Wednesday, May 8, 2013

There is no Finish Line

Nike had a famous advertisement that said, "There is no finish line." A crucified Jesus uttered the final words. ""It is finished," before dying on the cross. Minwax promises a long lasting finish to your wood products. While my running problems are nothing close to Biblical in nature, I do feel completely unlike the Nike runner who keeps running because there is no point in finishing up with running when you can enjoy it so much and instead I feel like a runner that may never get his legs back and realizing that as far as running goes, things might just be finished.

I am discouraged and embarrassed that I can't get my hip working and feeling right. The whole point of the blog is to announce that hard work leads to a victory some day over my hip problems so that I can happily go running off into the sunset. Every once in awhile  I get that hope that I am almost there, and then, I can't run again and my faith in my ever getting completely healed is destroyed.

Last week I ran a 2 mile treadmill run after going for my 2nd visit to the new therapist. The next day I had a trigger point injection for a really tricky trigger point deep in my glutes. I thought I would be good to go, for after my first visit to the therapist I had a close to perfect night of running at my first track workout in three years. I waited two days to run and Saturday I could barely make three easy miles. I took another day off and I had the same result on Monday. I have had only one good run in about one and 1/2 months (and it was awesome) and I can barely be encouraged my a couple of short awkward runs each week. My hip isn't working right and I am getting reoccurring  pains from my toe to my knee and up through the hip (adductors and gluteus ) and into my sacrum and lower back. It feels almost  like it did before I had to stop running before my surgery and is nearing the worst it has felt since the surgery.

I have a visit to the therapist tomorrow and if she can't get me back to how I felt after the first visit just two weeks ago, then I will be pursuing an MRI as my surgeon's office could only offer that to me two weeks ago. I really don't want to contemplate a failed surgery or a new surgery, but I am not convinced that my surgeon fixed everything. I learned that he is one of the few surgeons who doesn't believe in FAI (hip impingement due to bony problems) so he doesn't fix the parts of the bone that can create the impingement. It there is a bone problem, it can retear the labrum.

I know I didn't get the best post-surgery care either from my surgeon's office and I was left to pursue things basically on my own. I hope the labrum is still OK and I have a hard time getting answers from someone as to why the pinching feeling feels like nerve pain and then why that pain flares up through my body. I also also can tell my whole hip complex doesn't seem to work or move properly. The other day while trying to run, it felt like the whole hip was completely backwards.

I also realize that at another finish line, people had their legs blown off just  last month and there are so many people with much more pressing medical problems than me and my faulty hip, so I can't really feel too sorry for myself. I am a very lucky guy with the life that I have.  I would just like to know once and for all what is really going on with my hip and what do I need to do to keep running. And if I can't ever get back, then should I just retire the whole thought of ever running competitively again. It has been a good 40 years of running. I just want more.

I am at a loss of words in explaining the complexities to the doctors or therapists so that I can get a knowledgeable and satisfactory answer from them, particularly when it seems they don't get what I am saying. I know I am chasing lots of ideas around as I chase the pain around, but I can't seem to get a medical professional to join alongside me in my quest and my surgeon's office just seems clueless (and I am not the only patient to have questioned this surgeon- I have found many that have had to go to another surgeon for a revision). I don't think and I hope that is not me, but there is definietly something going on in my hip and I would hope that the surgeon's office would have some type of answer or advice.

I did see a wonderful blog post this afternoon that for the first time explains what the medical field should be doing with cases similar to mine where the hip just doesn't seem to cooperate. This type of arthroscopic hip surgery is relatively new (about 10 years), so the doctors don't have all the right answers yet. It is good to see that some doctors are starting to look at things a bit deeper due to patient concerns.

The blog Hip Impingement News by The Entrepreneurial Patient newest post Impingement and the Unraveling of Related Diagnoses explains this recent history and the struggles that certain patients have.  She talks about a recent symposium where some of the top hip surgeons began to address this situation with a layer of diagnoses:
Dr. Kelly presented his process for obtaining “layer diagnoses” for the painful hip as compensatory soft tissue changes are common. He encouraged attempting to identify diagnoses for each layer. He identified Layer 1 as bone and cartilage abnormalities. According to Dr. Kelly, Layer 2 diagnoses are defined by abnormalities affecting the tissues of the hip capsule and labrum, which lack ability to function. Layer 3 diagnoses refer to dysfunction of the muscle (contractile) tissues. Layer 4 diagnoses include processes affecting neural structures, such as nerve entrapment syndromes.
I think that is exactly what I have been trying to articulate to my doctors and therapists, but they don't yet seem to have ears to understand. While I had surgery. It only was a layer 2 correction. How do I get help for layer 3 (what I refer to as the hip not working properly and why I sought help with MAT) and layer 4 (the "pinching nervy problems" that I get). I am now also getting concerned with that Layer 1. I know my hip is abnormal with the femoral anteversion, so I wonder if there is some abnormality (maybe even FAI) that causes the pinching feeling. I wish I didn't have to think of these things, but I do want to know what the end result of all of this is so I can know if I can faster and more ably to more finish line or if that active part of my life is indeed finished.

It was be awesome if the therapist tomorrow can get me back to where I was 2 weeks ago after that first visit.

Things I am thinking about:

A short time post surgery, I started using Schiff Move Free for my hip joint. At first, it felt like it "juiced up" my hip for a short while, then I didn't notice anything in particular. I stopped using it in February right at the time I did a 71 mile week. I didn't notice any loss of hip function, but things started falling apart about two months ago. I also can't tell if the problem is in my hip joint, it feels more like the muscles and ligaments that surround the hip.

I started eating gluten-free at the end of November. Soon after, my running seemed to get better. I was hoping that a gluten-free diet would reduce inflammation. I stopped being real picky about being gluten-free about the time my hip started gradually doing worse. I really was not good at finding and making gluten free food that was enjoyable to eat. Maybe, I need to test out other anti-inflammation diets. I still try to be as gluten-free as possible. I am just not religious about it.

At my first visit to the new therapist, she tested my left TFL as weak. She activated the muscles then had my walk for a short time in my Hoka One One Bondi shoes. Then she retested my TFL and it was weak again. She thought the shoes may not be good for my feet (or maybe it was just getting up and walking). I decided to buy some new Brooks shoes and while I never felt good walking in the Hokas, I felt firmly connected to the ground in the Brooks. However, I haven't had a good run yet in the Brooks shoes and I liked running in the Hokas.

This new book from the author of The Entrepreneurial Patient blog mentioned above 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.


Joe D said...


I've been following your blog for 2 years and this is by far the saddest post... but I think I can empathize with you. We've emailed a few times in the past, I had Labral tear/FAI correction incl ITB release w/ Dr. Kelly back in 12/2011. Before the "proper" diagnosis, I had issues for 2.5 years. Post surgery has been setback after setback. After the latest, Dr Kelly said that 90% of his patients are good post surgery, but the 10% that arent take up 90% of his time! I am almost in that 10% at this point. Reading your post however, I feel like I almost could have written it:

1) "hard time getting answers from someone as to why the pinching feeling feels like nerve pain and then why that pain flares up through my body"

2)"so many people with much more pressing medical problems than me and my faulty hip, so I can't really feel too sorry for myself. I am a very lucky guy with the life that I have."

3) "know once and for all what is really going on with my hip and what do I need to do to keep running"

4) "loss of words in explaining the complexities to the doctors or therapists so that I can get a knowledgeable and satisfactory answer from them, particularly when it seems they don't get what I am saying"

Although, this one Dr Kelly has been quite good. Reading what you said about the layered approach - I am on layer 3-4 now. For layer 3 I did the PT, ART, and cortisone into the trochanteric bursa therapies. BUT, all though out I have had a "nerve-type pain" post-laterally down my leg, into my knee, my shin(which constantly hurts), and my heel. Also into my groin - although my PT thinks (and we have made progress here) that is impingement from anterior femoral glide). But like some of your medical pro interactions, I told a former PT that I thought that was the issue for months and he ignored.

So now we are exploring back issues - have you looked into that? I have some disc issues L4 and L5 that Kelly (and the physiatrist he recommended) believe may be my problem. MRI today (my 9th since 2009), then based on that probably injections.

If that doesnt work, possible MRI of sciatic nerve to see if there are adhesions?

Maybe you can try and get down to NYC to see Kelly? I was quite lucky he was "in network" for me!

Hope you (we) can get though this!

Jim Hansen said...

Hi Joe,
It is not so much sadness, just frustration. I am sorry to hear that you are still struggling and part of the 10%. It certainly is an ongoing process trying to get answers. I am not too sure that most therapists I have seen are even familiar with hip surgery patients and the difficulties that can happen. I did have a back MRI about 6 months after my surgery and surprisingly it was in good shape. I have been wondering if I should get another MRI and what I should do with it when done. Dr. Kelly was the guy I was thinking of. I have heard from two other guys who had hip surgery from my surgeon who had revisions from Dr. Kelly and they seem quite happy after the revision. I also believe that Dr. Kelly is the guy quoted in the symposium. Good to hear from you and I hope things start getting better for you with the results of your new MRI.

Jim Hansen said...

...and the therapist today said the pains that come and go from my toes up to my neck are from pronation. She does a mix of therapies: MAT, MET, and some Graston on my tight adductor. There are also some things that I don't know what they are, but I'l take the mysterious (close your eyes touch your fingers to your nose and such) along with the varied adjustments along with the stuff that seems to have worked the first time. I got some new simple foot exercises that may help with my balance.

Anonymous said...

I used to think chiropractors were big phonies. I have seen the amazing things they have done for everything from allergies to chronic infections to various body pains. I think they are gaining in popularity. Have you tried them? And I do think there is something to the gluten-free diet.

Jim Hansen said...

Chiropractors vary depending on the tools they have in their toolbag. I have had some great chiropractors and then there are others that have not done much. The "therapist" I am going to now is a chiropractor, but she uses a wide mix of therapies with just a little bit of adjustments.

I have to spend more time working on the logistics of the gluten-free diet as I just wasn't getting enough variety when I was 100% gluten free.

ThePetitePacer said...

Your complaints of pain from your toes up through the leg into your buttock has me thinking sciatica. Have you had that checked?

Jim Hansen said...

Not officially. I have mentioned it to many therapists. I forget why I was told it did not match.

Anonymous said...

Hi Jim

In terms of eating gluten free, joining a coeliac society (or following online) can be very useful. gluten free is hard but we thankfully live in an age where it's relatively palatable as compared with 20 years ago.

my husband is struggling with chronic injury, and can't run: I feel your angst. Good luck!

Jim Hansen said...

Yeah, when I was starting gluten free, I was trying to cook new things and be a bit creative (for a non cook). The problem is I started sliding into buying packaged gluten free food and that isn't really the same.

Thanks and good luck dealing with your husband who can't run right now. I know my wife would be happier to see me out and running!

Jim Hansen said...

Joe, Did you happen to see the new study that lots of cases of low back pain are linked to bacterial infections? They treated them with 100 days of antibiotics! I read another review, but it is sometimes linked to disk issues.

Jim Hansen said...

Here is a link:

Joe D said...

MRI results back... L5/S1 disc has degenerated further (since 2011 scan). Plan is to hit it with cortisone, both as a pain+diagnostic measure to see if that takes care of the hip pain. We shall see!

Jim Hansen said...

Well that is not good. I hope the cortisone works. I scheduled an MRI for my hip for next Friday.