A Patient's Advice
Hints & Tips from former hip arthroscopy patient and occupational therapist Mandy Graham.
You can also read the story of her surgery in our testimonials section.
Disclaimer – the following hints and tips are intended solely as a generic guide from a patient's perspective. You must follow the specific advice and rehab information given to you by your designated health care professionals.
Think about how you are going to spend your time post surgery. It sounds simple but it's really important. Our roles, routines and daily responsibilities all shape our personal identity, and these things change post surgery – not just for a few weeks but it may be months before you can return to activities and hobbies that make you who you are. Patients need to think about how this will make them feel. For me even though I was in pain for months before my operation I was still managing (all be it a daily struggle!) to work full time in a demanding job, be a mum, have a social life, and have a very busy routine. Suddenly all that changed.
As OT's we call this occupational disruption. At first it can be a novelty – time to watch movies, read books – great I hear you say! But after about 6 weeks it becomes a frustration and there's an urge to do more but the body is not responding as it needs time to heal – and this can lead some people to feel low in mood. This is even more of a challenge to sports men and women who are used to being physically active.
Be open with your employer about how long you may be off work. Of course this depends on your job role, your entitlement to sick pay and exactly what surgery you've had done. Working in the NHS my colleagues all thought they knew about hips and thought I'd be back in 6wks max. When I hit the 6 week mark and still felt so drained and tired I was so relieved for my doctor to explain that often people need 12 weeks or more off work. It didn't stop the feelings of guilt about being off though so it's important to view this as your time for your rehab. My surgeon says a successful outcome is 50% surgery and 50% physio and rehab afterwards – so you must commit to this and make others aware of the importance of this time on your recovery.
Ensure you have adequate child care sorted out – you will need help to look after young children due to all the bending involved. Older children may be able to help you with tasks around the home but you will need quiet time too to rest and sleep. There may also be financial implications if you are paying extra nursery / child care fees. From an emotional perspective it can be very hard when you can't pick your child up when they have fallen, or carry them when you are on crutches, or go to them when they wake in the night. Although it is hard try not to feel guilty about this – think about the longer term and hopefully that if you focus on rehab now you'll be able to run around after them in the future!
Practice relaxation methods in the weeks BEFORE surgery – I'll suggest some simple self help techniques in a moment but it's important that you are comfortable and familiar with these so you can implement them easily post-op. Relaxation also helps with pain management pre-op.
Realistic goal setting - Think about what's really important to you – what are your post-op goals going to be? Discuss these with your surgeon and physio – they will help you understand if they are realistic or not! For me all I wanted was to be pain free – I could not mentally see past that point which is why I think when I was pain free so soon after surgery (lucky me!) – and then off my crutches – it was like ok so now what? What is realistic? – I simply didn't know.
Focus on the here and now – I would often feel frustrated about how little I had accomplished during the day. My husband and daughters would leave the house at 6:30am and return at 6pm. My husband would ask (in a caring way) – "so what have you done today?" – Erm... I did one load of washing, put the dishwasher on, made a few phone calls / sent emails and had a nap! 11 hours would go by in a flash. I didn't feel lonely being on my own as it never felt that long, but having previously had a very busy work and home routine it did real strange just "being" rather than doing. However "being" and focusing on the here and now is very important especially as it can be difficult to plan for the future – such as days out, holidays – how far will I be able to walk in three months time? There are a lot of unknowns. For an athlete this can be even harder, thinking about when they will be able to return to training or competing. It may be useful to read up on "Mindfulness" which involves paying attention to the present moment, and can help people change the way they think, feel and act.
Adapting daily activities – Being independent in personal self care can be quite easily achieved post op with assistive equipment such as raised toilet seats, shower stools, bath boards and seats, grab rails, sock aids, long handled shoe horns and long handled grabbers – anything to make life a bit easier is good! Adapting leisure and work activities however is more complex as they are so individualised. An important coping strategy for me was re-establishing my priorities, expectations and aspects of my identity. For example, in my role as a mother I couldn't get down on the floor and change my toddler's nappy but I could still breastfeed her which meant the world to me. We had just moved house and although I couldn't help move any boxes I did all the phoning round, changing our address, organising workmen etc. It was about re-adjusting the daily activities to create purpose and meaning to my day.
Maintaining positive mental wellbeing – there are various self help strategies that patients can use to maintain positive thinking, improve mood and combat stress during difficult points in their rehabilitation. Guided imagery or visualisation CD's; Laura Mitchell method & progressive muscular method (adapted around hip area); Autogenic relaxation; colour relaxation; diaphragmatic breathing; meditation; positive affirmations and self talk; comedy and laughter; reducing caffeine intake; eating a well balanced diet; following sleep hygiene principles; complementary therapies such as acupuncture, reiki, reflexology, hypnosis – can all be very helpful. Patients should however seek prompt help from their GP if they are worried they are becoming clinically depressed.
Social support – is crucial for practical and emotional support. Consider your social environment – do you live alone? Are family aware of the rehab period post op and potential support needed? Many patients use online forums and blogs for support. Personally I found these on the whole very helpful as I was able to ask questions and seek reassurance in between medical and physio appointments. However there is a down side – hearing about cases that haven't been so successful, or over comparing yourself to others. For example I saw a post from a man who had completed a triathlon at 12 weeks post-op! Of course he didn't say exactly what surgery he had done and I suspect he was athletic and fit before his surgery, but it didn't stop me comparing that I could only just manage to walk around the supermarket! Just remember that recovery time is very individual and no two surgeries, or pre-op circumstances are exactly the same.
Measuring progress – Range of movement, muscle strength tests, and various standardised questionnaires about pain, daily functioning and quality of life are commonly used as clinical outcome measures. However for me it was more meaningful to think back about how I was a few weeks previously and what I had achieved in my daily life – which was of course unique to me. However remember to do this with the motto that this rehab is commonly "two steps forward and one step back" and that it may take a whole year to fully recover!
There needs to be a holistic approach to hip arthroscopy rehabilitation. Rest and physiotherapy exercises are important but patients also need to look after their mental health if they are to achieve the best outcome. We know there is a strong link between physical and mental wellbeing. As recommended in the white paper Closing the Gap: Priorities for Change in Mental Health (2014), best practice approaches for physical conditions should include potential psychological care needs. However there needs to be more research done in this area.