Hip Arthroscopy 3 yrs. post op and exercise has not made much difference

[Jamie]

When you see this new therapist, ask if they do Pressure Point Therapy. After my hip replacement, I developed small knots on my quad muscles and this therapy worked very well to eventually get rid of them. It’s a simple technique where the therapist locates the knot(s), then puts finger pressure on them for a period of time. This causes a release of the knot. At first, they do come back, but with continued pressure treatments, the knots are eventually resolved.

I image a similar result can be obtained with the right type of massage therapy. Good luck and let us know how it goes.

 

[benne68]

how long do you think it took to resolve the knot in your glute?

I honesty don't remember -- I lived with the problem for so long that any relief was welcome.
As I mentioned above -- the problem does return if I don't keep up with both the massage and yoga. When it flares up, it is painful to sit. I either lie on the floor or stand!

And has the knot truly “disappeared” for you?

No, but it does recede enough that I can sit comfortably for extended periods. I suspect the root of the problem will never completely go away unless I opt for back surgery -- which I am not inclined to pursue at this stage.

Good luck with your physical therapy!

 

[frogger]

As I mentioned above -- the problem does return if I don't keep up with both the massage and yoga. When it flares up, it is painful to sit. I either lie on the floor or stand!

I see. For me the problem can make it painful to sit and this was worse/stronger during the disc herniation 6 months ago. Which does suggest they're strongly connected.

No, but it does recede enough that I can sit comfortably for extended periods. I suspect the root of the problem will never completely go away unless I opt for back surgery -- which I am not inclined to pursue at this stage.

By "back surgery", were you imagining microdiscectomy?

I saw a spinal surgeon but they felt the herniation relatively small. For this reason, she has requested I have the electrogram exam, in which they test the nerve and determine whether it's under pressure/pinched at the moment.

I now believe the problem is spread across these 3 areas: the disc, the piriformis/trapped nerve and the labrum damage.

And for this reason, I don't even know if microdiscectomy would help me. If the nerve is trapped in the glute then surgery to relieve pressure on the nerve at the disc level wouldn't help. Right?

I don't really see how I can recover all of this. It feels like there's so much damage it's hard to believe I can recover with just physiotherapy, stretches or massage. I thought by having the hip surgery I would be on a clear path to returning to proper exercise and now I just feel I've lost another 3~ years of my life.

 

[frogger]

@benne68 if you don't mind, I have some more questions to ask you about your piriformis pain.

My goal is to understand how similar our problems are to determine just how likely a conservative treatment that has helped you might help me:

Where does the pain normally appear?

• The glute?
• The hip joint?
• The front of the thigh?
• Or all of these?

Do you find that when you bend forward on one leg, that your hamstring/joint will "pop" as you tilt/lean forward? This happens to me on both sides but especially on the right side and it releases the pain/discomfort when it happens.

Which stretches help you the most? I've seen the following recommended for piriformis in the past:

• Half pigeon pose in yoga.
• Figure 4 stretch.
• Seated ankle over knee forward stretch.
• Frog pose in yoga.

Which exercises help you the most? I've seen the following recommended for piriformis in the past:

• Glute bridges
• Lateral band walk
• Lateral leg raise

 

[benne68]

Hi @frogger,

Happy to answer your questions, but I do want to remind you that our herniations are in different places. Although L5-S1 is close to L4-L5, when the discs bulge they press on different nerves so our symptoms -- as well as the solutions -- may be different.

1. My pain occurs predominantly in the piriformis and the IT band, but occasionally all of the above.
2. No popping.
3. Figure 4 stretch is my go-to. Since my hip replacement, I no longer do pigeon or frog.
4. None of these. It's the work to strengthen the lateral core muscles (not the abs) that has been key to my improvement -- since that provide better support for my spine.

I don't really see how I can recover all of this. It feels like there's so much damage it's hard to believe I can recover with just physiotherapy, stretches or massage.

I felt that way, too, initially. Perhaps you are expecting too much too soon. Keep in mind that your hip surgery in 2021 would not have done anything to improve your bulging disc. They are separate problems.

Since your herniation was only six months ago, perhaps you just need to give the damage time to heal.
Unfortunately, recovering from back problems require a lot of patience.

 

[Jaycey]

I don't really see how I can recover all of this. It feels like there's so much damage it's hard to believe I can recover with just physiotherapy, stretches or massage.

Having been through this spinal journey I can tell you that physio to build core stability does indeed help. I had years of it before finally having spinal decompression.

Post my LTHR I had several instances of major piriformis pain. Hamstring stretches and trigger point massage by a specialist spinal PT helped ease this. Unfortunately spinal issues can be a major drain on patience!

 

[frogger]

1. My pain occurs predominantly in the piriformis and the IT band, but occasionally all of the above.
2. No popping.
3. Figure 4 stretch is my go-to. Since my hip replacement, I no longer do pigeon or frog.
4. None of these. It's the work to strengthen the lateral core muscles (not the abs) that has been key to my improvement -- since that provide better support for my spine.

It’s interesting you describe it as “piriformis pain”. For me I feel it in the glute but I can’t really say for sure that it’s “the piriformis” in particular that’s hurting.

I have no pain in the IT band. But I have discomfort across the front of the thigh. Often clicking or popping can occur across the front of the thigh which relieves the pain.

Thanks for answering all these points. It’s interesting to see the contrast. I think our conditions are similar but likely still different enough that I’ll need to find my own custom routine. Because if just “figure 4” stretching and a stronger core was enough for me then I’d likely have improved by now. As I’ve had PT at various points in the last 10 years and tried those options.

Perhaps you are expecting too much too soon. Keep in mind that your hip surgery in 2021 would not have done anything to improve your bulging disc. They are separate problems.

Yep. For sure. I wasn’t conflating the two. Although I believe that one can cause the other, I know that fixing one doesn’t fix the other.

At this point, I recognise that there are some more scans to do and consults to have. But I will explore a new conservative treatment with the new PT and focus on this “glute issue” with trigger point, exercise and stretching.

If that doesn’t work, I think a surgery for my L5-S1 disc might be in the cards to relieve pressure further.

 

[Caspa]

Hi Frogger. I just had my hip replaced 8 weeks ago. I have a really messed up back too. Stenosis, scoliosis, multiple herniations in all three sections with the worst being at L5-S1, arthritis etc. I had laminectomy for a major blow out at L4-L5 over 25 years ago. For the past few years I've had debilitating back, hip and knee pain. I had a partial knee replacement a year and half ago that didn't work so well but I blamed it on my bad hip. I was told by numerous doctors that my back pain was not related to my hip but I decided to wait until after my hip replacement to start epidural injections in my spine. (I tried PT for six months with no relief). Well, the hip surgery relieved 80% of my back pain. It did nothing for my knee pain though. My point is that this is all connected so it's really hard to tease out the source of pain when you have multiple issues. In my opinion, your hip should be better by now. Get a second opinion. But...don't rule out it could be that herniated disc. Microdiscectomy is an amazing operation. My brother has had three, my daughter one...each experienced immediate relief. I really hope you can find out soon what is going on. You're too young to be feeling so rough!

 

[frogger]

@Caspa Hey Caspa, thanks for the thoughts. Sorry to hear about your journey and yes I agree I'm too young for this... although I'm ok to have injuries as long as they get fixed. What I hate is how long it seems to take before it becomes clear that whatever I've tried/done (surgery, PT, etc) was not the solution and there's still more to be done.

For my hip, it's true the joint itself should be better but pain in the hip and inflammation can be triggered by the pressure on the nerve at the L5-S1 disc or via sciatic nerve entrapment in the glute itself. So maybe the surgery was successful but there's more I needed to solve.

Ultimately I think the answer is it's still just a combination of "all of the above". I think my cartilage is in a bad state and thus the joint itself will always create some inflammation with relative easy (unless I get a total hip replacement).

And I think the disc is now pressing a bit more which will always create some inflammation easily as well (unless I do a microdiscectomy).

My new PT wants us to try:

• Strengthening my core again to relieve pressure on that L5-S1 problem.
• Mobilizing/rewiring the hip and glute movements to free the nerve in the glute muscles.
• Strengthening my hips, glutes and thighs to relieve pressure on the hip joint / cartilage.

Honestly, I think this is a good plan. And I think the part that hasn't been explored to its full exten before is the second part – untrapping the nerve in the glute.

If after this, there are still problems. I might start with the microdiscectomy surgery. And if after that, there's still problems, I will look into total hip replacement. It seems extreme but I want this solved for the next 10 - 15 years. And after that, I will take my chances on medicine improving to enable another hip replacement if needed.

I'm open to any thoughts on my plan above if anyone has any...

 

[mendogal]

I don't think there's harm in another try at conservative treatment with PT.

Did you get the scan or test you recently mentioned? Has it been suggested you try a temporary nerve block at the level of your disc problems to see if it resolves the pain?

 

[frogger]

Did you get the scan or test you recently mentioned?

No yet. First available appointment isn't until 2nd of May for the test.

Has it been suggested you try a temporary nerve block at the level of your disc problems to see if it resolves the pain?

I've had 2 epidural injections in the last 6 months and they helped reduce the day-to-day pain for a few months.

 

[frogger]

Hi all, I wanted to post another update. A few things since my last post here:

1. I returned to PT and the gym. My PT has been focused on hip mobilisation and in particular I've been finding that the Copenhagen plank helps reduce my pain and symptoms.
2. As this targets the adductors, I have tried using a weight machine to strengthen my adductors. I've discovered that if I "push myself too far" with this though, I get a lot of hip pain.
3. I had the EMG scan/test for see if my muscles and nerves have shown degradation from the back herniation. All the tests were normal/successful. And in general, while my back is often stiff and I'm careful with it, I think it has healed substantially. I don't think that my hip pain is caused by the discs currently, I think it is indeed the hip itself.
4. I did some vacation and work travel in the last 2 months and my routine was not very consistent so I have not lost weight. However I think I've replaced fat with muscle at least.
5. At the gym, I'm just strengthening with squats, lunges, cycling and upper body work. And doing hip mobilisation on top of that. I'm not trying to return to running at this point.

The other day, I pushed myself too far with the adductor weight machine and 2 days later, I had a lot of hip pain. I continually wanted to pop the tendons around my joint. I couldn't shake the feeling. I took 200mg of ibuprofen and later on, I made a movement where I shifted my hips/weight between two legs while standing and felt a very distinct "thunk" as if something was released deep in the joint. I felt relief after this although there is still residual pain, as if now the joint can "calm down" now that it was resolved.

Honestly, I feel like what I felt was a shift in the position of the ball in the joint and potentially the labrum flipping around. This was hip impingement I assume?

One question I have now is... does this suggest my surgery needs a revision? Should adductor exercises really be able to trigger this problem so easily? I think I pushed myself up to 28kg on the machine, 14kg for each hip.

I've just re-read some of my posts this year and I feel, based on the above, the following thoughts:

• I don't think my current hip pain is caused by the discs.
• I don't think my nerves have suffered long term damage from the herniation.
• I don't think I need the microdiscetomy at this point.
• I wonder if a hip replacement is necessary to consider at this stage.

As usual, any thoughts are appreciated.