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The Unexpected Silver Linings of Major Hip Surgery

At almost four months after hip replacement surgery, I wanted to collect my thoughts about the whole process, in hopes that hearing about my experience might help others who are considering or definitely heading toward a similar experience.

The lead-up:

I notice that my pain is more frequent and more disruptive of daily activities about two years before surgery.

I go to physical therapy, hoping that will be enough. It is very helpful, but not enough.

I take time to make a list of possible doctors to see.

I see four hip surgeons over the course of a few months. They all tell me I need hip replacement because of advanced arthritic changes in one hip, and they think I’ll need it in the other one too (but I don’t think so).

I choose one of the doctors based on two friends who had surgery with him, plus I liked him and his staff at the initial visit. He’s Patrick Meere at NYU Langone, Hospital for Joint Diseases.

I delay choosing a date, putting off the decision for a few months. Just can’t do it.

My physical therapist encourages me to get the surgery while I’m in relatively good shape, and save the remaining insurance therapy allotment for afterwards.

I schedule a date in late September, giving myself 2 months of time off from teaching afterward, plus another month with no travel. (Actually, I began teaching private sessions after two weeks and classes after three weeks, all at my home studio.)

I am grateful that I have both a solid background in complementary healing methods such as acupuncture, massage, chiropractic and homeopathy, plus a basic faith in mainstream medicine from my father who was a general surgeon. This way I go into the process with confidence on both sides of that spectrum.

The surgery day and first two weeks:

I am nervous, but the morning of surgery I feel ready and grateful for family support. My son is a medical student and I’m comforted as he chats with the anesthesiologist about drugs with impossibly long names (he’s studying pharmacology at the time).

After about 3 hours of pre-op procedures, I say goodbye to family, walk into the OR and sit on the table, greeted by the anesthesiologist and a very nice nurse. They chat as they prepare to give me the drugs, and I marvel at the high-tech feeling of the room. Everyone is wearing suits and helmets as if it’s a space flight about to launch. Thankfully a nurse without a helmet is right by my side, and probably holding me up. The last thing I remember is putting my head into a face cradle while still sitting up. I have heard that people talk at this early stage of anesthesia but don’t remember any of it, so that probably happened to me. I probably lay down on the table still chatting with the nurse.

The next thing I know, it’s 3 hours later and I’m in the recovery room with a very friendly young male nurse by my side asking how I’m feeling. He brings me juice and I am filled with gratitude that it’s over and I’m awake and feeling mentally normal. I have no pain, and in fact, I feel euphoric, thanks to those drugs flooding my system. The euphoria lasts all day while I transition to a room upstairs (with a great view) and get settled, greeting visiting family members. The hospital staff gets me up and walking that afternoon. As I traverse the hallway near my room, there is a framed print by my husband artist Robert Kushner on the wall – a welcome sight.

The next day I have more pain, but I can still get up and walk. That night I have my first melt-down of frustration, and a very kind nurse offers me a hug and a shoulder to cry on. That means a lot to me.

The third day I am scheduled to go home, and there’s a flurry of people in and out to arrange all the discharge procedures. Finally at noon, I walk out on crutches and take the short 4-block trip home via Uber. Too far to walk at this point. But only 2.5 days in the hospital, not much.

At home, I have two places where I spend time – my bed and a couch in the living room. Pretty soon I have a routine and everything I need within reach – phone, laptop, water, reading, medications, snacks. This is when the new normal emerges – resting, walking, taking care of only basic daily needs. This is radical for me, being a person who’s always keeping busy and going from one thing to another all day. Here I am, just on the couch. It’s kind of fun learning how to put on socks and pants with a long-handled grabber.

I’m tremendously grateful for family members and friends who care for me, make my meals, rub my feet, help me navigate daily needs. For these first two weeks, an occupational therapist, a physical therapist, and a visiting nurse come to see me. The PT gets me up and walking outside the very first day. We walk to the corner and back, and that is plenty. When his time is up, I’m sad to say goodbye because we have become friends. He says he wants to come study yoga with me. He buys a rubber ball to help with his plantar fasciitis.

The long-term recovery

As an anatomy geek, I’m fascinated to watch the changes day by day. The incision goes from being quite gory looking with lots of bruises, to a thin red line. My walking becomes smoother, and I transition from walker to cane to nothing. Each week I keep track of my successes, and I laugh at how small but how significant they are. The first time I can wash my feet and put lotion on them. The first time I can put on lace-up shoes. The first time I can go to the grocery store, carry things home, and cook a meal. The first time I can sleep on my left side. The first time I do downward facing dog, sit cross-legged for meditation, do pigeon pose, sun salutation, kick-up handstand.

My muscles are sore and weak in unusual places, but physical therapy always makes me feel more fluid in my walking and confident in my strength. I gradually return to almost all of my favorite yoga poses, and although that process is slower than I anticipated, it feels right. My body clearly tells me yes and no. I get very creative with props.

 

The silver linings:

Ingenuity in figuring out how to do things in a new way.

Patience with myself and my “to-do” list which is ever present.

Gratitude for small and large kindnesses from family, friends and strangers.

Gratitude for yoga and physical therapy, both of which sped me along toward recovery faster than otherwise would have happened.

Awe at the body’s capacity to heal.

Awe for the medical profession to have figured out how to safely replace a hip joint.

And excitement to be in a new phase of wellness and enthusiasm for life!

 

Feel free to write me if you want to dialogue about any of this, or if I can support you in your journey.

Meet your hard-working (and possibly under-appreciated) outer hip muscles

The teams of muscles that support and move your hips are awesome.   Even if you’re not an anatomy geek, they are worth getting to know. You have the flexors in the front (with the iliopsoas as the team leader) which bring your leg forward to take a step. Their counterpart is the extensors in the back – gluteus maximus and hamstrings – the push-off muscles for running. We also have teams that rotate the hip joint – external rotators (piriformis being the midget but strong team leader here) and the internal rotators, which I’ll talk about below. Another team is the adductors on the inner thighs, a group of five that stabilize the inner thighs, pulling toward the midline.

My favorite group is the abductor-medial rotators, a team of three multi-taskers on the outer hips. This group does both abduction (pulling the leg to the side) and medial rotation (turning the leg in toward the midline). Its role for stability is often ignored. Yoga students usually want to “open the hips” and I can understand that, but it’s easy to get fixated on flexibility and ignore our need for strength and stability. In that sense, we can do well to consider practicing some techniques from fitness trainers and physical therapists.

Here are the three muscles: gluteus medius, gluteus minimus, and tensor fascia lata.

 

Because of their attachment on the bones above and below, these muscles have a variety of actions, depending on what part of the body is stable. If you put all your weight on one leg, the abductors will move the other leg to the side, and potentially also rotate it a bit. They’ll also be stabilizing your standing leg! Because the gluteus medius has such a wide attachment on the pelvic crest, it can either rotate the thigh externally or internally, as well as abduct it…the multi-tasker.

But if you have your weight on both feet, as in Tadasana or Uttanasana or Utkatasana, the abductors isometrically pull the upper thighs apart without affecting the lower legs, which adds to your stability and prevents compression in the hip joints and the sacro-iliac joint. I think it’s particularly good action in Utkatasana, the pose shown above.

You might say: I don’t want to strengthen my outer hips because they’re often achy and tired! Often when the outer hips are achy, it’s because the muscles are reacting to something we’re doing or not doing on a daily basis that causes all the teams to operate in a disorganized way. Perhaps we stand on one leg without realizing it, or we have some other slight imbalance or asymmetry that’s under the radar of ordinary awareness. Gradually over time, some muscles get a lot of stimulus and others not so much. This can be reinforced in our yoga practice or athletic activity like running, once the habits are established.

Here are some examples of good additions to your daily practice that highlight these abductor-rotator muscles, both for strength and stretch. First you can isolate them, and then focus on how they play a part in your favorite asanas. Practice these on both sides, of course.

1. Side leg lift from all fours: From hands and knees position, lift one leg to the side, at first with the knee bent, and then straighten the leg to the side, as in a slow karate kick with the heel raised slightly. This works the abductor-medial rotator team. Do 10 slow kicks on each side, and increase the number as you get stronger.

 

 

 

 

 

 

 

2. Side plank pose (Vasishtasana): In this pose, side body strength is emphasized, and the abductor team lifts up the hips. It’s a really good core strengthener.   There are many good variations of this pose, and here are a few.  Hold them for as long as you can, with your supporting shoulder pulled firmly back.

 

 

3. Outer hip and thigh stretch: A variation of Supta Padangusthasana, this crosses one leg over the midline, highlighting the outer hip and thigh. Keep your leg muscles strongly contracting as you hold the pose.

 

 

 

 

 

 

 

 

 

 

 

4. Another outer hip stretch, this time with bent knees. Be sure to keep the shoulders and pelvis flat on the floor, and adjust your distance from the wall as needed.

 

 

 

 

 

I hope this has peaked your interest in your hip muscles! You can appreciate the contribution of these multi-taskers in all standing poses, but especially in any balance pose, such as Vrksasana (Tree Pose), Trikonasana (Triangle Pose) and Ardha Chandrasana (Half-Moon Pose).

For more on the hip muscles, see my new book Anatomy and Yoga: A Guide for Teachers and Students, available online and in bookstores.