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:]

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.

Exercises to treat FAI/tight hip capsules

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

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

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

d

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

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

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

An actual, real life FAI surgery success story

One of the reasons why I've stayed away from surgery is the fact that I have yet to find a success story. I honestly felt that it was just not the solution.  However, I just came across a blog (http://mysistersfaisurgery.blogspot.com), that documents one girls recovery.  It's pretty detailed and shows how he fairs with pt and stuff.  ...It seems that she flew to Vail to see the top fai surgeon and then spent some time there rehabbing.  She took a lot of time, but it seems that a year after the operation she is doing great.  I don't know if I could take off that much time, one of the perks of being a high school student.

Anyways, I know people, like me, are looking for FAI surgery success stories, and after finding one I thought I should share.

FAI/labrum tear does not have to equal surgery!

So I just got a question from a follower from Denmark asking how I'm coping post surgery.  Maybe there's a bit of a language barrier, but maybe not and I haven't been that clear.

So let me clarify the record.

Two years ago I was diagnosed with FAI (cam and pincer type) and was told I may have a small tear in my labrum as well.

Incidentally I learned I had tight hip capsules.

I started seeing a massage therapist while doing exercises to treat the hip on a regular basis to release the hip muscles, and it starts to render me pain free.

Fast forward to August last year and I seemed to make the hip worse in an Olympic lifting competition.

I go get another MRI to see what's going on.  In the report it comments that my femur heads are nice an smooth, nowhere does it mention that there is an impingement.  It seems that my impingement has gone away.

I still have a laberal tear though (which seems to be the root cause of the pain), so I start seeing a Dr Hauser, a prolotherpist, and I seem to be progressing nicely.

Nowhere in there did I get surgery.  For me, surgery is not the answer for a hip impingement.  An impingement is the result of poor mobility, if you fix the impingement it will just come back because you still have the mobility issues.  Moreover, even if the surgery fixes the underlying issues it may not leave you pain free.  I'm willing to bet good money that the large majority of people who have pain and impingement actually have muscular pain and not joint pain.  If you fix the impingement, the muscles are still going to be too tight.  After months or years of learning how to be tight (and painful), the muscle is going to take a lot of attention to make it release and stop hurting.  If you go online and read people's blogs who just have the surgery, it just doesn't seem to work.  Even if you have multiple surgeries (like five of them).  Surgery is at best an incomplete solution.

First fix the mobility issue, the body will take care of the extra bone growth on its own (mine did).  If you already have a tear in the labrum, then try prolotherpy before surgery.  Prolo seems to be largely dependent on the skill of the administrator.  For example, the "expert" in Alexandria said he couldn't help me, but lo and behold I'm getting help from Dr. Hauser and it seems to be working.

My point with all of this is surgery is not the only answer.  Orthopods think it's the only answer because that's all they know.  They don't know anything about massage therapy or PRP treatments or anything else.  They just do surgery, and that's it.  So if you ask an Orthopedic surgeon for help of course all they are going to recommend is surgery.  But there are other ways, I'm a prime example.

[Edit 7/8/13: I am now seeing a PT who does dry needling, and it is doing wonders for the last remaining bits of pain. I highly recommend you find someone who does dry needling early on in your search for pain relief.]

First Prolotherapy session finished

Nervous as hell, I showed up to the doc's office at 8:45, 15 minutes ahead of time.  I had already taken my vicodin and xanax, and I was starting to feel a little woozy.  Still lucid, I filled out some sheets and then was taken to a room.  They had me gown up and applied a topical novacaine ointment to my hip/thigh area.  After waiting a while for the drugs to set in Dr. Hauser showed up.  I was handed two squeeze balls laid on my back, and he got to work.  I could feel some of the pricks of the needle, but just barely.  Then he had me lay on my side and started going at it from there.  I don't think the numbing agent had been applied there because I could definitely feel that more, but I just focus on something else, like those stress balls.

But then it was over.  It probably took like 2 minutes, max.  Apparently he gave me 60 injections, but I could have sworn it was like 15 at most.  My hip definitely felt some swelling, but it was discomfort and not pain.  They put a heat pack on me and let me just lay there for a while.  Eventually I got up and dressed.  I was pretty tired and I think the drugs were making me woozy, so shortly after Kristin started driving me home I passed out.  When we got home I laid down on the bed and then slept for six hours.

My hip definitely feels different, it feels swollen and like I'm stretching my glute or something.  There's not really any pain though, and the pain from the psoas being too tight doesn't seem to exist right now.  I don't know if it from the drugs or the swelling has allowed the muscle to relax.  I don't know.  All I know is that I now have to be very careful with what I do, to make sure I don't make my hip click.  If I do, I'm preventing my labrum from knitting together, and that is the last thing I want to do.  It will be tricky, all those little habits like crossing my legs will be tough to not do, but this is definitely worth it.

If I can beat all of this without surgery, I am going to be a very happy man.  The thing that I like most about this prolotherapy is that although I can't really exercise like squats or Pilates, I can walk around and be independent.  This is not like what I would experience if I had surgery, where I would be on crutches and my body would be recovering from the stress of putting my hip in traction.  Surgery really should be an option of last resort, and if this works I am going to be very, very, happy.

Has my FAI gone away???

The fact that Dr. Hauser couldn't detect any impingement has really got me thinking, is it actually gone?  I really need to check with the results from the MRI I had a couple of months ago to see if my cam and pincer impingements are gone.  If this is the case, then I'm proof positive of the importance of mobility work.  I always wondered if the extra bone growth would go away on its own.  I mean, it's no longer needed because the femur is no longer banging into the hip socket, so it could go away.  On the other hand, it would seem odd that the extra bone would realize it's no longer needed and would go away.

...I will call the doctor's office later today and see if they could help me out on this one, since I don't have the images for myself.

Met with Dr. Hauser

The meeting was... interesting, to say the least.  He did a few, quick tests and felt that I really didn't have an impingement of the hip (this would kind of make sense since I've been working on my stretching my hip capsules for almost two years to the day now.), but he definitely felt some instability in the hip joint as well as that laberal tear.  This is almost completely opposite of what the PRP Dr Wager diagnosed like two years ago (no laberal tear, but FAI). Perhaps all the stretching and stuff has made the impingement a non-issue, that would definitely be ideal as well as the hope of getting all those massages. 

He told me that he felt he could help, and if I wanted to he could do a procedure in like 30 minutes.  ...He gave me the option of taking some painkillers before the procedure, as I will get poked by a needle 30+ times.  That is a ridiculous amount of needle, so I felt I would be best served by some vicodin.  However, I have a lot of work to do, and I can't really afford to take today off so instead I scheduled an appointemnt for the 23rd.

There is one thing that really, really bummed me out though, and that's the recovery.  One of the main reasons why I wanted to try prolotherapy before surgery was because of the recovery.  In the clip of Dr. Hauser getting an injection of stem cells (the stem cells come from the marrow in his own tibia) for treating his knee he talks about how he was running three days later.  Well, appearently with a labral tear I would have to be inactive to let the labrum knit together.  I can swim and walk,but anything that causes my hip to snap would be bad (so no more than 20 degree movement), and I wouldn't be able to do any external rotation as well.  ...That last part may mean I might have to hold off on dance lessons (have been learning how to dance with Kristin in preperation for our wedding). 

It's that last part that kills me.  I've really been enjoying dancing with Kristin, and that I would have to hold off on dancing for like eight weeks is sad news.  The recovery time for prolo is almost the same as surgery, so it makes the idea of prolo less appealing.  However, I know that surgery is not always the answer, in various forums there are people who are months post-op and are still expereincing pain just walking.

So I think I've decided to try at least one prolo treatment, but I swear I'm not as near as excited about this as I was when I thought I could immediately get back into squatting and stuff.

I will keep posting about this, as well as some other things.  I apologize for the lack of posts, but since I've become more inactive there hasn't been too much to write about.

Possibly a light at the end of the tunnel of hip pain

Finding a way to relieve the pain pain in my hip has been been quite the journey, one that almost sounds like an episode of House, MD (although I was never dieing at any point). Because I'm not sure if I've been very clear on my plight for a cure, I've decided to write up a summary of my dealings with this problem:

Part One: Hip feels like it's on fire.

June 27, 2008: Started crossfitting, and soon after my right hip started to feel pain, like it was on fire.

July: Saw Dr. Bruno, an Orthopod, for my hip, and he wasn't sure what was going on but had some physical therapists work with me. This involved stretching and weight exercises as well as TEMS and ultrasound therapy. Nothing was really working though.

August: After researching the crossfit forums, I realize I need to see a DO, and I have the therapist confirm that my pelvis and hip are twisted, causing the illiopsoas to stretch unnaturally resulting in severe inflammation. This inflammation is what is causing the sensation of my hip being on fire. Dr. Craddock also tells me the twisting of the pelvic muscles is why my hip clicks when I raise and lower my knee (a problem I've had since I can remember).

August 26: I meet a DO, Dr. Craddock, for the first time, he resets my hip and the pain goes away almost immediately.

August '08 - June '09: I receive regular treatments from Dr. Craddock, but after two months of no longer experiencing the inflammation of the illiopsoas I notice there is still a lingering, deep throbbing pain. This pain doesn't feel like fire, and is much easier to ignore. I figure it's still the illiopsoas, that it just needs some time to get used to being un stretched. However, this pain doesn't really go away.

February '09: I see a massage therapist and tell her about all of my various ailments, although I find her massage relaxing I do not find it therapeutic.

Part two: Maybe it's a torn labrum?

July '09 part 1: I casually mention to Dr. Craddock that my hip still clicks when I raise and lower my right knee. For a brief moment he seems a little confused by this because all the muscles are in the right place. After a second he then says I may have a torn labrum in my hip, and this might be causing the clicking and the residual pain.

July '09 part 2: I see Dr. Bruno again and he reccomends an MRI, but without contrast. He gets the results and tells me I have a torn laburm, but he's not sure since he deals mostly with old people. He then sends me to another Orthopod, Dr. Johnson, who deals with sports medicine.

July '09 part 3: Dr. Johnson determines I have fermoral acetabular impingement (FAI), but is unsure about the labrum because the MRI does not have contrast. I believe the pain I am experiencing is in my hip joint, as it feels incredibly deep. It's around this time when I come across prolotherapy for torn labrums. Dr. Johnson says that if theses treatments don't work there is arthroscopic surgery for this condition.

August: I meet up with the prolotherapist Dr. Wagner, and he says he needs an MRI with contrast in order to do anything.

September: I see Dr. Wagner again, and after the MRI he tells me that I do not have a torn labrum, only FAI and that he can not do anything for me. So I'm back to square one. Or is it two? I'm confused now with all these doctors and procedures.

Part three: No, it's tight hip capsules.

September: I go back to Dr. Johnson, preparing myself to have surgery. He comments that there probably is a small, small tear in my hip labrum, but it is the FAI that is causing the pain. He suggests trying Euflexxa injections to lubricate the hip joint and render me asymptomatic.

November part 1: The meds finally arrive and I get my first injection of Euflexxa, where they take a needle, pierce the hip capsule, and then inject the viscous solution. During the procedure I find out that I have extremely tight hip capsules, which Dr. Johnson notes may be the cause for my FAI. After the procedure, thanks to the numbing agents I receive during the procedure I do not feel any pain in my hip, and Dr. Johnson takes this, as well as my description of the pain, as a sign that the pain is indeed in the joint and not muscular. However, as the meds wear off the pain returns. ...I have a feeling that this new piece of the puzzle is important.

November part 2: I meet up with the chiropractor Dr. Bills for back and shoulder pain, but then mention the tight hip capsules, he then works on them and they suddenly feel a whole lot better. This indicates it is muscular and not a joint problem. This gives me a lot of hope.

November part 3: second Euflexxa injection. Still have pain in the hip.

November part 4: I talk to Dr. Craddock, and he recommends Rolfing, a deep tissue massage. I find one and book three appointments.

November part 5: I mention this to Andrea and she recommends Olga, her massage therapist. I cancel my appointments with the Rolfer and make one with Olga.

Conclusion: There is hope still

So yesterday I saw Olga, and she worked me over thoroughly, and unlike the previous time I got a massage I felt like this was extremely therapeutic. She worked extensively on my hip/leg muscles, and it was an incredible sensation. I told her to go as hard as she could, and the pain was indescribable. It was like my muscles were bubble wrap, and she was a rolling pin. As she slowly dragged her elbow up and down my muscles, I had this sensation like some combination of popping or sparking in muscles I never even knew existed. She commented that my muscles were extremely tight, but they were releasing quite nicely. She worked both my right and left hip.

While she was able to get my left hip to release, she said she was unable to get my right hip to release. She also commented that because this is a chronic problem it will take a while to fix it. I've scheduled an appointment with her next week, and I really hope that next week will be the week the muscles learn to relax. Unfortunately, she told me not to workout after the massage, so I had to forgo the wod.

Today I saw Dr. Bills again, this time exclusively for the hip. As he worked on them, I asked if he noticed any difference, and he said they felt a LOT better, that he couldn't feel as much "gristle" in them as he did last time.

This makes me very happy. It has been a long, long journey, but it seems like I've finally figure it out: Tight hip capsules twisted my pelvis causing the inflammation of the illiopsoas, but the tight muscles also jam my femur into the hip socket, creating the FAI.

I know I've said this before, but I'm very excited by the thought of no longer being in pain. Hopefully there will be no more curveballs, and this will finally kill the throbbing ache that I experience everyday. I write this so that others out there who may have hip pain or any other type of ailment may have hope and learn from my experiences. If I help at least one person out there, then I am a happy man.

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