Embarrassing Return Post: Hip

[T-Runner]

Greetings, all. I've been here (the forums) twice before, once for a sustained period and once 10 months ago for a month or so. I'm posting about a continuing injury issue that I've mentioned elsewhere here. I was at one time a very fit individual, but not these days, owing both to my injury (injuries?) and to a lazy attitude that has come on strong the past 12-15 months. I apologize for making a plea for help (again) after a long time away from the board. Truth is, my shame over the way I've let myself slip physically contributes greatly to the huge space between posts.

The pain started after a hernia surgery (left inguinal): numbness in the left thigh, then left thigh pain which turned into groin pain which turned into hip flexor pain. Physical therapy (massage to break up scar tissue, stretching) provided temporary relief, but the pain returned after therapy ended, and it eventually grew worse. Two doctors diagnosed the problem as Femoro-Acetabular Impingement based on X-Rays. One ordered an MRI which showed minor damage to the labrum but no damage to the cartilage or bones. He recommended arthroscopy to trim away the damaged labrum. I had that surgery over a month ago. Due to continued pain that usually manifests following long periods of sitting or any sort of running, squatting, sitting "Indian style," or bending at the waist, I believe the arthroscopy did not help. I have done some water walking, which makes the left hip (outer hip) tired, but doesn't hurt, and some therapy exercises: single and double-leg bridging, isometric contractions, etc. The latter cause pain only occasionally.

My doctor is recommending two things: first, that I lose weight and hope that it helps reduce the pain. Second, that I consider hip re-sectioning in a couple of months. This is clearly a major surgery and one I'd like to avoid at the age of 30 if I can. I'm not entirely convinced of the diagnosis, especially given that I've had recent onset of minor groin pain on the opposite side, only on days that I run and/or walk extensively.

I feel that there may be a hip flexor issue here, shortening and/or weakening of some muscles during sustained inactivity following my hernia surgery, or perhaps an overuse injury related to marathon training that went on prior to the initial onset of the pain/injury. Success with physical therapy adds to my belief that it may be an issue of tightness, overuse, or muscle imbalance, but I understand that it is common with hip impingement for physical therapy to help temporarily but fail long-term.

I am looking for ideas as to how to proceed in the immediate future. Currently my plan is to continue isometric exercises and running as tolerable (not much, but this is due more to how out of shape I am than any failure of my hip) until such time as I can afford and/or devote time to a major hip surgery. However, I'm hopeful that an alternative diagnosis exists. I am going to see a doctor with more experience in sports injuries, as the two whom I have consulted so far (including my surgeon) generally do not work with active individuals. I know, though, that there is a wealth of knowledge and experience on this board, and I'm hoping for additional insight from some of you.

I apologize again for this being my first post after a long layoff: I just don't know where else to turn.

Regards,
Tim

[UConnJulie]

Tim,
First of all ... cut yourself some slack. No guilt here. If you search this subforum, there are many posters who only come here for the free advice! Not a big deal.

Second ... to me it sounds like you might have a low back dysfunction which is perhaps the root of all of this. Has your therapist checked this and cleared it?

Just from what you have described, from an exercise standpoint I would work on ...
1. Hip mobility
2. Quad, hip flexor, hip rotator flexibility
3. Gluteal function (activation and strength)
4. Abdominal function (activation and strength)
5. Foam roll EVERYTHING. Get a lacrosse ball to really get into the small areas (glutes, quadratus, etc)

If your therapist is good, then great. Have him/her evaluate your back and provide appropriate manual therapy. If you need the name of a good therapist, please provide your location and I'll see what I can come up with.

[T-Runner]

Julie, thanks for the reply. While I love free advice, I was at one time a contributor (in little ways) to the forums at Men's Health (where I met many of the folks here during the halcyon days of 02-03) and Runner's World, among others, so that's why I feel some guilt.

At any rate, a low back dysfunction has definitely occurred to me. About three years ago, I had what I thought was appendicitis. When that was ruled out, I went to an orthopedist who did a couple of chiropractic adjustments to even out my hips (my right was sitting an inch above my left) and sent me to a therapist who helped me through it. I have long thought that problem and this one could be related, and a low-back dysfunction is certainly a possible answer.

I have Magnificent Mobility and a foam roller, so I'll begin work on those things right away. Gluteal function has been an issue for me for a long time - no ass, dating back to high school or earlier - and I have had trouble with squats from forever as a result. I'll see what I can dig up to work on getting those suckers firing again: I have some 4000 pages of articles and information about the house, and I know I have some things on gluteal function.

Thank you again for all your help. I don't know any good therapists in my area - Dallas, TX - so any names you can post or PM are greatly appreciated.

Best,
Tim

[Aggie]

T-Runner: I was also diagnosed with femoro-acetabular impingement, AFTER months of physical therapy and ruling out a lower back problem (the first doc I went to was a back specialist so he focused on that area; after a year of the above-mentioned treatment, I asked him for a referral to a hip specialist). The x-rays were pretty convincing in my case. I had hip arthroscopy and osteoplasty in Jan. 2008. It took me months to completely recover. In fact, I think I was finally back to 100% in August. My understanding of the arthroscopy alone is that, since the hip joint is so deep, your recovery will take awhile. So right now, can you be sure that your pain is not post-surgery related? You could still have swelling, and if you are doing too much too soon, you'll definitely be in pain (not to mention you will delay your healing). But of course I'm sure your surgeon has instructed you on what you can/can't do. (I was on crutches for 6 weeks--how about you?)

I am very pleased with my surgery results. But it took me several months to be sure it "worked," if you know what I mean.

I completely understand not wanting to do the intensive hip surgery at your age. Recovery will definitely take awhile. However, my doc said without my surgery I would likely need a total hip replacement by age 50 (I'm currently 38). Has your doc talked to you about your prognosis, 10-15 years down the road? Also, what is a "hip re-sectioning" surgery exactly?