Any FAI (Femoral Acetabular Impingement) Hippies out there?

[aprilc]

Hey I thought groin pain and thigh pain were my best friends! And I feel ya when you spoke in your story about chasing the pain. I've spent too much money on dr's, surgeries, PT's, Rolfing, MRI's, cortisone shots etc etc etc.

I think the instability from the labrum problems is what has led to early OA for us. When you say you do not have "end of life" OA hip do you mean that your OA is not horrible? Mine wasn't horrible either but I couldn't do the things I like to do (ride a bike, long walks, work out) without paying for it afterwards so I could live life as a couch potato until my hip was at the end of it's life or get it fixed now and get my life back. Can't say I've gotten my life back yet but just got off the phone with my surgeon and he said it's still within reason to have soft tissue issues at 3 months so I'm just keepin' on keepin' on. BUT that said I'm still unbelievably frustrated and my patience is pretty much gone - I'm ready to be done with rehab and move on but I can only move as fast as my body. Stupid slow healing hip! One day I hope to never think of my hip again.

 

[Josephine]

I'm super super frustrated right now. I'm 3 months post op and still can't do much without paying for it later. It's all soft tissue stuff so I end up taking 3 very slow steps forward and then 10 giant steps backwards so progress is SLOW!

Okay then - would you care to answer my famous questions?

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)
And don't forget to factor in other forms of pain like soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

4. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

 

[aprilc]

1. When it's bad it get up to about 8. Right now I'm 5 days past my 3.5 walk (Saturday) that almost killed me and I'm sitting at my desk (I've been up and down) and my groin pain is at about a 6 - very nagging and annoying. Pain is better since the weekend but not resolved.

2. I'm taking 5 mg oxy, when I'm not hurting and trying to get off of the drugs I take one in the morning and one later in the day but then I usually do something to aggravate it and the pain levels increase. When it's really bad I go ahead and take some of the 10 mg oxy XR just so I'm not taking pills all day, so for example after my walk that almost killed me I went ahead and took one because I knew it was on and then needed one to sleep and the next day and night as well. Haven't been able to get to the point where I take less than 2, 5mg oxy in one day. I'm also taking a muscle relaxant - parafon forte (500 mg - 3x/day) and naproxen (500mg - 2x/day). I've tried the Naproxen without the oxy and it doesn't touch the pain but I think it does help me get less pain quicker (over days) if that makes sense.

3. I'm a school social worker so I'm at a desk but I'm also walking around the school. Per my PT instructions, I take the stairs half the time working on using the correct muscles to lift my leg (psoas instead of TFL) and use glutes to push up. I grocery shop, clean do normal household chore things without much trouble (that's progress!) but for exercise I don't do much beyond my PT. I tried to get back into swimming but had a huge flare up (not bc of swimming) so was told to lay off that and since i'm flared up now I debating if I should swim this afternoon (if I do it's usually swim for 250 yds then just pull for 250 and I have some strengthening leg stuff to do with the water for resistance). I walk but I wouldn't say it's daily - and again I feel like everytime I feel good and start to get somewhat active I do too much and go back to the starting line. Saturdays 3.5 mile walk was the longest I had done but I was feeling good beforehand and then hit the wall. My longest walk before that had been about 1.5 miles.

4. 3 sets of bridges 10 for 10 seconds
clam on back with resistance - red band
straight leg lift (3 sets of 6-10 - depends on if it hurts usually last set is less
side laying leg lift 3 sets of 15
regular plank, side planks 3 sets of 30 seconds
"pointer dog" where you're on your hands and knees and lift opposite leg and arm straight up 3 sets for 30 sec
10 squats - not super deep, focusing on using my psoas
stretching psoas by dangling leg off bed and pulling good leg bent up to chest to help keep lower back on bed

I think that's about it for PT - I don't have my sheet in front of me but that's from my memory. Really not much cardio at all - able to do 15 minute sessions on my spinning bike any more than that and I get the groin pain. But not groin pain like before, not deep, I'm pretty sure it's soft tissue.

Thanks for the attention @Josephine !

 

[Josephine]

1. When it's bad it get up to about 8. Right now ... my groin pain is at about a 6 - very nagging and annoying. Pain is better since the weekend but not resolved.

That's a lot of pain for 3 months out.

2. I'm taking 5 mg oxy, when I'm not hurting and take one in the morning and one later in the day ..... trying to get off of the drugs.
When it's really bad I go ahead and take some of the 10 mg oxy XR
also taking a muscle relaxant - parafon forte (500 mg - 3x/day) and naproxen (500mg - 2x/day)

You'd probably be better to take Tylenol 1,000mgs 4 times a day instead of all that. Though do remember that the parafon has acetaminophen in it as well so make sure you count that in! Max per 24hrs is 4,000mgs

3. I'm a school social worker so I'm at a desk but I'm also walking around the school. I grocery shop, clean do normal household chore things without much trouble
now I debating if I should swim

Then you obviously haven't read the recovery articles lately? Specially this one Activity progression for THRs

Per my PT instructions, I take the stairs half the time working on using the correct muscles to lift my leg (psoas instead of TFL) and use glutes to push up.

That sounds a bit aggressive to me.

Exercises: My comments in bold
3 sets of bridges 10 for 10 seconds - I think bridges are very counter-productive for this early out from THR
clam on back with resistance, red band - the medium band? Clams are also counter productive, cause a lot of pain in the ITB (ilio-tibial band) They're okay for when people are fit but not as part of a recovery/rehab regimen
straight leg lift (3 sets of 6-10 - depends on if it hurts usually last set is less - again, this is far too much Once you can achieve a SLR, no need to do them anymore
side laying leg lift 3 sets of 15 - same again, this can cause lots of IT band issues
regular plank, side planks 3 sets of 30 seconds - I had to look this one up and almost yelled out "no, no, no"! This is a yoga move and not for new THRs.
"pointer dog" 3 sets for 30 sec - another no-no!
10 squats - not super deep - and again but is you must do them, only do 5 a day
stretching psoas by dangling leg off bed and pulling good leg bent up to chest- probably the only one I find to not be injurious!
I have some strengthening leg stuff to do with the water for resistance - not!
I walk but I wouldn't say it's daily - Saturdays 3.5 mile walk was the longest I had done - 3½ miles? Ye gods! One mile would be plenty!

Do remember that hips actually don't need much exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

So to summarise, I would venture to suggest that the responsibility for your pain lies solely and totally with these exercises. Please stop them as indicated. Take a break from PT, at least a month, and if you're not much improved by the end of it, I shall be most surprised!

If you persist like this, you run the risk of having your pain go from acute to chronic and I would hate to see that happen to you. Only Tuesday I saw a lady who had her THR in February and has been doing these kinds of exercises - though much less - since then and now has chronic IT band pain, Trochanteric bursitis and Piriformis syndrome. She walks like she's one week out of surgery and is still taking narcotic pain killers! Just a cautionary tale for you1

 

[whiteshoecovers]

When you say you do not have "end of life" OA hip do you mean that your OA is not horrible? Mine wasn't horrible either but I couldn't do the things I like to do (ride a bike, long walks, work out) without paying for it afterwards so I could live life as a couch potato until my hip was at the end of it's life or get it fixed now and get my life back.

Yes, exactly. I've had a consistent ~2mm joint space since before my first surgery. It's that lack of a physical finding that has really kept my searching. To be honest your troubles post THR aren't very reassuring. I hope things take a positive turn for you very shortly.

 

[aprilc]

@Josephine OK, I'm going to lay off the PT for a month. So just to be clear I CAN:

1. Walk everyday around a mile to a mile and half? Probably increase distance slowly as tolerated.

2. Can I throw in some days of light swimming or indoor cycling for like 15-20 minutes or just stick to walking? I'm a swimmer so it's not something that is new or difficult. I wouldn't walk and swim or cycle on the same day.

3. Should I take the elevator at school all the time?

4. I read the activity progression and it says from 8 weeks on to basically do what you can as you can. I'm at 12 weeks, is there anything in my ADL that I shouldn't be doing?

I'm going to trust in you @Josephine , I feel like this is taking a huge step back, like a mile backwards but I do not want chronic pain so I'll keep you posted!

 

[aprilc]

@whiteshoecovers Apparently I'm still early in my recovery and I'm trying to push it too much. I kind of didn't pay attention when they telling me about the rehab before the surgery bc I thought I would "outperform" the average THR patient given my youth and history of being active. Now I actually think that being young almost makes it worse. You don't have the patience to take the time to have a slow uneventful recovery, you keep pushing the boundaries and prolonging the recovery.

Check out what Josephine has just told me above. I know they keep saying it's a marathon not a sprint and all the other mantras but I just want to feel strong again and see muscles in my legs again. So I guess my point is, come into this with realistic expectations, be patient, don't push it and you'll probably be fine. I'm creating my own problems.

 

[bottomshollow]

I'm creating my own problems.

@aprilc, spoken like a very wise woman who is beginning to understand, FINALLY, that recovery from this very major surgery takes TIME & PATIENCE. It means slowing down and taking it easy. In another 3 months or so, you can ease SLOWLY back into more activities and exercise, keeping in mind that whatever you do, it should not cause pain!

Take care and keep us posted. We care.

 

[Josephine]

Walk everyday around a mile to a mile and half? Probably increase distance slowly as tolerated.

I'd prefer a mile (that's ½mile there and ½ a mile back!) while you're in so much pain. Start increasing when the pain subsides some.

Can I throw in some days of light swimming or indoor cycling for like 15-20 minutes

Sure, just don't ever cause yourself pain during or immediately after!

Should I take the elevator at school all the time?

No not really. Stairs are good therapy. Perhaps for the first 2-3 weeks, take the lift up and the stairs down or vice versa!

I'm at 12 weeks, is there anything in my ADL that I shouldn't be doing?

Not a thing!

Now I actually think that being young almost makes it worse.

You got that right!

I just want to feel strong again and see muscles in my legs again.

I know but you WILL get there, pet. It just requires oodles and oodles of that P word we all hate so much!

I've had a consistent 2mm joint space since before my first surgery. It's that lack of a physical finding that has really kept my searching.

Funny thing about arthritic joints. Sometimes xrays tell the whole story and sometimes they lie in their black and white teeth!

Take me for instance: in October 2012 I had my left knee xrayed as I knew from a previous investigation it was doomed! My surgeon took one look and pronounced it bone on bone. He was also prepared to operate straight away (which in UK NHS terms meant sometime after Christmas!). But I was largely asymptomatic and said I'd sooner wait until I was significantly more pain that I was that day.

In June this year I had a spate of 'grit in the knee' pain and told him I was ready so would he put me on his list. But it settled and once again I am largely asymptomatic apart from the odd 'ouch' in twisty movements and the like. I kept thinking that if I was to be called in, say, the end of November or after, I'd probably be ready for it by then. But unexpectedly I got offered a date of October 22nd! Sadly I had other things booked up that I couldn't change and since still I wasn't in much that pain, accepted that now it will most likely be after Christmas. So 2 years and 3 months after he said it was ready to be done it's still going strong! It goes like that, it really does and the absence of symptoms does not necessarily speak of a normal knee - quite the opposite.

 

[scottfamilyman]

Hi, enjoy all your comments! 12 out of LTHR. After a month I was feeling real good. No pain meds and hardly any pain while doing my PT. I think I over did it. Lots of pain in upper thigh and groin area. My OS told me to rest for one week with no exercise. Leg lifts hurt. If it hurts, should I do it or what? I do walk around for short distances using my cane. Im back taking pain meds again. Any advice out there? Feeling lil down these days. Thanks!

 

[aprilc]

If it hurts don't do it! I'm still struggling with hip flexor/TFL pain. It's the last bit - if I can figure out how to get rid of that I might just be able to forget about my hip! Do you have a foam roller? Those upper thigh, hip flexor muscles get tight very easily and can cause a lot of problems. Roll Roll Roll all those muscles out, like kneading bread. I got a Tiger Tail which makes rolling easier and portable - my PT recommended it https://www.tigertailusa.com/ I got the 22 inch stick which is perfect. I'd go back to PT if I were you and have them help with the soft tissue stuff. You're not alone! I can only do about 5-6 straight leg lifts at a time. Trying to figure out if I need to strengthen my hip flexors or stop using them too much. ARe you still working on strengthening your glutes? Really really important, i'm sure they are very weak which is why you're using your hip flexor muscles too much and causing you pain.

 

[scottfamilyman]

Hi April, thank you for your great advice! Ya, it just seems I'm almost there. It's that antaganizing tightness and pain in upper groin and thigh area. I just don't know if I should try to stretch it out or rest it like my OS said too. I'm only 53 and weigh 185 pounds. I'm always on the go. Outdoors person and postal carrier! I just hate this feeling. Well, back to see my PT about this. I just have to stay POSITIVE! I wish you a full recovery aswell! Roll Roll and Roll! Ok sounds good!

 

[whiteshoecovers]

I wanted to bump this thread for everyone who isn't an older (wiser) bone-on-bone case.


I'm similar to the OP in that I do not have end of life OA (bone on bone) but have decided on a THR. I did have two scopes as you can read on my thread. They were by an expert (Dr. Brian White in Denver) and not sold to me as preventing or delaying the effects of arthritis. Since my joint space is constant (but not great) they were to address a practically 100% deteriorated labrum. It wasn't till the first surgery that he reported I did have significant cartilage damage and would need a THR one day. After the relief of my second scope (full labral reconstruction) wore off 18 months later Dr. White said that if the pain is indeed from my hip than a THR is the only option, very similar to the OP. So I spent the last two years checking off every other box for other things it could be, even made some new boxes, and then scheduled the THR.

 

[Josephine]

Thank you for your post. I'm sure there are many who will find it very useful.

 

[Brittany L]

@cj19mann can I PM you? I have a few questions

 

[cj19mann]

Absolutely @Brittany L Anytime!

 

[Brittany L]

@cj19mann I should've specified lol I'm new to this page and I can't figure out how to PM anyone....

 

[agileHippie]

@Brittany L to send a PM, click on cj19mann's username below her avatar. You should get a pop up box with her pic and several options. One is 'Send a Private Message'.

 

[Brittany L]

I tried that but it only lets me follow, ignore or view her profile

 

[Brittany L]

Anyway I guess I'll just ask her here lol. @cj19mann I wanted to ask you about your pain/restrictions prior to you getting your scopes/THR. I have FAI, moderate arthritis and a torn labrum as well, but my pain started when I was 18. I was always very active in sports and put it down to being too active. But now, it's getting more painful and my options are to either shave the spurs now and probably have THR later on down the road for my moderate case of arthritis...which is manageable with Aleve/Tylenol. Do you regret having the scope and not going straight for the THR? Are you able to still be pretty active after having it done?