Femeroacetabular Impingement

Am I the first?

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07/08/2012 at 18:04
You can try and 'manage' it, but like mrmoosehead says, its not gonna go away and it wont 'heal' given enough time...

I have heard stories of some lucky folk with labral tears that become asymptomatic, but i think these folks arent anatomically cursed with FAI. The rheumatologist who injected me treats military personnel at Headley Court (the services rehab centre) and stated that they are seeing more and more guys coming through with this injury - mostly from infantry units. He reckoned only 50% of them made it back to front line service and that the governing factor to success was early intervention. Those that had put up with it for a couple of years before getting operated on were generally found to have less favourable outcomes owing to the extent of the damage...
08/08/2012 at 18:56

At last, I'm getting my surgery!!! It's taken a whole year to get to this stage!!!

Got a phonecall late last week and offered 13th August for my hip arthroscopy with Mr Conroy at Harrogate....pre-op yesterday, in at 07.30 Monday morning and told will be an overnight stay & 6 weeks off work to recover.

Any bits of advice/what i can expect post op would be gratefully received...starting to feel a bit anxious right now.

08/08/2012 at 19:17

Many thanks to pipes for highlighting this thread to me

I await a second scan (this time with the one with the contrast dye) in about 8 weeks time (nhs) as specialist thinks i have 'hip problems'. This is a full 13 months after injuring my groin in hill sprints, 1 crap physio, 1 good physio who frictioned scar tissue away and started me on pilates core work, one MRI scan, some leftover groin pain which lates specialist thinks could be hip issues. Guess i have to wait for the scan

Im guessing that due to the particular scan he's thinking labral tear or FAI.

Can run with some discomfort, have to run slower tempo - after a year out any running is a relief and boy do i enjoy the camaraderie and social aspect of returning to my lovely local parkrun. Question - am i likely to do myself any more damage by continuing a limited amout of running in the interim? I also keep up my pilates/core work and use an exercise bike once a week?? Im 34, male

Thanks

 

08/08/2012 at 20:05
Parklife, I was advised by my consultant not to run at all as it would just do even further damage. He advised swimming (although find breaststroke aggrevates my hip) and cycling.

I've reluctantly taken this advice although my hip pain has just got progressively worse over time....I'm in more pain and having serious withdrawal symptoms from not running, not a good combination.

I'm 32, had my MRI last autumn, showed labrum tear....then spent months battling with my PCT to get them to approve funding for hip arthroscopy, finally approved in April....referral to Mr Conroy in Harrogate, had further x-rays when I was referred which showed FAI Pincer....at this point was told to stop running immediately, which I have
08/08/2012 at 20:46
Loverunning,

Glad you got a date for your op and you should be in good hands with Mr Conroy, from what I've heard. In terms of the recovery, here's what i've learnt (still trying to recover from mine, 12 weeks out)...

- Don't get hung up on rehab schedules... Listen to your body and don't think 'its week x and i shoul be doing this cos the schedule says so'. Let your body tell you when you are ready - you will know the warning signs when you need to back off, so take heed. If, like me, you are a type A personality, you are gonna need to reign that in!

- Make sure you have help for at least a couple of weeks. I couldnt put on ny iwn socks for this period of time, and needed assistance with dressing etc.

- Get a good stash of decent anti inflams - diclofenac, naproxen, whatever. With hindsight, i think I came off these too soon and at the same time as ditching the crutches, which really didnt help things. They also help keep scar tissue at bay which is crucial to stop the joint bindin up with adhesions. I hate taking anything, but they serve a purpose. Ice will also help with inflammation, so keep a good stash of that too.

- If you have issues with your good hip, be advised that this will take a hammering whilst on crutches - which may be anything for up to 6 weeks if you have microfractures... When it comes to weaning off them, i think it is crucial to do this gradually and use them until your gait has returned to almost normal and you are able to walk without limping.

- Dont take your eye off the ball during the rehab. Just because it doesnt hurt doesnt mean the pain wont come back. Just when you want to relax, soft tissues flare ups can come out of nowhere and bite you on the arse (psoas, rec fem, adductors etc). I am battling this at the moment, and cant help but feel that less is probably more sometimes with the rehab.

-if you do have a significant amount of synovitis in the joint, this appears to make you more susceptible to flare ups post op, so be mindful of that during rehab. I still think that those that recover in 12 weeks are the exception rather than the rule, too. I went in to this with too high expectations of recovery progress based on that timescale.

Im sure others will chip in, but anyway, good luck. Remember, the surgery is the easy bit, recovery is the test...

Davo
08/08/2012 at 22:26

Good luck, loverunning - delighted that you have got a date and not much time to wait until it arrives!  Dav0 makes most of the points I would have made, especially about keeping on top of the pain and inflammation with tablets.  I expected the post-op pain to be a lot worse than it was, which is obviously positive.  Also, the point about flare-ups is important - I had some days where everything seemed to be going well, then others where discomfort would suddenly return. Sometimes, this was due to trying to do too much; other times, it was just a normal part of recovery.  I still get good and bad days and can't always find an explanation for them.

Being on crutches was annoying and frustrating.  I found it difficult to be around crowds early on, as I was afraid of being knocked over.  It took a while to get my confidence back in shops/ on busy pavements.

Parklife - good to see that you've made your way over here. Lots of useful stories and advice.  You and I are the same age (for another 2 days, anyway!).  With regard to running before my first op, I could do a bit, but usually ended up taking a few days to recover each time.  I also love parkruns, so I'd use them to motivate me to go on the cross-trainer, which I find boring.  I did a few parkruns to get the buzz of running hard and having company and went to my club's speed sessions for a while as the run/recover/run formula worked better for me than continuous running. 

That was with my left hip. Now that my right hip is bad, I can do no running.  Running for even a couple of minutes gives me sharp pains in the right hip and leaves me very sore afterwards.  I even struggle with the cross-trainer.  I'm not sure whether the tear is in a slightly different place, but the hip just can't cope with it.  

If the tear is not caused by impingement, I'd imagine it should be ok to carry on running, while waiting for the op.  But if it's caused by a bone abnormality, I think there's the risk of causing more damage.  Perhaps if I hadn't carried on running a bit last year, my unoperated hip wouldn't be so bad...

mrmoosehead - great to hear your report - it's motivational, as ever.  I have started using the roller and stretching every day but only in the past week - I've had a few months of doing next to nothing and everything is stiff/ sore! Congrats on your long run!

I'd like to think that the left hip op has been successful, but a lot of what Dav0 and Bumble1 have said makes me more aware of the aches and pains still in my operated hip. For example, I've been trying to do an exercise my physio gave me (lying on my back, bringing one knee up to my chest then returning it to the ground) and, again, I get loud clunks in the hip when I do it. That doesn't happen in the unoperated hip! Also, the hip flexor is so tight it feels like it will snap - I'm trying to loosen it, but may be making it even worse.  However, because of the op I'm having next month, I'm blocking out these doubts and focusing on the hope that the tightness etc is different from the pre-op pain and therefore something I can work on when I've recovered.

Sorry for the long, rambling post and hello to anyone (eg. Mark S) that I haven't mentioned.

08/08/2012 at 22:56

Ive just taken the time this evening now that i have my laptop back to read through this entire thread and take a few notes(geek!) and ill read through the links that people have put up in due course. All very informative.

A number of people have re\ally been through the mill my sympathies are with them, hope all those affected have an upturn in luck soon. Some of the stories have made me a think alot just this evening about my expectations and i think the penny is dropping about some advice Dav0 gave about not going hell for leather and not doing too much. Running has been such a central part of my life but I might have to reign it all in and work round it somehow, even if it means an ongoing low level ache in my hip/groin. Perhaps i can do 1 or 2 genuinely slow runs a week, one on grass, and a slow parkrun, i can volunteer at parkrun, use an exercise bike(though that is a bore!) and maybe get hold of a real bike, i should count my blessings.All my nonrunning friends tell me im too old for it and its time to retire but they dont understand the soothing calmness of running between villages or along coastal tracks!! But i have to weigh things up.

Good luck loverunning with your long awaited and much deserved treatment, and  to pipes with your second upcoming op, and also hope Dav0 has a change of fortune and gets back to work role he wants.

Someone asked about physio - i must start a new thread at some point on how crap my first physio was and how really good my second physio was in taking forward adductor/core problems. Only when these seemed to resolve did the supposed hip issues become revealed.

Only when i upped the tempo of a run last night for the first time, has my hip discomfort/pain got worse - pain was at front of before today now its moved to the back of the hip and lower back. Could this be a sign of impingement?  So stupid- wont be doing a tempo run again!

09/08/2012 at 00:25
Pipes, sorry to hear about the grief that the unoperated hip is giving you. This can't make it easy for rehabbing the operated one... Interesting point about the crutches - I was shocked at how vulnerable they made me feel when out and about (always looking over my shoulder at the best times anyway!) and hated it - glad it was only for a couple of weeks. I'm still struggling with hip flexor tightness too, have been told that glutes still need strengthening/re-educating (gonna be doing clams and bridges for the rest of my life at this rate) and that stretching is a no-no at this stage. It is getting easier though, as at first I couldn't squeeze my bum cheeks without sharp anterior pain over the front groin.

Thanks for the kind words, park life. At 34 you are far too young to be hanging up your running shoes; all the other activities are fine, but the trouble is that nothing else quite hits the spot like a run. Much of my pain started off in the lower back, and although most of it was groin based, rear hip pain can also be an indicator of impingement (check out Byrd's c-sign on google as a classic indication of FAI pain - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953301/ ).

The MRA should give you a definitive answer and hopefully they'll put a steroid/anaesthetic cocktail in there at the same time which should give you a true indication of how much pain is coming from the joint. If you do head down the path to surgery, then from personal experience I would urge caution about running up to the surgery. I rode the wave of my cortisone shot I had two months prior to the op to cross train and sneaky treadmill runs (albeit at a gentle 10kph) thinking I was giving myself a head start on the other side of the op - bad idea. All the muscular strength I had gained was negated by the massive Inflammation I had caused in the joint, thereby causing post op problems in rehab...
09/08/2012 at 21:17

Cheers Dav0 i'm thinking of just knocking all running on the head until i get the scan at least. I had been injured for a year until a good physio sorted out adductor problems and graded me back to running before hip probs were revealed. During this year off i did no running at all(groin always got sore quickly) but went on an exercise bike regularly. Would do no harm to return to this regime for a while longer, along with core. However.......

Not long back from the leisure centre where i did 30 mins on bike - i always put the resistance up systemically every 3 mins or every 2 mins til im up near full resistance-is this wise?? I have noticed that the hip pain has now begun to move to the back of the hip- like a faintish burning sensation not too bad but worried that even exercise bike will make this worse?? Such pain is also in the context of trying running over the past 6-8 weeks including that stupid tempo run 2 nights ago.

I rang the NHS hospital department today - secretary told me that the specialist suspects a 'small labral tear' and i am waiting for arthogram, but she didnt think there was any cortisone/steriod shots nor any xrays?

By running on a labral tear am i likely to cause an impingement?

 

11/08/2012 at 19:23

Parklife,

The arthrogram is an MRI with a contrast dye injected into the hip in order to better visualise the labral tears/articular cartilage (sorry if i'm teaching you to suck eggs?)  Not wishing to freak you out, but they will put a big bastard spinal needle into your thigh to get to the joint and place the contrast down this - most folks have a steroid down there also as a diagnostic tool (if the pain resolves in subsequent days, then the joint is the generator of pain).  The procedure is pretty painless, i found, though there is some soreness afterwards...

I'm not a medical professional and I know how it is when you have your running curtailed, but if it were me, I'd steer clear of running for the time being until you know what the score is with your joint from the arthrogram.  Some people run on labral tears with no issues (some cadaver studies report a high instance of asymptomatic labral tears in people), but I would imagine that they don't have FAI.  I guess you could minimise it when cycling with a high seat height etc, and the lack of impact has got to be better than running but I guess you have to let pain be your guide.  Core work (planks, bridges, clams etc) helped me immensely in the run up to the op...

I'm still having big problems and can't walk, stand or sit without anterior groin pain.  Only ice gives me relief.  Had another steroid injection into the hip area - rectus femoris insertion - which was pissed off and angry on the ultrasound scan, but to be honest I think it is too far away from the pain area (an inch or lateral to the spot where the groin lump is and the pain centres arounf) to be the problem, although it might be part of it.  The scan did show that there isn't much fluid on the joint and that there isn't much scar tissue in there, either, so I'm at a loss as to where the pain is coming from.

It still hurts over my anterior groin to lie on my stomach and if the groin lump isn't coming from the joint, then the only other thing I can find which might suggest the problem is iliopectineal bursitis?!  Has anyone had any experience of this?

Found it hard today watching everyone in the sunshine, running and cycling etc...  At the moment I feel like I have played russian roulette with my body and lost with this surgery!!

Yours, a very frustrated dav0

11/08/2012 at 21:17

Thanks Pipes and Dav0 for your advice it helps hearing from people who have experienced this 1st hand. 

Dav0 sounds like you've had a pretty crap recovery so far and your hopes of getting back out and running must be very low at this point, makes it even harder when it's a nice sunny day and you see others out running.....but, hang in there, and be positive, your time will come. I've found the hardest part of FAI has been the psychological aspect from not being able to run...the physical pain I can deal with, but not being able to run or be active and outdoors makes me a grump

Pipes - I cant believe you are now need surgery on your other hip, how frustrating, I wonder how common it is to have the impingement in both hips? Surely it would make sense to have the MRI and x-rays in both hips rather than wait for symptoms to appear by which time the real damage is done. 

Parklife - don't run on it, no matter how tempted you are....it's scary how quickly my hip has deteriorated in such a relatively short period of time..mine started just with pain and stiffness after running....12 months later whilst waiting for surgery and having continued running/jogging for 9 months of that time I'm now in constant pain, walk with a limp, can't sit/drive for any prolonged period and hurts to lie down/the pain keeps me awake at night...I really think that the impact from running has caused that deterioration. My MRI authogram last November time only showed a tear, the consultant I was under at the time said I did not have FAI and advised me to continue running.

It wasn't until I got my referral to Mr Conroy at Harrogate in June and he did an X-ray that it showed I had FAI pincer impingment. He told me that running/jogging was THE WORST thing i could possibly do and told me to stop immediately!

12/08/2012 at 08:48

Ooooh, this thread has been busy.  Wishing I had been nearly as busy.  Extreme grumpiness from lack (I mean none) of exercise has been partially offset by fab time at the Olympics, but this has been the only highlight on an otherwise glum few weeks.   Well, here I am at 18 weeks post op, no exercising and not really expecting any in the pipeline.  Illiopoas still pretty unbearable, now 3 weeks post steroid injection and no improvement so can pretty much say that it hasn’t worked for me.  Dav0 interesting that you now have pain both sides.  Mine started on the RHS (operated side) and about three weeks later started in the unoperated side as well.  LHS is not quite as bad as the right, but bad enough.  I hate taking tablets but have now been on ibuprofen for the last three months solidly pretty much.  Have decided that, rightly or wrongly, from yesterday I am going drug-free, to see what the ‘real’ pain level is.

Not sure dav0 whether my pain is the same as yours, but does sound pretty similar.  I have pain on sitting (OK on a sofa where the hip angle is more obtuse, pain improved sitting on dining room type chairs but sitting on the ground is still a no no), pain/tightness on walking, and ad hoc pain at other times.  The pain I get is at the front of the groin, closer to the pubic bone rather than out towards the outer side of the hip, it’s definitely worse when I bend or squat down and feels like I am squeezing a sac full of fluid (illiopsoas bursitis??) when I do this.  I still think that the operated part of the hip is OK, so some positives I suppose.  I almost feel that the steroid injection which went into the illiopsoas sheath was in the wrong place, and they needed to have targeted the bursa, but will have to see what the consultant says when I see them again in a few weeks.

In the meantime, the consultant gave me a revised rehab programme for after the steroid jab.  Basically, lots of lying prone on my front with pillow under knees starting in the first week, then introduce some walking in shallow water for the second week (tried this a couple of weeks ago and my god was it aggravated both sides of the hip afterwards.  It has taken 2 weeks of nothing but a few gentle walks to get the pain levels back down to more bearable again), build on some glutes strength from week 3 (the article dav0 you pointed me in the direction of above v useful for this stage when I start), then core from week 4.  Think I have decided to miss out the water walking (can’t bear the pain again) so thought I might try a few glutes exercises in the next couple of days and see what the reaction is.  All annoying slow really, with no end in sight. 

Sorry for babbling on, I hope it’s been some help to you dav0 to know that you’re not the only one in this situation.  To everyone else, hang in there, your op date are getting nearer and recoveries are continuing. Albeit slowly for some of us!!

 Parklife – I really wouldn’t do any more running until you know what you are dealing with.  This is my second op for a laberal tear on the same hip.  The first time round it took 2 years to diagnose what the problem was and I continued to run a bit stop/start throughout that time as the pain was never so bad when running, but it probably wasn’t advisable given the increased risk of further damage with all the pounding.

12/08/2012 at 13:44

Its good to get advice from people who know what they are talking about, Dav0, Bumble and loverunning - and ive accepted there wont be any running over the next few weeks until i at least get the scan results. Reading your stories and advice gives me a shake not to take any unnecessary risks.

Interestingly, I was talking to a physio i know who works for the NHS here in Northern Ireland. He tells me that hip scopes arent currently performed in NI and that the NHS fly you to England to have it done, but that its difficult to get such a move Ok'd by the NHS purse-string holders in NI. Im jumping ahead a bit as im still just waiting for my arthogram and havent had suspected labral tear diagnosis confirmed, but sounds like fun and games for further on. If it comes to it, i might be asking on here for people's recommendations for a hip surgeon in England(or Scotland, or Wales)!!

12/08/2012 at 14:14
Bumble, thanks for the reply. On the one hand its comforting to know that i'm not the only one going through this recovery nightmare, but equally i wish that wasn't the case. I've just passed the 12 week mark, so am a little bit behind you but the longer it goes on, the worse i feel about the whole debacle.

Your pain sounds similar to mine with the exception of bending down/squatting, which doesn't really elicit any noticeable change in symptoms. Pain is exactly where you describe though - closer to the pubic bone/adductor area. No idea why the other one is hurting? I have cam in that hip too, but can't see what i would have done to tear it?!

I have a chequered history with injury and although this was my first surgery, i have come to the conclusion that i am a slow healer, which probably doesn't help things (had knee pfps/possible meniscus tear that took nearly a year to shift a while back!)

In terms of activity, I'm doing very little other than glute med stuff (clams and side lying abduction) and bridging - i can see that there is a huge dent in the side of my hip/buttock area where the glute medius should be and this, i am told, is crucial to femoral head control - as well as gentle walking and rom stuff. How long have you been told to give the injection before its declared not to have worked, bumble1? I was told 2 - 4 weeks...

Sorry for banging on, but i do find posting here helps! Hope all goes well for you tomorrow, loverunning and that there's not too much carnage in there... Parklife, fingers crossed mate that its not FAI for you, would be nice if it was something else, something simpler, to hang your hat on!!
12/08/2012 at 18:48

Spot on Dav0 these message boards are precisely for banging on so fill your boots! I know that when my injury plays on my mind one the first things ill do is log on here. Sincerely hope its not FAI ive got nor labral tear hate the idea of surgery

14/08/2012 at 09:49
Well op went well yesterday, still in a lot of pain, seen consultant...found I had cam + pincer impingement in my hip so they've shaved and debrided the bone so impingement has gone, repaired the tears to my labrum that the impingement had caused, but have significant cartilage damage where it's completely worn (he said about 15%) and clear signs of oesteo arthritis....no more running for me at all, any further damage and next step will be hip replacement.....out of bed, sat in a chair hoping I'll be discharged soon...
14/08/2012 at 10:00
Good News op went well LR, I'm still swithering as to whether I go for my op.
Keep us posted with your rehab.
14/08/2012 at 11:00
So sorry to hear that loverunning, glad the op went well but really feel for you to be told that...

Keep us updated, you have a long road ahead of you and i wish you a better recovery than mine...
14/08/2012 at 11:48
Thanks guys, can't believe at 32 I'm going to be hanging up my running shoes, but running is the worst thing I could possibly be doing the state my hip is in....but hey, im fit and healthy otherwise and will focus my energy on swimming and cycling instead.

Will keep you posted on my recovery, so far have managed to get out of bed but keep passing out....need to attempt stairs and crutches before they'll discharge me!
15/08/2012 at 20:34

loverunning - I hope you are feeling better now and not passing out anymore! Sorry to hear your news about running - I hope cycling and swimming give you enough of a buzz to continue doing them in the longer term.

parklife - what part of NI are you in? I lived (and ran!) there for half of my life.  If I'd continued to live there, I'd have been a stone's throw away from the Waterworks parkrun.

I ran for 10 mins on an anti-gravity treadmill this evening! It was a free open day in a local-ish hospital (Aylesbury).  I could book 30 minute training sessions for £10 a time - it may be worth it until my op/ when I'm able to get back into it after the op. Basically, you can choose to run on anything as little as 20% of your body weight!  It felt like much more of a running workout than aquajogging (which I currently do weekly) and I had no hip pain! I'll see how the hip feels tomorrow before deciding whether or not to book a longer session.

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