I am now 12 weeks post op from my arthroscopic surgery for hip femoroacetabular impingement (FAI) and torn labrum repair. I had 4 suture type anchors used to repair my labrum, an impingement on my femur corrected as well as a cyst debrided. I have something called “coxa profunda” in both my hips meaning they are deeper set than typical (it’s the Irish in me). Whether this is considered a true pincer type impingement or not seems to be a topic of some debate currently from what I can read in current medical journals, but my surgeon did a small shave down of the bone around the rim of my socket where he was doing my labrum repair to ease the friction as well as increase the blood flow/give them clear access to the area where the labrum repair was taking place and increase my rate of healing.

My particular surgeon never really used the terminology of cam impingement. He described what I have on my femur as “a very small overgrowth on your growth plate, most likely formed during adolescence; and your hips are just a little deeper set than the standard model.” Granted that was at our first meeting and he is probably used to using non-medical words to describe things to people – and that’s a pretty good way to describe it!

Before surgery I would feel like my hip was about to dislocate every time I would try to sit normally. After seeing the images of my labrum, I understand why since it was so loose and floppy from the tears that there’s no way it could have maintained the seal to keep my hip in the socket properly. It was only my muscles and tendons holding my hip in place all this time – I even had pre-existing scar tissue on my joint capsule, most likely built up from overuse! Now it already feels like the most stable joint in my body – granted that bar is abysmally low with my pre-existing connective tissue disorder.

In Physical Therapy

I learned that my physical therapist had the same hip FAI/Labrum repair surgery that I had done, which I think explains the laid back/focused balance she has. I reported in with the videos of the techniques I had done in class the previous weeks, as well as my ability to run through my yoga introductory routine without modifications. At my last session, I was able to taunt my way into getting an increase in weight for my single leg press from 75# to 87# (3×10) and then said goodbye to the TRX straps and hello to pistol box squats (3×5 on each leg, adding weight next time), and a 20# kettlebell instead of 10# for my balance drills. We’ve added leg box drills to warmups along with a hip up drill that I like to do before BJJ class. Progress is continuing steadily; in fact, I’m having to start to do some additional strength training on my left leg because the quads on that side are starting to look smaller than on my surgical side!

For my home exercise program, I’ve been swapping out some of the exercises I have graduated from in PT for more challenging ones. Now instead of dead bugs we are doing side plank holds for core stabilizing work, I’m doing my pistol box squats instead of standard bodyweight squats, and also adding in a few extra exercises that we do in clinic that aren’t listed in my app. I plan to ask at my next session if she can update my app program to reflect my progress.

By week 14 post-op I will have finished out the 20 visits of physical therapy that are covered under my insurance plan and will be paying out of pocket. I will be seeing my surgeon again at the 16-week mark and we will evaluate then if he wants me continuing with one-on-one rehab sessions for sport specific training (and at what frequency), or if he thinks what I’m doing on my own will suffice.

In Jiu Jitsu Class

Movements have been coming much easier now in class as I’m gaining better confidence in my ability to control my movements safely. Remembering my surgeon’s directives that I can “do any movements that don’t cause pain or pinching, being careful to not overdo it and cause inflammation” is the main key that I am focusing on when drilling in class. The thing I am having to be extra aware of is how much of Jiu Jitsu is contracting the abdominal/hip flexors – and hip flexor tendonitis is one of the top post-op complications that people run into after this sort of a surgery. To counter this, I have been adjusting my stretching routing and also working more posterior chain strengthening work to help counter the anterior tightness. More tummy time at home while reading and attempting to sleep less curled up.

I started drilling some simple takedown moves these past two weeks. Nothing too dramatic, and I was only able to drill to one side safely but it’s a work in progress and I was able to film to show my PT the movement that I need to be able to do with my surgical side as well. For week 11 I was able to do some tight inverted north/south re-guard drills without any pain or pinching, and even spinning into a few loose triangles (zero pressure of course.) For week 12 we were working on guard passing and I was comfortable being in single leg x-guard on my surgical side to work on passes, and also basing in de la riva guard for passing drills, and even doing standing guard breaks to double under and over/under passing combos. My hip definitely felt tired after doing that much focused work, so I took it a little easier with the hip flexor portion of my home PT program this week and did a little more focus on glutes and back.

I discovered that I can safely flow roll with the kids right now since they don’t have the body mass to be able to hurt me (physically at least). I may occasionally let one of them jump on me after they are done with kids class from this point on if there is room on the mats. My ability to chain movements together has become a lot more smooth, and I’m not running into too many positional issues where I have to compensate or adjust for inadequacies in my hip. There are a few things I’m hesitant to attempt doing on my surgical side, and that’s where filming on my non-surgical side to show my physical therapist comes into play – that way she can know the movements I need to work toward confidence in and adjust my exercises accordingly.

I was able to teach class this past weekend including a move that involved some impact to my hip that I did not think about before I demonstrated it. Thankfully our mats are slightly elevated on foam blocks like a gymnastics floor and have a little more give to them than if they were just laid straight on concrete – and it felt just fine, I just didn’t demonstrate it as forcefully as I historically would have. This weekend we have a seminar with Sophia McDermott that I am really looking forward to participating in, more on that with my next update!

12 Week Summary

Twelve weeks post op just sounds really good. I’ve reached the point now where I’m moving well enough in most drilling situations that people will ask me to roll afterwards but I have to decline still. I’ve been doing this long enough that I can compensate around areas of inadequacies and the challenge for me will be to not compensate for those once I’m out of the danger zone for re-injury. The 4-month post-op mark is when my surgeon says he will consider my labrum to be healed from the surgery: that’s when I plan to start pushing for more out of myself in class.

I did not do any research on my surgeon before scheduling my surgery because I knew if I went down the rabbit hole of surgeon research, I would probably spend months down it and would end up in decision paralysis. I chose to focus my research on pre- and post-op preparation and instead leaned on the power of trust transference for choice of surgeon. My surgeon who did my knee surgery a few years ago is one of the top names in the professional sports orthopedics field (over a decade as a dedicated NFL team surgeon) and is who my Jiu Jitsu coach sent me to. He runs his own sports orthopedics group now; but doesn’t do hips himself. I figured I could trust that he chose well qualified individuals to be part of his practice – and that his research into the matter would be better than any information I could find online through hearsay. After scheduling my surgery, I had a surgical nurse teammate ask me where I was having my surgery done and with who, and received a response of “Ok, good!” – so the inner circle validation was there as well! Since my surgery, I have had other people connected with health care tell me that he’s a great hip surgeon, so I guess my approach paid off!

I may go back to weekly updates for a little bit longer – I feel like so much has happened since my last post and trying to condense it all into a reasonable word count is challenging to say the least.