A Patient's Guide to Total Hip Replacement Exercise Pack

No matter what your age or health condition you can have the ability to build & maintain strength.

A strength exercise is any activity that makes your muscles work harder than usual. These activities involve using your body weight or working against a resistance.

Cardiovascular activity, sometimes called aerobic activity, increases breathing rate and makes the heart and muscles work harder.

You will need to be moving quick enough to raise your heart rate, breathe faster and feel warmer. This level of effort is called moderate intensity activity.

If you’re working at a moderate intensity you should still be able to talk but you won’t be able to sing the words to a song.

Seated Side-flexion
• Sitting on a chair with your feet apart, lean over to one side keeping your bottom on the chair.
• Hold for for a moment.
• Return to centre and turn to the other side.

Seated Thoracic rotation
 • Sitting on a chair with your feet apart, raise your arms to chest height.
• Keep your bottom on the chair and rotate from your lower back  to one side and hold for 5 - 10 seconds.
• Return to centre and turn to the other side.

Standing pelvic tilts
 • In standing place your fingers on the front of your hip bones and your thumb on the back of your hip bones.
• Slowly engage your core and raise the front hip bone towards you ribcage and lower you back hip bone.
• Repeat the opposite was to tilt the front of your hips down towards your feet.
• Make sure movement is slow and controlled.
NOTE: standing tall keeping your legs straight and engaging your bottom.

Heel Peel in Standing with Forward Lean
 • Stand holding onto a support.
• Lean forward slightly
• Peel your heel off the floor and lift the toe gently to engage the hip flexor muscle.
• Then slowly lower heel to floor.
 • Repeat slowly and with control.

Seated heel peel
 • Sit forwards in a chair with feet flat on the floor.
• Peel your heel off the floor and lift the toe engaging the hip flexor muscles.
• Then slowly lower heel to floor.
• Repeat slowly and with control

Isometric Hip Flexion in Supine
• Lying on your back with pillows supporting your thighs.
• Place your hands on the front pocket areas of your upper thighs.
• Very slowly and with control imagine that you are easing the pressure of the thighs from the pillow- you should not feel any muscle activation under your fingers
• Repeat slowly and with control.

Heel slides
• Lie on your back with a smooth surface under your affected leg.
• Engaging your tummy muscles slowly and with control slide your heel towards your bottom to flex your hip • Repeat slowly and with control.

Isometric Hip Abduction in Standing
• Stand behind a chair or table
• Place both hands onto the surface to support you
• Take your feet slightly wider than hip width
• Slow and with control –push your feet down and out into the ground
• You should feel an awareness in the ‘back pocket’ area of your gluteal muscles.
• Repeat slowly and with control.

Isometric Hip abduction in lying
• Lying on your back with pillows supporting your thighs.
• Place a belt around your lower thighs at a tension to allow your feet to be slightly wider than hip width apart.
• Place your hands on your upper thighs.
• Very slowly and with control take up the slack of the belt as though you are doing the side splits- you should not feel any muscle activation under your fingers.
• Let go slowly
• Repeat slowly and with control.

Bridge
• Lie on your back with your knees bent and bring your heels close to your bottom
• Gently tilt your pelvis back, push through your heels and lift your hips up.
• Keep the pelvis level
• Hold in the bridge position before you lower.
• Repeat slowly and with control.

Offset Bridge
• Lie on your back with your knees bent.
• Place your affected leg slightly closer to your bottom and the other more outstretched.
• Gently tilt your pelvis back, push through your heels and lift your hips up.
• Keep the pelvis level
• Hold in the bridge position before you lower.
• Repeat slowly and with control.

Glute Bridge with Alternate Heel Raise

• Lie on your back with your knees bent and your feet flat on the floor.
• Push through your heels, tighten your buttock muscles and lift your hips off the floor.
• Peel one heel off the floor, return to neutral and then peel the other heel off the floor – alternate as many times as you can
• Try and keep your hips levels throughout.
• Bring your hips back down and relax.
• Repeat slowly and with good control.

 Side stepping
 • Standing with your feet together lookingforwards, step one foot out to the side.
• Then slowly bring back to centre keeping weight on supported leg.
• Repeat slowly and with control
• Note: start with small side steps
• Repeat slowly and with control.

Isometric Slider into abduction
• Standing leaning slightly forwards onto a support or kitchen countertop
• Place a slider (or tea towel) under your unaffected leg.
• Keep a soft bend in the affected leg
 • Gently engage the lower tummy muscles and stick your bottom backwards keeping the hips and knees facing forwards
• Slowly and with control, slide the unaffected leg to the side- keeping the weight on the static leg
• With control bring the leg back to the midline
 • Repeat slowly and with control.

Isometric Slider into extension
 • Standing leaning slightly forwards onto a support or kitchen countertop
• Place a slider (or tea towel) under your unaffected leg.
• Keep a soft bend in the affected leg
• Gently engage the lower tummy muscles and stick your bottom backwards keeping the hips and knees facing forwards
• Slowly and with control, slide the unaffected leg to the back- keeping the weight on the static leg
• With control bring the leg back to the midline
• Repeat slowly and with control.

Sit to Stand
• Sit towards the edge of the seat.
• Bend your knees, and bring heels back slightly squeeze through your bottom to drive you up to standing. • Try and keep your knees aligned over your big toe as you stand up
• Slowly sit back down
• Repeat slowly and with control.

Offset Sit to Stand
• Sit in a chair
• Place your affected leg further back.
• Squeeze your bottom as you bend your knees in order to stand up.
• Try not to use any upper limb support
• This will bias your affected/operated leg when standing up.
• Repeat slowly and with control.

Air squat
• Stand tall with feet hip width apart.
• Squat down by sitting your bottom back and bending your knees.
• Return to the starting position.
• Repeat slowly and with control.

Offset squat
• Stand tall holding onto counter.
 • Step non operated leg back.
• Squat down with your feet offset bending at your knees.
• Return to stand.
• Repeat slowly and with control.
(Keep weight through the heel of the operated leg)

 Tapping step

 • Standing with your feet hip width apart
• Tap the step with one foot forward and back.
• Over time increase the weight you put through that leg on each step.
• Complete with alternate legs
• Repeat slowly and with control.    

  Step up
 • Stand in front of the step.
 • Using upper limb support as needed on the hand rail
• Step up onto the bottom step
• Continue to climb up further steps if you are able to.
• Repeat slowly and with control.

Lateral step up
• Stand side on next to the step
• Place one leg on the step and push down to step up sideways
• With control lower down back to the ground
• Repeat slowly and with control.

Eccentric step down
• Stand on the step
• Take one leg in front of you and lower the heel towards the floor by bending the opposite knee.
• Gently step down on to the floor with control.
NOTE:
Try to keep hip, knee and 2nd toe aligned.
Try to keep your pelvis level.
 Repeat slowly and with control.

Standing on Balance Pad
• Stand on the balance pad with your feet hip width apart
• When you feel stable, move your hands off the support.
• Try to maintain balance with control.
• To challenge your balance, close your eyes or turn your head from side to side to adjust your eye-line.

Standing on BOSU
• Stand on the centre of the BOSU with your feet hip width apart
• As you feel controlled move your hands off the support.
• Try and maintain balance with control.

Tandem stand
• Stand in tandem with one foot in front of the other.
• Imagine you are standing on a tight rope and keep your body upright
• Aim to increase balance to 30 seconds.
• Repeat with the other leg in front
 Note: To make this easier place feet slightly wider apart in a semi tandem stand

Single Leg Stand
• Stand on one leg
• Focus on a single fixed point and hold your balance.
• Note: Use your arms to help hold the balance or take support if needed.
• Repeat on both legs.

Alternate Heel Raises
 • Hold on to a solid object with your feet hip width apart
• Stand tall
• Peel the right heel from the ground and then lower
• Peel the left heel from the ground and then lower
• Repeat this alternating movement slowly and with control.

Double leg heel raise
• Stand in front of the counter top and hold gently to balance yourself.
• Lift both heels up for the count of 3s, hold for 3s at the top and then slowly lower yourself.
• Repeat slowly and with control.

Single Leg Heel raise
• Stand in front of the bar/chair and hold gently to balance yourself.
• Stand on to your operated leg. Lift heel up and then slowly lower yourself.
• Repeat slowly and with control.

Trans-Ab in Crook Lie
• Lie on your back with your knees bent and your feet flat on the floor.
• Place your hands on your lower tummy.
• Keep your breathing relaxed and steady throughout.
• Gently draw your lower ribs down towards your hips and engage your tummy muscles.
• Hold for 5 seconds and then relax.

Bent Knee Fall Outs
• Lie on your back with your knees bent and your feet flat on the floor.
• Place your hands on your lower tummy.
• Keep your breathing relaxed and steady throughout
• Gently draw your lower ribs down and engage your tummy muscles.
• With control allow one knee to slowly fall out to the side
• Keep the back and pelvis controlled throughout
• Control the movement as you bring the knee back up to the starting position

 Sitting on ball - circles
• Sit on the ball in optimal posture.
• Move ball in a circle using hips (as if spinning a hula hoop) and allow knees and ankles to participate in the movement.
• Rest. Reverse directions.

Pelvic Tilts
• Sitting tall gently tip hip bones forward to create a small arch in the lower back. Then tip hip bones back towards you to flatten your lower back.
• Repeat slowly and with control.

  Single Leg Marching on Ball
• Sit correctly on ball in optimal posture.
• Position arms out to side to assist balance.
• Lift one knee up. Put foot down. Repeat with other leg. Alternate sides.
• Do not allow trunk to bend when raising knee up.
• Ensure to complete all exercise ball exercises beside a wall or support for safety.

  Hip external rotation on forward lean
• Stand in a mini squat position with feet shoulder width apart
• Bend slightly forward at the hip
• Keeping hips level take your foot towards the other foot pivoting around your knee
• Then turn your foot outwards pivoting around your knee
• Repeat slowly and with control
• To progress you can place a looped theraband around your ankles for resistance.
• Repeat slowly and with control.

   Hip Rotation
• Place your knee gently onto a chair
• Lean slightly forwards
• Keeping your hip and knee in the same position, sweep your foot/lower leg across the chair pivoting around your knee.
• With control move your foot back to the starting position. • Repeat slowly and with control.