Supporting Clients Through Hip Replacement Surgery
As a Pilates instructor, it's essential to understand the needs of clients who have undergone or are preparing for hip replacement surgery. This blog post will walk you through the key points of hip replacement – from the reasons clients may need surgery to how you can help them transition from physical therapy to Pilates safely and effectively.
Why Do People Need Hip Replacements?
One of the most common reasons clients may need hip replacement surgery is due to arthritis. Here's a breakdown of the main types that can affect the hip:
Osteoarthritis: This is the most common form, often affecting middle-aged and older adults. In osteoarthritis, the cartilage surrounding the hip joint wears down, leading to bone spurs, swelling, pain, and inflammation. Over time, this limits movement and creates the need for surgical intervention.
Rheumatoid Arthritis (RA): RA is an autoimmune disorder where the body's immune system mistakenly attacks healthy cells, causing joint inflammation. While RA commonly affects the hands and feet, it can also impact the hips, creating nodules and causing discomfort that leads to the need for joint replacement.
Avascular Necrosis: It is a result of a temporary or permanent loss of blood supply to the bones. The lack of blood supply causes the bones to become weak and porous, eventually leading to the death of bone tissue. If this happens near a joint, it may cause the joint to degenerate and collapse, often necessitating a joint replacement.
Pre-Surgery Preparation
Before surgery, Pilates instructors may encounter clients in a “prehab” phase, where they’re working to stay strong and mobile before their procedure. Encourage your clients to avoid painful movements, as finding comfortable positions can be challenging with advanced hip osteoarthritis (OA). Here is a list of exercises clients should do before a hip replacement that can all be done on a mat or the reformer!
Research shows that staying active before surgery often leads to a faster recovery. Helping clients maintain strength, flexibility, and endurance can make a huge difference post-surgery. It’s important to avoid pain and focus on gentle, supportive movements.
Post-Surgery: What to Expect
Immediately following surgery, clients will need early mobilization to prevent blood clots. They may use assistive devices and take blood thinners for six weeks. Physical therapy will likely be part of their recovery, focusing on restoring function and range of motion.
Instructors should be aware of movement restrictions depending on the surgical approach:
Anterior Precautions: Avoid hyperextension of the hip, external rotation beyond 10 degrees, pivoting on the surgical hip, and crossing the legs.
Posterior Precautions: Avoid bending past 90 degrees, crossing the legs, and internal hip rotation.
Returning to Pilates Safely
Clients will likely return to Pilates once their surgeon has cleared them for more general exercise. Initially, sessions should focus on:
Alignment and Stability
Ensuring proper form to prevent compensatory movement patterns
Start with gentle movement like bridges, side lying work, standing side splits.
Adding props such as a band around the thighs can help clients have tactile feedback to check in on their alignment
Gentle Stretches
Supine Quad stretch on the reformer with or without one foot in straps
Standing hip flexor stretch with hands on the footbar and knee on the carriage
Core Activation
C-curve on the box facing the footbar with feet hooked under black strap for support.
Mid back series starting with feet on the footbar
Gradual Progression
As your client builds confidence and strength, progress the exercises introduced in the alignment and stability phase. Always check in with them to ensure they are comfortable and pain-free with each new challenge
Remember: thoughtful progressions build lasting results!
It’s crucial to collaborate with their physical therapist during this transition. You can continue the work they’ve started in therapy by adding Pilates’ emphasis on control and alignment.
Conclusion
Working with clients who have undergone hip replacement surgery requires knowledge, patience, and close attention to their limitations and progress. By understanding the anatomy, the differences in surgical approaches, and how to tailor Pilates programs, you can play a crucial role in helping clients regain their strength, mobility, and confidence. Learn more about how to help these clients through our hip replacement workshop here.