Hip Replacement Care

My relative is getting ready to come home from the hospital after a total hip replacement surgery. What do I need to know to set up my home and make them most comfortable during their recovery?

After a standard posterior approach total hip replacement, most surgeons instruct the patient (and all involved caregivers) in three major hip precautions. Familiarizing yourself with these three rules will allow you to promote a speedy and safe recovery for your family member:

1. Avoid hip flexion more than 90°- Lifting the leg out in front beyond 90° puts excessive stress on the posterior joint capsule of the hip as it attempts to heal. Exercises that require excessive hip flexion such as marching and straight leg kicks are not recommended after a total hip replacement surgery until the medical professional instructs the patient in the proper form.

2. Avoid hip adduction- If a line were drawn down the middle of your body from head to toe, the affected hip cannot cross over this midline. This rule is particularly difficult to abide by when rolling over in bed. Using a pillow between the patient’s knees can prevent them from crossing the midline.

3. Avoid internal rotation- Do not allow the patient to turn the toes on their affected leg inward. Again, placing a pillow between their feet can prevent the patient from being able to internally rotate their hip.

Depending on the surgeon, physical therapy can begin soon after the patient awakes from the surgery. Specific questions should be directed to the doctor or physical therapist directing the patient care. As the caregiver, remember you are an important part of the rehab team and helping to communicate with the medical professionals can best promote a safe and speedy recovery for your loved one.

-Rebecca L. Deal, MSPT

10 Steps to an Ergonomic Office

Where do you spend the majority of the time during your typical work day? If your answer is sitting in an office chair staring at a computer, it is time to evaluate your work station with regards to your health. Setting up a desk that minimizes prolonged postural stresses can prevent work-related episodes of low back pain. To set up your own ergonomically designed work station, follow these 10 simple steps:

Sitting Posture- When sitting in your chair, it is important to maintain three spinal curves: an inward curve in your low back, an outward curve in the mid-back, and another inward curve in the neck. Shoulder should remain relaxed but kept back in a retracted position. Your head should be kept level with the chin tucked in for the ideal desk posture.

Seat Settings- Adjust your office chair for optimal posture and comfort. For computer work slightly recline the back of the chair. Although some office chairs have lumbar settings, a separate lumbar support pillow is best. A small towel rolled and put in the small of your back works great to maintain the inward lumbar curve. When sitting against the back of the chair, there should be approximately two inches between the edge of the seat and the back of the knees.

Bending in the Chair- To bend over to reach an object out of a low drawer or pick up an object from the floor it is imperative to maintain the inward curve in your low back. Scoot to the edge of the seat and extend one leg out in front of you. Place one hand on the desk surface to assist with balance and bend from the hips. Using your hips as the hinge for this bending motion helps protect the low back.

Turning in the Chair- No Twisting!! When it is necessary to reach into the cabinet behind you or respond to a co-worker in the cubical next to you, it is important to avoid twisting motions that put excessive forces on the spine. Instead, move your body as a single unit in the direction you intend to go with the hips and feet pointed in the same direction.

Foot Rest- Optimal leg position is a 90° angle at the hips and knees. A 90° angle is best obtained using an appropriate height foot rest. Prevent “slouching” by sliding the office chair under the desk as far as possible while making sure to have adequate leg room.

Wrists over Keyboard- Chronic incorrect wrist positioning while typing can lead to the common office injury of carpal tunnel syndrome. To avoid carpal tunnel syndrome, use a wrist rest to position the wrists straight. Keep both of the elbows bent approximately 90° and supported by the desk surface. Adjusting the keyboard to maintain the straightened wrist position can help prevent the excessive wrist extension which leads to carpal tunnel injuries.

Monitor Position- The computer monitor should be angled to be level with the eyes in order to maintain proper head and neck posture. When attempting to type written material, use a document holder to position items at eye level.

Reaching across the Desk- Arrange the work area to eliminate tasks of repetitive reaching. Keep frequently used items close while storing rarely used supplies in a lower drawer. Repetitive lifting can irritate rotator cuff muscles and should be avoided without proper conditioning.

Talking on the Phone- When conducting business on the phone, do not support the receiver between your neck and shoulder. It is best to use a head-set or speaker-phone features to maintain proper neck alignment while talking on the phone for long business conversations.

Take Frequent Rest Breaks for Exercise- To take the strain off your back and prevent fatigue, change positions often. Alternate job tasks that require different postures when possible. The goal for all office workers is to take a break for one minute every hour to stretch and mobilize all the major joints of the body.

So if you’re up for the challenge of setting up your own ergonomically correct work station, print this list out, tape it to the bottom of your monitor and take the time to save your spine from the work-related aches and pains. For additional work station consultation advice or further questions, contact the physical therapy team at North Tahoe Physical Therapy.

-Rebecca L. Deal, MSPT