Quads strain after THR

[meg55]

I am a 56-year-old physiotherapist. Seven years ago I had a labral tear (hip) and OA developed secondary to this. By the time I got my THR, 10 days ago now, I had a fixed hip flexion deformity and my rectus femoris was consequently very shortened, despite my efforts to stretch it.
What I've discovered - through personal experience! - is that the usual post-THR regime of static quads plus Thomas stretches and gait-re-ed is a recipe for disaster in a relatively young, fit, motivated person, especially in the early days when significant analgaesia is on board. At 10 days I'm walking with one elbow crutch and have very little pain - EXCEPT for the grade 2 quads strain that developed one week post-op as a result of these exercises plus my attempts to regain a normal gait with full hip extension and push-off. My new hip joint gives me full extension - my rectus femoris hasn't stretched out enough yet. Especially damaging is hip and knee flexion in supine. I keep reinjuring myself trying this. When my rectus femoris contracts the tightness at the insertion with the knee flexed is agonising. The muscle goes into cramp with referred pain all the way to the ankle. I did not have this problem straight after the op. It only developed once I was back on my feet and progressing the exercises and strained the muscle. It's put my rehab back by ... I don't know how long yet. But it's very frustrating!

I hope someone can learn from my mistakes! These exercises and stretches are fine, but should be approached with moderation and caution in a young, fit patient.

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[violablue]

Have you tried release of the muscle through massage, rolling on a roller, or acupuncture "resetting" of length. Hopefully at 10 days you're not already experiencing full blown contracture.

[meg55]

Have you tried release of the muscle through massage, rolling on a roller, or acupuncture "resetting" of length. Hopefully at 10 days you're not already experiencing full blown contracture.

Thanks for your suggestions. I doubt this will be a long-standing problem but I'm not taking any chances. I'm a neuro PT and not a musculoskeletal expert but I'm going to my fabulous physio this morning and I'm sure she will do some of the things you've suggested. She worked wonders on me before the op.

[violablue]

Please keep us updated on your PT intervention.

And I should say, rolling on a roller is probably too aggressive at present. But you could try one of those tiger tails or The Stick, instead. That way you're not contorting your body to get down to the floor to roll.

Creep stretching as your hip allows.

[Brosnan]

Sir, try to apply ice pack pre and post stretching or prior to exercises over the point of strain which should ease the strain you are experiencing. With reduced pain, your rectus femoris should give more room for stretching and exercise. Cheers

I am a 56-year-old physiotherapist. Seven years ago I had a labral tear (hip) and OA developed secondary to this. By the time I got my THR, 10 days ago now, I had a fixed hip flexion deformity and my rectus femoris was consequently very shortened, despite my efforts to stretch it.
What I've discovered - through personal experience! - is that the usual post-THR regime of static quads plus Thomas stretches and gait-re-ed is a recipe for disaster in a relatively young, fit, motivated person, especially in the early days when significant analgaesia is on board. At 10 days I'm walking with one elbow crutch and have very little pain - EXCEPT for the grade 2 quads strain that developed one week post-op as a result of these exercises plus my attempts to regain a normal gait with full hip extension and push-off. My new hip joint gives me full extension - my rectus femoris hasn't stretched out enough yet. Especially damaging is hip and knee flexion in supine. I keep reinjuring myself trying this. When my rectus femoris contracts the tightness at the insertion with the knee flexed is agonising. The muscle goes into cramp with referred pain all the way to the ankle. I did not have this problem straight after the op. It only developed once I was back on my feet and progressing the exercises and strained the muscle. It's put my rehab back by ... I don't know how long yet. But it's very frustrating!

I hope someone can learn from my mistakes! These exercises and stretches are fine, but should be approached with moderation and caution in a young, fit patient.