Can Strength Work Prevent Hip Replacement (and Should You Do Pre-Surgery Strengthening?

Storm Baynes-Ryan
Dec 10
3 min read

A few years ago, I came across a piece of research that talked about 44% of people who did an 8 week strength programme improving their hip and knee symptoms so much that they delayed or cancelled their hip or knee replacement surgery.

And then a hip client came in and I talked to them about this piece of research, said I thought we could change things but may need 12 weeks and it did not work. The pain did not improve and they went back down the surgery route. It was successful. But, my prevention wasn't. I wondered what was going on.

Then ... It happened again and again and I started to wonder about the research.

Then I wondered about the population of people I work with.

Farmers are notorious for working hard and ignoring their bodies, until their body tells them it can't go on any more. So...

My question then was "are my clients so focused on getting things done that they only stop when the pain makes them? Is it that we are seeing them later than the time in which we can change symptoms?" What can we do for them in this situation.

Frustratingly for both clients and medical professionals, what imaging looks like has very little bearing on pain in many situations. What that means is that a hip can look very worn and degenerated, and the client can have zero pain. In other situations, people can be in significant pain, completely debilitated, and not have any significant changes on imaging.

What we also know is that we can't take a picture of pain, and pain is multifactorial - it's an output of the brain, not an input to the brain.

What I also noticed was that my clients that had the surgery were also doing really well afterwards. (this is well supported by science).

Doing the exercises beforehand (within the constraints of the pain and movement limitation) and especially strengthening the other side seemed to improve their outcomes. It also can make life more bearable in the interim. It possibly could stop surgery in some situations.

So now, here's what I say -

"We can possibly help your symptoms, and some people delay or cancel their surgery, but time is going to pass anyway, so we may as well do something. We can set you up with a progressive programme that makes your muscles work but doesn't hurt your joints. I'll need your feedback, and you will need to do the work."

What this means

My conclusion, based on the science and my experience is

exercise can possibly buy you some time until you need to have your surgery.
You don't necessarily need to have surgery, and my opinion is that you could prevent it if you start before it's intolerable.
exercise can make you more comfortable up until the point you have surgery because the wait lists are very long
The programme needs to be about 20 minutes, three times a week focused on hip and knee strength (I would also add foot, calf and breathwork, and spiky ball work but that's me).
I generally get my clients to do their work every day for 10 minutes (or what fits their life) as it's easier to set up daily habits than infrequent habits.
I am able to create an individualised programme for you that covers all the things that are happening in your body and for what you need for your body to be able to do. This is what I do!
Exercise can make post-operative outcomes easier/faster/less confusing and concerning.
what we see on the images doesn't translate to function.

If this is something you want to look into, please email me storm@thatfarmingphysio.com to enquire regarding appointments. Initial appointments are in hot demand and are one hour long and can be undertaken in person, or online (which is very successful, even if it can take a while to get used to it).

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