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Pilates for Hip Replacements

Emily Kimbro March 11, 2016

Costa Mesa, 2014-2015

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Abstract

Many of those belonging to the older population will need to have hip replacement

surgery at some point in their lifetime. Post operation clients need to commit to some sort of

rehabilitation in order to strengthen the surrounding muscles supporting the hip joint. Often

times rehabilitation is aided by a licensed physical therapist. In addition to physical therapy,

Pilates is an effective way to build strength in the hip and increase range of motion.

Changes to the hip joint due to a hip replacement surgery lead to alterations in other parts

of the body. Walking gait is effected due to lack of strength and range of motion. Fluctuations

in posture can occur. Devotions in knee and ankle alignment is also a result of surgery. Special

precautions and protocols need to be adhered to in order to minimize these changes and

reestablish proper hip functionality.

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Table of Contents: Abstract ……………………………………………………………………. 2

Anatomical Description …………………………………………………… 4

Case Study ………………………………………………………………… 7

Conditioning Program …………………………………………………….. 8

Conclusion ……………………………………………………………..… 10

Bibliography ……………………………………………………………… 11

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Anatomical Description of the Hip Joint

The hip joint is a ball-and-socket joint composed of the acetabula fossa of the pelvis and

the femoral head. A decrease in cartilage in this area causes severe pain and eventually a hip

replacement. According Cherney and Debra Stang, “Hip replacement surgery is an operation

used to replace the damaged ball-and-socket with new and durable artificial synthetic part that

mimic the ball-and-socket” (Healthline). This allows for complete support of the hip joint and a

decrease in discomfort in the joint. Diagram A depicts the hip joint before and after hip

replacement surgery.

Diagram A

Several muscles support the hip and allow for multiple movements including flexion,

extension, abduction, adduction, internal, external rotation. According to Rael Isacowitz’s Study

Guide: Comprehensive Course, the hip flexors consist of the iliopsoas, rectus femoris, sartorial,

tensor fascia latae, pectineus, adductor longs and brevis, and the gracilis (Rael Isacowitz). The

Centers for Orthopaedics notes as a general precaution that hip flexion should not exceed 90

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degrees for a patient who has undergone a hip replacement. To ensure the opposing muscles are

strengthened, the hip extensors should be activated as well. Rael asserts the muscles that extend

the hip are the biceps femoris, semimembranosus, semitendinosus, gluteus maximus and the

adductor magnus. The hip flexors (left) and extensors (right) are portrayed in Diagram B.

Diagram B

The muscles involved in hip abduction are extremely crucial in strengthening the hip.

These include the gluteus medius, gluteus minimum, tensor fasciae latae, sartorial, iliiopsoas and

the piriformis. It is important to note that the opposing muscles, the adductors, should not

exceed 0 degrees, according to the Centers of Orthopaedics. Diagram C shows both the hip

adductors and abductors.

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Diagram C

Finally, hip external rotation is initiated by gluteus maximus, gluteus medium when the

hip is in flexion, sartorius, biceps femoris, piriformis, obturator internus, obturator externus,

quadrates femoris, gambles superior, the gemellus inferior. Internal rotation is not recommended

for a client who has a hip that has been replaced.

A carefully planned and well-balanced combination of these movements in the hip aide in

recovery and restoration of strength and range of motion. Adhering to the special guidelines of a

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hip replacement is extremely important so that a client does not experience pain, damage, or a

dislocation of the hip joint.

Case Study

Name: Susan Case

Age: 61

Sex: Female

Occupation: Business Owner

Physical Background: Susan is an active individual who plays tennis and does conditioning

with a professional trainer. About six months prior to our first session together Susan had

undergone a full hip replacement in her left hip. Prior to that she had her right hip replaced as

well as both knees. She came to me for Pilates in order to have a more well-rounded work out

plan. She figured the machines would provide support for her while allowing to build strength

and mobility in her newly replaced hip.

At the beginning of our first session, I asked Susan to perform a roll down for me.

Almost immediately I could see the unevenness in her hips. She was lacking flexibility in her

hamstrings and hip flexors. There was also very obvious tightness in her back due to the

tightness in the hips. I could see apparent knee valgus, which I assumed was due to a lack of

strength in her hip external rotators as well as weakness in the knee extensors.

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Although gaining strength in order to support her hips was important to this client, I made

sure increasing range of motion was just as important. Given the information I observed from

the first few roll downs, I constructed an appropriate session to achieve the goals we had set.

Conditioning Program

Based on Susan’s history, I designed a Pilates program in order to suit her needs. As

previously stated, gaining strength in the hip joint and increasing mobility were top priority.

Below is an example of an hour long session tailored specifically for Susan.

Block Exercise Muscle Focus Objectives

Warm Up

Mat Pelvic Curl Spine Twist Supine Chest Lift Chest Lift with Rotation

Abdominals Hamstrings

Obliques

Warm Up Pelvic Stability Abdominal Strength Spinal Rotation

Foot Work Reformer Parallel Heels Parallel Toes V Position Toes Open V Heels Open V Toes Calf Raises Prances Single Leg Heel Single Leg Toe

Hamstrings Quadriceps

Ankle Plantar Flexors

Hamstrings Quadriceps

Warm Up Hip Extensor Strength Knee Extensor Strength Plantar Flexor Strength Plantar Flexor Strength Hip Extensor Strength Knee Extensor Strength Ankle Plantar Strength

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Block Exercise Muscle Focus Objectives

Abdominal Work

Reformer Hundred Prep

Abdominals

Abdominal Strength Shoulder Extensor Control

Hip Work Reformer Frog Circles (Down, Up) Openings

Hip Adductors Hip Adductors,

Hamstrings

Hip Adductors

Hip Adductor Strength Knee Extensor Control Pelvic Lumbar Stability

Spinal Articulation*

Stretches Reformer Standing Lunge

Hip Flexors Hamstrings

Hip Flexor Stretch Hamstring Stretch

Full Body Integration I*

Arm Work

Reformer Arms Supine Series: Extension Adduction Up Circles Down Circles Triceps

Latissimus Dorsi

Triceps

Scapular Stability Shoulder Adductor Strength Shoulder Mobility Shoulder Extensor Strength

Leg Work Mat Gluteals Side Lying Series: Side Leg Lift Forward and Lift Forward with Drops

Gluteus Medius

Hip Abductor Strength Pelvic Lumbar Stability

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Block Exercise Muscle Focus Objectives

Lateral Flexion and

Rotation

Mat Side Lifts

Abdominal Obliques

Lateral Flexion Strength Trunk Stability

Back Extension

Reformer Breaststroke Prep

Back Extensors

Back Extensor Strength Elbow Extensor Strength

*Spinal Articulation and Full Body Integration I are not appropriate until after 10 sessions

Conclusion

The effects of Susan’s hip replacement and other joint replacements were apparent before

our first session together. Lacking strength and mobility in her newly replaced hip presented her

with a series of complications including a deviated walking gait, pain, and inability to perform

everyday tasks. A constructed conditioning program designed specifically for this client allowed

her to improve on these complications. Focus was placed on hip stability, strength, and mobility.

Exercises including hip flexion, extension, external rotation, and abduction provide muscular

support for the hip joint. Stretches were given to free the hip and decrease the tightness in the

back that was noted after the client’s first roll down. Due to her active lifestyle, Susan was able

to execute exercises sufficiently and process cues.

Pilates has helped Susan and since her first session we’ve seen tremendous improvements

in her posture, alignment, and hip strength. Her walking gait is close to ideal and she has

experienced a significant decrease in pain. We’ve seen increased strength in her hip flexors, hip

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extensors, external rotators, and knee extensors. A positive difference in her hamstring

flexibility has also been observed. Because of her Pilates practice and therapy Susan has become

move active: playing tennis and mountain biking. Susan plans to continue attending Pilates

sessions and looks forward to seeing more of the benefits Pilates has to offer her.

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Bibliography

“Hip Joint Replacement.” Healthline. Web. 11 March 2016.

“Total Hip Replacement Protocol (cementless).” Center for Orthopaedics. Web. 10 March 2016.

Isocowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and

Science International, 2013.

Isocowitz, Rael. Movement Analysis Work Book: Mat. Costa Mesa, California: Body Arts and

Science International, 2013.

Isocowitz, Rael. Movement Analysis Work Book: Reformer. Costa Mesa, California: Body Arts

and Science International, 2013.