THR Spongebob's Recovery Journey

[Spongebob]

My feeling is that the podiatrist is right that leveling out your legs should help. I hope you‘re going to give this a try.

But I think you’re being too hard on yourself if you’re worried about aching pain after this marathon walking you did at a theme park. That can happen to anyone who exceeds their normal activity level. It just means you’ve overworked the muscles. The best cure for that is just what you did….rest and let things recover. When you exercise and muscles are pushed past their normal daily activity level, the fibers actually get small tears in them that then immediately start to heal. This is how you build muscle strength and why you exercise, then give yourself a day of two of rest before you exercise again. This is the process of building muscle strength and you’ve been doing it all along during your recovery. The results are that you are stronger now than you were months ago, but probably not so strong that a 10-mile walk in a day wouldn’t have any impact at all.

Firstly I have paid for the orthotics and I have got to wait 2 more weeks for them to be made specifically for me so that's the first thing I'm definitely doing daily from the day they arrive secondly I am booking in with a personal trainer next week so he can identify what muscles are weak in my hips and help me strenghen all my hip muscles and also drop a few pounds in the process so hopefully I will turn a corner soon and get my hips as strong as they can be and trim up in the process

 

[Jamie]

That sounds like a good plan.

 

[Spongebob]

That sounds like a good plan

My hip aches daily but walking or going the gym make it ache more it's like if I walk say 5 miles it starts to ache and stabbing pain is more and why when I walk does it feel like a stabbing pain in my groin is this tendinitis,bursitis,nerve pressing I'm confused now.

 

[Jamie]

It’s impossible to diagnose exactly what is causing pain like this. But, whatever it is, the discomfort means you’ve gone past the level of activity or exercise that your hip is ready for right now. Remember to always listen to your body and respond accordingly. Sometimes we just hurt with activity and you can‘t put a label on it. But you can take things a bit easier for a while and then start again .

 

[Spongebob]

It’s impossible to diagnose exactly what is causing pain like this. But, whatever it is, the discomfort means you’ve gone past the level of activity or exercise that your hip is ready for right now. Remember to always listen to your body and respond accordingly. Sometimes we just hurt with activity and you can‘t put a label on it. But you can take things a bit easier for a while and then start again .

I was also told by a osteopath that I have a inguinal hernia to which I thought was a little out there as I don't have a lump on my hip/groin it's just strange that it was ok for a while still ached but now the ache seems more and when I walk it feels like a stabbing pain

 

[myglasshalffull]

Well if you have a hernia accompanied by pain (Is pain from "hernia")? You should have that looked at & properly diagnosed.

 

[Spongebob]

It’s impossible to diagnose exactly what is causing pain like this. But, whatever it is, the discomfort means you’ve gone past the level of activity or exercise that your hip is ready for right now. Remember to always listen to your body and respond accordingly. Sometimes we just hurt with activity and you can‘t put a label on it. But you can take things a bit easier for a while and then start again .

I was also told by a osteopath that I have a inguinal hernia to which I thought was a little out there as I don't have a lump on my hip/groin it's just strange that it was ok for a while still ached but now the ache seems more and when I walk it feels like a stabbing pain

Well if you have a hernia accompanied by pain (Is pain from "hernia")? You should have that looked at & properly diagnosed.

But I'm not even sure it is that to be honest I'm awating a.mri scan but how would I know it was that

 

[myglasshalffull]

You don't know, that's why you need it properly diagnosed.

 

[Spongebob]

Hi evening all of my wonderful hippy friends how is everyone just here to say I start my p.t tomorrow morning so hopefully now instead of there being a dark tunnel with no light at the end now I'm looking into a tunnel with a light at the end of it that light is my future with my wonderful new hip all nice and strong and great mobility and working perfectly I now have a postive mindset and happy thoughts tomorrow is the start of me getting out of this slump I'm in and putting all the negative feelings back where they belong in the past and starting to think postive that things are going to change for the better and really putting in the hard work to make this happen I will do this I can't wait I'm so looking forward to it making me mentally stronger physically stronger and putting me in a better place physically and mentally
Just wanted to say a massive thank you to everyone that has supported me in the last year it's been so helpful and supportive

 

[Spongebob]

@Layla @Jamie @hiphip.hooray @Mojo333 Happy sunday my wonderful hippy friends (fathers day here in the uk)Just a quick update I have had a mri scan on Monday awating the results now so hopefully that will help actually medically diagnose what the issue is (I hope nothing major but muscle inflammation as pt thinks)and I have started work this week with a personal trainer who has given me a programme to follow 3 days a week and a nutrition plan but just a quick question has anyone suffered post op with either psoas tendinitis (just wanted to know what it felt like day to day what hurts it more and what it restricts you from doing) or what my personal trainer thinks i have is hip flexor weakness/tendinitis as when I lunge its ok in the lunge postion but as soon as come to rise up from the lunge I get a sharp pain in my groin it's the same when I tie my shoes I'm OK getting down to tie then but upon rising from tying them.i get the same sharp pain he seems to think it's when my hip flexor lengthens out that's when my body is like wow I dont like this at all and then I get the sharp pain
Thanks my wonderful hippy friends

 

[Jamie]

It sounds to me like you have a great therapist who is able to carefully analyze where and when you have pain and then help develop a plan to fix it. It takes patience as sometimes the “fix” will take months to resolve. You’ve been really good so far in dealing with a variety of soft tissue problems, so I know you’ll stick with it and hopefully this will improve your movements so you have less pain.

 

[Spongebob]

It sounds to me like you have a great therapist who is able to carefully analyze where and when you have pain and then help develop a plan to fix it. It takes patience as sometimes the “fix” will take months to resolve. You’ve been really good so far in dealing with a variety of soft tissue problems, so I know you’ll stick with it and hopefully this will improve your movements so you have less pain.

But what I wanted to know is what is causing the sharp pain upon rising from tying shoe or a lunge is it hip flexor issue ?also he says I have overactive muscles working for underactive muscles that's why I have a muscle inbalance and the reason why it aches all the time

 

[Jamie]

It would be difficult for us to pinpoint exactly what is causing that pain you’re experiencing since we’re not there with you. Your therapist is the best person to answer this question for you. It’s important for you to communicate this pain (when and where it occurs) so the therapist can work on that area. It most likely results from any muscle imbalance you still have. When the muscles get overworked, they tend to tighten up in spots and this plus strengthening exercises is likely what the therapist is doing for you. This can take many months to resolve. I’ve been working on my quads and glutes for 3 months now and I’m finally starting to see some progress….very little, but it’s there. I would caution you to try and avoid anything right now that you know is going to cause you a sharp pain. If it hurts when you do lunges, don’t do them until it’s more comfortable. Tie your shoes sitting in a chair. There are always “work around” you can do when something is painful. It’s never beneficial to try and push through sharp pain.

 

[Spongebob]

Hi it's been a while thought I would check in to see how everyone is on this fine friday
Just a quick 1 I have been told that the reason my hip aches all day and doing certain movements like rising from tying my shoe gives me a sharp pain and lunges too hurts they have said my prosthesis is fine all good they said I have tendonitis of the hip flexor (psoas) and that's what's causing it anyone else suffer from this please and can offer some advice please?

 

[myglasshalffull]

Hi Sponge,
Nice to see you here. There's a few articles on psoas on this site, take a look.
I have no advice other than to ice it & why are you doing lunges???
Hope someone with more info chimes in.

 

[Spongebob]

Hi Sponge,
Nice to see you here. There's a few articles on psoas on this site, take a look.
I have no advice other than to ice it & why are you doing lunges???
Hope someone with more info chimes in.

@myglasshalffull Hi where do I find articles about psoas tendinitis please?

 

[Layla]

Hi Spongebob,
If the lunges cause pain, consider eliminating them. If tying shoes gives you a sharp pain, consider slip ons. They have slip on shoes in every style of shoes these days, athletic, casual and dress shoes. The prosthetic hip will never match your natural hip. I am not saying you have to live with whatever is causing you the pain, if there is a solution, but it really doesn't make sense to engage in exercises that bring on pain, when I'm sure there are alternatives that won't.

Following are a few Psoas related articles from the BoneSmart Library to which I will leave a link here -> LIBRARY

Psoas pain

People often get confused about psoas pain as it seems to be so spread out. But the psoas is a huge muscle so if you get inflammation/pain, it can occur almost anywhere. You can see the spread of it here The psoas is a unique muscle. It connects the lower spine to inside of the hip and then...

bonesmart.org

Psoas Tendinopathy and surgery

broken link removed: https://www.arthrohealth.com.au/psoas-tendinopathy/ What is psoas tendinopathy? Psoas tendinopathy (or tendinitis) is inflammation and/or partial tearing of the psoas tendon, which is located deep in the hip joint, attached to the lesser trochanter (a small bony prominence...

bonesmart.org

Psoas Release for psoas impingement

Article updated July 28, 2022, by Jamie and CricketHip. Release for psoas impingement The psoas is a large muscle beginning in the lower lumbar region of the spine and extending through the pelvis to the femur as shown in the illustration on the left. It works to flex the hip joint and lift...

bonesmart.org

Thanks for stopping by. I hope you're able to get some answers on the pain you described above.
Best Wishes!
@Spongebob

 

[Hip4life]

@Spongebob Sorry to hear about your hip pain. IP (iliopsoas, these 2 muscles are so close to each other, they are usually lumped together) tendonitis is one of those situations that seems pretty straightforward and most times, it is. The ortho/PT people are always going to start simply and work their way forward. It's logical, easier to keep track of your progress, and not surprisingly, these simple things usually take care of the problem. It's kind of a Sherlock Holmes mystery solving exercise. I'll try and address what I understand about the subject.

1. Something is aggravating the tendon. So, what is it and what can we do about it?
You alluded to a couple of possibilities:
a. A particular exercise(s) can cause the IP to get irritated. You stop said activity and similar ones, rest, ice, and take NSAIDS as appropriate, if you are able.

b. The muscle/tendon can become shortened/tight with sitting for long periods of time with work or an activity. It can also do this while we wait for our THR. Gentle stretching regularly can help the muscle return to its proper length and role (and free up those other counter muscles.) A well-trained PT can manually pressure release this muscle/tendon to get it to relax, as well.

c. Sometimes a tight tendon can be sliding over the edge of the acetabular cup component. The diagnosis and treatment plan here will be from your OS.

Most of the above can be self-directed or in conjunction with your doctor/care practitioner. He or she may even offer a more potent anti-inflammatory to aid your endeavors. Then, it is a wait and see if anything helps. The ball always lands in your court to let your care team know if the pain continues or gets worse.

2. Let's talk about pain. How is your pain? How long have you had it (recently or pretty much ongoing?) How do you rate it? Is it intermittent, all day, or interfering with your daily activities? Do any of the treatments above help? Pain level and the effect on your life also drives diagnosis and next steps treatment.

a. If the pain is stubborn and you can't get it to settle, the next step could be an injection into the tendon. This is an anesthetic with a steroid. The results can be mixed but the hope is that the steroid will get that tendonitis to finally calm down.

b. What if nothing seems to help? If you've given it your best shot, then surgical intervention may be necessary. This is especially true if a physical impingement (like the acetabular component) is the cause of the tendonitis. This consists of lengthening the tendon by cutting some of the fibers, usually through an arthroscopic procedure.
I hope this sheds some light on this. The kicker here is that each step takes time and patience to sort out and move through. Trust me. I have been through them all. Let me know if I can be of further assistance. Blessings as you look for answers.

 

[Spongebob]

Morning people does anyone have any experience of hip flexor contraction or a groin tendinopathy

 

[Charlie33]

Sure do. My physiatrist and PT educated me on my situation a while back, so here we go!

Normal Hip Flexor Contraction:
This occurs during activities like walking, running, kicking, and even sitting. These muscles contract to help lift your leg or bend at the hip.

Me: Abnormal Hip Flexor Contraction (Hip Flexor Contracture):
This refers to a condition where the hip flexor muscles become chronically shortened and tight, limiting the hip's ability to extend fully. This can cause pain, limited range of motion, and changes in posture. This is me!

My left hip flexor, which is the Psoas muscle oft referred to in recent posts, has damage from a bad fall where my leg was twisted behind my back at age 20. This led arthritis and partial fixed flexion contracture,a condition where my hip joint became stuck in a slightly bent (flexed) position and had trouble straightening out, even with passive movement.

I have been managing this since I was in my early 20's. I am now 55 and had THR almost two years ago. I have led a fully active life with my family but had to 'manage' this since that time (more later on this). Did THR help? Yes! But...because I had muscles shut down for such a long time (15+ years) it means I have to consistently work on it more actively than most who had shall we say 'normal' hip replacement (pain at 65, 3 years later THR 68 etc). All of this leads to the biggest thing I've had to focus on....

Neuromuscular Re-education: Arthritis and tissue injury sends signals to your muscles to shut down and stop working! So....deep breath haha... we need to retrain the communication pathways between the brain and muscles. It involves teaching the brain to send the correct signals to the muscles to perform specific movements. I cannot stress enough how specific this is to each person in terms of intensity and type of exercise. Also..

Massage: tissues that don't work for a long time get stuck together. A talented massage person will get deep enough to break up the adhesions so you can improve tissue quality. And after a massage when the tissue is released I go for a walk and just do normal stuff, avoid sitting and no exercise for 24 hours. This also helps the brain figure out you've been 'adjusted'.

Lifestyle adjustment: get a standing desk and make sure you move around and dont sit too much!

The tricky issue? Pain. See, when tissue shuts down and you try to move it, it will hurt. The mantra here is if it hurts dont do it, which I agree, but work with your care team on 'discomfort' v. 'pain'. I have discomfort off and on all the time for 30+ years. I don't take meds, just know for me its part of the game.

To sum up: while we share many of the same isses with folks here, perthes and my situation likely means we have to manage this as a chronic issue: when tissue shuts down around a joint for a long time, the THR helps but some of those tissues will simply be chronically grumpy. We can only do the best we can and keep moving! I had to deal with gluteal tendonopathy and Trochanic bursitis around my hip replacement over a year out, simply due to tissues being inactive for so long. While the archive here can be very helpful, it was hands on work with my care team that got me through!

For me, acceptance was a hard pill to swallow: so many folks seem to bounce back and be 'perfect' after THR and forget about it. True or not, many years ago I had to accept my situation was different than most, and chronic from a young age which helped my frame of mind and forward path. Everyday I can walk and spend time with my family is a miracle, which I can do.

Please share this with your care team to see if they agree or disagree. The most important thing? Never give up, and always always always keep moving!

Hope this helps!