Franciscan St. Francis Health Rehabilitation Services

Transcription

1 Franciscan St. Francis Health Rehabilitation Services The more prepared you are for your surgery and recovery, the easier it will be for you and your family or other caregivers after surgery. The effort you put into your rehabilitation can determine how well you recover. We will provide you with the information, guidance and support you need to meet your goals for physical rehabilitation after surgery. Suggestions for success: Success starts with a positive attitude and determination. Yo u are the key player in your rehabilitation. We will assist and educate you, but your effort to rehabilitate your joint is vital. Start your exercise program as soon as possible. The stronger you are before surgery, the shorter the time necessary to recover. Being familiar with what you are going to do after surgery (exercises, how to get out of bed and other limitations) will make your rehabilitation in the hospital less stressful. We strongly encourage you to review the home safety tips in this book and prepare your living space for your return. Taking these simple steps ahead of time will make your first days at home easier and safer for you and your family. If you have questions, call Physical Therapy at (317) (Mooresville) or (317) (Carmel). WE ARE LOOKING FORWARD TO SEEING YOU REACH YOUR GOALS! SECT. 6.1 SECT. 6.1

2 Franciscan St. Francis Health Locations PHYSICAL THERAPY OCCUPATIONAL THERAPY SPEECH PATHOLOGY & AUDIOLOGY SPECIALTY PROGRAMS INDIANAPOLIS Physical Therapy, and Sports Medicine Hand and Occupational Therapy, Pediatrics (PT, OT, Speech) 5255 East Stop 11 Road, Suite 301 Indianapolis, IN (317) (317) Fax INDIANAPOLIS Specialty Therapy Services, Audiology, Vestibular, Adult Neuro (PT, OT, Speech) 8051 S. Emerson Ave., Suite 100 Indianapolis, IN (317) (317) Fax MOORESVILLE Physical Therapy and Sports Medicine, Aquatic, Vestibular and Lymphedema 1201 Hadley Road Mooresville, IN (317) (317) Fax MOORESVILLE Hand and Occupational Therapy (317) (317) Fax PLAINFIELD Physical Therapy and Sports Medicine, Women s Health 315 Dan Jones Road Plainfield, IN (317) (317) Fax CARMEL Physical Therapy and Sports Medicine B North Meridian Carmel, IN (317) (317) Fax SOUTHPORT Physical Therapy and Sports Medicine, Lymphedema Services (PT, OT) 610 E. Southport Road Suite 101 Indianapolis, IN (317) (317) Fax BEECH GROVE Physical Therapy, Hand, and Occupational Therapy 1600 Albany Street Beech Grove, IN (317) (317) Fax SECT. 6.2

3 Other Franciscan Alliance Resources Franciscan VNS Home Care and Therapy Services Serving 30 counties in Central Indiana. Providing in-home therapy when you are unable to travel. CENTRAL OFFICE 4701 N. Keystone Avenue Indianapolis, IN (317) (800) (317) Fax Beginning Your Exercise Program Do your exercises one to three times a day leading up to your surgery date. After your surgery, you will begin doing these exercises up to five times a day. Start with 10 repetitions of each exercise. Do your exercises slowly and maintain control of your movements. Make sure that you do not hold your breath while doing these exercises. It is a good general rule to exhale during the difficult portion of the activity. If you experience a lot of pain with an exercise, you might be able to modify the exercise rather than eliminate it. For example, if an exercise causes increased pain when you do 10 repetitions, try doing the exercise the next time with five repetitions. Then gradually add more repetitions as you are able. /// CAUTION /// Be aware that before surgery there will be limitations to the movement available at your arthritic joint while exercising. This limit is signaled by pain. When you exercise your arthritic hip before your replacement surgery, stay within the limits of your pain tolerance. SECT. 6.3 SECT. 6.3

4 Upper Extremity and Trunk Exercises Getting in or out of bed, up from a chair, and walking with a walker often can be challenging during the early stages of your recovery. The exercises outlined below are designed to improve the strength of the muscles that will perform these tasks after your surgery. If you are unable to perform this maneuver, try a modified version. Lying down with your arms next to your body, push your elbows into the bed, lifting your head and shoulders off the surface. 1. Sit in a chair with palms flat on the seat or on the arms of the chair. Lean forward slightly and push up so that your buttocks come up off the chair. Slowly lower yourself back down to the chair. 3. Practice getting in and out of bed by sitting up in bed first. Then bring both legs off the side of the bed. Using your arms behind you, scoot your body out to the edge of the bed. 2. Lie on your bed with your knees bent, feet flat on the bed, and your arms straight at your sides. Lift your head and shoulders off the bed, reaching toward your feet as you tighten your abdominal muscles. Be sure to keep your chin tucked. To get back into bed, scoot your body back by using your arms and legs to push. Bring both legs up into bed. Once you are straight in the bed, return your head and shoulders to your pillow. SECT. 6.4

5 Hip Replacement Exercises You should do the following exercises one to three times a day leading up to your surgery and up to five times a day after your surgery. Perform 10 repetitions of each exercise. 5. Place a firm roll under your knee. Lift your foot off the bed until your knee is straight. Slowly lower your foot to the bed. 1. Slowly flex your ankles up and down. 2. Tighten your thigh muscles by pushing the back of your knee into the bed. Hold for five seconds, then relax. 6. Keeping your knee straight, slide your leg out to the side. (You might need someone to help you.) Then slide your leg back in by yourself. 3. Tighten your buttock muscles by squeezing them together. Hold for five seconds, then relax. 7. Bend your opposite knee and place that foot on the bed. Keep your knee straight by tightening your thigh muscle, and lift your leg about 12 inches off of the bed. Slowly lower your leg while keeping your knee straight. (You might need someone to help you.) 4. Slowly bend your knee up in bed by sliding your heel towards your buttocks. (Keep your foot on the bed.) Slowly lower your knee back down to the bed. SECT. 6.5 SECT. 6.5

6 Total Hip Precautions Precautions for the first eight weeks after surgery For the first two months (eight weeks) after your hip replacement, it is important that you follow hip range-of-motion precautions. During those first two months, your body forms scar tissue around your new hip joint. This helps stabilize the joint, making it extremely unlikely that your hip will dislocate (come out of the socket). Your new hip is very stable. There is no need to fear using your new joint, but you do need to be aware of your precautions and follow them for the first eight weeks after your surgery. These are not lifetime restrictions, and your surgeon s team will let you know when you can alter your motions. Follow the three simple rules below to take care of your new hip during the first eight weeks after surgery. If you follow these very simple rules, the likelihood that you will dislocate your hip is extremely low (less than 1 percent). 1. KEEP YOUR KNEES APART. When you are sitting (in a chair, on a bed, on a commode, in a car) and when you get in or out of a seated position, keep your knees separated. They should be at least shoulder-width apart. Do not cross your legs when lying down or sitting. If you sleep on your side, place two pillows between your legs and log roll (move your shoulders with your hips) onto your side. 2. DO NOT BEND YOUR HIP PAST A 90-DEGREE ANGLE ( L ). If you are already sitting down, do not lean forward to pick up anything off the floor. Use a reacher or grabber to pick things up, or leave them there until someone else can pick them up for you. SECT. 6.6

7 Do not try to put on your shoes or socks in a conventional manner. Do not lean very far forward (past 90 degrees) to stand or sit. Sitting in a chair that has arms on both sides will help you not have to bend past 90 degrees to reach the cushion to lower yourself or to stand up. If your chair or sofa will leave you seated with your hips below your knees, either slide your foot out or sit on firm pillows. 3. DO NOT TWIST ON YOUR LEG. Avoid excessive twisting movements through your hips and torso. Try to keep your toes and your nose pointing in the same direction. This applies when lying down, sitting and standing. Do not try to turn around without moving your feet or to reach across your body while lying in bed. Do not pivot or twist your foot into a shoe. Be careful reaching behind you, such as when on the toilet. While standing facing a countertop or heavy piece of furniture you can hold on to, practice shifting your weight onto the surgery leg. Hold the countertop and lift your surgery leg out to the side with toes facing forward. Then stand on your surgery leg and lift the opposite leg. Do not be surprised if just a few repetitions make your hip tired. You may gradually discontinue use of your crutch, cane and/or walker. You may find you can walk short distances without assistance at first, but need it for longer trips. As long as you feel safe, do not limp and your pain does not increase, you can use your own judgment about walking without support. However, do not allow yourself to use furniture or walls for support when walking; this means you still need your walking aid. Some patients discontinue their cane or walker after two or three weeks; others need more time. Go at your own pace. There is no strict time limit for using walking aids. Daily activities You will need to gradually return to your normal routine. It s normal for you to feel very tired the first days after surgery, but you need to be out of bed, dressed and moving around at least every 45 minutes during your normal awake time. Slowly increasing your activities is most realistic. We encourage you to go out of the house. Walk outside or in an open area such as a mall, go to church, go out to eat or visit friends. Just don t do it all in one day at first! At the end of two months, you will no longer need to follow these precautions. Precautions for weeks two through eight Walking You can put full weight on your involved leg (unless specifically told not to) and progress from your walker or crutches to a straight cane. Before doing so, make sure you do not have a limp, and be sure you feel safe walking without assistance. It s not uncommon for patients to have a limp prior to surgery and need to really work at not limping or favoring the leg after joint replacement. To break the habit, try walking while facing a mirror. For some, only time and repetition will help. During long car trips (more than an hour or hour and a half in length), stop every 45 to 60 minutes to get out of the car and walk. Standing in one place (such as at the sink or stove) might make your hip tired. You may need to sit or walk around for a brief change. Do not vacuum, mop floors, lift heavy laundry or do strenuous yard work for the first eight weeks after surgery. Be very specific with your surgeon and physical therapist about what you need to be able to do physically to return to your job or hobbies. This will help us get you back to your activities as soon as possible. SECT. 6.7 SECT. 6.7

8 Driving You are allowed to drive your car when you can safely and comfortably walk with or without a cane. You must feel safe to get in and out of the car maintaining your hip precautions, have good control of your leg and not need narcotic pain medication. If you cannot meet all of these criteria, you should not drive. Other procedures Due to the risk of infection, we strongly discourage any non-emergency procedures for 12 weeks following your hip replacement. This includes dental work, even routine cleaning. Be sure to always tell any health care provider about your joint replacement. You will always need to take an antibiotic before any invasive procedure, even routine dental cleanings. Beyond eight weeks Follow the instructions given to you by your joint replacement team. Begin scar massage as instructed by your physical therapist. Remember to use sunscreen on your scar if it is exposed to strong sunlight. Follow your hip precautions as instructed. Avoid bending and twisting across your leg. Do your exercises for six months. Your therapist may add to your program at your post-surgery visit. Your goal is to get to 25 repetitions of each exercise. When you can do 25 correctly, do exercises once a day. Your goal over the next six months, as you become stronger and more mobile, is to gradually replace your hip exercises with low-impact exercises (walking, biking, elliptical machine). Do not use leg weights. Weight-lifting is not as beneficial for your strength and overall joint health as low-impact exercise. You might need to continue your pain-control measures. Ice your hip and elevate your leg as long as you feel some benefit. You should be able to resume all of your household duties and activities of daily living. Lifetime precautions We encourage you to live a healthy and active life. Exercise should become part of your normal routine. Most people are able to tolerate low-impact activities such as walking, biking, golfing, swimming and cross-country skiing. Avoid high-impact, repetitive activities such as running, high-impact aerobics, jumping, basketball and singles tennis. Avoid repetitive lifting of 25 pounds or more, such as in assembly line work. Repetitive heavy lifting, every day, all day, can lead to wear and tear on your joint. You may lift heavier weights, such as children, luggage or household items occasionally, as long as you feel safe doing so. Try to carry the weight close to your trunk so you have the best mechanical advantage. Your range-of-motion precautions should be lifted after eight weeks. After that time, do not put your joint in extremes of motion. Do not bring your knee to your chest. Avoid combination moves, such as bending fully forward and twisting to reach outside your leg. Have a successful hip replacement! Do your exercises. Walk. Control your pain and swelling with pain medicine, ice and elevation. Follow your hip precautions. STAY ACTIVE! ENJOY YOUR NEW JOINT. IT S OUR PLEASURE TO ASSIST YOU IN YOUR RECOVERY. SECT. 6.8

9 Adaptive Equipment As discussed in the Planning for Hospital Discharge section of this book, you will likely need some adaptive equipment during your recovery. Talk to your doctor before surgery to see what equipment you might need, and obtain a prescription for those items. Some of this equipment is optional, and insurance coverage varies, so check with your provider. Your equipment might not be covered. Walking aids Walking aids provide stability while you are walking after surgery and provide support for the operated leg. These items include walkers, canes and crutches. Nearly all patients start out with a walker, although it s sometimes possible to progress to crutches if you prefer. It s best to get your walker before surgery so you can bring it to the hospital with you. Having your equipment at the hospital will help your physical therapist determine if your walking aid fits you properly. Guidelines for fitting your walking aid: Walkers: You should be able to stand comfortably in the center of the walker. With your arms at your side, the walker grips should come to about the level of your wrists. Crutches: When you are standing up straight, there should be at least two fingers width of space between the top cushion and your armpit. With your arms at your side, the crutch grips should come to about the level of your wrists. Never hang on your crutches. Canes: When you are standing with your arms hanging at your side, the handle of the cane should reach the level of your wrist. Canes are used in the hand opposite the affected leg. Elevated toilet seat Use an elevated toilet seat at home to help you with getting on and off of your toilet while maintaining your hip precautions after surgery. Elevated toilet seats often can be found in drug stores like Walgreens and CVS, along with some large hardware/ home improvement stores like Lowe s or Menards. Elevated toilet seats are often not covered by commercial insurance and are not covered by Medicare. SECT. 6.9 SECT. 6.9

10 Bath seat You might need a bath seat to help you maintain your hip precautions while showering. This is especially true if you tire easily or cannot tolerate standing long enough for a shower. Keep in mind that most patients are allowed to stand to shower, but it is NOT permissible to sit in a tub for a bath. The seat is not necessary for all patients and might not be covered by insurance or Medicare. Bath seats often can be found in drug stores (Walgreens, CVS, etc.), as well as some large hardware/home improvement stores such as Lowe s, Home Depot or Menards. Reacher You can use a reacher to pick up objects from the floor without bending your hip past 90 degrees. You also can use a reacher to help you take off your socks or put on underwear or pants. Long-handled bath sponge A long-handled bath sponge will allow you to maintain your hip precautions while you wash your lower legs and feet. It will help you avoid bending past 90 degrees to reach these areas. Seat cushion Use a seat cushion or pillows to elevate the seat of any chair in which you plan to sit. You should plan to sit at a height that allows your hips to stay higher than your knees. In general, recliners are not recommended during the first eight weeks after any hip replacement surgery. SECT. 6.10

11 Dressing stick A dressing stick can assist you in dressing yourself when you are not allowed to bend. The combination hook and pusher on one end of the stick can help you pull on pants or skirts or remove socks. Long-handled shoehorn The handle on this shoehorn has been extended to assist you with putting on your shoes while maintaining your hip precautions. Place the shoehorn inside the back of your shoe, and push your heel down into the shoe. Sock aid During your first eight weeks of recovery, your limitation of not bending your hip past 90 degrees will mean that you will need assistance in putting on socks or stockings. A sock aid can help you perform this task independently. To use, place the sock over the end of the aid, pulling on most of the sock. Hold onto the ropes and lower the sock aid down to your foot. Place your foot into the opening of the sock, and pull the ropes until the sock slides all the way on. Pull the sock aid out of the top of the sock. Elastic shoelaces These rubber/rayon laces provide firm support yet stretch to allow your feet to slip into or out of your shoes without having to untie and retie them. To use, simply lace the elastic shoelaces through your shoes and tie them. Do NOT use your opposite foot on the heel of your surgery side s shoe to pull off your shoe. This pulls on your new hip and could cause pain or a problem. SECT SECT. 6.11

12 Turning in Bed After a Hip Replacement After hip surgery it s important you keep pillows between your legs when lying on your side. This will help you maintain your hip precautions and prevent dislocation. While on your back, place enough pillows between your legs to make sure you are supported from your thighs to your ankles. To keep the necessary space between your legs, maintain pillow placement and avoid breaking your hip precautions, you might need someone to help you roll to your side. You might also want to have someone tuck pillows behind your back and legs for support and comfort. Keep the pillows in place as long as you are lying on your side. SECT. 6.12

13 Getting In and Out of Bed After a Hip Replacement Getting out of bed While lying down, push up evenly with your elbows and hands until you are sitting, supporting yourself with your hands. Slide your legs out one at a time, using your hands to turn your upper body. As you sit at the edge of the bed, you should be supporting yourself with your hands. Use caution to make sure you do not twist your legs or your body while moving. (If you are supporting yourself on your hands, you need to make sure you are using both hands not one hand and one elbow, as that can cause twisting of your body and legs.) Getting into bed Sit on the edge of the bed. Then slide your legs back onto the bed one at a time. Use your hands to help scoot your hips around until you are in the long sitting position. Use care to make sure you support yourself with both hands and not one hand and one elbow. Lower yourself gently and evenly with the help of your arms. SECT SECT. 6.13

14 Using Your Walker Adjusting your walker for proper use Standing in the middle of the walker with your arms hanging comfortably at your side, the handgrip should come to where you bend your wrist, which is approximately hip level. With your shoulders relaxed and your hands resting on the handgrips, you should have about a 20-degree bend at your elbows. You should feel comfortable standing at the walker. You should not elevate your shoulders to bear weight through your hands. Standing and sitting with a walker You should not attempt to sit in low chairs or on soft surfaces such as sofas or recliners while your hip precautions/movement restrictions are in place. You will need to place pillows on most chairs to make sure you always keep your hips elevated higher than your knees while sitting. A chair with armrests will make it easier for you to stand and sit. Do not use chairs with wheels unless the wheels can be locked. Do not sit in the bathtub. Remember to scoot forward to the edge of the chair or bed and use your hands to push up from the sitting surface to a stand. Do not pull up on the walker to stand. The walker may tip backward and cause you to fall. Standing Scoot to the edge of the chair or bed, keeping the operated leg extended in front of your body. Without leaning forward, push up from the chair with the help of your arms and non-operative leg. Reach out and take hold of the walker. Bring your operative leg back underneath you as you fully straighten your other leg. Take a minute to make sure you feel steady before walking. Standing following bilateral hip replacements Scoot to the edge of the chair or bed and bring your feet back underneath you. Make sure you keep your hands and shoulders back as you stand to avoid bending too far at your hips. Push up from the chair using your arms and legs. Take care not to lean too far forward as you stand so you do not bend too far at the hip, breaking your hip flexion movement restriction. Reach out and take hold of the walker, fully straightening both legs as you stand. SECT. 6.14

15 Sitting Using the walker, back up until you feel the chair or bed behind your legs. Extend your operated leg in front your body. Reach back for the bed or armrests of the chair one hand at a time. Slide your operated leg out in front of you as you use your hands to lower yourself to the chair. Use your arms and legs to help you scoot back into the chair. Sitting following bilateral hip replacements Using the walker, back up until you feel the chair behind the back of your legs. Take a small step forward with each leg. Then reach back for the armrests of the chair one hand at a time. Use your arms to slowly lower yourself into the chair, taking care to keep your hands and shoulders behind you to avoid bending too far at your hips and breaking your hip flexion movement restriction. Be sure to sit back evenly onto both hips. Once seated, use your arms and legs to help you scoot back into the chair. Walking with a walker Move the walker forward until the back two legs of the walker are in line with the front of your toes. With all four legs of the walker on the ground, step forward with your operated leg into the middle of the walker. Do not step past the front of the walker. Remember to keep your head up and look forward. If you have bilateral hip replacements, it does not necessarily matter which foot you choose to lead with when walking, as long as you remain consistent. Managing stairs with your walker Learning to manage the stairs is easier than you might think. Step first with your non-operative leg when going up steps, and step first with your operative leg when going down steps. An easy way to remember? Tell yourself, the good goes up to heaven, and the bad goes down. Going up more than one step Turn your walker sideways, with the opening toward you but to one side. Place two legs of the walker on the step you are going to and two legs of the walker on the step or floor on which you are standing. Use the top handle of the walker as a portable rail. Further support yourself using the staircase railing, or hold onto someone walking up the stairs with you on your opposite side. Step up with the unaffected (stronger) leg first. Then bring up your surgery leg. Move the walker up one step, and repeat the process: up with the unaffected (stronger) leg, followed by the surgery leg. If your steps are not deep enough for the walker legs to be supported when turned to the side, fold your walker and place it in front of you for support when going up the stairs. Bearing weight as indicated by your doctor (and with some weight through your hands if needed), step forward with your other leg. SECT SECT. 6.15

16 Going down more than one step Turn your walker sideways, with the opening toward you but to one side. Place two legs of the walker on the step you are going to and two legs of the walker on the step on which you are standing. Use the top handle of the walker as a portable rail. Further support yourself using the staircase railing, or hold onto someone walking down the stairs with you on your opposite side. Going up a single step Forward approach Approaching steps with a standard walker, walk all the way up to the step. Put all four legs of the walker onto the step. Step up with your stronger (unaffected) leg and then step your surgery (affected) leg up. Backward approach Step down with the affected (surgery) leg first. Then bring down your unaffected (stronger) leg. Lower your walker one step, and repeat the process: down with the affected (surgery) leg followed by the unaffected (stronger) leg. If your steps are not deep enough for the walker legs to be supported when turned to the side, fold your walker and place it in front of you for support when going down the stairs. Be very careful to place your foot and walker securely before stepping. Approach the single step. Turn around and back up to the step. Step up with your stronger (unaffected) leg, and follow with the surgery (affected) leg. Be sure to have your balance and plenty of room for your feet and walker, then bring the walker onto the step. Turn around and continue walking. SECT. 6.16

17 Going down a single step Forward approach Walk toward the step. Put the front legs of a standard walker to the edge of the step and stand in the center of your walker. Place all four legs of the walker down onto the floor. Step down with the surgery (affected) leg. Then bring the stronger (unaffected) leg down. Slide your buttocks back onto the seat, making sure you are in safe, comfortable sitting position. Remember to maintain your hip precautions and avoid bending over to reach your legs, soap or shampoo. It is a good idea to have a reacher nearby and to use it to help you bathe. It is also helpful to fit your shower with a handheld shower sprayer prior to your surgery. To get out of the tub, reverse the process. Place your feet flat on the floor before you attempt to stand up. Use extreme caution and be mindful of slippery, wet floors. How to wash your hair at a sink With your walker in front of you, bend over at your waist and have someone assist you with washing your hair. It would be easier to wet and rinse your hair if you have a sprayer at your kitchen sink. Do not extend (kick back) your surgery leg when standing bent over at the sink. Using a shower seat with a walker Your surgeon will determine when you can begin taking showers after your surgery. At this point, it is best to have someone who can help you into and out of the shower stall or tub. A shower seat can be an important aid for those who cannot tolerate standing to shower. You should not attempt to sit in a bathtub. To use a shower seat with your walker, place the shower seat firmly in the tub or shower. Stand with your back toward the bathtub and your walker in front of you. Lower yourself slowly onto the shower seat while reaching back with one hand. Make sure you keep control of your motion and balance. Slowly lift each leg over the side of the tub, one at a time. SECT SECT. 6.17

18 Car Transfers Getting into the front seat after hip replacement Make sure the front seat is positioned as far back as possible. Get in and out of the car at street level and not from a curb. Reclining the seat before you enter might make it easier to get your legs into the car. Place one or two pillows on your seat to help you keep your hips higher than your knees and maintain your hip precautions. Back up to the car until you feel the car seat or frame on the back of your legs. Reach back for the door frame and front passenger dashboard. Do not pull on the door; it is not stable enough to support your weight. Scoot back onto the seat as far as possible. Begin to turn your body in to face the front of the car as you do so. You might need someone to help guide your legs into the car. Slightly recline the seat to avoid bending your hip and help you maintain your hip precautions. Sit down onto the pillows. Use your arms to help lower yourself down. Slide your surgery leg out as you sit. To get out of the car, reverse these steps and movements. SECT. 6.18