Saturday, May 11, 2013

Hip Problems? Labral Tear? FAI? Read this: A Patient's Guide to Hip Impingement

Anna-Lena Thomas of the The Entrepreneurial Patient has written the first (that I know of) book for the labral tear patient who has problems with their hips. The Entrepreneurial Patient: A Patient's Guide to Hip Impingement is a must read for any person (and therapist and doctor) who is curious about hip problems or suffers from a labral tear or femoroacetabular impingement (FAI). I found Anna's blog and this post last week that talked about the multiple and complex issues of the hip joint and helped categorize different layers of diagnoses. It was a very helpful post for myself.

While visiting her site, I noticed she has recently published a book: The Entrepreneurial Patient: A Patient's Guide to Hip Impingement While I have not been diagnosed with FAI (my surgeon doesn't treat it- I understand) I was curious about what she had to say about hip arthroscopic surgery and the different diagnoses, procedures, and outcomes. Upon downloading the ebook version, I did a real quick read of the book since it was late at night. I went back to reread it all over again this weekend and I wish this book had been written before I had my surgery in 2011. She walks you through her story, explains the mechanics of the hip and different forms of surgery. She uses data from studies and interviews and explains what a patient should know and do before and after surgery.

From my experience, just about everything I have learned about labral tears and arthroscopic surgery, (including my own) has been from my own research which is primarily found on online message boards from other patients. In fact, I believe I would never had been treated or had surgery if I didn't advocate for myself through self-diagnosis. No doctor or therapist ever suggested a labral tear to me as the source of my long-time problems, which started as a lower back problem similar to Anna's experience. I had the resultant back, sacrum, psoas, adductor, and glute problems as well as muscular imbalances long before I felt anything in my hip (although in retrospect the clicking, catching, and giving away in that hip joint should have been a clue that something was wrong with the joint).

Anna gives a solid education regarding the hip and it is good to have it in one place rather than in a bevy of numerous online postings. The book is worth its weight in gold, just because she tells you how to interview and seek out qualified surgeons and therapists. I thought I did lots of work to get my surgeon, but really he was only the second surgeon I called (the first considered me too old at over 50). My surgeon has excellent credentials, but I had heard he doesn't treat FAI and I really should have asked around to see if I have it and I never questioned him on it either. I still don't know if I have FAI.  I also did not meet my surgeon until right before the surgery. If I had researched and asked around, I would have found out how hands-off he is post surgery. I was given a sheet with a few exercises and told to call his office in 10 days, from which I was told I could start running when I felt ready. I waited until three weeks post surgery and I have yet to hear of anyone starting running so quickly! I don't think that was a problem for me, the bigger problem was I didn't know to ask about PT. I asked almost two months later, just to be sure.

If I had this book, I would have been much more prepared to question my surgeon or get second opinions from other surgeons before getting my surgery. Anna also highlight all the things to do pre and post surgery and the types of therapies that can help. She also goes over the many complications that can result from hip surgey: the muscle imbalances and the tight adductors and glutes, things that I am still fighting in my own recovery. One thing I found interesting is that Anna found that stretching the hip flexor was not helpful to her. I have noticed this too. If I stretch the psoas or hip flexor I seem to be worse off than if I leave it alone. Do you want to know how many times I have been told that stretching the psoas would solve my problem? Nope! She also gives advice for dealing with insurance companies.

This was one Kindle book where I constantly highlighted passages throughout my reading so I can go back again and reread. I got a wonderful one-stop education from someone who has done her homework. This should really help out the many patients who are curious about what is wrong with their hips. Message boards are great, but you can spend a significant amount of hours reading them to get the information that you need.

I thought I had done a lot of work researching on my own, but what I learned was only a small amount compared to all the Anna imparts. I am pleased to note that some of the important treatments that I discovered such as MAT are some of the treatments that she thinks are worthwhile. Hip arthroscopic surgery is a relatively new field that continues to grow. I also think that my recent frustrations (and last two posts) dealing with recovery and doctors and therapists mirror what Anna (and others) have discovered. It seems that getting a diagnosis is difficult (the pains of a torn labrum are referred to other areas), in surgery it is important to get the best surgeon that you can, and that recovery seems to be the most difficult part of all due to doctors and therapists not having a protocol or understanding of the needs of the patient after surgery. Muscles imbalances, deactivated muscles, and other problems such as in the psoas. glutes or with the adductors are common. Just like I have found, standard hip PT does not really help. I have some new ideas to pursue and some new ammunition when I talk with doctors and therapist that I did not have before I read the book. I think I was on the right track before, but this book will help me articulate things better and I now now that my hunches and speculations are probably right on, so I need to pursue them and not just trust that things will work out on their own. I can only tell you that if you are curious about your hip or are dealing with hip surgery and its aftermath, this is the one best book you can read and when you are done you can go to the message boards and fill in the gaps with the support and experiences from other patients that are so willingly shared.


Anonymous said...

I am a 68-year-old woman who has been experiencing intermittent left hip pain, weakness, and instability for more than two years. The first time it happened I was just walking down the street feeling fine, and then between one step and another I could barely move. The day before I had had a fairly strenuous massage, which at the time did not feel completely comfortable but did not seem to cause any immediate problems. After the painful and unexpected initial incident which happened the very next day, subsequent xrays and other tests showed no problems. A series of physical therapy seemed neither to help or worsen the condition. Even now, much of the time I can walk without any symptoms, except that after two years of this my gait is gradually changing and I am favoring my left leg more and more. I feel increasingly unstable. When the "catching" does occur the pain is excruciating and it feels as if my left leg will not support my weight. Each time this happens it begins a cycle of pain and weakness which seems only to be helped by resting for several days. I used to do walking, yoga, and Pilates but have stopped doing any exercise lest I make the problem worse. And it is gradually getting worse each time the cycle of pain and weakness comes. Normally I climb and descend stairs many times a day, do my own gardening and cooking and laundry, but when the pain starts, I walk with a severe limp and at times can not walk at all without some kind of support. Ironically, even when I am in severe pain during walking, twisting or pivoting, standing for extended periods,or climbing stairs, I am in absolutely no pain sitting or lying down. I am beginning to lose confidence in my ability to communicate about this problem and be taken seriously. As I am also overweight and a Type II diabetic, I am concerned about my overall health if this situation continues without some kind of resolution.

Jim Hansen said...

The "catching, "instability" and "cycle of pain" wound very familiar to my experience. A doctor cannot check for a labral tear through x-rays. You would need to get an MRA and maybe first and injection into your joint (doesn't hurt)to see if the cortisone masks the pain. If it is a torn labrum, I am not sure if all doctors would do surgery at your age to repair it. My father-in-law had a sudden onset of hip pain last year and had a hip replacement. He is in his 80s and is now walking around much better without any of the pain. Best wishes to you, but you may have to prod your doctors to get the appropriate testing done.