Femeroacetabular Impingement

Am I the first?

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03/05/2012 at 20:51

Hi, found you.

Xray has confirmed hip impingement (cam), waiting for MRI, currently avoiding all hip flexion to see how much it will settle. I normally do lots of olympic lifts at the gym which involve a lot of hip flexion so as soon as I stopped them, running and cycling it has settled a lot.

Had this for 3 years, misdiagnosed as groin strain and hernia and psoas syndrome.

Just wondering if its worth having the op done and was hoping to hear a success story!

Mick

04/05/2012 at 15:06

Hi Mickster, I'm less than 6 weeks post-op so it's too early to say whether or not the op has been a success. However, for what it's worth, I'm glad I gave it a go, whatever happens. I was never going to be happy with the 'sit and wait' scenario!  When you have your MRA results, you should have a better idea about what will need to be done in the op (i.e. whether there's a labral tear, etc). Don't be afraid to ask your consultant about his/her experience of improvement rates. It'll give you something to base your decision on. Hope all goes well.

 
15/05/2012 at 08:48

eyup there eveyone. I dropped off the notifications somehow, so you've all been busy with updates. 

For those who are interested, a little update. 

ALmost a year since RH arthroscopy, 6 months since LHS. Still have muscular issues on LHS - but soft tissues, so can work with them. Much better ROM, so much so that this is causing issues with clunking as my hip no goes places it hasn;t been for years. Basically, I have to keep piriformis, glutes, itb, adductors and abductors strong and stretched. This involves the usuialy stretching, but a lot of rolling around on a foam roller of doom and also sitting and rolling around on a hockey ball, to get deep tissue massage without the cost of the physio..

Anyway, good news - I ran two races last week. 5 mile fell race www.jackbloor.co.uk - took 40 secs off last years time (it was last race I did, and first back). And then a rarity - a 5 mile road race on sunday (starts outside my parent's house so was rude not to) - 32.23 for a hilly road course. Not bad for a lardy pie eating cripple like me I think. 

So, all is not lost. Ran last night on the moor again. Lovely evening. And can still walk today. 

I'm not going to lie - I ache and hips are clunking a bit, but still hopeful for another 5-10 years of running. Still trying to find the balance. 

 

Good luck to you all, who are post/pre op or just wanting to work out what's wrong with your hips. Don't take no for an answer, and get the best you can. 

16/05/2012 at 14:40

Great to read how you are getting on and that you have finally got back into the fell running you obviously enjoy so much. You are an inspiration!! I know that sounds sooo cheesy but it is true!

16/05/2012 at 15:57

Yes, Linz is right that it's reassuring and inspirational to read of people for whom the outcome has been positive (ie not just a reduction of pain, but an actual return to decent running).  Great work, mrmoosehead!  I will keep following your training diary and looking out for your updates on here!  I've also seen posts elsewhere by the guy who started this thread and he is posting super-fast post-surgery times (eg. 72 mins for a half-marathon!).  

Just got to keep telling myself that on really stiff and painful days, like recently.  Work is really busy at the minute (secondary teacher - exams/ marking etc), so I'm having no time for exercise and spending too much time sitting down.  Not good for either the operated or the unoperated hip.  I have a review of last month's MRA on 26 June - had hoped it would be sooner, but hey - at least I have a date to work towards.

16/05/2012 at 17:27

Hi all, so sorry to have completely lost track of a thread I started which has (unfortunately??) grown somewhat over the past year and a bit!  I've scanned through some of the experiences that people have had and it appears as though I may have been fortunate in many respects in my experience of FAI diagnosis, treatment and recovery.  For a start, there was never any question of whether the operation would be covered by the NHS, just the waiting time that ensued.  And they were quite happy to go with my (Curly's) surgeon recommendation.  Top man.

The story so far, if it's of any help:

2010
Nov/Dec 2010 - succession of non-diagnosis from physio, x-ray, MRI scans.

2011
Jan - referral to ortho surgeon, diagnosis of FAI - (possibly confirmed by a subsequent CT scan, except no one actually discussed the results with me!)
Then followed a rather frustrating period of chasing surgeon to write a letter to GP recommending me for surgery. Pretty much 2 months lost.
March - referral to specialist FAI surgeon, waiting list for consultation
June - consultation
end September - surgery

I was told I'd be on crutches for two weeks and return to running would be (a rather vague, and in hindsight, conservative) 3 - 6 months.  My actual recovery time-frame was:

On crutches for 4/5 days
1 week: Easy exercise bike work in the gym
2 weeks: walking completely normally, full intensity cycling
4 week follow-up consultation: surgeon very impressed with my (activity-enhanced) recovery and range of movement, suggested I try getting back into running just 6-8 weeks after surgery
8/9 weeks (early December) - started running again.

2012
Jan - back up to 50mpw, 5 runs per week, all easy pace
Feb - introduced tempo running
March - introduced interval training
April - racing.

Exercise/fitness management:
I'll admit that for the first few months of non-diagnosis and waiting around, I did a lot of moping and not very much exercise.  By April last year I realised that surgery wasn't going to happen anytime soon so I "HTFU" and got on the bike.  Did a LOT of cycling and x-training in the gym, with a few restrictions.  In particular, besides running the only activity I just couldn't do was indoor rowing, because of the ROM, but cycling was absolutely fine.

When I did get back into running, I started doing this on top of all the cycling and gym work, which effectively meant that I was doing a lot more total exercise than previously, which got me into better shape than ever.  So much so that I was running PBs as soon as I returned to racing.  (72:48 half marathon a couple of weeks ago.  )  There's no way I could've got back to that form without keeping the aerobic fitness up with x-training when I wasn't running, and I'm glad I've got into the habit and kept it up.  This includes regular core work, which may or may not have anything to do with my running feeling a lot more tidy and  "symmetrical" than before - or maybe that was the op preventing me for compensating for the dodgy hip??

So I think I've come out of it all very well.  The only major thing I've learnt that I might do different is in dealing with the healthcare "professionals".  In the grand scheme of things, I have to be extremely grateful that I've received the level of care that I have, but with GPs overruling physio recommendations for scans, ortho surgeons generally sitting on things and not getting things moved along, etc. it is definitely worth throwing your weight around, getting second opinions, etc.

Edited: 16/05/2012 at 17:28
16/05/2012 at 17:32

*x-post*  Oops!  Sorry, that was a bit long wasn't it.

mrmoose - glad you're back to it.  I'm still being cautious about doing anything too hilly, too fast.  Before diagnosis, one of the things that really brought on bad symptoms was running downhill.  I visited my brother in Vancouver in September 2010 and took part in a 27k mountain race while I was there - 4,000ft up a mountain and 4,000ft down again!  Two days later, joined in my first game of 6-a-side football for the first time in years.  Struggled to put a sock on after the shower. 

16/05/2012 at 22:43

The struggling to put a sock on - is that because you can't lift your leg? It's one of the issues I have on my left leg - and it's more adductor strength than anything else. 

 

Just got back from epic (and very cold) 4 hour MTB ride. tired now. 

18/05/2012 at 12:08

Yes, it would be painful to lift the leg beyond a few inches off the ground.  I think the increased range of movement of the football just compounded whatever damage I'd done with the running, especially downhill.

Edited: 18/05/2012 at 12:08
18/05/2012 at 15:24

Im still waiting for review of MRA  that I had at Feb half term Pipes so that seems quick to me!!

23/05/2012 at 13:44

Hi, I've been following this thread for a while. I'm based in the Leeds area and to cut a long story short after four years of misdiagnosis I was diagnosed in January with pincer FAI. I'm female and 27.

I was on the NHS and after not being satisfied with my consultant and researching my symptoms myself I was sure I had FAI so I paid to see Schilders who confirmed my suspicions. I then sought funding from the PCT which has been approved and I was referred to Jon Conroy in Harrogate who I saw a few weeks ago.

At the same time I have started a new job and it appears I am eligible for BUPA cover for my operation (even though it's an existing condition). My question is really what experiences, if any, people have had with either Schilders or Conroy as now I can go private it seems I can chose between the two.

Any opinions of what people have heard or experienced would be greatly appreciated. I'm really nervous about having this procedure done so want the best person possible to do it.

Thanks in advance.

Charlie

PS. For people going through the funding process now, my GP applied for funding on my behalf. I asked for a copy of the application, which was woefully inadequate in terms of setting out my ridiculous diagnosis journey I had been on. So I wrote an additional letter to the funding panel (you are allowed to do this under the rules) and my application was a success. I don't know whether it would have been approved in any case but I do think that my additional letter definitely helped with the outcome.

06/06/2012 at 21:15

Had MRI results today. No impingement, just "tiny marginal osteophytes at the margins of the femoral heads".

Hes suggested flexor tendonitis but Im not convinced.  Oh well, guess I should leave this thead and suffer somewhere else.

 

 

 

08/06/2012 at 11:06

Charlie Hope - Schilders is reputed to be one of the best in this area. 

His mannerisms are slightly odd, but he's quite funny and very clever underneath initial impressions. Not everyone likes his style. 

Don't know about Conroy as I had both sides done before the PCT decided they might pay for them, so I never saw him. 

 

08/06/2012 at 14:22

Mickster - I presume your disgnosis (or, rather, ruling out FAI) is a positive thing - do you? It doesn't really give you an answer for your 3 years of pain, or a clear way forward.  But it may show that you can get over it without surgery.  You're welcome to stay here with us FAI sufferers if you can't find a new home.

I saw the doctor today as my hip pains have been getting worse and have been joined by quad/glute/lower back pain as well.  Trying to walk around while on holiday a couple of days ago was very difficult and I felt like I needed crutches just to get around.  It's not always that bad - just when I try to do more walking.  I've had increasingly bad pain for over a year and a half now, and I know it will continue until I have the next op (which I assume will be no earlier than 6 months), so I wanted some help with pain relief.  He has given me co-codomol, to be taken when needed.  

While I was there, I asked if he could show me/ print out my MRA results, so that I could see them before my meeting with the consultant at the end of this month.  He happily obliged, and I'm strangely relieved that it shows "cam impingement with superior labral tear and hyaline cartilage damage".  Hopefully, this means the surgeon will do the same as he did with the left-hand side. And it didn't seem to suggest that the cartilage is in a really bad way.

Charlie Hope - good luck with your decisions/ operation.  I have heard good things about Schilders as well, and never heard of Conroy. Keep us posted on how things go.  I hope they get you sorted, whoever you go with.

Linz - any news yet from your MRA?

08/06/2012 at 17:13

Hi all.  Hope everyone's recovery from ops is going well and for those that are waiting, patience isn't getting the better of you.  I wanted to run something past those that have had their arthroscopies. I had my right hip arthroscoped at the beginning of April for a laberal tear (the second tear I have had in my right hip).  All seemed to be going well, had my post op check up at 6 weeks and they were pleased with progress, suggesting that the pain I had on the outer thigh was bursitis caused by the glutes being weaked following the op.  So they stressed the importance of building up glutes strength but said I could build up the walking/turbo stuff I was doing with a view to trying a run at the 12 weeks post op point. 

About 10 days ago (8 weeks post op) I did a turbo session (I don't have an exercise bike so figured the turbo was much the same thing), only for 25 mins, kept the resistance at previous levels but just upped the leg speed a bit.  No pain during the session, just a bit of discomfort as normal.  Iced afterwards (as I still do every evening) but the following day had debilitating pain in my groin, like a severe ache.  After a couple of days phoned the consultant's office to be told it was my illiopsoas muscle (hip flexor strain), again down to weak glutes which weren't keeping my hips centred at all times (i.e. illiopsaos taking more load than it usually would).  Has anybody else experienced this at all?  Was told it was quite common.  Pain level has improved but now the pain I am getting in the groin area, I can't determine what stems from the op and what from the hip flexor.  I have noticed that the hip flexor pain is particularly worse when bending down, crouching etc.however.  If others have had this, what stretches/rehab did you do?

13/06/2012 at 18:31

Hi Pipes. Sorry to hear you're suffering at the moment. Hope you manage to get an early surgery date. I'm getting my MRI results for the non-operated hip on the 27th June. I know that I've got pincer impingement fromt the x-ray last time, but I've got everything crossed that there'll be no labral or cartilage damage in this hip (unlike the other one lol).It's started to moan at me now I've stepped up my activity levels and just want to sort it before it gets too bad. 

Bumble1, I was just like you when I went for my 9-week check up. The surgeon thought I was doing well because I have good range of movement and no stiffness. I just have weak achey glutes and piriformis which makes it a pain to sit down for long. Also, my hip flexor is really tight. It's not the same as the groin pain I had before the op, though. I was told to do the stretch where you lie on the end your bed with one leg dangling down (sorry about the terrible description!). I also lie on my stomach on the bed for half an hour or so a day.Relaxing if nothing else! I'm doing lots of pool-based stretches too, which seem to be kinder on the body. A thought ... perhaps with the turbo, you're sitting position isn't upright enough (i.e., hip angle too acute)? 

I'm 11 weeks from my right scope now and sometimes I think it's worked and sometimes I think it's all gone pear-shaped.  It does feel like such a fine balancing act between not doing enough and doing too much.

Edited: 13/06/2012 at 18:32
13/06/2012 at 22:16

To echo what Sue has said, some days it feels like everything is going well, and some days it feels like the end is nigh. 

I think that my hips have more ROM now, and I'm working hard on flexibility in my hips/legs/back, and also on strength in adductors/abductors etc. 

Running a lot more, and cycling. 

Some days I feel great. Some days my hips feel clunky and achey. I think that this is often due to too much aggresive stretching. 
Still trying to find that balance...

 

 

16/06/2012 at 19:02
A friend of mine, who is also a Physio, has been researching FAI and has written a really good blog on it including links to research and suggestions for rehab.

It's available here;

http://runningphysio.wordpress.com/2012/06/16/femoro-acetabular-impingement-fai/

Hope you find it helpful

Tom
17/06/2012 at 10:42
That is an excellent post and really paints a whole picture (in a way you don't always get).
17/06/2012 at 13:53

Just read the blog and it's very comprehensive. I've done quite a lot of reading online about FAI and laberal tears but no one single article that has so much info as this one. 

Thanks for the posts above by the way.  Reassuring to know that I'm not the only one experiencing a bit of a roller coaster ride after hip arthroscopy.  You feel on top of the world if it's a good day and can be positive about the future, but hard to remain positive if it's a bad day.  Saw my physio a few days ago and he confirmed that I've got illiopsoas bursitis, caused by my glutes being so weak after the op.  So lots more stretching of the illiopsoas and glutes strengthening prescribed.  Had a litle go on the turbo last night for the first time in nearly 3 weeks (Sue - good point above about hip angles, sat with my arms dangling by my side and not on the handlebars to keep as upright as possible).  More discomfort than pain so I suppose that's a good thing.  Feels like a balloon full of fluid in my groin so now taking ibuprofen to try to reduce the inflammation.  Really not sure whether I should try a proper trot at the 12 week point or not.  Nearly 11 weeks post op now, and did have a little jog (v v v slowly ) across the back garden this morning, and hip felt OK.  Funnily enough, illiopsoas felt better after doing it, so we'll have to see how things are next week before deciding.  As MrMooseHead said above, think it's all about finding a balance - and will be a bit hit and miss finding it!!

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