Wednesday, November 3, 2010

A Trip to the Physiatrist

I had my first appointment with a physiatrist scheduled for the end of the month, but I got a call yesterday that there was an opening so today I had my first visit. When I arrived, I really wondered what I was doing there, It is a pain clinic and the people coming and going looked like they were in bad shape and I was just sauntering into the joint. Then I had to fill out all sorts of forms, a lot of them dealing with drugs and pain medicines. It was a longish appointment (over an hour with the doctor) to go over my history. He had already viewed my records. I liked the physiatrist, he was young and seemed  interested and puzzled. He listened and didn't jump to conclusions like he was a know-it-all and thought about each tidbit I presented him with. So things were off to a good start.

He moved my leg around and like the last orthopaedist didn't believe I had a labral tear because nothing was painful. That would be good news if I don't need surgury. From my x-rays he said my hip was in pretty good condition (just mild arthritis). He said this could be because of all my running, strangely enough my body has found it own way to move without damaging itself. He recognized the tibial torsion in my left shin and said I also had femoral antiversion (internal rotation) in my left hip. I was born that way and I guess you can't change either of those without breaking bones in surgury so that they grow back a different way (no thanks!). He said it is very rare for someone to continue running with these "defects". The average-normal-thinking person would have found something different to do with their time. But, he also doesn't think that running has to be a bad thing. I agree on one level, despite this new hip pain that I got in the summer, once I stopped running in September all my musclulo-skeletal imbalances actually feel worse throughout the day and night. Running usually removes a lot of this tension and pain for me.

He thinks the internal rotation of my hip has led to an impingement, not an FAI impingement that begets a labral tear, but a ligament or muscular impingment. The adductors are too tight to compensate and the abductors are too weak because the are not working. He is going to work with me to see what we can do.
First off, he wants x-rays of my knees to see if there is something going on in my left knee. I have avoided knee pains for much of my life, but when my leg and hip is out of balance and rotating wrong, I do get a tightness in my knee.

He also wants to try a cortizone shot in the hip. I guess I am supposed to not want it to work. If it clears things up for a while then it could mean a labral tear. But I wasn't clear on all that he said this would be about. That will be Monday morning.

He also said it would be very interesting to get a gait analysis done. I don't know if my insurance would cover some of this. What I did appreciate is that he went to a school with another doctor who specializes in running gaits  and he is going to call her and ask her about what to look for and to look into with my stride.

I am glad I got in there earlier to get the ball rolling. I am not sure what treatment or therapy I might get as I have already done most things that we talked about, but hopefully the doctor can stick with me and things a bit more to at least get me up and going again.

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.



Sounds like things are moving in the right direction, good luck!

Jim Hansen said...