Physiotherapy - Therapy following a Hip Fracture

This leaflet is designed to inform you of what to expect from the therapy team on Orthopaedics during your hospital stay. It is for patients who have been admitted with a hip fracture.

A hip fracture can be a life changing event. Few patients return to their usual level of ability and there can be long term mobility issues. Hip fractures tend to occur in people who have several medical conditions or are otherwise frail. The effects of these conditions or the overall frailty can affect your overall recovery.

The Integrated Therapy Team

The Integrated Therapy team on Orthopaedics is made up of Physiotherapists, Occupational Therapists and Therapy Assistants who look at ways to promote and support your independence in everyday activities. Activities including improving your mobility and how you get in and out of bed.

• Physiotherapist - wear a white top with a navy trim and navy trousers
• Physiotherapy Assistant - wear a pale blue top with navy trim and navy trousers
• Occupational Therapist - wear a white top with green trim and green trousers
• Occupational Therapy Assistant - wear a green top with white trim and green trousers

Before Surgery

A therapist will ask you questions on how you normally manage, what type of property you live in and if you have any help at home.

The therapist will assess the movements of your unaffected leg and arms and show you exercises to aid your recovery.

Exercises

Affected Leg

• Wiggle your toes
• Move your foot up and down

Unaffected Leg

• Move your foot up and down
• Bend and straighten your knee
• Take your leg out to the side.

Arms

• Move your fingers and bend your wrists up and down
• Bend and straighten your elbows
• Lift your arms up above your head and down

Breathing Exercises

• The therapist will go through some breathing exercises for you to complete too. (Please refer to Appendix A at the back of the leaflet)

After Surgery

Pain

Pain is normal after the operation due to the surgery you have had. Pain may be felt around the hip, groin, and thigh of your operated leg. The Therapy Team will aim to time their treatment sessions with the pain relief prescribed by the doctors.

Exercises

Your therapist will teach you the following exercises. These exercises will improve circulation, strengthen the muscles surrounding your hip and help you to regain movement. Aim to do this three times daily.

Operated leg

In the images used throughout this leaflet the model is acting as if the right leg is the operated side.

1.    Ankle Exercise

• Lying on your back or sitting
• Bend and straighten your ankles. Point your toes up towards your body and then down
• Repeat this 5-10 times

Scan QR code for video demonstration.

2.    Knee Exercise

• Lying or sitting on your bed.
• Slowly bend and straighten your operated leg. Your therapist will help with this movement if needed
• Repeat this 5-10 times

If you are following hip precautions, then do not bend your hip/ knee more than 90 degrees.

Scan QR code for video demonstration.

3.    Knee Strengthening Exercise

• Lying or sitting on your bed, with your legs straight
• On your operated leg pull your toes up towards you and push the back of your knee down on to the bed
• Hold for 5 seconds and relax
• Repeat this 5-10 times

Scan QR code for video demonstration.

4.    Hip Exercise

• Lying or sitting on your bed
• Slowly take your operated leg out to the side and then back to the middle. Your therapist will help with this movement if needed
• Repeat 5-10 times

Scan QR code for video demonstration.

If you are at a level of ability where your therapist can progress your exercises you may be shown standing exercises during your hospital stay. These exercises are in Appendix B at the back of this leaflet.

Hip Precautions

In most cases where a total hip replacement or hemiarthroplasty has been completed to fix your broken hip you will need to follow hip precautions. This is to minimise the risk of your hip dislocating.

The therapist will advise you of these precautions if needed.
 
The Precautions are:

• Do not cross your legs or allow your operated leg to cross the midline of your body
• Do not bend past 90 degrees (a right angle) at your hip
• Do not twist body separately from legs. Shoulders and feet should face the same way

The therapist will measure the length of your lower limb, from behind the knee to your heel and add 2 inches to this, this will be your safe height. This is the height furniture will need to be on discharge to minimise the risk of your hip dislocating.

The therapist will ask for a furniture height form to be completed to gain the measurements of the heights of your bed, chair you most commonly sit on and the toilet. Please return it to the ward as soon as possible. It is advised that you follow the hip precautions for 12 weeks.

Bed transfers

Your therapists will show you the best way to get in and out of bed.

Here is one way described below.

Getting out of bed

• It is generally easier to get out of bed leading with your operated leg and this helps to maintain hip precautions
• Bend your unoperated leg and move your bottom towards the edge of the bed
• Push through hands on the bed and sit up as you move your legs off the bed, bend your knees and place feet on the floor

Getting into bed

• Move bottom back into the middle of the bed
• Lift both legs onto bed
• Lie down

Scan QR code for video demonstration.

The model in this leaflet is allowed to weight bear after surgery. The therapist will advise you of the best ways to move should you be non-weight bearing.

Standing Up

Your therapists will show you the best way to stand up from the bed or the chair.

• You should have the walking aid in front you
• You should push up off the bed with both hands
• Then reach for the walking aid as you stand up
• Stand up tall

Scan QR code for video demonstration

Sitting Down

Your therapists will show you the best way to sit down from standing.

• Make sure you can feel the bed/chair on the back both of your legs
• Step your operated leg forward
• Reach back for the bed/chair arms with both hands
• Sit down

Scan QR code for video demonstration.

To maintain hip precautions in sitting ensure the seat is of safe height. Ensure that sloping seats do not make the knee higher than the hip.

Walking

Your therapist will advise and assess you with the appropriate walking aid and recommended the level of assistance needed to use it.  It is important that you practice walking with the nursing staff to and from the bathroom when able to help with your rehabilitation.

Walking with a Rollator Frame

• Move the rollator frame forward
• Step your operated leg
• Then step your non operated leg
• Repeat

Try and clear the floor when stepping and take small steps when turning

Scan QR code for video demonstration

Walking with Elbow Crutches

• Move your elbow crutches forward
• Step your operated leg
• Then your non operated leg
• Repeat

Try and clear the floor when stepping and take small steps when turning.

Scan QR code for video demonstration.

Initially after the surgery the therapist may advise that you walk with a frame and assistance of one/two people. In some circumstances it is too difficult for patients to stand to a walking aid or walk with one. Your therapists will find the most suitable way for you to move from the bed to the chair. This could be with the use a stand aid/ full body hoist.

Stairs

If you have steps and/or stairs within your property, we can practice these with you. Your therapist will advise the safest technique for completing the stairs. If you are unable to complete the stairs, we will explore the option of one level living. This will be discussed thoroughly with your therapists.

Stairs using rail and walking aid

Going Up

• Hold on to handrail
• Good leg up first
• Bad leg up next
• Walking aid up last

Going Down

• Hold on to handrail
• Walking aid down first
• Bad leg down next
• Good leg down last

Always do one step at a time.

Going Upstairs 

Scan QR code for video demonstration.

Going Downstairs 

Scan QR code for video demonstration.

Stairs using rail(s) only

If using a walking aid to walk with, leave this at the bottom of the stairs and have a second aid positioned at the top of the stairs.

Going Up

• Hold on to handrail(s)
• Good leg up first
• Bad leg up last

Going Down

• Hold on to handrail(s)
• Bad leg down first
• Good leg down last

Always do one step at a time

Going Upstairs 

Scan QR code for video demonstration.

Going Downstairs 

Scan QR code for video demonstration.

Washing and dressing

It may be easier for you to wash and dress from a seated position either on your bed, toilet seat or perching stool. This will help to conserve your energy. You will normally find it easier to dress your operated leg first and undress the operated leg last.

An occupational therapist will assess if any dressing aids may help, or you may require help from another person.

If you are following hip precautions do not bend down to wash/ dress your lower half, use the recommended dressing aids or have help of another person. We recommend a strip wash on hospital discharge.

Kitchen

You may benefit from completing kitchen tasks from a seated position initially. This will allow you to conserve energy and take the pressure off the operated leg. You may need to consider how you will access lower cupboards or the oven if you are following hip precautions. Initially you may need support from another person with kitchen activities.

You need to pace yourself with daily tasks and perform them as your fitness allows.

Sleeping

Sleeping on your back is the safest sleep position with a pillow between your legs. If you like to sleep on your side, sleep on your non-operated side with pillows between your knees and ankles. Do not sleep on your stomach.

If you are following hip precautions do not lie or roll onto your non-operated side and placing the pillows as above will reduce the risk of your hip dislocating.

Sexual intercourse precautions

Generally safe to resume intercourse at 4-6 weeks after your operation but check with your consultant.

To maintain precautions, lie on your back or operated side or in standing without flexing your hips more than 90 degrees, you may want to lean on to something for support.

Driving

You must inform your insurance company of your hip operation. You should discuss with your consultant when safe to drive or be a passenger in a car. Driving should be avoided for the first 6 weeks, and you should not be a passenger for the first 3 weeks. You must be able to safely control the vehicle including performing an emergency stop.

If you are following hip precautions, these should be maintained when both a passenger and driver of a vehicle.

Flying

Discuss with consultant any holidays planned especially if flying within 3 months of operation.

Planning for Home

The decision that you are ready to leave hospital is based on several factors. There are different services available to support with your discharge from hospital, which your therapist will discuss with you.

Your rehabilitation may continue where appropriate when you leave hospital with the community physiotherapy teams.

If you are aware of any issues that may hinder your hospital discharge, then please let a member of the ward team know. Thank you.

Appendix A - Breathing Exercises

This technique can help with deep breathing and clearing your chest of phlegm. It is called the Active Cycle of Breathing Technique (ACBT).

It is common to have secretions in your lungs after lying flat for some time and after surgery, which can be difficult to clear.

Do the following exercises hourly.

Ensure you are sat upright as possible and in a comfortable position to start with.

Active Cycle of Breathing Technique (ACBT):

This cycle can be repeated until your lungs feel clear. If you have any questions, please ask your physiotherapist.

Normal breathing - This is normal gentle breaths which can help to ease wheeziness and help you feel more relaxed.

Technique: Place a hand on your stomach and feel it gently rise and fall with each breath in and out. It should not feel forced.

Deep breath - Helps to take air down to the bottom of your lungs.

Technique: Take a slow deep breath in until your lungs feel full. You will feel your ribs expanding as you breathe in. Your physiotherapist may ask you to add a hold at the end of your breath in for a count of 3, before breathing out and a small sniff on top of the hold. Sigh out slowly, you will feel your ribs relax as you breathe out.

Huff - This helps to clear the phlegm from your lungs.

Technique: Take a breath in. Then, through an open mouth, force the air out of your lungs quickly, as if trying to steam up a mirror.

Your physiotherapist will advise on the breath in. This may be a long deep breath or a more relaxed breath.

Cough: Only cough if you feel there is something there to clear.

Appendix B

Standing Exercises

1.    Knee Exercise

• Stand. Hold onto a support
• Bend your operated leg at the knee lifting your foot off the floor then return to the start position
• Repeat 5 times

Scan QR code for video demonstration.

2.    Hip Exercise

• Stand. Hold onto a support
• Lift your operated knee up off the ground and then lower
• Repeat 5 times

Scan QR Code for video demonstration.

3.    Hip Exercise

• Stand. Hold onto a support
• Take your operated leg back behind you keeping it straight, then return to starting position
• Repeat 5 times

Scan QR Code for video demonstration.

4.    Hip Exercise

• Stand. Hold onto a support
• Lift your operated leg sideways and then return to starting position. Keep your trunk striaght
• Repeat 5 times

Scan QR Code for video demonstration.

Helpful numbers

Oldham
Oldham community physiotherapy - 0161 770 2300
Community occupational therapy - 0161 770 1447
Urgent care response team - 0161 770 4554
Crisis Enablement Team - 0161 770 4554
Social services - 0161 770 7777
AGE UK - 0161 633 0213

Rochdale
Rochdale community physiotherapy - 01706 517775
Community occupational therapy - 0300 303 8886
STARS (reablement) - 0300 303 8886
Urgent Community Care - 01706 517653
Social services - 0300 303 8886
AGE UK - 0161 633 0213
 
Bury
Bury community physiotherapy - 0300 323 3316
Community occupational therapy - 0161 724 2083
Rapid response team - 0161 253 5151
Social services - 0300 123 6720
AGE UK - 0161 763 903

Manchester
Community physiotherapy - 0161 681 0940
Community occupational therapy - 0161 255 8250/681 0940
Crisis Response - 0161 667 3292
Social services - 0161 234 5001
AGE UK - 0161 833 3944