Great golf after hip or knee replacement

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By Erin Hurley-Booker
 
As a physical therapist I often hear the question, Can I play golf again? Regardless of age, skill level or gender, everyone ' especially here in Florida, where we can, fortunately, enjoy golf year-round ' is eager to return to the sport. Many times these patients are recent recipients of hip or knee replacements.
 
Recent statistics reveal that each year more than half a million people undergo hip or knee replacement surgery. In my research, I have found that every surgeon encourages his or her patient to resume golfing following the procedure. And, in fact, more than 90 percent of patients successfully return to playing golf.
 
The face of those opting for hip and knee replacements is changing. Men and women who are younger and more active are choosing to have the surgery sooner. As with every procedure, the surgeons are refining techniques that advancing technology continues to improve.
 
This allows many patients to return to golf sooner than would have been possible 10 or 20 years ago. However, it is imperative that the new joints are ready to take on the tolls of returning to the game of golf.
 
Immediately After Replacement Surgery
 
Knee replacements-
Early range of motion (ROM) is the key. You will want to discuss with your surgeon the plan for immediate post-operative ROM. Quite often surgeons will prescribe continuous passive motion (CPM) machines or similar devices to allow you to start stretching the ROM immediately. Also, most surgeons recommend that you start Physical Therapy in the hospital and continue after discharge ' either at home, in a rehabilitation center or in an outpatient facility ' to maximize your motion gains.
 
Hip replacements-
This procedure is often accompanied with post-operative motion restrictions to protect the integrity of the new joint. The movements that are restricted depend on the technique that your surgeon uses. Most commonly, bending forward at the waist (hip flexion) and twisting the foot (hip internal or external rotation) are limited. Your surgeon and the technique he or she uses will determine the length of time for the restrictions. Once these restrictions are lifted, it is often easy to regain full ROM.
 
The amount of weight that you can place through the leg that has the joint replaced varies. Often times you can place as much weight through the leg as you can tolerate, but again, your surgeon determines this. You will have to use a walker or crutches immediately after the surgery, and then usually progress to the use of a cane prior to walking normally.
 
Strengthening the muscles around the joint should begin as soon as possible. Most surgeons will let you begin walking and light strengthening exercises the day after surgery. Your Physical Therapist will progress your exercises from simple movements to more complex, functional movements that mimic daily and even golf-related activities as you recover.
 
Most surgeons and physical therapists recommend returning to golf three to nine months after the surgery, depending on the progress of your recovery. Once you are cleared to return to golf, you will want to continue to progress the exercises you learned in rehab to ensure that your new joint is ready to face the challenges of a golf swing. In addition, follow these suggestions in your return to the links:
 
1) Use a golf cart
Although walking is a great form of exercise, a golf cart is advised as you return to playing, to decrease the stress on the new joint. Walking an 18-hole course is too strenuous for the new hip or knee joint, especially as you are first returning to the game.
 
2) Wear spikeless shoes
Shoes with spikes ' even soft spikes ' can create torque or rotational stress at the knee and hip joints. Following replacement surgery, we want to avoid any unnecessary stress or torque throughout the joint. Spikeless golf shoes are usually available at golf outfitters. Cross-training sneakers are also a good option. Additionally, your golf professional may be able to help you achieve a swing utilizing a step-through method, which also helps to minimize rotational stress throughout the leg.
 
3) Start slow and build up gradually
As with returning from any injury or time away from the golf game, it is important to start off with an easy, partial swing and gradually work up to a full swing. I always advise my patients to take only their wedges and short irons to the driving range the first few times they go. This helps to eliminate the urge to test out the new joint. I have them start in the chipping areas, progressively working up to a full swing with their pitching wedge or 9-iron at the range. After a few days of this, the patient is usually ready, both physically and mentally, to start swinging again with a driver and the longer irons.
 
4) Stretching
Stretching is always important, particularly with hip and knee replacements. It is good to stretch your thigh, hamstring and calf muscles before playing golf to ensure optimum flexibility and reduced stress around the new joint. Another important stretch is for rotation, which is often restricted after hip replacement surgery. To perform this exercise, lay down on your stomach, with the surgically repaired knee bent to about 90 degrees, or a right angle, the bottom of your foot pointed toward the ceiling. You may want to place a pillow under your stomach to decrease stress on your low back. Keeping your back relaxed and still, slowly rotate your hip by turning the lower leg to the inside (external hip rotation) and then to the outside (internal hip rotation). Do not allow your torso to move. Hold for three to five seconds in each position and repeat 10-15 times on each leg. This exercise will not only loosen up the hip rotator muscles, but also help to strengthen them.
 
5) Strengthening
There are many available exercises to perform after hip and knee replacements. Your Physical Therapist will help you determine the best exercises to continue to maintain strength for golf. One of the most important strengthening exercises is the step-down. This exercise will help you gain and then maintain the strength necessary to climb up and down small hills and bunkers, as well as improving balance.
 
To perform step-down, stand on a small (approximately four inch) step with a railing or wall for hand support. A phone book can be substituted if there is not a small step available. Stand with your surgical leg on the step, and your other leg raised slightly in front of you. Without leaning in any direction, slowly lower down until your other heel touches the ground. Slowly rise back up. Focus on controlling the downward movement of lowering your other leg to the ground. Start with two sets of five repetitions, working up to two sets of 10 reps. When you can easily control the knee during the step-down exercise for two sets of 10 repetitions, you may increase the step to six inches to increase the challenge.
 
With increased hip and knee replacements, and post-operative golfers staying active longer, we are inevitably going to see more golfers on the course. These tips are key elements in protecting that new hip or knee joint, and ensuring its stability through many rounds of golf. If you are contemplating a hip or knee replacement surgery, visit your orthopedic surgeon and physical therapist in preparation for your eventual return to golf. It is never too late or too early to improve your strength and flexibility!
 
Erin Hurley-Booker, MPT, MTC, CSCS, is a GFM Advisory Team Member and Clinic Director for Physiotherapy Associates in Ocoee, Fla. For further information on Erin, log onto www.golffitnessmagazine.com/advisoryteam
 

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