Welcome back to The Hip Replacement Podcast. I'm Chris Bystriansky, your host, and we're going to try to get through this tonight. It's pretty late in the day. I've been talking a lot today. I'm losing my voice a little bit, but we're going to try to get through this because I'm going to be gone for a few days.
I'm going to pick my daughter up from camp where she's been away for a few weeks. So, I want to get this out to you. I think it's a very important and very informational episode. All right, so we're going to get through this. We're going to do our best.
Okay, last episode and this is part two of the why did I why do I still have a limp? Okay, or walking with a limp. And last episode I talked about how we may be expecting too much from a hip replacement that it's not a fix for everything. It just replaces the skeletal components. But we may be expecting to go in for the hip replacement and have it solve everything.
It doesn't do that. Unfortunately, many times the surgeon may have done the surgery perfectly and you still may be limping. What happened? It's important to remember several things. This is why it's hard to recover from a hip replacement and to eliminate a limb.
All right? Because there's been years of moving incorrectly and the compensations your body has had to have made so that you can move in the least painful way possible. Remember also that the surgeon had to go in and move or cut through some muscles. Also the bone is healing. These all deal with why it's hard to recover. all of these things.
Also, keep in mind that you have a new piece of metal in your body and that you're also recovering on top of all that you're also recovering from a surgery itself. And that's all a lot to ask of your body. So, it's hard sometimes. Most of the time I read a lot particularly I see some stuff on social media and people make it sound so easy but it's not. The surgery takes care of the bone but the physical therapy is designed and the exercises are designed to address the muscles and the soft tissue issues that we all experience.
So our body's recovering from a lot So we have to address these other things to help ourselves get the best outcome possible.
So let's talk about six issues related to the limp, the dreaded limp. And I will tell you that after I knew my surgery was successful, my goal was to get rid of the limp because it was so embarrassing for me. I didn't want a limp. I didn't want the stigma. I didn't want the label.
So, I wanted to hide the fact that I had a hip replacement surgery by getting rid of the limp. Okay. So, let's talk about six issues.
And number one, that lingering old limp. You're limping now simply because you've been limping before. Before surgery, many people shorten the time they spend on the painful leg, on the painful hip. So they may take a quicker step, lean away from the painful hip, or shift more weight to the other side. And guess what?
After surgery, that original joint pain may be gone, but the body may keep using that same walking pattern out of habit. You're still using the muscles incorrectly that you had to use incorrectly before the surgery. The joint may be replaced and work perfectly. Okay, the skeleton, the needle hardware may work perfectly, but the muscles are still the problem. the surgery didn't do anything to help the muscles and even sets them back. I mean, think about it.
If you have an injury, never mind your hip, never mind never mind your hip surgery. Think about if you've ever had a muscle injury. If you've ever pulled a muscle before. If you've ever got a bruise before. If you've ever walked into something before in your life, you felt that for days.
Okay. Now, imagine you're doing that same thing to your hip joint for months or years. You're causing damage to that hip joint, to those muscles over time, walking incorrectly. It's going to take some time and some work to overcome that for that stuff to heal and start working the right way. and patience. Me, you, all of us.
We need to relearn to walk correctly. Not merely walk more, but walk correctly. Walking wrong or the incorrect way is not helpful. It just reinforces the limp. So, we need to get those muscles working together and in the right proportion.
Number two, we may have weak muscles. Maybe this is one of the reasons for a limp. And specifically, I'm talking about the muscles on the inside and outside of the thighs and in the butt, the glutes. This is what I really suffer from. the outside of my thighs, just outside my hips and the butt muscles or glutes were weak. And I really wouldn't have thought that, okay, because I've got big, strong legs.
I grew up playing hockey [clears throat] and baseball. I mean, my butt and legs are pretty big, but they were not proportionally big. The front of my legs were big and my butt was big, but it wasn't as strong as the front of my legs. So, I've had to work during my recovery to basically get proportional, to get strong everywhere. And I found this out working with the physical therapist.
They ran me through a bunch of tests or certain exercises after my surgery. And we all realized how weak certain of my muscles were. And I was a little bit embarrassed, but they helped me identify that issue and we worked on it. It was great. So, my legs were disproportionately weaker than the rest of my legs, but I can say that I've worked on them and they look fabulous.
I do have to say. So, anyway, I digress. Now, and notice that what these muscles do, the muscles in the front of the legs, the side of the legs, the butt, the glutes, these are the muscles that help keep our waist, our center of gravity, and our hips stable and our pelvis stable. And we need these muscles to be sufficiently strong to stay balanced. And if they're not strong enough, your hip will actually fall slightly as you walk, as you move.
The muscles aren't strong enough to hold your body up. And you're basically, as you're moving forward, what's going on is you're basically falling, your hip is falling, and your next step is used to catch yourself because you're not strong enough for one leg to hold your body up. So that's a question. Can you stand on one leg or is it really difficult? Do you not have any confidence standing on one leg?
I certainly had trouble with this for months after my surgery, but we worked on it. If it's difficult to stand on one leg, this may be the reason. Those stabilizer muscles are not where they need to be. And you may limp more as your leg muscles get tired, like when you walk farther. So, you may need some exercises targeted at strengthening those muscles.
But I'm not diagnosing anyone here. This is not what this is all about. I'm just helping to give you ideas of what to talk to your professional, your doctor, your physical therapist with or things to consider. So, get with get with a professional who can work specifically with you to identify which muscles may not be as strong as they need to be. And this is one of the things that I often see and I and I just wonder why it's happening.
Why do people do this? Why do people make this mistake? And what I see is that people are so quick to get rid of the walking assistance device like a walker or crutches or canes and they almost brag about it when they're talking about it or on social media how quickly they got rid of it. Like it's a badge of honor to not use a walker or a crutch. I was relatively young.
I was in my 30s when I had my first hip surgery. I was strong. I was athletic. And I was still my physical therapist still had me on a walker for two weeks. I was on two crutches for two weeks after that.
And then I was one I was on one crutch for two more weeks. So, I was on six I was I was on a walking assistance thing for six weeks. Did I want to be on that? No. But I understood that the purpose was to help my muscles get stronger before I got rid of those things so that I would not establish bad habits, so that my muscles would relearn how to move correctly.
You basically want a soft landing, not a fast landing. And what I mean by a soft landing is that you're transitioning away from a walking assistance device at the correct rate for your body as your muscles are slowly engaging more and more over time so that they have time to strengthen and get used correctly. And if you get rid of the walking device, the walking assistance device too soon, the muscles don't have a chance to develop, to relearn, to get strong enough so that you walk correctly and you may have a limp or cause yourself other problems by getting rid of that walking assistance device too soon.
Number three, another limp issue, short strides or steps or not getting full extension of the hip. So, one of your legs may be extending, but the other is not extending out the same length or amount. So, think about it. If you have a hip that's that was just operated on, you may not be able to move that the same distance. And this makes sense early after surgery and likely for a few months.
The operated leg may not travel far enough behind the body during the final portion of the step because you're simply not that flexible yet. And this may be caused by some hip flexor tightness or weakness or pain or fear or you may have some postsurgical precautions. Or another thing is you may have years of walking and training your body like that, not extending your hip. So that's going to take some time to loosen up. But gaining the strength and flexibility through exercises and time in the healing process should help this issue.
Number four, unequal leg length or feeling of unequal leg length. And leg length discrepancy is actually that the legs are different lengths. And this can cause a host of issues. And I'm not talking about the situation where one leg merely feels different length after surgery because of tightness in the leg or the pelvis. and the pelvis in those situations may eventually loosen up and the feeling of being uneven may go away. I'm I'm not talking about those situations where it's just it's just a matter of tightness.
I'm talking about actual leg length discrepancy where there's a measurable difference in the leg length. And I have this situation. My right leg is four millimeters longer. It feels like I'm standing in a hole. Like my if I were standing on the ground, it feels like my left foot is in a hole because I can't feel the ground.
I'd have to like reach for the ground almost. Even though it's only four millimeters. And the way I address this is that I correct it with a shoe insert. All right. Every time I wear a shoe, I have an extra insole in my shoe so it lifts up my left side.
And when I wear sandals, I usually wear two different sandals. One with a thinner sole and one with a thicker sole to even things out. And the way I we figured this out was when I first got out of bed in the hospital and I stood up on my this is after my second surgery. When I stood up, I felt it right away. And I went to the physical therapist several weeks later to start my physical therapy sessions and they measured it.
They simply had me stand and they put one millimeter boards under my feet, under my short leg until I felt like I was standing normal. And then they also measured it with like a tape measure. So, we came to 4 mm difference. That's great to know because if not, I wouldn't know why I was having issues. But I can tell that my gate or my stride length is different in my legs.
Naturally, my left leg or my left hip, which is the un with the shorter leg, has more rotation and more movement and feels more free when I walk. My right hip doesn't move as far because the leg is longer. So, I cover more ground, my foot moves farther with a shorter rotation of my hip than on my other side. The problem is that my right hip, the one that's longer on the longer leg side, that hip gets more stiff because it's not going through the full same range of motion that's as big or as full as on the other hip. And if I don't focus on this and purposely extend my right leg, the longer leg, my hip gets stiff.
So, I just constant consciously make sure to take a longer stride with my right leg when I'm walking. And this is even the case when I have that shoe insert because my hip is not rotating as much. The shoe insert helps, and I'll get to that, but I still have to focus on making sure my left hip travels farther. My left my right my right hip travels farther. and my left foot, my right foot, I'm sorry, travels farther so that my hip rotates more. And here's a little tip.
When I walk, I happen to be I happen and I happen to be on an uneven surface, I do my best to try to have my right side, which is my longer side, on the lower side of the road or the path. and I try to walk in a big loop. So that's maybe several miles. So I will always go in the direction that allows my right leg to be on the lower my right leg to be on the lower side. And I even did this on the iron man triathlons. I stayed along the edge of the road and even on grass at times because it allowed my right leg to be lower and this made a huge difference when going the distance of 26.2 miles.
And if I don't correct this, here's what happens. My longer the hip on my longer leg side will start to ache and the knee on my shorter side will start to ache. So if you have these issues, not only can it be causing a limp issue, but it can be causing some aches and pains if you these don't get addressed. So, shoe insert and try to keep that longer leg on a lower part of the ground. If that makes any sense.
I hope it does because it makes a big difference.
Number five, toes pointed out or in and you have this altered foot position. After surgery, you may notice that your operated foot points outward or inward more than it did previously. And this can be due to your anatomy, maybe a muscle weakness, stiffness, your long-term compensation, or changes in how the way the hip and the leg are aligned. And this also happened to me after my second surgery and I'm laying in the hospital bed. The surgeon came in the afternoon and explained to me that the guidance system failed and they had to eyeball or do some other type of measurement to put my hip to align my hip as best they could.
I didn't think anything of it, but then I realized later that yeah, my right foot points slightly out. It's not a lot. It's not so much, but it's there. And I have to work on the flexibility to walk with my foot as straight as possible. Because if I don't walk as straight as possible, it can have an impact on my ankle, my knee, or my hip as those other joints work to compensate and keep me straight and propel me forward while my foot is not working perfectly.
And one of the issues with the foot that points out slightly and I remind you that I can't feel it pointing out is that I occasionally run into something or stub my toe if you will. Then I use some colorful words that I can't repeat here and what happens is my daughters ultimately scold me for it. All right. So because of the surgery, my toes point out. I stub it once in a while on a door, door frame, a chair, a bed, whatever it is.
And one of my daughters will actually keep score of when I use profanity because of that. So when I stub my toe and say something maybe I shouldn't say, I'll hear her call out a number like she's she's even in a different room and I'll hear the number. So, sometimes I'll bump my toe on a door frame or bed frame and I'll say a word and I'll hear I'll hear a number called out from across the house like five, five, six. I've never heard a number higher than seven. So, even though she's keeping score, the number never gets higher than seven, but I'm not saying it couldn't happen.
I'm just saying it hasn't happened yet. So, toes pointed out, I can't really feel that, but I have to acknowledge that it's happening. I have to be aware that it's happening and do my best to walk as straight as possible.
Number six, poor balance or losing balance which may impact a limp. We talked about how the muscles in the legs or the glutes or the butt may not be as strong as they used to be and those muscles are responsible for helping us keep our balance, helping us be stable. Because as we lift up one of our legs, one of our legs at a time to walk and then it's the other leg and it's the other leg. The muscles in our legs, butt, hips and back help us to keep our balance. Remember, all of those muscles are important and they all work together.
But one of the considerations that doesn't get talked about much is our proprioception. Okay? And that's that's our body's ability as our body is taking in information from our nerves throughout our body, our vision, our understanding of what's around us to keep our balance. It's sort of like um a subconscious ability, maybe our sixth sense to move and control our body in space without simply falling down. It's a continuous feedback loop between of information between our body and our brain.
It's like if you were to put your arm behind you and even though you can't see it, you know where it is and you know what it's doing because you can feel it. Well, during hip surgery, and this doesn't get a lot of play for some reason. This doesn't people don't talk about this. During surgery, the nerves, the nerves in your legs or your thighs or your glutes specifically may be damaged because they're moved or cut sometimes, not on purpose, but maybe on accident. Some eventually, some of those nerves eventually may return to normal or some level of functioning over time.
That's why when these nerves don't work anymore or they're they're cut or moved, you may feel a burning or an itching sensation or you may even be numb. I had all these sensations. And while they were all pretty annoying, the itching was probably the worst because there was nothing that I could do to stop it. I could scratch and scratch and scratch and scratch and scratch, but I couldn't relieve the itching. There was also the burning at times and the numbness.
And there were times for many years where I couldn't feel anything in my pockets. So, I would lose my keys or my phone in my front pockets because I couldn't feel where they were. Well, I'm more than 12 years past one of my surgeries and 11 years past the other surgery and my thighs are still slightly numb. It's not that bad, but it's certainly nowhere near as good as it used to be. That means the nerves in the front of my legs, my thighs are not firing the way they used to, and they're not connected with my brain.
And that in turn that in turn means that my that means that my proprioal reception is not what it used to be. And I can tell you that because of that, my balance is good, but it's nowhere near as great as it used to be. My legs and body don't feel like they're connected to the ground as they did before. And that's a nerve issue. That's hard to explain.
Like, how can you not feel connected to the ground? But if you don't feel your nerves, if you don't if you feel numb, it's very hard to tell where the ground is. And if you can't tell where the ground is, there's a good possibility you could be you could lose your balance. And so I'm pretty young with good muscle tone and my balance is not as good as it used to be because of this. So if you're older and you have some muscle weakness and you're not as active as you like, you may have this issue as well and your balance is going to be off a little.
That just means you may have to focus a little bit more during your movements because your nerves may not be what they used to be and you may not be as steady as you used to be and you may favor your stronger side, meaning you spend more time while walking on your stronger side because you have more confidence there. This may also be giving you a little bit of limp. If you're spending more time on the side that's stronger because you have more confidence there because you feel like you have more balance there, you're going to have a slight limp because of that. So know that the proprioception issue may be impacting you. And getting a little stronger with these stabilizer muscles, meaning your back, your hips, your glutes, your legs, all of that may help your balance.
So, if you're feeling like, why am I off balance? Why am I limping? Why do I have this balance issue? This may be why? Because your nerves are not connected the way they used to be.
And your six sense of where you are in space and where you are, how you're connected to the ground may not be as strong as it used to be.
I mentioned this in my book and it's worth repeating here. I believe that the long-term outcome of the surgery of the hip replacement surgery is dependent upon three things. The surgery itself, the physical therapy in the short term after surgery within the first few months and third, the exercises and the maintenance you do in the long term. That's what I consider my rule of thirds. For a great recovery, three things, surgery, initial physical therapy, and exercise into the maintenance long term.
All of these things will help the limp. And you indirectly can control all of these. But what you have most control over are the exercises and the maintenance that you do in the long term because you can be doing those forever. They don't have to take a long time each day, but you can still do something.
I often hear this question and contemplate this. Is walking enough to recover. In my opinion, I don't think it is. But it really all depends what your end goals are. If you just want to be mobile, I think walking is probably fine.
If you want to return to all the activities and have all the [clears throat] confidence and all the ability or as much of the ability that you had before or that you can possibly have, I don't think it's enough. I don't think walking is enough in that case, but that's your decision to make. And I don't think walking is enough because it doesn't get at all the muscles your body uses to move. It doesn't it doesn't strengthen the muscles your body needs to recover from the abuse from the abuse it's taken. Not just surgery, but the years of abuse before surgery, how you trained it to move.
But absolutely follow the guidance of your healthare team, including your surgeon. There may be a very good reason you were instructed to do what the doctor told you to do. Maybe there are other limitations at play or different health issues. Maybe there's no physical therapists in your area. Maybe your surgeon knows of instances where physical therapists have done more harm than good.
Who knows? These are all fair questions to ask and talk to your doctor about your concerns.
But just remember, a new hip can remove the reason you learned to limp, but it may not automatically remove the limp you learned.
One of the biggest mistakes that hip patients make is that they focus exclusively and they talk about this how far they can walk or how far they've walked as if that's some type of meter of progress. Distance matters for sure, but quality matters way more. A hip replacement patient can walk two miles while reinforcing a poor gate and a limp and just reinforce this pattern for several thousand steps. That's not helpful.
A better progression or a better way to approach this rather than walking far may be to walk safely, walk evenly, walk smoothly, and when you start to limp, it's time to stop. Hopefully, you're near home. As you get stronger and more even and more balanced, then walk farther and faster.
This is not an argument against walking. The walking is good. Walking is one of the most important parts of recovery. But proper walking, not simply more walking, is a good way to help the hip recover and help you eliminate the limp. The more you want to do, the more active you want to be, the more you're going to need to add some exercises to take care of those muscles, the back, the hips, the glutes, the IT bands, strengthen the weak muscles, help them work together again the way your body was intended to move.
But you have to be your own judge. If you find yourself limping after several months after surgery and you didn't do any exercises as instructed or you didn't do anything, no judgment here. This is a judgment free zone. We all have things going on. You don't have to feel bad or guilty.
There's still time to fix these things. There's still time to work on those muscles. There's never not a good time to work on the muscles, on the flexibility, on the strength. I'm still doing it. I'm 12 years and 11 years past my surgeries.
I do stuff every day. Maybe sometimes for just a few minutes, sometimes I work that into a longer workout. But if I don't, I will feel some aches and pains and maybe a limp will creep back in. But I'm not going to let that happen. I don't let the limp back in.
There's still time to work on your muscles. Just work a little bit on the weak muscles. Maybe get the help of a physical therapist or a trainer at the gym and let them know what you're experiencing. They'll be able to recommend some exercises and activities to help get you moving better.
You can still get strong and flexible where it counts. Get help if you need it, though, because you should be as strong, as capable, and as confident as you desire to be after a hip replacement.
I hope this was helpful. Thanks so much for tuning in to The Hip Replacement Podcast. Until next time, I wish you the best recovery possible. Take care.
