Become an Insider

Hip Arthroscopy 3 yrs. post op and exercise has not made much difference

golfer67 said:
I don’t know if my comments here will help you feel better or if my comments will be discouraging but here goes. I truly hope that you are going to continue to get better and that your operation turns out to be a complete success. I am basically twice your age but due to my anatomy I also developed a torn labrum due to FAI. Because of my age the doctors told me that I would be much better off to have a Total Hip Replacement instead of the type of operation that you had. They also told me that I would recover from the THA much quicker than I would from an arthroscopic labrum repair however it has been 13 months now and I am still having trouble with pain from my THA. I am currently going through therapy and so far it has not helped. I only post this to show you that some of us just don’t get over hip surgeries as quick as we think we should, I know people who have gotten over having both hips replaced a few months apart in way less time than it has been since my surgery. So keep doing what the doctor tells you to do but also be aware that something may be wrong that is causing you to take so long to recover.
Click to expand...

Hey @golfer67 thanks for your thoughts. I read your entire thread. Really sorry to hear how difficult things have been for you after your surgery. It must be extremely frustrating that so many different types of problems also cropped up for you – such as the mistakes with the medication, the trip to the emergency room... if all of that happened to me I'd probably think I was cursed. I'm glad you are refusing to accept the pain and looking for new solutions. Really hope things improve for you.

A few thoughts on my side:
  • The fact I'm only 35 and have these issues scares me quite a bit. I was very overweight during my teenage years and I bulged a disc in my lower back a couple of times during my 20's while trying to get fitter.
  • With the COVID lockdowns and the surgery, my weight has gone up a bit again which can't help with the recovery. I've had regular back pain since the lockdowns started (I imagine because I just wasn't as active without my commute and whatnot). After the surgery the back pain has become more common and it feels more in tune with flare ups in my hip.
  • Part of my mistake was that I lived with the pain for so long before finding the labrum tear and getting the surgery. I've heard before that there's a concept of "pain memory"; that the body can still remember the pain even after the biological problem has been fixed and there are specialist pain clinics where patients just talk about their pain, to try to help reset the memory. I'm not saying the pain isn't real, but I wonder if there's a kind of feedback loop that our bodies can't let go of. How long did you live with the FAI and labrum tear before getting surgery?
Also after reading your thread, I feel that I should be more patient. All the initial medication I took worked well for me and I don't have swelling like you describe (it's not hot to the touch for example). But I do find it can feel stiff and it feels like things are inflamed when there's pain. And I do find the skin around my scars is tight at the surface level, I don't know if that means anything though.
 
Hi everyone.

I've been getting better the last month and simultaneously increasing my walking. I backed off my exercise intensity a fair bit and I tried to focus on strengthening areas that my doctor told me to.

However over the last week or so I fell backwards in my routine and felt some pain spikes this week after carrying some heavy stuff the other day.

I decided to look over my recovery diary and try graphing the information I've recorded in it.

Ultimately it's just a notepad I tried to record pain levels and notes about any issues I had each day. There are patches of it without notes because I wasn't feeling any problems during those times. But for the most part it's relatively complete. I also collected my daily movement data from my iPhone (i.e. walked 4km on day X). So I've graphed all the data together and you can see the info below.

[Bonesmart.org] 3 yrs. post op and exercise has not made much difference


It probably looks a bit overwhelming but you can see how my pain spikes have reduced and become more spaced out. Although the last couple of days have been surprisingly high. I'm hoping I'll bounce back within a day or two.

The nice thing is how the km per day data can be graphed against the pain levels. I also tried to calculate a "quality of life" value which I calculated as an "average of km walked in a week divided by by the average pain factor". My thinking here is that it's understandable that my pain spikes or continues to exist as I continue to walk more and return to the normalcy.

Overall it's been nearly 8 months since my surgery and I'm definitely still suffering from time to time but I'm still hopeful that there's still plenty more recovery ahead of me as everyone says. And if the next 10 months continue in a similar trend to this then I'm hoping that'll put me in a good place.

I thought I'd share this for others to see just how bumpy the recovery experience can be with a hip arthroscopy and that even though things can feel very bad at times along the way, it can still be improving overall.
 
That's a great chart, @frogger. It really does show your great progress over time and the impact of activity increases on your pain levels. Don't worry.....things will continue to get better.
 
Happy new year everyone.

I thought I'd share another update on my recovery. I wish I could say it was going really well but it's still fairly slow in my opinion. Considering it's now been 10 months since my surgery.

Here's a new graph of my recovery:
[Bonesmart.org] 3 yrs. post op and exercise has not made much difference


What surprises me and frustrates me most is that the pain spikes are still quite large in my opinion. For example, reaching a 4 out of 10 today.

Sometimes there's a clear connection between effort and pain. Like yesterday, I saw my physio and did some leg press exercises. And then today I went to the gym again and cycled for 15 minutes and ran for about 10 minutes. Now tonight I'm in quite a bit of pain. Taking paracetamol doesn't really help much.

But sometimes there isn't really a clear connection. For example... around christmas and new years, I stayed with family for 2 weeks and actually we stayed in almost the entire time. I didn't do anything (and maybe the lack of even basic exercises was part of the problem) but by the 12th day of my stay, I had quite a bit of pain on that day with no explanation. I marked it as 3.5 out of 10.

On top of that, whenever my hip pain spikes up, it aggravates my back as well. I have developed a muscle imbalance in my back due to my hip and so I feel every week I'm dealing with either pain from my hip or my back.

I know the trend line for the pain is still trending towards zero but when the pain spikes like today... I feel quite helpless again and I really question whether everything is on the right path still. It feels like my life is on pause.

At what point can it be said that there's still a problem that needs fixing? My surgeon said 1 in 50 surgeries require another arthroscopy. Or is a hip replacement necessary?
 
I should maybe mention that today, with my pain of 4 out of 10. I basically felt reluctant to do anything except my visit to the gym.

I didn't even want to walk to the shops to buy groceries because I didn't want to have to endure more movement or pain. I laid down and watched television on my couch. I didn't feel like I could focus on any personal projects either. Obviously my graph suggests my quality of life has improved because it's based on walking distance but when I end up like this today, I just feel like I'm broken. This is what I mean when I say my life feels like it's on pause.
 
Recovery is never a straight line. And every time you overdo things, you change the clock a bit, which is why we caution people about listening to their bodies and not doing the things that cause increased pain or swelling. There is nothing wrong with slowing down when you have a more painful day and using the days where pain levels are less to push a bit harder with activities or exercise. It's a fine dance to maintain that balance that your body likes.

In some ways your life is on pause. You had major surgery and now you're trying to recover. You're not "broken" but you do need to pick up on the signals your body gives you that you might be trying too much too soon. Doing that consistently slows your recovery. Please don't feel guilty about needing to properly recover before your life gets back to normal again.

If you have problems with your back and/or a muscle imbalance, perhaps you could ask your GP to order some therapy for that. It could help you with your hip.
 
Hey Jamie. Thanks for these thoughts. Yesterday I had another flare up again and felt pretty miserable.

I recently had a big work project which meant I stayed at home and my mobility was low for about a month. I had almost no pain during that month and after the project ended I went for two walks over the weekend. Roughly 9km on both days.

On the Monday my hip felt painful across the front of the hip. Probably a 2/10. It might not sound like much but I just find it crazy how fragile it is. I’m now nearly 14.5 months post surgery and I feel like I’m where I was at 6 months.

It really makes me think the surgery wasn’t a success and that I need a hip replacement at this point. I don’t understand what the point of doing the arthroscopy was.
 
Hello @frogger . I have just read your thread, and I am so sorry that you are struggling with pain again.

I found your graphs fascinating, and I wonder if you are still updating them?

I’m sorry that I don’t have any expertise to offer. I have only had hip replacements, and know nothing about arthroscopies. But I have a few thoughts, as a total lay person:

1. You had a month of low inactivity, then two days of 9 km walks. That in itself might explain the pain.

2. You are understandably frustrated, and wondering why the arthroscopy instead of going straight to replacement. I think doctors go for the more conservative treatment first. Hip replacements are great, much better than keeping a bad arthritic hip, but they do leave you with an implant which, I have heard, is never going to be quite as good as a good natural hip. Your surgeon must have hoped that your repaired hip would be good enough to keep. Even if you are unlucky enough that the arthroscopy isn’t the solution, it doesn’t mean that it was a bad decision to try it first.

3. You have had to put up with this recovery for ages, but it is still fairly early days. I continued to see improvement for 14 months after my first hip replacement, and someone said above that arthroscopy can be worse than replacement. I also took about two years for a broken wrist to stop hurting - the bone healed fine, but the ligaments took a long time.

4. @golfer67 had some useful info. If I recall his thread, he has undergone more surgery since his comment to you. I think he is a good example of someone who had continuing pain, kept being assured there was nothing wrong, persisted in seeking solutions, and finally got the help he needed. Many (most?) times when people worry about their recovery, there is nothing wrong, and all that is necessary is to be patient and avoid over doing exercise. But there are some cases where there is a problem, and it needs fixing. So you may reach the time when it is worth getting a second opinion. But then you will need to seek out someone who is highly expert in the field.

Wishing you well, and hoping that this turns out to be only a temporary setback, and you will soon have the Quality of Life line shooting back up.
 
Hi Klassy.

Thanks for your thoughts. I do keep track of my pain levels and the graphs. Sometimes it’s sort of reassuring but it’s also disappointing to see that after 14.5 months I’m not in a better place. I’ll attach the graph at the end of the post and you can see the state of things.

I agree it makes sense an arthroscopy should be the first step if it’s believed to be a possible solution. And it intuitively makes sense that arthroscopy will take longer to settle than replacement. Nonetheless I am still shocked by the timeline.

Back in Australia, surgeons floated the idea of things being back to normal after 6 months. Before the surgery, my French surgeon suggested 12 months.

After the surgery, he talked about the potential of needing 18 months.

At the 12 month mark after the surgery, he said some people need 24 months.

There’s something dangerous about pinning your hopes to a specific date, because when the day arrives and if things aren’t better, it’s actually more overwhelming I think. And yet people keep telling me these dates and I want to believe.

But you are also right there must come a day where I say I need to get a second opinion or I need to push my surgeon towards a hip replacement. Maybe that date needs to be the 24 month mark but that is a depressing thought as well, to think of how many years I will have lost to this situation.
[Bonesmart.org] 3 yrs. post op and exercise has not made much difference
 
You know, there is no harm in getting some additional opinions now. I see nothing to be gained by waiting if you’re not seeing a general improvement. But you need to see doctors not at all related to your current surgeon or his practice. You want independent eyes on your hip.
 
Well done on your graphing. I have been keeping a daily diary . I'm only 11 wks post op. Good to see you can walk further... I have had few major flare ups especially after coming off Naproxen and Celebrex. Trying to manage icing and Panadol osteo. Baby steps I guess eh. take care
 
Hi @Teresaj – yes it certainly can be a slow process. Congratulations on going through the surgery, icing and elevation (and the meds) will help a lot. I think the length of recovery for hip arthroscopy can depend a lot on how much damage had accumulated and how long there was sustained inflammation. I hope your problems were not as bad as mine and you recover faster!

Here's an updated graph:
1654871936529.png


My approach to the graphing is that I make notes when I feel the pain is spiking/flaring on a day. Which still happens rather frequently unfortunately. But you can see it seems to be becoming less strong when it flares up. And somewhat less frequent (I have another graph for judging the frequency, I'll add below). And when I write down that pain level, I try to think back since the last time I had pain and remember those days as best as I can (filling in the gaps). And then I also look up the kilometres I have walked in my phone's health app (to add those numbers in). If I exercise, I add that in another column (and that is added to my walking distance actually). So the walking distance represents general sport effort.

Recently the QOL has been improving, and I've decided to try going to the gym again. I cycled for 10 minutes and ran for 10 minutes, but then had some pain 36 hours later. Today I've been feeling ok, so I've tried 20 minutes cycling instead to see if the problem was just the running component (and the impact).

@Jamie that's true. I suppose I can go and find another surgeon now for a second opinion. Although it's hard to say if I'm seeing real improvement or not. Obviously my graphs suggest some slow improvement though... and that keeps the faith for me that my original surgeon did a good job and that his theory/understanding of what's happening is correct. In September, it'll have been 18 months post-op... I just never really believed I would need _that_ amount of time before being back to normal though. I think what I want to say is: the data suggests I'm improving but the way I feel is that I'm still more stuck than I expected.

Below are two graphs for judging the frequency:
1654872516104.png

The first is red if my total pain within the last 5 days was greater than 1/10 in total.

The second graph is red if my total pain within the last 3 days was greater than 1/10 in total.

I think this is an interesting way to visualise flare ups and their frequency and duration, without considering the pain itself in particular. Because a flare up is still a flare up and therefore it's a distraction or disruption to your normal life in my opinion.
 
Thanks I had injury for 3.5yrs getting worse all the time. The inflammation in the ligament they said was unusual. The hip ball etc itself was fine. Labral tears weren't the main issue. Keeping a diary also although not as great as your graph!! flare ups with walking to much really. Thanks
 
Hi all, I'm back with an update, twenty one months later -


Summary:
  • 12~ years ago I hurt my back badly (bulged disc in L5-S1 we think). After that injury, my hip started to feel different but it was a slow process of degradation.
  • 6~ years ago, I bulged the L5-S1 disc again.
  • My hip worsened over the years, and I realised something was fundamentally wrong. I got PT and scans etc. It was a hip labrum tear. 3 years ago, I finally had surgery to repair it.
  • Overall, I felt better. No more background pain in the day or at night. However it took 2 years for that to be the case.
  • However, when I exercised, I would still have pains in the hip. And by exercise I mean cycling or attempting to run again.
  • Finally, 6 months ago, I completely herniated the L5-S1 disc and fell into crippling pain for 1 month.
  • My herniation is now much better. I am feeling more like I was before this herniation but I attempted to return to the gym and go on some hikes recently and they created pain. See details below.
The surgery:
  • Situation was worse than thought from the scans. My cartilage was detached from the bone. They pinned it back onto the bone. They sutured the labrum. They shaved the bone.
  • Surgeon said it went well overall.
My current situation and thoughts:
  • If I attempt cycling, running or even hiking at the moment. I have flare ups of glute and hip pain again. My hip still pops/cracks across the front of the joint. Even just 30 minutes of cycling can trigger pain the next day for hours.
  • I now connect the original back injury 12 years ago with all of my issues and this has made me think more about nerve pain vs labrum pain. I feel my right glute is incredibly tight, there is the sensation of the muscle being inflamed. It has been like this for years and even after the surgery, it never really relaxed.
  • Is it possible all my pain and problems are actually a mixture of:
    • Slight pinching of the nerve around the L5-S1 disc.
    • Muscular (piriformis) inflammation pressing on the nerve.
    • The hip joint cartilage being worn, damaged and easily triggered by the pinching of the nerves above.
  • Or, do I have long term nerve damage?
I don't know what to do at this point. To investigate further with spinal surgeons? To return to my hip surgeon? To find a new hip surgeon?

Here is what I've booked as my next steps over the next couple of months:
  • Getting an electrogram test for my nerves to investigate whether the nerve is currently pinched by the L5-S1 disc enough to justify an L5-S1 microdiscectomy.
  • Going back to my hip surgeon to see what he thinks. Was my cartilage just too damaged? Do I need to consider a hip replacement to finally be fixed?
Thank you again all for your thoughts and advice from this forum. Three years ago this was a really supportive place to go to in difficult times
 
Hello frogger and welcome back. Sorry it's under these circumstances and I am also sorry for the pain you're struggling with, wishing things were better for you at this point. Thank you for the detailed update. It's very helpful.
It sounds like you have a good plan moving forward and I hope you find answers that lead to resolving the issue so you're able to enjoy life to the fullest, minus the pain. I am sure you'll receive feedback here, so please check back. Wishing you only the best, frogger. Please keep us posted.

Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting. Please post any updates, questions or concerns about your recovery here.
We are here for you always! :console2: @frogger
 
Thanks Layla.

I think you’re right. My current plan makes sense. But I’m just wondering if anyone else has thoughts based on my experiences and pain?

Has anyone else here herniated a disc and had hip surgery? Has anyone else had this problem of a deep knot in their glute that seems to also cause their sciatica ?

I’m trying to understand this problem holistically now. I no longer believe it was as simple as “the hip needs surgery”.
 
mendogal said:
Hi there.
Sciatica can be caused by the kind of lower spinal issues you've had AND for many people it's caused by sciatic nerve impingement in the butt by the piriformis muscle.
When it's piriformis, a simple stretching regimen can help...
Here's a link to an article about piriformis syndrome and sciatica.
Click to expand...
Thanks for sharing this. I’ve thought about piriformis syndrome. And I’ve tried stretches such as this in the past. It never felt like it “changed” the fundamental problem though. But it did feel pleasant to do these stretches.

I have so many fears now:
- fear that my labrum is damaged beyond healing.
- fear that I have nerve damage from the untreated disc or piriformis problems.
- fear that the piriformis knot has been around for so long that there’s little chance of being able to return it to a normal condition.

I can try taking ibuprofen, doing these stretches and icing the piriformis. But how long should it take for the knot to disappear ?
 
Hi @frogger I agree with mendogal that you are dealing with piriformis syndrome. Your story sounds a lot like mine:

I herniated the disc between L4-L5 in 2001. Went through a bunch of different therapies and medications to treat the pain. Over the subsequent decade, I suffered through frequent episodes of disc bulging and sciatica on my left leg. "Stretching" was not enough for me.

I finally got things under control by finding a massage therapist to work on that "deep knot" (piriformis muscle) and a yoga teacher to build core strength. Although I still had occasional episodes of sciatica, they became less and less frequent and I felt good most of the time.

In 2019, I had my right hip replaced. During the first two months of recovery, I was unable to practice yoga or get a massage, and my sciatica flared up. However, once I was recovered enough to return to both yoga and massage therapy, things improved. I've since been through 2 other surgeries, and had similar experiences with sciatica flare-ups during early recovery. I'm just getting back to good back health now from my December TKR.

I hope you find this information helpful. Be happy to answer any questions you have about my experience.
 
benne68 said:
Hi @frogger I agree with mendogal that you are dealing with piriformis syndrome. Your story sounds a lot like mine:

I herniated the disc between L4-L5 in 2001. Went through a bunch of different therapies and medications to treat the pain. Over the subsequent decade, I suffered through frequent episodes of disc bulging and sciatica on my left leg. "Stretching" was not enough for me.

I finally got things under control by finding a massage therapist to work on that "deep knot" (piriformis muscle) and a yoga teacher to build core strength. Although I still had occasional episodes of sciatica, they became less and less frequent and I felt good most of the time.

In 2019, I had my right hip replaced. During the first two months of recovery, I was unable to practice yoga or get a massage, and my sciatica flared up. However, once I was recovered enough to return to both yoga and massage therapy, things improved. I've since been through 2 other surgeries, and had similar experiences with sciatica flare-ups during early recovery. I'm just getting back to good back health now from my December TKR.

I hope you find this information helpful. Be happy to answer any questions you have about my experience.
Click to expand...
It’s reassuring to hear a similar story and I’m sorry to hear you’ve had your own pains and journey. But happy to hear you’ve overcome a lot of it, it seems.

I’m planning to see a new PT next week and I think they can perform massage as well. I think I will push for this and a focus on core strengthening.

Can I ask, once you found that combination of stretching, exercises and massage, how long do you think it took to resolve the knot in your glute?

And has the knot truly “disappeared” for you?

To be clear, for me, if I sit on a hard surface I can literally feel this knot in my glute. Thank you again
 
You must log in or register to reply here.
Active Antimicrobial Hydrogel

Members online

No members online now.
Total: 2,789 (members: 0, guests: 2,789)

Latest posts

Back
Top Bottom