198 replies to this topic

[SeanP]

Anyone had any experience with this? It is the likely cause of the osteitis pubis I am experiencing. Mismatch in size of femur head and hip socket causes friction and then bone spurs that then interfere with smooth movement of hip. This has put stress on to the rest of my pelvis and hence the OP. Eventually cartilage damage and arthritis = hip replacement. The size mismatch is fairly common but usually only becomes a problem in active people.

MRI next week to determine extent of problem and to consider surgical options. Surgery can be simple - arthroscopy to debride extra bone with full recovery in 3 months. Or complicated, with recovery up to 18 months.

The really hard part is getting in to see the surgeon. David Young is the guru but can wait up to 6 months to even see him, let alone get the surgery. In the meantime, I am not to do ANY exercise of any sort - no swimming or riding, even walking is bad.

So, anyone been done this path before and had surgery with anyone else with a shorter waiting list?

p.s. after 25 years of running with a previous longest break of 2 weeks, you can imagine the prospect of several months to over a year without running is not exactly thrilling me.

[NeillS]

I have some experience with it. The link to osteitis pubis is a tenuous one at best in my humble opinion. How have you had it diagnosed?

There are a few types of FAI as you would have already found out, most usually present after a labrum injury OR they can be developmental (neck of femur is poorly shaped during growth phase).

What are your current symptoms (in detail) and what is it stopping you doing? I gather you've just had plain films taken thus far?

edit: where are you located? The guy i send my hip scopes to in Melb is John O'Donnell, he's one of the best in Aus with these.

Edited by NeillS, 11 June 2010 - 07:21 PM.

[sportsphysio]

NeillS, on Jun 11 2010, 07:20 PM, said:

The link to osteitis pubis is a tenuous one at best in my humble opinion. How have you had it diagnosed?

Agree with Neill on this one. I frequently see hip/groin injuries in runners that have been previously diagnosed with OP caused by hip problems/leg problems/shoulder problems/financial problems.
The link is usually made because OP was the first label put to the problem and, when an actual pathology is found, the clinician can either admit that it was missed first time around or draw some tenuous links to explain it away.

Research on groin pain has shown that up to 50% of groin pain is actually referred from hip pathologies. Chances are that the "OP" in Sean's case was actually referred hip pain from the FAI.

Also noteworthy is that the term "osteitis pubis" actually refers to an inflammation (+/- infection) of the pubic symphysis that can occur after childbirth and suprapubic surgery. It is not a label for sporting groin pain in the absence of finding any other explanation or pathology (it tends to be used as a medical term for NFI).

Edited by sportsphysio, 11 June 2010 - 09:09 PM.

[SeanP]

Thanks NeillS. am in Melbourne and O'Donnell has been recommended by several people. So far just xray, which suggests a small spur on femur. I've had no pain in hip area or locking or clicking. Have always had poor ROM and MAYBE it has gotten worse in recent years, but I put that down to general muscle tightness than any actual locking of hip.

The OP was suggested as very probable by a physio I went to after several months of various groin pains. Began as tightness and pain on running in iliacus/psoas area. No particular incident brought it on, it just appeared during a normal low intensity flat run of moderate length. I had had some tightness there in previous years, usually brought on by return to long runs in the hills when somewhat unfit. Some simple hip raise exercises and lower back exercises had sen in right in the past but to no avial this time. Sought further advice from another physio. Both hips very tight and unstable, but especially left (where problem is). Gave me more rigorous exercises and lots of them, including clam shells. As soon as I started these I began to have adducter soreness and general aches and fatigue in the quad/groin area. I persisted but found I could not continue running. reduced the exercises and the new symptoms improved and eventually stopped them as they did not seem to ease original symptoms at all. Then went to a masseuse who greatly eased the iliacus/psoas problem. Over 3-4 sessions the pain reduced and seemed to move lower and become more localised. I was also running freer than I had in ages - the whole hip area felt freer and more able to produce power, which was what really brought home to that I had had loss of ROM in recent times. Pain eventually settled in what felt like the attachment of the rectus abdominis onto pelvis. If I did a half situp and tried some self trigger point work on it, I could greatly unlock the tightness and soreness, and would do so during a run two or three times. But it was hit and miss - some days it was very manageable, others I would have to curtail runs - less because of pain than general stiffness and loss of power through the left hip region.

I did Trailwalker in April and I had some pain and tightness in the spot for the first 60 k, but hip area not too troubling. By 60k the pain disappeared. Completely. for two weeks afterwards there was no pain or tightness at all. running 100k seemed to be the cure. But then it gradually crept back. I was actually running freer and more powerfully than I had in months but the masseuse reckoned I was way tighter than before TW, which got me thinking that all the loosening work had made things worse  and tightening it all up again by running 100k had helped it!

I went to another phsysio to see if he could help the localised sore spot. It was improved and less restrictive than before but still annoying. He thought OP and ordered two weeks off running and similar exercises to before. Straight away the adducter pain returned (there was none outside these periods of physio) and general soreness and weakness in the groin/hip area. Hard to tell if the original pain had improved as it mostly manifested during running but return to phsyio still showed positive crossover sign - indeed it seemed far worse. He then sent me to sports doc at Olympic Park Sprts Med. Poked and prodded and found left groin very tender, very poor ROM in left hip, very tight adducters, total lack of strength on squeeze test, and pointed out the small bone spur that MAY be involved, hence the MRI to confirm diagnosis and decide course of action - but she was very sure of FAI and felt that this had produced the OP. Some of it maybe rang true to me, but not all. as I said, before the phsyio there was just this one tight sore spot in what felt like rectus ab attachment area. And this was not tender to touch, indeed trigger point relaxed and relieved it.

If you made it this far - thanks!

[NeillS]

Certainly a long and convoluted history. It's not a regular osteitis pubis or adductor tendinopathy i would think. If you came to me and told me that story, the first thing i would do is have you get an MRI to assess both soft tissue AND bone/joint status in the pelvis. I don't think I would bother messing around with conventional treatment (which it sounds like you have already had). So the MR is a good step in the right direction. Can you please post up the results when they come in? I would be interested to see.

What you say about rectus abdominus insertion point is interesting. I have never seen an enthesopathy of this muscle although I do believe they exist. Indeed just today i was scanning through the Brukner and Khan clinical sports medicine textbook and saw a few sections on these types of things. If you have no luck with the sports med. doctor it might be worthwhile talking to the very bloke who wrote the book, Mr Peter Brukner (who i believe owns OPSMC), for a more 'in depth' assessment, although funnily enough regardless of the pathology the treatment is often the same - rectify any hypermobility issues with strength training, rectify any weakness issues with strength training and loosen any hypomobility issues with mobilisation before embarking on an intensive stability training regime to stabilise the pelvis.

Good luck!

edit: you repeatedly mention hip flexors and that the pain appears more anterior rather than medial deep in the groin? If so you could be looking at an iliopsoas issue, possibly lumbar in origin, but i'm sure you've already that that looked at and treated? I have also seen antero-superior labrum injuries cause similar problems but for it to be bilateral would be unusual.

edit2: have you had someone do a femoral slump test on you yet? They will get you in a Thomas test position (lie on back, one hip in full flexion, the other leg hanging into space) and test the neural tension in your psoas particularly to assess if it's neural pain. Positive test is reproduction of anterior groin/thigh pain sensitised by neural tension (cervical flexion or knee flexion).

Edited by NeillS, 11 June 2010 - 09:51 PM.

[SeanP]

thanks again Neill. I'll let you know what the scan finds. But I must say that after several days of no exercise and prescription-strength ibuprofen, everything feels a whole lot better!

[Nuffy]

Hi Mate
I have been down this path ( old thread ) and am going under the knife for a Laporoscope next week - I was treated for groin , hip flexor and whole heap of other suspects before finally getting an MRI revealling FAI with a Lump on the bone and torn labrum ... Was great to finally get to the bottom of 18 months of pain that was getting to the point where running was simply not possible without 3 days of pain and even walking is difficult some days .
I am in Sydney but found a well recommended Surgeon and was booked in 2 weeks after initial appointment.
Actually really pumped about getting this fixed and hopefully running again soon
Will advise how the recovery goes - won't have much else to do !
Andrew

[SeanP]

thanks andrew,

Seems there is a lot of it around! thanks for the heads up. The funny thing with mine is that there is no pain afterwards - just a small isolated area of tightness and short stabbing pain with each step. Or at least that is what it was before the physio exercises which seemed to bring on a whole host of adducter region issues - not so much soreness, though there was that too, but just loss of power and coordination.

great that you were able to get in so quick for the scope. best wishes for the surgery and recovery. please keep us posted on your progress.

cheers

sean.

[SeanP]

MRI today. Mixed bag of news. Couple of relatively minor spurs and minor labral tear. Surgery prob not necessary but doc will seek another opinion (and wouldn't you know it, their lab's system crashed today so have to wait yet again for a verdict once the scans can be viewed by the specialist).

The bad news is the the osteitis pubis is pretty clear and to go with it, a probable stress fracture of the pelvic girdle. Upped the anti-iflams to cortisone, and another 3 weeks of absolutely nothing before reassess. Seems should be flat on my back as much as possible as minimising weight bearing, even walking and even sitting, will be  a good idea. Hope to be able to return to some activity, including physio to start to manage this thing, in 3 weeks. But even best case it will be another 2 months before we can think about real exercise.

[NeillS]

SeanP, on Jun 17 2010, 09:29 PM, said:

MRI today. Mixed bag of news. Couple of relatively minor spurs and minor labral tear. Surgery prob not necessary but doc will seek another opinion (and wouldn't you know it, their lab's system crashed today so have to wait yet again for a verdict once the scans can be viewed by the specialist).

The bad news is the the osteitis pubis is pretty clear and to go with it, a probable stress fracture of the pelvic girdle. Upped the anti-iflams to cortisone, and another 3 weeks of absolutely nothing before reassess. Seems should be flat on my back as much as possible as minimising weight bearing, even walking and even sitting, will be  a good idea. Hope to be able to return to some activity, including physio to start to manage this thing, in 3 weeks. But even best case it will be another 2 months before we can think about real exercise.

Ouch. Best of luck. Sounds like your pelvis has seen better days unfortunately.

[SeanP]

damn. surgery back on the cards. closer look at scans shows the OP to be severe, involving the rectus ab and adductors - which explains why they were giving me so much grief. Doc figures seeing as I am going to be resting so long anyway, I may as well have the surgery as the FAI is likely a contributing factor. Waiting on appointment with surgeon. Experiencing a few twinges in the area that were not there before - wonder if this is due to deconditioning and the muscular support I had for the pubis is starting to wane? But even so there is nothing I would call pain or locking or real restiction, so it is hard to believe my first real running injury in 25 years turns out to be such a doozy!

Nuffy - you had your op yet?

[Nuffy]

SeanP, on Jun 23 2010, 09:51 AM, said:

damn. surgery back on the cards. closer look at scans shows the OP to be severe, involving the rectus ab and adductors - which explains why they were giving me so much grief. Doc figures seeing as I am going to be resting so long anyway, I may as well have the surgery as the FAI is likely a contributing factor. Waiting on appointment with surgeon. Experiencing a few twinges in the area that were not there before - wonder if this is due to deconditioning and the muscular support I had for the pubis is starting to wane? But even so there is nothing I would call pain or locking or real restiction, so it is hard to believe my first real running injury in 25 years turns out to be such a doozy!

Nuffy - you had your op yet?

Gday Sean
Sorry to hear your news , I know how you feel !
I am actually sitting in hospital after undergoing surgery yesterday ... apparently it was alot worse than the MRI's revealed and it certainly feels like they did some serious work . I won't be running for a long time yet and will be giving the marathons a miss .
At the very least my op has delayed me needing a new hip for another 15 years or so ...
If you want have a chat about it PM me for my #.
All the best
Andrew

[SeanP]

Finally saw the surgeon yesterday. very thankful he can fit me in to a very very busy schedule. He saw no sign of FAI. Yes, I have very stiff hips but they've probably always been like that. The indication that my sports doc saw as a likely bony impingement he thinks is a 'herniation pit' - benign and common. The labral tear was also insignificant. And the stress fracture he is preferring to call a stress reaction rather than a fracture (but it was impressive - he's making copies of the scans to use in lectures). So - where to? Yay! more scans, CT this time for closer look at everything. good news is he will see me as soon as the scans are done tomorrow. stay tuned.

[SeanP]

aaggh. CT made it clear that I do have FAI. femur neck has excess bone on it that needs to come off. Fairly confident that after this the osteitis pubis and stress reaction will resolve once proper hip function is restored. So booked for Sept 4. He'll clean up the larbral tear while he's at it. Looking forward to being back to full exercise by Xmas.

[Rell]

SeanP - it all sounds very complex!  What CAN you do exercise wise between now and the surgery?  And did the surgeon say an approximate recovery time until you get back into some regular exercise again?

Good luck with it, and remember to keep positive as much as you can

Rell

[NeillS]

who's doing your scope sean?

[Nuffy]

Gday Sean
I suppose that's progress and that is good news mate ... Just be realistic about your recovery to save you dissappointment. Every procedure is slightly different and with all the scans in the world they won't know the full extent until they go in.
One thing that I have realised is all the aches and pains I have been getting in my lower back / groin seem to have cleared up since my surgery ...may well have just been referred pain from the Hip issue ?
You may not want to hear this but getting one side fixed is usually half the job ...
Cheers
Andrew

[SeanP]

David Young is doing the scope, so am in good hands. Recovery is expected to take 3 months depending on how much they need to do - the scans show the bone clearly but they only give an indication of the cartilage damage (fingers crossed it is not too bad). Often the other hip is involved - about 40% of the time, but only about 10% of the time does it also need surgery. So am hoping those odds are in my favour! At least there has never been any right-side symptoms, though perhaps they'll develop in future.

Planning to at least start some swimming (and perhaps cyclcing) again now for the next few weeks and see what I can do re some of the physio exercises that don't aggravate the symptoms to build up as much strength as I can before the op and hopefully hasten recovery that way.

Thanks for the support guys - how's your recovery going Andrew? Rell you're off for a follow up today? good luck!

[NeillS]

David's a good surgeon but he's more of a knee specialist. There certainly are worse people you could see, but my pick of the bunch would be John O'Donnell or Vincent Yap. Best of luck with it all mate!

[Kev]

I am also waiting for an apointment with Dr Young after being diagnosed with FAI and a torn labrum. The MRI also indicated chronic Osteitis Pubis, so it looks like the two conditions occur together often.

I ran Gold Coast Marathon in July, and during the buildup I experienced increasing problems with what I thought were tight hip flexors.  Also woke up every morning with cramping in the adductors.  The second half of the marathon was a real struggle and I have hardly run since.

My Dr said that having the hip surgery will give my OP a chance to settle down, but to be honest I have read a lot about failure of conservative treatment (rest) for OP, with surgery the most successfull outcome in athletes.  Can anyone comment on this....

The hip surgery seems to be quite successfull in athletes, it's the OP that is really worrying me.

[SeanP]

Hi Kev,

This FAI boat is getting overcrowded! Sounds like a very similar suite of symptoms. I'm also a bit worried about how well the OP will settle, but it seems more and more that OP may be so difficult to resolve because the root cause, ie FAI, is often overlooked.

was watching one of the sports footy shows last sunday when my daughter yelled out there was a footballer on who was heading off for hip surgery. A bit of investigating and came up with the following:

http://www.carltonfc...16/default.aspx

So it's comforting to see that their OP settled completely after the op.

Two weeks ago I started doing some swimming again after giving the stress fracture/reaction some time to heal. It has made a huge difference to the adductor pain and general stiffness I was starting to feel in the region - I suspect a result of 8 weeks of inactivity. Have thrown some easy spinning on the windtrainer into the mix now as well and that has improved things even further. Still 4 weeks to surgery, but looking forward to crutching out of hospital on Father's Day! Good luck Kev. Let us know what Mr Young reckons after youv'e seen him and your surgery date.

[Kev]

Thanks for the link Shaun, just what I needed to hear.  If a footballer can be back to full training 12 weeks after this surgery then I am far more confident than I was before about the impact this will have on my running.

Very frustrating at the moment as I am pain free after 3 weeks rest, the inflamation from the OP has settled, but the sports doc still says no running till after the hip ops.  She thinks Dr Young will do both sides 2 - 4 weeks apart.  At this stage I am only allowed upper body work, boxing (feet planted) and swimming with a pool bouy between knees.  I have heard that you can do some cardio work on a hand ergometer, but not sure where to find one of those.

Good luck with your surgery Shaun, hopefully I will be going in not long after you, but still on the waiting list to see Dr Young at the moment.  My doc said he normally operates not too long after the first consultation.

Kev

[SeanP]

It's a frustrating wait for sure. But resist the temptation to do anything, as if the FAI is the cause, the OP is likley to just come back. I mowed the lawns on the weekend for the first time in 2 months and am paying for it big time now!

My surgery was booked for 5 and a bit weeks after the initial consult. It was the first slot avialable, and in fact the two guys who booked in for the same thing before me that day were actually booked in later - the slot I got was overlooked in the busy busy schedule he has. But I think they were only another week or two after that. Let's hope things free up a bit and he gets you in quicker than that, especially with two hips to do!

Is the sports doc you seeing Karen?

I've also found a physio who has a particular interest in FAI, OP and the like and recovery from the surgery.

PM me if you like and I'll give you my number and we can have a chat.

[SeanP]

home resting now after surgery yesterday. surgery went well apparently. the range of motion that has been restored is amazing - from zero degrees to about 35 degrees or more.  cartilage was a bit chewed up at the margins but he didn't seem too concerned about it and cleaned it up. crutches for two weeks. back on windtrainer for 5 mins twice a day starting in a day or so. remarkably little pain - actually just mild discomfort. only taking the odd panadol as a preventative more than anything (some of the physio exercises hurt a bit). came thru everything well - was naseous but only from lack of food! once i got fed I was fine

[Nuffy]

SeanP, on Sep 5 2010, 04:22 PM, said:

home resting now after surgery yesterday. surgery went well apparently. the range of motion that has been restored is amazing - from zero degrees to about 35 degrees or more.  cartilage was a bit chewed up at the margins but he didn't seem too concerned about it and cleaned it up. crutches for two weeks. back on windtrainer for 5 mins twice a day starting in a day or so. remarkably little pain - actually just mild discomfort. only taking the odd panadol as a preventative more than anything (some of the physio exercises hurt a bit). came thru everything well - was naseous but only from lack of food! once i got fed I was fine

Gday Sean

That's great news mate ! My ROM is a heap better as well , I am using muscles that have been long dormant and that has probably been the most painful part of my recovery ...

Was your surgery  just a cartilidge clean up or did they do some bone work too ?

I am 10 weeks post surgery and am back running 10km ... not fast but who cares ! It is a MASSIVE relief so hopefully that will allay some of the fears your self and Kev have.

Started very slowly after 7 weeks and have built up from 10 minute slow jog ... wind trainer sessions are the key , I ended up doing every second day between 45mins and 80 mins and threw in some HR efforts towards then end ... again just build up very slowly !

Enjoy your rest mate

Andrew

Edited by Nuffy, 06 September 2010 - 10:42 AM.

[SeanP]

Nuffy, your recovery has been really impressive! and sensible. I take a lot of comfort from it.  Yes i had lots of bone work too. can certianly feel that raw bone as I put the leg thru its ROM exercises. Not really painful but not a nice feeling!

I am not sure whether they just did a debridement on the cartilage or a repair job, ie, a couple of stitches to keep it in place. certainly no microfracture needed so that is good news.

Keeping my fingers crossed for Kev to be able to get in soon! Now that football season is almost over maybe he'll get in quicker - though while I was waiting in theatre my surgeon popped in to get the anaethetists started, saying he just had to go see a footballer, presumably from friday night's game! at least you know you are in good hands then!

[Kev]

Looks like November 18th is my surgery date, Karen tried to get me in earlier, but unfortunately David Young is off overseas for a while so no hope. Very disheartening, but then after seeing how well you guys are going I am at least more confident of a positive outcome.

Hopefully by New Year (6 weeks ex surgery) I should be able to start some light running.  Actually feeling quite good at the moment, with all the strength training my OP has really settled, and I am able to do a couple of light runs each week, just enough to keep a small base to build on.

Look forward to more updates guys...

Kev

[SeanP]

Kev, on Sep 27 2010, 11:37 PM, said:

Looks like November 18th is my surgery date, Karen tried to get me in earlier, but unfortunately David Young is off overseas for a while so no hope. Very disheartening, but then after seeing how well you guys are going I am at least more confident of a positive outcome.

Hopefully by New Year (6 weeks ex surgery) I should be able to start some light running.  Actually feeling quite good at the moment, with all the strength training my OP has really settled, and I am able to do a couple of light runs each week, just enough to keep a small base to build on.

Look forward to more updates guys...

Kev

at least you have a date now and a goal to start the new year off to a running start. and good news that the op has settled enough to allow some maintenance running in the meantime. I've now been 4 months without a run and nearly 6 months since regular running. good news is my limp is starting to fade and doing some decent walking and riding again - though I have mixed advice on how much I can do and when. Still got some op symptoms though, which I am disappointed about and will need to work out how best to tackle them. best of luck!

[Nuffy]

Update for Kev and Sean and any other poor buggers with dodgy hips !

Just over 3 months now since surgery and am back running 3 times a week ... doing approx 6-10km per session and the hip feels pretty good. It gets a little unstable and I get a bit of pain but my physio has told me my Gluteus medias is getting hammered ... I think that has been taking way too much load over the last couple of years that I have had this issue.
Physio is now focused on exercises to strengthen this and stabilize the area and it seems to be working ... it's one of those "mickey mouse " exercises that I used to write off as it can't possibly help but it really isolates the area and is getting better all the time.

If you get pain behind your hip in the top of your glute then that could be another cause... Its an area that gets hammered when your form starts to drop while running  ...so when you start running and your form starts to drop due to weakness in the area/ tiredness etc ... stop and walk home ... otherwise the whole area blows up !

As for the hip ... no clicking or clunking ... and feeling alot more positive about my running prospects now and have even signed up for a race in NZ in April !

Hope it goes well Kev

Andrew

Edited by Nuffy, 07 October 2010 - 11:02 AM.

[SeanP]

thanks for the update Nuffy.

the OP symptoms I was worried about are OK now, largely. Physio tested me for it last week and I was negative, so it is just a bit of general soreness. Your physio seems to have the same approach as mine - good to know they agree. glut med is what I am working on mostly. Had a lot of dry needling there and in surrounding muscles! Yowsers! but it really works. still got some soreness in adductor region. riding every second day for 20k/40 min and walking most days for 20-40 mins and swimming every second day. starting to shed some kgs now so making it all a lot easier. supposed to start considering jogging in a week or so but even a shuffle across the road to dodge traffic I find the muscles protest. Physio reckons it is muscles learning to work properly again after years of dysfucntion - makes sense.

keep up the good work!

[Kev]

Thanks for the updates, great to see you both progressing well. My physio has me doing glute exercises too, so seems most agree that that is a problem area.  I have been doing 2 hours a day of core exercises now for over 6 weeks, and even though I have not yet had the op I feel a massive improvement in the OP symptoms. (almost symptom free)

My physio has cautiously OK'd me to do a light run 3 times a week which seems to be going fine, but if I overextend my hip reminds me that it in need of attention.  Nov 18th seems a long way off, but part of me thinks that another 6 weeks of core work will really improve my strength and get me back running as soon as possible after the surgery.

I am not getting adductor pain in the OP area anymore, but my right adductor magnus is extremely tight and my physio still won't let me do any stretching exercises. As a result I am getting some soreness on the inside of my knee where the adductor attaches, but find a good sports massage does give relief.

On the main I am feeling positive about a good return to running, hope to see you guys back on track soon.  Thanks again for the updates, it's really helping me come to terms with whats ahead of me.

Kev

[SeanP]

two hours a day! far out! I am lucky to take 15 mins a day to complete my exercises (and that is if I am not being slack and skipping some). I've got some niggling soreness I can't shake and can't decide whether it means I need to do more, or less.

[SeanP]

ahhh, two steps forward, one back.

seems tfl tightness is contributing to adductor region soreness and restriction. eased off on my walking and the physio exercises until saw the physio again. massage and stretching and dry needling helped enormously but after a couple of days it returned. got into the area with a massage ball and found I was suddenly walking without any pain and limp almost gone. but again it has returned on odd days and today was especially sore and ball work and stretching seemed to do nothing.

saw the sports doc yesterday and the good news, which I hadn't actually heard, was that the surgeon's report showed there was no degen in the hip joint. Hip is still very unstable so doc will talk to my physio and refine the plan of attack for appropriate strengthening. I have to wind my walking back to no more than 30 mins a day, and not allowed to tumble turn in the pool. bike unrestricted as long as I stay seated. Doc is hopeful that in another month, so 11 weeks post-op I will finally be able to introduce a walk-jog regime. return to real running is looking a lot further down the track. Retraining these muscles is taking longer than I had hoped!

but it is certainly better than if I had persisted without the op and destroyed my hip (and I do enjoy the lie ins in the morning).

[Kev]

SeanP, on Oct 22 2010, 08:04 PM, said:

Hip is still very unstable so doc will talk to my physio and refine the plan of attack for appropriate strengthening. I have to wind my walking back to no more than 30 mins a day, and not allowed to tumble turn in the pool. bike unrestricted as long as I stay seated. Doc is hopeful that in another month, so 11 weeks post-op I will finally be able to introduce a walk-jog regime. return to real running is looking a lot further down the track. Retraining these muscles is taking longer than I had hoped!

Hang in there Shaun, sounds like a tough recovery... I was kinda hoping that 6 weeks ex op I would be light jogging but seems that may be a bit too optimistic based on your experiences.

Tbh, my op is in 2 weeks, but I have been having serious doubts as to the benefits in my case.  With all the strengthening stuff I have done I have managed to get back into near normal running k's, but only slow stuff and the hip does remind me that all is not OK if I push too hard.  However the O.Pubis symptoms have practically gone, but I am sure without the surgery they would soon return once I start racing again.

Also, reading some stuff on the net it seems without the op the hip will degenerate much faster....

So, its no surgery and be happy with slow jogging or take the risk that I will be able to race again if I do go ahead.  Racing is my passion so I am still leaning towards going ahead.

Shaun, do you think the instability in your hip that you mentioned is due to the surgery, or due to pre-surgery low core strength?  Knowing this would help me as I think I would be going into the op with much improved core strength than when I was diagnosed, and maybe this might help in my recovery.

It has really helped me having you guys share your experiences, good and bad, so thanks heaps.

[SeanP]

Kev, on Nov 3 2010, 10:41 PM, said:

Hang in there Shaun, sounds like a tough recovery... I was kinda hoping that 6 weeks ex op I would be light jogging but seems that may be a bit too optimistic based on your experiences.

Tbh, my op is in 2 weeks, but I have been having serious doubts as to the benefits in my case.  With all the strengthening stuff I have done I have managed to get back into near normal running k's, but only slow stuff and the hip does remind me that all is not OK if I push too hard.  However the O.Pubis symptoms have practically gone, but I am sure without the surgery they would soon return once I start racing again.

Also, reading some stuff on the net it seems without the op the hip will degenerate much faster....

So, its no surgery and be happy with slow jogging or take the risk that I will be able to race again if I do go ahead.  Racing is my passion so I am still leaning towards going ahead.

Shaun, do you think the instability in your hip that you mentioned is due to the surgery, or due to pre-surgery low core strength?  Knowing this would help me as I think I would be going into the op with much improved core strength than when I was diagnosed, and maybe this might help in my recovery.

It has really helped me having you guys share your experiences, good and bad, so thanks heaps.

Hi Kev,

Definitely my problems are due to years of poor core and glut strength, no doubt made worse as the FAI restricted the natural action of my hip and thus putting more strain on muscles that should not have had that role. It's amazing how committed to the physio you have been and how much it has helped. But yes, if you have a ganz lesion grinding into your cartilage it can't be good! My good news that the hip itself was fine should be incentive for you to have the op too before you do any damage. I imagine you could well be jogging in 6 weeks as your prehab has been so effective. I went into it very sore with OP and any phsio I was doing seemed to make it worse.

The other day I tried 'jogging' (slower than  cliff young - much slower) for 50 m at a time, about 4 times. and the muscles just tensed up and left me very sore. The hip itself is no drama, it is just the muscles objecting! I was so sore I stopped any physio exercises for a couple of days and didn't go for my usual walk, but did do some hardish 1k reps on the bike. Next day, the soreness had gone, totally! I went for a walk, it felt great, I did a few 50-100m shuffles and it still felt great. Back to the physio exercises and pulled up sore again! I am finding I need to do lots of self massage as well to overcome the tightness and when I do things are much better. So it's slow, but moving in the right direction. BTW, I am not suppossed to be jogging yet, and I am not really, I was just trying it out to see if it felt any better with all the phsyio because previoulsy even trying to jog 3-4 mts across a street so as not to get run over would cause the muscles to lock up!

so in short, go for it Kev. the op itself is really a breeze and your core is in soooo much bettr shape than mine, that I expect you will actually make a return to running before I will!

[Kev]

SeanP, on Nov 8 2010, 09:24 AM, said:

Hi Kev,

Definitely my problems are due to years of poor core and glut strength, no doubt made worse as the FAI restricted the natural action of my hip and thus putting more strain on muscles that should not have had that role. It's amazing how committed to the physio you have been and how much it has helped. But yes, if you have a ganz lesion grinding into your cartilage it can't be good! My good news that the hip itself was fine should be incentive for you to have the op too before you do any damage. I imagine you could well be jogging in 6 weeks as your prehab has been so effective. I went into it very sore with OP and any phsio I was doing seemed to make it worse.

The other day I tried 'jogging' (slower than  cliff young - much slower) for 50 m at a time, about 4 times. and the muscles just tensed up and left me very sore. The hip itself is no drama, it is just the muscles objecting! I was so sore I stopped any physio exercises for a couple of days and didn't go for my usual walk, but did do some hardish 1k reps on the bike. Next day, the soreness had gone, totally! I went for a walk, it felt great, I did a few 50-100m shuffles and it still felt great. Back to the physio exercises and pulled up sore again! I am finding I need to do lots of self massage as well to overcome the tightness and when I do things are much better. So it's slow, but moving in the right direction. BTW, I am not suppossed to be jogging yet, and I am not really, I was just trying it out to see if it felt any better with all the phsyio because previoulsy even trying to jog 3-4 mts across a street so as not to get run over would cause the muscles to lock up!

so in short, go for it Kev. the op itself is really a breeze and your core is in soooo much bettr shape than mine, that I expect you will actually make a return to running before I will!

Hi Shaun,
I would hang in there with the physio Shaun, I know it seems to create soreness, but I'm sure that you will slowly get over that hill and suddenly improve in leaps and bounds.  I can imagine it is very frustrating, but physio is the key.  What sort of physio are you doing now?  When you say you are pulling up sore, do you mean in the adductors, hip flexors, glutes or in the hip itself.

I am also doing heaps of self massage as I am having problems with tightness, which was causing me some knee soreness. My itb seems tight, I don't notice it when I run, but when I use the roller on it I get the same soreness in my knee that I get after a jog.  Also adductor is very tight, but I seem to be getting on top of that.

Good luck Shaun and keep us updated with your progress.....

[Will2010]

Kev, on Nov 8 2010, 02:07 PM, said:

Hi Shaun,
I would hang in there with the physio Shaun, I know it seems to create soreness, but I'm sure that you will slowly get over that hill and suddenly improve in leaps and bounds.  I can imagine it is very frustrating, but physio is the key.  What sort of physio are you doing now?  When you say you are pulling up sore, do you mean in the adductors, hip flexors, glutes or in the hip itself.

I am also doing heaps of self massage as I am having problems with tightness, which was causing me some knee soreness. My itb seems tight, I don't notice it when I run, but when I use the roller on it I get the same soreness in my knee that I get after a jog.  Also adductor is very tight, but I seem to be getting on top of that.

Good luck Shaun and keep us updated with your progress.....

Hello All
New to this but posting due to boredom from enforced rest.  Fifth week post labral repair and fellow frequent visitor to Olympic Park and The Avenue.  Found this article which you may or may not have already read.  http://ptjournal.apt...t/86/1/110.full .  Not a physio but I guess in summary bum strength trumps all.  Please  feel free to correct my interpretation.

Recovery is slow despite having been compliant with bum exercise pre-surgery.  In Fact so slow I almost envied my Dad's THR.  That's someone 3 decades older and next to totally inactive. Then again, no bum exercise could show up later when enforced inactivity is lifted.

I am interested to know if anyone has been told your running so soon after surgery can impede labral healing.  Are the little anchors and newly formed or forming fibrin network any match for the pounding and knocking during this much loved activity?  Frustratingly there is next to NO article on this issue.  I know they can't publish journal article unless well interpreted and constructed but I find surgeons rather tight-lipped with anecdotal experience. Please share it if yours is generous  

Anyway GOOD LUCK Kev for next week.  Smooth operation and fast recovery!

[SeanP]

Will2010, on Nov 10 2010, 09:43 PM, said:

Hello All
New to this but posting due to boredom from enforced rest.  Fifth week post labral repair and fellow frequent visitor to Olympic Park and The Avenue.  Found this article which you may or may not have already read.  http://ptjournal.apt...t/86/1/110.full .  Not a physio but I guess in summary bum strength trumps all.  Please  feel free to correct my interpretation.

Recovery is slow despite having been compliant with bum exercise pre-surgery.  In Fact so slow I almost envied my Dad's THR.  That's someone 3 decades older and next to totally inactive. Then again, no bum exercise could show up later when enforced inactivity is lifted.

I am interested to know if anyone has been told your running so soon after surgery can impede labral healing.  Are the little anchors and newly formed or forming fibrin network any match for the pounding and knocking during this much loved activity?  Frustratingly there is next to NO article on this issue.  I know they can't publish journal article unless well interpreted and constructed but I find surgeons rather tight-lipped with anecdotal experience. Please share it if yours is generous  

Anyway GOOD LUCK Kev for next week.  Smooth operation and fast recovery!

Hi Will,

I think it depends on how much repair work they had to do. with my labrum it was just a bit of a debridement of the frayed edges. If I had anchors etc I would be taking it a whole lot easier. A friend of mine tore chunks of her labrum in a netball fall but again had no anchors etc and they just took out the chunks. Her recovery was similarly slow but mostly to ensure she had enough strength to keep her hip stable - she has dysplastic hips which is why it no doubt popped out and tore so badly. with me, it seems that the lack of bum strength and consequent stress on adductors etc is going to take awhile to overcome. Have done a few more little jogs this week and been very slack on the physio exercises. In one week it has improved enormously and could even stride out a little with only some complaining from the adductors.

I would figure on another 3 weeks at least before resuming running, or even serious walking. As you say, those anchors might take some time for the tissue to restablish around the anchors. Did you have microfracture as well?

I agree, the surgeons are pretty tight lipped, but probably understandably so.

I'm off to the physio today - am hoping he can set me up with an ongoing program so  I can not go again for awhile.

keep us posted.

sean

[Kev]

SeanP, on Nov 12 2010, 01:59 PM, said:

I think it depends on how much repair work they had to do. with my labrum it was just a bit of a debridement of the frayed edges. sean

Sean, did David Young mention whether the debrided area grow back, or can the hip function fine without it? My MRI showed damage to the labrum, but not sure of the extent.

Glad I managed to sneak in a few easy runs before my op next thursday, but no more now as I had a blood injection in my hamstring a few days ago for an unrelated hamstring problem I have had for a while. Doc figures kill 2 birds with one stone as the hamstring can recover while I am recovering from the hip.

Starting to get a bit edgy about the op now, I think the uncertainty of the outcome is the issue, I am not concerned about the procedure itself.

Thanks for the link Will, totally agree about the glute strength, I am maxing out on exercises this week to try and go into surgery as strong as possible.  Kev

[Will2010]

Hi Sean & Kev
I went into the surgery with a lot of unknowns as I already expressed my surgeon's reluctance to commit.  My profound disappointment when I came around to find that I did not have a microfracture due to widespread arthritis was replaced by slight relief that the chondral wear caused by the labral tear was not as bad as he first thought.

I am quite sure that not only are MRIs quite inaccurate, what we do in the lead up to the op can make their interpretation even more so.  A minor tear turned out to be caught in the joint causing all sorts of grief.  Since it could be anchored back I guess I am thankful with the news overall.   The way I look at it, the op has allowed me to find out what I have done to the joint, what I can do to delay the inevitable and make plans on the work front.

If you haven't already done so Kev, perhaps cutting your toe nails before the op is a good idea.  My girlfriend had to do it for me recently and jokingly referred to my labrum as the princess that required a lot of babying.  Shortly before the op we went ahead with a kayaking trip overseas and this princess was constantly being squeezed to death in the flexed position of the knees while seated.  Ouch  

All the very best again Kev.

[SeanP]

Kev, the debridement was just to trim up the frayed edges, so no actual removal of cartilage from the bone.  If that is necessary, microfracture can stimulate new growth but I am not sure how successful that is.

Will,you're right. The MRI is indicative only. I really doesn't show the full story. I think Nuffy found his was a lot worse than expected. I had a CT as well to image the bone spur, but this doesn't show the cartilage.

Physio was generally happy with me the other day but my hip is still too unstable. However have green light for returning gradually to running. I find myself that I am not really ready - the muscles are protesting too much still. But can at least throw in a few 100m jogs in each walk now and hope things improve. continuing on with same physio exercises essentially. will try and up them as they don't seem to be making much of a difference at the moment. if the exercises were easy to do it would be OK, but they require quite a bit of finesse to get them just right and that's what makes them so frustrating.

very best of luck Kev - are you having the op at The Avenue or Glenferrie? Enjoy the time off afterwards - I really did enjoy the first couple of weeks catching up on sleep and reading etc and being waited on while lying up in bed!

[Freetoez]

I joined this club with surgery on Friday with osteoplasty to correct impingement and remove bony protrusions on femoral neck, two stitches in a labral tear, clean out of a cyst beneath the femoral head and tidy up of some worn cartilage.  All in all feel remarkably good with nowhere near as much pain as anticipated.  Am on crutches for a week or two, but can hobble around the kitchen or bedroom well enough without them.  Life doesn't stop for me to rest too much so it was a slow grocery shop today with a few helpers to push the cart and retrieve the things I wanted.  I think my surgeon has done a brilliant job, surgery like this really should hurt more than it does, I think it is a credit to his expertise.

[SeanP]

welcome to the club! Be interested in hearing the story of how you came to have surgery. I too was amazed at how painfree the aftermath of the surgery was.

good luck with the recovery!

[Freetoez]

I think it's a convoluted story with a lot of conjecture.  I had a horse fall on me in my teens leading to a slipped femoral epiphysis which had to be pinned until the growth plates fused when I stopped growing.  Since then my hip hasn't been quite right, limited rotation, intermittent pain.  I think the way this injury healed MAY have lead to the impingement, but maybe it's just the way I was put together.  The cyst is common sequelae from the original injury.  The labral tear I suspect was from helping my daughter with her ballet practice, not a thing to do for the first time in your mid 30's.  The cartilage is just wear and tear and an opportunistic clean up.  There is also lots of tendonopathy and a tear in the glute minimus tendon that surgery can't fix, but the rest while I recover will do it a world of good.

Interestingly, what lead me to inquire more into my hip pain was this thread.  I hadn't heard of impingement before and when I researched it, it seemed to fit the bill in terms of symptoms.  NeillS has been a great resource and when I described my symptoms and some of the assessment outcomes to him, he pretty much nailed it diagnostically as to what the potential problems might be.

[SeanP]

"  I had a horse fall on me in my teens "

Now THAT is a good excuse.

you've done well to progress from diagnosis to op so quickly. Hope you are still feeling all right today. The recovery weeks go by suprisingly quickly. at the start of all this I was horrified to have to have 2 weeks off initially when we were starting the investigations. Now anotehr month here or there seems like nothing. still have a goal of going for a 5km easy jog/run by xmas!

[Freetoez]

My goal is to be able to do the 5k by the end of summer, we'll see I guess, I'm not in any hurry.  If I can't get back on my bike in at least 6 weeks or so, I might start to get a bit antsy.  Still feeling good, have only had the one dose of painkillers this morning.  The nerves in my leg are starting to wake up so I have all sorts of tingling and twitching going on with interimittent numbness.  I'm hoping that once the nerve is back in full function it doesn't set off a whole world of pain.

[Kev]

Well, 2 days to go and the nerves are starting to set in, after all your comments I am not at all worried about the surgery, just the outcome.  I feel lucky that I was able to continue with some running so close to surgery, but only 5 days since my last run and feeling a massive flat spot.  I suppose I have allowed running to be too big a part of my life and now the anxiety of potentially losing that is building.

I know that some of you guys have had extended periods now without running, so feel a bit selfish even mentioning it, but like anything I am sure that I will adapt and settle into a recovery routine.  Luckily I have a holiday planned in 3 weeks time, so that will be a distraction from not running.  Have any of you been told how long it is typically till you can ride a bike? I know you can use an exercise bike fairly quickly, but I rely on my bike for local transport and am hoping to be able to do some easy riding not too far down the track.

Anyway, hang in there everyone, and hopefully my next post will be to say that I am now a member of the "post" surgery club....

[Freetoez]

No Kev, I haven't been advised and I already miss my riding.  I've been without running since about July/August so have gotten used to that.  Really, the worst thing about the surgery is the anaesthetic, or at least that was the case for me.  The 24 hours immediately after were painful, but not too bad at all.  My hip is clunking a little, but then I'm not exactly walking normally at the moment.  If you've chosen your surgeon well you should be just fine.

[SeanP]

I was back on the windtrainer two days after surgery. I reckon two weeks after I would have been right to ride for real, but I like my windtrainer and it's been wet and cold! Needed to be careful of using too big a gear until got some hip stability back and am still not suppossed to stand on the pedals - though I suspect am OK to do so now provided I don;t overdo it - but again that is me retraining my muscles to stablise my hip from years of being poorly used, rather than a result of the surgery. Depending on how much work they do on the labrum will determine a bit what you can do on the bike and how soon. The actual FAI surgery itself shouldn't make much difference at all. I;ve been back at the Hawthorn velodrome the past few weeks and now it is only fitness that is holding me back. Nuffy was cranking out some serious riding pretty quickly.

I know I was just as antsy as you about having to miss even more than a day or two running. But you do adjust quickly - it is taking me some time to actually get my mind back into the notion of wanting to exercise, rather than lie in bed or go for a coffee. The only way I;ve been able to overcome my natural slothfulness is to exercise everyday, often twice a day, for 25 years! And after being forced to break that habit, it is hard to restore it! But I think I am finally getting there!

[Will2010]

Interesting Sean that you obtained your op report through your physician and even more enviously so you could start the bike two days post op!  My report was handed to me at 'stitch-off" and the surgeon told me four more weeks on crutches and no physio yet.  As you can imagine my leg feels absolutely redundant and walking on two legs feels like a distant propect right now.  Were you told by your surgeon to go ahead or did he have a protocol?  I have yet to find someone with anchors and equally long rest.

I agree with the comment on the danger of wet surfaces. Sometimes boredom makes me risk re-injury by braving the element which thankfully has been quite friendly lately.  Went to a BBQ at the weekend and nearly slipped a few times on the host's newly polished floor.  The guilty party was the mother-in-law  

So atrophy is what I am facing now.  I hope someone has sound advice to share on top of my physio's expertise.