Femeroacetabular Impingement

Am I the first?

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20/06/2012 at 19:57
Saw Mr Conroy at Harrogate yesterday for the 1st time after having my funding approved. Had more x-rays during my appointment which confirmed I have FAI (pincer), the MRI authogram I had last November only diagnosed a labrum tear.

Signed the consent forms and had my pre-assessment so hopeful for my arthroscopy in the next 12 weeks. Mr Conroy advised absolutely no running between now and the op so have hastily signed up to my local gym to maintain some fitness, swimming and cycling top on my list, can anyone recommend any good strength exercises to get me op fit and strong?
23/06/2012 at 14:03

Hi there,

Have been following this thread for a while now, but now being 5 weeks post op on my left hip for a labral tear and cam impingement, I feel compelled to post.

I developed unexplained lower back pain after a roll around arresting someone at work last August, which pushed it over the edge when I fell hard across a kerb, resulting in a labral tear at the chrondrolabral junction due to cam impingement and a ton of synovitis.  Before this, I used to run 10k a couple of times a week...  Much investigation and head scratching (ignorant GPs anyone?) and a process of elimination led to the fai self diagnosis, and a hip block/cortisone injection allowed me to run again (albeit not pain free) for a while.  I'm only 28 and figured that if I left it, it'd grind itself to bits anyway and besides, I wanted my old level of physical fitness back.

The surgery was the easy bit, but the recovery has been a real rollercoaster.  I was off crutches at 2 weeks (no microfractures or sutures) and began cycling with no resistance and physio (mostly working on glute med and max, psoas and rom) and had almost returned to walking normally at 4 weeks when it suddenly flared up.  My groin is now swollen and the pre-op pain (vague, deep seated pain in my groin) has returned.  Hip flexors are crazy tight and the Thomas Test (lying on your back at the end of a bed, pull up good knee to chest and lay backwards keeping bad leg flat, dangling over the edge of the bed) was agony!

It feels like I am back at square one agan...  I am back on anti inflams hoping it will resolve itself, but one week of 'taking it easy' has yielded no results.  Lesson?  If you are like me and prone to 'overdoing things,' then don't!  I am the world's worst candidate for self control in this department (often to my detriment) and am paying for it, so please learn from this!

It has been good to hear of other people's experiences with this, as it gives me hope that one day I will be able to return to running and front line policing again. 

Keep the faith,

dav0

06/07/2012 at 22:10

Been a while since I last checked in here.  Thanks for the link Tom Goom - helps me to help other people understand my issue.

How are you doing now, Bumble1?  Have you been back jogging again yet?

Any news on a date, loverunning? How's the cross-training going? 

Hi dav0. Has everything settled down again yet? Keep us posted with your updates.  I hope you get back running and normal life again soon.

I had a meeting with the surgeon last week, who put me on the waiting list as an 'urgent' case.  My operation date will be 14th September - hopefully there won't be any cancellations this time.  I'm very excited about the prospect of having it done so soon.  Now time to get some exercise done before the op, as I've been pretty rubbish at cross-training.

I've had weekly sports massage on my quads, glutes and lower back to help with the muscular discomfort that has developed, presumably, from the hip problems. I know it won't actually help the deep pain within my hip, but it certainly makes everything else feel better.  Luckily, I know someone who is doing a massage course and needs lots of practice hours. She's fab and knows exactly what I need now.  

As dav0 says, keep the faith

06/07/2012 at 23:56
Hi Pipes,

Glad your date is relatively soon, just hope you don't get messed around too much with cancellations etc.

Sadly, I'm still riding this flare up and have forked out for a 3T MRI to see what was going on in there. There is still some post op oedema swelling in the capsule (probably to be expected really) and, more frustratingly, a partial tear of the rectus femoris proximal head (where it attaches just above the acetabulum).
Not sure if the tear is something related to the traction? Contracting my glutes still gives me bad anterior groin pain... Anyone else had rec fem issues after this surgery?
I am somewhat gutted at the stalled recovery because i had worked really hard pre surgery on core strength, glute strength and cross training etc to assist recovery, but feel that this setback has negated all the pre op effort.

I am also extremely jealous of your massage-on-tap situation!!
13/07/2012 at 11:36

Hi everyone, i just found this thread, its a blessing.

 

I have a labral tear in my hip which gives me pain which i can only describe as gnawing for 2 to 3 days at a time, i have limited range of movement in my hip which has been prominent for years.

My hip pain is exacerbated my positioning and strain on my lumbar back area, it makes me walk with a pronounced limp and really interferes with day to day life when present i get no relief rom any standard analgesia at all, Ive had a consult with Mr Gaston at Edinburgh royal infirmary who was very sympathetic as he himself was a runner, he told me he can have me in and have the op done in a short space of time, My problem is i have just started my dream job and dont really want to take time off as it may hinder my prospects of remaining there, however the pain is becoming more frequent and more prolonged and gets me down,

 

Catch 22 situation, do i or dont i go for the op,  interested to hear your thoughts, 

sorry for bumbling on....

13/07/2012 at 12:18
Hi Mark,

This is a tough decision to make, because it is essentially elective surgery and the bottom line is that it is down to you. I too suffered with dreadful back pain as a result of the tear and have a very active job. Whilst i was never limping prior to the surgery, I felt that i didn't really have a choice in the matter as it wasn't going to heal and I feared that to leave it until it became unbearable would only serve to cause further, irrepairable damage.

I am now 8 weeks post op and, to be honest, am beginning to regret having the surgery done. It was always a gamble, but at present i have bad inflammation of the joint and can't walk very far; in short, I am worse than i was pre op! Ci jope this is only a temporary thing, but there do seem to be some people who just dont recover from this...

Conversely, there are numerous success stories on here, so i think i am just unlucky, and its probably too early to call it yet in my case. Hopefully you work will understand your predicament and be sympathetic towards it?

Good luck mate,
Davo
13/07/2012 at 13:02

Davo thanks for that, Like yourelf im in an active job(Air ambulance), this is where the difficulty lies, it can interfere at times when you need to think and act fast, a bit like yourself, the flip side is when i deal with critical incidents it can trigger a flare up just because im crouched down, so im in a no win situation. My wife's very supportive and my kids are a bit older so i dont have too much about lifting a 2 yearold when he wants up..

Cheers

13/07/2012 at 13:34
I know where your coming from Mark. Like you, I managed to get myself a place on a much sought after team prior to getting injured; my thought process was that if i didn't sort it out, i was narrowing down future options for dealing with it and would just end up confined to an office job (which would psychologically do me in!) with a hip replacement and/or being ill healthed...

I couldn't live with my labral tears in the end as on a bad day i couldn't tolerate sitting down/driving, and knowing that i had this problem shot my confidence to bits at work (its not the same having a roll around with someone when you know you're broken... hard to explain, but it does have an effect on how you do things).

I really wasnt 100% convinced that i needed it done, but I was surprised at how much damage was in there when i came round and read the report. The joint was also mega inflammed... I felt i'd done the right thing and felt vindicated. If you haven't already, a hip block injection may assist you in your decision making process (local anesthetic and steroid cocktail into the joint); i had one done prior to surgery and althiugh relief was subtle, it made the difference between being able to run or not, which helped convince me of the decision...

How long have you been symptomatic for? It was sold to me that early intervention is crucial with this which also swung it...
13/07/2012 at 14:42

Davo, been symptomatic for over 5 years but only diagnosed  2 years ago.

 

How long are /were you expected to be off work for, im aware the the physicall activity is a prolonged rehab programme, to be honest i would give up running if told,  i like mountbaiking and road cycling so its not as if i wouldnt have an activity to go back to.

13/07/2012 at 15:47
I guess it depends on the extent of the damage, but as a rough guide, no running/contact sports for 12 weeks. Crutches is 2-4 weeks, or 6 if you end up with microfractures to 'plug' cartilage defects.

I was told 2 - 4 weeks off until i could return to light duties, but i would imagine it would be at least 4 months before you could go back to a physically demanding job like yours.

Everyone appears to heal differently... I thought i would be fine at 4 weeks until this setback...
17/07/2012 at 22:18
How is everyone else getting on? Sorry if i seem to have hijacjked this thread, but I am grateful to the others that have posted on here and hope that people may learn somethinf from my experiences...

Anyway, went up to London today to see a sports injury rheumatologist, whom I had been referred to by my surgeon. Ultrasound on the joint showed a fair bit of fluid around it and it was felt that this was probably the main source of the pain, not the rectus femoris. So, i had an ultrasound guided steroid injection into the joint in the hope to break the cycle of inflammation...

Why is it so badly inflammed? Not really sure, think the issues are due to synovitis found in the joint during arthroscopy, which the surgeon noted was pretty extensive. I guess this makes one more susceptible to post op flareups and is exacerbated by my hypermobility, apparently...

Anyway, fingers crossed that the shot calms it down. How is everyone else getting on?
20/07/2012 at 18:30

Long time since I have looked on here, so hope everyone is getting on fine. Glad that you've got a date now Pipes - even though a few weeks off, good to know that there is an end in sight. As for me, well, not great news. Bit like you really dav0. Everything was going fine up til the 8 week post op point (had laberal tear repair on right hip, with fatty tissue impingement), then after a session on the turbo severe pain again in right groin, confirmed by consultant’s office and physio as being illiopsoas tendonitis/bursitis.  Continued with my glute strengthening exercises but stopped everything else.  After a couple of weeks it was no better and, in fact, then developed the same pain on the left side.  Concluded glute stuff was just serving to aggravate so stopped everything, apart from walking.

To cut a long story short, rest has done nothing to improve pain, so had an ultrasound guided local anaesthetic & steroid jab into the illiopsoas sheath yesterday – just the right side to start with although the left side is also screaming out for relief.  Ultrasound showed up a lot of inflammation around the illiopsoas so the chap I saw recommended an MRI next if the steroid doesn’t do the job. 

How is yours feeling now dav0?  Mine definitely felt a bit better once the anaesthetic kicked in, but is now aching like hell.  Trying to stick to instrucs of doing v little over next couple of days.  I suppose the good thing is that I am pretty sure that the pain is not coming from the operated part of the hip, but from the illiopsoas (sort of backed up by the fact that the left non-operated side is showing similar pain), but it’s difficult to be positive when there is seemingly no end to the pain.  Had hoped to be doing a little bit of running by now – still dreaming of the day when I can, but think my legs have truely forgotten how to put one in front of the other at any sort of pace!!

 

21/07/2012 at 22:35
Hi bumble,

Sorry to hear you are still suffering, there seems to be a wealth of info about psoas tendinitis being a pitfall of post op recovery, Phillipon (one of the big US surgeons) has done a study into it - not sure if any of it is any use?

http://www.biokinetics.org.za/wp-content/uploads/2011/08/Philippon-Gluteus-Medius.pdf

I hope your injection breaks the cycle for you and allows you to get back on track. I was told to rest since having the shot and have been since Tuesday, though i'm getting similar symptoms in my right hip (the good one, though also cam fai present)... I think this is just down to glute weakness and poor core (have picked up bad anterior pelvic tilt as my core is so weak). Some pain relief, but still got the swelling in the operated groin...

I too was hoping to be jogging at 12 weeks, but at the moment i'd be thrilled if I can walk any distance pain free. This really does test your nerve; its certainly the hardest thing I've ever had to deal with... Hope it picks up soon for us!

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2642547/
23/07/2012 at 16:26

Thanks dav0 for links - have printed off to have a good read in peace once my little boy is in bed tonight.  Still trying to take things easy (not always easy with a 4 year old!), think pain is a little better than it was, so maybe the steroid is working?? Or maybe it's the ibuprofen which I'm necking at regular intervals.  How are you today?  Did you have the jab directly into the hip joint or into the muscle? 

This recovery process is just such a rollercoaster ride - the surgery itself was easy by comparison.  Getting so frustrated, no running for me for a year this week (amazing to think a whole year has gone by, my husband will tell you it has felt more like 10 years with all the moaning!) because I had chronic AT before the laberal tear (ironically, the laberal tear only happened because I was doing a little abs routine at home whilst not being able to do anything because of the AT).  Strewth, it's certainly character building if nothing else.

23/07/2012 at 17:01
Hi Bumble,

Glad the jab seems to be doing something. Mine was directly into my joint capsule, seems to have calmed it slightly (or is that the lack of any activity since i had it?!). Still have a noticeable 'ridge' in my left groin though...

I don't know how you cope with children and trying to get over this - it's bad enough just dealing with myself!

It will be a year for me at the end of August, and I'm beginning to forget what it was like not to have to worry about hips etc. The investigation, diagnosis and surgery etc currently stands me at ??12000, which also grates. Certainly, if i get over this, it has changed my perspective on a lot of things and I think i will now be quite content just to plod everynow and again rather than the balls-out-must-be-the-fastest approach i had before... I really dont want to go through this again if i can help it!!

Hope those links are of some use - seems that professionals are very much still learning with this procedure and those that have gotten back to running by 12 weeks are the lucly ones... Thinking happy, healing thoughts for us both!!
03/08/2012 at 10:19

Hi all,

Thanks for the advice Mooshead.

Just to keep you all updated, I've done a bit more research and have ended up down in London with Paul Jairaj. I've got an apointment with him in 2 weeks. From what I've read and heard, he does a less invasive procedure which results in better  and faster recovery rates. I will let you know how my consutlation goes but it looks like things are now starting to progress...

03/08/2012 at 11:00

Wow. It's got a bit busy since I last looked in. 

Troubling to read of people with post-op problems, but I guess that's the nature of the beast - it's not usually one singular thing, more a combination of problems, some of which will be solved, some of which may get exacerbated and some new ones from what is still invasive surgery, albeit a fairly light touch in comparison to olden days. 

bearing in mind my history (caught early) and my inability to take it easy, plus sparing a thought for those not findign resolution I just thought I should wave the flag of my latest progress. 

Biking lots more than running since ops. It's been just over a year since the first one. Run at least once a week. But hadn't done more than 10 miles so I thought I would try a bit further. So last saturday managed 18 miles offroad over Simon's Seat in just under 3 hours. Got into a rhythm that I felt I could have done further. Tired legs obviously, but hips seem generally alright. Short run on monday evening, MTB on Wednesday, everything workign correctly. 

Physio seems to think getting bounce back in muscles. Lots of rehab exercises to do still - more than I can possibly deal with, easpecially as working a 6 day week in 5 days at the moment.

Stretch hamstrings and glutes/priformis etc every night. Regularly use thigh master for adductor strengthening. Lots of foam roller and sitting on a hockey ball for deep tissue massage. 

 

All in all, things goign well. Not going to kid myself that I should run marathons regularly, but nice to know that there is life in the old dog yet. 

My old racing partner thinks I should do the OMM Elite again. I have disabused him of this crazy notion...

 

...though maybe next year?

Good luck all. Keep trying different things - there is no one solution to these problems, but ultimately if the problem is a mechanical one (too much bone in the wrong place) there is only one real solution - get rid of it. Then you can get to work on the rest of the problems.

 

05/08/2012 at 21:03
Glad to hear that you are doing well, mrmoosehead - even more so with the work that was done (microfractures etc, really some cutting edge stuff). It's good that you keep posting on here as it gives hip scope biffs like me something to hang on to!!

Bumble1 - how is the tendonitis? Can I ask how it actually feels pain wise, and where when you have psoas tendon issues? Still struggling with mine, and the other hip has developed a similar pain too, which i think might be tendonitis of some form?

Really drained with it all now, to be honest...
06/08/2012 at 21:08
Hi folks have been keeping an eye on thethread from afar, a question i was going to ask.
Has any one one had any relief from Physiotherapy, i totally appreciate that the problem is a mechanical one but the thought had crossed my mind.
Cheers
06/08/2012 at 21:29

You may get some relief, but as you know, if the problem is too much bone in the wrong place, physio isn't going to help that. 

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