Wednesday, June 12, 2013

Start "The Theme from Rocky" - and What was said!

It has been two weeks since I have even run a step and I feel like I am hanging onto the edge of a cliff, hoping I can scramble back up to the top, but not really sure of what my fate will be. In that time, I have got a lot of suggestions about what to do regarding running and my hip and some of them involve quitting running completely. Others are more hopeful. My best bet is to be careful, listen well, think things through, be smart, and ultimately hope for the best.

What the hip surgeon said:
Two weeks ago, my hip surgeon said he "could" do another hip scope, but wanted to try a cortisone shot first, which didn't seem to work, but about 5 days later I started feeling somewhat better. I am thinking if it was another labral tear the cortisone would have made things feel good quickly and only for the short term. That is not what happened and I find that interesting.

What the physiatrist said:
I went to a new physiatrist and he recommended seeing an osteopath (I will hold off on that as I am already having work done on me and I am hopeful that it is pinpointing some things to fix). He said the pulling in my adductors when I lift my leg is just the labrum loading. I haven't heard anything like that before. It could be or it couldn't be. He suggested a Heel Lift . I had already ordered heel lifts before the visit as I "feel" a tilting of my hip to the right side. My MRI notes also noted the higher left hip. I put a small amount of lift in my right shoe last week and felt much better balance right off the bat. He also gave me some meds for pain, but I haven't used them. He said my hip tightness is just my piriformis. I don't agree. Doing piriformis stretches makes things worse (see below).

What the best hip surgeon in the country may say?
I sent all my surgery results and records to the best hip surgeon in the country and he will evaluate them in the next week or two. I am curious if he notices any bony issues.

What was said at the chiropractor's office:
I brought my MRI notes to the chiropractic office I have been going to on a weekly basis. She saw two things: dyspalsia of the left hip (mild) and chrondomalacia of that hip in some of the notes and basically said I was done running. I think these are mild and inconclusive, but it made me start thinking my running days are sadly over. I was then told that I needed to give up endurance activities and start doing things like pulling weighted sleds or heavy tires around and to get into weight lifting as another way to get my "runner's high". OK that will be like telling me to grow spots on my own. I said that I had done kettlebells in the past, but was told that is too much for my movement patterns right now. I agree on that. I think the movement exercises I have been doing and getting from them are very helpful, but I have a hard time thinking that my hip is done, when just a month ago after my first visit there, I had my best most balanced run in years. That tells me there is a point where things work together well and I just have to give it time to get there. If I do need to give up running to protect my hip, I will, but I am not sure I have been given the knockout punch just yet.

What the fellow pain sufferer said:
In the last week. I actually had five really good days (including walking around Canobie Lake Park for 6 hours with no discomfort) so the therapy is working at least in my sedentary life. I was checking an FAI blog and saw a post from another blog written by another patient-athlete writing about Anterior Femoral Glide Syndrome. I had found information on this a year before I had my surgery and asked the ART chiropractor  I was seeing at the time about it, but he had nothing for me. Even thought it is written about from one of the most prominent PT people, Shirley Sahrmann, there isn't even written about it on the web that tells you what to do and her book Diagnosis and Treatment of Movement Impairment Syndromes is too expensive and not written for patients. I couldn't make sense of it back then. Heather over at Run, Bike, Swim, Fight provides a really readable explanation of Anterior Femoral Glide Syndrome and its sounds like she is fighting the same battles that I am post labral tear surgery. She writes:
In basic terms, the head of my femur is too far forward in the joint capsule, which was responsible for the constant burning pain I was experiencing. The other issue behind AFGS is that the hip flexors are activating when the glutes should be. So to correct this issue one has to train their body to activate the glutes instead of the hip flexors.
Gosh, that sounds like what I have been experiencing and finding hard to put into words. Reading some of her other experiences, they pretty much mirror my own with frustrations with therapy, similar pains, and finding that certain moves (like stretching the hip flexors or piriformis) seem to make things worsen. I was having a particularly bad 24 hours after doing my exercises that involve flexing my hip flexors (immediately threw things off on a really good day). Heather had a page of exercises for Anterior Femoral Syndrome Exercises and I did the mobilization at the bottom of her page first. I felt a little "pop"and very quickly my discomfort went from about 100% to only 15%. I did the exercises later that night and none of them "lit up" my body, but eased things up instead. I don't know if this is a problem I really have. It does sound about right to how I feel. There are so many things that can go wrong in the hip and they all have similar symptoms, but I am glad I found her page. I may have been knocked down, but I think I found some more information that just might help me climb up off the mat.

What the Neuro Kinetic Therapist said:
A couple of people that I have conversed with on some FAI boards highly recommended that I try something called NKT- Neuro Kinetic Therapy. I found a few people that practice this in the local area and started communicating with Brandon in Beverly, MA because he likes to work with runners. Last night, I went to an introductory appointment. NKT is a bit like M.A.T. which I found very helpful last fall. It was an hour drive to the appointment and it was full of muscle testing which found some of my weaker muscles. At one point, Brandon was pulling on my leg to loosen up my hip, which he said was incredibly tight. As he continued to do so, I felt a pulling or tightness happening in my glute area really close to the femur. I noted something right away. This was the exact area where I felt a tingling in the night of my great track workout about a month ago (last good run was the best I felt in years). My brain went into overdrive. I realized that at the first chiropractic visit the same move was done on my hip, but maybe with more or a sudden pulling. With all the other work that day, I felt great and loose that night at the track workout, until the "electric" tingling. I finished the workout, but was limping afterwards and the next day couldn't run 20 feet without my glute just slamming shut on me. I had trigger point injections, but they did nothing for the tightness. Every run since then my glutes ties up my whole hip by at least 2 miles and I find I can't run or move it properly. Yet, here was this muscle revealing itself as he pulled on my leg. He found the muscle's attachment right in the head of the femur exactly where I was feeling the tightness. It is a tiny spot. He then did some work on the middle of the muscle (the adductor magnus) and showed my some ways to work on it at home. It was rock solid tight. He also said this is the muscle that can pull my femur anteriorly just like in the Anterior Femoral Glide Syndrome as well as rotate my femur to the inside (like what my femur likes to do). Strangely enough, when I looked up this muscle at home, I found that the frog stretch that I had some success with when I did it a few weeks ago during a night of misery is a stretch recommended for a tight adductor magnus. There was a lot more to the visit, but I am thrilled at this discovery. Maybe it is not the hip joint itself that is hurting me. Maybe it is muscular after all! I will see how things go.

 I haven't run in two weeks, but I am running a 5k tomorrow night, because I signed up for it in advance. I am limiting myself to just jogging down the hill as mid-packer and to see how things go. I expect it to be my slowest 5k ever. Oh well. I may have been down for the count, but there is a little life in me yet and I intend to battle (sensibly) until I fully realize that my running days are over. Stay tuned. I am not down for the count!

What my brain says:


hstryk said...

So happy that my post could be of some help. Thanks for the shout-out. I didn't think I'd get such an immediate response from someone out there - I hope the exercises continue to help you. Best of luck!

Joe D said...


Experiencing pain in my groin and when I took my hip into flexion over 90 degrees, my PT worked on anterior femoral glide with me this past winter/early spring. My back went, but my hip has felt quite good since we got it to settle back into place. Worked on manual mobilizations (I did a lot with the yoga strap) and firing the glutes. Helped me a lot, hopefully that is part of your road to recovery.

Joe D

jdawg said...

still using a heel lift? Do you use the PCIs anymore? I'm still experimenting as well and have found a good pedorthist in the area that is going to make some real whiz-bang orthotics.

Jim Hansen said...

Thanks for those posts, Heather. They are the most readable information I have found on anterior glide syndrome.

Jim Hansen said...

That is interesting Joe. Is there any information on the manual mobilizations on the web? Do you think the back problems are complicated by a more stable hip?

Jim Hansen said...

jdawg, I just started with a little heel lift. It has not always worked in the past, but we will see. No, I stopped using the PCI lifts after a few weeks last summer. They were too harsh on the bottom of my feet. I had orthotics made for me before hip surgery by a top notch podiatrist, but I didn't like them so I don't use them. I find that certain foot mobilizations help my feet the most. I just wish I knew how to do them.