Why Walking Alone May Not Be Enough After a Total Hip Replacement
After a total hip replacement (THR), walking is one of the most important parts of recovery. Getting back on your feet helps restore independence, improves confidence and mobility, and gradually allows you to return to normal daily life.
However, walking alone does not necessarily provide enough stimulus to fully restore the strength and mobility lost before and after a hip replacement. This is something that becomes particularly relevant as the early recovery period passes. You may be walking further and managing more around the house, but that does not automatically mean that the muscles around your hip have returned to their previous strength.
Why is walking encouraged after a hip replacement?
Walking is encouraged very early following most hip replacements. Initially, the goal isn't to walk long distances. It is about safely getting moving again.
Over the following days and weeks, walking can help you:
Regain confidence putting weight through the operated leg.
Improve general mobility and independence.
Maintain cardiovascular fitness and general activity levels.
Gradually return to everyday activities.
As recovery progresses, walking distances will often naturally increase. Someone may progress from walking around the house with crutches to walking outside, visiting the shops and eventually completing longer recreational walks. These are all important milestones.
But walking further doesn't necessarily mean that your hip is getting proportionately stronger.
The muscles surrounding the hip have an important job. They generate movement, support the pelvis and help control the position of your hip, spine, knee and leg during everyday activities.
These muscles (Gluteals, Quads, Hamstrings and others) are particularly important with activities such as; getting out of a chair, walking uphill, getting up from the floor and returning to hobbies, exercise or sports. The strength requirements of these activities can be considerably greater than those required for straightforward walking on level ground. If these muscles are not strengthened, stress can be placed on other areas of the body such as the lower back or the soft tissues on the outside of the hip. This is why physiotherapists prescribe strengthening exercises following a hip replacement.
Remember what happened before your operation
It is important to consider the months or sometimes years leading up to surgery. Most people do not go into a hip replacement with a perfectly strong hip. Pain and stiffness from osteoarthritis can gradually change the way you move. You may walk less, avoid stairs, stop exercising or unconsciously put less weight through the painful leg. Over time, the muscles around the hip and leg can become weaker. Surgery then creates another period where activity and loading are temporarily reduced. Your rehabilitation therefore isn't simply about recovering from the operation. In many cases, you are also trying to rebuild strength that may have been declining for a considerable period before surgery.
"I'm walking every day. Isn't that strengthening my hip?"
To an extent, yes. Walking requires your muscles to work and, particularly during the early stages of rehabilitation, increasing your activity can provide a useful challenge. However, the body adapts to the demands placed upon it. Once walking a particular distance becomes relatively comfortable, repeatedly completing the same walk may provide progressively less of a strengthening stimulus. You may improve your endurance and become very good at walking that distance, without adequately challenging the muscles to become substantially stronger.
This is where progressive strengthening becomes important. A strengthening programme allows exercises to be gradually made more demanding as your ability improves. Depending upon your stage of recovery, this might eventually involve increasing resistance, repetitions, range of movement or the complexity of the exercise.
Walking develops your ability to walk. Strengthening develops your capacity to cope with greater physical demands.
Together, they can help you move beyond simply recovering from surgery and towards rebuilding the physical ability required for the life you want to return to. Your goal after a hip replacement shouldn't necessarily be just to walk further. It should be to develop a hip and leg that are mobile, strong and capable enough to confidently perform the activities that matter to you.
