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THR Almost Four Years After Hip Replacement: I Stopped Pushing So Hard, and Everything Changed

Hi all,

27 months post op THR. About three months ago I bent down and felt something give on my operated side low back. For last three months Feels like a string being pulled going down my left glute, inside leg and down to outer ankle. Classic sciatic nerve path. Physiatrist thinks it is an irritated nerve root at S1 looking at old MRI from a year ago. More like a dull numb feeling.

Problem is my glute medius muscle is ‘shutting down’ and not firing and progressively getting weaker despite PT. My leg pretty weak now. Wondering if anyone has had this experience and if so did a cortisone injection in back help? Understand not a cure but just getting muscle to fire again w/o nerve entrapment or whatever it is. Welcome any and all thoughts!
 
Hi, @Charlie33…..I’m glad you’ve posted about this problem and I hope that one or more of your fellow BoneSmarties will either have a similar story to tell or come to your thread to offer support. Sometimes just the assurance that you’re not alone when dealing with a problem can make all the difference in the world. And you’re definitely NOT alone when you’re a Insider Club BoneSmartie!

You’ve been around BoneSmart for a while and you probably know from reading here that problems with the glute muscles are a pretty common problem for post-op hip replacement patients. I experienced that myself with my gluteus medius muscle a year ago and I’m still working to get the muscle as strong as it should be. So, these things are not usually a quick fix for most people.

The idea of a cortisone injection is something I wouldn’t have thought of, but if there are problems with your spine, it might help. Who suggested this for you? It might be worth a try.
 
If the nerve root is being impinged by inflammation, blocking transmission to the glute, a steroid injection might be worth exploring with your physiatrist - who if is in agreement might need to refer you to another specialist for follow up.
 
Sadly, I'm a bit of a biomechanical puzzle. Going into my hip surgery, I had severely limited back flexion, only about 10 to 20 degrees. I never even considered discussing this with my surgeon, so I entered the operating room as a relatively active person, but with extremely restricted back flexibility. This led to a very difficult recovery, and I failed miserably at initial physical therapy. My first physical therapist was particularly harsh, making me feel like I had a mental block rather than a physical problem. However, being athletic and determined, I persisted, trying everything until, after a year, my body finally began to cooperate.

Even after that initial recovery, my limited back flexibility has remained a persistent issue, despite my MRI showing relatively normal results. The truth is, I've had ingrained bad biomechanical habits since I was 30, and was told I needed a hip replacement at 36. I kept pushing through with exercise and movement, trying to maintain strength. In hindsight, I probably should have had the surgery around 45, not 54, but I was managing a relatively normal life. Now, I'm caught in a cycle of hip and back pain, and it's proving incredibly difficult to break free. I'm definitely a unique case, and I work with a local care team, but I wanted to share my experience in case it helps anyone on BoneSmart dealing with long-standing back issues that impact hip recovery. These kinds of challenges, unfortunately, do happen.

So, for anyone who reads this who has long-standing issues like Perthes disease, or a hip that didn't work right from your teens or twenties like me, and you have a lot of biomechanical issues and potentially some back issues, even if your back looks fine on an MRI, you just have flexibility issues, just make sure to talk to your surgeon about it. It's all about the spinal pelvic dynamics. Hip surgeries are super easy recoveries for most people, but for people like us, it's a different thing. You add range of motion into an equation where muscles are like, "what the hell is going on?" So that's my advice. And the only other advice I'd say—this is my opinion—is get someone who uses the computer techniques to perfectly place your cup. I did not do that. I don't think you necessarily need it, but if you have access to it, I do think it will be the standard of care going forward. Okay, rant over. Have a great day, everybody!!!!
 
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@Charlie33 … you have a really wonderful way of looking at what appears to be a very complex issue. I agree with you that sometimes it can take a very long time to get things resolved. After all, when you have significant bio mechanical issues, your body didn’t get that way overnight and and positive changes won’t come quickly either. I know from my own hip replacement and some (much smaller) back issues that it is all related. Hang in there as you work through all this. We’ll be here to help when we can and will appreciate your updates if you care to share them. I’m pretty sure there are others out there with similar problems who will benefit from your story.
 
I really relate to this, @Charlie33. Having dealt with low back issues for years, I struggled to understand the source of my pain. My first hip replacement seemed to help, but I am now dealing with pain on the other side of my back, hip and thigh and have noticed significant loss of flexibility during yoga practice. I'm expecting to address the left hip later this year.

Thank you for sharing your story. I know it will help many others!
 
Hi all, posting an update:

1) Status: Walking my leg feels numb from glute down to outer ankle. Seems to be getting worse. Posas getting tender as glute medius is weak and/or not firing.
2) Physiatrist based on a year old scan thinks I have gluteal tendonopathy on operated hip plus S1 radiulopaty and L4-L5 disc tear. She wants to try an epidural injection near the disc tear to see if it improves pain.
3) Seeking second opinion from spine specialist on Monday.
4) Also seeking second opinion from hip surgeon (related to implant and glute, down the road when I can get in)
5) Seeing new PT to see if there is magic in those darn hands!

I TRULY believe this is all strength/back related. Remember I RECOVERED after 13 months (well yeah sort of was long with lots of pitfalls) but found the light. Tendonopathys are a pain in the butt. Its like calorie counting: you have to do just enough to push the tissue but not too much. And it can take months and months!

Sooooooo sick of this. I have people who talk to me about hip stuff and ask if I'm a medical professional LOL. I just want to go for a freaking walk with my wife. I could give a **** about hockey. But honestly? I am going down swinging. I'll do rest, ice, running, parasailing, whatever it takes.

Yes I'm frustrated. And please folks no need to console me, but who the hell wants to spend this much time thinking about this sufff. Anyway cheers all! And yes I'm just venting a little. I am documeting my craziness in case it EVER helps anyone else!

(Exhale) LOL
 
Thanks so much for telling your story. There is no doubt that there will be others out there who can relate to what you’re going through. I am on your side about keeping up the fight. You never know when something will click with someone on your medical team and things will start improving. Your spirit is wonderful. And bless your wife for being there for you through all this. ‘Your BoneSmart family is on your side too.
 
Venting + documenting is valuable. I'm glad you're here with us because it also teaches us a lot.

I know that when I've gone through severe injuries, chronic pain, or long up and down rehabs, what I found helpful is basically like what it seems you're doing:
Learning from all possible disciplines what helps me become the expert on me.
Understanding the pain or disability doesn't define me - it's not who I am! but neither is it apart from me like an enemy to fight - that literally feeds its power over me; it's something to find a way to integrate within me.
Focusing on my capabilities, putting my mind onto using them, picturing flowing like water in the river around obstacles.

@Charlie33
 
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Vent away! That's why we are all here to support each other & listen.
We know our words can't "fix" whatever is wrong but I still feel it's valuable to have people like us who "get it."
Many of us have had various setbacks & they are so frustrating.
 
The Brain-Pain Connection

Hey everyone, as a follow-up to my rant, I wanted to focus on another topic here, which is a bit more broad, but maybe helpful to folks dealing with chronic pain. Honestly this is a bit embarrsing to post; it doesn't fit with who 'I think I am' but candidly is the truth and posting for anyone who may stumble upon this and get benefit:

I've been dealing with persistent pain/discomfort for a while now, and something I've come to realize is how much the brain plays a role in long-term pain. It's like, when pain sticks around, it can rewire your brain. You might feel pain even when there's no actual physical damage—it's just your brain stuck in a loop, thinking something's wrong.

This is a whole different ballgame compared to short-term post-surgery pain. It's a tough thing to wrap your head around, but I think the first step is just acknowledging that this can happen. Then, focusing on movement that retrains your brain, showing it that things are safe and okay. Gradually building from there.

I've noticed this in my own journey. During recovery, one might have a setback, and you rest and ice. Then, you try to start moving again, but you can't move the way you did when you got injured. So you have to kind of figure that out. But sometimes, as you start to move again, you'll feel pain that's really just more related to the way your brain is trained to react, as opposed to what's actually happening. This is a hard thing to know sometimes. And for someone like me, my brain gets a little bit worked up because it says, 'Hey, something's wrong,' when maybe on a scale of 1 to 10, it's a two versus a seven. All your brain is trying to do is protect you. It's basic fight or flight. But when your pain sensations get wired into that, is when it can cause some problems for certain people. I know for me, I've had plenty of injuries over my life and recovered, but for some reason this time, when you get stuck in that place, is when things get a little out of whack.

For those of us in this situation, I think working with a physical therapist specializing in chronic pain is crucial, just like Jamie suggested. You're tackling two things: physical recovery and the mental blocks that can hinder progress, often without you even realizing they're there.

I know this might sound a bit out there, but if you've been dealing with chronic pain or discomfort, it's worth looking into. Understanding this brain-pain connection can really help guide your mental, spiritual, and physical recovery. And like anything takes time and effort to overcome.
 
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Thanks for sharing this, @Charlie33. I recently read an article describing how some doctors are using biopsychosocial therapies, such as cognitive-behavioral therapy, to help patients manage their chronic pain.

The article noted that ALL pain is brain-based and that this therapeutic approach can actually change the way the brain experiences pain. Certainly something to explore.
 
Charlie33 said:
The Brain-Pain Connection

Hey everyone, as a follow-up to my rant, I wanted to focus on another topic here, which is a bit more broad, but maybe helpful to folks dealing with chronic pain. Honestly this is a bit embarrsing to post; it doesn't fit with who 'I think I am' but candidly is the truth and posting for anyone who may stumble upon this and get benefit:

I've been dealing with persistent pain/discomfort for a while now, and something I've come to realize is how much the brain plays a role in long-term pain. It's like, when pain sticks around, it can rewire your brain. You might feel pain even when there's no actual physical damage—it's just your brain stuck in a loop, thinking something's wrong.

This is a whole different ballgame compared to short-term post-surgery pain. It's a tough thing to wrap your head around, but I think the first step is just acknowledging that this can happen. Then, focusing on movement that retrains your brain, showing it that things are safe and okay. Gradually building from there.

I've noticed this in my own journey. During recovery, one might have a setback, and you rest and ice. Then, you try to start moving again, but you can't move the way you did when you got injured. So you have to kind of figure that out. But sometimes, as you start to move again, you'll feel pain that's really just more related to the way your brain is trained to react, as opposed to what's actually happening. This is a hard thing to know sometimes. And for someone like me, my brain gets a little bit worked up because it says, 'Hey, something's wrong,' when maybe on a scale of 1 to 10, it's a two versus a seven. All your brain is trying to do is protect you. It's basic fight or flight. But when your pain sensations get wired into that, is when it can cause some problems for certain people. I know for me, I've had plenty of injuries over my life and recovered, but for some reason this time, when you get stuck in that place, is when things get a little out of whack.

For those of us in this situation, I think working with a physical therapist specializing in chronic pain is crucial, just like Jamie suggested. You're tackling two things: physical recovery and the mental blocks that can hinder progress, often without you even realizing they're there.

I know this might sound a bit out there, but if you've been dealing with chronic pain or discomfort, it's worth looking into. Understanding this brain-pain connection can really help guide your mental, spiritual, and physical recovery. And like anything takes time and effort to overcome.
Click to expand...
This is very true. We have muscle (pain) memory. Not just muscle memory. If for years you've experienced pain when you do a certain movement, you begin to anticipate the pain in advance. Because pain signals come from the brain it take a long time to re programme these thoughts. Also because where we experience pain & where it is actually coming from may not be related. For example, I had really bad ankle pain before being diagnosed with hip dysplasia. However my hips never actually hurt. In fact they never have. Despite that, my hips have been the main cause of my pain throughout my life. The body is both amazing, complex and often frustrating!
 
Very profound post, @Charlie33. Thank you so much for these comments. You can be assured there are folks out there reading them who say, “Wow…that’s me!” And that is one of the main reasons for BoneSmart’s existence and success. We are able to connect people so they are not alone in facing challenges. I love that you’re consistently trying to find out the “why” behind the way things are. :thumb:
 
@Charlie33 You mentioned perthes. I was diagnosed at and had femoral osteotomies at about age 10. Up until my RTHR in 2015 I had fairly frequent back problems. 2-3 times per year I could count on my back going out with spasms, pulling to one side. The arthritis that had worsened over the years had set my hips uneven, with the worse side (the right) effectively longer.

Since the 2015 surgery my back hasn't been a problem at all. Some occasional stiffness but nothing impacting my activities.
 
MRI Clear - Turns Out It Might Be My SI Joint!

Hey BoneSmart community,

I wanted to share an update on my back/leg pain journey, as it might help someone else down the line. I recently had an MRI of my spine, and the results came back clean! Which was a relief, but also a bit confusing, because I was still experiencing significant pain radiating down my leg.

After seeing a spine specialist who confirmed the MRI findings, he mentioned that since the pain going down my leg isn't explained by my spine, he's referring me to a neurologist. He suggested it could be something in the piriformis region, or other areas outside of the spine.

It's now looking like my pain might be stemming from my SI joint, or perhaps something else entirely. The symptoms I was experiencing were very similar to sciatica, which led me to believe it was a disc issue.

I have an appointment with an orthopedic surgeon tomorrow for a more thorough evaluation. I'm hoping to get some answers and a plan for treatment.

I just wanted to post this in case anyone else is experiencing similar symptoms and has had a clear MRI. It's a reminder that back and leg pain can originate from various sources, and as we all know, you just have to keep going and seeing these guys until you get the answers you need.
 
Good for you for pursuing this. You’re right that the SI joint can cause a lot of problems after a hip replacement. I experienced that as well after mine and sadly it tool a long time to get it pinned down and the problem resolved. I hope you are able to get the answers you need. Let us know how things go….we’re here for you.
 
Thanks for the update, @Charlie33. It can be so hard to identify the source of the problem when the back/hip/SI joint/etc. are involved because everything is connected. I hope you get an answer soon.
 
Hi @Charlie33. We haven't heard from you in a while and are wondering if the new surgeon was able to give you any answers.

Give us an update when you have a chance.
 
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