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.
27 comments:
Hi I have been following your blog . and im quite curious about labral tears and FAI . i have been recently diagnosed with FAI , and am due for an MRI. im really concerned since i have a baby and surgery is not something i want to opt for. DO u have any suggestions is surgery the only way to go?
martha.
Martha,
I assume this is the same Martha that posted a question in an earlier post as "the reflector"?
I fixed my FAI by doing a lot of exercise combined with mobility work (such as the mobility wods on Starrett's website) and deep tissue massage. I know they say surgery is the only way to go but one MRI with contrast clearly shows a cam/pincer impingement and two years later I get another MRI and lo and behold the FAI has disappeared. So it seems surgery isn't the only way to go.
Like I said when I answered your question earlier, Dr. Hauser claims to be able to fix impingements with prolotherapy, so that's another option.
So to answer your question yeah there are other options.
Hope that helps,
Adam
Oh yes I am the same Martha. just that i could not find that post where i commented so i asked you again lol. well im so glad to hear that i have other options my problems started two years back and in an xray report it showed a little Cam impingemnet i was stupid not to have collected my report and the doc did not explain to me anything . just showed me the bone spur almost two years later after having a baby im having a lot of problems with SI joint and Hip . so im going to have an MRI to confirm any tear. but did yours first show as a bony impingement before ? that sounds like a miracle that it dissapeared . i know chiropratic manupulation and massage does help .so ill keep doingthat and check the other options you talked about. Im in denver Co if you know of any good prolotherapist please let me know. and was wondering what kind of work out can i do in the mean time, without causing more harm which i did with bootcamps.
thanks
martha
The tear and FAI were diagnosed at pretty much the same time. For me, the MRI's with contrast showed excess bone on both the hip and femur, so I had both cam and pincer type impingement. Every week for two months I got a deep tissue massage on my hips and did lots of squats, deadlifts, running, just being active. After that I kept up the activity but went to getting a massage once every two weeks. I also did stretches like this every day: http://www.mobilitywod.com/2011/02/episode-161-hip-impingement-ais.html
...I have a very uneducated theory (since it seems like my activity goes against everything the doctor told me) to explain what happened to me. Once I got my hip capsules relaxed my activity chipped away at the excess bone, flaking it off and then the bone spurs get re-absorbed by the body. That's just my theory, I'm no doctor.
I don't know of any prolotherapists in Colorado, but I have two pieces of advice: 1) email Dr. Hauser and ask if he knows of anyone in the area, and 2) if you do see a prolotherapist make sure it is one that has healed multiple hip labrums. You don't want to be some one's guinea pig, at least not if your going to pay for it.
Here are Dr. Hauser's thoughts on impingement syndrome: http://www.youtube.com/watch?v=j99CxLus0gA
Thank you so much for all the information. its awesome how you could do so much. i feel mine started while doing squats and lunges, and bootcamp with lots of cardio on benches. and now im in a lot of pain after getting back from a long air plane journey and lots of walking during a vacation. SO though im desperate to get back to working out im taking it easy. will have my MRI arthogram next week hopegully it'll go well. In the mean time ive started deep tissue massage . hopefully it'll help. thanks for the advice. though can you suggest some workouts good for FAI?
Honestly I don't know how comfortable I am prescribing exercises since I'm not a doctor. However, I highly recommend the pertinent MWODs on Kstar's website. ...I imagine yoga couldn't hurt either. ...One thing to take note of is whether the pain actually comes from the joint itself or the muscles surrounding the joint. For me, and I'm guessing for most people, the pain is actually coming from the muscles. Do you ever do self massage with a foam roller or lacrosse ball?
I do feel that the pain if more from the muscles being so tight. Since I feel it's right till right under my ribs. But still I may be wrong. I'm just scary of being cut up so really want to find out ways to avoid surgery.
Yes I do use the foam roller. But my greater trochanter is really painfull and hurts even to walk . I don't have a limp but it gets really sore, so it hurts like crazy when I use the foam roller on that area. I'm avoiding bootcamp and hating it. :(
Hopefully things will work out.
Usually with massage the more it hurts the more it is needed. I'm not talking about feels like injury-type pain, but a different kind of pain. Sometimes its a burning sensation. With the foam roller do you ever get the muscles to release? Sometimes I've had to apply pressure to an area for over ten minutes to get it to release.
One thing you might want to try is just sit/lay down on the roller until either it stops hurting (then you move up or down the muscle to where it hurts again) or something like 15 minutes has passed.
If you have to keep cutting yourself off because of time hopefully if you do it everyday it will eventually release. I use my iPhone's timer for these things, because I always thinks minutes have passed when it's just been seconds (pain will do that).
You may already be doing this and if so I apologize, I'm just throwing it out there.
Just curious, does your massage therapist get the muscles to release? Mine had to work on my Psoas (possibly the muscle that is hurting up in your ribs) for like 45 minutes in order to get it to release.
Working on releasing one's hip capsules is very, very important. The FAI, bone spurs, and laberal tears are all symptoms of tight hip capsules. Meaning if you get the surgery it may fix the effects, but will not address the underlying issue. I personally believe this is one reason why so many people have surgery and are still in pain. Surgery didn't release any of the muscles, and muscle tightness is the source of the pain, so they're still in pain even though structurally they are fine.
That all being said, getting your hips nice and supple may not be a complete fix, depending on the severity of the structural damage. For me, I was fine for a while getting regular massages and working out, but at an Oly lift competition I made the tear worse and no matter how much self massage I got my psoas would immediately tighten back up, trying to protect the damaged joint.
I know this may sound confusing (and I apologize if I'm not making sense) so let me try saying it this way. I used to sit all the time and this shorten up all of my hip muscles. All these tight muscles tightened up the hip capsule. The tight hip capsule prevented the joint from moving correctly, it forced the femur to bang into the hip around the acetabular socket. The body responded to the trauma by producing extra bone growth. This bone growth pinched the labrum, causing at least one tear. The hip muscles respond by tightening up further trying to protect the damaged joint.
Therefore, the first step is to try to release all of the tight muscles in your hip (and I mean all of them, if you leave one muscle tight it's going to throw everything off and everything will tighten back up in response). Once you are successful with that, you might be able to live pain free and without surgery. Awesome right?
However, if that doesn't work, then perhaps you will have to address the joint damage. The next most conservative step that I know of is prolotherapy, and for me that works great.
If you are unable to find some one who has successful repaired torn labrums in the hip, and you decide you want to have surgery, you happen to be in the right place. Dr. Phillipion is considered THE authority in hip FAI/labrum surgery, although I know one person who is seeing Dr. Genuario (sp?). Both work in the Stedman Hawkins clinic, which is in Denver, where you live.
Each hip is different which is why I'm trying to offer up as many options/information as I can. But I would highly, highly recommend the first step of getting those muscles to release. That moment right before is the worst, but the feeling afterwards is indescribable.
Considering keeping your hips supple, one thing you might want to look at is how you sleep. Do you sleep with your legs bent, kind of like in the fetal position, or like you're sitting in a chair sideways? That's indicative of having tight hip muscles, and even if you release them they are just going to tighten back up in your sleep. I had to start sleeping with a pillow underneath my knees to keep me one my back, to prevent me from rolling to the side. Once I did that I saw significant improvement in the effectiveness of massage.
I usually sleep onmy side kind of like in the fetal position. Is that also indicative of tight muscles?
I had one more qs I also feel my calves feel achy and tight is it due to the hip. And can a chiropractor help? I heard about dr genaurio infact I was supposed to get an appointment with him but I found an appointment somewhere else sooner so took that. One more thing I chickened out literally from having the MRI arthrogram not because of pain but after I heard its a CT guided one , and I heard aweful things about CT radiation . I've had tons of X-rays this year and did not want more radiation. Do u know if MRI arthrograms are always done with CT? Or other options are there aas well. I was told that to inject dye they'll do the ct first then the MRI is that how it works? Btw was dr genaurio good?
on you side in somewhat in the fetal position is exactly the position I'm trying to describe indicating tight hammies/hips. I would def recommend sleeping on your back. It may take a while to get used to it, but it is worth it.
You know how stretching helps loosen muscles and joints? Well keeping your joints bent does the exact opposite, it shortens the muscles. You might see the best massage therapist in the world once a week, but a 2 hour massage will lose every time to the 35+ hours you spend scrunched up in a ball. I know this from personal experience.
A chiropractor can help, especially if they know anything about trigger point massage. Usually having tight muscles pulls things out of joint, so putting them back in to joint can obviously help. It should be noted, however, that it's also important to address the reason why things are out of alignment: muscle imbalance/tight muscles.
Tight Calves are usually causes by tight hamstrings or hip flexors. Think of your knee as a rope, and your calf is playing tug-of-war with the tight hamstring or hip flexor.
When I had my MRI with contrast they injected the dye under the guidance of flouroscopy, which is some type of X-ray radiation, might be the CT radiation you're talking about. So to answer your question yes the hip is such a deep joint usually doctors don't feel safe injecting it without some kind of radiation/guidance, so I don't think you really have any other option.
I have never met D. Genaurio, but some one I met through this blog has him and has only positive things to say, he has very good customer service.
If I could only give you one piece of advice it would be this: make sure to seek out experts in the field. Whether it be massage therapist, chiro, prolotherapist, surgeon, make sure you seek out the best. The hip is too complex to just see some any ol' massage therapist or orthopedic surgeon. Make sure that whoever you are seeing has not only done this before, but has done it with success multiple times. Can your massage therapist release your iliacus? Your Pectineus? Has your prolotherapist healed hundreds of torn hip laburms? Does your surgeon perform this operation at least once a week for the past five years?
It's like going to get a haircut and you have really difficult hair to work with (two cowlicks, super frizzy, etc). You can't go to the most junior hairstylist in the salon and expect great things. You have to seek out the best. Except unlike hair, your hip's bone/labrum/tissue won't grow back.
Through this website I met one poor fellow who elected to have FAI surgery. He thought he was in good hands because this was the sports surgeon for the local NFL team. I mean, that's pretty stellar right? Thing is, this was the Dr.'s first time to do corrective FAI/labrum surgery, and you know what happened? Bad things. The acetabular lip was completely shaved down, so that the only thing keeping the hip from dislocating was one hip flexor muscle. Now he's worse off than before.
I don't want to come off as anti-surgery, I've have met quite a few people who have seen Dr. Phillipion, and have great success. I want to come off as anti-amateur. If the Dr you're seeing is a hip specialist who deals with this all the time then great, go for it. If not, it may be worth the wait for some one who does.
I have to thank you for writing in such details and helping me. It's really nice of you . I found out that the ct guided mri arthrogram is different from the fluoroscope guided one . So I have asked the doctors off to find out one where they do the fluoroscopic one .
And sadly I'm not getting a chiropractor who specializes in hip. My earlier doctor my PC used to be an osteopath who was not aware if my FAI and I felt his manipulation s and stretches made me worse . So I'm now in search of a good chiropractor I've been going to one I know it helps me for few days since the psin literally disappears but it comes back too soon.
I was going through blogs of FAI surgery and I really find very few success stories even with famous doctors I hv read about scar tissue development and long long recovery . For me I have a 12 month baby and such long recovery with no assurance the thoughts killing me . It sucks to give up sports but I'm totally not sure which is better having a sugery and risking worse outcomes or working on it alternatively ? And I'll have to talk to my massage therapist to release all those muscles in my hip . Hopefully it ll help . I'm scared that my xray showed some signs of cam impingement so not sure how bad it actually is . In most people's case xrays are generally clear . However keeping my fingers crossed . Thanks for all you comments and concern . It was so helpfull I can't even begin to tell u. Any other queries ill surely ask u some more questions . Thank u .
Some more advice, if you'd like:
1) if the pain does go away for even a day, that tells me the joint is not the cause of your pain, and that the structural damage isn't so bad that the muscles are really tight trying to protect it. That is really good news.
2)The position in which you sleep might be helping everything get back out of whack. If you try sleeping on your back with a pillow under your knees the relief may last longer.
3)Hip surgery is no small thing, that is one thing why I try so hard to make people see that there are other things to try first, especially because it always seems to be presented as the only option.
4)Concerning sports/activities, it could be your mechanics are off. Like when you squat you might be doing something not quite right because of tight hip flexors. When you did bootcamp I imagine form/technique went out the window for the sake of intensity? Perhaps if you try working on technique for a while it could help, and then you could reintroduce boot camp. Have you seen a physical therapist? They might be able to diagnose what muscles are tight and what are weak. For example, I had really, really weak abs because my hip flexors did all the work. Again just a thought.
4)Have you tried any of the mobility work on Kstar's website? I really, really think doing the stretches he offers will help you tons. Here's another one: http://www.mobilitywod.com/2012/01/episode-363-pre-squat-hip-opener-mob-rx.html
Just let me know if you have trouble finding more and I'll make a list for you. Actually, I might make that list my next blog post.
5)The fact that you are able to experience periods without pain makes me really, really, really think you can come out of this without surgery and getting back to being active, but it's going to require quite a bit of dedication. These tight muscles/FAI didn't happen overnight, and they won't resolve themselves overnight either. But it is possible, I hope you see that.
6) All I ask is that you keep me in the loop with how it goes, and that if you have any questions please don't hesitate. Hip issues seem to be the most complex thing out there, and if I'm confusing on any point please ask for clarification. Believe it or not writing is not my forte, so I might've missed something or might not have been clear on a point.
Also, if you like books, he's come out with one: http://www.amazon.com/Becoming-Supple-Leopard-Preventing-Performance/dp/1936608588
Martha,
Just posted my top ten exercises to do for the hips, hope that helps!
Adam
Thank u so so much !!! You should have been a doctor your patients would be really happy with you.ill take a look at the work outs and stretches and let you know how it goes. Till then adios !!!!!
Hi Adam,
I had my MRI arthrogram last week and everything seemed normal . So now I'm even more confused i still have hip pain and groin psin so I'm not sure if I have FAI . I don't know if FAI can be missed in mri arthogram . Will wait what my ortho says and let u know . Happy holidays !!
Sorry to hear the results are confusing. Diagnosing hip issues is not easy, it's such a complex joint and it's such a deep joint it really can be hard, even for experts, to figure out what is going on.
Regardless, you have to take charge of the situation. By that I mean keep asking doctors questions, keep learning about various hip ailments. "Could it be FAI?" "Could I have a torn labrum?" "could tight hip capsules cause the pain?" "Why does it hurt when I do this?" Etc., etc.. The more you learn, the closer you will be to figuring out your situation and what you can do.
How is the mobility work going? Have the stretches alleviated the pain at all?
Honestly I did few of then few times and then have been. Caught up in the holiday atmosphere ... So have not been sincere . I'm actually happy with my MRI result even though its confusing but I know for sure that I don't have a bad labral tear since it did not show I guess anything too bad would have shown . May be I have some problem but I guess it's no major . That's what I feel . :) and again will be traveling over seas so dreading the long flights which I know makes things worse.
Yeah I hear you on the holiday stuff, it can be hard to start something new this time of year. Yeah it sounds like you've got some good news there with the test results, am happy for you.
Concerning the long flight, I present to you mobility work that can be done in an airplane seat!
http://www.mobilitywod.com/2010/09/episode-35-surviving-airplane-seat.html
Stay Hydrated Martha!
Hi Adam can you tell me if prolotherapy is working for u ? My pain is getting pretty bad . With my baby of one year old I'm not sincere enough to stretch. I'm also finding it difficult to sit for long . Did u have the same problem when u had the impingement ? I'm also doubting my MRI since I never really sat looking at my pictures and when I did I felt I do have the slight bone spur . I know I'm not a doc and this is freaking me out .im wondering if the MRI was correct ? I hate surgeries it scares the hell out of me . And being young the thought of surgery freaks me out more thinking what if I'm never be able to get normal again !! Okay enough of my cribbing . Can you tell me when u did have an impingement what symptoms did u first notice ?
I would say prolotherapy worked great for me, albeit by the time I saw Dr. Hauser I no longer had FAI. I no longer feel any of the pain that I used to experience as a result of the FAI/torn labrum. For me, the pain was pretty constant once I got out of bed. Sitting didn't seem to worsen the pain, but it did seem to be the source of all of my troubles.
MRI's are a tool, nothing more. They are not the end-all, be-all. The first doctor I saw looked at my MRI and said my labrum was fine, when in fact if he had done a manual test and felt it he would have known I did indeed have a torn labrum. It is possible to have false negative or false positives with MRIs so they should be only one factor in making a diagnosis.
For me, I never really noticed the impingement, I noticed the catching in my hip first. This catching was caused by a torn labrum. Then later I started feeling like my hip was on fire, caused by my psoas being stretched. After I fixed that I had that dull, throbbing pain that was caused by the tight muscles trying to protect the joint.
Honestly, I think if you can devote the ten minutes a day to stretching you will see marked improvement. I'm not sure what you mean by being sincere enough to stretch, but I take it you're not doing the mobility work? I imagine with the one year old it is tough to find time, but it's all about priorities.
You can either try the mobility work and possibly alleviate your current situation with no downside, find a prolotherapist who might be skilled enough to help you (make sure he's done it lots of times before with success), with the downside being money and time spent, or surgery, where even if nothing goes wrong you will have months and months of recovery.
There might be some other options for you that I'm unaware of, but to me that's about it. The choice is yours, but personally I'd try the mobility work before doing anything else.
Again, if you have any other questions feel free to ask.
Yes I will do the mobility stretch its like a New Years resolution . But I have to ask u this did your X-rays ever show the xtra bone causing FAI. I'm asking u this because honestly I was so glad to know that ur impingement disappeared it gave a lot of hope . And after my MRI when everything seemed normali was even more excited . But just to clarify I'm asking u this . I'm currently away from home and will start pt I guess once I get back if my doctor suggest I read a few other people who avoided surgery with pt . Just hoping for the best . Last but not the least Happy New Year !!! And happy cross training !! Cheers to getting stronger with every passing day in the new year !!!
Yes I did have Xrays (and at least one MRI) that showed the extra bone growth on the femur and the hip socket. I should still have some Xrays lying around and when I find them I'll post them. Hopefully later in this week I will have the latest MRI that showed my hips to be normal.
Wish the best of luck to you, seems like with PT and mobility work you'll get to being pain free without surgery. Please keep me in the loop, would love to hear you make a full recovery, and have a happy new year!
Thank you so much . Do u mind reciprocating via email , I guess that will be easier .
Don't mind at all, what's your email?
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