Wednesday, March 26, 2014

Joint Hypermobility

I've been reading up on joint hypermobility. The orthopedic surgeon said I had hypermobile joints, and back when I was a teen, I was diagnosed with it as well (but was told - don't worry, you'll grow out of it).

Here are the list of injuries I've had that potentially could be from joint hypermobility:
Neck and back disc issues at a young age
Knee chondromalacia
Flat feet
Hip labrum tears
Vasovagal syndrome (autonomic nervous system control issues)

There are some simple tests to see if you are hypermobile (I can do most of these, except for the bending at the waist but that's mostly from my back issues):

There's genetic disorder for joint hypermobility - Ehlers-Danlos Syndrome - which can come in several different forms, as well.  Just because you are hypermobile doesn't necessarily mean you have EDS, as well.

I'm not really sure what to do with this information at this point.   There really isn't any "treatment" and it's mostly managed by lifestyle changes...and  I have basically figured out what works and what doesn't via trial and error (well, I think I do, at least!).

It is interesting to know that all my injuries might be linked, and that I'm not just some sort of massive klutz.

Tuesday, March 25, 2014

My favorite gear

I have accumulated quite a bit rehab- and PT-specific gear over the years.  I am pretty sure I could start up my own therapy office with all the stuff I have purchased.   I'll skip over the foam roller standard, because everyone's probably already on that bandwagon.

The torture foam roller AKA rumble roller
For when a foam roller is just not painful enough.  The little nubbies really dig into tight muscles.

This 5" ball is great for hitting hard to reach places, or places where a little circular motion helps.  I sit on it to work out piriformis tightness and on my lower back to loosen up the QL.  I also have these balls which are smaller and harder but can be used in a similar way.

This helps with core and stability.  I will do one-leg balance moves with this disc, like this:

These are so inexpensive and can be a great hip and glute strength tool.   I have the green and blue for my side lunges, monster walks, clamshells, etc.  Youtube is a great resource for hip-specific workouts.

While not a rehab-specific, TRX is a great whole-body workout for those that are looking for strength training but don't have access to weights.

Sunday, March 23, 2014

The Hip Story

I realized that I never really covered the backstory to how the FAI and torn hip labrum started.  Because everyone's path to diagnosis is a little different, it can be helpful to hear where it all began.

I had been running off and on (off mostly due to injuries) since 2010.  In early July 2013, I ran a 5k without issues and sat down afterwards to rest and talk with some friends. When I went to stand up, my entire right hip was frozen. It was extremely painful to get into a standing position, but once up and moving I was OK.  I never felt a "pop" or any other indication that I had some something to the hip that some people report.  Really the only pain I had was when I was trying to stand up out of a sitting position. It was brutal.  I went for a run at one point soon after that 5k and I had a "pulled muscle" feeling in my inner thigh for most of it.  I decided that I probably shouldn't try to run through this, so took a break from running and just biked, which gave me no trouble.

After two weeks of no running, it felt normal enough that I went running again.  A few miles in, I got a sharp pain in my groin/inner thigh and decided it was time to go the doctor.

I was (incorrectly) diagnosed with adductor tendonosis and after 4 months of PT/Graston/massage and little improvement, decided to just continue running and deal with the pain. Eventually it got better for a few months and I even hit a monthly mileage PR during this time.  I figured the hip stuff was all behind me.

But of course, the sharp groin pain started again and that's what sent me back to the doctor to get the MRA, which resulted in the diagnosis of a labrum tear.

I had never had any hip issues prior to last summer, and even between July and my February diagnosis, I had periods of almost no pain.   My pain is more constant now, but more like an ache than the sharp groin pains I was getting during runs.   It's so odd how the labrum tear pain migrates and changes, which apparently is pretty common with this injury.

Wednesday, March 19, 2014

The stages of being injured

This has been rehashed several times in the blogosphere, but here's my spin on it (based on many years of experience, unfortunately).

Stage 1:  The downplay
In this stage, you might say things like: "I'll take a day off, that should help whatever this pain is."  "I need to start stretching, something is too tight."  "I should hit the foam roller a few more times, just to keep this from developing into a real injury."  Which quickly progresses to something like "A solid week off will do it."  "I need to crosstrain more."  "Maybe I should see my massage therapist and have her work out this knot."   If you have a real injury, the next step is usually...

Stage 2:  Admitting you have an issue.  Maybe.
By now you've admitted to yourself that there is a good chance that something wrong and no amount of ice or rest or will power will fix.   Now you need professional help.  You might see your primary care physician who tells you to take advil and stop running, since it's bad for you anyway.  After that fails, you might head to a physical therapist or orthopedic specialist, who will get you to Stage 3.

Stage 3:  Something's wrong and now you're depressed.
Here you're faced with the reality that you are injured and there's a name for it. Oh yeah, it's real.  It's a thing.  And you have it.

Stress fracture.  Labrum tear.  IT band syndrome. Runner's knee.  Pinched nerve.

Life. Is. Not. Fair.

Stage 4:  Pissed
Stage 3 and Stage 4 sort of blend together at time.  Some days you are upset.  Some mad.  Some sad.  Some spent wondering why karma hates you.

Stage 5:  Acceptance
At some point, you realize that there's no amount of crying or whining or ranting that's going to change anything and so you just might as well deal with it.  You start Googling for forums and chat rooms full of people with the same issue.  How did they recover?  Are they back running again yet?  You engage with complete strangers, the only thing in common is that you both have a bum hip.  You start making recovery goals - determined to do what the therapist says, committing to going through surgery, whatever it is you think will get you back to 100%.

Stage 6:  Hope
The final stage of injury is the one that carries you through rehab.  The hope that this too shall pass.

Sunday, March 16, 2014

The pre-operation plan

Thankfully, there are things I can do that don't cause pain (and unfortunately, running is not one of them).   I'm trying to keep up with as much as I can before surgery, so I go into rehab strong.  The key for me is no or low impact workouts, as well as working on hip and core strength.  I don't do much stretching anymore because it almost always results in increased soreness for me.

My basic weekly schedule:
Sun - Elliptical with hip work - lateral lunges, hip bridges
Mon - Spin bike
Tues - upper body weights with core
Weds - rest
Thurs - Elliptical with hip work
Fri - Spin bike
Sat - Aqua jogging

To help my pre-op activities, I bought a pair of Hoka One One Bondis. I really wanted something with more impact protection than what I had been wearing - they are running shoes known for their (almost comical) amount of cushion. They also have a small drop from heel-to-toe unlike common running shoes, which I liked. I did the elliptical today and I definitely noticed less overall ache afterwards.   I wore them for most of the day, as well, as they were really comfortable and kind to my hip.

Hippy Chick

Yep, I'm a hippy chick.  I don't mean this as a treehugger sort of reference (even though I am that kind of hippy chick as well).

The adductor tendonitis that I'd been fighting for 6 months was finally correctly diagnosed as a torn hip labrum.  Part of the struggle with this injury is that it can act like a lot of other things - low back pain, hip pain, groin pain... The only real diagnostic tool is a magnetic resonance arthrogram (MRA), which is an MRI after a radioactive dye has been injected directly into the hip joint.

The answer is not as simple as "just" a torn hip labrum, as those who go through this quickly realize.  The bigger issue is why it tore.   Typically people will start complaining of hip/groin pain without any direct trauma or accident to blame.   The analysis turns to the hip structure itself and the myriad of issues that can cause improper alignment or improper motion within the joint such as hip dysplasia, retroversion and anteversion, and femoroacetabular impingement, or some combination of the three. Under normal circumstances, the labrum shouldn't be at risk of tearing.

In addition to the multitude of reasons why the labrum has been damaged, there is the high risk of further degradation to the hip once it has, as the labrum offers protection to the hip joint.   Damage to the cartilage is not uncommon with hip labrum tears, particularly ones that have gone undiagnosed for a long time.

And so, with the complexity of the diagnosis, so begins the quest of figuring out what to do.  There are a number of "hippy" related groups, blogs and forums out there, with a wealth of information and a wealth of ways to scare yourself silly about your prognosis.

These have been most helpful:

Here is my MRA image showing the suspected labrum tear (in the red box).  The MRA also showed that my psoas tendon is pressed right up against the hip joint, which can also cause the labrum to tear.  There was also some cartilage damage.

And here is my x-ray showing a potential cam (too much bone on the femur) and pincer (too much bone on the acetabulum) impingements.  These bony structures eat at the labrum, eventually leading to the labrum shredding or tearing.  The x-ray also shows a slight "crossover" sign, meaning that the front of my socket is a little deeper than the back (called retroversion), causing the femur to preferentially face outwards a bit (though X-rays are not the best way to fully diagnose this).  This can also cause abnormal wear and tear on the labrum.

I met with the surgeon on Tuesday, and he was really clear that the imaging can only show so much and the damage internally can be worse or better than what the images show.   Based on my exam, the MRA and X-rays, here is what he is suggesting for my surgery:

  1. Labrum repair
  2. Removal of the pincer impingment (shaving down the bone so it no longer pinches the labrum)
  3. Partial release of the psoas muscle
  4. Microfracture, if the cartilage has been significantly damaged
Rehab will approximately take 3-4 months, but he feels the prognosis is good because, as he said, I am "young and thin".    It's a long road, but the dr believes it will only continue to get worse so it's best to take care of this now.