Hip Resurfacing [BILATERAL] Could it be impingement?<

[slinky]

I'm six months post bilateral resurfacing.

Recovery has been slow but I've been able to rehab ok. My left hip has felt great aside from muscle issues where I've been fighting off psoas tendinitis. My right from day one hasn't had as good range of motion and I've felt a catching sensation on certain end of range activities and getting in the car. This has just given me sharp pain and been sporadic.

Anyway, as of two weeks ago both hips have flared up, I was in the gym and was doing some mobilisation exercises. I've stopped all activity and taking anti inflams but they are yet to settle.

I'm freaking out a bit; is it possible to develop problems six months in with the tendons? Could it be impingement or would that have felt worse? If its mild impingement could that settle down?

I'm also slightly worried as I stopped breastfeeding right about the time the hips flared, if my ligaments suddenly get tighter would that cause new impingement?


Any thoughts appreciated.




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[Jaycey]

What other activities are you doing @slinky ? If you are in the gym - how often? Does icing the hips help? I'll tag @Josephine for you. She will need a bit more detail on your activity levels and the exact area of this pain.

 

[slinky]

So prior to this I was on a slow and steady rehab protocol, things like bridges and planks, focused on firing my glutes and not my hip flexors. I had no problems with this stuff for the past 3 months (although my left started to get cranky - Prior to my surgery after my scope I had started to develop tendinitis so backed off).

My right has been flared by an exercise on my back and just holding my shin and moving the joint around in my socket where I've felt a catching sensation. After that day I stopped everything as it flared it but a week later my Physio asked me to do straight leg raises; previously I've struggled with this and felt a catch in the front but it's not caused pain. Now it's clearly inflamed so that's just aggrevated it.

I guess I'm worried about this catching sensation, and given getting in and out of the car has been hard with my right. Is it possible that even at six months it's still a case of inflamed tissues that will stop catching when it settles?

Thanks


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[Jaycey]

I'm not a medical expert but I do know based on what I see here that recovery from resurfacing can take awhile and can be painful. I think the extensive exercising early out may have contributed - especially since you say you have been fighting tendinitis. Let's see what Jo recommends.

 

[slinky]

Thanks jacey,

I get that with my left hip but it's my right I'm worried about as a different history and symptoms wise re the catching... anyway will see what Josephine says!


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[Josephine]

I've never been a fan of exercise post-op and most hip surgeons of my acquaintance aren't either. In fact most of them say NO exercising like that. Certainly things like bridges and planks are custom designed to cause problems after hip surgery.

For members here I always leave this bit of wisdom: Hips actually don't need any 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 I would imagine that your problems are being caused by your exercising.

To define all this a bit better, perhaps you would tell me the exact site of your pains using this chart

 

[slinky]

V/T r2f/r3f groin pain. It's coming from my illiopsoas.

Ive needed to do some Physio work as my left glute doesn't fire and overactive hip flexors which means I'm not walking correctly - I've not been able to walk much since my surgery. I no longer have a piriformis on that side from an old release surgery.

Anyway I've stopped everything right now. I'd just like to hear thoughts on whether impingement can happen so late or whether it may disappear once inflammation goes (six months seems a long time for it to subside?) thanks vm


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[AlGroomer]

Slinky why would you think you have an impingement? I had an impingement for years and didn't know it, I could never get down in my squat when i was doing crossfit.


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[slinky]

I've had a catching sensation since the operation on certain range of motion on my right. I also get that same pinch getting in and out of a car, which apparently is one of the signs. Not able to do straight leg raises either but that could just be a strength thing.

I'm hoping it's not that and just inflammation that will settle. Fingers crossed!


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[Josephine]

You mean here?

seems like a very similar pattern to this from a knowledgeable site

which is psoas pain.


However, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[slinky]

Sure please go ahead.


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[Josephine]

Here y'go then!

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 approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

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

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

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

7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[slinky]

I'll try and answer in order
- posterior
- 7/8 if I don't medicate. 3-4 if I do.
- still pane (paracetamol and codeine), cannabis oil
- yes icing twenty mins every 1-2 hours
- resting/neutral psoas position
- I've cut activity down to nothing now, was previously doing normal activities such as grocery shopping. I don't have stairs and I have a cleaner so no housework


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[slinky]

Exercise - none

I was previously doing glute activation exercises; I coped with these fine and had no issues.

An example routine was
10 x bridges,
sit to stand x10 with thoroughband
10 x standing calf raises
10 x plank
10 x laying on my front on a ball and lifting my leg with bent knee

My Physio got me to do straight leg raises and did joint mobilisation, it was after these specific exercises when I had the catching sensation that have then irritated it. Annoying as I told the Physio I shouldn't do it! However now it's inflamed normal activities are aggrevating it so I cut out everything, I haven't done any Physio or rehab for three weeks. I've assigned myself to bed rest and back on crutches to see if I can rest it 100pct.

I'm also having treatment with APS, stimpod and ultrasound for inflammation. Previously this has worked well.

My surgeon is now recommending a cortisone injection as it hasn't settled the last 2-3 weeks with relative rest and antiinflammatories. Hopefully it will resolve once the inflammation is gone and the catch is just caused by inflammation rather than an overhanging prosethic. I went to one of the top surgeons globally so I have to try have faith that structurally it's all ok.



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[ljpviper]

Slinky, I am also a resurfacing patient, with a prior scope going through the same situation. I am 11 month out of HR with Dr. Gross. I was okay dealing with with on and off psoas tendonitis. Something triggered a nasty flair in my HR hip. I went to Dr. Gross the X-rays looked perfect. Had psoas injection things became even worse after that. I have no clue what's going on. Something is making all the muscles shut off in my hip. I was able to walk, 2 plus miles no problem, same excercises you were doing.

I don't know if I have bursitis now added to the psoas issues. I am lost. back in december I walked 2 hours plus no issues, great glute an core strength.

Very odd, his office has been great but something is not correct. Not sure what to to next. It's to the point I am 24/7 in pain.

 

[Josephine]

7/8 if I don't medicate. 3-4 if I do.

Ouch!

paracetamol and codeine

You've not told me what doses you are talking nor what schedule.

icing 20 mins every 1-2 hours

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

resting/neutral psoas position

Not sure that the 'psoas' position is but I'll take your word for it!

I've cut activity down to nothing now, was previously doing normal activities such as grocery shopping. I don't have stairs and I have a cleaner so no housework

Sounds good!

My comments in bold
10 x bridges - these are punishing for hips
sit to stand x10 with theraband - I also don't recommend the use of theraband or weights. Veyr harmful
10 x standing calf raises - a pointless exercise in my view!
10 x plank - pointless and harmful!
10 x laying on my front on a ball and lifting my leg with bent knee - another pointless and harmful exercise!
straight leg raises - a tip - once you can do SLRs easily, you don't need to do them any more!

I've assigned myself to bed rest and back on crutches to see if I can rest it 100%

Well, I can 100% say that this pain has been caused by the harmful exercises you have been advised to do. I suggest you read this BoneSmart philosophy for sensible post op therapy