A New Hip and an Old Routine

A New Hip and an Old Routine

Two hours after I was put to sleep on the morning of the 7th October I woke up with a new left hip; to be precise a ‘Birmingham Hip,’ thanks to my surgeon Mr Ronan Treacy MD FRCS and the Birmingham Hip Resurfacing (BHR) process. I’m writing this on the 10th November and already I’m doing resistance training for my upper body, walking well and also uphill walking at a good angle on the treadmills at the gym and low pressure static bike work.

Not my hip, by the way...

When I look back it’s nearly two years ago that I started with the pain in the groin, thigh and lower back, eventually to find, when X-rayed, that I’d worn the cartilage away and had osteoarthritis. I was still at that time able to kick, although with some pain but over the past six months that became impossible as the condition worsened and although over the period I’d had two steroid injections in the hip for pain management the effects lasted days not even weeks. If you have a joint problem - hip, knee, shoulder or wrist, pain management is fine (pain killers or anti-inflammatories) but it’s disguising the fact that there may be a serious problem that you could be making worse

As many readers will know, who may be experiencing the same symptoms, that apart from seriously inhibiting ones training it eventually affects normal, daily activities, and when this became an issue for me I knew I had to take the plunge and get the surgery. Again, as many people will have experienced, hip arthritis can prevent movement in a number of ways, but not affect others. For me, I could still move across the ground dynamically, so able to work drills on focus mitts and bags, hill sprint and even stretch, but not do squats or chamber either leg to the side for the purpose of any round or side kicks.

Mentally, the frustration is what builds up alongside the increasing pain when one has arthritis, and the need to get back to full functionality was the driver in my case to have the surgery, not the pain specifically which could be managed. Not being able to have that functionality across the range of martial arts and fitness training was what got me to Birmingham for the operation and whilst it might seem strange that I left it as long as I did, again, it was a mental issue that held me back - very simply the recognition that, post surgery, it would be some months before I could get back to the level of training which has been my life for 52 years. Facing that prospect was what kept me hanging on and making compromises in my training, needlessly I know, but the prospect of not being able to kick and punch dynamically and train legs as I have done for years held me back from making the necessary decision. If you’re at that point all I can say is do what I’m now saying not what I did - get it sorted out.

But when it comes to a hip replacement what does ‘getting it sorted out mean’? Essentially, there are two main choices; there are actually some other options, but for this article I want to look at the two main alternatives. These are a full, primary hip replacement and the BHR process. Let me go back some 10 years or so when I was at a MA exhibition in the midlands and was talking to an old friend who mentioned he was having the ‘Birmingham Hip‘ (BH), explaining that he knew the surgeon who had developed the process. However, this stuck with me and recently I’ve had the pleasure to be re-acquainted with an old English and British Karate Team member for the early days, Shotokan’s Bob Poynton of the KUGB. I knew Bob had had both hips replaced, but hadn’t realised he’d had the BHR, the first, in fact, being some 21 years ago at a time the process was almost experimental.

His surgeon had been Mr Ronan Treacy who had alongside a MR Derek McMinn MD FRCS pioneered the process and by being bullied by him (which would be more the term than encouraged), Bob made it clear that I should put myself in the hands of Mr Treacy for the BHR if I had any sense. My confidence was also based on the fact that I knew other top Karateka who had taken this route and if anyone researches this process you will see examples of martial artists from around the world who have chosen the BHR over the primary hip replacement, many of whom have travelled to the UK to have it done.

It’s also the choice for ballet dancers as the BHR, due to its unique construction, allows a sporting and athletic future that a full replacement would not tolerate for long, necessitating either another replacement or a cessation of the training. I know of martial artists that have effectively worn away a new hip in just a few years, necessitating another hip surgery. So how is the BHR different and the first point to make is that it is far less destructive of the femur that a primary hip replacement which removes far more of the leg that the BHR, meaning that any further needed revision after a BHR there is a good amount of femur available - even if another BHR is not possible and a full replacement is later required.

If you look at the two diagrams below, this is clearly illustrated. However, the main difference is the technical nature of the BHR that allows far greater range of movement, allowing martial artists particularly a ‘life‘ after surgery that a ‘primary’ hip replacement won’t give, albeit that for many people it will be quite adequate.

However, adequate was not enough for Mr Treacy and his partner Mr Derek McMinn who recognised that there was a large group of people who after a hip replacement wanted to maintain a high level of activity and whilst hip resurfacing had been attempted as far back as the 1950s it was the new metal and metal designed that they developed that changed the landscape. Their first BHR took place in July 1997 with thousands of operations now having taken place and with the BHR having a 98/99% success rate over 10 years in patients with osteoarthritis.

Now back to it.....

So, the plan is to get back to my pre-surgery training routine and I thought I’d share that horror story with readers...! As has always been the case, my weekly training routine rotates around three key areas - the martial arts side of training, resistance training and the support cardiovascular (cv) work that is separate from the cv result that comes from the other two. To be accurate, the typical ‘long/slow‘ cv training that typically we’d associate with steady state jogging, bike work or any other similar work is kept to a minimum as most of this work turns into more distressing, intense interval training - and hill sprints would be a good example of that - anaerobic and lactic fuel state training.

As many people know, my martial arts training is focussed on drills - focus mitts and shields, sparring and bag work. The drills are intense, dynamic and exacting, so the support training, be that resistance work or other gym work is designed to support these demands, so for example with the weights, we are on fairly light/medium weights but very high reps to build muscular endurance; our impact comes from technique not strength.

Have a Target

The other training philosophy is that everything we do has a target. If its weights we may have an obvious number of reps, but we might also make it time - say one exercise but for a minute.. Hill sprints have an obvious finish point, but on one we will introduce a variety of targets using natural features as ‘trigger‘ points. With the pad work, which can have a variety of outcomes, again we may be on numbers, time or, like the sprint work, distance. So these are the three goal - time, number or distance around which we construct all our training routines.

My Saturday Hill Sprinting Track. At its longest sprint its about 200 metres in length

Having these target goals is just that, we have a target, so even if we think our heart is going to stop you know we only have two more drills, 15 more feet of a hill or another 10 seconds of a high intensity interval training type (HIIT) on a static bike or treadmill.

You can’t set fitness as a goal from one of the three key areas as they all obviously overlap with fitness being an outcome of all three, by whatever definition we are describing fitness. Also we overlap all three with certain drills, for example we will use dumbells in continuous padwork, for example we’ll do two minutes continuous padwork but holding 3kg or 4kg dumbells to burn out the shoulders and the same with continuous hooks - even worse. We’ll have sprints down to a partner with a shield and with each run there will be an increasing number of kicks.

The real benefit of developing a wide range of padwork drills is so that we can emphasise different requirements; this might be drills testing impact and speed which may be very testing on form and technique, drills solely hitting anaerobic and lactic thresholds and drills that are very tactically oriented to fighting, be that points or full contact. So how do I split my week.

The Training Week

If I start on Monday this will be weights and cv and I’ll get to the gym, which is one of the national chains by around 1630. Tuesday will be the same and these are my two primary weights days where I split the body in two parts over each day, but excluding legs. Wednesday is a non-training day and Thursday morning is my first martial arts day wit my ‘training day’ group 0900 - to around 1015 or thereabouts. This is why I don’t do legs on Monday or Tuesday as I wouldn’t get through this session.

Friday afternoon would in the past have been the big shoulder session and legs in the ‘functional fitness’ gym attached to the Dojo, the leg part which has dropped off over the past few months as squatting became impossible with the osteoarthritis.

Saturday is back to the large gym to pick up anything that I missed on weights during the week, HIIT on the treadmill or static bike and abs. Although I hit stomach with most of the training during the week, Saturday is a more dedicated day for abs. For the past few months I’ve been mixing hill sprinting on Saturday morning with the Gym work, sometimes going on to the Gym from the hill, sometimes just the hill and, if the weather is really bad, doing the hill sprints on a high incline on the treadmill.

This takes us to Sunday which is my second kicking and striking session, again at 0900 for an hour or more and that’s the week, with a potential 6 days of training sessions, but accepting that for one reason or another there are weeks when I simply can’t make every one, but it will be seldom less than 4 and most times all 6. But lets stand back a bit look at training from a more strategic position. Within all this, there’s the issues of training time, but with one or two exceptions, I’ve kept up the work with only very few missed sessions.

Training times are a lot like trying to save money, in that if you look for 20 pence to save out on one pound at the end of everything else you’re going to spend it will not usually be there to save. If, however, you take the 20 pence out first before you start to spend the pound, you’ll mange on what’s left and probably not notice the loss. This way you definitely get to save up for a rainy day. The analogy with training is that you MUST put the training times in the diary for each week before anything else so they become a fixed asset, rather than hope that you have some spare time at the end of the day.

Sparring with my long-term training partner, Brian Seabright, of the British Karate Association (BKA)

I know it’s a luxury and not practical for most people, but my week revolves around my training schedule. If I have to be away for a meeting for my security consultancy I’ll completely try to avoid arranging it for a Thursday morning and arrange things so that I’m back in time for my Monday and Tuesday gym sessions that start at four. The same applies to Friday and although it seems easy to move times a bit this shouldn’t happen as it will throw out the discipline of meeting a specific goal and affects your training partners for whom it’s better to train without you but at the same time as every week.

It obviously doesn’t matter when you train, whether it’s seven in the morning or in the evening, you just need to be consistent with it. From a motivational aspect, having a routine that you simply ‘plug’ yourself into is the key thing, so you know exactly when you’re going to train and don’t have to ‘psyche’ yourself up to it.

This is the end of the original MAI article and below I bring the strory up to date as of the early part of March 2108.

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Update - March 2018

When I wrote the MAI article I had set a target date of January 2018 for getting back to a complete recovery. I was accurate for most things I train, be that martial arts, strength and conditioning and specifically the heavy anaerobic/ lactic state training drills, with the exception of kicking - which I can do but am still being cautious about. One problem being that the way I kick involves a lot of torque between the two hemispheres of the body and places a lot of strain on the hips and joints so, at the moment, I’m doing what I call ‘positional’ kicking which is executing kicks in slow motion, getting the shapes and muscular control of the positional holds.

This is getting leg my strength back for the necessary stability whilst kicking and is challenging flexibility which, in general, has come back very well. It’s not a ‘symetrical caution,’ so to speak, as I’m already kicking head height on the bag with right roundhouse, something I’m not yet attempting with my left. I’m still cautious, however, when kicking with my right as the holding and twisting for support is all on the left hip, but it’s been holding up well to the dynamics.

I’ve been hill sprinting on my usual track and apart from the bulging eyeballs, red dots in front of them, and a general feeling of being close to death after each sprint, there’s been no issue with the hip - no pain or inhibition.

The difference now by contrast with 12 months ago is remarkable and if anyone is suffering with an arthritic hip then take steps to get a replacement. For me the process of choice was the BHR, but if you need a new hip and you can’t get one through you private health insurer (although you should have no difficulty getting approval), or your local health authority, a primary hip replacement will still change you life.

Intermittent Fasting (IF)

I thought I'd write about this as since the operation in October 2017 I’ve been subscribing to the above regime for eating. I’ll avoid the use of the term ‘diet’ as the IF protocol is not some fad diet with hugely restrictive calorie intake, or some diet with over-emphasis on protein or fats, or the restricting yourself to just the griiled left foot of a frog. IF is about having a time (a window) when you eat, but more critically, a time when you don’t eat. There are variations on these two parameters, but the one I subscribe to is what’s termed 16 - 8. Effectively this means I don't eat for 16 hours but then can within the 8 hour window.

From getting up in the morning I won't eat until around 1500 when I break my fast and then I'll probably have a last snack around 2130 - 2200. What I intend to do is put together a separate article about this as there are many benefits from adopting it or something similar and I can vouch for it in my own case.

Peter Consterdine