Unwarranted(?) Fears Regarding Post-Surgical Performance of Hip Internal-Rotator Exercise
Linguistic Failure Leads to Missed Opportunity for Healing
[This post is directed toward those readers in the exercise and physical therapy communities. Lay readers are welcome to partake.]
After conferring with Sean McNicholas (nurse and SuperStatics certified practitioner in Wales) over the past several days regarding the static (TSC) exercises I recommend in the book, Hip, I decided to share one of his findings. This specific concern is about the TSC (Timed Static Contraction) Hip Internal-Rotation (HIR) exercise for post-surgical hip replacement (as well as for other hip concerns).
From viewing several videos on hip rehabilitation, Sean discovered that HIR exercise is strongly and ubiquitously contraindicated. This was unknown to me before now, but it is not surprising. As I have explained numerous times in my 25 books, physical therapists (PTs) and orthopedic surgeons are not sharp on exercise. [I will not, herein, go into my many specific criticisms of these groups.]
The hip internal rotators, especially the intrinsic ones, are delicate and often disrupted in hip surgeries, especially during hip replacement surgery. Early on, they do not tolerate the forces involved in dynamic rotation (internal OR external*), therefore DYNAMIC exercise for these muscles must be avoided in early-stage rehab.
[*Note that, even during hip external rotation—performed dynamically—the internal rotators are stressed.]
But dynamic exercise is almost never preferable in any musculo-skeletal rehabilitation although it is overwhelmingly prevalent in rehab clinics. Only with TSC can both the SuperStatics (SS) practitioner and the patient be extremely particular with levels of effort and the avoidance of pain. Dynamic exercise dispenses with all of these required nuances of therapy. Thus, opportunities for enhanced progress and safety for the patient are dashed.
My Most Salient Point:
As the SS practitioner, expect to receive a list from the patient’s orthopedic surgeon and/or PT of positions and motions to avoid for the first several weeks post surgically. Expect it to include HIR as a motion and exercise to avoid.
So if you instruct the patient to perform TSC HIR as I explain in Hip, you will NOT be violating this guideline… You will NOT be allowing the patient to move into an internally rotated position… You will NOT be exercising the internal rotator muscles in the haphazard, dynamic mode that the PTs have in mind when they rail against HIR exercise.
A discussion might go like this between the PT and the SS practitioner:
SS practitioner: “The patient is doing well with HIR.”
PT: “You’re not supposed to be internally rotating the hip. This is dangerous.”
SS practitioner: “We don’t encourage or permit internal rotation.”
PT: “You just admitted to doing HIR.”
SS practitioner: “Yes, but we don’t internally rotate.”
PT: “How can you perform HIR exercise without internally rotating?’
SS practitioner: “TSC.”
By this time, the PT, figuratively, will be going cross-eyed as he has no reference or context for this superior approach.
This is linguistics failure as it is possible and preferable to perform exercise for the internal rotator MUSCLES without performing internal rotation of the hip JOINT(s).
Statics are fascinating. It blows people’s minds to hold that exercise doesn’t necessarily involve movement