A patient s guide to. physiotherapy exercises and advice following proximal femoral replacement

Transcription

1 A patient s guide to physiotherapy exercises and advice following proximal femoral replacement

2 This booklet outlines the likely physiotherapy treatment you will receive while in hospital. Although timescales are given, these are approximate and will be different for each patient. Exercise instructions are included but you must not commence any until taught and instructed to do so by your physiotherapist. It is important to do your exercises regularly so as to maximise your range of movement and strength. It is not unusual for the exercises to cause some aching or discomfort but if they cause severe pain, please seek advice. Take your pain medication 30 minutes before exercising so it will be most effective in controlling your symptoms. 2

3 Day 1 after your operation Following your operation, the muscles and tissues surrounding your hip need time to heal. At this stage you will be on bed rest and will only carry out bed exercises. You will have a wedge shaped cushion between your legs and your operated leg may be in a gutter pillow. These are to make sure your leg is kept in a good position. 3

4 Precautions Hip precautions need to be followed for 12 weeks unless otherwise instructed by your doctor or physiotherapist. DO NOT bend your operated hip past O 7 7 4

5 DO NOT cross your legs or move your operated leg across the imaginary line down the centre of your body. 7 7 DO NOT twist your operated leg. 5

6 DO NOT role your operated leg in or out when resting; your knee cap and toes should point up to the ceiling. 4 7 DO NOT lift your leg out to the side when standing. 7 6

7 Bed exercises 1. Lying in bed, take a slow deep breath in feeling the air going into the bottom of your chest. Hold your breath in for three seconds then breathe out. Repeat times every hour. 2. Lying in bed, bend and straighten your ankles briskly. Repeat times every hour. 7

8 3. Lying in bed with your legs straight, push the back of your knees down against the bed, hold for five seconds then relax. Repeat times every hour. 4. Lying in bed, squeeze your buttocks firmly together, hold for five seconds then relax. Repeat times every hour. 8

9 Day 2 after your operation Today a beam will be set up over your bed and you can commence the slings and springs exercises. These enable you to start active hip exercises to regain strength and control around your hip. The Physiotherapist will initially set up the slings and springs and you can remain resting in them all day if comfortable. Otherwise you may choose to use them for an hour or so a few times a day while you carry out your exercises. The nursing staff will assist you with this. Your doctor may request that you need to wear a brace for walking and while you are out of bed. The orthotist will measure you for this brace. 9

10 Slings and springs exercises The nursing staff will help you into the slings and springs in the mornings and you can remain in them as long as comfort allows. Perform the following exercises times a day. Resting position - ensure that your toes and kneecap are facing up to the ceiling and your leg is not rolled out to the side 10

11 5. Move ankle up and down. Repeat times. 6. Pull your toes up towards you and lift your heel off the bed to straighten your knee. Hold for few seconds then slowly relax. Repeat times. 11

12 7. Straighten your leg and toes and point them towards the ceiling, move your leg out to the side. Hold for a few seconds then return to the starting position making sure your leg does not pass the midline on the way in. Repeat times. 12

13 8. Bend and straighten your knee, making sure your knee and toes point towards the ceiling at all times. Repeat times. 9. Pull your toes towards you, keep your knee straight and push your whole leg down towards the bed against the resistance of the springs. Repeat times. 13

14 Getting out of bed Once you have adequate strength in your operated leg you will start getting out of bed. This will initially be with the physiotherapist and then with the nursing staff. The physiotherapist will tell you how much weight you are allowed to put through your operated leg. You may have to wear a brace when walking. Your doctors or physiotherapist will tell you if you require one. The brace helps to prevent your operated leg moving into positions that put your hip at risk. The brace is to be worn whenever you are out of bed, for example, walking, sitting in a chair and showering. You do not have to wear it when you are lying in bed. You will need to wear the brace for approximately three months after your operation unless you are told otherwise. You must put the brace on before getting out of bed and not remove it until you are back on the bed When you first get out of bed, the physiotherapist will show you how to safely move to the edge of the bed. You will stand using a frame and may transfer to the chair. Gradually you will increase the amount you walk and may progress to elbow crutches if appropriate. 14

15 Hip brace (if required) It is important that you continually monitor your skin to ensure the brace does not rub and cause sore areas. It is also important that it is fitted correctly to prevent rubbing and ensure it is protecting your hip properly Fitted correctly Fitted incorrectly 15

16 Slide board exercises When your physiotherapist is happy that your hip strength and control are improving they will teach you the following exercises. These will continue to build strength in your operated leg. You should continue to do these exercises after discharge from hospital. Lie on your back with a sliding board or plastic sheet under your leg for the following exercises. You may sit up slightly but avoid bending over 90 Perform these exercises times a day. 10. Bend and straighten your hip and knee by sliding your foot up and down the board. Make sure that your knee and foot face up to the ceiling throughout the exercise. Repeat times. 16

17 11. Slide your leg out to the side and then back, being careful not to pass midline on the way back in. Make sure your knee and toes face up to the ceiling throughout the exercise. Repeat times. 17

18 12. Lie on the bed with a rolled towel under your knee. Pull your toes towards you and straighten your knee pushing your knee down onto the towel so the heel lifts off the bed. Repeat times. 13. Try to lie on your back for at least 20 minutes a day. If possible use only one pillow. This is to stretch out your hip and thigh muscles. 18

19 14. Lie flat on your back. Roll your leg into the centre so that your knee and foot face up to the ceiling. Hold for 10 seconds and relax. Repeat times. 19

20 Standing exercises 15. In a standing position holding on to a solid support, bend your operated leg up in front of you. Hold for 5 slow counts and slowly lower. Repeat times. 20

21 16. In a standing position holding on to a solid support, bend your operated leg up in front of you. Hold for 5 slow counts and slowly lower. Repeat times. 17. In a standing position holding on to a solid support, bend you knee and lift your foot off the floor. Hold for 5 seconds. Repeat times. 21

22 Going home Before discharge you will need to achieve the following goals: Independently put your hip brace on and take it off (if required) Be independent and safe with your hip exercises Walk safely with appropriate walking aid Climb up and down a step or stairs if appropriate for your home circumstances On discharge from hospital you will be referred for on-going outpatient physiotherapy at your local hospital, or if you prefer you can be seen for outpatient care by the RNOHT physiotherapy team at either Stanmore or Bolsover Street. 22

23 Stairs Always go up and down one step at a time. If you have a handrail, then use it and hold your other crutch in your spare hand. Ascending stairs: Stand close to the step. Step up with your good leg first. Then step up with your operated leg onto the same step. Lastly bring up your crutches. 23

24 Descending stairs: Stand close to the step. Place your crutches down first. Then place your operated leg down. Lastly place your good leg down onto the same step. 24

25 Questions When can I return to driving? You are not able to drive for the first 12 weeks. After this point your physiotherapist will advise you on when it is safe to return to driving. Can I have a shower or bath? Your occupational therapist will discuss this with you and may provide equipment to allow you to shower or bathe while maintaining your hip precautions. If you require a brace then this must be worn for showering or bathing. You will need to rest on the bed after your shower whilst your brace dries. Can I sleep in any position in bed? For the first 12 weeks you should sleep on your back; after this point you can try sleeping on your side as comfort allows. When can I return to work/school/college? This will depend on your job and needs to be discussed with your physiotherapist, doctor and occupational therapist on an individual basis. 25

26 When can I return to exercise? To protect your prosthesis from loosening or fractures it is important that you avoid all contact and impact sports. It may be possible to return to swimming, cycling, Pilates, PE or other hobbies but this should be discussed on an individual basis with your consultant or physiotherapist. When is it safe to resume sexual relations? Unless you find it painful, or your doctor advises you otherwise, it is safe to continue sexual relations with your partner, so long as you keep to the previously mentioned hip precautions. Generally a comfortable and safe position for both men and women is to be on their backs underneath their partner. If you wish to discuss this further, please speak to your occupational therapist. 26

27 Operation date:... Consultant:... Ward:...Ext:... Physiotherapist:...Ext:... Occupational therapist:...ext:... Weight bearing status:... Walking aid:...for... Brace: Yes/No for...weeks Out patient physiotherapy referral sent to: Telephone:... 27

28 If you have any comments about this leaflet or would like it translated into another language/large print, please contact the Clinical Governance Department on /5717. Royal National Orthopaedic Hospital NHS Trust Brockley Hill Stanmore Middlesex HA7 4LP RNOH Publication date: June 2014 Date of next review: June 2016 Author: Suzy Hudson