Part 2: FAI and Labral Repair — Road to Recovery
As I mentioned in my last post, this fall, if you see me at the West Loop clinic, I’ll be your fellow patient — as of today I am just shy of 6 weeks post-op from arthroscopic labral repair, femoral osteochondroplasty, acetabular rim trim, and capsular plication.
Part 1 of this blog talked about what that all means, and how to manage it in a non-surgical way. But, sometimes surgery is necessary. I want to share with you my decision making process and why I decided to have the repair and femoroacetabular impingement surgery. If you’re out there struggling with hip pain, maybe it’ll help to see it through a fellow patient’s eyes.
For about 5 years now, I’ve had a “trick” hip. Any time I would sit for a prolonged period of time, when I rose from my chair I’d get a pinch in the front of my left groin, like my leg was stuck. If I stood up and shimmied my leg around a bit, it would unstick and I was on my way.
I had many of the classic femoroacetabular impingement/labrum symptoms:
- Pinching in the front of the hip
- Dull/achy pain that was worse with prolonged sitting
- Occasional sharp catching pain with activity
A few Chicago winters ago, the pain flared up to the point where I was consistently hurting, day in and day out, so I accepted I was legitimately hurt and started regular physical therapy here at React. Not surprisingly, I saw an incredible amount of relief, and was finally able to get through my day to day with minimal issues.
But as time wore on, the joint was still cranky. I drive a stick shift, and clutching was tricky. Sometimes my hip would buckle as I plant-and-pivoted out of the driver’s side. Riding my bike to work was hit-or-miss. Repetitive squatting was misery —I loved doing the high-intensity interval training classes at Crosstown Fitness (insert hyperlink here) but was always that weird kid in the corner doing glute bridges while everyone else was doing lunges. At that point, running was still pain-free and I was able to continue my 4-day-a-week yoga habit with minimal problems.
After about 6 months, I consulted with Dr. Shane Nho at Rush, who confirmed my suspicions about my diagnosis via X-ray and MRA. Dr. Nho, an orthopedic surgeon who specializes in hips, advised me that for that moment, as long as I felt like the amount of activity modification I had to do was acceptable, there was no rush to have it fixed. This was basically the best news I could have gotten, and for about another year and a half I kept managing it conservatively. With PT and some workout modifications, I was able to get my body back in balance, build a ton of glute and core strength, and improve my mobility significantly.
Unfortunately, the bony abnormalities were still there, and on the days when the pain was bad, it was getting worse. The pinching had turned to stabbing and during a flare-up wouldn’t be able to be relieved at all. I had significant muscle spasm in my hip flexors and adductors, my quad was cramping at a moments notice, and my hamstring was shot from trying to compensate for the laxity and incongruence in the joint. First I had to give up HIIT training all together because even one deep squat was misery and eventually I had to scrap distance running because anything over 5 miles flared my hamstring up for days.
So, back to the surgeon I went for the repair. It was an outpatient procedure — I was in and out of the surgical center in less than 8 hours, and it was done arthroscopically, so I only have three little incisions where the instruments went in. They sent me home with an arsenal of equipment: a continuous passive motion machine, to keep my joint moving in the early post-op days, an ice machine, some crazy foam boots to keep my legs steady while I slept, a giant hip brace that made me look thoroughly bionic, and crutches. I had plenty of pain meds, and very clear instructions as to what I could and couldn’t do and how to proceed.
To sum up the first week of recovery I would have to say it looked something like: wake up, nap, nap, go to PT, nap, nap, home exercise, nap, continuous passive motion (CPM), nap, go to bed.
The first three days were a bit of a painkiller haze but after a couple of days I was mostly just taking Tylenol to manage symptoms. I needed a lot of help — help putting my pants on, help getting in and out of bed, help fetching anything and everything. It’s worth mentioning that during that first week you really need a companion, and I couldn’t have done it without my husband helping me 110% of the time.
Since then, it’s been nothing but progress. As of today I’m approaching week 6 and I’m off of the crutches, I’m walking a few miles a day, and I’m able to get up and down the stairs. In PT, my exercises seem more like exercises and manual therapy is helping me make gains in joint/capsular mobility and addressing soft tissue restrictions that I’m not able to handle on my own. I can even manage those pesky pants by myself. (Though shoes are a different story.) There’s a long road ahead, but I’m pleased with how it’s going so far.
I have to say — the great thing about seeking conservative care early was that once I decided to go forward with surgery, I felt like I had really set myself up for success. I was as strong as I could be, I was flexible, my range of motion was as good as it was going to get. Obviously as a physical therapist I’m going to advocate for physical therapy as a first line treatment for any musculoskeletal complaints, but I can’t stress enough that even if you KNOW you need surgery, pre-habilitation is absolutely worth the work.