Preparing for a total hip replacement (THR) involves more than just scheduling the operation. A regimen of exercises performed before surgery, often called pre-habilitation or prehab, proactively improves surgical outcomes. This preparation focuses on fortifying the muscles that support the hip joint. By engaging in targeted, low-impact movements, individuals enter surgery in a stronger physical state, which positively influences the speed and ease of recovery.
The Goal of Pre-Surgical Conditioning
Pre-surgical conditioning aims to maximize physical function before the body experiences the trauma of an operation. Even with the best surgical technique, a hip replacement temporarily causes muscle disruption and subsequent weakness. Strengthening the surrounding muscles beforehand creates a functional reserve that minimizes the extent of muscle atrophy following the procedure.
This proactive approach improves the pace of physical therapy after the operation. Patients who are stronger going into surgery often demonstrate better functional performance, such as walking speed and sit-to-stand ability. The goal is to elevate current function, making the transition to post-operative recovery smoother and potentially reducing the length of a hospital stay.
Low-Impact Strengthening Movements
The most effective pre-surgical exercises are those that build strength in the glutes, quadriceps, and core without putting excessive strain on the already compromised joint. These movements are typically performed while lying down, which reduces weight-bearing stress.
Quad Sets (Thigh Squeezes)
To perform a quad set, lie on your back with your legs extended straight. Tighten the muscle on the top of your thigh, pushing the back of your knee down into the bed or floor. Hold this static contraction for about five seconds before releasing the tension. This exercise isolates the quadriceps muscles, crucial for extending the knee and supporting the leg during walking.
Gluteal Sets (Buttocks Squeezes)
Gluteal sets are performed by lying down and squeezing the buttock muscles together as tightly as possible. Contract the gluteus maximus, a powerful hip extensor, without moving the pelvis or arching the back. Hold the squeeze for five seconds, then relax, focusing on a slow and controlled release. Strengthening the glutes provides a stable base of support for the hip joint.
Heel Slides
Heel slides are a foundational exercise that strengthens the muscles while gently introducing movement into the hip and knee. While lying on your back, slowly bend the hip and knee by sliding the heel along the surface toward the buttocks. Slide the heel back to the starting position in a controlled manner, keeping the kneecap pointed toward the ceiling to ensure proper alignment. A plastic bag or towel can be placed under the heel to reduce friction.
Chair Push-Ups
Chair push-ups are an upper body and core exercise that indirectly supports hip recovery. Sit on a sturdy chair with armrests and place your hands firmly on them. Push down to straighten your elbows, lifting your buttocks a few inches off the seat. This movement strengthens the arms and shoulders, which will be necessary for safely using a walker or crutches after surgery.
Improving Hip Mobility and Balance
Maintaining a safe range of motion and improving stability before surgery are important for reducing the risk of falls and simplifying post-operative tasks. These exercises focus on controlled movement and balance control rather than pure strength.
Ankle Pumps
Ankle pumps are a simple but effective movement that can be done while sitting or lying down. Briskly point the foot and toes down, and then pull them up toward the head. This action improves circulation in the lower legs, which is important for preventing blood clots, and also helps to lubricate the ankle and foot joints.
Gentle Standing Marches
While holding onto a stable surface, such as a counter or the back of a sturdy chair, gently lift one knee toward the chest, as if marching in place. Do not lift the knee higher than what is comfortable or what causes pain in the hip. This exercise practices the necessary movement pattern for walking and helps to improve single-leg balance and coordination.
Simple Weight Shifts
With both hands resting lightly on a stable surface for support, shift your body weight slowly and deliberately onto one foot, then back to the center, and then onto the other foot. The goal is to feel the weight transfer and engage the hip abductor muscles, which are important for stabilizing the pelvis during walking. This movement should be performed slowly and within a small, comfortable range to avoid stressing the joint.
Critical Safety Precautions
Before beginning any exercise program, consult with your orthopedic surgeon or physical therapist. Medical professionals provide personalized instructions, ensuring the exercises are appropriate for your specific condition and surgical approach. They will also advise on the number of repetitions and frequency safe to perform each day.
Stop any activity immediately if it causes sharp, stabbing pain or significantly increases swelling in the hip joint. While mild discomfort is sometimes expected during exercise, pain that lingers or intensifies is a sign that the joint is being stressed too much. Movements to strictly avoid include deep squats, crossing the legs, and any high-impact activities like running or jumping, as these can aggravate the joint and potentially worsen symptoms.