Of course, the first course of action (which you’ve already done) is to make sure the client has clearance from his or her physician to return to physical activity. The exercise guidelines and limitations provided by the client’s healthcare provider should always be followed first and foremost, as most surgeons have developed their own protocols based on the type of surgery, their own preferences, and available research.
In general, a fitness professional may begin to see the client between six and 12 weeks after hip-replacement surgery. If movement restrictions are lifted, the client may be progressed as tolerated. The client should be monitored for surgical-site pain during and after training sessions. This pain is often described as “sharp or stabbing” rather than the typical low-grade “muscle ache” [i.e., delayed onset muscle soreness (DOMS)] that is often felt following a vigorous workout session. It is recommended that the following specific exercises be avoided for hip-replacement clients:
• Deep squats, lunges, yoga poses that produce greater than 90 degrees of hip flexion
• Side-lying adduction and stretching the leg across midline
• Yoga poses that produce internal rotation
• Yoga poses, seated groin stretches, and sitting with the legs crossed that produce external rotation
• Lunges and prone hip extension that produces hip hyperextension
General strengthening should focus on building local strength and endurance throughout
the hip region and abdominal core. Early fitness activity may include isolated hip open-chain exercises [e.g., seated straight-leg raise and side-lying leg raise (abduction)], using lighter resistance and higher repetitions to improve strength, endurance, and muscle recruitment. The goal should be to restore proper strength and neuromuscular control prior to advancing to functional activity.
The functional program should challenge the abdominal core and lumbo-pelvic-hip complex in all planes of motion, but must be progressed from basic functional activities. The post-operative client may be at a lower functional level than a relatively healthy client. Basic functional tasks such as sit-to-stand, rolling in bed, stair climbing, and picking up objects may still be difficult. The client may need to master these basic skills prior to progressing to more intense exercises.
Deficits in general balance may be evident due to disuse of the kinetic chain. Basic functional ability should be obtained prior to implementing balance activity. Early balance activity can be combined with basic functional tasks. For example, the client can do the sit-to-stand exercise with a foam pad under his or her feet or pick up objects while standing on two air-filled discs. When appropriate, the client can be progressed with tandem and single-leg stance balance activity.