BlueSkiesHere
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THR Struggling after emergency THR
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BlueSkiesHere
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BlueSkiesHere
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BlueSkiesHere
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The notes from my last visit with the After Care PA was just posted to my chart. I found it interesting to hear her take on my groin/hip flexor/abductor pain....or whatever it is. I guess it is that big ole psoais muscle.
She says:
Assessment & Plan
1. Hip pain.
The patient's discomfort appears to be predominantly muscular in nature, as evidenced by the exacerbation of symptoms during physical therapy and the subsequent improvement upon cessation of therapy.
The possibility of an occult fracture can not be entirely ruled out at this stage. However less likely given the above-mentioned exacerbation and improvement with physical therapy exercises. The pain may be attributed to a strain or inflammation of the adductor muscle, potentially resulting from trauma or surgical intervention. The application of heat has been found to alleviate her symptoms. She is advised to discontinue physical therapy and focus on activities of daily living (ADLs). She is encouraged to apply heat to the affected area and to engage in walking exercises at a slow pace. She is also advised to avoid prolonged periods of sitting, standing, or resting, and to limit excessive activity.
I did discuss the possibility of follow-up CT scan with Dr. Gaunder but based on review of patient's x-ray and physical exam findings, we are going to hold off on that for now. A prescription for a Medrol Dosepak, consisting of 10 mg tablets to be taken over a period of 10 days, will be provided.
PROCEDURE
The patient underwent a hemiarthroplasty procedure.
> weightbearing as tolerated Right lower extremity
> Continue working with PT, Assistive devices as needed. Wean per PT recommendations.
> We will plan for follow up 6 to 8 weeks
So there it is. I love she used ADL! We know what that is. It's just been over a week and I must say some days are ok and some days aren't. It reminds me of my TKR when sometimes it felt as if there was no rhyme or reason why the pain came or where it moved to. I'm just trying to do my best and not over do or under do and wait a day and see if it lessens or moves to another area.
Fun this is not.
She says:
Assessment & Plan
1. Hip pain.
The patient's discomfort appears to be predominantly muscular in nature, as evidenced by the exacerbation of symptoms during physical therapy and the subsequent improvement upon cessation of therapy.
The possibility of an occult fracture can not be entirely ruled out at this stage. However less likely given the above-mentioned exacerbation and improvement with physical therapy exercises. The pain may be attributed to a strain or inflammation of the adductor muscle, potentially resulting from trauma or surgical intervention. The application of heat has been found to alleviate her symptoms. She is advised to discontinue physical therapy and focus on activities of daily living (ADLs). She is encouraged to apply heat to the affected area and to engage in walking exercises at a slow pace. She is also advised to avoid prolonged periods of sitting, standing, or resting, and to limit excessive activity.
I did discuss the possibility of follow-up CT scan with Dr. Gaunder but based on review of patient's x-ray and physical exam findings, we are going to hold off on that for now. A prescription for a Medrol Dosepak, consisting of 10 mg tablets to be taken over a period of 10 days, will be provided.
PROCEDURE
The patient underwent a hemiarthroplasty procedure.
> weightbearing as tolerated Right lower extremity
> Continue working with PT, Assistive devices as needed. Wean per PT recommendations.
> We will plan for follow up 6 to 8 weeks
So there it is. I love she used ADL! We know what that is. It's just been over a week and I must say some days are ok and some days aren't. It reminds me of my TKR when sometimes it felt as if there was no rhyme or reason why the pain came or where it moved to. I'm just trying to do my best and not over do or under do and wait a day and see if it lessens or moves to another area.
Fun this is not.
BlueSkiesHere
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I have a question for @Jamie or @Layla ... or anyone!
So I am doing as the above instructions I posted and what is happening now is...I would not say it is getting any better. It seems to be staying the same (I guess that is not bad). However, now it seems to be spreading from my right side groin area and over to include my left groin area. Not as severe. There is that hip flexor stiffness and ache and it spreads down into the top of my thigh area - stiffness, ache and a bit of burning sensation. I've not tried to panic because I know from my TKR that pains, aches, etc. can move around and be there one day but not another. Since she has ruled out my PT exercises, I'm left with a few gentle stretches and trying to walk enough (slowly) to ease up all the stiffness.
The pain is still in my groin/pubic bone area and radiates up into my abdomen and I still have the lower back discomfort. If I walk slowly, I can avoid the inner thigh abductor sharp pains now but I can't walk TOOO much or it appears.
Anyone else had this spread? I'm just doing ADL within reason and walking as tolerated. I see her again March 25.
So I am doing as the above instructions I posted and what is happening now is...I would not say it is getting any better. It seems to be staying the same (I guess that is not bad). However, now it seems to be spreading from my right side groin area and over to include my left groin area. Not as severe. There is that hip flexor stiffness and ache and it spreads down into the top of my thigh area - stiffness, ache and a bit of burning sensation. I've not tried to panic because I know from my TKR that pains, aches, etc. can move around and be there one day but not another. Since she has ruled out my PT exercises, I'm left with a few gentle stretches and trying to walk enough (slowly) to ease up all the stiffness.
The pain is still in my groin/pubic bone area and radiates up into my abdomen and I still have the lower back discomfort. If I walk slowly, I can avoid the inner thigh abductor sharp pains now but I can't walk TOOO much or it appears.
Anyone else had this spread? I'm just doing ADL within reason and walking as tolerated. I see her again March 25.
You may be getting positive benefits from the steroid treatment you’re on. So if you’re not seeing any real improvement, I’d be concerned that pain levels might increase once you complete the treatment.
There are some specific physical therapy treatments that can be done for muscle issues. Pressure point therapy and massage seem to work for a lot of people (me included). Dry needling is also done.
Tell me what your therapy consisted of? Did it include any pressure point work on the muscles? If not, then I think you should pursue finding a therapist who is able to diagnose an treat muscle tightness with these methods.
In my case, there were little knots within the muscles that had tightened up and were causing pain and poor gait. The therapist isolated each area and then applied pressure until the muscle released. By then end of a session, I was always noticeably improved. But, it took almost 8 months to resolve. At the beginning, the muscles would soon revert to the tight stage a day or so after I left therapy. Gradually, with the releases done twice a week it was longer and longer before they would tighten again. My case also involved a twisted SI joint, which the therapist resolved with massage therapy to get the joint back in place again and stay there.
There are some specific physical therapy treatments that can be done for muscle issues. Pressure point therapy and massage seem to work for a lot of people (me included). Dry needling is also done.
Tell me what your therapy consisted of? Did it include any pressure point work on the muscles? If not, then I think you should pursue finding a therapist who is able to diagnose an treat muscle tightness with these methods.
In my case, there were little knots within the muscles that had tightened up and were causing pain and poor gait. The therapist isolated each area and then applied pressure until the muscle released. By then end of a session, I was always noticeably improved. But, it took almost 8 months to resolve. At the beginning, the muscles would soon revert to the tight stage a day or so after I left therapy. Gradually, with the releases done twice a week it was longer and longer before they would tighten again. My case also involved a twisted SI joint, which the therapist resolved with massage therapy to get the joint back in place again and stay there.
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I agree that there's a variety of hands on soft tissue bodywork that can be of benefit: myofascial trigger point therapy, craniosacral release therapy, and hands on feldenkrais come to mind.
You want a practitioner certified in the specialty, with several solid years of experience, and willing to adapt to your postop needs as made clear by your medical team.
@BlueSkiesHere
You want a practitioner certified in the specialty, with several solid years of experience, and willing to adapt to your postop needs as made clear by your medical team.
@BlueSkiesHere
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I feel for you @BlueSkiesHere It's a very rough road you are on at the moment. Like @mendogal I think hands on therapy could be helpful. As you know from my previous posts, I had a a lot of groin pain after my RTHR last year which took many months to resolve and was incredibly debilitating. The main things for me were stopping the aggressive PT and reverting back to the so called ADLs and the heat pad, but what I didn't think to mention last time was that I also saw an osteopath a number of times and she did some sort of pressure point work and I think it did really contribute to my recovery. At one stage I went twice a week..... it was very gentle. Osteopaths are not chiropractors and here in Australia they qualify through a 5 year university course, which is actually one year longer than physiotherapists, so they are very well trained. I believe it is similar in the US. It was my GP who suggested I see her and I am really sorry i didn't mention this to you before. I do hope you have a some sort of relief fairly soon. Lots of positive thoughts and hugs to you 
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BlueSkiesHere
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@Jamie and @mendogal - to answer your question the PT that I saw did do something like a massage in the tight areas twice. It did help for a day or two and then the relief disappeared. @Jamie you had suggested this before and I have actively tried to find a therapist able to offer the pressure point therapy however all I have found it a massage therapist outside of my medicare coverage and it is quite expensive! It is $100 a pop which we can't afford. You are in the states - is that something I could ask my After Care PA specifically to see if she knows someone and it could be covered under my insurance possibly? The PT they subscribe is usually the aggressive kind and includes the exercises.
@mendogal - that is my concern about going to anyone outside the medical office - the massage therapist I found that charges $100 a pop - says they do medical massage but can I trust someone at this point not to do more damage?
And you are right - the prednisone has ended. That might be why I'm feeling it more.
I think you both are right about being able to relieve the tightness in this area. The question of if it is an occult fracture is still on the table. The CT scan is on hold until I return at the end of March.
I appreciate you guys sending me this support and sound advice. I am a'lookin!
@mendogal - that is my concern about going to anyone outside the medical office - the massage therapist I found that charges $100 a pop - says they do medical massage but can I trust someone at this point not to do more damage?
And you are right - the prednisone has ended. That might be why I'm feeling it more.
I think you both are right about being able to relieve the tightness in this area. The question of if it is an occult fracture is still on the table. The CT scan is on hold until I return at the end of March.
I appreciate you guys sending me this support and sound advice. I am a'lookin!
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BlueSkiesHere
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@Jamie and @mendogal - I found a massage therapist with this description:
"Neuromuscular massage therapy (NMT) is an advanced form of bodywork which integrates specific techniques, including flexibility stretching, to remove neuromuscular pain and bring the central nervous system into balance with the body’s muscular system. Neuromuscular massage focuses on the five elements which cause pain – nerve compression, decreased blood flow, biomechanical dysfunction, postural distortion, and trigger points. One of the main differences from general deep tissue massage is that neuromuscular massage sessions may not include a full-body massage, as treatment is focused on the specific area of discomfort. You will be booked with a certified Neuromuscular Therapist for your session. "
Is this what I'm looking for? She mentions trigger points or would this be too much?
"Neuromuscular massage therapy (NMT) is an advanced form of bodywork which integrates specific techniques, including flexibility stretching, to remove neuromuscular pain and bring the central nervous system into balance with the body’s muscular system. Neuromuscular massage focuses on the five elements which cause pain – nerve compression, decreased blood flow, biomechanical dysfunction, postural distortion, and trigger points. One of the main differences from general deep tissue massage is that neuromuscular massage sessions may not include a full-body massage, as treatment is focused on the specific area of discomfort. You will be booked with a certified Neuromuscular Therapist for your session. "
Is this what I'm looking for? She mentions trigger points or would this be too much?
BlueSkiesHere
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@Cillacat - thank you! That is very helpful and thank you for mentioning this. You are still the closest I've found so far to my situation. I've put a note in to my Ater Care PA about pursuing this. I can also check with my GP. She may have someone to recommend.
Also - the heating pad is my new best friend.
Also - the heating pad is my new best friend.
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@Jamie and @mendogal - update. I asked my After Care PA about the massage and she has gone ahead and scheduled me a CT scan for next Friday to see what is going on. She said the massage may help or may irritate. So we are holding off on the massage to not add anything new to the equation for now. She is hoping the CT scan will uncover the problem.
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@BlueSkiesHere
I agree it's prudent to defer hands on body work until after you and your team review the scan.
If you can find out the certification and years of experience the person providing Neuromuscular Massage Therapy has, it would be worth checking out with your PA's ok.
I agree it's prudent to defer hands on body work until after you and your team review the scan.
If you can find out the certification and years of experience the person providing Neuromuscular Massage Therapy has, it would be worth checking out with your PA's ok.
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I’m glad to hear your PA was proactive in addressing this for you with a scan so you can rule out any problems that are not soft tissue related. Gold Star for your PA!! And asking for a referral to someone is a good idea as well.
I agree that paying $100 a pop is not a good plan. Pressure point therapy (which is probably more what you may benefit from than massage therapy) is a very gentle form of coaxing muscles back into a proper functioning mode. The only problem is that it can take months sometimes to get the job done. As Cillacat mentioned in her post, when you start the treatments, you feel pretty good afterwards, but it doesn’t last. It’s only after those areas of tightness are treated multiple times over weeks and often months that they get the message and learn to relax completely. Improvement is frustratingly gradual, with the time that the muscle stays relaxed growing longer and longer until finally it just stays that way. One thing I did to help with the cost was to ask my therapist to teach me how to find the knotted areas in my thigh muscles. She did that and I learned that I could do at least some of my own pressure releases at home. This was especially helpful toward the end of my sessions with her as I was only going to see her once a week or every two weeks. For me, because she was finding so many points that needed the pressure releases early on, I needed her to do that initially. But later when it was just one or two spots, I was able to make it better myself.
I think you’re on the correct path here. I’m proud of you for taking an active role in your recovery.
I agree that paying $100 a pop is not a good plan. Pressure point therapy (which is probably more what you may benefit from than massage therapy) is a very gentle form of coaxing muscles back into a proper functioning mode. The only problem is that it can take months sometimes to get the job done. As Cillacat mentioned in her post, when you start the treatments, you feel pretty good afterwards, but it doesn’t last. It’s only after those areas of tightness are treated multiple times over weeks and often months that they get the message and learn to relax completely. Improvement is frustratingly gradual, with the time that the muscle stays relaxed growing longer and longer until finally it just stays that way. One thing I did to help with the cost was to ask my therapist to teach me how to find the knotted areas in my thigh muscles. She did that and I learned that I could do at least some of my own pressure releases at home. This was especially helpful toward the end of my sessions with her as I was only going to see her once a week or every two weeks. For me, because she was finding so many points that needed the pressure releases early on, I needed her to do that initially. But later when it was just one or two spots, I was able to make it better myself.
I think you’re on the correct path here. I’m proud of you for taking an active role in your recovery.
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Hi BlueSkiesHere,
I want you to know I saw your tag, but regretfully I have nothing to add to the comments and advice you've already received. I am sorry you're going through all of this and hope you find answers soon. I am following with interest. Best wishes!
@BlueSkiesHere
I want you to know I saw your tag, but regretfully I have nothing to add to the comments and advice you've already received. I am sorry you're going through all of this and hope you find answers soon. I am following with interest. Best wishes!
@BlueSkiesHere
BlueSkiesHere
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myglasshalffull
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You are advocating for yourself & taking the proper steps. Good for you!
It's such a good idea to get the scanning done before anything else just to rule out other issues, @BlueSkiesHere. I hope you can get some decent recommendations for some sort of manual therapies that are affordable. I was lucky that here in Australia I have medical insurance that covers almost half the costs of therapies such as osteopathy so that makes it more affordable. And although you must be sick of hearing it, don't forget that often the greatest healer is time. I really do believe you will regain your mobility and comfort. If the tendons are involved which it sounds like they probably are, they are much slower to heal than bone but they DO heal. By the way, I'm so pleased to hear that your heat pad is your new best friend.... it was for me for months!!!
