Labrum seems fine, pulled groin

Well, I can say with quite a bit of certainty that I have a pulled groin.  I saw Bobby again this Friday and when he worked on my pectineus and adductor magnus it was pretty painful, for the second time.  However, my psoas and everything else was pain free.  Also, the pain just feels… different, it feels like an injury to the muscle rather than the muscle is tight to protect the hip joint.  So I think I can now say that I’m done with PRP for my hip, and am glad I can close that chapter of my life. It has been a long time coming, let me tell you!

I guess I’ve just been making the pulled groin worse and worse over the months with Starting Strength, and now I feel pretty darn foolish.  I mean, I just figured the hip pain was related to my labrum as was something I could just ignore.  Instead, I was just making an injury worse and worse.  At least this groin pull should be a lot easier to handle than any issue with the labrum.  However, groin issues can linger.  I mean, I basically didn’t squat for a year, did rehab on the hip and then slowly introduced squatting again, and even then when I started adding weight it reared its ugly head again.  So it seems this injury will have to be dealt with patience. A lot of patience.

I saw an Orthopod and he prescribed physical therapy, so I have that if I want.  I also plan to see if he can write up a letter of medical necessity so I can have massages covered by my FSA account, that would be awesome.

From what I can tell, one reason why you pull a groin injury is weak abs.  That sounds about right, given my abs have always been weak and I still have a hard time getting  them tight while I squat. Weak abs, actually, are pretty much the culprit for all of my hip problems. Weak abs led me to anterior pelvic tilt, weak abs led to tight hip capsules, weak abs led to the tear in my labrum. And now they have led to a pulled groin.   I finally got the knack of engaging my abs while squatting near the end of SS, but I worry that by the time I return to squatting I will have forgotten everything. I think I’ll do some Pilates in addition to everything else when my groin is no longer an issue.

This is really annoying though.  I mean, I take my squat from 125 to 270, gain 20 pounds in 14  weeks, and all for what, just to have it all go away due to injury? I’m tempted to now just take this as an opportunity to go into a cutting phase, but I really don’t want to just yo-yo between 200 and 180. I will have to come up with a plan, a goal, and then figure out a way to get there.

Good news on the shoulder front.

Well, after the last prolo session my shoulder has gotten way, way better.  I saw Bobby and asked him to check out my rhomboid or lavater, and it was my rhomboid that was super, super tight.  He worked on it for a bit but after going nowhere fast he decided to release my tricep first, then did the rhomboid.  The rhomboid released almost too easily. So it seems like my tricep and rhomboid were playing tug of war, with perhaps mymedius scalene joining in on the fun too.  But wow after that almost everything felt normal.

Saw the Chiropractor as well, and for the first time ever, in the 1.5 years I’ve been going to her, my C6-C7 joints were not out of alignment.  This is pretty awesome, I think we made huge strides in the last prolo treatment.

Although everything feels much better, it’s not yet 100% and I have another appointment with Dr. Hauser tomorrow.  I will only have him work on my shoulder, and this, I think, will also be my last visit concerning this matter.  Feels really, really, good to be done with this.

First it all started with tendonitis in the shoulder, then it progressed to working on the scalenes because it was causing referral pain in my back, I retaught myself how to sleep, switching from ALWAYS sleeping on my side to sleeping on my back, and then I learned that I'm tricep dominant, and that was messing up my neck, and then after that I learned that just hanging from a bar would help me out, but every time I peeled back one layer of pain/discomfort it would only reveal a new, different one.  As I look back on various posts on my shoulder pain, I found this particular passage:

I really, really hope that I can find a cure for all of this pain I experience. Not a day goes by that my hip and shoulder ache or throb, and imagining living without pain just sounds like an idea that is so tempting I don't trust it. I catch myself getting excited at the idea that PRP could be the cure for all my ills, but I have to remind myself that there is a chance that it might not work, that I might have to deal with this pain a little while longer.

That was writtenOVER THREE YEARS AGO!!!! Wow I am one stubborn SOB, you think I would've thrown in the towel after all this, after all this pain and discomfort.  But for some reason I am determined to fix these issues, I don't feel like I should have to live in pain for the rest of my life, that I'm too young to start limiting my activities. Even though it seems like beneath every issue/injury is another one just waiting to reveal its ugly self, I figure it has to come to an end some time, right?

I've tried not to let these issues define me, I don't talk about them to anyone except for my wife, and even then I try to limit it.  But these issues have been what has been motivating me to keep updating my blog, there always seems to be a new breakthrough, a new angle I haven't thought about before.  Hell, I haven't even done a WOD in like 16 months, yet I still consider this a "crossfit" blog.  Blog-wise, injuries seem to be all I have, really.

Eventually, hopefully, I will run out of injuries to talk about.  And when that time comes, I'm afraid I'll stop updating this blog. But at least I will be happy and pain-free.  That's a really, really nice goal.

All signs point to pectineus

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

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

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

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

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

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

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

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

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

When is enough?

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

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

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

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

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

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

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

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

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

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

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

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

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

Exercises to treat FAI/tight hip capsules

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

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

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

d

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

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

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

Still getting stronger.

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

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

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

5 rep back squat PR

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

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