I had a rewarding, 30-year career in physical therapy before I decided to hang up my goniometer (it measures joint motion) and open a martial arts dojo and personal training studio. During my time as a therapist, I treated people with just about everything you can imagine in military and civilian settings: fractures, dislocations, back injuries, stroke, amputations, shrapnel wounds and…total joint replacements. And after so many years of trying to coach people through their post-operative phase of rehabilitation, I find myself in the same boat. I (finally) had a total hip replacement 10 days ago. Yeah, about that….
It has been a long time in coming, about 10 years since I was diagnosed with a CAM lesion in my left hip. The easy description is malformation of the femoral head or neck of the femur. And how does something like that happen? Oh, I don’t know, maybe 40 years worth of side kicks, break falls, grappling and running on cement. Anyway, I held off for a long time because I knew the risks and the residual limitations. I was confident that I could rehab my way out of this mess, so I did my due diligence with a combination of a lot of research, exercise, activity modification and finally trying to ignore the pain all together. So much for the clinical approach.
So, this is the first of a two-part summation of my experience, especially for the aging athlete or martial artist like me because there are not a lot of resources out there for folks who eventually want to return to sport or other activities after hip or knee surgery. And I offer experience as both a clinician and a patient. Keep in mind, of course, that everyone’s story is a little different and that there is no cookie-cutter way through this. With that said, allow me to offer the first piece of advice.
Choose the surgeon who is right for you. I feel blessed every day that I have a military pension and affordable healthcare, but my insurance tier did not allow me to pick the surgeon I wanted. I initially went to the base as directed and saw one of the two orthopedic surgeons stationed there. During the consultation, I asked about return to sport and there was this dumfounded look on his face. Biking, walking, golf…those were my choices. Rightfully so, he explained that there was going to be a tree splitter in my femur for the rest of my life, so vigorous sports are not recommended. So, I spent some extra money and contacted a surgeon I knew and respected to get his take: “No restrictions.” How can there be such a difference of opinion? Well, all surgeons have their own techniques and approaches. But the best answer I received was that there is no way to tell the lifespan of the current prosthetics used in modern joint replacements. My doc told me that all we have to go on is data based on parts used 20 years ago, and that those are lasting far longer than the ones used 20 years before. Furthermore, I was simply not the typical hip replacement candidate. A lifetime of weight training and vigorous activity will stack the deck in your favor as far as bone density and healing. Bottom line, I chose a surgeon who didn’t tell me I had to lay down and die. Keep in mind, 59 is relatively young for a hip replacement. 49 is really young, hence one of the reasons I held off for so long.
Understand post surgical pain and trauma. I’ve never been a fan of any medications and have made it this far with nothing more than occasional Advil for a number of years. But I was on a drug concoction for the first couple days after surgery that made me a slobbering mess. Now, this is going to sound a little conceited, but lifelong athletes generally have a higher pain tolerance than the average Joe, and the drug combination prescribed to me is prescribed to just about everybody. Fortunately, I know my way around a total hip rehabilitation protocol. I understand the procedure, the anatomy and the physiology. I know enough to understand the effect surgery has on soft tissue and nerves, the difference between normal pain and a call to the doctor. So, it doesn’t bother me, for example, that the bruising in my leg looks like a huge Roschach test…it freaks everybody out, but I tell people this is actually a good thing. The point is, do some research and get an idea of how much pain you’re going to be in as well as the difficulty sitting, walking, etc. I can see daily progress, though it may not be as soon as I’d like. The nerve pain and swelling was tough without all of the meds, but I took myself off of everything except Tylenol as needed after two days. The meds intended to make activity more tolerable actually made me a little too relaxed to the point of lethargy. Did going "cold turkey" make rehab harder at first? Yep. But I am a martial athlete; I can deal with pain as long as I understand the purpose and the prognosis. I also did a lot of research before I decided what I absolutely needed (blood thinners, antibiotics, etc.), and what I could do without. Now, this is just me; you should always communicate with your medical team before you do anything in those first crucial days after surgery.
Understand the long game. This one is particularly tough for me because I have a martial arts business and typically teach all of the classes. I am also a personal trainer and strength coach, so it’s going to be tough to have clients load their own plates for a while. But I constantly have to remind myself of why I did this. As I said, I see progress every day. For instance, this is the first time I can sit down and stand up without pain in my hip…well, arthritic pain anyway. I can squeeze my knees together without intense pain…I know, weird right? That’s how messed up my hip was. But this is going to be a long haul and I have to be patient. I’ve also come to realize this is an investment in my business and quality of life. Good investments take a long time to mature, so I guess I’m along for the ride for a while and that’s ok. The next few months will be a process of seeing what I can and cannot do. There will be times when I overdo it and that’s part of the process. I’m just thankful for future possibilities and that is probably one of the biggest takeaways from this experience. I am very grateful for the number of really smart, dedicated people out there who spend their lives in medicine and research trying to make the world a better place.
Utilize your warrior mindset. Whether you're a lifelong athlete or martial artist, you have a unique understanding of grit. You've spent hours and years in the gym developing your physical and mental health. You've done "two-a-days," trained for marathons, pushed past limits. You've put in the hours of self-practice, striking, kicking, running, lifting. You know who you are and what you're capable of better than anyone else. Use that. When you're several days out of surgery and the inclination for self pity and doubt enters your mind, stand up with your cane or walker and limp around the house for a bit. Push it, the only way you know how...without ignoring your precautions, of course.
So, if you happen to be in a similar situation or know someone who is, consider sharing this. It’s not much, but believe me, I read everything I could get my hands on before I decided to take the plunge. I'm looking forward to realizing the benefits in the coming months.
Thanks…I’ll report back.
Dave Magliano
Tatsu Dojo
Jissenkan Budo
Dojo Cho
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