All signs point to pectineus

Update: I am doing dry needling for the trigger points in my pectineus, and it is working wonders. If you can find a physical therapist that does dry needling in your area, please do it because it is amazingly effective.

It’s been about two weeks without squatting (or working out at all, unfortunately), and the pain in my hip has alleviated quite a bit. As I think about it the symptoms seem to point to a strain than protecting a joint more and more.  As I

Pectineus trigger points. If it hurts
here, it's probably the pectineus.

continued squatting the pain got worse and worse.  At first, after the previous PRP treatment, I didn’t have any pain at all, it felt amazingly normal.  Then I tried squatting again.  I remember the first time I tried front squatting I felt something in my hip go off, kind of like a pop.  I just figure it was the damage in the labrum, but now it’s becoming apparent that it was the pectineus.  While this makes me feel foolish/wasteful for an unnecessary PRP treatment, the idea/hope that this is merely a muscle strain makes me feel… cautiously optimistic.  As usual.

I realize I must sound crazy, going from one idea of what’s wrong to the next, but my hip keeps presenting different problems. The pain has moved around, it seems like muscles (e.g. psoas) that were tight from protecting the hip joint are no longer tight. Meanwhile, other muscles like the pectineus, are tightening up. This hip issue has been like those Russian nesting dolls where each doll holds another one inside of it.  Every time you think you’ve reached the end, that there couldn’t be another doll, there is.  Every time I find and address one issue, another one shows up in its place. Every time I peel back one issue, it reveals another.  I understand this is the price I pay for being active, that most people, years ago, would have just given up and said “ok, well, I guess I just can’t squat anymore” or something like that. But I really, really believe that I should be able to do whatever I want without pain. Just because it’s really complicated doesn’t mean it’s impossible.

I’ve found this thread on Tnation that is helping me diagnose this as a pectineus problem and not as a psoas problem. To surmise the thread:

1. If the pain stems from squatting, it probably isn't the psoas since the psoas is hardly at maximal stress during the squat. However, if you experience pain coming into and getting out of the hole, then it is probably the pectineus.  As you get into the hole (end of the range of motion) you stretch the pectineus and other adductor muscles as well. As you come up, those muscles have to fire to counter the effects of the glute med/min on the knee's position.
2. To diagnosis: lie on the floor, bring both knees up to either side of you chest, like they would be in a deep squat. Is there muscular pain? If yes then unlikely to be psoas, more likely to be adductor related, specifically pectineus.
3. Any pain/tenderness on the pubic tubercle? Again yes points to pectineus, since that is the origin of the muscle.

So the plan is to rest it for a while, perhaps until it stops randomly hurting throughout the day, and then the whole stretching and rehab thing can begin.

[Edited on 7/11/13, added points on dry needling and took the info from the Tnation link and put it on the post in an easier to understand format]

When is enough?

Back in Chicago for part of the holidays, so I saw the whole team of people who've helped me deal with my shoulder/hip issues.

Saw the chiropractor on Saturday, and she could tell something was wrong with my pectineus again. However, nothing was wrong with the psoas or anything else.  When she addressed the pectineus, it was like she hit the bulls eye on my target of pain.  So it seems that the source of all of my pain is in that one muscle.

So I saw Dr. Hauser on Monday, and made sure he knew that my hip clicked with internal rotation. He felt it acknowledged it, but when he heard that I was doing ok until I started squatting with weight, he told me something along the lines of, “I can eventually get your hip to stop clicking, but it might be a whole lot easier if you just stop doing squats.”

This was kind of sad news, but it was something that I think I needed to hear. When is enough enough?  These treatments are not cheap, and perhaps I can figure a way to exercise my legs without doing stuff to aggravate my hip.  I’m tired of being in pain, and if I’m doing this to myself, perhaps there is a workaround I can figure out. In the meantime, I think I’ll just avoid doing squats and try other things (think deadlifts are ok, so there’s that.)

Wednesday I saw my massage therapist, and he released the pectineus, and that was super painful.  Everything other muscle he worked on was tight, but nothing like the pectineus.

So now it’s Thursday, and I’ve been moping around for a bit, just running through my mind the whole situation with my hip, I felt like I was at a crossroads and I needed to process everything so that I could make the right decision.  Eventually a new idea came to me: what if all of the pain associated with the labrum has been fixed?  What if my pectineus isn’t tight/painful because it’s protecting a damaged joint?  Before the Oly completion it was pretty much only my psoas.  But then it became apparent that I pulled a groin during the meet, and all of my adductors were hurt, including the pectineus.  What if I strained my pectineus more than originally thought?

I think perhaps I should try to focus on the pectineus as a separate, but related, issue.  Perhaps PRP has taken care of my labrum, perhaps this is just a groin strain that I have been aggravating over the past 14 weeks, making it worse and worse.  I think I may try to seek out an orthopod’s opinion, and see what I can do.  If all my work leads me back to the fact that the pectineus is misbehaving because it’s trying to protect the hip joint so be it, I can go back to PRP or just figure out a way to stop aggravating the hip.  But for now, I feel like this is the right avenue to explore. 

Given that one treats strained muscles with NSAIDS, I actually took an Aleve today.  Then I realized that this will reduce the effectiveness of the PRP that I just paid good money for.  Made me want to get my stomach pumped, but there is nothing I can do now but just not take anything more. At least I only took one, and at my body weight that’s not too much. Still, feel stupid.

Concerning the shoulder, everything seems to be heading in a clearer direction, and all for the better:

Chiro said my C7-T1 were out of whack, like they always are.

Everything seemed to work out with Dr. Hauser, although this time he worked on both sides of my back when I told him that I get  tingling sensations in my ring and pinky fingers in both hands.  He also poked at my shoulder joint with his hand, which hurt a lot, so he addressed that as well.  As of today everything seems to be feeling better.

Got the massage therapist to work on only one muscle in my upper body, and it was my medial scalene.  He worked on it for a minute and my lord the pain was intense before it released. But when it released it was awesome, the therapist commented that my whole shoulder changed after the release.  I need to figure out how to do this on my own, or let the wife figure it out.

So it seems like things are going in the right direction with my shoulder.  I will definitely take this as a victory, I don’t know if I’ve won the war here but I feel like I’m winning some major battles on the shoulder front.

Exercises to treat FAI/tight hip capsules

The last 3-4 people I've tried to help with FAI have asked what exercises they can do.  I always direct them to Kstar's website, but it seems like everyone has problems figuring out what exercises are going to help them.

So, in order to help everyone out, here are the top 10 exercises I've found to help with get your hip working right, and hopefully render you pain free:

• http://www.mobilitywod.com/2011/02/episode-161-hip-impingement-ais/ (My favorite!)
• http://www.mobilitywod.com/2012/01/episode-363-pre-squat-hip-opener-mob-rx
• http://www.mobilitywod.com/2011/08/episode-301-psoas-flossing-and-biker-hips
• http://www.mobilitywod.com/2011/07/episode-280-mobility-is-about-position-stretch-with-purpose-not-to-warm-up
• http://www.mobilitywod.com/2011/06/episode-262-hip-flexion-case-study-and-mobrx
• http://www.mobilitywod.com/2011/05/episode-245-unglue-your-hips-and-thighs
• http://www.mobilitywod.com/2011/05/episode-239-better-purer-hip-extension
• http://www.mobilitywod.com/2011/04/episode-238-hip-opening
• http://www.mobilitywod.com/2011/03/episode-198-open-up-you-hips-for-better-squatting
• http://www.mobilitywod.com/2010/12/episode-113-improving-squatting

d

You can do 2 of these 5 days a week, it’s like a ten minute commitment, just do it whenever. Your body will thank me for it.  Another set of exercises to try are here. The whole thing takes less than two minutes and I know a few people who claimed instant relief, it's definitely worth trying.

Also, stop sitting all the time!  Kstar does a better job than I could ever hope to in explaining why here.

Update: I have come across this series of articles on FAI and exercises to do with FAI written by Dan Pope, a physical therapist, it's a four part series, with part 1, part 2, part 3, and part 4. 

Still getting stronger.

Back in 2010 when I tried back squatting 255 five times Jerry told me that that my issues stemmed from problems with my core muscles.  That was definitely true, as I had very weak abs and way too tight  hip flexors.  Anyway, my point is that back in the day what was preventing me from squatting heavier was my core, not my legs.  Yesterday, when I squatted 265 five times for three sets, I didn’t really feel the struggle in my torso.  I felt it in my legs.  Struggling with my legs I can handle, pushing through that is a lot easier for me.  I think the reason behind the improvement is the fact that I squat 3 times a week, and with heavy but not too heavy weight.  I think that reset a while back when I failed to squat 240 was key, that allowed me to work heavy but light enough that I could work on technique/my core.

One of my hip flexors, I think the either the Rectus Femoris or the Sartorius, is getting sore to the touch now that I’m really starting to push my legs. I think I'm timing it great seeing Dr. Huaser next week, as by then I'll be squatting 285, and I feel like that's about as far as my hip will take me.

First let me say that I really enjoyed my time at Crossfit Durham. The guys there were cool and it is because of coach Ryan that I learned about starting strength programming as well as some of 531.  I really enjoyed the guys there too.  I was definitely the weakest, I was squatting 145 while others were lifting 185, but all were really nice to me.  All that said, I’m very glad that I left Crossfit Durham. It's just I can do this program on my own and in the process save $160 a month.  The Duke gym is only $130 for the year. Quite the bargain.  I do miss those guys though, all of them were really cool. However, right now I need to save all the money I can, and not going to a crossfit gym is an easy way to put $2k a year in my pocket. …I also have stopped seeing a massage therapist as well as chiropractor.  All the pain I am currently experiencing is related to the hip, and hopefully that will be resolved in about six weeks’ time, I hope.

5 rep back squat PR

Well, thanks to starting strength I just did work sets with the back squat of 255#s, that is an all-time personal best.  Three years ago when I was deep into xfit my pr was 250, and two years ago when I tried 255 I failed, so this, I guess, is a big deal.  It really doesn't feel like a big deal, just another day at the office.  …I think this new PR is tempered by the fact that in less than two weeks’ time I am going to see Dr. Hauser for another treatment, which is going to throw off my exercise routine bunches.  I am going to take it easy on the hip this holiday break, I’m going to allow for maximum recovery because I want to be done with this.  I sincerely hope that this new diagnoses of a tear in the labrum concerning internal rotation changes things.  For a few weeks after the last treatment my hip felt absolutely normal.  Like I could not pick up on a single thing wrong with it.  And then I did some Roman chair lifts, felt it go click, and it all went to hell.  These last two sessions I have signed up during this break are probably going to be my last.  I don’t really foresee another opportunity coming my way in a long time, so they had better clear up this damnable issue.

If I don’t see any further recovery I will be ok.  I’m not 100% but I’m not anywhere near where I was a year ago before I saw Dr. Hauser.  But I've had a taste of normalcy in my hip, and I want more of it.  A lot more.

Trying to get bigger.

180#, Perhaps my most
defined body composition

Wednesday I squatted 3 sets of 5 reps of 240#’s which is a within recent memory PR for me.  Once the weight gets above 225, I find it really starts to affect my hip muscles.  When I bounce out of the squat, sometimes I wonder if I hear something… click. Like I feel something quickly go out of place, and then go back in to place.  I don’t think I’ve ever really noticed before because I’ve been so focused on the weight, but this could be the symptoms of that last part of the tear still hanging around.  …Other than this possible clicking I have not made my hip click for months.  With everyday stuff, walking around, sitting, climbing stairs, getting into the bathtub, I make sure I externally rotate my hip so that it will not click/aggravate the labrum tear.  It seems that the healing process has continued, but I can tell something isn’t right still.  My psoas and hip adductors are tight and sometimes painful.  When there is hip flexion there is pressure in the hip.  All these things led me to believe if I tried flexion with internal rotation, it would result in a click. I haven't tried this theory because I don’t want to test it out, all it will do at this point is irritate the labrum, and that’s the last thing  I want to do.

A recent breakfast

For the past two months or so I made the commitment to try to gain weight so that I can get stronger/more muscular.  I see these athletes on TV who are my height (6'2") but have a good 40 pound advantage over what I weighed when I made the decision (180#).  And these guys aren't like offensive lineman, they're like the quarterback.

So I've decided I needed to gain weight.  I was pretty damn happy with my physique at 180, I could actually see my ab muscles!  But I guess now that I had accomplished getting abs (somewhat) I wanted to see if I could get more muscle.  Never have been one to be satisfied with the way things are, always want it to be better.

I think as opposed to going through a "bulk phase" where I'd balloon like a pufferfish and then have to go through a cutting phase I would rather just do a slow and steady approach.  I think it would be better for me to do a slow and steady gain, trying not to put on any fat, just muscle.  I am still maintaining the intermittent fasting, but I am now trying to take in 200-250g of protein a day, so I am feeling super full when I'm eating, but I get to eat some pretty massive meals, which is tons of fun. However, if I'm not careful I will become a fatass.  With thanksgiving there has been an abundance of pie, and as of today I'm in Indianapolis for a wedding and it's going to be an epic meal.  It took me about a month to gain 10 pounds, from 180 to 190.  Since thanksgiving I shot up pretty quickly to 197.  I don't really have a goal weight.  As a matter of fact, right now I don't have any real goal (I don't think "getting more muscular" qualifies as a real goal).  I'm just taking it one big meal at a time, one set of squatting at a time.