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So, Andy Murray, Britain’s most successful tennis player, an elite athlete, underwent a hip replacement at 29 years old. 
 
My 3x takeaways from his inspirational story:

1. A Remarkable daily Consistency
2. A Focus on evidence-based Recovery
3. A Choice between high Load + Timing of hip replacement 

After those lessons from elite sport (click link to read more), I was struck by another everyday, but no less inspirational, lesson from clinic a couple of weeks back…
 
 
The Check Up
 
A good check-up, every now and again, is key to moving more.
Be it self-service or a professional check up.
 
Thanks to one of my anonymous patients for this one. 
You know who you are. Here's the story...

 
A 74-year-old woman, 5 years post hip replacement.
 
She said…

• ‘I'm generally doing well, but
• ‘Some discomfort in my lower back
• ‘..which spreads to the outside of my right hip.
• ‘Came on lifting two 40L compost bags a few months ago.’

 
I checked…

• No groin pain (= hip joint)
• Pain & function score dipped in:
  • Spring 2021,
  • Spring 2022 +
  • Spring this year.

• Walking tolerance = 2 miles that morning with the dog. GREAT!

 

On Examination…

• Sciatic nerve stretch -ve.
• No muscle / sensory deficit.
• Tender gluteal muscle insertion greater trochanter.
• Lateral straight leg raise weaker. Single leg stance unsteady.
• Full flexion and rotation of the hip replacement, importantly, pain free. 

That builds a picture, but let's check..


X-ray film

Well-fixed components, with no signs of problems, and

Good joint space on the other side...

My Thoughts

Pain around the hip generally comes from the:

• Back
• Muscle
• Hip Joint

For this 74-year-old woman:

• Back => She likely has degenerative change (it's very common) BUT no trapped nerve.
• Muscle => There is likely age-related changes, inflammation or a small muscle tear
• Hip Joint => All is well. Phew..

 
My Suggestions

• Back => General strengthening through low impact activity. 

An indoor exercise bike provides a mix of movement for a stronger back. Particularly through those winter months where there's been a dip in pain and function.
 
MRI imaging / injection / surgery is NOT necessary in absence of  +ve sciatic signs (stretching that nerve).

• Muscle => Add in specific gluteal muscle strengthening.

• Hip Joint => Reassure. Stay active. Maintain good bodyweight. Next check 5 years.

And that’s it.
Like the service on a car..
That check-up can keep us all on the road. Be it...
 
Self-service
Checking in with how you’re doing + feeling.
Writing stuff down. Assessing the need to make changes.

OR

Professional
If you’re unsure about what’s going on.
Or need an objective physio or surgical opinion.
 
That clinic appointment inspired me to check in with myself.

Next week I’ll dive deeper.
I’ll outline the exact advice I gave..
The exact detail that I wrote down in my clinic letter.
The exact detail that your healthcare professional is welcome to copy + use.
 
1000s of my patients achieve statistically high gains in pain + function by following this advice.

Please feel free to recommend next week’s newsletter to your healthcare pro:  

• Practice nurse
• Physio or
• GP. 

Anyone is welcome to copy + paste this evidence-based advice into leaflets or future patient letters to help others.

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And catch up on past Newsletters at the same link.

Good luck and one more thing...