Hip Replacement Exercises

We're going to look at programs for post operative and preoperative hip replacements that van similar. In fact, we in fact are almost the same, but we just have to uh, deviate just a little on each exercise. When you think of someone with who is about to have an operation, um, for a hip replacement, what do you think? They're going to feel? Pain. It's going to feel pain. They're also going to have trouble with alignment and they're going to have trouble with gait. And also one of the other big troubles is Muslim balance.

And although it's involved with the leg and around the hip by sh, by just limping and trying to stay off the leg, the muscles up the whole side of the body will be, um, will be, will be, there'll be difficulty with it. So we can't just think, right, it's hip. We're gonna work around the hip. We need to look at the, for the full picture if you like. So each program should not just involve this area here, but it's, that is the prem, the, uh, the main part, the premiere area. But we have to work in everything else. Now. Pain. It's, we have to think of the pain right from the beginning. So we have to put the person into a comfortable position to begin with.

It's no good lying them on a hard floor or uh, on their back or on the front. They need to be, uh, supported so that the pain isn't intensified while I working. Any ideas where we should start? Where do you think of a muscle group that's going to be really, uh, compromised right from the beginning, but glutes, my favorite part of the body. So we're going to start with the glutes. First of all, I think it's best to with your client is to watch them quite a lot, observed them walking, observe them if they're, if they're using a stick, observe how they're holding the stick.

Quite often you'll find someone with a stick that's much too short. So they're leaning into it. So it's quite often looking at how they're holding their stick, which are, which hand they're holding it in, which side, um, watch the way they sit as well. Because quite often they'll shift off that. And the other thing is watch them get off the seat. And again, all these things will will tell you what needs to be worked on.

But we're going to start off, we're going to start with the, the back of the leg and you need to, of if they're lying on their back on their front, the lumbar spine has got to be supported. So could you reach me a pillow, please? Add the two towels. That'd be great. Thank you. I use pillows and towels and cushions a lot. And in fact, my studio's like the Bedding Department of the big department store.

What I want you to do is I ideally, I do most of this work on a, on a flat bed like this on a table. It doesn't have to be as high as this, but it's good to have the feet off the floor, off the edge of the bed. Um, what you find is if people are limping or have had a history of being off one, like the feet are not very mobile. So if you're lying them on their front with very tight feet, it's going to affect their knees. So ideally have the feet over the edge of something.

So Amy, can you lie on your front and just have your feet, just the feet of the end. The idea what, why the pillows here, if you've got someone I like to dress my, um, my students, you can see if you've got someone, again, if they've been limping, if they're onto one hip too much, they get go into quite a battle or doses. And so you need to support that loader lordosis because if they're going to lie in this position that too long, it's going to tighten into the lordotic spine. So we need this to be soft. If we, if I took the pillow away, Amy's back would be quite tight in the back extensors. So I want it to be reasonably, uh, not loose but soft, soft ish. So when she starts working down here, we can get some movement through the lower back here.

The other thing you need to think about is what's happening here. If there's a gap here, there's going to be a lot of tension in the upper trapezius and in the neck. So I would want to support that gap. If there's a gap anywhere in the body, it's going to cause tension. So if you're just, if, if you were to feel Emmy's up at two pieces here you'd find it quite tight.

So can you put your hands until, what I'm gonna do is, this is probably not enough, but I'm going to place this under her armpit notes. I'll just do this one side so you can see and just a rolled towel. We'll do it by placing that and closing that gap there immediately. This whole part of the upper body releases, so obviously we'd have them on both sides and that opens out the upper back. Now from there I try and get the legs as parallel as possible.

Speak slightly apart and what I'm going to ask Amy to do is just to s think of an area, just think where the sitting bones are and I want her to, without outward rotating, I wanted just to gently pull the sit bones together, almost thinking of a Kebab stick going through the glutes and she's going to hold that for a second or two. And then let go while she does it. Just watch what's happening to her lumbar spine. So to see how there's a slight elongation there. Now she's not tucking under because her hips are anchored onto the bed. So by just giving this slight squeeze, this opens, which is going to help her to, to strengthen this part of the back.

So if she squeezes here and this opens, what else happens? If you've got an elongation through here by getting this working, what else is happening? If you think of the back like this, so the lumbar spine length, and so the abdominal wall lifts, so you're getting some work in the, in the abdominals. So you're putting the pelvis into more of a correct position. Also, if you think where, uh, the [inaudible] D'orsay is joined into the spine, which is, you know, it's one of the big muscles at the back here. So if she ilang these gates, this area of the back, the Fascia of the litters, Smith's door size also drawing down.

So already she's getting this to be opened. Okay. The other thing you'll notice here with the, you'll notice there'll be a definite chain effort difference in the glutes. Here we have a a nice gluteal crease. Yeah. Which has both exactly the same, but if we say this is going to be the hip that's going to be replaced, you'll find that the gluteal crease probably isn't there, that the, the, the muscle area all the way down here has wasted. So what we'd have to do is instead of thinking of squeezing both, we'd squeeze one, so we'd get them to let go and squeeze again.

So you'd start firing this muscle a little more, so about four of, and then hold it and now bring the other one in to match it. So you do however many you needed to to fire that muscle a little more. Okay. So we've got the glutes to work. Remember there's no outward rotation. It keep you keep it, um, parallel that we need to work down into the hamstrings. So we're going to get her to do the squeeze here. Can you squeeze quite fully?

Now I'm going to ask her to let go about 50% okay, good. And now with this leg, we're going to do a bending the knee to 90 degrees with a soft, easy foot. So she's going to bend and straighten. Now you can see with Emmy's, like how the hamstring really kicks in there and then, but she's going to do it quite slowly. So quite is make sure the support in the knee and you can just place your hand here. Now Amy, just gently pull it, push into my hand, push into my hand. There we go. And then you can gently resist. Again, you have to decide what pressure you're going to use up depending on the person. Now I want you see how she works the belly of the muscle very well. I would like to work a little more up into here. Okay, so what we're going to do is Ben, and then without changing the pelvis at all, she's going to just very gently lift the knee away from the ground.

So we get up right up into the top and then low. And then Don, obviously the ratio would be different. Let's say this is the injured leg or the preoperative leg. This is the leg that's doing a lot of work. So we'd obviously work on this one much more if you want to work. If there really is a lot of wastage here, what you can do is can you sit up Amy again in this position, it very careful with the clients lower back.

Sometimes this doesn't work with people, but if you get them onto the the small, can you go forward just a little? There we go. And again had the, the line from the uh, the, the tailbone and the coccsyx up to the spot as much of the straight line as possible, even if you need to pat up through here. Okay. So what we're going to do with the same leg, I'm going to ask her to from quite often I will put a yoga block under the knee. So that's supported and position and she's going to just lift that like in parallel. That's it. So you get much more work up into here.

And then from there we turn the leg out, open it out and bend the knee and you do say okay and that you see how that really works even more. So I always support the leg [inaudible] sometimes I need to support through the knee, so if you just hold and just gently put her dead and then you've got where you get this area working well before the operation, this can be too much, so you'd have to find out. Anything in that position can be much more difficult. So you'd have to check, maybe just keep it parallel for the time being. Okay. [inaudible] do you want to try that with each other? Just try the WWE lying on your front.

If you need a pillow just to get the feeling what happens with the glutes? Squeeze. Check the splits on each side and just see if there are exactly the same cause quite often because the way we stand, the way we teach, some times we're not too good at standing on both legs. Just initiate from here, which we'll draw down. Okay. And then going into breed leaders. Okay, let's see. Matcha the days.

It's like a sandwich very nicely. Yeah, it's crazy. She's got very strong legs. [inaudible] football player. Right. So, yeah. So what I would want to do here, if you see if the takes just sometimes take the leg like that and rotate it. That's it. And you feel that, okay. No, let's try that. Squeezing us again.

[inaudible] yeah. How does that feel? That's harder. Harder? Yes. Cause we've activated into there rather than to here. Okay, I see. Okay. How's it going here? She just said it's kind of hard to do. Kind of hard actually can track [inaudible] yeah. So that's make quite often a lot of people want to lie.

Can you do with a slight rotation? Yeah. A lot of people want to lie like that. Right? So what we need to do is just to take hold of the leg and very gently rotated parallel. There we go. And it takes it off here and now think of this. Yeah. Squeeze to sit back. That's better. That's good. Yes. Yes. Okay.

Let go again and a squeeze. Right. Okay. Try the Hamstring Co's in that position. Alright, so that's cool. [inaudible]. Okay, so go ahead, give me you first and then let's start with [inaudible]. So no, we'll sh what we'll do is let go, let it go down again.

Think of the squeeze the fullest. Full squeeze. Now let go about 50% okay. And now do the banding from there. Okay. Then relax your foot. That's it. Yeah. Think of the movement concentrically and East centric.

They said it's not foe whopping back and forward. They have to be supported and now come down. You can push against my hand. Yeah, keep it per shot. Put down the, let it take like all the way down. But yeah, that's it. Yeah. Right. Okay. [inaudible] again, it seemed like, okay, can you keep skewering the hood? Let's squeeze be selective. Stop with this leg. Relapsed.

That's good. Yeah. I could see it working there. And then when you go to Europe, relaxed. Okay. We're going to switch to post operative for the same exercise. So it saves time. You'd need to think to begin with a shorter range of movement. So for post operative, so you need it to begin with.

You can take it from the flat, but after the operation, start with a much shorter range. So if you think of this, you bring, so what I do is I put a pad under here, you can do it against one of the barrels or whatever, but that's going to be the range. So from there they're going to move from that range to 90 degrees. So lift up, that's it. And then back to begin with yes and back. And then you can gradually increase the range. So it's the end range. We're working, it's not this short range here cause quite often by lifting the foot from here, it tenses the whole leg. So we need to um, make sure it's this shorter range of angle. Okay.

You can put the bat a barrel there. Absolutely. Let's see what that might be. That's it. Yeah. And you see how that works. Much easier on that. Okay. I always ask what, what does the pain feel like between one and 10? Check with how feel with the pain. And they'll tell you, some people won't because they're, uh, wanting to be strong, but always check to make sure. Quite often you can look at that. I mean, in this position it's not so easy, but you can check by their face for, they'll tell you anything. It always work up to pain.

Don't, don't try and work through pain. It's not good in this position for a leg that is like postoperative, I would do, may have sometimes 30 do 10 rescue, 10 more. What I do, instead of resting, we rest the leg and then go to the other leg and do a few and then go back. But it needs to be done two or three times a day. So if they do it in your studio, that needs to do it at home as well as it's very important to have a, a homework program. Okay. Right. So from there, let's change over change.

Okay. [inaudible] same position with the pillow. Now what you're going to have, you're gonna have a use this tile for your forehead. What I want you to do is to have your partner with the hands by the sides, palms facing upwards. And again, I wanted very slight squeeze here. Just [inaudible] open out the lumbar spine. Okay, now this is working because first of all, if you've, if you're with a stick, they're going to be like this or if they're holding the hip, that can be forward. So there's going to be a tightness in the pecs and tightness in the upper trapezius. I don't want you to go open your shoulders out.

I want you to work from the back to do it. So from here, the arms by the sides, we've got to support here, but not too much. Just enough to keep this open. Now holding that position, you float the palms of the hands up. Then you gently draw the scapula down and lift the head away from the ground, but still looking down, lift the sternum up a little as well, but keep the elongation in the back of the neck. Then from there you reach your fingertips and rotate the palms outwards and pull down steel. Yeah, that's it. So you're getting the work into the mid traps and [inaudible]. So let's try that again.

So from there, the arms float up. Yeah, just just think of your, the palms of your hands coming up. Just don't do anything with the shoulders. Just, just let your, there we go. That's it. Now Scott Kulick lovely. Now the head and rotate and reach and keeping and you should feel it through here and you'll feel it in the triceps as well. And then relax back and try a couple of those. Just imagine that your palms are floating up and then drawing the scapular down and now rotate. Imagine your face is on a mirror. So then pat, you're looking straight down at the face rather than looking at chin or at your forehead.

So you're really getting the, the system as store side working so the shoulder blades are going to fall into place rather than trying desperately to put them done. Beware that people don't push their hands down to lift. It's just as gentle float. Okay. You see what I'd normally do is get up onto my hands and knees and go into the rest position, which is a no, no. Yeah. Okay.

Go to the good side. Bend your knees, both knees up in front of you. And now just lift yourself up from there. There we go. Oh the, yeah, exactly. Yeah. This is why I like using the table. Okay, let's change over and doing the lie on your back. Now with your knees bent where you want to get rid of the pillows actually. Okay.

Actually can you, um, photo mats in half and have your feet on the floor. So cause we then the slide. Okay, so the f B have your behind, right? So have your head on the mat, but just the torso and have something under the head. So again, they're quite comfortable. Okay. From here we're just going to think of the ABS because they, if they're the pelvis isn't in line, the abdominals aren't going to work.

Go ahead to think, just make sure the pelvis is neutral and the rib cages down. Make check the ribs are done. And now just allow the lumbar spine to find its own level. So just think of the weight of the organs. Just face softly opening out the lower back. But don't try to think of being a neutral spine. I like to think that there's a softness in the lumbar spine. Okay. Right. Think of your sip Burns that you've worked already.

Think of your hip bones and the low floating ribs. And imagine those three areas pulling into the center line. So you take a breath in and as you breathe out, just feel those three areas pulling into the center. Think of the hipbones narrowing that of obviously they don't move with it's sensation they would go. So we get the bleaks working there. Imagine you've got a very wide belt, so it's pulling right around the waist and you're tightening that belt to take a breath in. And as you breathe out, just really poor.

Don't think of any weight going down into the lumbar spine that stays exactly. There's no pressure down. Right. And you should feel a narrowing of the waste, the obliques, and the transverse working. How's that? Okay. Do you feel that? Okay, try add on as you do that add on a very, very small pelvic tilt, tiny one just so that the tailbone comes off two or three centimeters off the ground and you'll just get a little deeper work into this area here. Okay.

Yeah. A lot. They don't, they don't let go. They allow to go back into place. Okay. Which sometimes it's quite different, so it's a lowering don. Okay. In fact, when they go down, it's a preparation to go back up again so they don't have to collect everything together all the time. Okay. Now this is pre-operative exercise. From there, they're going to draw in the ads and then they're going to slide one leg away, but not move the pelvis at all and they, you get them to stop if there's any pelvic movement already paid and then back. And so they're working very strongly into the abdominal wall on the side that the legs going away. Right. You feel that pulling up in that position and then back, but not even think they're thinking of the heel. They're just allowing the movement to, to do, to get the muscles working rather than gripping. Would she, what did you ask?

Can you repeat it? OSHA, as she said, do you ask them to use the hamstrings and, no, I just want them to use the movement. Just imagine that the heel is on a small wheel as they come back and forward so you don't get that grip and they'll slide away. I'm just drawing through here a little more. That's it. Yes. And then come back. Yeah. Okay. You notice I don't, I haven't mentioned pelvic floor. Why not? Yes, thank you. Many. Because if you really feel the SIP, burn hip burn and floating ribs, you're going to use your pelvic floor.

And once you get into the way of this sliding away, this drawing up of this area is going to work. The pelvic floor. I'm finding that a lot of people are overusing it. You know they're going to pulling up and you see the eyebrows come up and you go, you know, I'm using my pelvic floor. It's really isolating in this area. So it's it's I want the body to work naturally.

I don't want it to be like this is the same when I s about the hamstrings. If they draw the hamstrings up, they've got a grip to pull it up rather than to use it naturally. Okay. If I say to stabilize, it means just this pulling in. So just think of that feeling of the from the hips, sit, Burns, hips and floating ribs, just drawing in. You can use it. Any imagery like I like to think of a wide belt type thing or just a pair of hands coming around from the back.

So you're sort of melding around and what I used to do is say, pull your navel to the spine. I don't often use that now because people were going like this and tensing. Whereas this is a much more usable thing, which they can do when they're standing up. Because I want people to do this program at home. And so quite often you have to find ways that they don't necessarily have to get down on the floor at home. They can do it standing, doing whatever they have to do. So this one is very easy to do standing up.

Okay. Now I'm going to, I want you to, I want to use this as a support so that the, we can judge how far the leg will go without the pelvis moving. So what we're going to do, we're going to take a breath in and we're going to stabilize and then slide the leg away. Just slide it along. Imagine the legs on a wheel and it, you don't have to do the full range of movement. If the leg gets to there and the pelvis starts moving, that's when you stop. So you gradually can the movement. So the feeling is that the, the abdominal wall is going that way as the light goes this way.

So you're getting that feeling of drawing up through here, which will help them with that gate so that they're not going down that sort of lifting as they move the leg. Okay? And then come up. So this is a before the operation. Now afterwards we're going to add something on. We're going to place, I'll use the same leg that you can see. So this is postoperative. Going to do the same thing. They're going to slide the leg away and then bring the leg back to the, and putting a hand on the opposite hip. Just gently open the leg out to the side and then close and stretch away.

So we start getting the outward movement at the hip. So this is an inward breath. You breathe out as you open, dropping the opposite hip, done, breathe in. And uh, so not only are you getting the, um, the work into the joint to get it more mobile, but you're also using the abductors coming back in, into the, um, into the starting position. Change the breadth on this. When you're doing, for example, you know, when we were sliding the leg away, start with what breath is comfortable for them and it's usually the ultra deep breath. Is the stretch away and into come back, change it after a while so that they can we go back to this, this exercise. So we started with the outward breath as you go away and then in to come back, change, breathe into, go away and then breathe out slower and you'll get much more work into the abdominals.

Okay. I do it. I don't do it straight away because they sort of go to that. So start with the ultra breath and then go over to the inward breath. Okay. You can also adding on this to help to get a little more work into the upper torso as this like slides away.

I'll let you decide which breath you want to do as you this. Like simultaneously you're going to take your arm back, so the leg and um, get to the end position at the same time and then come back. Almond leg, Don [inaudible], why do you think we're going to do this? What? What have they lost? Coordinate. They've lost coordination because of limping.

And so this is helping them to bring coordination back. So we do the same side and then we do the diagonal to help them to get this feeling of moving back and forward. Do you want to try that? Yeah. But we've watched that the Pellis doesn't move. What we could do there actually, which is a, actually this is quite a good point here with the legs. Some people, because of the way they'd been walking, I don't have never straighten their legs. So if you can you stretch this leg out, fill the gap so you will, you'll see them do it and then you will know which gap to fill.

So you fill the gap and then they can just gently press down there and you'll get a little more hamstring work. Okay. And then with your pressing down, you can pull back here just a little bit more, which will open out the hips. Well, okay, I'll do that. You'll find this is, this is the leg, this is that your bad leg is this, this one? I think that might help that just to get the stretch. Yeah, it's a back filling the cat jack on labs. Her Path was to stay. Yeah, exactly. Yeah. And helps to support the lumbar spine.

There you go. That's it. Good. And occasionally, you know, let them hold the position for a few seconds so they can feel the elongation work at it rather than stretching and bending. So there's a slight pause and if the breath doesn't work for them, let them breathe the way they want to. I, I don't, I can't get hung up on the breath pattern. [inaudible] it's so fun to hear a little more. Yeah, just keep the, just the side stand and Bay soft [inaudible] we did the opening one as well. So bear bend your knee up and a stabilize the side and stretch.

So this only goes as as she can keep this. Yeah, exactly. Yeah. Okay. That what the temptation is to get lift this hip off and it really stabilizes. Yeah, that's it. Yeah. Yeah. So I want the, um, from here it's through here and then it goes over to the opposite side and then it's the adductors doctors that are gonna pull you back.

That's it. You want to say? Yeah, try the, try the alternate, the side stretches without where you can do it with the ball as well. So as your light goes away, the same arm and then come back. Okay. Can you actually, can you watch Amy do this and tell me what you think I'd want to come up on here too. Yeah, come up.

Okay. Woo. We'll do two. Oh, you can do it with the ball. Just tell, watch. Tell me what you think. She probably won't do it now. Okay. Amy Harmon, like Almond Beck and back is how well she takes her mom back is hanging. So what? So and th and with a lot of people, they can't really get any further back than this.

So what w w the teacher has told me to take my arm, the bat all the way back. So when they don't have the movement in the shoulder, they'll do this. So what I want you to think of doing as you do it amicar I want you to think of from your low ribs to your elbow. Don't think of your hand at all just from your low ribs to your elbow and open up that position. Just open it up. Open it out. Well, armpit. Well that's it. There we go. And just how you get much more movement through here.

I'm working through something so perfect that you caught that. So that will, rather than doing this, and even if it just goes to there, it's that opening there that will fact as you do it, you'll feel the scapulas lightly come down. I should have just taught something in this position, which will really help both before and after to help to just to feel where the scapular should be, because I really think we tend to draw shoulder blades down too much. Just allow them to fall where they belong. So what we're going to do this really, it's going to relate to hips. The why. How does this relate to hips?

That's scary. Okay. I know it does. Now that you ask. Remember? So they know the Walker. I mean, that's total exaggeration, but once the back one for getting them up, we want them upright because we're going to teach them how to walk again correctly. So if they're there, they're not going to. So we want them to feel that this is happening. Okay.

So what you're going to do from that position, Amy's going to just feel the scapular on the back and she's going to think of her elbows and she's going to vate gently draw her elbows down to the mat and turn the hands and then just Jen to float them up and turn the hands back. And you'll feel that in your shoulder girdle. Simple, easy to do. Do you want to try that? I'll spray. It's just very easy and it's quite a lot of, we do it standing, but in fact lying down, you can just feel this whole area open up and relax. Try it. Try It on your backs. Do you want to stay there so we can see the demonstration such as lying, semi supine. Do you want me to come onto this? Uh, to try it? Yeah.

Okay. So have your hands roughly 90 degrees, not too high. Make sure the shoulders are in place. And now from that, just thoroughly, gently draw the elbows down and turn the hands. Think Scapula, but don't do anything to the pillar. Don't feel a draw down. Just think where it is. And just imagine a weight on your elbow as you pull down and turn.

That's it. Thank you. So with something I'll do ahead. Yeah, that's it. They easy thing. Get, see you're going to be about the, no, just, just imagine your fingers staying there and your Elbers doing the work and turning their hands. Turning their hands. Turn it. That's it. Yeah. Try and keep the Hatton's at right angles that come up. Not, don't think of doing anything. Just like think of gravity. Drawing your elbows down in a very soft, easy turn. Easy. That's it.

Yeah. That's a stay open. Not through here. Okay. Just do, do one more. Okay, good. How does that feel? We want, we've done the hamstrings, we've done the glutes. Uh, we want to do the quadro sets because again, they haven't worked too well.

So you're going to, from there, I do this before the reformer. I mean, I get them onto the reformer as quickly as possible, but in the meantime, just to get them to do some work on the hips and the legs before they get onto the reformer. So this is just a pre reformer work after the operation. So what you do is you from the, you bring your leg up straight into a comfortable position. Now you're going to take the leg down in four counts. So you're dividing the movement into four. So it's one, two, three, four and then lift two, three, four. So this getting working. Yeah. And also the working into the hip flexes. So it's done.

And then up. That'd be contracting my leg. No, no, no. Just allow the movement. If it's support the abdominals. The question was should I be contracting my leg? No.

Allow the movement to do it. I mean you see with Amy, she can use you. She can use her legs. She knows how to use it. Where working with people who've lost the feeling of working the legs. So we want the movement to translate to their feeling. Okay.

So you'll do it parallel, then we'll do it very gently, outwardly rotated. And the same thing. Why do you think I asked you to do it on four cards? Exactly. Absolutely. So you're controlling rather than swinging it back and [inaudible] okay. You're are then going to, Ben didn't eat up roughly to about 90 degrees with the, the upper thigh, straighten it, soft flex and take it down.

So spa, their hamstrings are so tight, they can again say that again if the, if the hamstrings are too tight, you only go where the hamstrings allow it to. For example, if, if that's Amy's hamstring stretch, that's where we'd go to. So she, we, we would go quite often that this, they would find this fine, but as they straighten the leg they can go to the and done. So they would go to the stretch of the hamstring and then gradually they would um, get a little more movement into it. In fact, what we're doing here is it's like when the hamstring, cause we're warming it up, getting the muscle wall and, okay. Do you want to try that? Why not? Huh. Awesome. So just do the, the straight lifts, just a couple for up for Dan and remember with stabilizing through the center and we're thinking what's happening in the upper back at the same time.

So we're trying to to build in a program of involving the whole body as you do it rather than concentrating just on one bit. It's more work. Yeah. Thank you. And don't worry if they can't point the feet, it doesn't matter. Sometimes I think we'll try to get them to work too much on things that, that they're not capable of doing. Just just lift away from the leg a little more.

As you bring the up this time, just do just a little more drawing in here. That's it. Yeah. And then you're going to hold onto that as the leg goes down cause then that will lighten the leg. Yeah. So just involve the abs a little more and then bend and stretch. In fact, in the be a straight after the operation. Be Very careful. The lake shouldn't go any higher than that.

Even if they're quite loose, they shouldn't go any higher until the muscles have gotten a little stronger. I haven't thought that. Yes, they are. Okay. They can be very nervous about overdue over doing the work. So what I tend to do is if the another side, I will take the leg and just we'll come together and go up and so they can see where and I won't look at the leg. I'll look at their face cause then I'll know when it says so even if it goes to, there we go. Okay. That's, that's the range we'll do.

And I will hold on Twitter while just, you know, give them this feeling and we can both feel where, cause I can feel when it'll start sticking. That's what I was going to ask you. So you're watching that face but you are oh yes. Yeah, yeah. I'm a very hands on person. Should I, I've got a touch to really too. Cause it, you can feel what's happening through the leg if you're touching. I mean you don't go all the time, but just know, make sure they know what's happening. Okay. Right. Can you lie on your right side facing the audience.

This is the leg because lying on this side can be painful. So wherever the scar is, you stand, you lie away from it. But what we need to get is to get, can I have the top leg now? Where do you suggest I put the padding on this? Cause I do use padding. Yeah, yeah. Between the head and the um, yeah, yeah.

And the waist. Can I? Yes. Yes. Got So and really bad. Much depends on the width of waist and the, the width of the, of the waistline. So sometimes that really helps them to keep the spine in line. Now eventually I want them to put their hand just here.

Sometimes I'll do it for them. The leg is turned in and out from the, they're going to elongate the leg and lift to get the work into the glutes and into the outside of the leg. Okay. Now in the beginning I will take it only to here so that it's in line with the center line. It can go a little. Uh, so it's in line with the spine. But uh, the advice is not to go over the center line. That is changing slightly. A lot of, uh, people who I'm working with know the, uh, the surgeon has said, yes, you can take your leg as far as you like, because I think the technology has changed, but I, I'm very wary about that.

So it's up to there. Absolutely. Yeah. So if it's this one, this older model that that's what we're very careful with. Yeah. I want to say that. Yes. Well, I know much. I was thinking about something else.

It's always fun to [inaudible] depending if, depending who, I always like to have feedback from the surgeon that they will tell me all day, we'll write a report and say what style of operation that done and whether it's safe to go across the line or back. It's always good to check up. Even if you just drop them an email and ask them. They're usually pretty good at reporting back. I, I work with one, um, person who does quite a lot of hip replacements. She's not, I'm not popular with her in that when they, because we do pre-op, she has to fight more muscles. So I'd just say that's part of your job. Fight the vassals. Whereas if she has someone who's never done anything, it's easy to get through. So this is going to, you feel that working all the way through here, up into the glutes. Okay.

That's important. Right? Any questions about that? Okay. She's more parallel, more parallel. You can take it, I wouldn't say in the beginning, but you can take it. But the trouble is with internal rotation, that's usually where it goes when they're in pain.

So we wanted to try and get them to go a little more open. But again, not, not overdoing it, any of the movements sort of keep a neutral position on that. Okay, we need to work the doctors. But that traditional way of working the doctors of, um, bending this at the knee and lifting this like is world work mainly because they'll be lying on the, the scarring area of the operation. I personally doesn't think, I don't think it works very much anyway because it's such a short range of movement. Now you go from flat here to here, whereas we can do it away that you get to this much bigger movements. So what I want you to do, can you sit on the floor now? Can you sit with your legs apart?

Not Too wide. Okay. And I want you to, in this position, I want you to sort of slightly sit back. Don't sit up straight, just just lean back. A little slight lumbar curve, slight curl. The flex feet and the legs are parallel. I just leaning back, try not to get them into their shoulders too much and I get them to focus on the inner thighs and then just slide the leg to the center line. And then back. You could open the leg as much as you like. You can abduct as much as you like, just one at a time.

One abduct as much as you can, but adduct only to the center line. You're going to do it parallel. And then very, very slightly rotated outwards. Do you feel you're inner thighs working there now? Plus three fingers halfway down about a quarter of the way down and just get pressure with those fingers just to get that working a little more. I sometimes get them to hold onto that one leg.

So it helps to hold the position. If this is, this is not good. If it's all get them to do it against a wall with the, the spot of the pelvis just a little further away. I feel the energy going through the front of the heel as you do it, then try the other leg just if, if they're sitting up too straight on this, it really does get into the hip flexes a bit too much. I mean we're obviously we're using the hip flexes but it tightens the quads too much if you're sitting up too straight. I was just going to ask that. So it's again, like I asked if they're not, we don't want, we don't know. Don't over. I mean the, this, the quads would be engaged who threaten the labor. You're not gripping. Right.

Cause what happens is the grip and the pull in to go across. So it's a feeling of elongating out of the hip and keeping the, the, the leg as much as possible onto the floor. Don't let the lift, don't let the leg lift. That's not too bad. But don't lift the leg off because then it just over develops this, right? Yup. Yup. Okay.

And that really is for anybody ever where I do this in my macbook classes for the doctors, uh, but with the um, with people who have healthy hips that can go right across and get the stretch in the TFL is they do it. So that really helps to get more work into it. What I want the clients to do is to do a home program and it's not always good for them to be at home on their own and get down on the floor. You know, I, I want to think of the safety angle of this. So one of the exercises is really good to get them to work. This is to do, to stand in a small v and just feel the s just standing the, no, you're going to get the sensation of this rapping effect. Can you feel, just imagine a path hands coming round from the back and the fingers are getting into the center now. Squeeze your sit burns together. Now from there, what I asked him to do is to rise up on to the toes and then back down to get the strength in the legs and into the hamstrings and glutes and also to work the carves. But as I see you wobbling a little, I would not ask them to do it. I will. Mainly I get them to what? Put the hands onto a shelf or piece of furniture or a mantle shelf to hold.

So you're going to use your partner to do that. So just support yourself with a partner. Now I really theater, think of the posture. Think of that alignment from your just behind the ear, through your sh shoulder joint, through your hip joint to the knee joint, down to through the ankle joint. And now squeeze and slowly lift balancing yourself. Just imagine your partner's a wall, hold it and then slowly go down.

So you should feel your carves working there as well as so go up. Now what I want you to feel this time is go up. Feel. Imagine that your head is staying there and lower your heels down, but keeping your head where it is so you feel the body lengthening away. Try that one more time up. Just get this feeling of wrapping around here as you do it. Good, good, good.

That's it. And I'm okay. How does that feel? Good. And it's also this, this idea of if you're in the grocery store, standing in line, standing sweetish glutes together just to get the feeling that it's working that you can feel and working. So by the time the you are well over the operation, you're using the back of the leg to walk. So we're aiming to get very good gait with good posture and to relearn ways of using your body because it's, it's a quite a long build up to the hip replacement. You know it's pain, it's more pain and it's very painful.

So they'd have to relearn how to use that side particularly. And also relearn how to think of posture and w w you need to think of practical things, how to teach them how to get out of bed. Again how to get off a chair or how to sit into a chair. The other important thing is to show them how to go upstairs, so you need to think of all the things they have to do at home that it's fine doing the exercises, but you need to put them into practical use for them. Okay. Do you have any questions of some of the things we've gone through?

The question is why do I use four counts? It's, it's a really to slow people down because what they want to do is just to kick their leg and lower it. What I want them to do is just to divide that, that distance into quarters if you like. So it slows them down and it allows them muscle groups to to work much harder, much more meaningful it. The question is how about range of motion of movement? The range depends very much on the individual and you need to test the range before they do the exercise. You know, say we're working with the leg, just see where the leg goes. [inaudible] a preop operation.

You can take the leg and see how you know you can move it as within the pain threshold after the operation. Don't go any higher than 90 degrees, but quite a lot of people will not be able to even to go to 90 degrees. So you need to just, just test it. Just take the leg, always have a hand to stabilize the hip and to bring the leg up, lift the leg always when they're lying in a a semi supine position rather than lying flat. So they've got the steps, stability of the good leg being bent. The question is about the leg slides when we were lying in semi-sweet pined and the one where we bent the knee. Dan, how much engagement of the muscles we want. Do you know, I don't really want you to think of engagement. I want you to think more of movement.

I want you to think as the leg slides up. Um, it just, you just bend the knee so naturally bends the knee and then Dan, so you're not thinking hamstring quads. It's just what happens when I bend my knee. I will do that for quite a while. Just this bending and straightening and opening, and then I'll start adding on, try and feel what's happening as you bend your knee up, see, feel what's happening to your hamstring. Actually where I'll start is field what's happening to your abdominals as you lift the leg and then start working.

And so you, you, you let the feeling rather than saying hamstrings, glutes. Abductors I never give too much feedback to begin with. Basically, these are very simple exercises because I want them to be most of them without equipment because if I want them to do their program at home, they don't have equipment and they, you can, I want them to do a regular on a regular basis. I mean, if you see a client twice a week, that is not enough. They should be doing something every day, sometimes twice a day, just to really get the, um, to get the rehab working. Okay. Thank you.