Hip Replacement in the Martial Arts World

Hip Replacement in the Martial Arts World
Keith D. Yates kicks after his surgery.

A Look at Hip-Replacement Surgery for People Who Kick for a Living

People don’t realize this, but we (humans) are made to lift our legs to the side about like a dog does when he goes potty. But we (martial artists) do all these stretches, we side-kick to the head, and we hit the heavy bag and people with our legs. We wear out our hips.

”Those are the words of Bill “Superfoot” Wallace, a man who knows what he’s talking about. He’s had both hips replaced — twice!

Yes, Wallace has had the surgery known as total hip replacement. So have many other well-known martial artists like Chuck Norris, Dan Anderson and even me. It wasn’t all that long ago when hip replacements were considered risky and the possibility that they would wear out within the patient’s lifetime was considerable. But now, it’s one of the most common surgeries in the United States, and predictions are that in 10 years, there will be more than half a million procedures done annually. And that’s just in the United States.

Is it because Americans are staying more active as they age or because medical science has improved so rapidly? Both, actually. As Wallace points out, “These days, athletes often have shoulders, knees and hips replaced because of the strain of football, karate or whatever.”

Dr. Robert Klapper, Chuck Norris’ orthopedic surgeon, agrees that some martial artists are susceptible to hip problems. He believes that the kicks we do — in particular, the roundhouse kick — can cause injury to knees and hips. He sees what he calls an epidemic of hip replacements in still-practicing athletes 50 and older.

The good news is this surgery is one of the most successful you can have these days. But while it may be routine, it’s still a major event for the human body. So you’ll want to have all the facts. Talk to your doctor and talk to other martial artists who’ve had the surgery. That’s what I did.

My StoryI started experiencing hip pain about eight years ago. At first, it was simple stiffness and soreness after class. It slowly progressed into a “catch” in my left hip while doing something as simple as mowing the yard or climbing stairs. I found myself asking the younger black belts to demonstrate kicks in class because I couldn’t whip out that roundhouse without wincing.

Eventually, I had Dr. Mack Lancaster, my orthopedic surgeon and the same doctor who did my ACL replacement years ago, give me a cortisone shot in the hip. It provided a few months of relief, and I had another one almost a year later. But he warned that repeated shots are often counterproductive because they can injure the joint.

Looking at the X-rays, he said I’d eventually need to have my hip replaced, but in the meantime he wanted me to see another doctor who specialized in platelet-rich plasma, or PRP, treatments. So I went to Dr. Hal Martin at the Hip Preservation Center at Baylor Medical Center in Dallas.

Stretching the Timeline

With PRP therapy, your blood is drawn from the arm and then spun in a centrifuge to concentrate the platelets, which have effective healing properties. This concentrated plasma solution — rich in platelets — is then injected into your hip joint (with a rather large needle, I might add).Incidentally, this injection is the opposite of a cortisone shot in that it stimulates an inflammatory response rather than the other way around. And it’s not the same as the “stem cell” procedures that you might see advertised and which, by the way, are largely unproved scientifically for this particular issue.

Soon, my hip felt better, and I gained a wider range of motion. But Dr. Martin cautioned me that while the platelets could improve function for a while, my osteoarthritis and deterioration of the ball-and-socket joint would eventually catch up with me and I’d need the surgery. So a year or so later, when the pain got bad again, I decided to go ahead.

I know what you’re thinking: Why didn’t I just do the hip replacement years before and get it over with? Well, even though statistics say an artificial hip should last for 25-plus years, I wanted to put it off as long as possible because I didn’t want to risk making the decision on another one down the road.

So after a couple of cortisone shots and a PRP injection over a period of about six years, I decided — at age 67 and with more than 50 years of teaching taekwondo kicks — that it was time.

Like I said, many other martial artists have had it done. World karate champion Dan Anderson underwent the procedure in 2019. He says he attributed the stiffness and soreness in his hips to just getting older. “I hadn’t done high kicks in years,” he admits. “If I swept you, I’d kick you in the head but that was about it.”

Eventually, his wife convinced him to get checked. “She said since I was now on Medicare, it wouldn’t cost anything, so I agreed,” he says. “I was shocked when the doctor came back with the X-rays indicating that I had severe osteoarthritis. I showed them to a couple of my students, and they said, ‘Oh yeah, look at that!’”

Anderson did some research and, after talking to his doctor, decided fairly quickly to have the surgery.

Bill Wallace admits he was one of the people who put it off. “But eventually I couldn’t climb stairs,” he says about his life preceding his first surgery. “So in 1998, I just decided to do it.” He recommends that others not wait until hip pain adversely affects their quality of life.

Buddy Matthews is one of my senior black belts, and he’s had both hips replaced. His were done 12 years ago, and he did both at the same time — something he doesn’t recommend for most people.

All of the above had their surgery done with the posterior approach. Mine, in contrast, used the anterior procedure.

Which Side?

Posterior, anterior? I’d better explain. The anterior approach was first proposed decades ago but didn’t become widely available or popular until recent years. In fact, estimates are that close to a third of hip replacements now are done in this manner.

The anterior procedure is a more minimally invasive technique involving a 4-inch to 6-inch incision on the front of the hip area, as opposed to a large cut toward the back. The advantage is the orthopedic surgeon works between the muscles rather than spreading them apart to get to the ball and socket.

As a result, there’s less recovery time because the muscles aren’t disturbed, and there are also fewer restrictions immediately after surgery (like no crossing your legs or sleeping on your side). So why don’t all doctors use the anterior approach? Well, it requires a delicate hand to avoid nerve damage, so it demands a higher degree of training and expertise.

So some surgeons opt to stick with what they’re more comfortable with. Incidentally, long-term results are virtually the same for both methods. So it’s really up to you and your doctor. Mine was highly experienced in the anterior approach, and I liked the fact that I would be back on the mat a little sooner.

Recovery Time

I was teaching again in a little more than two weeks. OK, I wasn’t actually out there on the dojo floor, but I did bow-in with the classes and then sat in a chair while directing exercises and drills. That lasted a month, and then I was standing and walking among the students again. Within six months, I was kicking. But I was careful to do my exercises for the weeks I was in physical therapy.

Dan Anderson agrees that it’s crucial to listen to your doctor or physical therapist and to not push too hard at first. “I did that a couple of times and paid for it,” he says. “It’s a great time to practice your patience.”

Obviously, the condition you’re in before surgery dictates how long your recovery will be. Active martial artists will be better off than the general population. The protocol is to check your heart, lungs and overall physical condition before you undergo any major surgery. The doctor said I was in good shape for my age, and he predicted that my recovery should be smooth — and it was. He said I could do anything my body allowed me to do after that first six months.

Bill Wallace says his doctor also conveyed the usual precautions but basically said, “You are in great shape, so go ahead and do what you want.”

Still, you should be aware of your age and limitations. In spite of the fact that Wallace says he now can do anything without pain, he did have to have both hips replaced a second time.

Dr. Klapper, Norris’ surgeon and the author of Heal Your Hips: How to Prevent Hip Surgery, says that martial arts can, over the long term, cause stress on the hips and knees. He points out that this stems from the dislocation of the labrum, a crucial tissue within the joint capsule that’s located in the pelvic bone. The large muscles of the hip and thigh are attached to the capsule and labrum, and those muscles can pull the labrum out of place when kicks are performed, particularly with great force, he says. He suggests that martial artists develop a high level of muscular strength and flexibility to help prevent injuries.

My surgeon, Dr. Lancaster, recommends controlling your weight because every extra pound puts additional strain on your knees and hips. Running and other repetitive-impact exercises can cause stress, he says, so consider bicycling or swimming instead.

Dr. Klapper even says that hard-style martial artists should consider how their art’s movements match their particular physiology. Some people just have a joint-and-bone structure that lends itself to possible overwear and injury, so those people might want to think about switching to tai chi or another soft style as they age.

Exercises for Your Hips

Fitness centers often have machines that seem specifically designed to strengthen the muscles around your hip joints, but using them can be problematic if you’re experiencing hip problems. So skip the hip-abductor and leg-press machines and focus on the following exercises instead. Bonus: You won’t need an expensive gym membership; the moves can be performed on your living room floor. (A mat might be helpful.)The side-leg or hip-raise exercise will strengthen the hip abductors with repetition, which is the key to deriving benefit from any exercise. With your shoulders and hips stacked on top of each other, raise your leg about 1 foot off the ground and hold for eight to 10 seconds. If you can, add a resistance band. Repeat on the other side.

A yoga exercise called the “Bird Dog” will boost your core strength without overworking your hip flexors, which squats and leg presses can do. The Bird Dog also can lengthen the front of your hip muscles and strengthen the muscles in the back of your legs. Start on your hands and knees. Extend one arm and the opposite leg, then bring them back in and touch that knee to that elbow. Repeat up to 10 times, then do the other side. (This is also a great exercise for a bad back because it strengthens your core.)Speaking of exercises for your legs and lower body, swimming and bicycling are often recommended. Running is also beneficial as long as you have good shoes and use caution if you already have hip or knee problems.

Be Careful How You Kick

Some young martial artists might be able to kick straight up in the air, but most orthopedic doctors recommend against forcing your hip joints to extend out to such an extreme degree. Obviously, stretching exercises help keep your joints and muscles flexible, but proper technique and alignment can go a long way toward keeping your hip joints from overextending.

Turning slightly to the rear before you extend your side kick can reduce the pressure on the ball-and-socket joint of the hip. This actually helps rotate the hip forward and prevents the femur from pressing against the pelvic bone. Turning the supporting foot into the kick also promotes proper alignment.

By the way, never throw full-power side kicks — or any kicks, for that matter — while wearing ankle weights. That will pull on the ligaments and cause them to overstretch. Practicing side kicks and roundhouse kicks on a heavy bag is the best (and safest) way to develop power and accuracy.

Finally, doctors like Klapper and Lancaster say you should be aware of how your body is “speaking” to you — and always consult a physician if you’re experiencing joint pain.

Unlike a lot of martial artists, Anderson says, he’s “never been the kind of guy to just say, ‘Let’s meet that pain and tough it out.’ Problems in one area can begin to affect your whole body.”

In fact, his blood pressure was approaching the hypertension level before he got his hip replacement and it dropped back down afterward, he says. “It seems weird, but maybe that constant strain and nagging pain put a stress on my system that jacked up my blood pressure.”

Wallace adds, “The longer you wait, the more you start to compensate, and then your back or the other hip can start to feel the effects.”

We martial artists often adhere to a “no pain, no gain” mentality, but that can hurt us in the long run. If you’re having hip pain — or back, knee or shoulder pain — consult a medical professional. We tell people who want to learn how to defend themselves that they have to learn from a professional, not from a book or video. We should follow our own advice.

Keith D. Yates earned his black belt in 1968 from Allen Steen and has been teaching ever since — except for that two-week period after his hip replacement. For more information, visit akato.org.

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