Total Hip Replacement – Precautions

Total Hip Replacement(T.H.R) is a surgical procedure of removing the diseased hip joint and replacing it with an artificial one.

Usually the patients considered for T.H.R are

  1. Young patient
  2. Osteoarthritis of hip joint
  3. Rheumatoid Arthritis
  4. Avascular Necrosis
  5. Septicemia

There is a progressive increase in chronic pain and difficulty in walking, stair climbing and rising froma chair.

Usually there are two types of prosthesis which are commonly used for the surgery: Cemented and Uncemented Prosthesis.

Difference of cemented and uncemented prosthesis:

Cemented prosthesis is usually used in older patients who are less active and have less bone moneral density.

Uncemented Prosthesis is used in younger and more active individuals.

The primary disadvantage of uncemented rposthesis is the extended recovery periof. Because it takes long time for natural bone to grow and attach to prosthesis, hence the person has to limit his activitties for upto 3 months to protect hip.

Your hospital stay my last for a week. If you go home you will need help for several weeks.

The following steps can make your home coming easier:

  • In kitchen as well as other rooms, place items of daily use within reach so you dont have to reach up or bend down.
  • Rearrange furniture you can walk easily with walker or stick.
  • Get a good chair that is firm and higher than average seat.
  • Remove rugs or area rugs that could make you slip.
  • Securely fasten electrical cords around perimeter of the room
  • Install a shower chair grab bar and raised toilet.
  • Use assistive devices such as long handle sponge and grabbing tool or reacher to avoid bending too far.

Once you get home, stay active.The key is not to overdo it while you expect some good and some bad days, you should notice gradual improvement over time.

WEIGHT BEARINGDiscuss with your physical therapist regarding the weight bearing of operated leg as the rehabilitation protocol will be different for cemented and uncemented prosthesis.

STANDING: Move your operated leg first and pushoff the armrest of chair to stand up.

SLEEPING POSITIONS: Sleep on your back with legs slightly apart on your side with abduction pillow.Be sure to use the pillow atleast 6 weeks or untill your doctor tells you to use. Sleeping on stomach is alright.

SITTING: For atleast 3 months donot cross your legs at knees. Make sure the seat height is good so as to avoid bending of hip beyond 90 degreesGet up and move around possibly every 1 hour.

SEX: Some sex positions can be safely resumed 4-6 weeks after surgery. Ask your doctor regarding the same.

CLIMBING: Stair climbing should be limited if possible untill the wound is healed.

Following pattern of stair climbing should be followed.


  • the unaffected leg should step up first
  • then bring affected leg to same step
  • then bring the cane


  •  put the cane first
  • next bring the affected leg down the step
  • finally step down with unaffected leg.

DRIVING: You can begin driving an automatic car 4 to 8 weeks after consulting your doctor and symptoms after surgery.

SITTING INTO CAR: Be sure the passenger seat is pushed all the back.Recline the seat as far as possible.with the walker in front of you slowly back up the car seat.Swing your legs into the car.Lean back if you need to avoid the hip more than 90 degrees.

GETTING OUT OF THE CAR: Push the seat all the way back.recline the seat and lift your legs out.lean back if you need walker up in front of you and stand up on unaffected leg.

RETURN TO WORK: Depending on the type of activities you eprform it may take as long as 3 months to 6 months to return to work.

OTHER ACTIVITIES: Walk as much as you like once doctor gives you permission, but remember donot substitute walking to exercise.Swimming is recommended once suture are removed and wound is healed.Acceptable activities are dancing, golfing with spike less shoes and cart,bicycling on level road.Avoid activities that involve impact or stress on joints such as tennis, badminton or contact sports like baseball, football,squash, jumping or jogging, Lifting weights is not a problem but carrying heavy and awkward objects that cause to stagger is not advised especially if you must go up and down stairs or slopes.

Do’s and Dont’s

The do’s and dont’s vary depending on orthopaedic surgeons apporach.Your doctor and Physical therapist will provide you with a list of the same to remember with your new hip.The precautions will help you to prevent the new joint from dislocation and ensure proper healing.

 The Dont’s

  • Donot cross legs at knee for atleast 8 weeks
  • donot bring knee up higher han your hip
  • donot lean forward while sitting or as you sit down
  • donot try to pick up something on the floor while ou are sitting
  • donot turn your feet excessively inwards or outwards
  • donot reach down to pull your blanket when lying down
  • donot bend at waist beyond 90 degrees
  • donot use pain as a only guide for what you may or may not do

The Do’s

  • Keep skin dry and clean
  • Notify doctor if wound drains
  • Swelling is normal for first 3-6 months. Elevate leg slightly <30 degrees on pillow and put ice packs for 15-20 min
  • If you get calf pain , chest pain and shortness of breath notify doctor immediately
  • Do exercises prescribed daily.
  • A balanced diet is very important.
  • Maintain an active lifestyle after surgery.

DISCLAIMER: Kindly refer your doctor and Physical therapist for the instructions depending on your surgery procedure.


Ergonomic Handbags

In our last post we spoke about The Handbag Syndrome. Now lets talk about ergonomic handbags.Distressed_Nylon2010

The scientific technology behind ergonomic purses is that their design is such that it distributes the centre of gravity thereby reducing the stress on the back, shoulder and neck muscles.

How to Choose an Ergonomic Handbag?

This applies to ergonomic laptop bags as well.

Choose a handbag that is proportionate to your body size (this rule applies in elegance and fashion as well!).

  1. Preferably, choose a lightweight bag to best minimize the weight you are carrying around.
  2. Don’t purchase a big bag, you’ll only be tempted to fill it.
  3. Alternate shoulders by switching the bag from side to side.
  4. Do not slump your shoulders when you are carrying your bag on your shoulder. It adds to the strain.
  5. Don’t let your bag cause you to lean to one side.
  6. Your ergonomic shoulder bag should not interfere with your motion.
  7. Use a bag with padded straps to help distribute the weight and pressure across your shoulder
  8. Go for wider straps.
  9. Reduce the load you carry around by constantly ‘editing’ your wallet, purse or bag. Carry only the bare essentials.
  10. If you must carry an item, try to get the travel size option.
  11. If you can, try to carry smaller bags.
  12. Pick the bag that allows you to alternate carrying on your shoulder, around your wrists or by using its handles.
  13. Leave your loyalty cards in your glove comparment of your car or a ‘shopping’ bag (bag that you use when you go shopping)
  14. If you cannot seem to reduce the weight of your bag to about 6 lbs (3 kg) or less, consider a backpack. A backpag is more of an ergonomic bag since it distributes the weight between your shoulders

Ergonomic Backpacks

  • “Backpacks” are excellent ergonomic bags and are appropriate for people suffering from back or neck pain.
  • Backpacks also have various pockets for you to be able to segregate and arrange your items accordingly and get the total weight distributed evenly.
  • They come with thick padded shoulder straps that don’t unnecessarily compress your skin and are comfortable on the shoulders too.
  • You may carry them across the back or on both shoulders and move about comfortably thanks to the ergonomic design.

Ergonomic Sling Bags

Another option for ergonomic purses is “Sling backs”.

  • They have a teardrop structure that tend to take the weight of the back away from the neck and shoulder and evenly spreads out the weight on the back making them extremely comfortable to carry.
  • The added thick and padded shoulder strap makes it easier for carrying without straining yourself.
  • Use it for any purpose, as a gym bag, for college, for shopping or any other purpose, their design is such that they look smart with any outfit and suit all ages too along with being gentle on your back.

Ergonomic Clutches

If you are not into backpacks and feel it would look inappropriate with your dress or for the occasion go in for smaller compact purses.

  • Firstly, since they are smaller in size you will have to cut down on the things you put in it that would automatically make it light weight.
  • “Clutches” are a perfect example for compact small ergonomic purses.
  • They are stylish and chic and would fit in your palm and cause no strain what-so-ever to your back.

Keep a number of them to befit the occasion and keep only the essentials you need for that time in them.

Other Ergonomic Handbags

Alternatively, you may take “small bags with small handles” that cannot be hung on the shoulder. These too can be carried along without any straining your spine. Even if you are carrying a “tote bag” with a long strap, ideally you should put the strap diagonally across the chest for distributing the weight. Alternating between the shoulders on which you carry the purse would also help a great deal.

Handbag Syndrome

KateKylieES1312_468x477A camera, mobile phone, make-up, wallet, laptop, umbrella, water bottle, laptop, a change of clothes, a bottle of wine, books, groceries … we’ve pulled all of these items out of our purse on different occasions. Big handbags are in fashion for a couple of years now, so inevitably the amount of content these bags carry grows That is the rise of heavier handbags and typically such a bag can weigh 3kg or more. And that’s not good, because overstuffed handbags not only lead to broken straps and misshapen purses, but also to back problems for those carrying them.

There is an increase in the cases of heavy handbags induced headaches & neck, shoulder and back pains. Though such syndrome affects mainly women, men do get such pains as there are rising trends of men who carry heavy bags (eg laptop bag).

Worse news! This spinal distress is exacerbated by high heels!

A heavy handbag, shoulder bag, or purse can injure the neck, back and shoulders. The neck has a natural curve that evenly distributes forces on the spine. Hence, when a person carries a heavy bag on one side over a long period of time, this natural curve starts to get distorted which can lead to chronic neck and shoulder pains, back pain, and even headaches. Left untreated, it can lead to more serious injuries such as herniated discs and accelerated degeneration of the cervical spine.

Are you suffering from Heavy Handbag Syndrome?

The reason why heavy purses cause stiffness in neck, back and shoulder is because they induce an uneven distribution of weight.Spine

While carrying a heavy purse on one shoulder the blood flow due to the weight of the purse gets unevenly distributed. The half that carries the purse is under constant duress and the muscles in that area get sensitized and may ultimately start aching. This overload on one half of the back causes strain on the spine and back too and cause pain and extreme discomfort. The pain may be in the form of stiffness, aching, numbness or just tingling sensations.

Another common problem is that one shoulder becomes slightly higher than the other. Some scenarios such as talking on mobile while carrying the heavy handbag, will worsens the problem, because in addition to balancing too much weight on one side, she is lifting the shoulder at the same time, straining the neck and shoulder ligaments and muscles.

Typically, handbag syndrome brings about neck, shoulder muscles and ligaments strain/ injuries, causing poor neck and shoulder postures. Left untreated, these can lead to more serious injuries such as herniated discs, accelerated degeneration of the spine and less commonly, traction injury of the brachial plexus, which symptoms are weakness and sensation changes (i.e. numbness over the shoulder and arm).

What do WE do?

So what are the alternatives to avoid getting caught in a similar situation?

  • Weight of the handbags/ shoulder bags/ laptop bags should not weigh more than 10-15 percent of your body weight.
  • Check by feeling the bag on our shoulder. When you sling the bag on your shoulder, and it feels uncomfortable, especially when the weight pulling shoulder down, it is time to downsize or reduce the contents in your bag.
  •  Lighter bags (contents included) are recommended, not more than 2-3 kg as we tend to carry such bags frequently and over a extended period of time (travelling to work and back home, shopping) which can change the biomechanics of the neck , back and shoulders and lead to pain and dysfunction.
  • Get into the habit of switching sides when we are carrying our bag.

Still have Pain?

3444735038_shoulder_pain_xlargePhysiotherapy can help resolve these pains by:

  1. Analyzing the structure of the your body, such as how does your head sits on your shoulders or how your posture could have brought about the biomechanical changes in your neck and shoulders causing pains.
  2. Apply various strategies in the restoration of spinal and shoulder girdle mobility and stability that results in a reduction in the patient’s pain and spasm. Strategies include manual techniques, such as joint mobilization and manipulation, deep tissue massage, muscle energy technique and neck and shoulder girdle stabilization exercises.

However, treatment is always more effective if the problem is detected and treated early as chronic problems (more than 3 months) have poorer treatment results. Therefore, if the pain does not resolve within 3 days and seems to get worse, it is time to make an appointment with your physiotherapist.

We think our vow to take better care of our back and the return of the chain strap is serendipitous. If you’re guilty of using your handbag as luggage, what items do you think you’ll take out?

Next Week! Visit Us to know more about Ergonomic Handbags!!


New Year Resolution: Fitness

This New Year our resolution is Fitness!…and here are a few exercises we are using to get fit ASAP!


4.-the-chop-420x420_0This highly functional exercise not only works the core, it also challenges the important reactive process involved in core stability. It’s amazing the sweat you can produce with this move.

  • Stand sideways with your feet wider than shoulder-width apart and hold a weighted ball at about forehead level, arms bent 90-degrees and knees slightly bent.
  • Then, as if you were going to hurl the ball down and behind you to the right, tighten your abs and rotate your body into a lunge-style stance, bending both knees until the back shin is parallel to the floor.
  • Your arms will straighten with your hands traveling to the outside of your left knee.
  • To reverse, tighten your abs and explode up through your legs, returning to the start position.
  • Do 15 from left to right and another 15 from right to left.


6.-butt-ups-420x420_0These are a fave because they work your core while strengthening your upper body and stretching your back and legs.

  • Start in plank position on your forearms with your tailbone tucked and core braced.
  • Press back into a down-dog like position with your butt in the air, back flat, and chest press downwards.
  • Return to start while engaging your core.
  • Try up to 3 sets of 15 reps.


18.-rond-de-jambe-420x420This exercise works the entire body. I love this one because it challenges balance and is effective in producing accelerated results.

  • Step your right foot on top of the band and stand with your heels and inner thighs pressed together, toes pointed out, hands on your hips.
  • Reach your right leg forward and circle it around to the back, maintaining external rotation of the legs.
  • Reverse the direction to complete one rep.
  • Do 2 sets of 10 repetitions on each leg.


1.-mountain-climbers-420x420From a full plank position, alternate ‘running’ your knees into your chest as quickly as you can. Push your speed as much as possible so that you are completely out of breath by the end of your 20 seconds.

Lets get FIT!!

DISCLAIMER: Please consult your medical professional before beginning exercises.

Dance to Fitness- Part 2

dancer-bandage-footRegardless of gender or generation, more and more people are moving to the dance floor for a workout that is exciting and effective. Though dance fitness is considered a fun full-body calorie blaster, like other physical activities, it isn’t risk-free. If you’ve embraced dance for your workout, here are some tips to make sure you keep dancing injury-free.

Dance-related injuries to the lower body are common

“For avid dance fitness goers, the most common injuries are repetitive strain injuries which occur when there is too much stress placed on weak points of the body for long durations of time,” says Andrea Wilson, a former ballet dancer & physical trainer.

The most common injuries are to the foot, ankle, knee & lower back, most often occurring when dance enthusiasts are fatigued (read: too much dance, not enough recovery) or have recently changed their workout parameters (type of exercise, frequency or intensity).

The most common types of strain injuries:

Though dance is considered a safe & effective modality of fitness, some types of dance can put you at higher risk for injuries, such as ballet, are more injury-prone than other forms of dance. Ballet, in particular, has a very high incidence of injury because of the extreme stresses and demands it places on the body. However, any type of dance that involves repetitive impact also puts dance goers at higher risk for injury, particularly for dance participants who are not well prepared for the repetitive movements & positions.

Tips to Avoid dance-related injuries:

Don’t let the potential for injury deter your dance fitness enjoyment – all forms of physical activity present some level of risk. Simply be smart about your dance workouts. Here’s how.

#1: Don’t be Extreme

In order to avoid dance-related injuries and safely & effectively partake in dance fitness it is essential to gradually increase frequency, intensity  the duration of your exercise.

#2: Take the time to Warm up

Stretch gently & always warm up with a few minutes of light exercise before a dance class allowing your muscles to loosen & warm-up & you will be better prepared for a dance-fitness workout.

  1. Cardiovascular Exercise: The first part of every warmup routine should be cardiovascular exercise to get blood flowing to your muscles. Start your warmup routine with five to 15 minutes of cardiovascular exercise such as jogging, marching in place or skipping. Do this aerobic activity until you feel your pulse increasing and you start to break a sweat. Do not include in your warmup routine any aerobic motions that require extensive flexibility, such as kicks or high knee lifts.
  2. Dynamic Stretching: Once blood is flowing to your muscles, engage in dynamdynamicstretchic or active stretching. In this type of stretching, common motions used in dance should be performed to ready your muscles for action. Straight-leg swings, high knee lifts, torso twists & arm circles are all dynamic stretching motions you may include in this portion of your warmup routine. A dynamic stretching routine must include stretches for all major muscle groups from head to toe. Execute eight to 10 repetitions of each motion in a fluid, dynamic fashion. Start with a smaller range of motion — for example, a low kick forward and swinging back — increasing your range with each repetition.
  3. Static Stretching: Because of the high degree of flexibility required in dancing, it is important to incorporate some static stretching into your warmup routine as well. Static stretches are those that are held in a stationary position. For example, include leg stretching at the ballet bar, lifting one leg up onto the bar and leaning forward, aiming your nose for your knee. Include many static stretches for your legs and also a few for your upper body and arms. Hold these static stretch positions for 30 seconds. Repeat each static stretch three times.
  4. Increasing Flexibility: Stretches to increase flexibility should not be part of your warmup routine. Flexibility gains are better made at the end of your practice when your muscles are supple & thoroughly warmed up from your workout. Static stretches alone or with a partner are the best way for you to increase your flexibility. Stretch your muscle until you feel a gentle stretch & then hold that position. When aiming to increase flexibility, do not bounce or stretch to the point where you feel pain.

#3: Cool down Properly

  1. It is extremely important to allow time for a proper cool down & more intensive stretching after class.
  2. This will prevent lactic acid build-up & any unnecessary injuries that might occur if you simply walk out of the class & head on with the rest of your day.

#4: Focus on Proper technique

  1. Watch your dance instructor to learn proper dance technique as well as ask questions about moves you are unsure about.
  2. Proper technique is a key ingredient in the prevention of dance-related injuries. Turning your body the wrong direction or holding a position incorrectly can instantly lead to injuries.
  3. Also, listen to your body – if something doesn’t feel right, don’t do it.

#5: Footwear counts

Before you do a dance-fitness class, ask the dance instructor for recommendations on the best footwear for that particular type of dance. You might be able to get away with your regular running shoes for a class here & there, but if you plan on partaking frequently, you can prevent unwarranted injuries by investing in appropriate shoes.

#6: Crosstrain

  1. No doubt you get a full-body workout in most dance fitness classes, but doing only one type of workout puts you at risk for injury.
  2. Many injuries can be prevented with improved posture, flexibility & strength. That means instead of only doing dance classes every week, get in a couple days of strength training, a Pilates class & another type of cardiovascular workout. Not only will you reduce your risk of injury, you will also get more fit and avoid single-workout burn out.

You’re hurt, now what?

If you do happen to get a dance-related injury, you can put yourself on a fast road to recovery by refraining from dance classes – and other workouts that exacerbate the injury – and following the PRICE approach. Remember the acronym PRICE – protect the tissues, rest, ice, compress, and elevate an injury. And for persistent problems, see a physical therapist for specific recommendations & exercises.

Also Check out out Post Dance to Fitness-Part 1

Trigger Finger: What you can DO

Trigger finger, often experienced by the elderly or by people diagnosed with conditions like rheumatoid arthritis, causes the fingers to pop or get stuck when you try to extend them. Diagnosis is often made by a physical examination & manipulation of the finger by your doctor. Exercises & physical therapy treatments for a trigger finger are suggested before more serious treatment options such as surgery are recommended. 


Trigger finger is a bone & joint condition caused by a contraction of the flexor tendons lining the inside of the finger. The flexor tendons are secured to the ligaments and bones of your fingers with sheaths. If your finger flexor tendons become thickened or develop small nodules due to age, wear or tear, you’re often unable to extend a finger or a thumb. This causes your finger to bend into a fixed position as you try to extend, much the way you’d hold your finger to pull a trigger, hence its name.

As with all disorders of the upper extremity, proximal segments must be screened.  Also, because posture can contribute to distal problems, it should be addressed to provide the patient with optimal outcomes. It is important to commence Physiotherapy soon after diagnosis to prevent the condition from getting worse & to get back to your normal level of functioning.

Physiotherapy treatment will help to reduce swelling, relieve pain and stiffness & regain functional movement of the finger. Physiotherapy treatment may include:

  • Ultrasound: Reduce swelling & accelerate healing
  • Soft tissue massage
  • Joint mobilisation
  • Passive stretching
  • Supervised hand & finger exercise program to regain strength, dexterity & flexibility
  • Splinting or Taping

Patient Education

Since trigger finger is observed as an overuse injury, education is very important. Education should be given on:

  • Rest
  • Modifications of activities
  • Specialized tools
  • Splinting
  • Modalities
  • Posture

Modalities such as heat/ice, ultrasound, electric stimulation, massage, stretching, & joint motion (active & passive) can have some positive effects on trigger finger. Following heat with stretching can provide more extensibility with plastic deformation. Joint movement & mobilizations increase joint & soft tissue mobility via a slow, passive therapeutic traction & translational gliding.


Tendon Exercises

  • Perform a series of tendon gliding exercises.
  • Start with your fingers extended outward and your thumb pointing away from and perpendicular to the palm. Flex your fingers toward your thumb, as if you’re making the shape of a duck’s beak. Your finger and thumb should be approximately 1/2 inch apart. From this position, curl your fingers into your palm, placing your thumb along the outside of the index finger. Curl your fingers more and make a fist; this time, curl your thumb over the outside of your knuckles.
  • Slowly open your hand and lift the fingers, knuckles bent, into a upright position, your thumb again extended away from your palm. Repeat the sequence several times.

Soft Tissue Mobilization

  • Massage or soft tissue mobilization may help reduce the severity of your trigger finger or thumb constriction.
  • Massage manipulates muscle, tendon & ligament tissues & floods the affected area with blood & nutrients.
  • Massage also helps relax tightened muscles, which may facilitate other trigger finger exercises for greater efficacy and benefits.
  • One method of massaging a sore trigger finger is friction massage, which a physical therapist can do or you can do yourself. Stroke the affected finger in a downward motion toward the palm or upward toward the tip of the finger. This may help relieve pain and stiffness caused by nodules & lengthen the finger muscles and tendons.

Palm Presses

  • Hand & finger exercises that contract & extend the muscles & tendons of the fingers may provide relief & greater range of motion of the finger & thumb.
  • Pick up small items & place them in your palm, squeezing tightly for several seconds. Release, opening your fingers wide, & then repeat as instructed by your physical therapist.
  • Regular exercise and movement may help lengthen the flexor tendons, relieving symptoms of trigger finger.
  • Avoid activities which involve a sustained grip. Hold off on the use of grip strengthening devices or exercises involving repetitive squeezing – these put stress on the irritated tendon.

If fingers bend & lock during the night and are painful to straighten in the morning, it may be helpful to wear a splint to keep them straight while sleeping.

A first step in treatment is to stop doing activities that aggravate the condition. Splinting is one of the best ways to limit motion. There are various ways to splint a patient but, ultimately, it will depend on what provides the patient with the most relief. Splints are usually worn for 6-10 weeks. It should be noted that splinting yields lower success rates in patients with severe triggering or longstanding duration of symptoms.Two major types of splinting most recently studied:

  • Splinting at the DIP joint.  This showed to have resolution in 50% of the patient’s symptoms.
  • Splinting at the MCP joint with 15 degrees of flexion.  This showed to have resolution of the patient’s symptoms at both 65% and 92.9%, which is consistent with current literature.




Taping Technique (Click for video on Taping)

DISCLAIMER: Please consult your medical professional before beginning exercises.