by Thomas Kurz
Information on this Web page is for educational use only, and is not intended as medical advice.
Every attempt has been made for accuracy, but none is guaranteed. If you have any serious health concerns, you should always check with your health care practitioner before treating yourself or others.
Always consult a physician before beginning or changing any fitness program.
Recently a woman who is an accomplished martial artist asked me for advice on regaining her strength and flexibility after surgery she plans to have soon. The surgery is for double hip replacement. Her hips were destroyed by the methods of stretching and teaching how to kick that are common in the martial arts, such as those methods taught by Bill Wallace (both hips replaced) and Chuck Norris (one hip replaced). I gave her my thoughts and info on preparing for the surgery and on rehab. My advice applies to any kind of orthopedic surgery, not just to hip replacement. Here is what I wrote:
Most injuries, certainly the chronic ones as well as many of the sudden ones, are end results of muscular dysfunctions that through a chain of compensations culminate in the most vulnerable body part. So you need to realize that the damaged body part is at the end of a chain of compensations for a dysfunction elsewhere, sometimes quite far from the place of your symptoms. Examples: lower back pain due to poor head position; upper back or shoulder pain due to a foot injury; hip joint damage due to imbalance of thigh muscle activity.
Now that the damage to your joints is so severe as to require surgery, you need to realize something else: A surgeon is not going to correct the cause of your joints’ damage—but only fix the damage itself. So the surgeon will remove damaged cartilage, or remove bone spurs, or put in artificial joint surfaces, but will do nothing about the muscle imbalance that caused you to need the surgery. The surgeon also will do nothing about the secondary imbalances caused by the damage to your joints. (When your joints hurt you use your muscles differently than when your joints are normal, and if this lasts, the abnormal pattern of muscle use becomes so ingrained it may not go away on its own after the surgery.)
So to ensure regaining normal function after the surgery you must do three things:
1. Choose your surgeon well—find the best available specialist on the joints you need operated. A lot of things can go wrong in the operating room, so check references. Ask how well this surgeon’s patients function after the operation. Are they doing their sports? Did they need other operations later on (for example, after a knee replacement a hip joint replacement)? This is a bad sign.
2. Prepare for the surgery—the surgeon will tell you that you need a certain level of strength and mobility prior to the operation to increase your chances of a good outcome. But you need to do more. Prior to the surgery you need to find and fix muscular imbalances—those that caused your joints’ damage and those that resulted from your joints’ damage. If you don’t do it, the post-surgery rehabilitation will be an uphill struggle, and you might not regain normal function. The specialist who will work on correcting those imbalances will tell you when you are ready for the surgery. I recommend you seek the help of someone certified in Muscle Activation Techniques (MAT) and Active Release Techniques (ART) or at least one of those.
3. Do rehabilitation after the surgery with the same people who prepared you for the surgery. Some physical therapists are certified in MAT and ART, some even know applied kinesiology, but a sports chiropractor with either ART or MAT certification seems like the best choice. You can learn more about Active Release Techniques at activerelease.com and about Muscle Activation Techniques at muscleactivation.com.
I close with a list of questions a prospective patient should ask the surgeon:
1. What is the diagnosis, and can I recover my full strength and flexibility without an operation?
2. Do you have experience with this type of injury?
3. If not, do you know a surgeon who has such experience, and can you help request an emergency second opinion?
4. When should this be operated on?
5. How long before it is too late?
6. What should I do or shouldn’t do before the operation?
7. How long is the planned hospital stay after the operation?
Happy New Year!
You sometimes write things like, “I don’t know why people ask me these questions instead of talking to a doctor or physical therapist….” I think it’s because you understand the body’s relationship to martial arts and so many doctors, physical therapists, and so forth don’t. They may know how to get you up and walking or maybe playing golf after a knee or hip replacement, but not how to do the splits or throw head-high kicks.
Speaking of which, I came across your methods a little too late. I needed to replace my left hip (anterior approach) two years ago and am fighting to get my strength and range of motion back.
I’m close to and in some ways can exceed my best pre-surgery flexibility, and can throw one head-high kick at a time, maybe two, without putting my foot back down. I’m trying to get to the point where I can consistently throw three or four at a time without dropping my foot as I once could. Keeping my leg up or not dropping it during kicking combinations involving hook kicks are especially difficult for me.
You may have guessed that I typically use Bill Wallace’s kicking methods, but I’ve used your stretching methods for about a decade. I’ve read Stretching Scientifically a few times (and even bought extra copies for friends and students) and the Secrets of Stretching video.
I thought isometric stretches might redevelop my strength, and eighteen months after my surgery I gave them a try. I did the inner-thigh stretches from the horse stance and the hamstring stretches pushing down on the steps of a ladder.
They REALLY hurt my left hip. Not immediately, but in the days afterward, I felt hip pain for the first time since before the implant. I thought I was careful not to overdo it. In fact, my muscles felt fine and never hurt, my right hip joint felt fine, so I think the stretches placed too much stress on the prosthetic. The left hip also started to pop, painfully, when I would raise my leg for dynamic stretches. I quit isometric stretches and everything felt fine after a couple of weeks.
I hasten to add that I don’t blame you. Your materials don’t specifically address rehabbing from a joint replacement and I didn’t consult my physical therapist or surgeon before doing them.
I wonder…. What does the research say about isometric stretches after a hip replacement? Should I do them at all? Should I avoid or try any in particular? Any other advice for martial artists trying to regain flexibility and kicking skills after a hip replacement?
You haven’t read this post before your surgery, have you? How about consulting those physical therapists Kurz recommends? Better late than never!
“3. Do rehabilitation after the surgery with the same people who prepared you for the surgery. Some physical therapists are certified in MAT and ART, some even know applied kinesiology, but a sports chiropractor with either ART or MAT certification seems like the best choice. You can learn more about Active Release Techniques at activerelease.com and about Muscle Activation Techniques at muscleactivation.com.”