RELAXED AWARENESS – SIMPLICITY WITHOUT EFFORT. Sam Harris.
It reminds me of that song: Sitting on the dock of the bay by Otis Redding:
Imagine yourself sitting quite relaxed, somewhere quiet, subtlety aware of what is going on but without mental effort. Otis Redding could be singing about a state of mindfulness. It takes repetition and practice to be good at relaxed awareness. It’s not so easy to pause – every little JUNK thought starts suddenly flying through your brain. But I think if we could all waste a bit of time and pause during the day, to take it in, just like Otis sings about, our breath would slow, our muscles would release a notch and our day would get just a little better.
Have you got a song that takes you into a similar state or zone?
This relaxed state is a great way to produce “Happy Hormones” SERATONIN and ENDORPHIN. Let these flood your brain and surge around your entire body. This can suppress the emotional response to pain and is like opening your own drug cabinet to aid your body’s natural healing. So, waste a little time, breathe, and enjoy the moment!
“I’m sittin’ on the dock of the bay Watchin’ the tide roll away, ooh I’m just sittin’ on the dock of the bay Wastin’ time
Protein is used in the body for muscle building, growth and structure. It aids the synthesis of hormones and enzymes while also improving metabolic processes. Protein is involved in fluid balance and acid-base regulation. Protein contributes to satiety or that feeling of fullness. Importantly for surgery, antibodies are made of protein and protein provides energy and supports your immune function.
What is Protein?
One of three Macronutrients in your diet is Protein, the others being Carbohydrate and Fat. Protein is made up of building blocks called amino blocks. There are 20 amino acids, 8 being essential amino acids with the others being non-essential, meaning you cannot produce them from other substrates so therefore you need food to supply them.
Animal sources are complete proteins (contain all essential amino acids) and are found in meat, fish, chicken, eggs and dairy products.
Plant proteins have a more incomplete protein and therefore have limited amounts of one essential amino acid. Protein is found in legumes (beans), grains, nuts, seeds, vegetables, soy beans and quinoa.
Note: Combine sources of plant protein across your diet to ensure all essential amino acids are in your diet.
Sugar: reduce daily intake of free sugars to less than 10% of total energy intake, 5% (25g or 6tsp) for further benefit
Fibre: 25g for females, 30g for males
Protein: 15-25% total energy intake
Fat: 20-35% total energy intake.
Sources of Food
Grams of Protein
Yellow cheese (40g)
100g lean beef/chicken
250ml Full Fat milk
100 g Tofu
Almonds ¼ cup
Broccoli 1 cup
Kidney beans 1 cup
Bread 2 slices
Pre – Op Nutrition Guidelines
Your pre-surgery diet should include as many nutrients as possible before surgery. Here are some tips:
Eat enough protein. At least 1 – 2 weeks before surgery, make sure to eat enough protein every day. Protein needs are based on the amount of muscle that you have, but research has shown that 65 – 100 grams per day are proving to be optimal. Protein provides building blocks for our muscles, bones, and our immune system. You want to be as strong as possible going into surgery.
Stock up on fruit and vegetables. Include fruit and vegetables at most meals and snacks. More specifically, greens. Greens are great for your skin and repair muscles, bones, and cartilage because they contain loads of vitamins and minerals including vitamins C, K and magnesium.
Include whole grains. Be sure to include good sources of whole grains to give your body all the B vitamins it needs to combat stress.
Eat less of these. Consider reducing or eliminating additional sugars, caffeine, and alcohol from your diet. These create more stress on the body and actually remove nutrients from the body to metabolize properly.
Post-op nutrition guidelines
Great post-op nutrition makes it possible for a speedier recovery and help you return to doing the things you love as soon as possible. Maintaining a proper post-op diet is essential. Some people lose their appetite after surgery and while taking pain medications. However, surgery increases the body’s need for calories, and you need more calories to heal.
Eat smaller meals more often if your appetite has decreased.
Include fibre. Add fibre at each meal and snack from fruits, vegetables, cooked beans, and whole grains. Fibre helps maintain normal bowel movements.
Eat enough protein. Have protein at each meal for your muscles and bones. It is found in meat, fish, eggs, poultry, nuts, dairy products, soy products, and cooked dried beans.
Calcium is an important component of bone. Drink milk or calcium-fortified juices and eat yoghurt or cheese. Your doctor may recommend a calcium pill and vitamin D if you don’t get enough from your food.
Vitamin C helps the body heal wounds and form bone. Get vitamin C from citrus fruits, green and red peppers, collard greens, broccoli, spinach, strawberries, tomatoes, and potatoes.
Remember to drink plenty of water. To avoid constipation, drink at least six to eight cups of fluid a day.
By Carol Armitage Surgerycoach.com. PreKure certified health coach and physiotherapist.
Article shout out to the PreKure Team preKure.com Dr Caryn Zinn
However you do it, road, mountain, ebike, stationary or spin class – Cycle away your OA!
Pain and loss of function are the main symptoms that people to seek treatment for their Osteoarthritis (OA), which is usually medication and surgical approaches.
If you have mild to moderate hip osteoarthritis, self-managing your symptoms in the early stage of the disease process may have a substantial long-term benefit.
The eventual treatment for end-stage hip osteoarthritis is joint replacement surgery, which is a highly successful operation in terms of clinical outcomes and cost-effectiveness. However, surgery still presents major risks and complications such as dislocation, blood clots and infection. While hip prosthetics continue to improve, wear is unavoidable, and so for patients undergoing surgery at a young age, a revision procedure will also likely be required.
The Cycling against Hip Pain (CHAIN) UK programme for people with hip osteoarthritis encourages self-management of symptoms, to reduce pain, and to improve functional ability through a 6-week, 60-minute programme of education and static cycling sessions at their local leisure centre once a week.
The education topics included: A thirty-minute education session, delivered by a physiotherapist on the benefits of exercise for osteoarthritis, diet and nutrition, pain relief, pacing of activities and lifestyle change and weight loss where appropriate is appropriate.
The exercise component: A thirty-minute indoor cycling session, led by an exercise instructor, were progressive and supplemented with home exercises, (aerobic and local muscle strengthening).
Published results of the initial programme showed statistically and clinically significant improvements in patient-reported outcome measures, hip function, pain on weight bearing and improvements in sit-to-stand and timed up and go tests after the programme was completed.
Many participants, including those with complex other conditions, also reported psychological benefits, including increased confidence in managing their own hip pain and an increase in motivation to exercise.
So, what about 5 years later?
A study published this year, 2020, explores whether participants continued to self-manage their hip osteoarthritis five years after completing the course.
Eighty-three (87%) participants responded to a survey, five years (range 4–6) after completion of a six-week cycling and education programme, 37 (45%) participants had not returned to their general practitioner for further treatment of their hip pain, and 47 (57%) had not pursued surgical intervention. All participants were still engaged in at least one physical activity per week and many reported that they had purchased a bike (29%), joined a gym (30%) or cycled regularly (indoor cycling 25%, outdoor cycling 24%). Eighty (96%) participants reported an increase in knowledge of self-managing their symptoms.
The findings from this study suggest that many patients are motivated to self-manage their hip osteoarthritis, five years following a six-week cycling and education treatment pathway that encourages lifestyle change.
By Carol Armitage, Pre Kure certified health coach and physiotherapist
Cheers to Franco Celligoi pictured, self-named Elderdude, who has successfully cycled his way through 2 TKJR’s.
Keywords: hip; osteoarthritis; physical therapy; total hip replacement (THR); exercise; cycling
Article Self-Management of Hip Osteoarthritis Five Years After a Cycling and Education Treatment Pathway
Thomas W Wainwright 1,2,*, Louise C Burgess 1, Tikki Immins 1 and Robert G Middleton 1,2 1 Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8EB, UK; firstname.lastname@example.org (L.C.B.); email@example.com (T.I.); firstname.lastname@example.org (R.G.M.) 2 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth BH7 7DW, UK * Correspondence: email@example.com; Tel.: +441202 91656 Received: 24 January 2020; Accepted: 11 February 2020; Published: 12 February 2020.
A GOOD KNEE HAS TO BE STRAIGHT, STRONG WITH A GOOD KNEE BEND.
1. A STRAIGHT KNEE:
Osteoarthritic knees are often stiff and may lose their ability to straighten as the person holds them slightly bent when their knee hurts, to reduce the stress on the knee. If the knee stays bent for too long, the bend becomes permanent and the knee is stiff. Sometimes the surgeon can correct this, but you need to do more work the get the knee completely straight after the operation.
2. A STRONG KNEE:
The big muscle (quadriceps) on the front of your thigh keeps the knee stable when you take weight through your leg. It pushes you up stairs and out of a chair and allows you to sit down in a controlled fashion, without using your arms for support. You need this muscle to be strong, to straighten your knee under load right through the full range of movement. This provides good knee control in walking.
3. A GOOD BEND:
The knee is designed to bend at least 120 degrees and it is useful to have a good range of bending movement. Knees bend to 70 degrees in normal walking and 110 degrees is necessary to go up and down stairs normally. While you can manage with less knee bend, it is convenient.
PREP (PRE OP SURGERY PREPARATION)
NB: Surgerycoach.net will support you all the way, that’s what we do.
Get prepared and get your home sorted prior to surgery.
Hire, beg, or borrow an exercycle so it’s ready to go when you get home –start using it now. Ensure you have a solid chair with arms you can get out of and sit down into.
Clean up your diet. Reduce carbohydrate and sugar intake to lower the inflammatory markers in your blood which can assist with reducing pain. Reduce your weight. Arthritis NZ guest speaker Prof David Hunter, a leading researcher in OA states that losing 10% of your body weight can lead to a 50% reduction in pain.
Get fit. Ask surgerycoach.net what you can do at this stage. Practise knee exercises 2x per day on most days with both of your legs.
Identify the landmarks of your knee as you exercise your muscles, this will make it much easier to do what’s required when you get home.
Practise mindful practise and relaxation techniques to aid recovery such as deep breathing and meditation. Get your sleep sorted so that you can wake refreshed and recovered.
EXERCISE FOR A STRAIGHT KNEE
STRETCH THE KNEE STRAIGHT
Sit or lie with your leg out in front of you. Put the heel up on a block or pillow so that the knee hangs in mid air. Let the knee stretch for a short time, building up to 5 minutes, less if it is too painful.
This stretches the tight structures behind the knee which are stopping it going completely straight.
STATIC QUADRICEPS EXERCISE
This exercise can be done right after your operation and it really is good if you can practise it before surgery.
With the knee as straight as you can, tense up the muscles in the front of your thigh and try to lift off your heel. Hold for a few seconds and then relax Up to 10 x, 2x per day.
INNER RANGE QUADS
Sit with the knee bent over a towel, high enough to be able to lift the keep off the ground.
Push you knee into the towel and raise the heel as high as you can.
Hold 5 seconds then relax and repeat
10x, 2x per day.
STRAIGHT LEG RAISE
Sit with your leg out straight. Tighten the thigh muscles (quadriceps), straighten the knee and lift the whole leg up off the surface you are on. Hold for 5 seconds and then lower slowly.
10x, 2x per day.
EXERCISE FOR A GOOD KNEE BEND
KNEE BENDS ASSISTED
Keep the heel down and slide the foot forward towards you, bending the knee.
10x, 2x per day.
KNEE BENDS IN SITTING
Sit in a chair with your foot on the ground. Slide the foot firmly towards you and then release. Hold for 5 seconds in the fully bend position. Do not allow your hips to move, just the foot. Release and repeat 10x, 2x per day.
You can use a board or plastic bag for this exercise to assist in moving.
Once you are discharged from hospital it is expected and encouraged that you will build up to practise walking for 10 minutes, 2x per day. Initially for up to 2 weeks this will be with 2 crutches. At Day 14 you will go to 1 crutch. At Day 28 days you will go without crutches.
How can you prepare for walking with your new knee?
If it is not too painful or unstable, start by timing your walking on a flat surface such as around your garden or driveway, perhaps the hallway?
Is it possible to walk with walking poles, a walking stick or use the pool for walking?
If it is too painful or unstable, you may find you can use an exercycle instead. This will be very useful from 28 Days when it is encouraged to commence using an exercycle. So getting prepared by hiring, borrowing or purchasing one now, to be ready to go. *
If you are unable to manage an exercycle, can you practise stepping with alternate legs forward and backwards 10x, like marching on the spot, holding onto the back of a chair, or Tai chi movements that involve stepping?
REHAB – EXERCISE REGIME ONCE DISCHARGED – TWICE DAILY.
Walk 10 minutes
10 x small knee bends
10 x up-on-toes
20 x knee bend in sitting
20 x leg lift Straight leg Raise
EXERCYCLE from Week 4
SWIMMING from Week 6
DRIVING – Check with Surgeon
DAY 14 1x Crutch in opposite hand
DAY 28 No Crutches
GAS up: Good leg – Affected leg – Stick SAG down: Stick – Affected leg – Good leg
We are upright, bipedal, locomotor systems as my anatomy professor said way back in my very first lecture. He also reinforced that we are designed to move and do not perform well when stationary.
When you have an upcoming surgery, it is good to check your walking ability and balance. It would be unrealistic to imagine after a new joint replacement or similar surgery that you will be off racing about like a two-year-old. In fact, you will most likely experience stiff and unused muscles and pain in other places such as ligaments and other joints. The wait for surgery can cause a loss of muscle mass and an overall reduction in fitness. This is a journey and while the main reason to have a joint replacement is for pain, I am sure you want to get going quickly and enjoy activities with friends and family.
At surgerycaoch.net the team recommends ways to help you to prepare your whole body for your new joint.
Let’s firstly check your walking ability.
Stand upright and as you step forwards, try not to sway your torso from side to side. If you feel you are doing this, usually is it pain and weakness that makes offload away from the side of pain. Check in the mirror or window as you walk towards it. You can work on that prior to surgery with exercises to strengthen and stabilise your body, even lying down.
Try to be balanced with stepping. This includes all directions front, sideways and backwards. If you feel unsteady, sometimes this is simply age-related change but often there is a loss of feedback from your joints and muscles (proprioception). This is because the joints are worn, and the muscles are compensating as best they can. You can practice stepping in all directions prior to your surgery to gain balance and control with changing direction. If this is difficult to understand, I can help.
Arm swing even slightly while walking, encourages a natural rotation of your whole body. Sometimes when you are in pain you may find you walk with your arms close to your body, as perhaps it feels safer and more secure. What ends up happening is you tend to flex forward, lean over and lose more balance.
Walking poles that trampers and walkers use give your body a natural swing and rotation through your trunk and torso which is naturally balancing for your body and can spread the weight-bearing across all four limbs. Using walking poles is highly recommended if you want to keep active prior to surgery.
Preparing for using crutches.
If you are to have joint replacement surgery on your lower limb the chances are you will go home with crutches or similar. Crutches allow you to get up on your feet from day one post surgery. While you may use a frame with nurses and a physio present on the first day, getting upright is great for circulation, stopping you getting stiff, preventing pressure areas and of course your mental well-being.
If you haven’t used crutches before your operation, the physio’s at your hospital will teach you so don’t worry.
The right height of crutches is important:
When measuring the crutch handle height, place your arms relaxed by your sides, standing upright. Have another person measure two fingers above your wrist bone for the height of the crutch handle, this will be perfect. You want your shoulders to be relaxed and arms slightly bent.
Crutches need to have good stoppers on the base to avoid slipping on surfaces.
There are four levels of weight bearing your Surgeon will instruct you to do. This is based on the type and extent of your surgery. Check with your surgeon.
Full weight bearing (FWB) is when you can fully load your new joint.
Partial weight bearing (PWB) is defined as some weight bearing can go through your leg. Most literature defines this as 30% to 50% of a patient’s body weight.
Touch weight bearing (TWB) means the foot or toes may touch the floor (such as to maintain balance), but no weight is taken by the affected limb. Imagine having a potato crisp underfoot that one is not to crush.
Non weight bearing (NWB) means that no weight can be placed on the operated leg. This is the most restrictive of all weight-bearing limitations. Since you are not able to bear any weight on the leg, an assistive device, such as a walker, frame or mobility scooter where you kneel on a scooter with the affected leg and zoom around on the good leg.
Here are 5 Tips to ensure you are safe and balanced with crutches:
Walk upright with your head up looking ahead, not at your feet. This will allow you to use your core muscles more effectively and allow your peripheral vision to scan for obstacles.
Start with placing the crutches forward first then your affected leg and follow with other leg.
I like to instruct with “Step up to the crutches (affected leg) then step through the crutches (good leg)”.
Heel toe action encourages a normal walking action which may take a while to get the hang of. You may find you are walking flat footed for a day or so.
Cadence or rhythm should be smooth and even after a few days of practice. Try counting as you stride out.
Two times per day after you are home from hospital it is advisable to have two, ten minute walking sessions where you focus on the above techniques.
Stairs and steps
Many people are daunted by stairs on the first few attempts, so it is always advisable to have someone with you, below you when going both up and down stairs or steps.
The easiest way to negotiate stairs with crutches or sticks is to use this each step.
GAS – Give it the Gas going up (Good leg, Affected leg, sticks or crutches).
SAG – Sag going down (Sticks or crutches, affected leg, Good leg).
With a frame you will need to use a ramp.
With a bilateral (both legs) operation, you must decide which is the strongest and make this your good leg. Check with your rehab physio before you leave hospital.
Down to one Crutch?
Every surgeon has a guide to when they like you to go to one crutch which is usually around 14 days post operatively. Please follow this guidance.
The main thing to remember is to keep the crutch on the OPPOSITE side to your new joint replacement i.e. Right knee replacement, keep the Left crutch, this will off load your body weight off your new joint by approximately 1/8 of your body weight.
The better prepared you are for your upcoming surgery – the quicker and easier you will come out the other side.
Manage your expectations around your mobility and train up beforehand – seek advice as this can be activity in the pool, on an exercycle, walking with walking poles or a stick.
Even on your bed or in a chair.
Seek professional advice com is here to assist you, you can even book a 15 minute meeting over the phone to chat.
Exercise with a buddy or to music and although you may be in pain, exercise is a great pain reliever, if done correctly.
Always seek medical advice from your Doctor and surgeon if you have any concerns about this article.
Breathing is something we rarely think about and yet the power of smooth, calculated breaths positively affects us both mentally and physically.
After surgery, from the minute you wake up you will be reminded by the medical staff looking after you to take deep breaths regularly (at least 4 deep breaths every hour) except when you are sleeping. This is usually for 48 hours and until you are moving around by yourself comfortably. WHY?
Deep breathing after surgery will deliver oxygen effectively right into your bloodstream to oxygenate your body. This is vital for tissue healing, assisting with pain relief and keeping your lungs clear of secretions.
Purposeful Deep Breathing
Breathing with purpose is also very helpful to calm you and clear your mind.
TIP: Elevate your arms to shoulder height on your IN breath to move your lower ribs out to the side and gain further chest expansion.
As a rehab physio in hospital, I like to instruct my patients to do four counts on the IN breath through your nose (1-2-3-4) and four counts on the OUT breath through your mouth (4-3-2-1). Repeat four times.
Breathe IN through your nose.
Your nasal passages have tiny hairs which filter your air and keep it moist. Often you will wake from surgery with nose prongs, little plastic tubes placed just inside your nostrils with plastic tubes going behind your head attached to the wall. This delivers a controlled flow of oxygen into your airways and may remind you to breathe in through your nose.
Breathe OUT through your mouth.
Letting your jaw relax will allow a sigh and this aids in getting the air out to allow for your next beautiful IN breath.
Chest clearing breathing or Active Cycle Breathing, (ACB)
This breathing technique helps clear mucus from the lungs in three phases. The first phase helps you relax your airways. The second phase helps you to get air behind mucus and clears mucus. The third phase helps force the mucus out of your lungs. It is called Active Cycle of Breathing and here is how you do it.
Breathing control is breathing gently, using as little effort as possible. Rest your hand on your rib case/upper abdomen. Feel your upper abdomen rising under your hand as you breathe in and falling as you breathe out. Try to breathe in through your nose and out through your mouth at a rate that feels comfortable. I suggest four of these breaths.
Deep breathing exercises
This helps loosen secretions. Take four long, slow, deep breaths IN through your nose if you can. Pause at the end of each breath for two to three seconds, then breathe OUT gently through your mouth, like a sigh. Try to keep your shoulders and chest relaxed.
A huff is a way of exhaling your breath forcefully out through your mouth, but without coughing. You only need to one or two short sharp exhale breaths. Try to avoid excessive coughing as this may reduce the effectiveness of removing phlegm.
Repeat this cycle, four times.
To Cough or not to Cough?
If you have had abdominal surgery or your surgical site is near to your torso it will hurt to have a big hearty cough. The best way to have a cough is to prepare yourself with four sets of Active Cycle Breathing (ACB), then cough one or two times at the end of this sequence.
TIP: Have a pillow already placed over your abdomen and press firmly with your forearms into the pillow to minimise the jarring from coughing. It helps a lot!
Everyday breathing Practice
The way to ensure you are breathing well after surgery is to practice it now.
Make it a regular part of your day up to four times a day.
Take four purposeful deep breaths, IN through your nose (1-2-3-4), and breathe OUT through your mouth (4-3-2-1), four times.
If you feel unwell or have a cough, practice the Active Cycle Breathing technique with a hearty cough at the end of the breathing cycle.
Check in with your doctor if you need more advice.