as the findings of your wife’s PT, a “very tight” iliopsoas is typically determined using a test that doesn’t really have much utility. Plus “very tight” is more of a subjective call than anything that we can quantitatively measure with any accuracy. Also, leg length discrepancies don’t have any real correlation with symptoms and 0.5cm actually falls in the standard error of measure for the test so that would fall in the inconsequential category. Stretching out the thigh isn’t going to change any range of motion in the way it is typically prescribed but the FAAOMPT stands for fellow of the American Academy of Manual Physical Therapists and MTC is a Manual Therapy Certification through the University of St Augustine which is a highly manual oriented school so this individual likely has a manual therapy slant to his worldview. Clamshells are a fine exercise to START with, but this should progress quickly according to your wife’s tolerance.
Without taking a look at your wife, the chronicity of symptoms would likely have me advocating for taking a few weeks off the barbell but it doesn’t have anything to do with inflammation. If she has been training for this long, her body has adapted to whatever acute inflammatory response she elicits after training. That’s just a gobbledegook explanation. I would make sure the therapist has a quantitative way of tracking her strength gains. Just saying someone is “getting stronger” is the equivalent of saying her hip is “less tight” or “more mobile,” it doesn’t mean anything. It is perfectly fine to start low(er) level with exercise, but this should progress quickly according to your wife’s tolerance.
Derek
Derek,
Thank you for taking the time to post such a thoughtful answer! I forgot to mention that along with the constant positioning pain, my wife has had a pronounced limp ever since the surgery. Her home care PT and later, her clinical PT both thought there might be a significant leg length discrepancy causing the limp. A 3-month after care visit with her ortho surgeon showed the artificial hip was aligned almost dead even with her natural hip…and her current PT confirmed the minuscule 0.5cm difference.
Final questions:
–What is your opinion on how her gluteus medius atrophied despite the squats and deadlifts prior to and after the surgery?
–Could the atrophied medius cause such a limp (I seem to remember reading about something called a Trendlenberg(?) gait)?
–Any opinion on what might be the main contributor causing the trochanteric bursitis?
Thank you again for your time and opinions! All of you on this site have really helped me and my wife (Michele) get stronger!
(I believe her surgeon said he did an anterior approach, but the scar was on the side of her leg. I’ve included a picture of the scar. Okay, that pic was a lot bigger than I thought it would be…sorry. She is facing to the right.)
