Issue link: https://www.massageandbodyworkdigital.com/i/81195
MYOFASCIAL TECHNIQUES 7 whatsoever after an anterior hip replacement.4 However, the most conservative recommendations say that for six months to one year after surgery, hip replacement patients should avoid: • Adduction, internal rotation, and hip flexion past 90 degrees for posterior hip replacements; • Abduction, external rotation, and hip extension for anterior replacements. Given these variables, the best practice for manual therapists is to inquire about any movements your client's surgeon or physical therapist has recommended he or she avoid during the recovery period. Many hip replacement patients continue to experience soft-tissue-based movement restrictions long after their surgeries have fully healed. For these older, healed hip replacements (approximately one year or more after surgery), these techniques can be a great help with longer-term recovery and maintenance of mobility. However, because we aren't trying to stretch or alter the artificial materials of the prosthesis itself, go easy on the end-range of any stretching applied to the replaced hip. Think about keeping the tissues around the joint long, easy, and mobile, rather than trying to deeply stretch the artificial joint itself. Finally, don't hesitate to adapt these techniques with senior or physically challenged clients. By being sensitive and staying in communication about their comfort, you'll often be surprised how comfortable and effective these releases are, even for those with limited active mobility. With practice, these techniques will become part of your technique toolbox, enabling you to assess and release many hip restrictions within the context of your regular work. Your clients of all ages and activity levels will appreciate this. 8 Notes 1. K. Horikawa et al., "Prevalence of Osteoarthritis, Osteoporotic Vertebral Fractures, and Spondylolisthese Among the Elderly in a Japanese Village," Journal of Orthopaedic Surgery 14, no. 1 (2006): 9–12. 2. M. Harris-Hayes et al., "Relationship Between the Hip and Low Back Pain in Athletes Who Participate in Rotation-Related Sports," Journal of Sport Rehabilitation 18, no. 1 (February 2009): 60–75. 3. Other types of hip mobility that correlate with less back pain are hip flexion, hip extension, and hamstring flexibility in men, and hip flexion and extension in women. G. Mellin, "Correlations of Hip Mobility with Degree of Back Pain and Lumber Spinal Mobility in Chronic Low-Back Pain Patients," Spine 13, no. 6 (1988): 668–70. 4. N.M. Jones, "Yoga After a Hip Replacement," accessed February 2012, www.expandinglight. org/free/yoga-teacher/articles/yoga-therapy/ yoga-after-a-hip-replacement.asp. X-ray of a total hip replacement (total hip arthroplasty). Public domain image from the National Institutes of Health. The "C" (internal rotation) variation of the Push Broom Technique. Image courtesy Advanced- Trainings.com. Til Luchau is a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. He is also a Certified Advanced Rolfer and has taught for the Rolf Institute of Structural Integration for 22 years. Contact him via info@ advanced-trainings.com and Advanced-Trainings.com's Facebook page. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 117