11 days out from my fifth Prolotherapy treatment

It's not yet two weeks out from the fifth treatment, but I'm really feeling better. I think a lot of the discomfort I was experiencing was stemming from the damage to my rib cage.  It's also pretty amazing how much my shoulder has changed after just one treatment to the shoulder capsule.

I don't know why, but Dr. Fullerton kind of ignored the shoulder capsule this time, even though I was pretty certain I could use another treatment.  He asked of I could hold a plank now, and I said something like, "Maybe??"  I didn't really know how to respond because I haven't tried doing a plank/push up since the last treatment.  ...I now realize that I should've simply said that, but for some reason I felt nervous and just didn't know what to say.

I'm still pretty impressed with how much more I can decompress my left ear now.  It's pretty much identical to the right ear.  Also I haven't felt as near as much need now to try to crack my neck, so that is obviously a good thing.

I still feel the need to try to roll out some areas in my upper back, like where the upper trap attaches to the shoulder blade, I think?   One of the hardest things about this whole process is that because it's my back, I can't easily point to it.  Like I can only approximate the location.  I think next time I will have to roll out and then turn around and show him where my skin is red.

I've really been tempted to go early this January and get a treatment just for my hips, but I think I will probably just wait it out for the next time.  ...if my shoulder/back is still giving my trouble I will book two sessions a week apart, and go from there.  So I guess I'm betting that I will need a sixth treatment on my back.  ...That's kind of sad, but I keep getting so much better after each session.

We will see;  we will see.

Fifth Prolotherapy treatment.

Sorry y'all for not having been more active, my laptop has been down for a month and I really didn't feel comfortable using my work computer to upload blog posts (government security and all).  Anyways, it's back and so am I.  Here's the vid I took right after my fifth treatment.  We had a major breakthrough in that it seems my ribs were "looking pretty rough" under the ultrasound.  When I had the injection at my chest it felt like a huge pressure/weight had been lifted. It was a type of pain I didn't even know was there because I was simply so used to it.

Anyways, here's the vid:

Two weeks out from Fourth Prolotherapy Session.

Concerning the shoulder/back, I'm still pretty weak/sore in the shoulder. Like grabbing and holding onto a soup can doesn't feel good.  It's weird how much it's affecting me. Like I rolled over onto this shoulder in my sleep and the pain woke me up.

I'm halfway there to re-starting weight lifting. Going to do rehab (phase 1) until it doesn't hurt anymore, then doing phase 2 until I feel good with that, then on to sprinting and lots of Pilates Barre method classes. I know I know, a dude doing pilates and barre. But they seem like a really good solution to working my core in the correct manner, and will help me get proper mechanics down.

Once symptom of the laberal tear is my shoulder gets reall tired with constant pressure. Like if I try to hold a plank or a downward dog it really wears out quickly.  So I'm really looking forward to see if I improve in that area.

I'm really interested in seeing how this past session changes things. I think he really got the remaining muscles that were bothering me, especially my serratus.  I'm really looking forward to trying out deadlifting again. I've never done deadlifts without hurting my back, so if this works it will be pretty damn amazing.

I just really hope that my back is done, that I can move on. I accept that the pit in my shoulder capsule may need a few more treatments, but as far as the muscles go I really hope everything is set.  I just wish the Doc had started treating the tear in my labrum, the pit in my capsule, sooner.  It still makes me pretty mad that he hadn't addressed it until now. Hopefully I can get some pity points and he'll do it for free while he works on my hip. 

Speaking of my hip, I'm definitely feeling different. Although it's hard to tell if it is the PRP because four days after seeing Dr. Fullerton I had a varicose vein removed in the same leg.  Well, not removed, but burned shut with a laser that was placed inside the vein.  While my body reabsorbs the burned up vein, I'm experiencing a lot of pain in my groin, not unlike what I was feeling before I started up dry needling.

I do find though that bringing my knee up doesn't hurt like it used to. I am now realizing how much I used to brace myself for pain while bringing my knee up, say to cross my right leg over my left.  It will be interesting to see how squatting will feel.   Can't wait really.

So I'm only two weeks away from being able to try out my new body, albeit I will have to approach things conservatively.  Still, there is a possibility that I won't need another treatment. The pit in the capsule could be completely healed, and it could be that the tissue in my hip Dr. Fullerton addressed is really all I needed. If that turns out the be the case, I will be overjoyed. Of course, if I need a fifth treatment I really won't be mad because I have been experiencing such progress over these past nine months.

As I read what I just wrote I see so much hope and excitement for what's to come. I can't help but think about how I've been excited for what's to come for years now. Heck back in '09 I was pumped because I just needed to figure out the pain in my shoulder and hip and I was good to go.  I wonder if this is normal, or if I am just really, really strange.  I guess I have to be constantly optimistic, otherwise I would just get beat down and wouldn't be able to keep going forward. Yes it's been a long journey, and yes I always think that I'm just one step away from being completely healed, but I figure as long as I keep getting better then I'm doing something right.

And I am getting better all the time. Every step I've taken has made me feel better. I guess my body only allows me to feel as certain level of pain, and as I fix one thing or another I realize how much pain I was actually in.  I am still surprised that I had so much wrong going on with my back and I was still able to crossfit.  Or even walk, for that matter.

For the first time, when I left Dr. Fullerton's office two weeks ago my neck/ear felt completely normal.  This is obviously a good sign. I just hope I don't need a second treatment for the shoulder capsule.

One Month after Second Prolo Treatment.

So I'm 4 weeks out from my second prolo treatment, and I feel... better.

For the first three weeks following the treatment my lower back was killing me. I figured it was just the muscles all inflamed from the treatment. I didn't really stop to think about how that's really different from what I have experienced in the past, I just accepted it.

Anyways, this week my lower back was bothering me I decided to try to foam roll it out. I found that my back was seriously tight, and once I was done rolling out the knots, I felt 100% better. It made me wish that I had done this earlier.

My point with all of this is that the source of my pain could be addressed through soft tissue work.  I think it's important for me to do soft tissue work after a prolo treatment because my muscles responds to the trauma by tightening up resulting in adhesions.

I may feel like I'm worse off the week after a treatment, but if I roll out and break up those adhesions suddenly I can feel how my body has improved for the better.

Riding out this "prolocoaster" has been wearing me down. I'm just ready to get this over with, to be pain free and to get back to lifting like I used to.

I'm also hoping that past session will be my last treatment.  I'm still doubtful, just because I still don't feel right, but the Doc seemed pretty certain I would only need 2 sessions.

I'm looking forward to lifting again this weekend. Eventually I'll test everything out and squat with full ROM, and I'll see if my hips are in alignment now. Used to be off, with the treated hip going lower than the non-treated hip. Perhaps this is from tightness in the hip rather than a sign of how the joint is moving, I'm not sure.  I would be interested to see if I can pass my Ober test now with either leg, perhaps I'll ask my PT guy when I see him next.

...Also, I'm thinking to ask the doc for a prescription of PT so my current dry needling guy can address both hips/lower back. That would be amazing.

Second Prolo Treatment for Shoulder/Back

So Yesterday was my second visit with Dr. Fullerton. When I saw him he had me perform the same functional tests as last time, but this time I was able to pass a couple of the tests! Progress has been made! I Still have a pit in my left hip capsule, and there was still a lot of work to be done on my back.

In fact, more issues were found with my back muscles than last time. I don’t know if it was crossfit or

Band-aids where I got
poked. Also, I feel like
 my back is  really
asymmetrical

high school wrestling, but something really messed me up. Thankfully, Doc keeps searching so that’s why he keeps finding things. I am very impressed with his thoroughness. They call this the “old couch new carpet” problem. When you get new carpet (fix one issue) you suddenly notice what you once thought was a perfectly good couch (some other body part) isn’t actually all that great (there’s an issue/pain).

 After he addressed issues with my back muscles the first time others issues became apparent. I didn’t really notice the pains just standing around, but when he poked and prodded me there were definite spots of tenderness that weren’t there before. Leaving the office, I was actually feeling pretty good. I felt stiff as all get out, and I definitely didn’t feel normal, but I have felt worse. I chalk it up to taking a Tylenol 3 with codine beforehand.

 At the end I commented about how Dr. Fullerton hadn’t addressed my labrum yet, and he said that he didn’t treat my labrum last time, and wasn’t planning on doing so since it didn’t seem to be causing me issues, combined with the fact that the tech report on my MRI was a little wishy-washy. I felt a little hesitant about this, but I’m not really in the position to boss a doctor around, especially while on painkillers.

Because he addressed so many muscles/points around my spine, both lower and upper back, I feel pretty stiff while typing this. I can’t really lean over to get anything, and even standing causes some issues. Thankfully I have a wonderful wife who is helping me out while I lay on the couch with a heat pad on my back as I watch the NCAA tournament. It could be worse.

Phase Two of Rehab from Prolotherapy

8 weeks out from the first prolo treatment. I can see why Doc wanted to space these treatments out 9 weeks apart.  I'm still feeling everything... settle.  I now really don't feel any of the pain that I felt after the treatment when I hold things, and I'm still not cracking my neck like I used to, so that seems to indicate progress is being made.  I've started working on strength and range of motion.  I think, for my shoulder muscles, using the Indian Clubs is pretty much ideal. It works on strengthening and stretching at the same time, plus it's pretty fun.  In addition to using Indian clubs (I use them as a warm up) I am now doing an upper body day and a lower body day, here's the program:

Upper Body (A)

DB Bench press (5 X 10)

Lat pulls (5 X 10)

DB Rows (3 X 12)

Tricep extentions (3 X 12)

Bicep Curls (3 X 12)

Shrugs (3 X 12)

Shoulder Raises (3 X 12)

Lower Body (B)

KB stiff leg deadlifts (5 X 10)

KB Box squats (light) (5 X 10)

DB Lunges (3 X 12)

Leg Curls (3 X 12)

Leg Extentions (3 X 12)

Note: one thing that is important to note is that I don't have any movement where I elevate my shoulder past 90 degrees. I'm still not ready for overhead movements like incline bench or overhead press.

The frequency of my workouts is Day 1 is conditioning (sprints), Day 2 is A, Day 3 is B, rest day, then repeat. It's three days on, one day off, like crossfit.

Leg day killed me, especially the lunges. On the second set my hammies cramped up so I just stopped.

I've noticed now when doing bench press I experience a clicking in the very front part of my shoulder. It isn't accompanied by any pain, but this might be important because Dr. Fullerton thought there might be something wrong with the front part of my shoulder. Who knows.

I'm still feeling all the normal pangs, but then all the pangs are not bothering me as much as they used to. I feel healthier. I feel like I'm better. I actually feel like I can get back to 100%, something I haven't experienced in over a decade.

Six weeks out from first treatment

So it's been two weeks of doing the scapular stabilization exercises. After the first day of exercise, my muscles were sore/unhappy for about 5 minutes, but then everything went back to normal. I get the same experience after each workout, but each time it's to a lesser extent.  These past couple of times I've had no increase in pain after working out, so I think now I'm going to start getting back to strength/ROM, so that means I'll get to work with Indian clubs, in addition to some other dumb bell/barbell exercises.

I think I've been babying my body for a while now. I've been really conservative just because I want to heal up ASAP.  But when I expressed my concerns to the Dr. he just said to let pain be your guide and to keep moving.


Letting pain be my guide has been difficult, because right now I'm back to being in pain all the time.  The amount of pain/discomfort that I'm in is less than before I started this, but it's still there. So knowing that my muscles are still frayed, is it ok to use them, to push them? It seems from Doc's advice that it is ok.

The pain/discomfort that’s going on in my back is... evolving. It used to be just this big knot of pain, but now I can feel each muscle separately and feel the pain in each one.  It's like a room of people has gone from everyone screaming and you can't hear what they're saying to everyone is talking loudly and you can now make out each conversation. Hopefully after the second treatment it will be reduced to a quiet murmur.

Concerning my hip. It's been... interesting. When I mentioned to one PT that I still experience hip pain despite the fact that I haven't squatted/deadlifting for six weeks he asked if I've considered the possibility that it's a sports hernia. I have, in the past, been given that diagnosis, but I think that is not what I have.  The main reason being that there are times where I do not experience any pain. I think because there are things that I can do to relieve the pain, it's not a sports hernia. I may be wrong, I'm not an expert on the subject matter. However, I figure it my groin pain is stemming from some type of structural damage then it should be fairly constant. That's how it was before I had PRP injections to treat the torn labrum in my hip (constant pain no matter what I did).

As of right now, when my groin/pectineus acts up I also have a tight TFL and possibly glute medius and piraformis.  I roll out on a soft ball, and it is amazingly painful but when I get that release in the back of my hip, the pain in the front seems to go away, or at least diminish greatly.

So it seems that my current hip/groin pain is coming from tight muscles in the back of my hip, and those, in turn, may be tightening up because of the structural damage to my left hip capsule or to the fact that my left spinal erectors don't seem to work very well right now.  In either case, that first week after my first prolo treatment for the left hip/right spinal erectors, I had no hip/groin pain whatsoever.  ...I hope this hasn't been too confusing, if there's any questions just leave a comment and I'll be happy to respond.

I've starting running hard for short bursts on the treadmill, and it doesn't seem to cause any trouble whatsoever, so I'm thinking it would be ok for me to get into sprinting. There's a sprinting group that works out nearby. I'd like to join them but I'll have to tell them that in about three weeks I'll have to stop going for about a month.  We'll see what happens.

Rehab from Torn Labrum in Shoulder: First Day.

Excited because today I get to do resistance work!!!
Going to start out conservative, going to work on scapular stability.  I should point out that I'm not just working on recovering from a torn labrum, but I'm also working with damaged rotator cuff and various back muscles.

On a related note, I've realized what I'm doing is broader than just treating a torn laburm. Through this process I've found out that I have an injured rotator cuff as well. There are a lot of people out there that might benefit from avoiding surgery to repair their rotator cuff, so I'm going to make it easier for them to find some of these videos.  A torn labrum and damaged rotator cuff go hand in hand, actually. This might be one reason why surgery repairing a labrum only might be ineffective in relieving pain, it might be only a partial repair. Plus, if you have poor mechanics you're just going to tear it again.

Anyway back to my protocol for scapular stabilization.  My rehab will go through three different phases. First is endurance, second is range of motion/strength, and the third is speed strength.  Endurance will get those stabilizers back to strength, so I will develop proper mechanics. Then I can work on strength, like bench press. And after that has been worked some then I can work on explosiveness, like in Olympic lifts and sprinting.

Here is the document describing the exercises I'm doing for phase one. I'm planning on doing only 2 sets for the first two times, and after that bump it up to three. Also, I'm doing these every other day, adding weight bit by bit. Hopefully I can move on to phase two in two to three weeks, depending on how I'm feeling.

Post Prolo: First Day of Exercise

So it’s been two weeks since I saw Dr. Fullerton and I’m now able to do really low-impact stuff. For example, I can now walk on a treadmill for 10 minutes!!!!!! Sad as that is, I’m happy to be out doing something. …I’m also a little surprised how winded I get walking on a 3% grade incline.  As I understand it, if I feel good from today’s work then I can do 15 minutes 

We will see how it goes.  In another two weeks I will be able to do some type of resistance training. I’m already trying to plan out some stuff and when I have it all figured out I’ll post the protocol here for all to enjoy.  I’ve reached out to my friend/trainer/pt guy in IL who programmed my rehab for my hip in the hopes that he’ll do it again. If he does this will be amazing because his understanding of the body is amazing.  Here's the latest entry for the Vlog:

Seems to be a Connection between my Right and Left Hip

Interestingly enough, even though Dr. Fullerton addressed my left not-that-painful hip, the pain in my right pectineus has gone away.  I don’t understand the reason why, I mean how could a pit in my left hip capsule affect the front of my right hip?  But my right hip pain really isn’t there anymore. On a scale of 1 to 10 it was down to like .5, but now it’s where I forget that I’m pain free. It’s the kind of pain free where I haven’t thought about it, which is the ultimate goal.

I have to admit, I wonder how much of my struggles have stemmed from the injuries/weaknesses in my back.  I know the back muscles (especially the rhomboids) play a large part in stabilizing the torso with the front squat, and that was definitely where I would fail.  My legs could handle the weight, but I would still dump the bar on the way up because I’d lose my balance.  I’ve been doing dumb bell rows, and I’ve noticed it’s way easier to pull the weight with my right arm than it is with my left. The weakness has never felt like a strength issue, it’s always felt like a “muscle just stops responding” issue. Having a frayed trap/rhomboid/lavator will do that I guess.

…The fraying of the muscles in my lower back could also be a reason why I struggle so mightily with deadlifts. A common reason why people fail a deadlift is a weak upper back. If my lavatory, etc. are frayed and weak this could be the reason why I have so much trouble with the heavy pulls. Also, if my left spinal erectors are the ones doing all of the work, then that could explain why my lower back just kills me after deadlifts.  It’s never been a matter of leg strength. Never has been. I was doing leg presses (don’t judge) of 450# for 10 reps pretty easily right before seeing Dr. Fullerton, yet I’m struggling pulling 300# off the ground and doing anything above 230# with the front squat is killer.

All these things give me hope that once I’m healed I’ll have a much higher ceiling with the front squat, deadlift, pull ups, and rows.

And the Vlog continues:

First Prolo Treatment with Dr. Fullerton

Fist off I have to say that I really like Dr. Fullerton. He's very professional and very thorough.  Heck even my wife likes him and now thinks that prolotherapy is a valid form of treatment.  The plan was to meet him on Thursday afternoon for an examination, and then friday morning for the treatment.  The first meeting went much longer than I expected. First, it took a long time to go over my medical history. It was fairly confusing for both the PA doing my intake and myself since I've seen four different doctors in VA and IL for the hip that I wasn't seeking treatment for, while having seen a PA in NC for the shoulder pain who gave the diagnosis of a torn labrum.  There's a lot of information there that can get jumbled up over the six years I've been seeking treatment.

So after my intake was complete Dr. Fullerton came in.  Like I said, he was very thorough.  He had me do a bunch of different functional tests to see what was wrong.  It was very similar to getting an assessment from a PT.  He then used the ultrasound machine to see what was going on.  He also did palpitations to see if any spot hurt.  Using these methods he pretty much pinpointed the exact areas of pain in my back.  The lavator, the rhomboid, the trap, and the supraspinatus.  He said these muscles all looked "frayed". That's not exactly what one likes to hear, but he said he's seen worse.  This fraying is all in addition to the torn labrum.  He also found some weakness in the spinal errectors on the right said of my back.  If they couldn't do anything, perhaps my left side has to overcompensate, which is why I've always had a tight QL and pain on the left side.  He also examined my left him, the one that now doesn't seem to move as well as my right, and said there was a pit in the capsule.  That doesn't sound good.  He also found out that when doing internal rotation with that him it caused pain on the inside of the hip joint, the part right next to my junk.  I'm not sure what all of the diagnosis were or meant, all I know is that he found a boatload of problems and he had his work cut out for him.

 

Then I saw him the next day for treatment.  He had me do all those tests that I failed again. Then he injected me with lidocaine to numb the relevant body part.  He waited for the numbing agent to take effect, and then injected the body part with dextrose under ultrasound guidance.  After that he then had me do the test again, and I passed!  It was very strange how immediate the effect was.  For example, he twisted my hip into internal rotation and it hurt on the inner part of the joint. He then injected some solution into the outer part of the capsule, did the motion again, and it no longer hurt!  After he went over everything with Dextrose, he then did the injections of the blood.  He had 180ml drawn to be spun out, so I imagine he had a lot of PRP to work with, so I think he injected everything with the PRP as well.

There was almost no pain during the treatment. None.  The lidocaine really worked at making the real injections painless.  The pain that I did experience came from the pressure of having so much solution

Lots of band-aids after the treatment.

injected into my body.  The pain immediately after the treatment got a little intense.  It's not that the pain is really that severe, is that you know you can't get away from it, nothing you can do will alleviate the pain, and that's hard to accept.  They put an ice-pack on my back for 10 minutes (That's the max you want to do, and only the day of since you don't want to reduce any of the acute inflammation it's suppose to cause.) and gave me some Tylenol and I was good to go.

The injection sites feel like hot water balloons underneath the skin.  My hip didn't feel anything for the first two hours, but my back felt it immediately.  I was able to sit in the car while we drove back home from Austin, and then I went out and ran some errands and then went to the museum with some friends. If I had the chance to do it all over again, I would've just stayed at home and slept, but I was able to do everything and anything I wanted to.

I really like that Dr. Fullerton was able to find so many things wrong.  Well, I don't mean to say that I'm happy I have so many things wrong with me, just that I feel that he was so complete that after these treatments I won't have anything unaddressed.  I won't have anything lingering.

I now definitely want him to examine my right hip once he has finished fixing the left hip, if the left hip proves not to be the source of the lingering pain in my right hip.

Given a choice between the two, I would rather go to Dr. Fullerton than Dr. Hauser. Dr. Fullerton's examination is much more complete. Dr. Hauser isn't really for diagnosing, just fixing.  So if there's something missed in the diagnosis, Dr. Hauser isn't going to find and address the problem.

Here's the part of my recordings the day of the treatment:

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.

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.

An example of different prolotherapy styles

Not all prolotherapists are equal, experience is one key, but another is approach.  Here is an example of what the majority of prolo experiences are like:


Here the Dr is using fluoroscopy (basically continuous X-rays) to guide the needle into the hip and specifically the tear.  Very little solution is used, and he has to be very precise in delivering the solution to the tear.  I liken this to a sniper taking out a specific target.

Here is Dr. Hauser's method, the Hackett Hemwall method:


I should also note he had me flip over and worked on my backside as well. The man uses a lot of solution, no guidance, but covers the entire area so even if he misses with one he'll hit it with another. I liken this to carpet bombing.

Sniping sounds like a nice tactic, but your sniper has to be spot on, and even with the xray a miss is possible.  Also, and more importantly, you have to be dead sure that your target is the real target.  Maybe you will hit the tear, maybe your won't but what if there's some other issues as well that's causing the pain?  I know for damn sure I have no pain nerves in my labrum, so maybe other things are causing the pain, and so maybe other things need to be addressed.  If you carpet bomb that shit and make sure no one is left standing, you might not be sure what the problem was but you can be damned sure it was taken care of.

...My hip is really so much better then what it used to be, all thanks to Dr. Hauser.  He's not the first prolotherapist I've seen, but he damn well will be the last.

Rehab is slow going. Literally

Ok so I've been rehabbing the hip for a while now, and I thought I should share what I'm allowed to do and (more importantly) what I'm not allowed to do.  The important thing is for me to work on strengthening all the stabilizing muscles.  If I work them too hard too quickly I can undue some of the healing that has taken place.  Alright, here are the rules for my rehab currently:

• Begin SLOWLY AND GRADUALLY
• Begin with more reps at a lighter weight and slowly increase the weight. I need to gain endurance before I can increase how much I lift so that my hip will be stronger and less likely to become injured.
• When doing my lifting it has to be in click free range of motion. If I begin or continue to get pain or clicking/clunking during high activity it may mean that I need one more treatment.
• When I first begin lifting weights it has to be a slow smooth motion. Do not rush into the exercise. Slowly lift the bar and do more reps.
•  Do not do anything that causes a sharp pain
• Having a little pain during exercise is ok but the pain has to go away within 2 hours of my exercise.
• No triple extension of the hip yet.

So I have to start doing things slowly, gradually increase the ROM, and build up to high reps (like do sets of 15 reps) and then increase the weight.  It's a little annoying that I can't work on speed/explosion strength but all in due time I guess.

So here is my lifting routine right now. I'm only listing the leg workouts since that's what I'm rehabbing, but I'm also incorporating upper body exercises as well (want to look buff for the honeymoon). 

Day A

Quarter squats

Hip Adduction

Day B

Modified Deadlift

Hip Abduction

That's it for now.  I'm doing 3 sets of 8-12 reps, if I can do 12 reps then I up the weight.  It's not sexy I know, but for now it's all I can do in terms of strength training.  I've also been given the green light to use an elliptical machine, so now I can work a little on cardiovascular endurance.

Looking forward to being able to squat and sprint, really hope this happens within a couple of months.

Neck/shoulder is feeling awesome

I've only had two treatments for my neck/shoulder, and I have to say it's feeling a whole lot better.  I haven't cracked my neck at all after the last treatment.  To be honest I don't know if I could crack my neck if I tried, the joint feels that much more stable.  I still find myself releasing all kinds of knots in my neck, so it's not 100%, but I don't feel that itch to crack my neck like I used to.  I also think my neck muscles are  tightening up because they are responding to another, different muscle that is tight and I just can't get that one source muscle to release, if that makes any sense. So hopefully when I see Bobby he can release that one muscle and boom I'm set. ...I can not stress how much of a role massage therapy has played in my recovery, I think it has really accelerated the process with prolotherapy.

I'll give you one guess as to
when I took this picture.

One of the biggest things is I can now wear my watch.  A couple years ago I bought myself a Breitling Super Avenger, which weighs a hefty 153.30g, and that's without the bracelet!  I love this watch, but I couldn't wear it because after a while the weight would pull on my neck and shoulder and make it worse, especially when I was dealing with the tendonitis in the shoulder. 


Now, I can wear the watch and it doesn't seem to set off my neck/shoulder.  I find myself wearing it all the time now, and it makes me happy.  So thank you Prolotherapy!

Possibly last hip treatment, first shoulder injection

So I saw Dr. Hauser for hopefully my last hip treatment.  I’m hopeful that it will be my last treatment, but I’ve also been through too many “hooray I’ve fixed my hip” experiences to really celebrate until it is completely done with and I stop experiencing pain in my hip.

My recovery with each session is faster and faster.  However, for this last treatment Dr. Hauser decided to be real nice and inject me with 80cc of Sodium Morrhuate instead of the regular 60cc.  ….That is a lot of solution to get into your hip.  But even with the eighty injections my hip was feeling less locked up then it had the previous time.  It still hurt (the sodium Morrhuate tends to burn), but that’s what the vicodin is for. Day of I was still able to walk and go up and down stairs, albeit with a bit of a limp.  …On a side note I should mention that I try hard not to limp, because last time I limped the muscles in my leg patternized in such a way it caused a lot of discomfort, if not a touch of pain.

I asked about when I can get back to squatting, and the answer wasn’t exactly the best.  After allowing the three weeks for recovery, it looks like I’ll have to ease back into it a bit.  Starting with half squats and stuff like that, gradually getting more and more range of motion back.  I’m guessing I can do power cleans and maybe some other stuff, but I’m excited to get back to really working out.

I also asked him to check out my shoulder, and he disagreed with my self-diagnosis of supraspinatus laxity being the culprit.  Instead, because of the way that I crack my neck to feel relief of pressure, he believes that my issues stem from laxity in my neck.  Specifically, the ligaments/tendons that are connected to my C6 and C7.

He actually seemed hesitant to try prolo for this, suggesting I try the more conservative treatment of wearing a neck brace when I sleep.  Just by not cracking my neck, things should slowly go back to where they should be.  However, I’ve got money in my flex spending account that I need to spend and I’m all for healing the fastest way possible.  So I’m now doing a combination of prolo for the neck and sleeping with a neck brace on.  I feel a little silly wearing the thing, but I’ve worn it and I think it helps.

The hardest thing is that I can’t crack my neck.  It wants to go so badly, but it’s been two days and I’ve refrained so far.  Each time I want to I just foam roll the knots in my neck and the want lessens.  This is a tough one, but I want this to be over asap and that means no cracking.

Thankfully I can do pretty much everything with the neck injections.  As long as I keep good form, I can do pretty much anything, so once I’m back with the hip working at 100%, this won’t stop me.

Again, I really cannot believe that I should be done with hip treatments, and am on my way to healing my neck/shoulder.  Yet here I am, on the cusp of fixing both.  This year has been turning out to be a damn good year.

hip is getting better!

Met with Bobby yesterday, and he had some pretty awesome news

1.       The pectineus did not feel damaged.  It’s a stabilizer that is being made super tight, like the psoas was, to protect the hip joint.  I think I’ve always felt pain there, there have been occasions when I thought there was something wrong with a hip adductor.  I just didn’t really pay attention to it because my psoas was stealing the show being insanely tight.  Which leads me to my next point…
2.       My psoas was tight, but nothing like what it was three weeks ago.  When he worked on the muscle it didn’t put up a fight, it released fairly easily.  This is fantastic news, progress is being made!

I see Dr. Hauser this Monday for another treatment, and I have to say I’m super excited.  I never thought I’d look forward to having 60cc of sodium morrhuate injected into my hip through 60 injections at once, but that is the case.  The pain is temporary, which is way better then experiencing pain ALL THE TIME.

The next step is my shoulder.  I still have a lot of tightness in my scalenes that I work on constantly.  Bobby worked on them and there were a good ten or so knots in my neck that he had to work through.  On the ride home I felt more comfortable than I had in a long, long time.  My neck and tricep muscles are tightening up in order to protect my shoulder joint (specifically the Acromioclavicular joint, otherwise known as the AC joint).  I believe what is wrong with my shoulder joint is that rotator cuff injury I had four years ago when I just started crossfit, combined with sleeping on my side for years, which may have caused some weakness and laxity. 

How am I guessing this?  Back in June last year Bobby figured out that it was sleeping on my side that was causing all of my shoulder pain.  So I already know that sleeping on my side helped cause this situation and I have an injury to my supraspinatus.  Then I read this paragraph on Dr. Hauser’s website (excerpt from here):

The supraspinatus tendon often refers pain to the back of the shoulder. Sleeping on the shoulder causes a pinching of the rotator cuff muscles and can lead to rotator cuff weakness. There are cases where the cause of the rotator cuff tendon laxity was due to years of sleeping on the shoulder.

…This is exactly my situation, and Dr. Hauser seems to be once again promising a cure.  I told myself that I would wait until after prolotherapy proves to cure my hip to start working on my shoulder, but now that I’m seeing results I’m itching to end this shoulder pain as well.

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.