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[THR] Can't do a straight leg lift, groin pain

Discussion in 'Hip Replacement Recovery Area' started by StaceyA, Jan 2, 2013.

  1. StaceyA

    StaceyA New Member

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    I had Ceramic hip replacement on 12th July, 2012. I have not been able to do a straight leg lift since prior to the operation. During a physio session about 3 weeks after surgery, my physio insisted even though I said I really couldn't, that I do a straight leg lift on the count of 3. Determined that I am, I gave it my best shot, and what an extremely horrific stabbing pain in the groin. I have been very good and doing all other physio given. Getting into and out of chairs, cars, bed, all painful in the groin area. I have read about iliopsoas impingement from hip replacement and couldn't believe the symptom match. I had to have my hip screwed in (3 screws) due to shallow hip sockets. I am seeing my surgeon on the 6th of February, but would love to know if there are any exercises for this condition that might help, in case this is what it is! I'm desperate to get better. On the bright side, I love my new hip...way better than grade 4 arthritis!
     
  2. sharonslp

    sharonslp Forum Advisor

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    Hi Stacy. I'm tagging alexthecat for you. She's our resident guru on all things exercise, so she can give you an intelligent response. I've been fortunate to not have any groin pain issues, so I can only offer sympathy and good wishes. Now if you need some advice about quad muscle pain, come back to me. :)

    Sharon
     
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  3. alexthecat

    alexthecat Forum Advisor

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    Hi Stacey! I'm sorry that you are in pain. I have a couple of questions to help me get a better idea of your situation.

    1. Are you experiencing this pain all the time, even when you are not moving around, or does it only happen when you do things that cause you to lift or lower that leg?

    2. Are you able to do this stretch with your THR leg down and your non-THR leg pulled up toward your chest?

    [​IMG]
     
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  4. StaceyA

    StaceyA New Member

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    Hi, Alex! Thanks for your message.

    This pain in the groin is only severe when lowering or lifting the leg. It is, however, impossible for me to do a straight leg lift while sitting on a flat surface. I can move my leg, but must support it to do so, and the pain is there. And yes, I can do the exercise you gave me, pulling the non hip replaced leg up to my chest is possible. I just tried it :)
     
  5. alexthecat

    alexthecat Forum Advisor

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    How did that stretch feel? Was it uncomfortable or did it feel like a nice stretch or ???
     
  6. StaceyA

    StaceyA New Member

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    I guess it was good :) It didn't hurt at all. It wasn't a sore good, if you know what I mean. It just felt like a healthy stretch should. lol
     
  7. alexthecat

    alexthecat Forum Advisor

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    This is a progression of that same stretch if you want to give that a try:

    [​IMG]

    Only do that if it feels good though. If you don't feel it at all or if it feels bad, don't do it. Stretching might give you some short-term relief. Icing and anti-inflammatory medication might help as well.

    Have you talked to your surgeon or doctor about this? When I had symptoms similar to what you were describing, they said it was bursitis. If that is what you have, they can give you an injection and clear it right up.
     
  8. StaceyA

    StaceyA New Member

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    I have tried it and it is fine. I have an appointment with my surgeon on the 6th of February. I have had bursitis before, and eventually it got less painful, but this is something terrible. They have never stopped me from lifting my leg. I have read about iliopsoas impingement and wonder if this could be the problem. What do you think? My history is:
    bilaterial SCFE operations age 11 (left side severe, right side pinned in situ)
    pins removed age 12
    open osteochondroplasty for FAI left hip age 32
    pins removed age 33
    left hip total replacement age 36 (3 pins ceramic)
     
  9. alexthecat

    alexthecat Forum Advisor

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    It is my understanding that impingement is very rare. That isn't my area of expertise though, so I'll ask Josephine to comment. She may want to know what your activity level has been like since THR, so perhaps you can discuss that?

    I can tell you that when I had iliopsoas bursitis, it certainly did keep me from lifting my leg or from moving around much at all. When you are experiencing a lot of pain, your body will override your desire to do things. Your brain may say, "lift that leg now," and your body says, "no, I'm not doing that because it hurts too much." When you have reached a point where the tissue is being irritated by day-to-day activity, like rising from a chair, it's not going to get better on its own, as you've experienced in the past. It needs to be actively treated and I wonder if you might get in to see your surgeon a little sooner?
     
  10. StaceyA

    StaceyA New Member

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    Unfortunately it is the National Health Service, so the date is as good as it's going to get. I am a teacher, so am up and down a lot, more than my legs would like! I am also a mother of a 3 year old. So, never a dull moment. My activity levels are low though, as I don't walk anywhere. I use two crutches for distance (other hip though I'm not sure which one needs more support at times) and a walking stick otherwise, but in house, am ok. Going up stairs I lead with other leg as my left knee (THR side) is also messed up and it hurts to lift my leg in the groin. So, do you think that I should continue with stretches you gave me? Will this help bursitis if that's what it is? I'm off to bed (late here in UK). I'll update tomorrow. Thanks a million!
     
  11. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    I need to know a few things, Stacey
    Like:
    1. are you prescribed any medications, if so, what, how much are you taking and how often?
    2. are you icing the area, using a heat pad? If so, does it help?
    3. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and PT?
     
  12. StaceyA

    StaceyA New Member

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    1. I take 30 mg of Amitriptyline (nights). I take 75 mg of Diclofenac Sodium 2x a day. I have Nefopam as well (90 mg. up to 3 times a day, but I don't take that as I don't find it does much). I can't take any of the other opiates as they cause constipation.
    2. I have never tried icing it. I have used a hot water bottle on it and it feels nice when it's on, but it doesn't have lasting effects of pain relief.
    3. I don't do much housework. I get a cleaner to do my floors and clean kitchen units too low for me to reach. I manage to clean the bathroom sink and toilet ok. Someone else does bath. I cook in my galley style kitchen, leaning on surfaces and moving to a seat to rest every 5 minutes or so. I will do anything to stay put in one place. Moving is makes the pain worse, so I send my kids for errands in the house, or will wait to do things until later when I know I will get more out of my "journey" to the next room, etc. Pretty sad, but that's how I live my life. I don't go to the park with my kids or to the promenade to watch them ride their bikes/scooters. I have recently attemted a return to work. I'm attempting full time return next week. I know it's going to be tough as there is so much demand to be moving around and I can't very well tell students that they'll have to wait till another pupil needs something and then I'll get around to it! I have to say though, that this pain in the groin is only part of the problem, as I have pain in my right hip which is FAI related. It sure would be good to get my left hip (THR) pain free though so it wasn't sore too. Also in my left side, I have a sore knee, which recent CT scan showed TT-TG distance of 16 mm. I haven't spoken to my surgeon about this yet. I am seeing surgeon 6th Feb.

    Anything else, please let me know. Any strengthening exercises I should be doing, I will. I'm just desperate to be doing the right things.
     
  13. alexthecat

    alexthecat Forum Advisor

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    I wouldn't recommend any type of strengthening exercises until it is clearer what is going on with that hip. I'll tag Josephine to so she can see that you answered her questions.
     
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  14. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Amtriptyline is not a pain killer, just an anti-spasmodic. Diclofenac is okay but you are taking very small amounts. Why not take it three times a day as I am sure it is prescribed? And you could try adding a couple of paracetamol 4 times a day to the mix. You might find that more effective.

    Constipation can be resolved with a little planning - it's no reason to deprive yourself of decent pain meds. Constipation and stool softeners.
    Well, I should try ice. It might work for you, it might not. But the problem with heat is that it increases inflammation and therefore pain. But having said that, though I use ice all the time for my knee, I do use heat for bad backs and other aches and pains!
    That's quite a bundle of pathology to blight you!
    Glad to hear it but is this then a wise move?
    Do you feel ready for this? Anything else, please let me know. Any strengthening exercises I should be doing, I will. I'm just desperate to be doing the right things.[/quote]I agree with Alex, this is not the time to be doing more exercises, rather less.
     
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  15. StaceyA

    StaceyA New Member

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    Regarding the Diclofenac Sodium, I take a total of 150 mg per day. This is what is perscribed and I was told this is the maximum amount to take. The Amitriptyline I was told, is an effective pain killer (so said my GP), so she increased it. I must admit, the number of times I wake up due to discomfort, it at least, helps me to get back to sleep. Another reason I don't like taking the opiates is that I have to be able to drive to get to work and then, I have to function.

    Regarding the housework, it gets done. I get help to do what I can't manage. I do what I can, when I can.

    I am petrified of the work thing. I just know it's going to take it all out of me. I am sick of people looking at me in disbelief when I say how much pain I'm in. How is it possible? She's too young? It takes me ages to move around and get the job done. I am exhausted from trying so hard to do anything and this makes me grumpy :gaah: and getting through daily life as a mother, wife and teacher very tricky!

    Anyway, I shall take your advice and rest up, ice it and I will feedback when I see the "hip man". He seems to be the only one who fully understood me in the past. But it was the case of, let's deal with one problem and then we'll talk about the rest. :-/ Happy Days! Thanks to you all who care to answer me. I REALLY appreciate it!
     
  16. StaceyA

    StaceyA New Member

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    Hi, all! I have seen my surgeon and following ultrasound examination and guided anesthetic/steroid injection, it doesn't look like any impingement of tendons. I had the most unusual dream last night. And I don't know why I never thought of this before when awake, but I dreamed that it was the femoral nerve block that they gave me during the THR surgery that caused the groin pain when lifting in straight position and in some other extensions. (for example I cannot not do sit ups without this stabbing pain in the groin). Could it be that it is nerve damage? How can such a thing be diagnosed? Is it reversible? Thank you!
     
  17. sharonslp

    sharonslp Forum Advisor

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    Hi Stacey. It is my understanding that nerve issues can take a long time to resolve. I'm tagging Josephine for you.

    Sharon
     
  18. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Well, it could be. The nerve block for hips is done pretty high up as you can see here
    femoral nerve block for hips.JPG

    It's just possible that might be so but is this the place you are having your pain?
     
  19. BarbieJ

    BarbieJ Member

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    Hi Stacey,
    I read your thread. I have the same issue. I had a left THR anterior approach 15 months ago and noticed on day one in the hospital that I had groin pain and that I could not lift my leg. You are 8 months post op, correct. It is still impossible for me to do a straight leg lift while in a seated position on the floor. I am supposed to do the injection into my tendon, but my insurance will not pay for it into the hip. Insurance would pay for it in the knee, however, it is only considered as diagnostic. Can you explain how your doctor determined that it is not an impingement?
    I have to help my leg with my arms to get into the car or into bed.
    Did you have the anterior approach?
    I know the pain you are experiencing and it's horrendous. I am sorry that you are still having pain. I can tell you that it did get a little better in the first year, but I know now it will be a chronic problem. I understand there is a tendon release surgery but if yours is not an impingement, what are they saying?
    I just wanted you to know that others are reading your post and in the same boat. :)
     
  20. StaceyA

    StaceyA New Member

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    Hi, Barbie, I'm not sure if I had anterior approach. I'm guessing not since my incision is on my side??? Yes, the injection (steroid combined anesthetic) is a diagnostic test, but it could be a treatment as well. You just never know until you have it done. It's terrible that a person at a desk has made a decision that your pain isn't worth a diagnostic test. Basically my surgeon looked at the xrays (laterals and pelvic) and he said that from the xrays, it didn't look like there would likely be any impingement, but sent me for an ultrasound of the groin area and injection. It was the consultant radiologist who did the examination and said that he couldn't see any impingement. But as the surgeon requested that I have the diagnostic anesthetic combined steroid injection into the area where I have pain, he went ahead anyway. It didn't work for me. I have read about tendon release surgery is an option if you have impingement; however, it would appear that I don't. But I'm not stopping here. I want to get to the bottom of the pain and hopefully, there will be a surgical solution as I cannot imagine living like this for the rest of my life. I never thought about it before the other night in my dream, but I wonder if it could be a side effect of the femoral nerve block I had during surgery. Did you have femoral nerve block during surgery? I am having surgery on my right hip soon to try to remove acetabular impingement. (This is what happened 5 years ago to my left hip - and it's now replaced as you know, so I'm not holding out much hope on the long term success of this op). I'm so grateful for the National Health Service. I moved from the States here 15 years ago and don't know how I would be managing now if I were still living there. I feel that your insurance is denying you the chance to live pain free. How can they say no to a diagnostic test if the surgeon says it's necessary? Thanks for your message. It was nice to hear from you :)
     

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