I just came back from taking my dad to his follow up appointment after having a total hip replacement on his right hip 6 months ago.
The surgery took place in Bangkok. He is a 73 years old man.
As soon as we arrived he got his hip X “rayed”. Then the doctor called us to his office and saw the image, suggested not to walk more than 1 kilometer a day for fitness purposes and not to get fat. After that he set a new appointment 6 months from today.
He never even glanced at my father’s gait, how he walked or how he sat down on the chair. Not once.
I was shocked. Even though I don’t expect much from doctors these days, I just couldn’t believe the lack of concern.
According to the doctor he was fine, since his hip replacement was in place and there was no sign of a problem. To a certain extent, I agree with him. But… What about the functionality of my dad’s hip? What about its integration? Was he able to have a normal life again? Had he recovered independence and confidence? What about range of motion?
Those things obviously didn’t concern him. He is an orthopedic surgeon after all, but then who should ask these questions?
If he didn’t ask, a normal patient would believe that whatever he had or hadn’t accomplished until then was all that he could ever have.
Mechanical medical intervention, NO reintegration
I was lucky to be born in a family where my uncle was one of the best internist doctors in Mexico. He was kind of a House Doctor. I blame him for setting the bar so high when it comes to medical care and practitioners.
He would ask questions, auscultate,(examine) try to understand the whole situation until he could narrow down the most probable cause of discomfort or disease.
Today doctors don’t even auscultate, as if were afraid or disgusted of the patients, or perhaps just nervous about the time they have.
They barely ask you questions, they just see x-rays and lab results.
A surgeon has truly become a mechanic of the body. Detect the part that doesn’t work, replace it, bill it, send it home.
I wish it was that easy, but it isn’t. The body is interconnected in ways that we are still figuring out. You can replace parts but only at the cost of the whole.
Once you cut and replace it is necessary to “reconnect” the part to the whole, and to get the whole to “relax” and “include” the replaced part.
The brain has to get notified it is all fine, to get back to relaxation, and functional tension (not rigidity), full range of movement and organic, natural movement patterns.
This isn’t a criticism to this doctor, at the end of the day hs is only the surgeon. It is a criticism to what the medical practice has become and to its protocols.
The consequences of surgery and long convalescence
Being a total replacement of the hip meant keeping my father from moving much for 3 months. I know some doctors advocate less convalescence, but we decided to go for the more conservative approach.
For those 3 months, my dad lost muscle mass, and mobility. Even prior to surgery he had to endure unimaginable pain as the head of the femur kept breaking – ever so slightly -, while he was waiting for his operation.
That meant that the area in pain was contracted and isolated by the brain to reduce pain and further injury as much as possible.
To do this, the body has to create a series of compensations that allow the hip and leg to be immobile.
So once my dad got the “clear out” from the doctor, my dad’s body was contracted and withered.
I had warned my dad that this was going to happen to him. I showed him plenty of mental exercises to “inhabit his body” and start rehabilitation while still in bed, without moving. But he dismissed the advice.
By the end of the 3 months, his head tilted to the left. His left shoulder elevated, while the right one “dropped”. His right scapula completely winged and the left one weak and inactive. His left pec contracted permanently, locking his left arm to his upper torso. His hips displaced to the left, so his new hip replacement was right in the center of his body, almost below his spine. His left waist was elevated and his whole torso rotated. His right leg and foot hard as rock, while his left leg and foot had no tension at all.
He was rigid and weak. His lower back in full lordosis (arched, hyper-extended).
So once he was let out of bed, he was in a bad condition. Not only his body, but his spirit looked broken. His facial muscles lacked tone. His hands were uneven in contraction and relaxation. His whole body had “arranged” itself to protect his hip.
I wasn’t there when he went for physiotherapy to hospital, but later he showed me the exercises he was shown and told to do. Some strengthening exercises, but no integration of the hip was considered.
My dad had aged 10 years while bedridden after his hip replacement for 3 months. My heart sank when I saw him standing for the first time after surgery. I realized his mortality and obviously wanted to help.
Reintegration after total or partial hip replacement
I had never worked with someone’s after hip replacement nor total or partial, so I was ultra-conservative using my movement method for reintegration.
I asked him NOT to do the rehabilitation that was given to him in hospital, since I am a firm believer of not adding function to disfunction.
The strategy was simple:
1. Relax the hip and all the areas that were locking the hip into “safety” by convincing the brain he was already out of danger.
2. Separate the hip from all the muscles surrounding the area. That returns independency to each muscle to go back to its primary function, moving or stabilizing the body as a whole.
3. Recover full range of motion. Using gentle, mindful movement practices the body itself explores the “locks” the body has imposed in the area and start releasing them.
4. Strengthening the area affected and the body as a whole in a single, seamless practice. In this way, strength isn’t based on rigidity, but in relaxation.
5. Reintegration. Ingraining new, healthy movement patterns that takes all parts of the body as one.
It isn’t a matter of getting the body back to “pre-surgery” state, since that state resulted in a hip fracture (I believe the chronic, extreme pulling of his hip to be the reason of the fracture). It was about to get back to ranges of motion and movement patterns inherent to a healthy, balanced and strong hip.
It’s more like bringing the whole body back in time. Taking it back to a time where his body’s mobility wasn’t compromised by sedentarism, fear, stress, trauma and bad habits.
Unlocking the body through body awareness
The brain locks areas of injury and pain. Immobility to a certain extent protects the body from further damage. It is like a “mental cast” that the brain puts in place to protect the body from further injury and pain.
But after 3 months of pain and immobility, the brain leaves the area locked “permanently”. The “cast” is never “removed, so the body learns to “live with it”.
Trying to strengthen an area that has been “frozen” by the brain will only bring more dysfunction, since the real problem – the cast left by the brain -, hasn’t been addressed.
So I got my dad in all fours, one of the primal positions I use in my method and got him to move while I was cuing him constantly to wake up his body awareness. The only way I know to unlock what the brains “leaves unlocked”.
I did that for the first 3 days, 2 hours per day. Then because of work I couldn’t coach him for 3 more days.
When I saw him next I found a man that had rejuvenated the 10 years he just had aged after surgery! I couldn’t believe it!
His face was different, the muscle tone of his facial muscles was back, and I could sense an “air” of positivity that wasn’t there before.
When I saw him walking WITHOUT the cane I was blown away! I had never expected results to come so fast.
Now, I am not saying he had no more compensations, far from it. They were all still there, but it was obvious that the extreme rigidity that had become natural on him had diminished.
The limitations of my method for reintegration after total hip replacement
The next few weeks he kept doing the movements I had asked him to do, but quickly stopped having results.
Because he was doing everything mechanically. Even though I was constantly cueing him to develop his body awareness he wasn’t even trying.
This I have seen is a limitation of teaching my method to older people. They seem to NOT have the “imagination” to follow mental drills to enhance body awareness.
They probably come from a time where people believe reality was fixed and we couldn’t influence it with our mind alone.
Cues like “relax your finger with your mind”, “inhabit your body” or “imagine you don’t have a leg” aren’t taken seriously. All they hear is the “buzzing of flies” when I speak in those terms.
So far I haven’t found better ones.
So it took more than a couple of very heated arguments with dad to get him to understand that doing things like a mindless machine wasn’t going to get the job done.
Unfortunately for my clients, I can’t shout at the the top of my lungs to them. My dad has that “privilege”, others don’t.
But he got it. He understood that he either started following abstract cues with full trust, or he could go back and make best friends with his cane and sofa.
Soon he got the hang of it. His body awareness was awakened and he started “feeling” his body from the inside out.
This body awareness and the ability to follow abstract cueing to a certain extent allowed him to override his brain. His body relaxed and real progress came hard and fast.
Fast-forward to 3 months later, today
So today was the follow up, and as I said, the doctor didn’t even consider asking my dad to walk or sit.
I must admit I wanted the doctor to mention how well he had recovered. I wanted my dad to have his moment of being “proud” of his recovery. We all need a pat on the back. We didn’t get one.
For doc, as long as the leg is still attached to my dad’s body, surgery and rehabilitation are complete and successful.
I do appreciate very much his skills at doing his hip replacement and doing a good job about it. I appreciate he is a doctor that still has compassion. I dislike the way medicine has lost its way and has stopped caring about the real “outcome” every medical intervention should have: quality of life and maximum recovery of function.
I understand that surgeries won’t necessarily leave you as if nothing has happened. They are artificial, traumatic interventions. But we should try more, and we should try better. Because there is a way.
What did I want the doctor to see after his hip replacement?
My dad, only 3 months after his convalescence from his total hip replacement surgery is back to total functionality.
He walks fine, without a cane or help of any kind. Goes up and down stairs unaided and without problem. He has no pain or discomfort whatsoever.
He even spends 5 minutes in deep squat every day. The sciatic pain that had troubled him for 15 years is gone.
There are still compensations, but they are minor and on their way out. There is still rigidity on his hips, but it isn’t noticeable.
If he continues to pursue and develop his body awareness he could be moving better than he moved when he was 40 years old. Remember he is 73.
Afterthoughts: Recovering function after injury or surgery is your responsibility
The current understanding of what rehabilitation is, falls short of what it should be. Returning you back into real health and well being isn’t part of it.
So if you have orthopedic surgery, or any surgery that needs long convalescence, do understand this, you better take your rehabilitation in your own hands.
It is not only about getting yourself back to a proper range of motion, mobility and functionality. It is also about preventing further wear and tear from all the compensations you have developed post-surgery.
It is like buying insurance, just cheaper and far less painful.
Is it difficult? Nah, it only takes time, patience, imagination, the ability to follow abstract command, lots of guidance and effort. But as far as I am concerned that isn’t much of a price to get back to a healthy, functional lifestyle.
Are you or someone you love in a similar situation to my dad? There is a way out. Together we can device a movement plan that delivers quality of life.