Hip pain

Managing Pain and Function Following Joint Replacement Surgery


More than 1 million patients undergo total knee or hip replacement surgeries each year in the US and numbers continue to climb. The trend might be easily explained by an increasing number of elderly people, but reports are showing that there is a growing trend for younger patients to opt for surgery.

No matter how old you are when you go for surgery, one thing is certain: you will feel pain.

For most patients this is not a new sensation. The majority of patients seek joint replacement surgery because they have been living with pain for extended periods of time. It is easy to think that surgery is a quick fix and in some ways it is. The new joint is ready to function immediately and many patients are beginning their physical therapy rehabilitation on the same day as their surgery. But what most people do not expect is how much recovery it will take to overcome the damage caused by the surgery.

The nature of joint replacement surgery involves deep penetration into the body that requires tissue cutting, splinting, stretching, stapling, nerve severing, and bone scraping/removal to name a few. Having a clear understanding of what you are getting into, and how much pain to expect following the surgery, will help you recover quicker and help you manage post-operative pain more effectively.

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Holistic Mind Body Treatment: Relieving Head, Knee and Hip Pain

My aches and pains have been steadily diminishing since seeing Shmuel Tatz, PT, PhD for the first time but they hadn’t vanished completely – yet. Only because it’s been a long and winding road of minor injuries over the decades. This being my tenth visit, I didn’t know what to expect since there are a variety of problem areas in my small frame. Tatz, usually a man of little words, surprised me when he sat down and spoke at length before my treatment began. He was insistent that I understand, “People don’t always want to hear what their real problem is.” I was a little worried he had something unpleasant to tell me about my own health, but I listened.

First he told me that sometimes people have psychological problems and not physical problems. “I always tells my patients the truth but sometimes they get upset with me.” Very recently, he told one of his patients that she might want to consider talking to a professional about her emotional problems; she left in tears. He explained in cases of the mind, doctors such as bestselling author Dr. John Sarno are very good at helping people understand that they can heal themselves by addressing underlying emotional issues. He also noted that can only happen if there is not an underlying physical problem. He was very concerned about this patient of his.

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Discovering the Source of Pain and Connecting to the Body


Pain in any part of the body is a sign that the body of out of “tune.” For instance one can complain of pain in the knee, but the x-ray, MRI and even manual testing show that there is nothing wrong with the knee.  So the question becomes why is this person complaining of knee pain? In this case we need to look at the body parts that are directly related to the knee such as the back, hip and ankle.  One must analyze the hip and ankle to understand what is occurring in the knee.

A person with a limited range of motion and flexibility in the back, hip and/or ankle requires the knee joint to work twice as hard, eventually causing discomfort, then tension and finally pain in the knee. If the issue is not addressed simultaneously in the back, hip, knee and ankle it can lead to inflammation of the tendons, sprained ligaments and inevitably major problems in the knee.

In order to resolve the problem in the knee, one should have a number of body tuning treatments on the back, hip and ankle as well as perform movement exercises at home.

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A Body Tuning Session with Shmuel Tatz

Peter Brook’s production of the Indian epic The Mahabharata was stunning. But for Tara, whose hip joint and upper back have been giving her problems, watching the drama was an excruciating ordeal. The play began at one in the afternoon and ended at midnight; to add to the effect of antiquity, the seats in the specially remodeled theater in Brooklyn had been converted to bleachers with only light padding.

Though she loved the play, Tara’s hip and back ached as she left that night.

To add to the problem, Tara has just completed a five-day vipassana meditation retreat, a 14-hour-a-day regimen of hour-long sittings alternating with mindful walking. Despite her best attempts at yoga stretches and an ergonomic variation on a zafu for sitting, the course had left her hip and back in poor shape to endure the day-long play.

Luckily, Tara has an appointment with Shmuel Tatz at his Carnegie Hall studio.

At the session’s start, Tatz has Tara up on his bodywork table, lying on her left side. Tatz himself strikes a thoughtful pose before beginning to work.

“Before I touch anyone, I try to tune my own body,” says Tatz as he takes a comfortable t’ai chi stance, one leg a step ahead of the other, his body balanced between. Taking a moment to center, Tatz then gently places one hand on Tara’s back, the other on her ailing hip.

“I find the person’s rhythm of breathing, whether fast or slow,’ he says. “I breathe in tune with her.”

Then, pressing on Tara’s sacroiliac, he begins top massage her lower back with his left hand, checking to see if she is relaxed. Wherever he finds some tightness, he relaxes it with massage, then gently rocks Tara’s body side to side with his right fist.

The pressure at the sacroiliac releases tensions there and in the lower spine, while the rocking motion helps Tara’s tight muscles relax, at the same time letting Tatz see if they are indeed relaxing as they should.

Tatz himself rocks his legs in time with Tara’s rocking, simultaneously coordinating each press of the fist with her breath: pressing in as she breathes out, relieving the pressure as she breathes in.

This careful movement, finely tuned with Tara’s own natural rhythm of breath, typifies Tatz’s work as he moves his focus on her lower back, checking the motion of each vertebra with the fingertips of his left hand as he rocks her side to side with his right. As his fingers examine her spine, he stops between the third and fourth vertebrae. “Feel that?” he asks. “Yes, it’s painful there,” Tara answers. The diagnosis is right.

Trained as a physical therapist Tatz sometimes uses X rays to find the exact cause of compression between vertebrae – whether a disc problem, calcium deposits, or poor alignment, for instance. With Tara, he uses his fingertips to massage between the discs, softly forcing open space between them as he rocks her from side to side.

Shifting his attention to her legs, he lifts her right leg at the knee, working it through it’s natural range of motion. In doing this, he sees that the quadriceps is shortened, a mass of tightness in the quadriceps and tendons of the leg, each problem playing into the other. The back, too, is part of the same pattern; nerves running between the back and hip can cause a problem in one place to travel to the other.

In order to help free the hip, Tatz works with the leg, easing the muscles into relaxation through a combination of massage, guided movement, and acupressure. The body is so interrelated, he says, that working on a zone far from the central problem is all part of a holistic strategy aimed at the center. For instance, with Tara’s leg extended, he presses an acupressure point to the side of her ankle, tugs at the leg, extends it as though it were in traction, massages her abdomen, and tugs at her hands raised over he head – all to open the joint at the hip.

As she lifts her leg and waggles it, Tatz says, “Always I ask a question of the joint or muscles. As I lift the leg, I ask the hip joint, ‘How’s your internal rotation?’ If it’s okay, I go to the abductors and ask how they are. If they answer, ‘Very tight,’ I give some help.

The session ends with a touch of the Alexander technique, Tara walking around the room with Tatz holding her neck from behind in a balanced position where it is not fighting gravity. He explains that jutting the head forward, as most people do, creates constant tension in the neck and shoulders, as the muscles there struggle to counterbalance the 10 pound of the head.

The walk is just part of the re-education of Tara’s body. Tatz also gives her some homework, showing her a series of movements and easy stretches to help her body to hold the changes he has made in it.

After the session, Tara’s report is that she feels “great: free of pain, more balanced, and relaxed.”

Yoga Journal

By Daniel Goleman, PhD. – a psychologist and contributing writer on behavioral science for the New York Times.