Is It Safe to Do Mobility with A Joint Replacement?
15 min read.
This is a question that comes up often. Over the years I’ve met people who are either scared to do anything after a hip/knee/ankle/etc. replacement or see it as a new super joint that can do anything!
So, we thought it’d be super helpful to collect experiences from some of our SMMers in the group to help you if you are after surgery or on your way to one!
Massive thank you to Brendan, Marie, Emma and Toni for sharing.
Marie – Two Hip Replacements, Pins in Hand, Knee Fracture, Ankle Surgery
I’m so glad you are doing a hip special, the misinformation around recovery post hip surgery amazes me. Having had the 2x replacements in my 40’s I was really struggling to find a way back to full mobility. I am happy to offer my story if it helps others get back on track.
I am 48 years old and have hypermobile joints and widespread early onset arthritis. Since my teens I was managing this with daily Pilates to build strength and mobility.
6 years ago, my femoral head died and collapsed. One year waiting for surgery on strong pain medication, I lost all my muscle and put on loads of weight. Over the next 4 years I had further surgeries; pins in my hand, micro fracture on my knee and clean out of my ankle. I was left with nerve damage and having to relearn how to walk with limited function in my ankle and toes. Then my other hip died and had to be replaced as-well. This all left me with a very odd combination of hyper mobility, weak and really tight muscles, constant back pain and prone to injury.
Over the last 2 years I have been focused on getting my fitness back. Clean eating has greatly reduced the inflammation in my body and really helped lose weight and manage my pain. I was doing daily Yoga, Pilates and foam roller, when I couldn’t manage to get onto the floor for my exercises, I used the couch or bed.
I try to be mobile through the day, fitting little bits of exercise in where I can, walking, using stairs, one leg balance, ankle pumps, neck rotations etc., every little bit helps. However regular setbacks from my loose joints has made progress really slow. I have been struggling to rebuild the strength and mobility I need to effectively control my joints.
I have been following Tom and Jenni, doing SMM and Stability Builder daily for just 6 weeks now. 1x full session in the morning and a mini set of mobility moves in the evening.
I am making amazing progress, my constant lower back pain has mostly gone, my hips are moving more freely, I have better posture and walk much easier. I no longer have to do daily foam roller to release tension in my muscles. I have also managed to correct 2x episodes of pelvic twists in days rather than weeks.
I know I will still have setbacks, but SMM has an amazing amount of support and regressions. I love the can-do mindset and am so thankful that I found this program.
Brendan - Bilateral Hip Replacement
Get them Hips out.
About me, I’m 45 now and had both hips replaced simultaneously in 2017, due to OA. Hearing that you need such a drastic operation is very daunting at first. I knew my right hip had to go as it had been bothering me increasingly over a long time, getting progressively worse. What I wasn’t aware of was that my left hip wasn’t far behind it, so my surgeon said it was a no-brainer to do the two together and only have one recovery.
When you’re a bit younger than normal for this type of thing (average age is in the 60s I think), the conventional advice is to wait as long as possible, as a second revision operation, if you need it in the future, is much trickier. I would say in hindsight, that once the pain starts seriously affecting you and interfering in your life, it’s time to pull the trigger. I waited too long and could barely function by the time I had the operation. I was in constant pain and on increasing levels of painkillers plus anti-inflammatories for months beforehand and that’s not great for anyone.
It was a relief for me to go into hospital to get them done by the end!
On the procedure itself, my advice would be prior to the operation, to do your research and find a surgeon that you are confident with (if you have any choice). There are different types of procedure available now also (anterior vs. posterior approach) and your age and choice of surgeon will probably dictate that as well. I would also recommend getting a training programme in place prior to the operation, which sounds strange as you will probably be in a fair amount of pain at this stage. I used a local physio for some recommendations with the goal of building up some strength to make recovery easier. (I’m sure Tom would have some excellent suggestions on that, maybe even a modified version of SMM).
On the operation, it’s a spinal block only but I told the anaesthesiologist I wanted to be fully out, and I didn’t want to see or hear anything!!!!! It was scary but I can tell you, I was in less pain the day after than the day before. The pain management was excellent. The first night is the worst because you’re stuck in bed not able to move much and sleeping is tough. The next morning they will be in to get you up and about. Once you take the first few steps (on crutches for me) it’s a big relief when you don’t collapse!
SMM will not be an option initially in the first 4-6 weeks. It will probably be range of motion and walking practice. For me, it was two crutches to one crutch to none, building up the time walking at each stage. Stairs might be an issue (and was for me with two new hips and no “good” leg) so if you can arrange sleeping downstairs it might be easier (I did for 6 weeks). I found night-time and sleeping to be particularly hard as I could only sleep on my back, not turn at all, and found it impossible to sleep for more than a few hours at a time.
As soon as I was able to drive (ca. 6 weeks), I found a pool I could use and stretching/walking/marching in the pool really helped with confidence to get moving better and would highly recommend that if it is possible. Again, my advice is to have a programme ready at this stage for post-op. You will be discharged with only very basic recommendations (in my case anyway) which are ok for the first while but then you need to be moving on depending on your age and ability I used the pool, stretching/strengthening work at home and a lot of walking. I also found a great osteopathic masseuse and found that a great benefit to loosen up the concrete legs!!!
I discovered Tom and SMM a bit late (probably 3 years after the operation). I had been working away myself doing bits of training, but nothing very consistent and I didn’t focus enough on mobility in that period. I liked SMM as you could do it anywhere, didn’t need any equipment and it combined flexibility with strengthening so ticked all the boxes for me. It was also trackable so you could see your own progress.
It was very tough initially though. I had to regress nearly every exercise and the first week (tests etc.) was very hard. It all seemed a bit pointless. For someone with a hip replacement, I think SMM is great as its scalable to your ability, combines a lot of good areas into one session (e.g. flexibility, strength, balance) and you will discover a lot of things you didn’t know about your body. If you are in doubt on when is ok to start, check with Tom and your doctors/physio before starting.
I won’t lie, my progress was/is very slow and 18 months later, it’s still a hard workout for me, every single time. The SMM group are fantastic but when are you coming from such a low start, it can be disheartening to see people getting elbow touchdowns in DLR after a month or being able to do side plank marches after a few weeks. These took me over a year and for example, a separate issue (disc issue) means that I’ve learned I can’t push the DLR movement too much as the obsession (it will be) of getting that elbow down will make you round from the lower back to get there, and I upset my back that way.
The lesson I got was that you have to measure your progress against yourself. You won’t want to especially in the beginning, but take pics/video of yourself regularly. I didn’t and regret it now so it’s hard to remember exactly how bad I was. I’ll probably never be able to replicate what Jenni demonstrates exactly BUT, at the start, I could do nothing, now I can most of the exercises if I stay consistent (no hands 90/90s, DLR to ground and side plank marches are always the nemeses!)
On this point (and in fairness Tom probably has a t-shirt for this) consistency is everything. When I do SMM 3-4 times a week, I made or held progress. If I did less, I go back. That is ok too - kids, pets, work and life get in the way. SMM gives you a tool to evaluate where you are and then a way to address the things you need to work on most. I still do it as much as I can and sometimes mix in other things to vary it up too.
My goals are fairly basic – I want to have no pain, be able to bend down, pick up the kids, not have pain/stiffness and be comfortable walking (jogging is not recommended for us hippies anyway) (Also I’d like to do movement flows, handstands and cartwheels, but hey - you have to have a dream !!!)
SMM helped me to have confidence that I can move the way I want without hurting myself.
Toni – Tibia Realignment
Many years ago, I twisted my right knee and damaged the meniscus on the left side. The right side was ok. My consultant decided that because I was bow legged (!) and still rather young (forties) for a knee replacement an operation to realign the tibia would be best and would delay the need for a total replacement. The operation was brutal and the recovery very, very long! This was massively frustrating for me as I have always been really active, running, cycling, gym etc and to be unable to do much for so long was very depressing.
To be honest, I have lived with pain/discomfort in this knee ever since the operation. I have never let it stop me doing anything and have completed 26 mile hikes (in a day) and 100 mile bike ride challenges regardless suffering the consequences later. I’d simply ice/bandage up whatever hurt and rest up for a couple of days. I took up yoga because I sort of felt that some of the poses would be beneficial for my knee but there were many that just made it flare up.
So, for 20 odd years I have carried on with a cycle of pain in my knee, my left foot (balance is absolute shite!) and in my right hip which I always felt had something to do with what was going on with my knee.
My younger sister was always in pain with her back, and I came across one of your videos (can’t remember where I saw it, but probably You Tube) and sent it to her. She loved it and then started raving about how much your SMM programme was helping her, so I thought I’d give it a go too. That was about 11 weeks ago. Hello SMM!
My biggest issues starting were complete lack of glute strength on the left side, very tight right leg & hip and a lot of fear around letting my knee doing over my toes. Side plank marches were shite; absolute shite! And barely any balance on my left side.
So, today I can tell you that despite being mega sceptical about whether this programme would make any difference to my old bod, I have to say that I have seen many improvements.
It seems that for far too many years I have let fear of hurting my knee further stop me from progressing and improving my ROM. Whilst I haven’t quite got to doing unassisted split squats, I’m really pleased to say that I can let my knee go well forward of my ankle and nothing bad has happened to it!
I could never do a standing quad stretch on the right side because I couldn’t bend the knee and reach for my foot; I can now thanks to exercises like the Couch Stretch! Obviously, nothing for most people but something that has been pissing me off for years so a big win in my books.
I have improved on all the exercises; even the bastard Side Plank Marches! Still can’t do ten each side but CAN do 4 proper marches and then regress to finish. Definitely work in progress but considering I couldn’t even lift my hips off the floor for that exercise this is BIG.
Something else that I thought could not ever be improved is balancing on my left foot. I massively over pronate on that foot and wear orthotics. However, I now take every opportunity to balance on that foot and unbelievably I have improved. Not a lot but definitely an improvement. I’m able to stand on that side much longer than I ever have done. Doing Tree Pose has always been so frustrating for me cos I’d topple over immediately unless I was holding on to a wall. Now I can stay in the pose for 20 seconds or so.
In summary, I have learnt that although there are no quick fixes for my hundred-year-old issues turning up every other day (via my laptop!) to do these SMM exercises is making a surprising difference to my mobility. The subtle improvements are what keep me showing up!
Thank you Tom/Jenni for turning this mega sceptic into a believer!
Emma - Ankle Replacement + Plates & Screws
I had a rugby injury in 2011, I was tackling a girl out over the line, and she caught the cog of her boot in my lace, brought my ankle around the back of my leg & then she came down on it. I just heard an 'oooooohhhhhh' from the crowd but I was unaware of the injury myself until she got up.
The foot was hanging limp off my leg, no movement.
In the hospital they discovered I had a fractured tibia, fibia and had shattered the ankle joint itself.
I had an ankle arthroplasty (replacement titanium joint) and an ORIF (open reduction internal fixation - plates, screws & a Kirschner wire) surgery to give power to the ankle joint and to stabilise the factures, which were apparently quite serious.
I went into a soft cast for two weeks and was sent home with a morphine pump for 7 days (these were the best 7 days of the 9 month recovery period!). I had a hard cast then for 9 weeks and then into a boot for 3 weeks, all with crutches, then finally, naively, I was expecting to just come out of the boot and go back training!!
But I'd to go to the hospital every day to learn how to use the foot again - I could lift it, but flexion in it was painful and I was awkward when planting the foot - it was likely to land anywhere (I later learned this was because of the severed tendons and ligaments).
I was told by the surgeon I would indefinitely walk with a pronounced limp forever more. And if I wanted to go back to rugby, no problem, but he wanted me to know that titanium is stronger than bone, has no malleability and if I incurred any awkward tackles/turns, I would likely fracture above and below the plates because there was no real give in the metalwork inserted into the leg.
I was rigid about recovery, if I was to do 10 x 20 of any exercise, I did it. I didn't want a limp.
I suffered with changes in sensations and feelings in the toes, around the wound for 3-4 years after the operation, I found that changes in the weather really affected pain levels. I can feel my screws through my skin with my fingers.
I was broken, not my spirit, but I had been on crutches for 4 months, I was lob-sided but didn't know it and I couldn't bend over to pick things up, couldn't get out of the car without slowly swinging both legs out together & using the door of the car to leverage myself slowly out. I was basically like my 86yr old grandad.
I had built a house since, started CrossFit and laboured on my own house for the block layer, lifting 5,500 blocks up onto scaffolding by evening and weekends, after sitting in a car all day managing construction sites (self-employed). I was strong, gaining strength by the week, but I was building strength on a sinking foundation! I'm famous for the stool I bought for my new walk-in-wardrobe to sit on to ease my socks on slowly, deliberately.
Then Darragh Lennon, a guy at my CrossFit box tagged me in one of your posts in March 2019. I started watching all your videos & posts, created a folder and started doing them daily. It was slow, frustrating, and incredibly humbling for someone who was capable of lifting so heavy.
I soldiered on, slow & steady, like a snail, it's my approach to life really. I bought SMM & advanced further.
I had an absolute breakthrough Christmas 2019 when I got my elbow to the floor in the Deep Lunge Test on my right side, by February, I had both.
Covid hit, so did the amazing weather, I built a CrossFit gym at the house in an old barn that was on my site & my friend and I (who worked the whole way through Covid) soldiered at the 90/90 kick backs and the side plank marches, while most others were sitting out in the sunshine, revelling in the forced shutdowns.
I no longer have localised swelling at the joint, weather changes do not affect the ankle and day-to-day I don't even realise I have a replacement. I had a dexascan two weeks ago for the bone density and I scored densities associated with 21-23yr olds typically. This is mobility & CrossFit related for sure.
I am now able to put on my socks, balancing on the other foot, I can bend down to pick up stuff from the ground, I no longer have to find adaptive ways to do basic acts of daily life and I am building solid strength on foundations underpinned by SMM!!!
In conclusion, a joint replacement doesn’t have to be the end of everything! Always talk to your doctor about returning to physical activities and what the best timeframe is after healing. With a little maintenance or using a program like the Simplistic Mobility Method, you can happily train just as anyone else with your new super joint!
If you have any questions or concerns, just send me an email and we can work out the best options for you!