Throughout a lifetime as an athlete, I’ve had my share of injuries, surgeries, and comebacks. On December 27, 2021 I had my left hip replaced and started a 3-month return-to-training process that culminated in coaching on the bike at a week-long cycling camp in March 2022. As I’ve shared my journey, many athletes have inquired about the training, nutrition, and pain management strategies I used. I have tried to put together the details of my hip replacement training plan to help other athletes and active individuals in similar circumstances.
Please note, I am not a physician nor a registered dietitian. I have been an endurance athlete for more than 50 years and professional endurance coach for more than 30. I followed my orthopedic surgeon and physical therapist’s directions. In the process I applied proven principles of training and sports nutrition to my recovery, and experienced remarkable results. Although everyone and every surgery is different, I hope sharing my experience can inform and enhance yours.
Background: Why I needed a hip replacement
Back in 1986 I raced for the 7-Eleven Pro Cycling Team, including the Tour de France. That winter, I broke my right femur in a cross-country skiing accident. It was a bad break that split my femur at the knee, between the medial and lateral epicondyles. The resulting surgeries cost me an inch of leg length on my right side. Although I returned to professional cycling, I never fully regained my previous form.
After a few seasons and subsequent knee surgeries, I retired. Shortly thereafter I started my coaching career in 1990. In the decades since, I have worn lifts in my right shoe – cycling and lifestyle shoes – to compensate for the leg length difference. Generally speaking, I did quite well for a long time. In my late 50s, however, I experienced progressively increasing pain in my right knee. By my 60th birthday it was clear I needed a total knee replacement.
I put off my knee surgery through 2020 and most of 2021. However, during the summer and fall of 2021, the pain in my left hip superseded the pain in my right knee. For years, I figured the aching in my left hip was just from my left leg compensating for the shorter right femur. I didn’t realize, however, that the imbalance put so much strain on my left hip that I’d worn away all the cartilage in the joint and was down to bone-on-bone.
Within a span of 8 weeks in the fall of 2021, the pain and stiffness in my left hip increased to the point I could barely climb or descend stairs. It was keeping me up at night, and I was just barely able to control the pain with a combination of acetaminophen, Celebrex, and CBDa soft gels from Planetarie.
The Hip Replacement Surgery
After discussing my options with my orthopedic surgeon – Dr. Jepson of Colorado Springs Orthopedic Group – we decided to prioritize the hip replacement and move the knee replacement to a later date. I contacted my 7-Eleven teammate and eminent orthopedic surgeon, Dr. Eric Heiden, for his advice as well. Initially, I wanted him to perform the surgery. After the joy and suffering we shared in the pro peloton, I have unbreakable trust and confidence my teammates have my back. The only reason I wasn’t Dr. Heiden’s patient was that I couldn’t spend 3-4 weeks in Utah after the surgery.
Anterior vs. Posterior
The two most common ways to approach a hip replacement (total hip arthroplasty) are through the front (anterior) or the rear (posterior) of the hip. The posterior approach is a more established procedure and more surgeons have more experience with it. The anterior approach may have shorter recovery times, but the surgery is more complex. As an athlete, I favored the posterior approach because it spares the abductor muscles (muscles that move your leg laterally away from your midline). The incision is through the gluteus maximus muscle, which heals without repair. The external rotator muscles are detached and reattached during the posterior approach.
Surgery and Immediate Post-Op
The day of my surgery was uneventful (thankfully). I had the surgery at Colorado Springs Orthopaedic Group’s Orthopaedic and Spine Center of Southern Colorado in the late afternoon. I stayed overnight after the surgery and was awakened every few hours to walk around the recovery floor. I had a nerve block for pain management, which lasts for about 24 hours. As such, those nighttime walks were awkward but not painful. I was home by mid-day the next day, after less than 24 hours in the surgery center.
Hip Replacement Training Plan
“Puttering around” is the best way to describe my first day home with a new hip. Every two hours or so, I’d get up from the couch and use a walker to cross the room and get food, water, or medication from the kitchen, or go to the bathroom. For the first day I took an opioid pain killer every four hours, as prescribed. As the nerve block was wearing off, I wanted to make sure I was staying ahead of the pain. I was also instructed to take Aspirin for the first four weeks, to reduce the risk for blood clots.
Having used opioid pain killers after previous surgeries, my top hydration and nutrition goal was avoiding constipation. I purposely drank more water than normal and a combination of protein and lots of fruit and vegetables. I wanted the protein for recovery and the fiber from the fruit and vegetables for regularity.
After puttering around the house, Day 2 was my first venture outdoors. I slowly walked to the end of the driveway 3-4 times during the day – about 5 minutes each walk. Although I didn’t feel like I was at much of a risk for losing my balance, I used the walker because I couldn’t have caught myself if I had tripped.
I continued with my diet of primarily protein, fruit, and vegetables, and lots of water. I had to track my food intake and remind myself to eat when I wasn’t hungry because my appetite was suppressed. For pain management I cut the opioid pain killer from every 4 hours to every 8 hours. I was also taking Tylenol, Celebrex, and Aspirin.
I wanted to get away from opioid pain killers as fast as possible, so by Day 3 I was completely off them. I continued with Tylenol, Celebrex, and Aspirin, and today added back CBDa soft gels from Planetarie. Today I ventured beyond my own driveway and walked about a block around a small park near my house. I repeated that one-block route three times: morning, afternoon, evening.
Day 4 was the start of what I’d call the training plan. Up until this point, I had been just getting through the trauma and immediate post-op pain. Today I repeated the exact same routine as the day before, including the diet, pain management, and three separate walks around the block.
The general format of the training plan was to repeat a given volume of walking for two days, then extend and repeat. So, I did three walks around the block for two back-to-back days, then aimed to extend the walking distance/duration for Day 5.
Instead of three individual laps around the block, I walked two laps at once and completed that twice during the day – or that was the plan. On my afternoon walk, another 7-Eleven teammate – Jeff Pierce, who won the final stage of the 1987 Tour de France – joined me. ‘Pepe’ lives three houses down from me, and after about a mile of walking I told him I thought I was done. His response was reflective of the whole team’s attitude then and now. “Kidd, it isn’t worth kittin’ up for such a baby walk,” he said. I replied, “Pep, you realize some people out there would consider hip replacement kind of a significant surgery.” Pep shot back, “Save that for someone who cares. Let’s go, it is getting late.” Like always, he pushed me to dig deeper, so we went around the block again.
Repeat of Day 5, almost verbatim. The total distance for the day was a little more than 1 mile.
Day 7 and Week 1 Summary:
I was crushed after the increased distances on Day 5 and Day 6. I took a day off to just putter around the house again. Through the first week, I noticed I was sleeping a lot more than normal. I typically sleep about 8 hours per night and I go to sleep around 9:00pm. Due to the energy expenditure from healing, perhaps lower caloric intake from suppressed appetite, and the fatigue from walking, I was wiped out by evening. A few nights in the first week I went to bed before 7:00pm and woke around my normal time of 5:30am.
I dropped the walker in the second week but continued to use a walking stick for stability. Mainly, I wanted to avoid falling because I was still recovering from the trauma of surgery. The incision was still closing and the muscles that were separated and cut were still healing. The hip itself was secure and safe; the doctors assured me the hip wasn’t going anywhere and that I could walk as much as I could tolerate from a pain standpoint.
During the first two weeks I lost weight, despite trying to be conscious about consuming enough calories to support healing and energy needs. I think the suppressed appetite was a major factor, along with the energy needed for repair and recovery.
From an exercise standpoint, I continued extending and repeating walks. At the beginning of the second week I was walking .6-.75 miles twice a day. By the end of the week, I was completing two 1-mile walks per day. I have been a big fan of double-days in training, whether during post-injury recovery or during event-oriented training. Double days are a good way to get more volume or intensity.
Between January 11 and January 18, I went from doing three one-mile repeats (walking) to completing a single 3.5-mile walk. At this point I also started incorporating hills. Through the first three weeks or so, my walks were on flat ground and smooth surfaces. I was purposely conservative on terrain because I wanted consistency and duration. That means reducing the risk of falling.
During weeks 3-4 I was also doing more strength work that was prescribed by my physical therapist. The exercises were pretty basic, including glute bridges, isometric contractions of various leg muscles, and a little bit of work on internal and external hip rotation.
By Week 4 I was walking 3+ miles at a time and needed to get outside my immediate neighborhood. That meant climbing and descending a steep hill, which added to the challenge. I finished the first month of my hip replacement training plan by hiking 4 miles on groomed trails. Nothing technical, and I wasn’t going very fast, but I was back in the woods!
On January 29 I ventured out on my first post-surgery bike ride. Walking is the best rehabilitation exercise following a total hip replacement. And, of course, there’s concern people might fall off a bicycle. I’ve been riding for so long I’m more likely to trip over my feet than crash on my bike. Nevertheless, my surgeon was not thrilled I insisted on riding outdoors instead of inside. My first ride was 18 miles in Santa Ynez, California. I spent a week or so out there, riding 14-25 miles/day and hiking 3-4 miles in the evenings.
When I returned to Colorado in the second week of February, I continued riding and hiking. By this point, my pain management routine was down to Celebrex (prescribed for the knee pain, mostly), Aspirin, and CBDa. I’ve been taking CBDa in a soft gel or drop form in the evenings before bed, and I use Planetaire’s Muscle Rub on my legs – particularly my still pre-op right knee. I can definitely tell a difference if I miss a day of the CBDa: the swelling and pain from my knee flares up and I don’t sleep as well.
For the majority of February I aimed to ride 18-30 miles per ride – mostly road riding with a few gravel rides. I rode 10 times in the first 15 days of February, and walked 1-3 miles/day each day. For the second half of the month, the mileage increased to 30-35 miles/ride and I closed out the month with a 50-mile ride on February 27 – 2 months after a total hip replacement.
I finished the month of February with 444 miles covered (between walks and rides) in 35.5 total hours.
Return to Training Camp
I reached my goal of coaching at the CTS Santa Ynez Cycling Camp from March 14-20, 2022. I’ve been running spring training camps in the Santa Ynez Valley since 2000. I missed a year in 2020 due to COVID, but I didn’t want to miss this year. We had a great group of riders and completed some big rides, including “Manny’s Ride” – an 80-mile round trip from Santa Ynez to Jalama Beach – and the 4,000-foot climb and descent of Figueroa Mountain.
For the month of March, I increased my time and mileage on the bike and reduced my walking time and distance – but I’m still walking nearly every day. In total, I covered 466 miles in March in 36.25 hours.
Summary and Take Aways
I approached my recovery from a total hip replacement almost the exact way I approach training for a major endurance athletic goal. I was conservative in the modes of exercise I used and kept my activities simple. Walking is the best exercise for hip surgery rehabilitation, so I walked. I didn’t complicate it with extraneous activities that increased risk without adding much benefit.
I stayed very consistent with the frequency of activity, my sleep schedule, and my diet. You can see the progression of my training volume on my Strava profile. There were days when I was tired, or when I wanted a heaping mass of pasta instead of lean protein, vegetables, and fruit. But I kept with the simple and consistent steps because the overall effect is greater than the sum of the parts.
I was patient with myself and kept my eyes on the prize, which was successfully completing big rides and being an effective coach on the bike during the March Santa Ynez Cycling Camp. When I started to feel good, I didn’t push my luck or try to test myself before I was ready. I trusted the process, stuck with the plan, and stayed right on track.
There was absolutely some luck involved in my process. I didn’t get an infection, nor did I have any complications with the incision site. I was able to manage the pain effectively with Tylenol, Celebrex, Aspirin, and CBDa. And I had a wonderful support system with my doctors, my partner Sarah, and my teammates, kids, and staff at CTS. If you have a hip replacement in your future, I can’t guarantee you’ll have the same experience I had. But, I hope you can learn from my journey, have a successful return-to-training, and join me for a ride sometimes soon!