Ep 64: How To Get Back To Golf After A Hip Replacement

Have you had a hip replacement? Thinking about getting one?

Today, Chris shares how to get back to golf as quickly as possible after a hip replacement. Ask your surgeon about prehab and rehab, and ask your physical therapist what therapy looks like.

 

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:00):
Welcome to the Golf Fitness Bomb Squad podcast with Chris Finn,
a production of P for S Golf. Welcome to the
Golf Fitness Bomb Squad. My name is Chris Finn. I'm
your host, and I'm excited to have all of my
Golf Fitness Bomb Squads with me today because today we
are going to talk about hip replacements. This is a

(00:24):
topic that I don't think it's enough time on the air.
I think it's one of the most common things that
we see in terms of whether it's people coming acutely,
like immediately after they've had to hit replacement. Maybe they're
coming because they're preparing for hip replacement, or maybe they
had the hip replacement, you know, six years ago, whatever

(00:44):
it may be, there is such a mess, like absolute
dumpster fire in the orthopedic world after the hip replacement's done.
In the types of advice that people are getting in
terms of getting back to golf, it's literally ridiculous. The
number of people that I meet, golfers I meet who've

(01:04):
been told by their orthos or you know that like, hey,
you don't need pt just go walk around, you'll be fine.
These are guys that are trying to get back to
playing the game of golf. And a lot of times
it's their lead hip, like they've literally like they're the
hip that they put all of the load and pressure
to and they're being told like, you don't need to
go rehab anything, or they'll go to maybe they'll go
to some initial pt, they'll get to the point of walking,

(01:27):
and the rehab recommendation is after that, Like it's like, hey,
I just go start chipping and putting and then just
work yourself back as much as you can. Like stupidity,
absolute stupidity. So, if you've had a hip replacement, I'm
going to talk to you in less than ten minutes
here about the exact steps you need to be taking
to make sure you get back to playing. You should
be better than before the surgery. Your golf game should

(01:50):
be better than before you had to hip replacement, because
before the hip replacement, your hip hurt, so you couldn't
drive through the hip, you couldn't produce as much force
because it freaking hurt. So if you pay tens of
thousands of dollars to have a hip replace have a
new joint put in your body, it's common sense it

(02:11):
should be better afterwards. Right, Like that's I don't understand why.
That's a question for a lot of people. But and
people don't unerstand why. People there's this false belief that
it's like they people accept that, Oh, it's it's a
replaced joint, so it shouldn't be as good. Like, dude,
you got rid of all the problems, Like you got
rid of all the arthritis or whatever it was that
was in that joint that was causing you problems. It

(02:32):
should be better. So here's the deal. You'd need rehab
after hip replacement. Right, if an ortho tells you before
you go to get surgery, and if you talk to
a surgeon they say, yep, you're just gonna have the
surgery and then just walk around. You'll be fine. Go
find a different surgeon. That guy's an idiot, that girl's
an idiot. Okay, you need surgery. And I think to

(02:53):
understand the the just the continuum and the roles of people,
the orthopedic surgeon is the builder. They build the house
right structurally. Once the house is built, they wipe their
hands and they move on. Now, great surgeons don't wipe
their hands. They then pay attention to the interior decorating
the finishes, that's your rehab. Okay. But if you just

(03:14):
have an orthopak surgeon who's just a builder and they
build a structure and they say, hey, we met code,
good luck figure out the rest. That's not the person
you want doing your hip. Find somebody else. A good
ORTHO is they're gonna talk to you say yep, after surgery,
we're then getting you into therapy immediately so that we
can get all your muscles activated. And honestly, we'd recommend
that you start doing some rehab prior some prehab so

(03:36):
that way you're stronger going into the surgery because you're
not gonna make the joint worse and they're just gonna
take it out anyway. So literally go to as much
as you possibly can, get as strong as you possibly
can get, and then when the joint is replaced, that
is going to expedite your recovery back to where you
want to be. Okay. The next step is then you
should be going to physical therapy right and in the
physical therapy it should be progressed based on obviously the

(04:01):
tissue healing protocol. Obviously that the surgeon is going to
give you guidelines based on how the surgery went and
what they saw on how confident, how stable everything is.
But you should at some point in the eight to
twelve weeks. Generally it's about a twelve week process, but
if you go fast, sometimes people are out in eight.
But like, there should be squatting, there should be hinging

(04:23):
with legitimate weight guys, not like thera bands only right,
Like you should be seeing a therapist. You shouldn't just
be seeing their little assistant who's gotten trained for a week.
You know. Unfortunately, the way the therapy world works a
lot of times is because reimbursement rates have gone down
so much. For therapy clinics, the business constraints are they

(04:43):
have the actual licensed physical therapists do the evaluations because
that's where they get paid the most money, and then
every fole up after that, you may see the assistant,
the physical therapy assistant who has two years of school,
or you may see the physical therapy aid who's literally
could be a high school kid who just got trained
to watch some exercises. Okay, So generally you'll get the

(05:03):
licensed person for like fifteen minutes, then you get passed
off to go do exercises with everybody else. If that's
the case, go find a different place for rehab because
that place sucks. Right, you should be connecting with that
physical therapist every single time. Believe me, the physical therapist
wants to connect with you. Every physical therapist worth their
salt wants to see you every time. They want you
to get to where you want to be. Unfortunately, you know,

(05:25):
as a consumer, you need to understand the constraints of
the system that you're going into, and that is the
insurance based healthcare system that we have in the US.
So you should be looking at like, how am I progressing?
You want to get back to swinging a golf club.
You want to get back to hitting drives, swinging eighty
ninety maybe over one hundred miles an hour. That's a

(05:45):
ton of force through the ground. We're talking thousands of
watts of force going through the ground, right, the equivalent
of jumping, you know, at least nine inches off the ground. Like,
you have to produce some serious force there, ladies and
gentlemen like So you need to do more than a
free theraband, right, You have to do more than just
body weight squats. Are they teaching you how to use
whether it's kettlebells or dumbbells and yeah, and obviously some

(06:08):
of this is going to depend on your fitness age
going in, but you need to get the tissue and
everything around that joint as strong as humanly possible to
make sure it's stable and that it can actually support
everything you're going to want to do. And then you
also need to think about your mobility and you need
to get that hip internal rotation back. Now, there's going
to be limits on how much internal rotation how early,
based on what type of approach the surgeon used, but

(06:30):
once you get twelve weeks plus out, there's no reason
why you can't get full hip rotation into that into
each hip internally rotating right into your trail side and
into your lead side backswing and follow through. So first
just to recap quickly the surgeon that you wanted to use, obviously,
talk to a couple of his patients, his or her
patients who have actually used them. What were their rehab

(06:53):
what was their whole entire experience, Like you want to
hear them say we want you to do prehab, we
want you to do rehab, and then you want to
talk interview the therapy side, and they should be you
should be able to spend more, you know, every session
with the therapist, that's your ideal scenario. You know, in
the cash world, you get full hours with the just
the therapist. There's no aids or assistance that may not

(07:15):
be feasible. And honestly, if you've paid, you've maxed out
your insurance deductible, it makes financial sense to find an
insurance clinic where you can get the most time possible
with the physical therapist, less with the assistant or with
the or with the actual aid. Right, So have those conversations.
What does therapy look like if all you see is
therap bands and basically you have a sheet of home

(07:36):
exercises some places doing in an app now, But then
every time you go into the clinic, you just do
your home exercise program and they just watch you. So
that's a freaking waste of money. Guys, like, like, there
should be progressions every time you're in there. There should
be manual work being done and massage and like deep
you dry needling potentially based you know, obviously depends how
far out you are after surgery, and but there should

(07:59):
be manual in a mention that's occurring to help the
tissue recover quicker. To help you deal with trigger points
that are likely to develop as you're getting stronger. And
then what should happen is then you're going to get
to a point where insurance is going to stop paying
for you, which is basically when your pain is generally
gone and you can walk, you're considered community ambulating where
you can go at least three hundred feet, you can
kind of like go to the store and stuff. Right,

(08:20):
they're not going the insurance company is not going to
pay for your golf rehab, right, they just need you
to get back to function, and then they're done. They're
going to wipe their hands and they're out. Otherwise their
profits go down. Right, they charge you more every year,
they pay the clinics and the doctors less every year
that delta goes to them, and then they don't want
to continue paying it for you. They're in the business

(08:40):
of not paying. Unfortunately, that's just the fact of where
we're at. So then you're going to get to this
point where you're going to be discharged because the therapists
can't say, hey, we're working on return to golf stuff,
and we're looking at their golf swing and we're doing
golf specific training. Right, insurance company is going to say Nope,
not paying for that, So then you likely need to
transition into probably a cash pay scenario with the clinic

(09:03):
or you go find another place that that does this.
This is not what our successes where we actually take
these people. You know, people get to that eight to
twelve weeks, then there's like there's this like no man's land,
other put people like, yeah, just go chip and put
and figure it out. Well, like we no, like what's
your hip rotation? Look like? What about your other joints?
What's your shoulder rotation? Your spine, your neck? How good

(09:24):
or bad are those? Because if those suck, then you're
gonna put more stress on the surgically replaced hip. Like
those need to be really good to keep as much
stress off of that new hip as possible while you're
getting it stronger, while you're training it to be powerful.
And then we need to look at it. Well, now
your weight transfer is gonna be weird because you ain't
gonna trust that hip guarantee you that your weight shift's
going to be You're gonna be off your kinematic sequence

(09:45):
in terms of the sequence in what you're moving each
of your joints in the segments of your body is
going to be off. Your kinematic, your kinetic, how you
use the ground is going to be off. Right, You're
gonna have to retrain all of this right, And so
I think that's where you want to look at somebody
who understands the gull return to golf side of things,
who also understands what you've had done medically, and they
can kind of meld those two together. A full return

(10:07):
to golf program encompasses all of these things. Guys, Okay,
it is a ortho who understands that the hip replacement
isn't just replacing the hip. It's not just building the house.
You have to do the actual tissue strengthening and rehab
and recovery, and then you have to do the actual
sports specific return stuff. And if you do all of that,

(10:28):
I promise you you will be swinging faster, You'll have
more mobility, you'll feel better. Literally, you will finish rehab
a better golfer than when you started, which makes common sense.
If you had to get a joint replaced, wouldn't you
think that you'd be better off afterwards? I don't know. Sorry,
I'm on my soapbox here. It just it blows my
mind that people just accept that I'm going to drop
five figures and like I'm okay being worse. That's just

(10:52):
so dumb. And it's just because of the constraints. It's
not like it's not that person's fault. It's the constraints
of the system and the false beliefs that unfortunately we
kind of been I guess used to used to living in. Right,
Like it's it's normal to wait forty minutes when you
show up for a nine o'clock appointment. It's normal for
them to not come get you till nine thirty or
nine to forty, Like, no, that's shitty customer service. Like

(11:13):
they should get you at your appointment. They expect you
to be there, You expect them to be there. Right.
A lot of stuff, just in the medical world, is
a nature of the business model where they have to
book two and three people at the same double and
triple book people because they get paid so little, Like
it is just a it's a vicious downward spiral where

(11:34):
they get paid less, so they try to do cost
savings and it just makes it worse and worse experience
for the consumer. And so I just want to make
sure that you understand that system so that you can
understand how successfully navigated and gets you back to playing
the better golf that you deserve to play. So anyway,
I went fast, you made I'm not sure that was
my Northeast. Real quick talk there, because I get them,

(11:54):
I get fired up about this topic. We're gonna do
another one of these Knees and Shoulders, so definitely look
for those episodes as well, because I want to talk
specifically about each of these replacements that are very common
these days, and what you should be looking for and
how you should be navigating the process. Now, the general
process is going to be the same. You want the
same type of surgeon who's who's aware in thinking about

(12:15):
that rehab process. You want the same type of rehab
experience where you're seeing the actual physical therapist, not the
assistant or the aid. You want to see the same
person every single time. And there's lots of great assistance
out there. But if you're being passed from one to
the other, I can tell you from being in the
system and you get you like cover for somebody. It's
basically an initial session because you've got to try to

(12:35):
feel out you can read all the notes in the world,
but you got to feel out and you're assuming that
the notes were done A and B that they were
done well but which they're not. FYI. Yeah, and then
that you can actually but it's literally a first session.
So every time you see someone for the first time,
it's you're starting over. It's literally a waste of a
session for you as a consumer. So you want to

(12:56):
see that same person every single time. Uh, And then
you want and then obviously there's going to be an
end to where insurance will cover you. And then you
got to know that that's when you need to transition
to the actual golf specific side of things. And if
you can get your therapist to be to creatively document
and say, hey, you know we were doing increasing activity
is tolerated, but in reality that meant we hit thirty

(13:17):
balls yesterday and you know this time we're hitting forty
five balls, and like, maybe they can get away with
it for a little bit, but you know, they're definitely
running the risk of not being reimbursed whatsoever if there's
ever audits or those sorts of things. So the same
system navigation exists, but the different concerns will definitely be there,
so hopefully that helps for all of you had a

(13:38):
hip replacement thinking about having a hip replacement in terms
of things that you should expect, you should it is
normal to expect to see a better physical ability post
surgery than pre surgery. Okay, it is not normal to
be the same or worse, so hopefully that sticks in.
Hopefully we diffused a few false beliefs here and hopefully

(14:01):
help some of you get back to playing golf for
a really, really long time. So thanks as always for
hanging out with me on the Golf Fitness Bomb Squad
and we'll catch you in the next episode.