Wednesday, 22 April 2015

Walk before you run!

Today is exactly three weeks to the day since my left total hip replacement and it also saw my first physio appointment since leaving hospital (on day 4).

Before the operation I had received a physio booklet outlining the exercises that I should carry out both straight after the operation (whilst still in hospital) and ongoing for the weeks after leaving hospital. It also contained plenty of other do's and don'ts plus techniques for things "normos" can do easily such as climbing and descending stairs, going to the toilet and putting your pants on! All useful info I can assure you in my recent situation! It's quite strange getting to the bathroom and then wondering how to physically do what you have always done naturally, but I'll leave that there.

Before I left hospital, the on-site physio team had repeatedly tested my understanding of the exercise routine and I felt well drilled before I left.

Further instructions in the booklet described what I should do regarding walking, both that it should be with two crutches, should start with small distances, but also that the distance should be slowly increased daily.

So here I was, left with a set of exercises to repeat and walking distances to increase daily, plus what is best described as a "runner's brain"! And advantage you would think.....

My "runner's brain" told me that, if I can do these exercises well and comfortably, then I should gradually increase the quantity. So what started out as 5 repetitions of each exercise gradually became 15 of each exercise, with all the exercises repeated as a block 6 times a day. AND what started out as a 100m round trip up the road and back had increased to 600m within a few days, had gradually increased to half a mile 3 times a day and then for the last 3 days, it had increased further to 1 mile each time, 3 times a day. Over that period, my walking speed had increased too, fairly significantly early on, but for the last week it had evened out at very roughly 2 miles an hour, or around half the speed I would usually walk. This was a safe speed and I had no desire to go any faster than this whilst using crutches.

To runners that just sounds like training doesn't it? Gradually increase repetitions. Gradually increase distance. Gradually increase speed.

Today I saw my physio and finally understood the point of all of this!

For years, due to my deteriorating hips, a sub-concious decision to prevent the discomfort of osteo-arthritis, a concious decision to prevent the sharp pain I would sometimes get when my hip got into the wrong alignment, plus the gradual physical changes to my skeleton (yes my skeleton actually adapted itself to prevent pain), my walking gait had become abnormal. To anyone that knows me, I'm sure this has been obvious for many years, and even to myself, when catching a glimpse of myself in a mirror or shop window, it was obvious that I was walking like "the missing link", hunched forward, leaning into the next stride. And it was impossible for me to correct.

This style of walking is not normal, and along with removing the pain, one of the main objectives of the surgeon and the physio team is to return me to a "normal" walking gait. That does not mean back to my normal, but instead to "normal" normal! And this is the point of the physio exercises and the recovery period. Now this might be obvious to everyone else, but as a runner I had missed the subtlety of the old adage of "quality NOT quantity". Today I finally got it!

I have now been given a greater number and variety of exercises. These are to be performed in smaller sets. The idea here is that for each exercise, the first repetition is naturally tentative, the second increases the range of motion and by the 4th and 5th you have probably gone as far as you are going to that time (trying to push the boundary a bit on those last two if possible). Any more are pretty pointless. As my physio said, "this isn't strength training - you are only lifting your own leg!". But there was thing I had spot on, I should be repeating all the exercises as many times a day as I can, without causing too much pain or swelling.

Walking greater distances at greater speeds is also important, but I really do have to "walk before I can run". And in my case I need to learn how to walk properly again first, This is not just a mental thing, I also have to physically teach my muscles, tendons and ligaments to be able to allow and control a different and greater range of motion in all directions. For the last 5 years I have been a runner, when I couldn't really do any other sport any more. This can only be due to the fact that moving my legs in a straight line (front-to-back) didn't hurt (as much) in the same way as lateral movement. But this has also ensured that front-to-back movement is all I can really control, and controlled movement in all other directions now has to be re-learnt.

So, for the next week at least, I will be on a reduced daily walking distance and an increased and more varied set of physio exercises. I'm really pleased that I had my physio appointment today and that my focus has been shifted into the right areas that are really going to have the effects I need to get me back to "normal".

And one thing is for sure, now that I know the exercises that I need to do, as "a runner" I have no problem at all in repeating those exercises over and over again - after all, it's only training!

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