Thursday, September 2, 2010

Hip Hobbling Around

It took a long time to decide go to a doctor about my hip, but I had some deep suspicions about what is wrong with it and after everything I have tried it has suddenly become worse. I got an x-ray of the hip last Friday. It turned up negative, but I saw an orthopedist this this week. After a short time, he said the words that I expected. He thinks it may be Labral Tear and want me to get an MRI to confirm it. I have read about labral tears for the past couple of years, and many things about it seem to fit my hip, however, I wasn't ready to look into seeing if I had that without trying all the available options, particularly when I could still run (even with my constant imbalance, stability issues, and loss of coordination in the hips).

Over the past couple of months, the muscles around my hip have been bracing (or splinting) making them very tight as they seem to want to "protect" my hip. I have tried to run through it and this summer threw everything I could at it, but it just never seemed to resolve. A couple of weeks ago I started taking anti-inflammatories before runs and that seemed to help some, but I wasn't consistent with it.

Last Thursday, I finished up a very active series of races with a track 5000 meters at the Loco 5000 in Dover. I was very hopeful that I could run an "elusive" decent time. Two days earlier I ran 19:13 for a season PR at the Lowell race, but the twists and turns of that course are not to my liking. I thought a flat track race would be the ticket, particularly since my track workouts this summer have been better efforts than my races. I had not run a track 5000 meters in 30 years and set a goal of finishing within 3 minutes of the time I had last run on the track in 1980 which was 16:02. Honestly, I thought I would do a whole lot better than 19:02 and was looking to get under 6 minute pace. I started the race with a 6 minute first mile, but then my muscles around my hip started tightening up again. I got slower and people passed that I should have been able to hang with, but the hip got worse with each mile and I finished last in my heat with a 19:42. After the race, I could only sit down because my hip hurt. When I got up, I was limping again and had a hard time walking, let alone running, and I think it was at that moment when I "knew" it was time to get the hip checked out by a doctor, so I made the call the next day.

Friday, the doctor had the x-rays taken and he told me to take the inflammatories full-time. I have, but for some reason, running hurts more. Maybe, the inflammation is being removed making the hip hurt more. I struggled through 8 miles on Saturday and then again on Sunday. Now, I am limping almost full-time. I tried running Tuesday and after a couple of miles, I had to stop, as the hip got really bad. I even had a hard time walking home. A group of three older walkers even passed me. That was humbling.

I don't know if it really is a labral tear, but it sounds right, and I am not sure of the degree of it, if there is an impingement, or if there is athritis in there. The diagnosis and treatment of labral tears is a new science in the past 10 years or so. If I need surgery, it seems like it might take 6 months before you can return to running, and a year until you are back in form. I guess I am finally ready to go through with that, if that is what I need to do. I have tried everything else and I don't think there is anything else I can do to make my hip better on its own, particulalry now that the pain is getting pretty constant.

Long coolrunning forum thread, but it ends in 2007
Long Runner's World forum thread
Long Letsrun thread "Loss of coordination in leg" thread that I have been following and contributing to since 2006 (introduced me to labral tears-but it is not only about labral tears)
Great information on labral tears from one of the best surgeons for this injury
Video explaing FAI-Femoro Acetabular Impingement- a reason for labral tears and show how surgery is performed

Anyhow I got a lot of staisfaction out of my summer running (even though it was slower than I'd like and not pain-free). I know I still have the abillity to do 70-80 mile weeks. I hit 85 miles one week with 52 miles of it in three days of running. I can still race a lot (although not at the speed I feel capable of running). I do know this. I enjoy running a lot, even when it does not feel well. The challenge I have is to fix this. Although a labral tear is not confirmed, my suspicions are that it might be my problem and I bet they find an FAI-Femoro Acetabular Impingement that has caused my hip problems through the years. I recall knowing something was wrong with my hip even back in high school. My suspicion is that my femur does not settle into the hip properly-it is precisely what I have been feeling for years with all the instability. I only hope I haven't worn things down too much with all the running I have done.

With all my hip and leg problems on the left side, I think it has come down to three problems: the Functional Hallux Limitis which I have been using insoles to correct the past two months. FHL caused my left leg to collapse at the arch and pronate out throwing my left leg into a weird stride. I am starting to think that the insoles have started to correct the angle at my hip, which may be what made my hip feel worse over the summer. Maybe that is where the tear is felt most-when the hip is in a more proper running position. I also have a tibial torsion of the left foot and it angles out to the side. Both the FHLand tibial torsion could have caused a labral tear as they altered the mechanics of the hip joint over time. That is just my reasoning of the situation. I like the way the insoles have kept my feet from collapsing and they have truly been helpful in many ways.  I am supposed to have Dr. Dannenberg make a more permanent orthotic for me later this month. I can't solve the tibial torsion. Now if my hip can be fixed and get me back to running, then 2 out of 3 problems will be fixed and maybe I will be able to run in a more balanced, effortless, and pain-free way.

I look forward to getting the MRI to see what it says. I also wonder whether I may get a cortisone shot.I have read that sometimes this actually helps the condition. Sometimes it allows for a week or a few months of pain-free running, and sometimes it doesn't work at all or creates more pain. Depending on the MRI, I may find out I have shredding the labrum or have arthritis that makes a surgery or a return to running doubtful or I may find I need the surgery. I certainly don't look forward to any surgery and it looks like it is usually 6 months until a return to running and one year until full training if things go well.

Nick Willis, the Olympic silver medallist in the 1500 meters in Beijing has had this surgery and has returned to running sub 4 minute miles. Adam Goucher is considering retirement from elite level running because of his hip. "The doctors diagnosed an impingement in the hip joint that is causing bone buildup in the area. There’s also a possible labral tear. Surgery will be required to fix it, and then six months of recovery and rehabilitation will follow." Alex Rodriquez had surgery for a torn labrum.

I haven't been able to run since the aborted run on Tuesday. I have been able to eat extra ice cream to compensate (this won't be good). I also tried mountain biking today and that was fine, so it looks like I am back to biking for awhile.

This new book from the author of The Entrepreneurial Patient blog is a must read book for anyone with hip problems and is thinking about about arthroscopic hip surgery or has had arthroscopic hip surgery for a labral tear or FAI.


Ski Coach said...

Why don't you take a break from running and do some cycling for a while to see if the hip can recover on its own. I love both sports but cycling lets you workout much longer (6,8 even 9 or 10 hours) without injury risk. At least you could retain your fitness benefits and if lucky perhaps heal and get back to running without surgery. At age 50 I took up amateur cycle racing here in france and really enjoy it - this year it's all I did due to plantar fasciitis from running - but my fitness level is now higher than ever.

Jim Hansen said...

That is a great suggestion that I need to follow. I did ride my mountain bike a few days ago and the hip felt OK. I went from running to triathlons in the 80's (and did 5 Ironman length triathlons) and loved the cycling leg, then I trained with a local cycling club after that for a few years. It killed my back as I wasn't fit on the bike correct. I know some of my running friends are doing more triathlon and cycling training and they seem to be doing better all around. I guess I have to change my mindset and get used to a saddle again. Thanks for the encouragement!

Ski Coach said...

Personally I'd do anything to avoid surgery. In my youth I made the mistake of trusting doctors and surgeons instead of trusting my body. When did you last take a total beak from running?

10 years ago my left knee was twisted right around in a skiing accident where the binding didn't release. I was in great pain and had a knee like a balloon. The doctor took a fluid sample from the joint and found blood in it and was adamant that I should have surgery. I refused and witnessed the knee recover progressively just through good management. Perhaps I was lucky - but the same happened when I refused back surgery.

I also had discomfort on my bike but this year I bought a bike directly from and used their online measuring system. The difference has been incredible. The previous bike had been bought in a shop and it was all wrong. I got a carbon frame - which is unbelievably good - and top spec componentry - for 50% of shop prices because they cut out all the middlemen. Their mountian bikes look great too and their xc ones are even lighter than my old racing bike.

I read recently that 50% of runners are injured at any one time - so it is really part of the game. Cycling removes the impact stress and violent eccentric muscular contractions that cause the problems, but allows fitness in general to develop and even go further.

Personally I have found my enjoyment of cycling increasing after adapting to much greater endurance levels and improvements in technique. I think what is important is to avoid getting stuck in "running", "cycling" or anything else, but to see the most important thing as being your health and what works best for you at any particular moment. I've realised - especially due to ageing - that without endurance training good health is impossible.

Unlike you I'm not a top end performer in any of those sports - so I don't feel an obligation to stay at the top of my game. I'm an Alpine skier by profession and that is about power and strength, not endurance. It's only really endurance however that brings health benefits. Most of my winter is spent getting fat and over feeding in mountain restaurants.

Jim Hansen said...

Ha, Ha... ain't that the truth-"getting fat over the winter!"

I sure would hope to avoid surgery. I have never had surgery and wouldn't look forward to it. Maybe the MRI will tell me that nothing in the hip is wrong. That would be cool! It will be interesting to find out about that hip, however.

I am going biking today. There is good wisdon you have in that health is the most important thing. Running certainly can bring some "bad" health into the equation when it impacts negatively the way that you move and feel.