Hilary Cartwright was a soloist and Ballet Mistress of the Royal Ballet in England. Later she was the Director of the Royal Winnipeg Ballet and the Netherlands Dance Theatre Junior Company. She teaches ballet at ABT in New York. As a Master Gyrotonic® teacher she is in demand worldwide. -NR
I had THR on my left leg, May 2nd 2003, shortly after my 60th birthday. Two rather monumental events at once it seemed! It had taken me nearly 5 years to arrive at this decision, and en route I had tried every alternative therapy available. By May 2nd I was actually looking forward to the possibility of maybe finally being out of pain.
Initially it had felt like a strained tendon in the front rotator area, and with the conditioned mentality of a dancer I decided to work through it, certain that it would go away. Increasingly though, as I taught a passé retire and then a la seconde, extension became impossible.
I sought help from my chiropractor Dr Richard Klein, a wonderful practitioner, friend and a real healer. He had seen me through a trauma with my back many years previously, when some of the lumber vertebrae had rotated and fallen inwards trapping the nerves running down my left leg. At the time neurosurgeons had said only surgery and fusion of the spine would help. Dr Klein proved them otherwise, so I knew I was in good hands. He was able to keep me going for a long time, but the problem lay deeper: arthritis had already set into that joint, and as I was to find out later, bone spurs had formed. The spurs eventually grew to a point where they snagged the sciatic nerve, literally causing paralyzing pain whenever that happened. The cartilage also got thinner and thinner, until by the time I had surgery, I had reached a condition of bone on bone (Interestingly I do not have arthritis anywhere else!)
Like others before me I took all the supplements, such as glucosamine/chondroitin, etc., trying many different brands over the years, but honestly not really finding much relief that I could be aware of (although afraid to stop in case it got worse!). I also had acupuncture, massage, consulted with an osteopath, had sacral/cranial work to help the spine, and went to several different healers, hoping someone could "see" exactly what was going on. I also kept trying to analyze for myself what was happening, and why, and what I could do to help myself. Very seldom I took Ibuprofen for the pain, as I generally dislike taking any kind of drugs which can both mask the problem and can cause unnecessary and health damaging side effects.
The situation with my hip was also a source of embarrassment for me as I became more and more restricted in my movements. Here I was a teacher in not only ballet, but also in a therapeutic form of Yoga for dancers and Gyrotonic®. The latter I had been involved with from its initial conception. Gyrotonic® was developed by my former partner Juliu Horvath, with a view to help dancers work correctly and with the least amount of injury to themselves. By virtue of my own limitation I felt I was letting everyone down and providing a prominent contradiction to the methods I was promoting.
I have since spoken with other people who also felt ashamed having to admit they were having THR. It is difficult not to feel you must have done something really wrong to have ended up with this condition, but there are many other factors that come into play.
Some can be congenital, and ballet technique can certainly provide an aggravation to these conditions. In my case, my lower back problems dating back to a bad fall during my performing days with the Royal Ballet, England in the '60's, had a lot to do with what finally culminated in a hip problem.
It's really worth tracing back through one's history in order to feel comfortable with acknowledging where the problem originated. Not only do you learn where you may have contributed to the condition and accept that responsibility, but you also learn what else contributed to it, such as a fall or accident of some sort. It helps lessen any morbid guilt or regrets, and allows you to move forward positively, which is a very important part of the healing process both before and after the actual surgery.
It's not only the physical activities themselves that can promote hip injuries, but also the personality type has a lot to do with it. I was always impatient with my own progress as a dancer, and would push myself as hard as I could to attain and improve technical abilities. If my body complained I would ignore it as much as possible and simply expect it to comply. As a result small injuries or displacements, when ignored, seem to eventually disappear. Actually, however, they had gone "underground" only to surface at a later date on a larger scale. With time and experience I have learned to be both a little kinder to myself, and also a little wiser in my approach to injury or fatigue. But I recognize that demanding perfectionist in many of my students. The indomitable spirit of youth cannot be stopped, but it can be guided into constructive rather than destructive patterns.
Many of the stories on this website describe the relief and joy when the pain is gone after the surgery, and I wholeheartedly join in that. The process of my recovery was similar too, and Dr. Padgett was also my surgeon. He is the kindest and most concerned surgeon I have ever met. My first interview with him was over one hour long which was amazing to me and immediately made me feel I was in good and safe hands. He had been strongly recommended by both John Meehan and Georgina Parkinson at ABT who I worked with and knew well.
I also owe a lot to the encouragement of my good friend Stephanie Saland, ex ballerina from NYCB, who went through THR a few months prior to me. We had both limped around together for years, partially in denial and sure we could find an alternative to surgery. I admired her courage in finally facing up to it and she was a great inspiration to me. We continue to exchange notes and experiences, she being a step ahead of me along the recovery route.
Another friend and associate, Deborah Zdobinski,also an ex-dancer and who I worked with in both Yoga and Gyrotonic®, also had surgery prior to me. It was interesting for, in advance of my own surgery, to work with her both on her pre and post operative condition. She gave me wonderful advice, prior to THR, having also been at Hospital for Special Surgery, which helped me enormously with being prepared for dealing with the day to day practicalities one has to encounter when first home, Getting dressed for example can be quite a challenge due to the "hip restrictions" that must be observed for at least the first eight weeks. I got quite good at lassoing my underwear over the extended leg! And found the "reacher" an instrument designed to pick up or retrieve objects out of range, was invaluable.
Their experiences inspired me to go forward with THR, but only after I had tried Synovial fluid injections. These were given by Dr. V. J. Vad, also at Hospital for Special Surgery, who has developed this technique. Synovial fluid is the naturally forming fluid around the joint, providing it with lubrication. The technique is particularly helpful for knee joints, but is still fairly new for hips.
Had I seen Dr. Vad earlier, when the condition of deterioration was less advanced. I may have been able to continue with these injections for a while, but they were expensive and not covered by Health Insurance at the time. The first time, I was able to walk out of the office without pain for the first time in years, but gradually over 2 - 3 months I was back where I started again. I tried one more time, but that only lasted 10 days, and at $600.00, it was an expensive Band-Aid. He agreed I had reached a point when I should consult a replacement specialist, and also recommended Dr. Padgett. I then had the THR with a titanium and plastic combination on Dr. Padgett's recommendation, and feel comfortable with that choice.
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As for my progress after surgery, I am deeply grateful for the attention and wonderful work of Marika Molnar at West Side Dance Physical Therapy. She was both instructive and protective. When I started teaching again for the American Ballet Theater's Summer School, 7 weeks after surgery, she insisted I still use my elbow crutch outside the studios. She was absolutely right, because I felt safe in the studio, in control of my own actions, but on the streets and in the subway I was subject to being pushed and shoved indiscriminately, regardless of the crutch, and I was glad of it to fend of possible accidents. My scar was still fairly vulnerable, and being summer there were no thick clothes to protect it from accidental bumps and jostling, so the crutch came in handy for keeping people at bay!
Marika was assiduous with me about learning to walk correctly again, after years of limping and compensating, and she truly taught me how to walk again. And that, if nothing else, was a reward in itself. I still get a kick out of it every day when I am out, not having to think how far it is to walk somewhere and whether or not I can make it. And climbing stairs is almost fun, in that I can do it with no pain!
I have nothing but gratitude for everyone concerned with my recovery. I am perfectly willing to accept some minor limitations and weaknesses, which I still feel, but with time and work I am sure will improve. Having worked together with my Gyrotonic® clients with hip-problems, I have developed a series of exercises to both strengthen and free up the joint and the surrounding muscles, ligaments and tendons. And it is encouraging for me to see their development, and to keep working on my own as well. Being a perfectionist by nature, it has been a valuable lesson in learning to take things slowly and not be impatient for instant achievement. It is also encouraging to hear from Stephanie and Deborah how each month brings new growth and strength, even more than a year after surgery.
February 22, 2004
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