When I was in my 30s I was told that I would need knee replacements in the future due to osteoarthritis and cartilage deterioration in both of my knees. The idea of surgery was scary, especially at that age, and I tried to put it off for as long as possible. I had been working as a movement teacher since the 1970s and I trained in the Feldenkrais Method, graduating in 2005. I wanted to be able to continue with that work, and the pain was making that difficult, so I eventually decided to go ahead with the first of five joint replacement surgeries in 2009.
My knees had begun to bother me a great deal by that point and then I began to have a pain in my right hip as well. Actually it was pretty difficult to tell if the pain was in my hip or my back. But standing had become my biggest issue, even just standing to cook or at a party was very uncomfortable.
After some extensive research I eventually chose an orthopedic doctor who had done many knee and hip replacements and whose clinic conducts long term research and follow up on their patients. Researching my surgeon gave me some assurance of quality and provided confidence that I was making the right decision.
In 2009 the doctor and I both agreed that I needed my right hip replaced and both knees. I had my right hip replaced with a posterior approach in December of that year, then my left knee in May 2010, and the right knee in December 2010. It was a pretty intense two years and I went through extensive rehab during that period.
Then my left hip was replaced by the same doctor in January 2019, again with a posterior approach. Posterior approaches are less common these days as they often require a longer recovery process. There was also a noticeable difference in the techniques and the aftercare provided in that ten year period.
In January 2020, just one year after my left hip replacement, I had a spiral fracture of my left femur which left me non-weight bearing for over three months. I was confined to a wheelchair or to hopping on one leg using a walker. This was very confining as I live in an old house so I had to get creative in the ways that I implemented my movement practice.
Being a Feldenkrais Practitioner who has gone through joint replacement surgery themselves, gave me unique insight into the process and how the Feldenkrais Method can be used at all stages in the process to help with rehabilitation, easing pain and tension, and unlearning habits of movement that are easily be developed when you are in high levels of discomfort.
The Feldenkrais Method played a big part in my own journey with the joint replacements, as I employed the principles of moving slowly and developing increased self awareness to delay my surgeries and to maximize my recovery afterwards.
I used the Feldenkrais philosophy of moving slowly, with awareness, and I started to explore what movement options were available to me, without any stress of needing to achieve something, taking conscious rests during the process. This allowed me to keep my joints moving and legs strong whether I was seated, lying or standing on one leg. Being non-weight bearing for over three months, I was very concerned that my femur would not heal properly. I would also imagine that I was standing and weight bearing on that leg, which seemed to make a positive difference as well.
Hopping on one leg using the walker and using a manual wheelchair further damaged my arthritic shoulders and in December 2022 I had a left shoulder replacement as well (Reverse Shoulder Arthroplasty). This decision was easy for me because the pain and dysfunction in my shoulders was affecting my sleep and the use of my arms.
I used the Feldenkrais Method to prepare for the surgery, immediately after surgery and during my rehab. After the surgery the movements I could do with my shoulder were pretty limited, so I worked around it by stabilizing my arm and moving my rib cage around the shoulder. This helped keep the area active and stopped me from developing negative habits with my breathing during that time.
Between my first joint replacement in 2009 and my fifth joint replacement in late 2022, I have had the opportunity to see how the surgical, pre-habilitation and rehabilitation processes have evolved over the years.
The hip replacement surgery and my two knee replacement surgeries in 2009/2010 required home physical therapy for two weeks, then a further six weeks of outpatient physical therapy. But for my second hip replacement in 2019 I only had physical therapy using an app on my phone.
Shoulder replacements are more complicated than hip and knee replacements for a variety of reasons and require more specialized after care. For that surgery I had twelve weeks of outpatient physical therapy.
I have used this experience of deteriorating joints and my own surgeries to learn and study – both from a patient’s and a professional’s perspective.
The knowledge I gained during the process continuously informs all my rehab work with clients and I have become a bit of an authority on the subject due to my personal experiences.
As a Feldenkrais practitioner I felt empowered in my own recovery process, which allowed me to be interested and curious about my new movement abilities and to explore them in a safe way.
After all the surgeries I began moving the joint immediately using my imagination, which is a commonly used technique in Feldenkrais when pain is present – both imagining movement in the joint itself and also imagining movement in other parts of myself which really helped to reduce the tendency to narrowly focus on the challenging area. This is something I had learned from the Feldenkrais Method, and it became an invaluable tool in my own recovery process.
After a short time I progressed to moving the joint as the protocol allowed, but I continued to use slow and aware movements, with rests after every few repetitions which really helped the learning process. The protocol for each surgery, from each doctor and for each joint is different and it is important to follow the protocol as you begin moving. But this is your body – so the more time you can spend reacquainting with it after surgery the better the outcome will be.
Currently the protocol with hip and knee replacements is that you are fully weight bearing immediately and up walking within hours of your surgery. You will be informed of exact movement parameters as your new joint begins to heal. Most implants are titanium – a non allergen causing metal – and it will either be cemented in place or held in place until the bone grows into the implant.
The knee implant itself is very stable from the beginning with the difficulty being that the muscles, tendons and ligaments must reform to the new shape of the joint and learn to work in a new way. The hip and knee are usually full weight bearing immediately after surgery. An assistive device is used just after surgery to minimize the risk of falls. The hip and shoulder are more at risk of dislocation just after surgery if you receive a blow to the joint. The shoulder requires special attention due to the shape of the joint and the surrounding musculature. With the reverse shoulder replacement the deltoid reconfigures to take over the work of the rotator cuff and so extra support and time are required before beginning to work on full range of motion and strength. The protocols will give you the amount and type of movement allowed after surgery and during your rehab.
Using the Feldenkrais Method after surgery helped me feel how the new joint worked and how the initiation of movement and moving through an action was different after surgery. Beginning with moving in my imagination and doing very small movements enabled me to determine the most efficient and pain free way to move with my new joint. Resting after doing any repetitions allows the body time to integrate the new way of moving.
Your imagination can be a powerful tool, as many of the same neural pathways that activate when you move are also activated when you imagine movement. The muscles, tendons and ligaments are also working when you imagine movement so it can be a wonderful way to begin your movement pre and post surgery.
Before you begin, go through the movement beginning to end in your mind, noticing how you begin the movement, the path the movement takes, where the movement stops, and how you bring the movement back to the beginning. Do this a few times in your imagination, and then begin the real movement.
Getting both the maximum range of motion, strength and endurance in the new joint is the goal in rehab and the Feldenkrais Method can make a great contribution to achieving all of these milestones.
As an addition to that, many people going through joint replacement have had a reduction in their life activities because of long term pain and dysfunction in their joints. The dysfunction and pain is different for each person and each joint. But when you are in constant pain, you learn to ignore the joint that is causing the pain. The Feldenkrais Method can be useful in teaching that it is OK to begin to pay attention to the affected part again, enabling you to discover that the pain is greatly reduced and the movement much improved. After surgery there is pain, but it is usually much less than before and totally different.
The small attentive movements used in the Feldenkrais Method bring many advantages to the affected area to prepare it for rehab – from warming up the muscles, ligaments, tendons, and fascia, increasing blood flow, increasing muscle recruitment, increasing proprioceptive awareness, increasing synovial fluid secretion, encouraging formation of new nerve pathways, facilitating scar tissue formation in the correct direction to giving the soft tissue time to acclimate to the movement requirements of the new joint. This all prepares the joint and tissue to heal, to be able to participate more fully in the rehab and to maintain health and function going forward.
In my own experience the Feldenkrais Method has been helpful in all stages of the process – It helped me delay the surgeries for many years, to prepare myself for the surgeries, and it especially helped me learn to move safely again immediately after surgery and as I worked my way through rehab.
Ongoing work with the Feldenkrais Method is especially useful in helping establish new movement patterns that maximize the function of the new joint and it can help get rid of any compensatory movements acquired while the joint was deteriorating.
About Jane:
Jane Johnston began teaching Feldenkrais Method® Awareness Through Movement® classes in 2003 and graduated in 2005. The Feldenkrais Method is her passion and influences all area of her life. Jane specializes in seniors and special needs students and uses the Feldenkrais Method in all her teaching. Jane Johnston began teaching group fitness classes on land and in the water in the 1970s, yoga classes in 1995, personal fitness training in 1996, the Feldenkrais Method in 2003 and Taiji in 2012. Jane is a Guild Certified Feldenkrais Practitioner, holds several advanced land and water pre/post rehab certifications, is a Certified/Registered Yoga Teacher and a Certified Yang Family Tai Chi Instructor.
Jane’s website and email contact:
https://fitoverfortyvirginia.com/