Pilates for Hip Replacements

Transcription

1 Pilates for Hip Replacements Emily Kimbro March 11, 2016 Costa Mesa,

2 Abstract Many of those belonging to the older population will need to have hip replacement surgery at some point in their lifetime. Post operation clients need to commit to some sort of rehabilitation in order to strengthen the surrounding muscles supporting the hip joint. Often times rehabilitation is aided by a licensed physical therapist. In addition to physical therapy, Pilates is an effective way to build strength in the hip and increase range of motion. Changes to the hip joint due to a hip replacement surgery lead to alterations in other parts of the body. Walking gait is effected due to lack of strength and range of motion. Fluctuations in posture can occur. Devotions in knee and ankle alignment is also a result of surgery. Special precautions and protocols need to be adhered to in order to minimize these changes and reestablish proper hip functionality. 2

3 Table of Contents: Abstract. 2 Anatomical Description 4 Case Study 7 Conditioning Program.. 8 Conclusion.. 10 Bibliography 11 3

4 Anatomical Description of the Hip Joint The hip joint is a ball-and-socket joint composed of the acetabula fossa of the pelvis and the femoral head. A decrease in cartilage in this area causes severe pain and eventually a hip replacement. According Cherney and Debra Stang, Hip replacement surgery is an operation used to replace the damaged ball-and-socket with new and durable artificial synthetic part that mimic the ball-and-socket (Healthline). This allows for complete support of the hip joint and a decrease in discomfort in the joint. Diagram A depicts the hip joint before and after hip replacement surgery. Diagram A Several muscles support the hip and allow for multiple movements including flexion, extension, abduction, adduction, internal, external rotation. According to Rael Isacowitz s Study Guide: Comprehensive Course, the hip flexors consist of the iliopsoas, rectus femoris, sartorial, tensor fascia latae, pectineus, adductor longs and brevis, and the gracilis (Rael Isacowitz). The Centers for Orthopaedics notes as a general precaution that hip flexion should not exceed 90 4

5 degrees for a patient who has undergone a hip replacement. To ensure the opposing muscles are strengthened, the hip extensors should be activated as well. Rael asserts the muscles that extend the hip are the biceps femoris, semimembranosus, semitendinosus, gluteus maximus and the adductor magnus. The hip flexors (left) and extensors (right) are portrayed in Diagram B. Diagram B The muscles involved in hip abduction are extremely crucial in strengthening the hip. These include the gluteus medius, gluteus minimum, tensor fasciae latae, sartorial, iliiopsoas and the piriformis. It is important to note that the opposing muscles, the adductors, should not exceed 0 degrees, according to the Centers of Orthopaedics. Diagram C shows both the hip adductors and abductors. 5

6 Diagram C Finally, hip external rotation is initiated by gluteus maximus, gluteus medium when the hip is in flexion, sartorius, biceps femoris, piriformis, obturator internus, obturator externus, quadrates femoris, gambles superior, the gemellus inferior. Internal rotation is not recommended for a client who has a hip that has been replaced. A carefully planned and well-balanced combination of these movements in the hip aide in recovery and restoration of strength and range of motion. Adhering to the special guidelines of a 6

7 hip replacement is extremely important so that a client does not experience pain, damage, or a dislocation of the hip joint. Case Study Name: Susan Case Age: 61 Sex: Female Occupation: Business Owner Physical Background: Susan is an active individual who plays tennis and does conditioning with a professional trainer. About six months prior to our first session together Susan had undergone a full hip replacement in her left hip. Prior to that she had her right hip replaced as well as both knees. She came to me for Pilates in order to have a more well-rounded work out plan. She figured the machines would provide support for her while allowing to build strength and mobility in her newly replaced hip. At the beginning of our first session, I asked Susan to perform a roll down for me. Almost immediately I could see the unevenness in her hips. She was lacking flexibility in her hamstrings and hip flexors. There was also very obvious tightness in her back due to the tightness in the hips. I could see apparent knee valgus, which I assumed was due to a lack of strength in her hip external rotators as well as weakness in the knee extensors. 7

8 Although gaining strength in order to support her hips was important to this client, I made sure increasing range of motion was just as important. Given the information I observed from the first few roll downs, I constructed an appropriate session to achieve the goals we had set. Conditioning Program Based on Susan s history, I designed a Pilates program in order to suit her needs. As previously stated, gaining strength in the hip joint and increasing mobility were top priority. Below is an example of an hour long session tailored specifically for Susan. Block Exercise Muscle Focus Objectives Warm Up Mat Pelvic Curl Spine Twist Supine Chest Lift Chest Lift with Rotation Abdominals Hamstrings Obliques Warm Up Pelvic Stability Abdominal Strength Spinal Rotation Foot Work Reformer Warm Up Parallel Heels Parallel Toes V Position Toes Open V Heels Open V Toes Hamstrings Quadriceps Hip Extensor Strength Knee Extensor Strength Plantar Flexor Strength Calf Raises Prances Ankle Plantar Flexors Plantar Flexor Strength Single Leg Heel Single Leg Toe Hamstrings Quadriceps Hip Extensor Strength Knee Extensor Strength Ankle Plantar Strength 8

9 Block Exercise Muscle Focus Objectives Abdominal Work Reformer Hundred Prep Abdominals Abdominal Strength Shoulder Extensor Control Hip Work Reformer Frog Circles (Down, Up) Openings Hip Adductors Hip Adductors, Hamstrings Hip Adductor Strength Knee Extensor Control Pelvic Lumbar Stability Hip Adductors Spinal Articulation* Stretches Reformer Standing Lunge Hip Flexors Hamstrings Hip Flexor Stretch Hamstring Stretch Full Body Integration I* Arm Work Reformer Arms Supine Series: Extension Adduction Up Circles Down Circles Triceps Latissimus Dorsi Triceps Scapular Stability Shoulder Adductor Strength Shoulder Mobility Shoulder Extensor Strength Leg Work Mat Gluteals Side Lying Series: Side Leg Lift Forward and Lift Forward with Drops Gluteus Medius Hip Abductor Strength Pelvic Lumbar Stability 9

10 Block Exercise Muscle Focus Objectives Lateral Flexion and Rotation Mat Side Lifts Abdominal Obliques Lateral Flexion Strength Trunk Stability Back Extension Reformer Breaststroke Prep Back Extensors Back Extensor Strength Elbow Extensor Strength *Spinal Articulation and Full Body Integration I are not appropriate until after 10 sessions Conclusion The effects of Susan s hip replacement and other joint replacements were apparent before our first session together. Lacking strength and mobility in her newly replaced hip presented her with a series of complications including a deviated walking gait, pain, and inability to perform everyday tasks. A constructed conditioning program designed specifically for this client allowed her to improve on these complications. Focus was placed on hip stability, strength, and mobility. Exercises including hip flexion, extension, external rotation, and abduction provide muscular support for the hip joint. Stretches were given to free the hip and decrease the tightness in the back that was noted after the client s first roll down. Due to her active lifestyle, Susan was able to execute exercises sufficiently and process cues. Pilates has helped Susan and since her first session we ve seen tremendous improvements in her posture, alignment, and hip strength. Her walking gait is close to ideal and she has experienced a significant decrease in pain. We ve seen increased strength in her hip flexors, hip 10

11 extensors, external rotators, and knee extensors. A positive difference in her hamstring flexibility has also been observed. Because of her Pilates practice and therapy Susan has become move active: playing tennis and mountain biking. Susan plans to continue attending Pilates sessions and looks forward to seeing more of the benefits Pilates has to offer her. 11

12 Bibliography Hip Joint Replacement. Healthline. Web. 11 March Total Hip Replacement Protocol (cementless). Center for Orthopaedics. Web. 10 March Isocowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, Isocowitz, Rael. Movement Analysis Work Book: Mat. Costa Mesa, California: Body Arts and Science International, Isocowitz, Rael. Movement Analysis Work Book: Reformer. Costa Mesa, California: Body Arts and Science International,