Here we go again

I haven't posted must mostly because things were going really well.   I was back to running, biking, hiking, doing pilates and keeping up with my weight training.  I had finally gotten to the point where I had no limitations on activities and the hip was staying (mostly) quiet.

A few months ago, I felt a twinge in my non-surgery hip.  And then another twinge.  Which turned into a deep, awful ache, a sharp pain and a feeling of something "stuck" in my hip.  I pretty much knew what was going on, but finally got the arthrogram/MRI this past week.

I haven't seen the doctor yet, but I am pretty confident that there is a tear.

The red arrow is pointing to the tear (I am not a doctor, I just play one on TV).   The labrum should be a deep triangle on the left hand side of the joint, and the dye cuts across where the labrum should be in tact (it basically should be symmetrical with the black part on the right hand side).

As a comparison, here was my right hip pre-surgery (slightly different angle):

The pain so far is not anywhere near where I was pre-surgery on the last hip, so I am hoping that some activity modification and additional rest will be enough to hold off heading back into the operating room.   I have no real desire to deal with into the 3x/week rehab, limited activity, and all the other unpleasantness of a major surgery.

It's been said that about 20% of the population has FAI in both hips.  I guess that puts me in an exclusive minority!

Race Day Eve

It's been a long time since I have raced.  A year exactly, as a matter of fact, as of tomorrow.  I participated in a Turkey Trot on Thanksgiving, but that was more like a laid back rolling party than a real race environment.  Tomorrow will be the first race post-op and the first in a year.  365 days.  I'd like to say that time has flown but it hasn't.

I'm not planning on really racing it, though - I mean, I just graduated from the run/walk so while I can cover the distance, there's really no point in pushing the speed.  But I'm still working on my pre-race "stuff" tonight, for old time's sake:

-Made sure I ate some good carbs.  Ok, let's be honest, it was more that I wanted an excuse to eat pizza.  It's just a 5k.

-Made an iTunes playlist.  I normally don't race with headphones on but I'm feeling that a little music will help keep me focused on not watching my Garmin the entire time.  Lead song:  Happy by Pharrell, of course.

-Charging the Garmin.  Mostly to record that it actually happened.  Like, for real.

-Picking out the outfit.  It's going to be in the 20s and windy at race time.  Somehow I need to figure out how to wear my InkNBurn holiday long sleeve and layer enough under it to stay warm.  The struggle is real, people.

-Foam roller everything.

Game on.

First real week of the AIP and 6 months post-op

So, OK, this first week of the Autoimmune Diet isn't exactly over, but I'm giving you a report on this week anyway. :)

Overall, I'm still not finding sticking to the diet to be very difficult.  Though trying to do this diet through the Halloween Candy Season was tough, in the end, I was able to avoid all candy and not die of deprivation (someone brought in SNICKERS to work!).   Planning enough food so you are never starving and making hungry choices is really important.

Breakfast
I had the sweet potato, apple and pancetta hash for breakfast this week.  Better than the smoothies in terms of staying full, but not by a ton.  It's really tasty though!

Lunch
Lunch was a mix of turkey deli meat rolled up with bacon, a big ass salad or fried bananas and ham.  Yep, fried bananas with ham!  It's something my dad used to make for us when we were little and is a great combination of salty and sweet.  He used to dip the bananas in egg and breadcrumbs before frying, but in my case, I just let them fry up nekkid.  Even if you don't like the ham part, fried bananas are super yum.

Yummmmmm

Dinner
I made grilled salmon with roasted veggies,  thai basil stir fry, and a roast chicken and vegetables.  A few were enough to have leftovers, too, which is always nice... but doesn't happen very often when you live with a marathoner.

Snacks
My snacks are mostly fruit and sometimes leftover vegetables.  Not terribly exciting.  I made plantain and apple fritters once and devoured the entire thing...yum.  And I splurged and bought a box of Jackson's Honest Sweet Potato chips (fried in coconut oil!).  They are way too good and probably should not have bought 6 bags all at once.

Six month Hipaversary
Next week is my 6-month check in with the surgeon.  He'll also be taking a look at the other hip as well.  I imagine he'll finally send me for an MRA on that hip and while I want answers as to what's going on there, part of me wants to just pretend that it's nothing and ignore it entirely.

I am not exactly where I thought I would be 6 months out, but I am not entirely disappointed either.  My hip is 100% better than it was before surgery and I am about 80% of where I was before I was injured at all (oh so long ago!).

Here's what I did this week:
Sunday: Run/walk (3:1) 30 minutes, spin bike 30 minutes
Monday: Squats/lunges followed up with aqua power aerobics class
Tuesday: Upper body lifting and core work
Wednesday: Run/walk (3:1) 30 minutes
Thursday: Pilates

Tomorrow will be a rest day, Saturday another run/walk and then Sunday either a spin bike workout or maybe a hike if the weather is nice!

My last few runs

Two weeks ago, I ran for a few minutes on the treadmill.  Not sure why since I was pretty sure it was going to suck... but I guess runners can be stubborn.

And it was OK.  Not great, not bad.  Tolerable.  

Over the next ten days, that was followed up with:

20 minutes run/walk (2 min/1 min)

20 minutes run/walk (2 min/30 seconds)

20 minutes run/walk (3 min/1 min)

and then

26 minutes run/walk (3 min/1 min for 20 min, 1 min/30 sec for 6).   This totaled about 2.4 miles at about an 11min/mile pace average for the run/walk.

Huh?

Now, none of the runs I would classify as "pain free".  Achy, some sharper pains, but nothing that made me think I needed to stop.  And my surgery hip feels fine, it's really all in the other hip.

After today's 2.4 miles, I went out for 6 miles on the ElliptiGO.  That felt great.  Wheeeee.

After the running fail three weeks ago, I upped the hip flexor stretching.  I figured that it couldn't hurt and maybe it would help some.  I stretch 2-3 times a day most days.  I had noticed that my hip had started to snap, loudly.  And often.  Now that's almost totally gone.

This one I do at work:

These two are also in the rotation:

You can also have someone push down on your hanging leg for an extra stretch.

I still get enough of an achy pain in my other hip that I'm sure the hip flexor tightness is not the only issue.  There's something functionally wrong, but maybe I am keeping things at bay with some added flexibility.  Or maybe pilates has been the key to keeping things OK.  Or this is some sort of fluke and my next run will suck again.   Who knows!  The running gods are fickle and cruel.

A life without running

Yeah, yeah, I can't run without pain in my not-yet-fixed hip.  And hiking this weekend was tough with the hip pain.  But I can do a lot of other things, and I am trying to not lose focus on the positive.

Here has been my schedule over the last week:
Thursday - Squats, lunges and my hip PT work
Friday - 5 miles on the ElliptiGo
Saturday - 1 hour power reformer pilates
Sunday - 4 mile hike (cut short from the 6 miles I originally wanted to do), 30 minutes on the spin bike
Monday - Elliptical, squats and pull ups/dips
Tuesday - rest and massage
Wednesday - Elliptical, squats, core and hip PT exercises

Overall, this is a pretty good week.  Nothing causes me more pain or aggravates symptoms.  My operated hip feels fantastic - little aching, decent ROM.   The other hip stays about the same.  So I call that a win.

Surgery was six months ago and while this wasn't where I thought I would be at this point, it's also not all bad.

My appointment with the surgeon to have my other hip examined is November 12th. I'm trying to not focus on it too much because I can't change anything between then and now.

Deja Vu

My run/walk yesterday was a complete fail.  The goal was to move from 30 seconds run/30 seconds walk to 60 seconds run for 15 intervals.   I made it to about the fifth interval before my non-operated hip started in with intense groin pain.  I felt like I was right back to July 2013 with the first hip.

Frustrating.

I am trying to not think too much about it without the definitive diagnosis, but in the back of my mind, I know my odds are not good.  Hip, hip, hooray.

About 20% of people who need surgery on one hip go on to need it in the other hip.   So a large enough percentage to make it something that's a real possibility, while being small enough that it feels like horribly bad luck.

Today I was released from physical therapy until we can determine what the course of action is for the other hip.  Because I am only allotted a certain number of sessions a year, we wanted to conserve the remaining covered by insurance for now.

In other news, I completed a three-session intro to pilates.  I really like it!  It's more strength work than stretching like yoga, and is a serious core workout.

We did some crazy ab stuff in today's session like side crunches from this position:

And whatever the heck this was called:

Have you ever tried pilates?  Did you like it?

Dartfish Running Gait Analysis

I decided to have a running gait analysis done before I got too far into the run/walk program because I knew I know I still had a lot of strength deficiencies and compensations.  But, I wanted an idea of what and where I needed to focus my efforts and how bad (or good!) my running form looked to a professional.

It was pretty simple - I warmed up on the treadmill and then ran for about 3-4 minutes while they video taped me from the front, sides and back.   From there, the trainer was able to analyze my various angles and strides and determine where things might be going wrong.

All in all, my running form is pretty solid.  I am a  forefoot striker, good knee tracking, soft landing and no pronation issues. 

Where it falls apart is with my hips. (OK, is anyone surprised? Not really, right?)  Both hips show strength issues, and on top of that, my operated hip shows a lack of flexibility/ROM.

This shows what's going on with my hips as I land.  In the top left, you can see that my right leg (operated hip) tracks almost to the center of my body, as opposed to underneath my hip (red star).   My left leg does as well a little, but not nearly as much as the right.  The screen capture is too small to see the actual measurements, so just take my word on it.   This is all hip strength related, specifically strength in the lateral (side-to-side) direction.

In the bottom right, you can also see that when I strike with my left leg, my right hip drops.  This is hip and core strength and stability.    Planks, side planks, bridges.

The other interesting thing the trainer noticed was that my stride on my operated side is more shallow - I don't get as much hip flexion nor hamstring activity (less of a knee bend) as I do on my "good" side.   He believes this is a ROM, hip flexor issue.

The non-operated hip from the side:

The operated hip:

All in all, I really got a lot out of the gait analysis.  I want to repeat the analysis in 4-5 months and see if I have made improvements.  I received a set of exercises to work on and a few tweaks to the PT exercises I have already been doing to work on the specific deficiencies.

The Dartfish program is easy to use.  I have a copy of all my images and videos on a CD that I can review at any time.

Don't call it a comeback

When you first make the plans to have surgery, your goal is to get back to where you were before you were injured.  But this is sort of a false premise to go by because you really never can "go back".  It doesn't even have to be surgery we're talking about here, lots of people have nostalgia about a prior point in life and really... you just have to let it go.   Time marches on.

So you've gone through surgery for what then?  It's to have a better future.  Or, rather,  it's to get on the path that you think will lead you to a better future.   It's a risk.  It's a gamble.  But you believe it's your best shot, so go for it.

I am at five months post-op today.  Things are good.  But different.

My repaired hip doesn't make a peep 95% of the time.   I really only notice it when I need to do something that requires a full range of motion or am in PT being reminded of the weakness of that leg.   I can hike, elliptical, lift and do pilates without issue.   I have started a run/walk program, and it feels fine during and after.

But.  Every time I've run, my other hip (you know, the good one?) has been achy.  Then it locked up in PT for a second or two.  And for the last day or so, it's been achy almost constantly.    

If I needed proof that things aren't the same after surgery, there it is.  And that's not to say that surgery somehow caused my other hip to start to have issues, at all.  But two years ago is just that - two years ago. 

And who knows, maybe the other hip will calm down and be a non-issue.  That doesn't change the fact that  I need to embrace the now and accept that is where I am.  And that everything is okay even if it's not.

Hip Labrum Repair - Surgery Day!

Last night, I was pretty anxious. My massage therapist had given me a CD to listen to so I decided to give it a try. I'm not usually one to do mediation or even much in the way of alternative medicine, but I found it really calmed me down and I was able to fall asleep without much trouble. I liked it so much that I might try it more often - I definitely felt relaxed and zen.

The relaxation didn't last long and I was up at 2am.  When the alarm went off at 4:45, I had only dozed off a few times.   So needless to say, I was tired.   But I figured I was about to get a two hour nap!

We arrived at the hospital a few minutes early at 6am.   I got all checked in and my husband snapped this photo:

I was not on any meds at this point, btw.  That cheeky grin is au natural.

I spoke with the surgeon for a few minutes and he signed my hip.  At about 7:15, the anesthesiologist came in to tell me what to expect.  I explained that I get nausea from just about anything that can possibly make someone nauseous so he decided to go ahead and give me a scopalamine patch.   Good call, as I didn't feel any queasiness at all.

At 7:30, right on time!, I was walked back into the operating room.  There were probably 6-8 people, buzzing around.  And it was about 60 degrees in the room so I immediately started shivering!  The gown I was in didn't offer much in the way of warmth.

They had me climb onto the traction table (do yourself a favor and do NOT google image hip traction) and covered me with a warm blanket.   Ahhhhh.  I was out cold pretty soon after that - a few breaths of the happy juice and it was nap time.

I was wheeled out into the recovery room around 9:45, so I think surgery took just about two hours or so.

I was in recovery until about noon, mostly because they were having trouble getting my pain in check.  I ended up getting a GRAM of tylenol IV.   A gram....  of a pain med that has questionable safety margins?  Oy.  Then fentanyl.  Then oxycodone.  And it still wasn't quite enough.  :(

The surgeon came in and explained all that happened.  He said my hip was "the real deal".  He commented "I see this sort of thing in college athletes.  Usually in people approaching 40, it's more wear and tear type degradation.   This was  a traumatic athletic event."    I took this to mean that I am as fit as a college athlete.  Right?  RIGHT.

He was a little surprised/impressed by how big the tear was, especially since it didn't look that bad on the MRI.   It was a large tear and spanned three of the four "quadrants" of the hip socket.   

In addition, the cartilage around the edge of the hip socket had started to delaminate from the bone.  He was able to anchor that and labrum to the acetabulum, so it should be functionally repaired.  In total, he needed three anchors to reattach everything.  The rest of the cartilage looked to be in great condition.

I  had a triple impingement - meaning, I had a cam, pincer and psoas impingement on my labrum.   He took down the bone on my femur, hip socket and cut the psoas tendon partially to give it more length.  I think the psoas is what is driving most of my pain post-surgery.  It is a sharp pain right above the groin.  The meds have it to the point where it only hurts if I move and not constantly bothering me.  But it sure makes getting up and to the bathroom fun.

My back made it through surgery without any major worsening, which was a relief.  I sure I would have some sciatica issues.  Of course, I am still numb from the top of the leg down due to a femoral nerve block (I think), so when that wears off, it may be a different story.   For now, it seems fine.

My throat is SUPER sore.  Like, I'm losing my voice, sore.  

Otherwise, I am so glad to be on the other side of this and can now focus on getting better. :)  First PT session is Monday!   And tomorrow and Sunday I have some moves to do to keep the formation of scar tissue down.

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.