Addressing the other side of the hip

See how one hip joint is lower?

So for the past, I don’t know, 6 years or so I’ve been addressing the pain in my right hip.  PRP seemed to repair the torn labrum as well as stabilize the joint in dramatic fashion.  When physical therapists examine both hips, they find that my right one moves better than my left one.  Also, when I lam hanging out in the bottom of a squat I notice that my right hip joint is lower (I.E. moving better) than my left.

Now that Dry needling has finally released all those painful adhesions in my groin, I’m pretty much pain free on the right side. Sometimes I feel some pain in my gracillis (pain in the inguinal crease, gets worse when I try to raise my leg). But I’ve noticed when I do some work with the softball on my piriformis area it seems to go away.  So with regards to my right hip, I think I’ve got things about as good as it’s going to get (almost no pain while doing heavy lifts).

But one sensation that I’ve always been dealing with is pain/tightness in my lower back on the left side. It would usually flair up every once in a while, (I mean, almost five years ago I was thinking it was a kidney infection) but now that I’m back to deadlifting it’s always there. Either that or I just got used to it and it took a while to realize something was wrong.  I find my L5 is almost always out of alignment, and when I twist my torso one way it hurts that side, but when I twist the other way there is no pain.  So I’ve started thinking about my left hip.  I know the psoas on that side is always really tight, nowadays it’s tighter than the right side.  I also remember that the MRI came back with the diagnosis of bilateral FAI both cam and pincer type.  That means that the FAI was also going on in my left hip. And to finish it all off. I spent MONTHS of PT trying to get my left hip working correctly so that I would pass the Thomas test AND the Ober’s test. 

So all of this information points to the fact that perhaps my left hip should be addressed.  I’ve tried PT and that really didn’t do very much at all.  However, perhaps one or two prolo treatments will tighten everything back up? I’ve decided that while I’m down in Austin to see Dr. Fullerton about my shoulder I might as well find out my options for my hip. 

I don’t expect to get anything done when I’m down there for my first visit. For one, I might be going alone so I have to be able to drive back up to Dallas the day of the treatment, and I don’t think I could do that if he shoots up my hip.  Secondly, with my shoulder labrum healing I will probably be restricted from doing pretty much any upper body exercise. I’m hoping he will give sprinting the green light and I’ll join the local sprint club here in Dallas.  If I’m going to be able to sprint for exercise, I doubt getting prolo treatments for the hip will be allowed. …However since there isn’t a torn labrum being treated here perhaps I won’t be limited in what I can do with my lower body three days out from a treatment.

I have a lot of questions, but I am hoping that treating my left hip will help balance things out, and perhaps stop the lingering muscle tightness in my right hip. Only three more weeks until I see Dr. Fullerton!!!

Note to Future Self

Next month I’m going to use prolotherapy to treat my shoulder.  It’s been a ridiculously long journey to finally find the root of my shoulder/neck issues, but I seem to be near the end of it.  However, even though stabilizing my shoulder is necessary to get stronger a part of me is still really, really not looking forward to limiting my upper body strength training.  Yesterday I just overhead pressed 140#s easily, and my arms are looking bigger/better than they have in a long while, if ever.  The idea of no bench press or overhead press for like 3 months is scary, but I know treating my shoulder is the only way I can get rid of the constant pain in my neck/shoulder.  So to help remind me of how bad my current situation is, I decided to write down a day in the life.

• Wake up, crack neck from sleeping on my side/back.
• Figure out which ball to use to try releasing the knots in my neck, back, and arm.
• Try desperately throughout the day try to release various knots, sometimes being successful.
• Always feeling pressure in my inner ear, like I need to decompress my left ear ALL THE TIME!!!!!
• Sometimes crack my neck again, feeling the temporary relief as various muscles relax for a time.
• Feeling the mechanics of my left arm differ from the mechanics of my right arm in any pressing movement.
• Looking in the mirror and seeing more of my left trap than my right (I have noticed this since high school and if this fixes that it will be a great relief)
• My left shoulder muscles giving out on my near the 10^th rep of something heavy because they are already waaaay too tight and can’t be pushed any farther.
• This simple knowledge that I know something is wrong with my shoulder, sitting in the back of my mind the whole time.

All these things just wear me down, day after day. It’s so much of my routine I don’t even think about it now, but I want to be able to look back and remember exactly what I’ve overcome.

If this prolotherapy treatment works like I think it will, I will be in a much, much, much better shape.  I’m going to make video entries documenting my progress. I want the whole world to know about prolotherapy and how well it works as an alternative to surgery for damaged labrums.

Traveling abroad? Do these things first!

So I took a quick visit to London to see my best friend Allan, and I have to say I was the most prepared I think one can be for traveling international. When I touched down at Heathrow and turned on my phone I got an email from Allan saying he was sick and I needed to get to his apartment on my own. He gave me a great detailed guide (almost too much), but it wasn’t a problem because I was prepared. How was I prepared? Three simple steps:

1.       Credit Card: I called the credit card company a day in advance to let them know I was traveling to London, so when they saw charges coming from there not to freeze my card. This definitely saved me some hassle when I’m at the airport and needed to buy a train ticket.

2.       Phone plan: The day of my departure I called my carrier (AT&T) and bought myself an international voice, data, and text plan.  Buying these plans in advance and in the US is much cheaper than buying one overseas. Not to mention it’s a lot harder to gain access to the right number to call when your smart phone isn’t working.  This was super important for me because I planned on using the GPS feature of my phone to navigate the streets of London, which means I needed data.

3.       Cash: Pounds, to be specific. I contacted my bank four days ahead of time and got myself some cash. You get the foreign currency at a much, much better rate then at the airport. Cash was super important for me because the cabs/buses were cash only,  and they would not have appreciated me trying to use American Dollars.

So if you’re leaving the country, doing these three simple things will let you be prepared for anything that may happen.  Also, when you go to work out, make sure what you’re lifting is in kilos or pounds. Mistaking one for the other will lead to some definite surprises.

The Morals of a Paleo Follower.

Today I’m going to talk about a subject matter that I think about all the time: diet.  I think about it all the time, and read about it all the time, but I rarely, if ever, talk about diet.  I’m not going to be breaking any new ground here, but I feel the need to get this off my chest so I can get on with my life.  It seems that the old saying should be remade to state “Never mention politics, religion, or diet in polite conversation”, since the easiest way to raise a paleo person’s hackles is to talk about how unhealthy red meat is, or visa versa with a vegetarian/vegan. There are many flavors of diet out there, but specifically I’m going to be talking about veganism and paleo(ism?).

First off, why can’t we be friends? Paleo and vegan (in spirit) are both pro-local, unprocessed foods and both hate Monsanto and McDonalds. Both are also anti-dairy in general(Although Paleo does allow one to eat dairy if you it turns out you’re lactose-tolerant, same with grains too, actually). Given the small difference in what the diets perscribe, we really should be holding hands and singing kumbaya and make plans to help out local farmers and fight corporations like Monsanto aka the devil.

But for some reason we can’t get along. Taking morals out of the equation and talking strictly about health, I’ve noticed that a vegan simply won’t try out paleo for two weeks, nor will a paleo person try abstaining from meat for two weeks.  Why is that? Why do people refuse to try the other side? Well, my guess is that they both work pretty well. I mean, what happens to a person who goes from eating whatever to veganism or paleo? THEY SUDDENLY START CARING ABOUT THE FOOD THEY PUT IN THEIR BODIES!!!  You start to really monitor what you eat. This, combined with the lack of processed foods and probable reduction in sugar, and guess what? You suddenly lose fat, get healthier, and feel better!!

The problem is that it seems to be human nature to say “Hey this worked great for me, so if you’re not doing it like how I did it then you’re doing it wrong.  What’d you say?? I’m doing it wrong??? NO YOU’RE DOING IT WRONG!!! YOU DIE AND GO TO HELL!!!!” We tend to think there is only one way, and that our way is the best way.  This passion can blind us from the fact that what might work for you might not be right for some. Or perhaps what works for someone else may also work for you, if you cared to change things up. But the thing is people don’t care to change things up, at least not very easily.  Would it really kill a paleo person to have a meal where the main source of protein is tempeh? Would it really be unhealthy for the vegan to occasionally have some liver (a real super food)?

We always try to take our own personal experiences and then apply them to the world. This doesn’t work because 1) the world is a much bigger place than our own experience and 2) our application is always biased by our beliefs.  We tend to accept things that strengthen our belief, and tend to ignore things that weaken them. Just  seems like human nature, I guess.

Health vs morals

The argument about which lifestyle is healthier will probably go on decades. Again, I don’t see why paleo  and vegan can’t get along because there are quite a few commonalities. Whatever the case, I’m not going to really argue which one is healthier. If it makes you happy, then go for it. I was once called into a debate on FB to argue that grass-fed meat is actually healthy. I try to avoid these things because arguing is useless, for every Super Size Me there’s a Fat Head, but because I was asked to do so I obliged and for my arguments/beliefs I was likened to one who believes the earth is flat. I found that funny because I always viewed the media’s love for veganism as analogous to the belief that the earth is flat: An idea that was once popular but is now defunct by science (Personal belief here, I know “science” can be manipulated).

But I think people tend to confuse health with morals. I guess the idea is that if a lifestyle is healthier than it must be a more inherently moral lifestyle as well, that our bodies are the ultimate judge of what is right and what is wrong, and act accordingly. Morals you can’t argue about. I mean, I could tell you your morals are wrong, but I believe that would be pointless. I understand this is my own personal belief on morals, but I believe there are no “correct” set of morals, there are only your own personal set of morals. And if it works for you, then God bless you. Others may believe differently, but if you believe in something, well, then whatever makes you happy you should follow through on.  I should also note that Veganism is much more closely tied to a set of morals (prevention of animal cruelty) then paleo. Probably why it seems that I see a lot of Paleo people will have the occasional cheat (myself included) while Vegans will almost never cheat. When it’s about someone else (or other animals), you tend to stick to your guns more readily than if it’s just about you.

But why do we even fight on the matter? It’s not like a vegan is going to get into a discussion with an omnivore and suddenly be like “Oh my God you’re right, I’ve been doing it all wrong!!!!”

To use an analogy, raising children is like believing what is the best way to eat, a real personal belief based on morals.  It’s like Mrs. Hall’s article about how she is raising her kidsand Morgan’s response to it saying she’s an awful mom. These two ladies simply have different morals, and so they are never going to see eye to eye.  Parenting styles are highly individualized, and so are eating habits/beliefs.

Again I know I’m not really setting the world afire with this post, but I am going to conclude with my own personal views.  I’ve had some inner conflict about being paleo while still caring about animal rights, and this has been going on for quite a while.  Early last year, I’ve tried to explain to myself how I can mourn the loss of a pet guinea pig while enjoying bacon. I don’t know if I really got to a full resolution that day, but now after a year or two to let it stew I think I’ve come up with a more complete explanation.

For some being to live, another being must die. Hell this even applies to plants in the equator who compete for the sunlight. For example, even following a vegan diet requires thousands of insects to die in the form of pesticides, not to mention the whole bunch of plants that also have a right to live. So it’s a slippery slope to me. If it’s ok for insects to dieso that you may live why is it not ok for other animals to die? So I feel that while it is alright to eat other animals from a moral standpoint, I feel like you owe that animal something. When you take that animal’s energy and make it a part of your own, that should create the obligation to not waste it, to use it to become the best possible human being you can be.  So for me, I try every day to make that day have meaning, to never pass up the chance to do the right thing and better the world around me as I know how. Note that I’m talking about death here, not suffering. I’m very much against animal suffering, which is why I buy grass fed beef, humanely raised pork, and try to buy eggs that came from happy chickens(I try to buy everything from local sources). If I thought I’d be happy living off the land in Alaska, I would.

So that is where my moral compass is pointing. I’ve never heard of another paleo person talk about the morals of paleo, but perhaps now that I’ve written this I may spark some kind of dialogue.  Please let me know what you think in the comments.

Training update

Up until now I've been following the strength programming Starting Strength (SS) for the squat and deadlift, and the 531 powerlifting program for the overhead press and bench press.  I like the starting strength because it produces linear gains, my squat working sets have been going up 15 pounds a week.  When I was finally given the ok to squat by my PT back in Durham, I was doing 65#, and even that wasn't done very well (was quite rusty).  The other week I did work sets of 225# with the front squat. That's a 160# gain in a couple of months.

Thing is SS requires that I squat 3 times a week.  Now I'm not really complaining about that, I like squatting, and I don't mind squatting all the time.  But the thing is, trying to do SS with 531 takes a lot of time.  ...A LOT of time.  Like suddenly I'm spending 2 hours at the gym.  Perhaps there's some other way I can incorporate the two and still be in the gym under an hour, but I don't see it.  So I've decided to do 531 for every lift except for the deadlift, which I only do once a week under SS anyway.

It has freed up quite a bit of time at the gym, so now I've decided to do the big but boring challenge with the 531 program.  After you finish the strength part of the lifting you do 5 sets of 10 reps of lighter weight.  Well I decided to do with with dead lifting as well. So on Wednesday I decided to do 5 sets of 10 reps of 135#.  This definitely raised the heart rate, and definitely wore me out, like I was expecting.

What I was not expecting was to wake up the next day with stabbing pain in my back.  It's seriously painful.  I can tell it's my QL, but the weird thing is that it's on my right side.  In the past I've always has a hard time with my left QL, hell four years ago I thought it was a kidney infection.

Not too sure that this change is a good thing or a bad thing, but I believe change is good, no matter what. Perhaps I'm peeling one more layer of the onion of pain.

Know Thy Enemy. Meet, the Laberal Tear!

So I finally got the MRI images of my shoulder mailed to me.  I looked through the images until I found the one that the PA used to show me the tear. I've added the yellow arrows to help highlight the labrum and its tear.  It's actually really nice to finally put a "face" to the source of all of my neck/shoulder problems that I have had for years.

Again, the tear in the labrum seems to be unique for two different reasons. First, it was causes by just one case of blunt force trauma.  Back in high school I was thrown to the mat on my shoulder so hard I cracked my collarbone. Never knew about the tear in the labrum until 15 years later.  Second, the tear is near the back of the shoulder. It's not in the front or top, so it's not a SLAP tear, which is much, much more common.  It's funny, I never thought I had a tear in my labrum in my shoulder because I had a tear in the labrum in my hip. I figured the odds of having a torn labrum (some piece of anatomy I had never heard of until like 6 years ago) in two different joints was just too high.  I didn't want to be the guy who was seeing labrum tears everywhere. Guess I was wrong.

Seeing the damage has re-motivated me to get something done about it.  I've been training to get stronger using 531, a power lifting program.  I've noticed that no matter what weight/rep scheme I use my calculated one rep max is about 228. Perhaps this is as heavy as I can lift with an unstable shoulder. So given my success with prolotherapy for the hip laberal tear, I'm going to try prolotherapy for the shoulder as well. I've decided I will begin treatment in January, when my flex spending account is replenished.  Although I'm seeking the same treatment- prolotherpy- I am going to see a different practitioner, Dr. Fullerton down in Austin. Now that I've moved from Chicago to Dallas, I want to see someone who is within driving distance. Besides, I've always wanted to visit Austin.  So in about three months expect me to start blogging more frequently, documenting the recovery process.  I'm not looking forward to being unable to bench or press during the time of recovery, but if this is the only way to stop being in pain all the time, so be it.

Sprinting??

So right now when I start to squat heavy (front squat over 200#, etc.) I start to affect my groin. This has be kind of treading water, or making gains at a very slow rate. I’m also not too happy with the almost 20% body fat reading I had a few weeks ago, so I want to do something that will burn off some fat, keep muscle, and be fun.

I have decided to try sprinting.  I like feeling fast (whether I am or not is another story), and I want to be faster.  I’ve thought about trying out a soccer league or something, and it would be nice to not be that guy wheezing the whole time. I do like running, just in real short bursts. So sprinting it is.

Thing is, I’ve never done track sprinting in my life. Soccer was about it. So I have no knowledge of technique or training programs. Thankfully there’s ton out there on the internet, so I’ve been doing my research.  Since I’m such a noob I’ll be doing my sprints at 50% to start out with while I try to work out on technique. I also don’t want to overtrain. I’m squatting 3 days a week right now with starting strength. I’ve thought on switching over to 531 with legs so that I can sprint more, but first let me try this combo out and just see how it works, especially since with my lack of technique I can’t push myself THAT hard on the track.

This should be interesting to see how it plays out.

New Game Plan, Going to try Rolfing.

So I’m going to try dry needling less often, and I’m now going to try squatting to less depth.  I always figured that if I got everything in my hip working correctly then I would be able to squat as deep as I want. Problem is, I might never have everything in my hip working correctly.  I’ve done so much to address my issues, FAI, torn labrum, just instability in general, that I figure I should be good to go.  Talking to the PT, though, he does make a good case that perhaps with my issues I just might not be able to squat to depth.  Squatting as low as I am doing is putting a massive strain on my adductors, and that is why they are forming trigger points (at least that’s his thought).  I have my doubts, partially because everything everyone seems to tell me is wrong in one way or another.

My counter argument is that perhaps there is something off with my hips that is causing my right adductors to for trigger points.  I have also noticed that as I start to squat heavy my left knee starts to ache. Well, not the joint itself like the patella, but it feels like the quad/tissue just surrounding the knee.  Front squats require a lot of knee strength because you start off the squat with a knee break in an effort to keep the torso upright. (If this doesn’t make sense just ask in the comments), so I’m just chalked this knee discomfort up to learning the front squat, to getting my knee used to the movement.  But, perhaps this left knee discomfort is more than just getting used to front squatting, perhaps it is a symptom of some kind of twist in my pelvis. I still experience some sort of anterior pelvic tilt, although I recently got back to doing my PT exercises that help quiet down my spinal erectors.

So to test this theory, to see if everything is in its proper place, I’ve decided to go see a rolfer.  I almost went to one back in December of 2009 but the cost was a bit steep for me. Now that I’ve been promoted a few times, I am ok with seeing one.  I have offered rolfing as an option to people who come to me for help, so I also have that as motivation to try it.  I figured a good massage therapist was the same as a rolfer, even got into an argument with someone about it in the comments section.  My old massage therapist also told me the same thing, that all rolfing really is is steady applied pressure until the muscle relaxes.  Since he was so good, I was inclined to believe him.  But perhaps he was wrong, perhaps I there is still something off that hasn’t been addressed yet.  The only way for me to know is to find out, so I’m going to go see the rolfer on the 18^th.  I am very excited to see what he has to say.

Things that drive me crazy

Normally I try to write posts that are full of content, and less about opinion. I mean, who really cares about my opinion on something? You don't see me on news TV being interviewed on subject matter. Regardless, things are going fantastic on the injury front so things have been quiet on this blog. I decided to spice it up with a "grinds my gears" piece, so enjoy:

I’m not sure how my personality comes across on this blog.  A lot of the times I think these posts are boring (at least to anyone other than myself and my mom who loves anything and everything her darling son does) updates on my physical well-being and don’t contain that much useful content, though I try to put out as much content as possible.  Anyway, I like to think of myself as a nice, easy-going guy. I take whatever challenge that is placed in front of me, and I don’t wig out, I just try to figure out how to deal with it. I think the barbell Buddha would be proud.  Anyways, through facing my own personal challenges I know that we all have our own ways of perceiving and dealing with the world.  If I tried what would work for most of the population with pretty much any challenge I’ve faced, I would not have been successful.  So when I see other people doing things differently, I try very hard to just accept them as they are.  Even though I would take a completely different approach to achieving whatever goal, I will never tell someone they are doing it wrong.  You want to lose weight so you go Vegan? Fine. You want to lose weight by eating breakfast? Hey whatever works for you. Different strokes for different folks.

Ok, so now that I’ve buttered you up, telling you that I’m a nice guy, I would now like to tell you the ideas/concepts that annoy the absolute shit out of me. In no particular order:

• Squatting below parallel is bad for you. This idea is complete horseshit and needs to change. If anything, partial squats have been shown to place a lot of shearing force on the knees.
• Something like a Nutrigrain bar is good for you.
• Protein bars are good for you. Saw an episode of Good Eats explain how they are made. The protein from protein bars come from horse hooves, so basically you’re eating glue. Never again.
• Eating small, frequent meals “stokes the metabolism”.
• Cardio is the ONLY way to lose weight.
• The idea that you can out train a poor diet.
• ALL red meat is bad for you.
• Dietary cholesterol will increase your risk for heart problems
• Take anti-inflammatories to deal with muscle pain.  Although there really isn’t a pro-NSAID movement out there, it just bothers me to hear people taking something that is making them weaker, not stronger.  Here is another article explaining inflammation.  Really try to get the word out.
• Lifting heavy will make you bulky (I especially don’t like this one with regards to how it scares women off from lifting).
• People who take their own personal experience and think it then applies to everyone else.  “I’ve lost 10 pounds by going vegan, so you should too!”  “You don’t eat meat? You are an idiot because that shit is just unnatural.”
• Cholesterol is the marker for heart health. No it’s not, High Cholesterol isn’t bad for you, it’s high cholesterol and eating sugars.
• Juice Cleanses. Honestly what good comes from a "cleanse"? Just do intermittent fasting instead.

Alright, end rant.  I'm going to have some more stuff up here, all not necessarily exercise related, just things I would like to share with the world.

Dry needling for hip and shoulder.

So this week I got the PT to dry needle both my shoulder and my hip.  Concerning the hip, it seemed that the adductor magnus, a usual suspect, was fairly quiet. However, I had quite a few trigger points in the anterior part of my hip, so some small hip flexor muscles of which I forget their names. I imagine the fact that my body presented itself with new/trigger points to be a good sign, but also I must figure out why the change, to see if there is anything I can do to prevent the trigger points from forming.

Concerning the squatting, This past week I went up to Chicago to celebrate the one year anniversary with my wife, and we followed that by driving a U-Haul full of stuff from Chicago to Dallas.  Needless to say, I didn’t do very much squatting.  Once I got back home to Dallas, however, I did three sets of five reps of 170, and I could tell that my technique was a little rusty.

Right before the move, I had made a revelation with regards to my technique.  When coming up out of the hole, I was leaning forward a bit. After leaning forward, I then had to compensate and straighten up my torso. This was something that was not comfortable, and I think it is the motion that strained my adductor.  I also noticed that I was keeping my weight in my mid-foot, although occasionally on a bad rep I would feel my weight shift towards the balls of my feet causing me to have to take a step or two forward.  What I figured out I could do was really keep my weight back. At first it almost felt like I was going to fall over backwards, but after a few reps I started to get the hang of it.  …I record all of my reps on video, and when I reviewed the tape I felt like my pelvis was more stable than it has ever been coming in and out of the hole.  This is great news, really felt like I made a breakthrough.

However, it seems that I lost my feeling for it because when I came back I noticed that I was once again leaning forward just a schotch, and it was affecting my groin, although not too badly.  I just have to shake the rust off from not squatting for almost a week and just get back to it.

Concerning the Shoulder, when he worked on my trap oh my lord did that jump while he was poking it!!!  Afterwards my shoulder was super sore, but it did feel better.  However, almost 48 hours later I work on overhead press and my shoulder feels… more injured?  It’s like now that the muscles that were tight protecting the joint are relaxed, the joint feels more vulnerable.  I did get a new rep max though (eight reps of 115# woot!) but it was my first experience where the shoulder just didn’t feel right.

I am still looking at prolo as an option, but I am going to do it in 2014 at the soonest.  I’ve found a doctor here in Texas, down in Austin, who seems to do it right, he's method is similar if not the same as Dr. Hauser up in Chicago.  I have wanted to visit Austin again as an adult (went once as a kid) for some time now, so I would be excited to make a trip of it.  Not going to lie getting my shoulder fixed would be amazing, much like getting my hip fixed.

My friend Bobby said it best:

You’re a handsome young capable man in the flesh. Underneath, you’re for shit.

You’re like a low miles BMW that’s priced to sell on the used car lot.  Little does the hapless buyer know you spent a week underwater during your “Katrina days”.

I think about how messed up my body has been, and now think about how much progress I have made, and I know I should be happy, but all I can think about is that last little bit that I need to be 100% whole.  Like always, I feel so damn tantalizingly close I can almost taste it to be injury-free.  So close, yet so far.

Dry Needling Update and Shoulder Treatment Decision

Ok so I’ve been trying out dry needling, four times so far, and it seems pretty legit.  The process is a very strange sensation, and not at all comfortable, but it seems to work, so I’m all for it.  Each needle feels different, and the bigger the trigger point, the bigger the response. For example, yesterday when he addressed my sartorius (which makes a lot more sense than what I thought it was: my rectus femoris) it wasn’t really a big deal, didn’t really feel anything.  Then the PT worked on my adductor magnus and wow it was sensitive.  Each needle prick felt different. One time when he put the needle in it felt like I was hit by a Taser in four different places on the back of my hamstring. Another needle and it felt like a hot wire of pain up my leg.  Each one was different, and each one was significant.  Thankfully, the pain/discomfort is very brief.  He also worked on my tensor faciae lata, and that almost felt like nothing.

The Physical therapist really worked me over yesterday, and when I got up off the table I walked with a bit of a limp I was so sore. But I also felt better, strangely.  Now a day out, I feel much, much better. I will also be seeing him on the Fourth, two days from now.  Based on how I feel from that we’ll decide to keep up the twice a week or go down to once a week.  This guy I’ve found though is amazing, like he is hitting exactly where I’m feeling the pain.

Oh yeah, I’m still squatting. Yesterday before seeing the PT I went and front squatted 170 five times for three sets.  My ultimate goal is to front squat 315 without pain.  If that happens, not sure how I’ll celebrate but it will be awesome.

Concerning the tear in the back of my shoulder’s labrum, I’m going to see if I can convince the guy to needle my tricep, and just keep lifting.  I am in some discomfort, but for the past two weeks or so it has been really, really tolerable. I would be tempted to try prolotherapy, but it means I would have to give up pressing for like 2 months at least.  I’m still making some good gains on my lifts, and my neck/shoulder is feeling ok, so I’m going to just wait.  Maybe if I start benching 300 and then stop seeing gains I’ll consider prolotherapy, but right now there’s just not enough upside for me to try it right now.  …Although I do have to say, for the record, that there is a big part of me that wants to treat this injury.  I am so damn close to being whole, to no longer having these lingering issues, that it is tempting to give up pressing for two months just to be no longer injured.  Anyways, I’m going to keep lifting.

[UPDATE: I've started prolotherapy for the torn labrum, and am now doing PRP injections as well as continuing to see a PT for dry needling. Here's my Vlog entry:]

History of my neck/shoulder pain

Ok folks it's been a lengthy journey. I'm sure I've forgotten bits and pieces but I think this is main gist of the issues I've experienced with my shoulder. It doesn't feel like it, but it has been more than a couple of years of me dealing with issues with my left shoulder. Hell, my very first post on this blog was about me recovering from a partial thickness tear in my supraspinatus.  That was in 2008, FIVE YEARS AGO. That post was titled "hopefully short road to recovery"


Twice in my life I’ve had small partial thickness tears of the supraspinatus, first in high school during wrestling and again shortly after joining crossfit in May '08. Did physical therapy for both and seemed to make a full recovery.  As I got back into Crossfit I developed tendonitis in the shoulder. Learned about self-massage with a tennis/lacrosse ball, and finally fixed that.  Still had issues with tension in my neck, would crack my neck countless times throughout the day. Would also always sleep on my left side, with my shoulder compressed pretty much up to my ear. I also experienced some pain on the inside of the shoulder blade, but when I went hunting with a lacrosse ball I never seemed to really find it.  I also learned through seeing a chiro that my first and sometimes second ribs were almost always out of joint. 

Came across the Kstar Mwod that talked about stretching out the scalenes and how they can cause referred pain on the inside of the shoulder.  Started massaging the scalenes and that helped a lot; without the scalenes pulling on my ribs all the time they stopped being out of joint. However, it seemed like I was having to massage them all the time.  Learned I am tricep dominant (weird right?) and sleeping on my side was shortening/tightening all of my muscles. Eventually taught myself to sleep only on my back and things got considerably better, but still had a lot of discomfort.  I learned about hanging from a bar to help stretch things out.   With the hanging from the bar I could feel the adhesions in my neck tearing and eventually everything learned to stay loose and supple.  This stretch seemed to also help loosen up my tricep and chest.

It is at about this time I started to notice that I when I woke up I would experience temporary numbness in both of my ring fingers and pinky’s. Learned this was from my C7-T1 being out of whack almost constantly. Got some prolotherapy to tighten up everything and now I no longer have the numbness, but I still have the discomfort inside of my shoulder blade.  After seeing a massage therapist I learned that the pain I’m experiencing is coming from a super tight Rhomboid. He tried releasing it first but it would not budge. So after a while he gave up and released my scalenes, then my tricep, and then the rhomboid released “almost too easily”.  This granted relief for like two weeks, but my rhomboid slowly tightened back up.  According to the massage therapist it seemed like the tricep and rhomboid were playing tug of war.  This thought led me to start thingking these muscles are tightening up in order to try to protect some joint, but what joint or why I wasn't sure.

Saw a physical therapist for it and although there were some exercises that helped some, it did nothing to help the tricep and rhomboid relax.  I even told my PT I thought there might be some damage to the shoulder joint, causing the muscles to tighten up, and he told me that everything looked strong so that was unlikely. I finally decided to see a Physician's Assistant and after some tests he ordered an MRI with an arthogram. That proved that I have a laberal tear in the back of my shoulder, probably from an injury I got in high school.

So now I know what is going on, and the question is what am I going to do about it.  I am going to ask Dr. Hauser a ton of questions, and perhaps go the prolotherapy route since it helped out my hip so much. But for now, I'm just going to have to grin and bear it while I move to Dallas.

MRI Results

Well, looks like I have a tear in the back of the labrum in my left shoulder.  ...Having a tear in the back is fairly rare, but I think I know the exact moment of when it happened.  I was on the wrestling team in high school, and during practice I was slammed into the mat, shoulder first, so hard that I cracked my collar bone.  Upon that impact, the head of the humerus slammed into the labrum and caused the tear/damage.

It's not that severe, and obviously I can do a lot with it. I just have super tight muscles that hurt sometimes.  I don't think surgery is really a good option, so I'm going to try to do some physical therapy and then if that doesn't help maybe do some prolo.  It's a hassle since Dr. Hauser lives in Chicago and I am moving to Dallas, but I will be going back up there for the wife's family.

It's late so I'm not going to review the path that led me to this place, I'll do that tomorrow, but it is really, really nice to finally have an answer for everything. Now hopefully I can do something about it.

Needles, Needles, Needles!!!

Ok so yesterday I had an arthogram on my shoulder. Right now, my shoulder is feeling… different, and not in a good way. Maybe a little looser in the socket? It’s like the arthogram awoke something wrong in my shoulder, now it clicks every once in a while when it didn’t before. The joint is super sore in the back area near the lat, completely opposite of where the injection site was. I cannot wait to see what the results will tell.

So I got a big injection yesterday, and today for my groin I tried dry needling for the first time.  Dry needling is similar to acupuncture, except they just stick the needles where the knots are.  Going in my hip/groin was feeling better than it ever has, so I was a little worried I was just wasting my time.  That turned out to be a needless concern.  When he worked on my groin it caused all kinds of… sensations. Like it felt kind of like a cramp, kind of like a shock of electricity. It was also an extremely specific like it was just a single strand of pain, the diameter of a iPhone connector cable, shooting up from my knee to my hip.  Highly foreign, and highly uncomfortable.  The PT told me that the sensations indicate that the procedure is being effective.  If that's the case I really needed this.

Afterwards it still felt like there were needles in me, but when the PT tested my range of motion it was pretty ridiculous how much more I could open my leg.  It still feels... strange, but I am to keep stretching it and hopefully it will get a whole lot better.

I also got my allergy injections today, so there’s another case of me being stuck by a needle.

Also, if this shoulder thing proves to be a torn labrum, I’m probably going to go the route of prolotherapy again.  That, as you know, means even more needles.  I wish I were more comfortable around them, but even if you’ve been stuck as often as I have, it’s still no fun. But if it makes the pain go away, then I’m all for it.

MRI for shoulder, done

So went in for the MRI/arthogram today. The Dr. had some issues getting the contrast into my shoulder joint, but the dude was an artist, only felt pressure, no pain. It was weird though knowing he was rooting around with a needle inside my shoulder joint.  Perhaps he had trouble getting the needle into the shoulder joint for the same reason they had issues getting the needle into my hip joint: the joint was super tight. The Dr. didn’t say that was the reason, but it would make sense if that were the case.  I see the PA on Friday, and he’ll go over the results with me. I can’t wait.

The should felt a little strange after wards, but in a couple of hours I was in the gym working bench press, got a new (calculated) 1RM with 11 reps of 185#, pretty happy with the 531 system.

Another Labral tear????

Well, I finally saw someone to figure out what is wrong with my shoulder.  …I don’t know why, but I feel like I’ve seen many, many Dr.’s about my shoulder. But as I sit here and think about it, I am not so sure.  So I saw a PA today and we did all kinds of tests.  After passing quite a few, he then gave me one where I had to resist pressure with both arms.  My right arm resisted, and my left arm went straight down. Like, I couldn’t muster any strength at all.  “Now we’re getting somewhere.” He tried a couple more tests, all of which I failed.

He told me these all point to having some damage to the labrum in the shoulder.

Really?  Really? Another laberal tear???

We are going to confirm with an MRI with arthogram.  It was funny, having the PA explain to me what the labrum is as well as an arthogram. …Sometimes I wish I wasn’t so familiar with this stuff.

I have no idea if this comes from my time with crossfit and its dangerous kipping pull ups, or it could have come from wrestling or whatever. This kind of damage can happen slowly over time, and I think that is what happened to me. Whatever the case, I am looking forward to getting the MRI and following that a real diagnosis.

Interestingly enough, I might decide to go back to Dr. Hauser for more prolo, this time on the shoulder. I’m pretty darn sure the situation isn’t dire enough to warrant surgery, at least not surgery without trying prolotherapy first. We’ll see how this works out.

I just want to know what is going on, so I can start fixing it.

If you want something done right...

So about 1-2 years ago during all these massages, physical therapy, prolotherapy and God knows what else I've done to my hip I've felt some nagging discomfort in what I felt was right near the inguinal crease.  I kept thinking that was the psoas, but once I got the prolo and the psoas died down I realized there was something else going on.  I would sit on a softball for a bit and that seemed to help.  I would tell this to Bobby, and I've told it to other massage therapists as well, and even my pt.  They all responded with nodding their head as if they understood, but after the treatment I would still feel whatever it was that I was feeling.

I have no idea why it took this long, but the other day I thought to myself, "you know, why don't I just try to release the knots myself without the softball?" So I tried, and oh my Lord I came across some serious knots.  I tried some home made graston with a butter knife and some massage oil and the area felt like it was gravel.  ...In graston, the metal picks up the knots of facia as rough spots.  That gravelly area was rougher than anything I've ever felt before.  So it seems like there is this patch on my thigh that has been completely ignored, allowing for all kinds of knots to develop.  And I'm left here thinking why the hell no one else has worked on this area???  I guess I understand, I mean is seems to be my pectinues, it's on the innermost part of my thigh. But seriously?  Perhaps that's not the reason, perhaps it's just a really odd spot to have knots.  I don't know. All I know is that I've figured out yet another piece to this puzzle and am really, really happy for it.

Whatever the case, when I worked on them I felt some real intense burning sensation, I am  familiar enough with this sensation to recognize it as adhesions tearing.  It felt like I was stabbing myself with red hot pokers, but afterwards I felt much, much better.  I have no idea why no one else has worked on this area but once I did it I felt amazing, like the pain went away completely.

Like, I'm completely pain free.  It's pretty amazing, and the solution was so freaking simple and easy.  I am now squatting deep, and am pain free.  Just need to keep this up and I will be super, super happy.  Pretty amazing.

Scared to celebrate

Well I have some great news to report.  For the past five days I have not had any hip pain.  Well, I sometimes feel some tightness in my psoas, but I rolled that out and I'm right as rain.  One reason for this could be I saw a highly recommended massage therapist.  He was definitely the best I've seen so far here in the Durham area.  He mostly worked on my back.  The more me and my PT work on my back the more we're finding out that the issues in my back are affecting stuff going on in my hip.  So I decided to direct the massage therapist to my trap/rhomboid/tricep.  He lessened the knots in my back, but nothing was released completely, like what Bobby does.  Sadly, I'm probably not going to be able to find a massage therapist as good as Bobby.  Regardless, the work this guy in Hillsborough did seemed to help quite a bit.

I've been squatting for two weeks now, as well as using the leg press and pistol progressions.  I've decided that before I start squatting anything over 135 pounds I have to be able to pistol squat with either leg.  Before, I could only pistol with my right leg.  I always thought this was odd given my dominant leg is my left leg.  Now, in hindsight, I see that I had no control over my left adductor so I didn't have any stability in my left leg.  So I want to know that I'm able to pistol with either leg.  The pistol progressions are also feeling like great physical therapy.  ...I should also mention that my glutes have been incredibly sore for the past couple of weeks.

So things are going great for the hip.  But to be honest I'm too timid to celebrate yet.  I've experienced some honeymoon phases before, and I'm just afraid that this is the same thing.  I worry that as soon as I start lifting heavy again, I'm going to go back to having hip pain.  I pray that this time it is different, but I'm very, very weary with this.

While all this news with the hip is awesome, now that my mind isn't distracted by any hip pain I'm realizing how uncomfortable I am in my shoulder/trap.  I am using a lacrosse ball like all of the time now, and nothing seems to help release these damnable knots in my back.  I have no idea what is causing them, but they are impossible to release.

I am going to try to convince my PT to start a Graston regimen, maybe twice a week?  I've only had one session and I felt like it was very effective.  I'm going to also ask my PT if we can figure out what the hell is going on in there.  We haven't done any tests for range of motion or anything one my neck and shoulder. So all we know are that there are some incredibly tight muscles back there.

If Mike says no to the Graston idea, then I'm going to see if I can get someone to do this for me with like a butter knife and coconut oil.  It's that bad.  Hopefully I can resolve this issue as well, and in doing so will fix whatever is going on with my hip.

I can start squatting again!!!

So it’s been a couple of weeks and up until yesterday it felt like we had stalled again.  When the discovery was made that my upper body is affecting my hip mobility, I made the suggestion that doing some graston on the knots in my left shoulder/back might help my left hip finally pass the Obers test (and thus indicating the femur is in the correct spot of the hip socket).  Mike just kind of grunted while looking across the room. Clearly he didn’t think that would help.

Anyways, I’ve been doing the PT and have been trying to keep good posture (keep the ribs locked down) but I still find myself arching my back, like even when I lie down.  I think the more I arch my back, the more my groin/psoas hurts. I’m not exactly sure where the pain is coming from, it’s very vague and ghost like.  Sometimes I think that I’m just too sensitive right now, I’m too in tune with my body so that any little thing that is off I feel.  Honestly nowadays I would describe it more as slight discomfort than pain.  I try doing some self-release and it does help, but I think I’m going to have to cave and see another massage therapist and get some help.  Someone who has no problem working the psoas and the pectineus, possibly the hamstring. For some reason I register knots in my hamstring as pain in my groin. At least, I think it’s my hamstring, it’s right where the glute and hammie meet, right under my sit bones.

Regardless, the last two weeks have felt like I’ve been in a holding pattern, trying to figure out what causes the pain in my hip (I THINK it’s my posture, but I’m not sure) as well as trying to figure out how I can pass my damned Obers test.

Well I saw Mike yesterday, and we had a re-assessment of goals and what I wanted to get out of this.  I told him I wanted him to work on releasing my shoulder a bit and see how it affects my hip. I also said it would be great to get back to lower body work.  …I think he’s been thinking about it a lot because he said he trusts me because I understand the underlying principles that explain why we do what we’re doing, and gave me the green light to start squatting again.

I can start squatting again!!!!

Of course certain rules apply: Has to be with super light weight and until I can consistently get correct pelvis positioning I can’t go up in weight. Also, I need to do hundreds, if not thousands, of reps.  So I’m thinking I’ll do 5 sets of 10 reps of squats every day I’m at the gym.  I can also do leg press, and the step ups.  I’ll do the step ups as progression for doing pistol squats.  Another prerequisite of mine is that I should be able to pistol squat with both legs (never could do it on the left side and its relaxed adductors) before I start squatting with any real weight.  So I have some new goals and I can start squatting again!!! Halelujah!!!

Also, I convinced Mike to work on my back and sure enough lo and behold after releasing my back some my right hip pretty much passed the Obers test.  So it looks like the issues I’ve had in my back/shoulder are connected to the issues I’ve had with my hip.  Who would have thought?  I did! I was the guy who thought they were connected!

Feel very proud of myself, as well as hopeful. I’m also excited to get back to squatting, and looking forward to finding a good massage therapist.  All in all, an excellent week.

Progress with Physical Therapy

So it's been about three months of physical therapy, and although I have been making progress, the progress has been slow going.  Part of that reason is that the source of all of my hip immobility is a mystery. For some reason, none of the exercises I have done sets up my hips to pass an Ober test right away in the morning, and I have yet to pass the test with my left (never-been-in-pain) hip.  This has been the sticking point for like two months now.  Once the PT can get my hips to pass that test we can start doing more real-world type of exercises (read, exercises done standing up).  Until then, we need to figure out what is going on, what is making my hips immobile.

Well, they seemed to make a bit of a breakthrough last week. Having two PT's work on me at the same time last week (because I'm oh so special), the idea came up that maybe my upper body is driving the show.  Mike had previously noticed that my shoulder internal rotation was atrocious, so they decided to work on that.

The odd thing is, after each exercise done to mobilize my shoulder, my hips became more mobile.

Even odder, the first three days after PT my hip was pretty much pain free. Sometimes I would experience some pain, but it was definitely in the minority of time and was less severe.  So I really think this is the answer.

I have also started seeing a chiropractor again, thinking the two different therapies will help out each other, so perhaps that is working as well.

This is all very interesting because this could mean that the huge knot next to my left shoulder blade is part of the reason my left hip isn't moving correctly.  I've almost always had the two issues, it wouldn't be that unreasonable to think they are intertwined.

In order to try to fix my back they've given me some exercises that stretch my back.  It's kind of like doing a plank but instead of trying to pinch your shoulder blades together you do the exact opposite, you try to extend your shoulders forward as far as possible, spreading your back.  This stretches out the muscle some.

...When I was training for the Oly competition, I was front squatting all the time.  Two or three times, when I was squatting, I felt this brief, very sudden, stab of pain where my knot is.  The pain felt like I was being stabbed by a hot poker, but just for a split second.  Right after the sensation I felt completely normal.  I was asking Bobby what this could mean and he said it was an adhesion tearing.  In front squatting I have my shoulders shifted forward in the same manner as this plank exercise, but when squatting they are also being flexed at the same time for stability sake.  That summer was also the most normal my left back/shoulder area has ever felt.  So I think we're really on to something here, at least to treat my back/shoulder pain.

Unfortunately, I did have a bit of a setback later in the week.  I was at the gym with a friend, and I was helping him out with his deadlift form.  I was demonstrating how he should approach the bar, and when I lowered my hips to the proper depth, while holding my spine in what I think is a straight posture, I felt my groin get tweaked.  It feels like it's the pectineus/psoas.  So at least that other pain that I've been experiencing, the one that seemed to be from the rectus femoris, has still disappeared and has not resurfaced its ugly head.

Still, now I'm experiencing some slight groin pain during some different times throughout the day.

...That is one thing that is absolutely maddening for me about this hip pain: I can not figure out what causes it and what helps it go away.  Sometimes I wake up with it, sometimes not.  Sometimes doing my PT exercises helps, sometimes not.  Sometimes working on it with a softball helps, sometimes not.  All this does is confuse me and irritates me.  I pride myself on listening to my body and figuring out what is making it respond the way that it does.  This groin pain, however, never seems to go away.  When I saw the chiro he noticed my pubic bone was out of place, but I can't remember if putting it back in helped or not.

Speaking of groins, I feel like my left adductors, previously completely turned off/hard to use, have gotten significantly stronger.  Once I actually thought I tweaked my left groin pushing off of my left foot to go around a corner.  I feel like I've gotten much, much stronger in that area, hopefully it means that it is no longer an issue.

I will be seeing three physical therapists tomorrow.  Feel a bit like a lab rat but hey the more brains the better.  Last week it seems like we've reached a turning point, and barring any stupidity on my part (won't even think about deadlifts) this week might be the first week I've been pain free in a long, long time.

You’ve been diagnosed with FAI, now what?

So you’ve had hip pain for a while, finally caved and saw an Orthopedic doctor, and duh-DUH-duh, you’re told that you have FAI and need surgery. You’ve been told no more squatting and your world has been turned upside down.  Well in this blog post I’ve created a protocol of things to try before surgery.

Medical Disclaimer: I don’t have a medical degree, nor do I know your medical history. I’m posting this in order to let people out there know about options other than surgery. So please put all of these ideas into your own context. Be smart, and consult your doctor(s) before trying any of these things.

“Why should I trust you?” 

You shouldn’t, I’m just some random guy on the internet without a medical degree. However, I’m not telling you what you should do, I’m just trying to let you what is out there, that there are alternatives to surgery. I also think you should listen to what I have to say; I’m a guy who has dealt with hip pain for almost seven years now, and has seen it all. I have seen multiple physical therapists, massage therapists, chiropractors, orthopedic surgeons, even multiple prolotherapists, and throughout these years I kept asking questions and did my own research.  And in that time I’ve learned that you shouldn’t trust ANYONE. I’ve encountered many a Doctor who felt free to give advice on subjects they were ignorant on, so I took everything they said with a grain of salt.  That’s one reason why I have avoided surgery like the plague; I just don’t feel comfortable putting the fate of my body’s health into the hands of another person. I mean, once you go the route of surgery, there’s no coming back.  So while I am only self-educated, I have learned a lot and have dedicated quite a significant portion of my life to helping people trying to prevent them from going under the knife.

 “Ok I have FAI, how did I get it?”

So how did this excessive both growth occur?  Why does this question even matter? FAI doesn’t just randomly happen, FAI is the body’s response to the concussive force of the femur bashing into the acetabular joint. I should point out that it is a response; it is an effect, not a cause.  That is one reason why I didn’t believe I needed surgery, because if I only address the symptom (remove excess bone growth) but not the underlying cause (femur hitting hip socket), my body will just respond with more bone growth.  A physical therapist by the name of Dan Pope wrote this excellent article about FAI (and squatting) part one here, part two here, part 3 here, and part 4 here. All this begs the question...

“Why is my femur bashing into the acetabular joint, causing the concussive force?”  

It seems that most people I’ve talked to have had at least somewhat unstable joints. It seems that the femur head can move around a little in the hip socket, there’s a little leeway for the femur to move around.  However, if the femur isn’t nestled in the right part of the hip socket it can rattle around and cause those concussive forces that result in the extra bone growth. From what I’ve seen most people with FAI have excessive anterior hip capsule laxity, I know I did.  So what causes anterior hip capsule laxity? This is not an exhaustive list, but these are the factors that I am aware of that can cause unstable hip joints.

• Poor hip mobility. If your hips aren’t working properly, you’re probably going to cause issues when you use them (like squatting and being active, pretty much doing anything).  Find yourself sleeping on your side with one leg thrown over the other? That’s because you have tight hip flexors (and I recommend sleeping on your back to help straighten that out).  That is one reason why I highly recommend doing these ten exercises for hip mobility for a while to see if it helps.
• Anterior Pelvic tilt (APT).  This is my own little devil I’ve been fighting with.  When you have weak abs you get APT, and when you start working out with APT you shut off the glutes and start using your hip flexors. This will tighten up the hip flexors and pull your femur to the anterior part of the hip socket, allowing the femur to bang around and cause the FAI.  The physical therapist Lisa Bartels wrote up a beautiful article about APT here. If you have APT I highly recommend you go and read it. Go on, read it.  It’s ok, I’ll still be here when you’re done.
• Tight hip capsules aka tight hip flexors. You might simply have tight hip flexors without APT. In today’s world of desk jobs and never sinking down into a full squat (“ass to grass” as it’s nicknamed) there are multiple opportunities for a person to shorten all kinds of muscles in the hips.  Sitting a whole lot? Work a desk job? Used to sit a whole lot with school and studying? Sitting shortens up all kinds of muscles in the hips, this one Harvard article even calls sitting the new smoking.
• Developmental Hip dysplasia. This I am the least knowledgeable about because I don’t have it, but basically it is malformed hip sockets.  From what I’ve read it’s genetic.  I have also read that if you have hip dysplasia then you are not a good candidate for the typical FAI surgery; you would have to get some other operation performed.

“Alright Adam now I know how I got FAI, but what is causing this pain I’m feeling?”

That’s an excellent question and I’m glad you asked it.  In two words: muscle tightness. I am aware of two types of muscle tightness that can cause pain: adhesions and muscles being stretched from joints being out of alignment   I found a great description of adhesions (scar tissue, gristle, trigger points, it has many names, like the devil) from this website here.  To quote from the site:

Fascia is a connective tissue within the body. Think of your entire body wrapped in fishnet hose both internally and externally including each individual bone, nerve, and muscle. Over time, fishnet hose get entangled and require adjustment. If not, you develop an impingement. Fascia works in the same manner. Once fascia becomes entangled, impingement occurs. It may impinge blood circulation, muscle movement, or nerves within the body. Over time, myofascial adhesions occur as a result of unattended impingements. You may feel tingling or cold extremities due to poor blood circulation and/or nerve impingements. You may feel extreme tightness or lack flexibility in certain muscles while having extreme pain or pulling sensations in counteracting muscles. Knots develop over time known as Trigger Points. And then there is the ultimate myofascial adhesion, scar tissue. Yes, all of the above mentioned forms of chronic pain can be a result of myofascial adhesions. Myofascial adhesions occur for many reasons. Injury, illness, inactivity, lifestyle, job type, nutrition, dehydration, and the aging process all play a contributing role in the development of myofascial adhesions.

From pretty much every person that I’ve talked to, the pain comes from a combination of muscles being too tight and inflamed (usually from a twisted pelvis) as well as having all kinds of adhesions in the hip flexors.  One source of hip pain can be SI joint dysfunction, something I'm starting to see as something that is really common with FAI.  Try out these short, quick exercises here and if they help then your SI joint might also be an issue.

If your pain is constant and doesn’t change no matter what you do then it might be pain from joint damage, but if your pain worsens throughout the day or gets worse after squats, then that is probably muscular pain. Also, if you seek any of these treatments and it alleviates the pain then FAI is not what is causing the pain and so the surgery will not help with the pain, it might even make it worse.

The good thing about muscular pain is that it is typically treatable without surgery (various treatments are listed below). Yay for hope!

Concerning hip pain/fai, I’ve seen three main reasons for muscles to become tight and inflamed. 

1. The most popular is you always keep your hip muscles short, by sitting for example.  Do you always sleep on your side, with one leg thrown over the other? That’s another sign of tight hips, and that needs to be addressed ASAP.  I now have a standing desk and things are much, much better.
2. Another, less common experience is your hip muscles are stretched because your pelvis is twisted.  When I first started my journey towards health I discovered that my psoas was causing my pain. The reason why it felt like it was on fire was because my pelvis was twisted, stretching my psoas to the point of becoming “piano wire tight”.  If this is the case stretching will only make things worse. So if you’ve tried yoga/pilates/stretching to relieve your muscle pain and it’s only made worse, this is probably what is happening to you. 
3. Last but certainly not least is your hip muscles could be tight in order to try to protect your hip joint.  Even after I got my pelvis untwisted I still had a really tight psoas. After releasing it through massage it would tighten back up fairly quickly, and I realized it was because the psoas was trying to make up for the fact that I had a really unstable hip joint (I had a torn labrum).  If you’re in that particular situation (damaged labrum or some other part of the hip) then you’re probably going to have to get more aggressive in your treatment. This may mean surgery but it may not, I was able to address my torn labrum through PRP injections (see below).

Here are things you can try that in order of aggressiveness, starting from least aggressive to most aggressive.

Mobility work

Here are my top ten hip mobility exercises.  Though they may be my personal favorite, there are even more stretches/exercises out there, just use google and search Kstar's website.  If any of exercise hurts in a bad way, then stop.  What I mean by hurt in a bad way is that there are two types of pain: pain like stretching a recently pulled muscle (bad), and the kind of pain of feeling adhesions tearing (this is what causes the discomfort in myofacial release massage). After a while you learn to tell them apart.

Massage

Massage is great for breaking up scar tissue/adhesions. I highly, highly recommend massage if you're experiencing hip pain. 

Self-massage. I am a huge fan of self massage, mostly because it's free and you're on your own clock.  Get a foam roller, a softball, a tennis ball, and at least a lacrosse ball. These are your tools to get your muscles to release.  Find a way to apply pressure to what is bothering you and keep that pressure constant until the muscle releases. It may take five minutes, may take fifteen minutes. But just camp out and wait.  Fair warning, muscles tend to hurt the worst right before they release, trust me, the feeling of relief is worth the couple seconds of pain.

You can be excellent at self-massage, but you will still probably need to supplement with a professional's massage.  Find a massage therapist. Make that a great massage therapist.  The problem with massage is that it is only as good as the therapist you see.  So here are some ways to try to find a good massage therapist:

1. Word of mouth from people who work out. I message my local crossfit gyms asking them if they have any massage therapist they could recommend. Crossfitters need massage therapists who know what they are doing so they tend to find solid massage therapists
2. Try to find a Rolfer. Rolfing is a type of deep tissue massage. It’s a much safer bet that a Rolfer will be able to help you than a random massage therapist.
3. All else fails, try to find a massage therapist that specializes in deep tissue work. Ask if they are comfortable/ familiar with releasing your psoas. If the answer is no, walk away before you waste your hard earned money.

Dry needling is also a popular option that is supposed to have good results. As of the time of this writing I have yet to experience it but my physical therapist believes I'm a good candidate for the treatment.  Once that happens I will update this post accordingly.

Chiropractor or Doctor of Osteopath

This could be more of a temporary Band-Aid, but it can be a very helpful diagnostic tool. Through them you can find out which muscle might be causing your pain.  There are also a lot of Chiros out there that also do trigger point massage, which can also be helpful.

The reason why this could be only a temporary Band-Aid is because although they address the symptoms (e.g. a twisted pelvis) they most likely will not address whatever it is that you are doing to pull everything out of alignment.  However, doing exercises that work on your core (like squats, deadlifts, pilates) WITH PERFECT FORM will make your body more responsive to the treatment.  I responded really well to my D.O.’s treatment because I was doing such exercises at the time.

Physical therapist

This one is tricky. A great physical therapist will be able to figure out what is off with your mechanics and figure out exercises to retrain your body so that your femur sits in your hip socket correctly and will render you asymptomatic. A so-so PT will tell you they can’t help you. A really bad PT will tell you they think they can help you but end up doing nothing.  Again, you’re left with word of mouth, but do your best to find the best PT in your area. Trust me, it’s worth that extra 20 minutes of driving.

Prolotherapist

This was the option I took to treat my laberal tear.  Again, this is all depends on who is doing your prolotherapy. Four years ago I saw “the best” in the Mid-Atlantic area and he told me I had FAI with no laberal tear and there was nothing that could be done except surgery.  Then I saw one of the best in the world, Dr. Hauser in Chicago, and he was able to pretty much fix 95% of my hip.  Of what I know, there are two different styles of prolotherapy, both of which I talk about here with video examples.  I can only attest to Dr. Hauser’s method, but on an intuitive level it makes much more sense to me.

"Ok I’ve tried everything and everyone says the only way to fix this is surgery, now what?"

Like with the above treatments, try to see the best Dr. you can. That doesn’t mean some surgeon who has performed arthroscopic surgery before, I mean someone who dedicates their practice to helping people with FAI. You wouldn’t want some random Orthopedic surgeon doing a total hip replacement on you, would you? No, you would want someone who does that day in, day out.  It’s no different with treating FAI.

Takeaway points

• Don’t rush into surgery, try other approaches first.  I would try every other approach before going under the knife.
• Ask all kinds of questions. “What is causing the pain?” “Why will your treatment help?” “How will your treatment help?” When you see a specialist they will rush through things as quickly as they can if you don’t stop them by asking questions. Make a list on your phone, be ready, and after the meeting send out an email confirming what you took away from the conversation.
• Be your own advocate, your health is your own responsibility. If I had listened to the first doctor I would still be crippled and inactive right now.
• Be Patient!  It took years of bad posture/mechanics to get you into this mess, it's going to take some time to get you out of it as well.
• Try to see the best Dr./therapist you can. Usually that means someone who has seen your type of situation multiple times and has had many, many success stories.