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Hip Surgery – 13 weeks post-op

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I was worried at the beginning of the week that I might have overdone it for the first time.

At the seminar on Saturday – the day after my 12-week mark – I was the seminar guest instructor’s demo partner for techniques. Since it was all guard retention work, and my right/surgical leg is my lead leg, my surgical leg was getting wound up and working overtime for the entire 90-minute seminar. In addition I was drilling the moves myself too of course – because a gal’s gotta learn! It was spider guard details/variations to a shin guard dump sweep with some options for then coming up on top to control.

After all that I cocooned up for the rest of the weekend and did take my meloxicam that evening as well as Sunday night. My surgical hip joint itself feels okay, it’s just all the stabilizing muscles around it feel very tired and well worked over.

Monday

At physical therapy I reported to my PT what I did and she told me that as long as I was able to get out of bed the next morning without feeling pain, then it is fine. She wants me to keep doing more work and pushing it this next week since we are in the strength training and rebuilding portion of my rehab now.

I did feel some extra stiffness in my hip while warming up on the elliptical, but I did warm up in just a few minutes and it went away. I’ll have to make sure I’m not slacking off on mobility training while amping up strength – just to keep the stiffness at bay!

Exercise highlights this session: I got to do my straight leg raises over a 12-16ish inch block this time – I had plenty of clearance for that one thankfully while sitting upright on the table and I actually felt it activate my quads a bit more than I expected. For my leg press we kept me at 87# for the single leg since we increased that last week, but I added reps with my left leg while my right rested between sets (my right thigh has noticeably more muscle than my left now, trying to balance that out a bit). My pistol box squats were changed to 2×10 on each side, and then 3×10 of bodyweight squats with elevated heels.

I had a fun new movement to strengthen hip rotation! Just standing on one leg with it slightly bent and holding onto something about shoulder level, I keep my other leg slightly behind me as I allow myself to sink back and rotate on my hip first one way and then the other. It’s hard to describe but man does it feel good! Finally, I was taken out to the gym side of the clinic and put on the hamstring curl machine to do 3×10 on that. I elected to do 25# of fast curl and slow to lower reps. I could have done heavier weight without the slow uncurl, but I’m rebuilding so I’ll start out low.

By the time I got home I was ready for a nap but plugged into my work computer instead, and then proceeded to roll onto my belly and keep everything stretched out as it cooled off. I went to Jiu Jitsu class that evening and was able to drill de la riva guard sweeps without any problems, including a hook sweep using my right leg as the hook to sit up on/over. I skipped out on sparring rounds as per my usual but felt pretty good overall – it was definitely a jam-packed day!

Tuesday

The real test of Monday was how I felt waking up Tuesday morning – and I woke up feeling just fine. I had no soreness, just a little muscle tiredness from the energy expenditure. I noticed a little more tightness in the deeper abdominal muscles on my right side, so for my morning stretching routine I gave some extra time to that area and my hip flexors – making note to take a few extra breaks from sitting during the workday.

In class that morning we drilled the same move that was taught at the seminar on Sunday – it was good to review the movements! I did some super light free movement with one of our black belts for a couple of minutes during sparring time which felt pretty good although that’s the extent of what I was willing to attempt doing at that time. I had originally set myself the line of only drilling until the four-month mark, but my PT wants me to add more sport specific activity during the week, and I don’t know that I can do that without starting flow rounds.

I went over more focused stretches and strength exercises during evening competition classes. For strength training I did the heel elevated squats, standing hip rotators, pistol squats, single leg kettlebell balance drills, and a few others. I’m breaking a sweat now with my PT routine now which is good, although I have diverted almost entirely away from my routine listed on my app. I really need to remember next week to request an updated app routine from my PT. I get daily reminders to do my exercises and just click the button that I completed everything – I just modified everything up to a more intense exercise.

Wednesday

I did more stretching in the morning on Wednesday. I’ve been feeling a bit more overall soreness in my deep abdominal muscles on my right side (which are the main hip flexors) with the little extra push I’ve been doing in class this week stacked on top of the seminar and then the extra exercises in PT. I’m working to counter that with more stretching and belly time to keep it from becoming an active problem.

That evening I taught my usually scheduled ladies no gi class. I was able to demonstrate techniques from closed guard including options for maneuvering to a ghost armbar and then taking the back. I stayed for the advanced gi class afterwards and drilled for 30 minutes the techniques we learned at the seminar on Saturday – adding on a submission finish to the sweep (with the feedback from the class instructor). I then proceeded to watch sparring for the rest of class and mused over if I could start adding flow rounds in this week or not.

Thursday

New achievement unlocked in class this morning! I was able to be comfortable with drilling the move and also having it drilled on me. We are still working on de la riva guard sweeps which are primarily done on my lead leg – which was the one which was operated on. So it does feel pretty good to feel stable enough to be able to let people sweep me off that lead leg – even if it is only during light drilling practice.

I got really frustrated in morning class however because my knee had a minor subluxation. It’s a pretty common occurrence for all of my joints and usually doesn’t cause me any harm beyond some temporary inflammation, but it’s just an annoying reminder of my need to be hypervigilant at all times. I ended up not staying for evening class and opted to go home to rest my knee and test out the new red/infrared light mini panel that my ortho recommended for collagen/inflammation. It did seem to have a soothing affect, so I’ll add it to my evening joint care routine.

Friday – The 13 Week Mark

Today is the day that marks 13 weeks since surgery and it was another day of mostly me working from home. It was marked however by the second of our team association ladies competition class in the evening – I decided to test myself to see how many of the drills I was able to execute safely. The short answer was that I was able to safely do all of them myself, although there was one of them that I was unable to safely have done on me (rolling back take) due to the impact and twisting motion around my hip.

I was getting really hyped up and feeling frisky enough that I was about to throw caution to the wind and jump in to spar lightly when coach caught my eye and said a quick “you’re not ready yet”. He usually lets me do whatever I want (because I’m usually trustworthy), but he’s the coach for a reason and will put his foot down when needed.

Conclusions

I am struggling right now to find the balance for what more I should be doing. I know I don’t want to overdo it and hurt myself, but I also don’t want to sell myself short and be doing less than I could be doing. Erring on the side of caution has been the theme of my recovery and it seems to have been working in my favor thus far, although at this stage of my recovery it is driving me a little crazy. I do for the most part feel fairly normal and capable of doing most of the things I want to do.

Sticking to the plan is probably the best right now still. Who knows? Maybe when I see my surgeon again in 2 1/2 weeks he will tell me to go ahead and amp it up since it’s the 4 month mark and my labrum is all good for impact? I can wait until then at least to see what he says about adjusting my training plans at any rate!

Hip Surgery Recovery – 12 Weeks Post Op

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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.

Hip Labrum Surgery Recovery – 9-10 weeks post op

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Week 9 – First Outdoor Bike Ride

I dove right into it this weekend by taking my first bike ride since surgery on Saturday. My dog was out of food and the pet store that makes his is just a mile and a half away from my apartment – which seemed like a good distance for a test ride after getting the okay from my surgeon for outdoor biking.

I started out with the idea of just biking up to the top of the nearby hill, and checking in with myself to make sure I was still okay to continue. It was very slow going. I did not push for any power, walked up steeper hills, and took breaks. I took a slightly longer route getting to the pet store in order to avoid a busier road (staying on the sidewalk of course) which ended up also having more hills. Overall, what would have previously been a 20-minute round trip ride before surgery took me about 50 minutes including the time to pick up the food. However, it still felt like a huge accomplishment to be back out there! I am not a speed cyclist to begin with and have always tended to bike in a more upright position – so my normal biking style does not put that much pressure on my joint anyhow (in hindsight, that’s probably because of the chronic tears/impingement in my hips). I still felt good the following day on Sunday when I hung out with the ladies during our Sunday ladies BJJ class – so apparently my pacing was spot on!

My goal is to do short bike rides on the weekends until I work up the stability and stamina to ride my bike to work again. It hopefully won’t be too long – depending on others for rides to work for this long has been very annoying.

New Physical Therapist – Monday

I got to meet my new physical therapist on Monday! She’s taking over just at the interval where I’m switching gears to focusing on strengthening more so she started by adding some more strength/stability training to my program. It was a good balance as I was not sore the next day and didn’t feel inflamed, but still managed to get my heart rate up a little bit. Here is the new stuff:

  • Shuttle leg press. Really light weight for first time (I think just 50#) She said we will increase next time if I feel okay the day after this time
  • Lateral heel tap downs. (I don’t know the official name for these) I stand with my surgical (right) foot sideways on a step and let the other foot hover off the edge. Keeping hips level I do mini “squat” motions with my right side to tap my left heel to touch the floor. I did a lot of these for my knee rehab.
  • Blood flow restriction squats. I lie flat with the blood pressure cuff high around my thigh so it calculates my blood pressure then restricts my blood flow by about 80%. Then I do a sequence of movement reps with 30 second rest (with pressure still on). It’s 30 reps, then 3 sets of 15. The oxygen deprivation to the muscles lets you mimic high impact/intensity muscle load with lower intensity activity – getting a similar HGH hormone release for the muscles. It’s great for muscle building when you aren’t free to actually do the impact/intensity loading due to joint issues. Plus it burns real nice!
  • Balance practice: I passed a small kettlebell back and forth from outstretched hand to hand while balancing on my surgical leg. I have a feeling I’ll get more time or a squishy pad to stand on for that one since I started passing it behind my back and around my body to make it harder.

I was really tired by that afternoon and really wanted to take a nap, but instead I got a ride over to the Jiu Jitsu academy to watch the evening training class. I’m glad I was able to make it in because we had yet another belt promotion this evening, this time it was Jackson getting his purple belt! He is one of my favorite training partners and I look forward to getting to roll with him again once I’m allowed! (It seems like all my favorite people are getting promoted lately)

Jiu Jitsu Training

This week we have been working on control and attacks from North/South top position. This works well for me as I’m able to do most of the drills pretty safely with minimal modifications since they don’t involve my hips in very many twisted angles like some of the other positions we work from. I didn’t get much training in during this week because I had some systemic inflammation issues and didn’t want to cause any sort of flare up in my hip joint. The systemic issue is unrelated to anything with my hip recovery, it’s a chronic condition that flares up periodically and I have just learned my best option is to ride it out and rest for a couple of days instead of pushing through it.

Friday the 19th we had our first ladies’ competition training class. It was a joint training class open to our other local affiliate academy ladies. It ended up just being the ladies from our local academy this first time around, but they absolutely killed it and the overall consensus was that it was some of the best training ever. We are going to have it at least once a month and shoot for twice if possible. Hopefully the ladies from our other local academies will get on board but if they don’t that’s fine – we had a great time anyhow and I look forward to joining in myself in a few months.

On a slightly unrelated note: I had a follow up with my neurologist this Friday morning. I have been on a daily medication to prevent migraines that has been working splendidly. It’s an anti-epileptic that was a bit harsh with the side effects initially but now that I’ve adjusted to it I have gone from having several headaches a week to only one or two breakthrough headaches a month. He also gave me a more effective medication for those break through migraines as well that doesn’t make me feel trashed for the rest of the day.

Week 10 Physical Therapy

I recovered from my flare up thankfully in time for my physical therapy session on Monday. We added more weight to my leg press (3×10 at 150#) and then dropped it to add single leg press (3×10 at 75#). I had a new standing variation of a clamshell where I had my foot propped on the wall while balancing on the other while using the resistance band, and we modified the banded bird-dog to accommodate my tactile ick to the touching the band with my hand and we did a bird-dog row on the table – which honestly I found much more difficult a move anyhow (imagine doing a “hands and knees” bench row while holding your opposite leg up parallel to the floor while doing your row). To my “step ups” we added a “tap down” in front – just barely tapping my heel to the floor in front of me off of a 4-inch box.

I let my PT know I have access to a full collection of plyo boxes, physio balls, and trx straps at my Jiu Jitsu academy – so she said she would work on upgrading my home working program to include those for me.

Everything felt pretty good and didn’t make me feel worn out, so I put my gi on and joined the evening Jiu Jitsu class. The position this week is turtle bottom – I wasn’t sure if I would be able to do any drilling this week from the position, but I was able to do the moves Monday evening without any modifications, even the wrestling sit outs. Now granted, I did not do many reps and it wasn’t against heavy resistance – but I am able to do light movement drills with a gentle training partner.

Tuesday morning I drilled again in class. I did a few more reps of various moves from the turtle bottom position. I am once again reminded how blessed I am to have great teammates who are happy to be a part of my recovery process and help me drill movements even when I’m not 100%. This was a pretty special class as well because coach promoted Jeremy and Denaro to their purple belts. They’ve both been training since they were smaller than me, a fact that didn’t really hit home until I took a photo with both of them and realized how much they have grown over the years, it got me a little bit emotional! I did my PT exercises during the evening competition class. My muscles were a bit sore but not to a level that it might cause any compensation movement patterns so it was all good.

Wednesday I had as a bit of a rest day and just did my stretches, although I did teach Jiu Jitsu for the first time since my surgery. It was 1:1 in the corner with one of our brown belt ladies during the evening no gi class and I came up with a lesson plan that I could both demonstrate safely and also have practiced on me safely as well. We did a lasso guard sweep as well as an omoplata – then we strategized an open guard concept to help her with a specific goal she has been working toward in her sparring rounds.

Thursday morning was another drill in morning class day – this time I got to get reps in with coach and several of our other black belts. It was a more hip intensive movement but I can feel myself getting more stability and confidence. I would not have been able to do this particular movement a few weeks ago but have built up the joint stability since then to be able to. Every new movement I’m able to achieve gives me more confidence – it’s not perfect at first of course, but it’s a starting point for growth! PT exercises in the corner that evening again during the competition class of course – I think I smell an updated home program coming this week! I stayed over for the last class of the evening with the intent of getting some more movement reps in – but it ended up being me assisting some brand new white belts in class instead.

The Official 10 Week Mark

Friday is officially 10 weeks post op! I decided to mark it by running myself through a slow careful yoga flow session – which I haven’t done since before surgery. It went pretty well even though I just did the opening movements. It was a work from home day since Fridays are a bit chaotic for coordinating rides to and from the office, and my stamina for bike riding is not road ready (especially for around Nashville traffic). I’m doing short sidewalk bike rides around my neighborhood on the weekends to work on my stamina as the weather permits.

The hardest challenge for me in PT right now is reclined straight leg raises. I stay propped up on my forearms to keep my core engaged but I have to really focus to keep all my muscles engaged so as to not isolate just my hip flexors. If that happens then I will feel a sharp pain in them – which thankfully doesn’t last past the exercise. It just acts as a cattle prod to remind me to use proper form.

I’ve been slowly gaining more and more confidence moving through various movement angles and drills in class since my surgeon told me I could drill techniques. I occasionally get someone asking me to “roll light” after drilling and am strictly declining still. Since my surgeon said he will consider the repair work he did on my labrum to be healed around the 4-month mark, that’s going to be my personal benchmark for return to flow rolling – unless he tells me otherwise when I check back in at my 16-week post-op follow up appointment.

Further clarification on that 4-month mark: that’s strictly just the specific surgical work he did (and also could be specific to my individual surgery and/or his own protocol). I still will need additional time after that to work on strength and stability for return to full impact. He said the usual time frame for that is 6-9 months post-op depending on what the sport requirements are and whether or not you run into any difficulties with recovery.

Hip Surgery Post Op Visit – 8 weeks post-op

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I had my long anticipated post-op visit with my surgeon this week!

Post-Op Visit

No x-rays this visit, I just reported to the intake nurse how PT was going and that my range of motion was doing well enough that we had already changed gears to focusing mostly on stability and strength already. My surgeon popped into the office shortly after she took down the info. I told him my PT said I was on track and ahead of schedule so far and he said to hop up on the table so he could verify everything.

First, he checked my hip flexion. He flexed my hip to 90 degrees and when I told him it was all good, he took me to full flexion and agreed I was definitely ahead of schedule there. Then we went for external and internal rotation which he was happy with. Straight leg raise and then a hold there against a slight press down. He did tell me he wanted me to sit more often with my right leg in a butterfly position during the day to let my hip stretch more at that particular angle. He said I can even press down on my knee a bit at this point and that I’m not going to hurt anything in my hip at this point to do so. (Appointment notes were: progressing well for 7 weeks postop labral repair…. flexion – 120 degrees, extension – full and painless range of motion, internal rotation – 30 degrees, external rotation – 50 degrees, abduction – 70 degrees). He scheduled me to see him again in another 8 weeks, but I will call his office to get in sooner if I have concerns before then.

At this point he agreed that I am ahead of schedule for healing from the surgery and opened the floor for questions. I tried to rapid fire them since I knew he was running behind schedule already in the clinic (answers are not word for word since I just scribbled shorthand)

The Questions:

  • Where was the tear exactly? I could tell the general idea based on the incision portal locations and residual numbness where most of the action was but was curious the specifics.
    • He detailed that he used the anterolateral portal mostly for viewing, the anterior portal is where he was doing most of his actual work through, and the modified anterolateral/lower portal is where he was mostly passing sutures and such through. The tear was pretty much the entire anterior/front facing portion of my labrum (which explains why I always felt like my hip was going to dislocate forward when I was sitting)
  • Nerd question: Does the labrum stretch like all the rest of my connective tissue (I’m hypermobile)
    • No, labrum tissue does not stretch. The only part of me that he worked on that was “stretchy” was my joint capsule tissue. His primary objective was not associated with my hypermobility.
  • What sort of bone anchors does he use for his labrum repairs?
    • Suture anchors – he named the exact kind but I forgot
  • In my random reading I came across various commentary that said certain vitamin supplements shouldn’t be taken after this kind of surgery because they encouraged rapid bone regrowth after it has been shaved down – so I discontinued all mine just to be safe. What are your thoughts on that?
    • I’m okay with you resuming anything you were previously taking at this stage.
  • I only get 20 PT visits covered by my insurance, am I ok at this point to spread them out to weekly?
    • Definitely since it looks like you’re doing your at home assignments well
  • You told me at my initial assessment that my hip socket was a little deeper set than the standard model. Is that something I should think about modifying future training methods to accommodate for? Less deeper squats for example?
    • No, I took a little off the edge of the hip socket just to give you some leeway there. It also served a dual purpose to give you some extra immediate blood flow to the labrum tissue to speed initial healing. (I don’t think I officially had a pincher impingement, he has given off the impression that the bony issue was rather minor)
  • With my underlying hypermobility, I know I’m in a rather baseline level of fucked and am pretty much a chronic coper. What is the point at which you recommend getting something checked out?
    • When pain or instability reaches a point that you can no longer cope. For prevention, keep doing what you are doing as far as strength and stability training – it’s working well for you so far.

I asked about timeline. He said that at the 4 month mark he considers the labrum itself to be healed and that it’s generally 6-9 months post-op to regain full functionally of the joint itself for return to sport usage – which depends on how everything goes in recovery and what level of usage your sport requires. The main risk for me at this point now is overworking myself and causing something to flare up which could set back my recovery timetable. I asked for some specifics:

  • Is the competing at the European Championships in January a reasonable comeback event (8 months post-op)
    • Based on what I see today, it’s a very reasonable and achievable goal provided you don’t overdo anything in the early stages of rebuilding movement.
  • When can I ride an outdoor bike
    • I’m okay with you doing that now, again just keep in mind you could wear yourself out easily and get sore/inflammation easily
  • Rowing machine?
    • That’s the one most people have more difficulties with because of the range of motion causing more pinching in the hip. (I interpret that as a soft “not right now / proceed with caution”)
  • Teaching Jiu Jitsu classes?
    • I’m okay with careful controlled movements
  • Drilling in Jiu Jitsu class? (this was the biggie)
    • I’m okay with you doing careful controlled movements provided it’s movements that you know you can do safely and without pain or any pinching sensation in the hip.

He summarized everything then to tell me that any movement that I do in PT I can do outside of PT. The key things he said is that the movements I do need to be controlled, pain free (no pinching sensation) and they need to be without impact on my hip.

I baked some cinnamon walnut pound cake the night before to bring to the PT clinic that day since it was my last week with my PT (she was going on maternity leave). I brought one for my surgeon and his PA as well and they must have been running ragged all morning without a break based on the way they snatched it up quickly.

At the PT Clinic

I got to start off on the elliptical machine for the first time this week in PT. I only got 5 minutes on it and the first few mins felt a little awkward in the joint but about halfway in it started feeling really good. I think next time I may sneak in early just to get some extra time on it (or play on it afterwards while I wait for my uber home).

I gave my report to my PT from the surgeon and let her know about needing to drop to one day a week for physical therapy in order to conserve my remaining covered PT visits – which meant that was my last session with her. She sent me off with a bang adding leg box drills with a lean forward, extra height to my step ups (since I reported walking up the hospital steps one at a time that morning), and pistol box squats (TRX assisted, but I didn’t need too much help beyond minor stability). She was also very excited to receive her cinnamon walnut cake and promised to write useful notes in my file for my new PT such as “talks shit but follows instructions well”.

Re-Joining Jiu Jitsu Class

I opted to not try joining class that same day that I had a 90 minute PT session – I figured that could fall under the umbrella of “overdoing it” that my surgeon cautioned against. So for context: My post op visit was Monday morning of this week, and I went straight to PT afterwards. I elected to just watch the evening Jiu Jitsu class with plans to drill in the Tuesday morning class. (position of the week is turtle top/attacks)

Tuesday morning the techniques were back takes that I did not feel confident I could do with the allowable movements I have in my card deck, but coach said I could just walk the room and jump in on people to rep moves of things I could do safely. So, I practiced clock chokes and a few rolling finishes that involved me rolling shoulder first. Everything felt really good, and I did not feel any pressure on my hip at any of the movement angles. I waited until later in the afternoon and put myself through a light version of my PT circuit as well and then watched our evening comp class get smeared into grease spots on the mat. I did take video of the technique being taught in the morning, and then video of what I actually did so that I can show my PT next week how I was modifying in class in order to participate.

Wednesday: I had thought I might try dropping taking my daily meloxicam at this stage and see how I feel, which I did Tuesday but by mid-morning on Wednesday I was starting to feel a bit of an ache in my hip joint that I hadn’t felt at all before. I figured since I am upping my activity levels and getting started on more strength building in PT now may not be the best time to taper off it. So I decided to take my dose again the Thursday morning and stay on a bit longer.

I worked in the office for most of the day and then did my home PT exercises in the afternoon. We had an all female turnout for our 4:30 pm no gi class in the Jiu Jitsu academy next door and I decided on principle that I should jump in to get some technique reps in if possible. It’s a technique drilling class and I was able to do it the drills without any pressure on my hip. I avoided being drilled on however just because I did not want to worry about having someone’s bodyweight on me while I had my hip flexed in turtle position (next week will be difficult for drilling since we are working specifically from that bottom position, I may have to improvise).

We had a guest instructor visiting from San Diego who taught our 5:30 no gi and 6:30 gi classes for us. The drill he taught was using the underhook to escape side control and various methods of back takes to sweeps for no gi, and for Gi class going to deep half guard and working sweep options from there. I was able to do the no gi drills with skilled drilling partners who were able to position themselves to keep all pressure off me (lightly interactive grappling dummies), but I was not stupid enough to attempt any deep half guard positions in the gi class – so I just enjoyed watching!

After doing my PT exercises that day, and drilling slowly about 20 reps of exercises in one class and 10 compound movement reps in the second class (reps all spread across a 2 hr time frame), my hip felt tired in a similar way to the first time I did straight leg lifts for the first time in the clinic at PT. I considered icing when I got home, but after lying down I didn’t feel any actual discomfort, so I opted against it.

Thursday morning I woke up feeling just fine after my evening of “excess”. I had skipped taking my meloxicam for the previous two mornings and didn’t feel horrible for it but remembering the slight ache from the previous morning I opted to resume my morning dose for the time being.

Normal day at work, with a break for me to jump into the 10:30 Jiu Jitsu class. I did just a couple reps of one of the moves demonstrated. It was an armbar attack using your legs to hook the near side arm when you’re in turtle top position. I was able to safely do it on one side (surgical hip down) but I wasn’t gonna try to do it on the other side with my surgical hip doing all the hooking and pressure. The next phase was to do a back take when your partner defends by tucking their arm which I just watched since I didn’t want to pull someone’s weight over top my surgical hip.

I opted to just do the stretching portion of my PT home program this evening and even pulled out my ice machine to give myself a little extra tlc that evening. I didn’t have any pain, but I was feeling a bit tired around the joint and figured since I was considering it for the second night in a row I should go ahead and use the ice.

Friday brings me officially to the 8 week post op mark! I’m working from home today again as it’s a difficult day to get to and from the office due to everyone’s schedules.

The Grand Recap and Thoughts

Mentally and physically I have been feeling great since I have been able to participate a bit in Jiu Jitsu class again. I’m being patient because I am keeping the goal of competing at the European Championship in January on my mind. Overworking my joint will set me back in my recovery, so if my muscles start to feel tired, I stop. I modify the class technique as needed to avoid pressure points on my hip – if I can’t modify then I just observe instead. I will not run the risk that one risk that one instance of over-working or moving incorrectly could mess up my long-term goal.

The formula I used this past week for each class was as follows. For a simple movement drill: 20 reps spread out over the 1-hour long class. For a compound movement: 10 reps spread out over the 1-hour long class. That doesn’t sound like a lot of reps compared to what I was doing before surgery, but it was plenty for slow methodical movement and testing out the safe limits of what I can do.

When my PT updated my home exercise program a few weeks ago at first it was pretty tough and I could only do it every other day. Last week I was able to do it every day without feeling trashed. This week with the extra activity I felt the need to dial it back a little bit so what I did was add more rest and recovery time in between exercises which seemed to do the trick. Thursday however I skipped the exercises entirely and just did the stretches as my joint felt tired and I did not want to overwork it. My muscles feel a little bit of workout soreness as well since I have added resistance bands now to my home exercises (since we have done so in the clinic). Most of my exercises focus on core, glutes, and quads.

I’ve been training Jiu Jitsu for about 13 years and as I’ve mentioned before, I was in peak physical shape before my surgery. This has contributed to my ability to drill in a somewhat safe manner. I additionally have good, experienced teammates who are happy to help me with my recovery by positioning themselves appropriately at right time to keep pressure off my surgical hip. My 14 years of hands-on study of kinesiology and anatomy due to being a structural focused massage therapist, as well as needing the self-learning to manage my hypermobility condition has really helped give me a good baseline for this recovery process.

A big difference between my recovery for this hip surgery and recovery for my knee surgery is that this time I am not feeling isolated and unsupported by my community. Around the time of my knee injury was one of the darker times of my life and that compounded the whole issue. By comparison, this is a much smoother process knowing I’m surrounded by people who have my back – figuratively and literally!

Hip Labrum Surgery – 7 weeks post-op

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I had a bit of a switch over in therapy this past week. My therapist said that due to my pre-existing hypermobility, I’ve really gotten my range of motion back in record time and she doesn’t want me really working on pushing any more range of motion for the time being. Instead we are going to focus on stability and strength and let my joint capsule have a break to recover a bit. “Why put strain on it when we don’t have to at this point?”

Exercises progressions are as follows: increased band resistance for standing hip flexion/extension/abduction, added band resistance with bird dog, increased reps of staggered bridges, increased reps of single legged timed balance on squishy pad, increased reps of reclined straight leg lift. Added new exercises of dead bug, holding shallow squat on balance board for time, and slow step ups on a 4 inch step.

Next week the plan is to start me on the elliptical trainer instead of the bike. That will be after seeing my surgeon earlier that morning as well so I’ve been writing down a bunch of questions to ask him. My PT suggested I ask him what would be a good timeline to start integrating sport specific movements into physical therapy. Jiu Jitsu is a very different type of movement than the typical sport and she wanted to make sure she had everything lined up as well as possible in my notes. Next week will be my last week working with her as she will be going on maternity leave – if she makes it that long!

My therapist said that I am right on track with my recovery – and trending a bit ahead of schedule even. I do only get 20 PT visits covered by insurance and I’m pretty sure that is a hard limit, but I will budget to pay for additional myself as I want to make sure I’m able to recover properly (I did send an email to my insurance rep and he is doing some research for me to see if I have any wiggle room). My PT said since I’m so good at doing my own work at home I’m a good candidate to just be in the clinic once a week and be on my own the rest of the week.

I’ve reached the point where I’m starting to really normalize a lot of my daily movements. If I didn’t have the cane in hand most people wouldn’t know that I had a hip surgery such a short time ago based on how I’m moving around. (I don’t use the cane except for when I’m outdoors or walking a lot like when I went to the farmers market this past weekend.) I’m looking forward to the push to regain strength and power with stability because while from the outside it looks like normal movement, it is with very conscious thought and focus still. I have one speed setting: casual amble – and I need to level up to gain more settings safely. Yes this is 100 percent a video game character build out.

Future Jiu Jitsu Training

I had a thought for my future Jiu Jitsu training that has gotten me quite excited. I have been training now for almost 13 years, and the past 8 or so years has been focused primarily on variations and offshoots from open guard and half guard that started developing when I was a white and blue belt. The one thing I was never able to integrate in was shin or butterfly guard techniques – I just could not for the life of me get the positions or sweeps (in particular butterfly) to work for me. Now I have an inkling of why.

The orthopedic surgeon showed me how the type and position of this injury that I have – which happened right before I really got into Jiu Jitsu training – caused instability in my hip joints and subsequent muscle weakness right at the angle and position I would need to properly execute most butterfly guard maneuvers. I’ve been able to work around it for most other moves and techniques but this was a specifically targeted move that I just could not find a work around for.

I’m excited to revisit trying to work butterfly guard into my game once I get the all clear from my surgeon. Now that the injury has been repaired, I want to test if I can make it work for me now with a functional hip. Even just this short of a time out of surgery it already feels like the most stable joint in my body.

Hip Labrum Repair Recovery – 6 weeks post-op

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Physical therapy amped up a bit again this week!

Monday started off with warming up on the stationary bike for the first time which made me feel pretty awesome! Then back in the main room my PT told me she was going to push my range of motion, which made me nervous because I had flashbacks to painful months of attempting to push flexion back into my knee post op (it healed stiff by surgeon’s design). Thankfully since this procedure didn’t require ligament immobilization/support for an extended period of time, my range of motion hasn’t suffered too badly.

I was able to comfortably flex my hip to about 120 degrees flexion on my own, which she said was “full range of motion”. I then demonstrated flexing/rotating my non-surgical hip to be able to put my leg behind my shoulder and she amended her declaration to “normal” range of motion. She did some passive range of motion work which included external rotation for the first time since surgery which felt pretty good, as did the abduction stretch she put me in. All around everything is coming along really well and my range of motion on all points is not requiring any aggressive intervention thankfully!

Up until this point I had been sticking to the post-op hip movement restrictions since I hadn’t been told otherwise, other than the end of last week when I was told I could start bending past 90 degrees if comfortable. So, she sat me down at the end of our session and clarified for me that those post op restrictions are pretty much lifted and now I’m at the phase where movements are allowed, provided that they are controlled, not excessively uncomfortable, and no impact. Still no aggressive isolated hip flexor engagement, single foot per stairs on ascent/descent, etc. Thursday we did start adding some shallow straight leg lifts to start strengthening my hip flexors again, and also added a band around my ankles for my standing hip extension/flexion/abduction reps.

My cane has been approved of although I have been 100% okayed to walk around without it. I am going to continue to carry it when out and about for two main purposes; to slow me down so I don’t do something stupid, and also to alert other people that I’m slow and to not run me over.

New Home Program

My therapist gave me an updated home program which I dove into for the first time on Tuesday – she also said I was free to do any additional exercises that we did in clinic as well. I got done with my first run through and it just seemed like it was more exhausting than doing the session in the clinic – probably because I had done PT the day before. It could also have something to do with the new mobility work of work of external rotation, and activating/opening up a bunch of muscles that haven’t really been targeted for a hot minute. After my discussing with my PT on Thursday she agreed it might have just been exhaustion from two days in a row and agreed I should do the stretching and mobility work every day and just do the strength work every other day while I’m rebuilding.

Some of the new exercises this week have been 45-degree wall sits, non-banded clamshells, standing leg extension, and bird dogs. I’m also now adding a butterfly stretch for external hip rotation. Additionally, a “bend knee, grab toe, straighten knee” hamstring stretch has been added to the stretches now that I can comfortably/safely bend far enough for that movement.

Since I was told my post-op movement restrictions are eased up, I decided to test myself and (with the support of my cane at first) discovered I was able to do box drill movements with my legs. I like to use my cane or a strap for support if I am trying a new movement so that I can bail on it easily if it starts feeling awkward. I showed my PT and she approved the movement since it feels smooth in my hips and I’m not leaning forward or putting any weight the joint yet. I’m able to control the full movement including extending my right foot in front of me and holding it off the ground while switching between internal and external rotation. I currently am moving my left leg first and using it to base but eventually will work back up to moving both sides at the same time.

My current weaknesses that I notice are definitely in any “step up” motions with my right leg and the clamshell actions are weak as well since it’s new. The first time I did them on Monday I was not able to comfortably bring my knees together again since I had still been observing “pillow between knees if lying on side” precautions as I hadn’t been told differently so I was stiff at that angle. Doing them on my own Tuesday I was already able to comfortably bring them together, so the stiffness was already worked out.

Week Recap

By the end of the week, I could already tell a huge difference in confidence/strength for my hip flexors. I went from barely moving to able to use the light resistance bands without any soreness afterwards. We are of course keeping an eye out to make sure nothing we are doing is causing any tenderness that might be a signal that we are progressing too quickly.

I’m a bit slow to post this update (I usually post it on a Friday but today is Sunday), but I wanted to wait and add on my Saturday adventure before posting. A friend came to visit and I was able to (slowly) walk all over our local farmers market. I brought my cane of course and it was exhausting, but I did it and had no pain – waking up this morning feeling just fine.

I’ve noticed with my home program that with some of the movements I will feel an occasional small pinch in my hip. If I pause the exercise and internally rotate my hip for a small stretch which relieves the pinch and then I can resume the movement without the sensation. I’m going to bring that up to my PT and also my surgeon when I see him at my follow up. My guess is it probably has something to do with scar tissue and/or my hypermobility – since it resolves easily I’m not too concerned at this point.

This coming week I will only have one session in the clinic of Physical Therapy since Thursday is Independance Day here in the US. So I will be in the office Mon/Wed, and have PT on Tuesday. Thursday the office will be closed and I’ll likely work from home on Friday as well. The following Monday is going to be a big news day – post-op visit with my surgeon. I’m writing out a whole bunch of questions to annoy him with!

Hip Labrum Repair Surgery – 5 weeks post op

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It has been a big milestone week!

I started Monday morning in PT with my usual therapy routine and at the end we added weight bearing tests. First I stood at the edge of the table and just slowly shifted my weight from foot to foot “until it felt ok”. The first one felt like waking my hip up a bit but the second one felt pretty normal so then my therapist told me to do longer holds on my right (surgical)side. After a few reps of that she watched me while I changed to shifting my weight to my right foot and then lifting my left foot off the ground. At the first rep she said “Oh perfect! No hip drop at all! Do 10 reps and hold for 10.”

After that I did step throughs at the edge of the table. Which is basically just walking one step forward and then backwards next to the table, while making sure to use heel to toe foot impact pattern. That took a lot of focus since I’m usually a toe walker myself (bad I know!) I did 20 of those and my therapist announced I was definitely ready to be walking this week. I also did standing straight leg kicks forward, to the side, and back at an angle on both legs – very minimally of with the hip extensors of course and with no resistance.

She told me to go down to one crutch in the meanwhile and if I do well with that I would be able to drop that and be free after my session on Thursday. That first night I felt pretty good but decided to fire up the ice machine for sleep just in case. I probably did not need it, but I decided any time I do a big new thing I will add ice pre-emptively for the hip flexors to help keep the savage beast soothed. The approach seems to be working so far as I woke up feeling just fine!

Adjusting to just one crutch was weird at first and I just slowed myself down to about a quarter of the speed I had been going at with two crutches and then I was fine. Just like drilling Jiu Jitsu moves, I had to practice the movement slowly first to make sure I do it correctly – and as I gain the muscle memory/dexterity/strength, the speed is coming back slowly on its own. Pushing speed first is how injury and pain happens.

Tuesday/Wednesday: in the office

I went back into the office again on Tuesday and Wednesday. I was super slow moving around of course and I allowed myself to stretch out in a more comfortable position as well for the day. I’m still going to be sticking with the pattern of working from home on days I have physical therapy just in case I end up having a really exhausting session and just need a lie down afterwards.

The walking practice does definitely exhaust me. I’m not sore at all so far but I’m definitely really wanting to nap by mid-day. Hopefully I’ll build my stamina back up soon but I’m doing my best to reign myself in so I don’t overdo it and flare anything up when things have been going so well so far!

My boss picked up some supplies for me from the hardware store to repair my old wooden cane, so that’s going to be my project for the weekend! I took it into the back of our warehouse and got it structurally sound again, but now I need to sand it down and figure out what I’m going to do to finish it out and make it pretty again.

Being in the office these two days means I get to pop in on the daytime Jiu Jitsu classes again as well which has been nice! I’ll be planning the same itinerary for next week as well since it seemed to work out pretty well this week without too many hiccups.

Thursday:

Back at physical therapy again today, my therapist said we that I looked really good walking in on my one crutch and that when I did my one-legged stands and movements my balanced looked rock solid on my surgical side. So she okayed me to walk without my crutches a little bit in my apartment this weekend if I felt up to it. She additionally told me that we could start pushing a little bit more range of motion and a tiny bit of external rotation (she specified TINY). I translate that information to: I’ll move myself as far as she moves me during her passive range of motion work but I’m not pushing anything on my own.

She also mentioned that she might be starting me on the stationary bike soon for session warmups. That got me all excited about getting back into outdoor biking and she slapped me back down pretty quickly from that – but said I might be able to get back outside before the weather gets too gross for it.

I also got to add on sets of shallow bodyweight squats to my routine as well today – those felt pretty good! Basically, activating muscles and moving around makes everything feel good, so it’s just a matter of reigning it in and riding that fine line of enough to let it heal, but not overdoing it or causing anything to flare up.

Friday:

Today ended up incidentally becoming a work from home day as well because my coworkers were unable to pick me up this morning. So everyone missed out on the momentous moment that was me being able to put on leggings for the first time since surgery! Since my PT said I could bend a bit more, I decided to see if it was comfortable to bend far enough to put on leggings, and I didn’t feel a stretch at all in my hip even to straighten my socks! Now having shorter legs probably comes in handy a bit here; but still!

This made me realize how much my legs need the biofeedback of compression leggings. It’s a small thing but it really does help me feel so much better after spending over a month wearing baggy shorts. I have a lot of sensory issues that go along with my autism: temperature regulation, touch, etc. – and they are a protective barrier in that regard. I also get episodes of orthostatic hypotension, basically a circulation/blood pressure issue where they tell you to watch your fluids and electrolytes levels and I also tend to get swelling in my legs a bit – compression leggings help with the swelling. Finally, I also have a connective tissue disorder that affects everything, and the little extra bit of outer layer just sometimes feels like it’s just the tiniest ease of that burden.

Anyhow, that all said, I love my compression leggings. In fact, I just ordered some more because why not?

What’s Next?

I see my surgeon again on the 8th which will put it in my 8-week post-op update. Depending on how news is flowing I may then switch from weekly updates to every other week or monthly updates on surgery recovery. The goal is for this series to just naturally morph into a training log back to the tournament podium.

Hip Surgery Recovery – 4 weeks post op

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Note: 4 week healed incision photos in this post! Well, I made it to that first milestone marker that my surgeon laid out for me! He said the first 4 weeks would be the most restrictive on crutches (50% weight bearing), no hip flexion past 90 degrees, no external rotation of the hip, no isolated activation of hip flexors, and no crossing the midline with my leg.

That said, I’m not going to suddenly drop the crutches and do all the things I wasn’t allowed to do for the past month. From reading and researching post-op issues, it seems to me the common thread for setbacks when you’ve had a well-executed surgery, is that people start feeling really good and then push forward too quickly. This inflames the soft tissue around the joint that is trying to recover from the trauma of the surgery. The hip flexor in particular is the main culprit for this sort of complication and I’ve been very careful to not put extra strain on it over the past month – especially taking note of where my surgeon had to make his main usage entry portal as you can see in the photo below.

4 weeks post-op – the larger of the three incisions was apparently where most of the movement of the surgery took place based on the scar tissue I feel under/around it

Thankfully I have a very experienced physical therapist who told me yesterday that her plan for getting me off crutches is gonna be a gradual process. I will start with weight bearing exercises this coming Monday and we will just take it one session at a time – not in a rush at all. At least with the crutches I look like a stereotypical injured black belt sitting on the sidelines during Jiu Jitsu training sessions – without them I’ll just look like some lazy rando creeping on class. I’ll have to break out my cool cane or something later to balance it out.

As you can see from the photo above, I was able to remove the steri-strips finally. I have always had some minor issues with delayed wound healing, most likely from my hypermobility. I’m starting to get some more sensation back in the area and have started some light scar tissue mobilization work on the two smaller incision areas as well as some lymphatic work to help with circulation. The larger incision is not healed enough for even light scar tissue mobilization – it needs the stability right now to continue to heal the surface skin layer. I look forward to working on it when it’s ready because I can feel the scar tissue below it pulling a bit already. My decade+ of Myofascial massage specialty is paying off for myself!

Additionally in PT this week my therapist added straight leg bridges with my heels dug into a large physio ball, and my physio ball crunches got a crunch “up” variation added on as well for more core activation. Those ones are super fun! She also did some light manual release work on my glutes and hamstrings for the first time this week as well in addition to the usual quad/IT band release and passive range of motion work. In total my PT sessions are tipping over an hour in time now and I’m not even adding in the Game Ready ice therapy option yet (let’s see how weight bearing goes next week!)

I have worked from home this entire week, which has definitely been very beneficial for my hip recovery! I was also picked up twice to pop by the bjj academy for an evening class for some enrichment time as well.

Next week I do plan on returning to the office for a couple of days if my hip allows. This time I plan to use the couch either in our office, or in the bjj academy next door in order to keep myself stretched out as much as possible and avoid the pinchy issue I had last week. I’m still planning for PT days to be work from home days though since it takes up a decent chunk of time and then wears me out. I will play by ear with my plan however – if weight bearing training makes me feel sore and I feel like I need to sit on my ice machine at home I’ll do that instead. I am very fortunate to have a supportive work environment, as well as a job that CAN be done remotely.

Thoughts on Returning to Training

I’ve been chatting a bit with several people who are in various phases of injury recovery and rehab and there’s a common thread among everyone of being nervous about getting back to training and having to start over because you suck now. And it’s gonna be true for a while. Depending on how long you are out, you lose your reflexes. Depending on what sort of injury and/or surgery you had you may have to re-learn how to move certain body parts completely.

I say embrace the suck. Let go of the feeling of having to measure up right away, and just enjoy the fact that you are able to train again. You will eventually surpass where you were previously but why frustrate yourself during that process? Yes, always strive to improve every day, but in order to improve you need to accept what your current state of being is. And the state of being when coming back from an injury is – it sucks.

I’m gonna lean into it when I’m allowed to train again. I’ll work my bad side (since my dominant side was my operated side anyhow!) I’ll practice the techniques I never thought I could make work – the 12 yr old labrum tear and subsequent joint instability was likely causing a movement deficiency and I want to see what I can actually do when I’m not having to compensate for it. I’m gonna think of myself as starting Jiu Jitsu all over again and just see where it takes me when the “the suck” passes.

Arthroscopic Hip Labrum Repair Surgery – 3 weeks post op

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And now I’m at 3 weeks post op! For context: my surgery was on a Friday – so my weekly benchmarks logically fall on Fridays.

I’ve had a busy week comparatively speaking – I actually got to get out of my apartment to DO things.

Last Sunday I met up with a friend at the cafe in my neighborhood to grab a treat – there were no seats there I could use comfortably so we just strolled back to my apartment building and chatted for a few hours. After that I was picked up by some of the ladies so I could hang with them during the Sunday ladies BJJ class. I told them to start jogging for warmups and they unanimously rebelled against my authority – presenting the logic that I’m going to be pent up and angry when I get back on the mats anyhow, so it doesn’t matter if they make me mad at them now or not. I respect the logic and therefore am not angry. It was really nice to get out and see people I care about again after being locked away for two weeks!

Monday I had physical therapy and told her I had a concern about my incisions. I had been told when my stiches were removed the previous Tuesday, that they were putting the steri-strips on just for a couple extra days and then they could be removed. That seemed a bit off from how I remembered steri-strips working, but I always follow directions, so I removed them from the lower less angry incision that Friday evening. That one looked good but when I went to remove them from one of the upper ones it was still open – so I covered it back up quickly but was worried that I had messed with the integrity of it. My physical therapist confirmed that my lower incision was closed up nicely and said that the upper one that I had tried to remove tends to take longer to close up because it’s an area of more movement – it was also a lot more swollen and a larger incision since it was one of the primary entry portals. She made sure there were no signs up infection and reapplied fresh steri-strips for me. We are just going to leave those on until they show signs of wanting to fall off on their own this time.

Monday afternoon I got a text message from my coach to let me know that he had gotten back into town from the Jiu Jitsu world championship and was going to promote my teammate, Ray, that evening in class. I have known Ray since I first started training (he was in our kids’ program), and I told coach that if he didn’t find a way to get me over to the gym I would be severely upset and never let him forget it. He was super busy but knows I don’t raise a stink very often, so made the trip out to pick me up before class. It was pretty exhausting hanging around, but one hundred percent worth being there to celebrate. Congratulations Ray!

Tuesday was my first day going back into the office after over two weeks of working remotely from my apartment. The hardest hurdle for being in the office is trying to figure out how to handle the 8-5 office hours schedule when I’m not supposed to be sitting for extended periods of time – and I can only stand for so long really. We decided to try this setup using a comfy chair from a coworker’s office. It worked pretty well for the first half of the day but was getting pretty achy on the hip for the second half of the day and I ended up needing to be taken home a little bit early.

Here’s where it gets a bit tricky for me. Even pre-surgery I can’t drive myself due to a permanent disability. So, in order to get into the office, I need to get a ride into work. Usually, it works out to where a coworker or my coach is able to pick me up on their way in and then I hitch a ride home afterwards usually after evening jiu jitsu training since the academy is in the same building. I live fairly close by and seasonal biking is great when I’m uninjured! On off days I take an uber. Currently I’m unable to ride uber to and from work because I have to ride in the front seat (due to hip movement restrictions), and I am unable to juggle my crutches and my dog while safely getting myself in and out of an Uber. A friend driving me won’t mind holding Dmitri – but a random uber driver might not be so chill about it. So, I’m highly dependent on someone consistently being able to pick me up and drop me off for work.

Tuesday ended up working out okay although a bit uncomfortable, so I spent some time stretched on my stomach that evening and decided on a plan for Wednesday.

Wednesday, I asked a coworker to place an extra cushion on the chair so that I could sit a bit higher and at less of an angle for my hip. This definitely helped from the start, and I also tried walking around a bit more as well, so I was hopeful! It was unfortunately still too much culminated sitting time that I think snowballed onto the sitting time from the previous day. I hid my discomfort as well as I could and tried to see about finding a ride home when the office closed at 5, but it was a very busy evening unfortunately for everyone, so I ended up stuck which was quite frustrating and it did make me break down for the first time since surgery (I’m sure there will be others coming). My Jiu Jitsu academy is in the same building, so I waited around for the 5:30 class to end at 6:30 and one of my teammates was able to give me a ride home. I loaded up my frozen water bottles in my ice machine for the first time in over a week to wrap up my hip and went to sleep like that.

Thursday was a physical therapy day. I had established that PT days were going to be work from home days because of the logistics of interrupting coworkers’ workflow to get them to come pick me up after my sessions when all my work can be done from home anyhow. She checked in on my incisions and said they are looking good still. I mentioned the past two days in the office to my therapist and her professional recommendation was to work from home as much possible until I’m at least off crutches and have some better range of hip motion for sitting. Thankfully my workplace is extremely accommodating and has given me the green light to take the time I need – especially since my work can be done from anywhere. I do prefer to be in the office for efficiency and communication purposes, but recovery is important so I’m going to rein myself in here.

Speaking of PT:

I haven’t gone into much detail on what that is looking like so I’ll summarize a little bit. I did a lot of reading and research and noticed that most post-op therapy schedules were all variations of the same theme. Some have you using stationary bikes right out of surgery, some have you using resistance bands, some have you non-weight bearing, etc. The similarities are that the first few weeks are all about keeping the muscles moving, preventing adhesions/controlling inflammation response, and protecting the surgical repair work while it heals. The differences are in how they approach these goals and you should follow the protocols laid out by your surgeon and his team – you trusted them enough to let them do surgery on you, you should trust that they know how their work will heal best. Disclaimer: discomfort is to be expected, but if you’re in pain bring it up of course.

My PT clinic is attached to/downstairs from my surgeon’s office, and they can even read each other’s notes in my file which is very nice for communication. So far it appears that my first 4 weeks is a very strict table work only protocol – no weight bearing in PT since I’m strictly 50% weight bearing on crutches for the entire 4 weeks regardless of how I feel. I’m told that after next Friday we can start working on weaning down to one crutch and if I’m doing well, we can work off to none at all, but it will be very slow so long as I’m not limping or having any other gait issues.

My table work generally starts with doing some warmup mobility work. Heel slides don’t do much for me since I was comfortable with 85 degrees flexion in my hip in my first day in PT and am not allowed to flex past 90 yet, hip internal rotation reps (not allowed any external rotation yet), prone quad stretches which feel amazing, holding cobra pose which also feels amazing. For strength I currently have a base lineup of isotonic glute squeezes, quad squeezes, hamstring digs into the table, adductors against a ball, abductors with a strap around the thighs. In the past week we have started adding some more movement in the shape of hamstring mobility curls on one of those large exercise balls (only flexed to 90 degrees of course and no lifting of the hips), and then using the same exercise ball braced against the knees to crunch against while on my back to maintain my 90-degree limitation while still getting to activate my core. I also get to do quad extension reps with an ankle weight while sitting with my leg dangling off the edge of the table.

One of the new exercises we added yesterday was prone hamstring curls with the ankle weight. That one felt good on my quad since I have the mobility to get a counter stretch on my quad as well as quad activation at the top before handing the muscle activation back to my hamstring. The other exercise we added in that my PT was very happy I did well with was bridges – I knew it was coming eventually and she had me do 20 with a 3 second hold at the top.

At some point in the middle of all of this my therapist will do some manual therapy on me as well. She is usually overseeing 2-3 people at the same time with the help of 1-2 assistants. Currently manual therapy for me consists of passive range of motion with her moving my leg around and feeling for any restrictions in my range of motion and then checking my quad and IT band to make sure I’m not developing any tightness that could be a sign of things to look out for. This part will probably get more uncomfortable for me in a couple weeks when I’m clear of the majority of my hip movement restrictions – but for right now I don’t really feel anything besides a very slight pull at most extreme of allowable angles. She was already comfortably flexing my hip at 85 degrees 3 days post-op and again at 90 degrees my following session.

All together therapy generally lasts about an hour. I have the option to use the game ready ice machine at the end as well for a bonus 10-15 or so minutes but I haven’t taken them up on this offer as of yet since we aren’t doing anything really inflammatory at this stage of rehab. I’m anticipating things getting spicy later on once my post-op protective restrictions loosen up.

Other Closing Tidbits

I’ve now met my out of pocket maximum now with my insurance provider which is super nice and means I should not be paying any more medical expenses for the rest of the year thanks to an insurance plan with excellent coverage. I’m really thankful to have great insurance coverage through my employer – he makes sure we have high quality coverage! I was able to pay for all surgery and associated costs with less than one paycheck thanks to that – certainly a far cry from the financial hole my knee surgery put me into (I’m still paying off some if it!)

So for today, Friday, I was working from home. In Nashville it is CMA fest weekend as well as several other big events in town, so we are going to be cancelling our usual ladies’ class this weekend because navigating the city is going to be a nightmare. I already had groceries delivered and am stocked up for the weekend. I have one more week of being guaranteed on full usage crutches – I was worried that I was wearing out the tips, so I bought some new ones. A friend of mine loaned me the crutches and I didn’t want to give them back to her entirely mangled so I figured she would appreciate them being a bit prettier than just standard gray.

I see my surgeon again in about 4 weeks on July 8th. He told me originally that his plan for me was to have a very staged 3-4 months time period of physical therapy and then I’d be released back to doing whatever I want 6 months after surgery – which would be in November. I plan to ask him his thoughts about me competing in the European Championships in January now that they are finally back in Lisbon. I imagine he will probably tell me to wait and see how I’m doing a little closer to the date, but I do so like to have a concrete goal to help keep me focused on the process.

Of course, I do also know that a surgeon’s release to activity essentially just means that I am no longer in danger of ruining the reconstruction work that he did in my joint. There will still be a longer rebuilding and recovery process that will take some time afterwards. When I had my knee surgery it took a solid year after my surgeon gave me his “return to play” release before I really felt like I was back to full functional useability again. I have similar expectations for this process, and it seems to ring true with what I have read online about other people’s experiences.

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Arthroscopic Hip Labrum Repair Surgery – 2 weeks post-op

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Today is my 2 weeks anniversary of surgery!

I have so far had four physical therapy sessions, gone off all pain meds other than my Mobic/meloxicam, had my stitches removed at my post-op appointment, and been given the all clear to begin doing some fascial work on my incisions to limit scar tissue formation.

Post Op Appointment

Day 11 was my follow up appointment with my surgeon’s PA. I was first x-rayed and then we went over concerns to make sure I didn’t have any residual nerve issues (none) and he asked about the hypotensive episode I had a couple of days after surgery. Then he gave me an assortment of photos from my surgery and thanks to all of the pre-op research I did, they actually all made sense to me. He pointed out I had some rather unusual scarring on my joint capsule itself that the surgeon cleaned up for me at the start of the surgery since it was in the way anyhow.

As far as my labrum goes, it was super floppy and required 4 suture anchors to be hammered into the edge of my hip socket to secure it in place. My surgeon first did a light shave of the bone around the area to encourage blood flow and therefore improve healing. Once the sutures were in place you can see in the photos how much more secure it looks (no more flappy-floppy!)

After the labrum was secure, they took a quick trip inside my hip socket to clean out some old leftover fatty tissue debris that he said was just hanging out back there, so they usually clean it up while they are there. Now of course I want to know what it’s leftover from, so I’m going to do some research and if I don’t find an answer before I see them next visit I will ask!

Now they were free to let the traction off my leg so it could slide back into the socket and check that the seal of the labrum was secure (apparently it was!) and address the issue that is the head of my femur.

I had a small bone overgrowth on the neck of my femur, right on the growth plate that the surgeon said most likely formed during adolescence. This was what caused the tear in my labrum since the bone didn’t fit quite right when my leg would move a certain way – and is also why the conservative measures I had taken to address the issue could only help me so far. I could get the inflammation to die down, but it could be easily re-irritated by that overgrowth/impingement again. It was a very small one, and my hypermobility gave my hips a lot of leeway for movement around it, but this latest episode tore it worse and there was no point repairing the labrum without addressing the stick that was poking it.

The surgeon filed down this area of the bone and sculpted it to fit properly, typically this assisted by x-ray scans and then is then also checked by moving the leg through range of motion while watching through the operating camera to make sure that the bone is no longer catching on anything.

Additionally, I had a bone cyst that had formed underneath this area – reaching into the marrow (from what I can see from the photos). After confirming that the impingement was corrected, my surgeon debrided the cyst. He said that these sorts of fluid filled cysts are not entirely uncommon and while this one was a bit larger than what they typically see it will scar over just fine now that it has been cleared out.

They rounded out surgery with a capsular closure (stitching the joint capsule closed after they opened it to do all this work). I ended up with three entry ports: Anterior, Anterior-lateral, and a modified anterior-lateral.

I got my stitches removed and replaced with steri-strips to just continue the incision support for a few more days – and was told to start doing some aggressive scar tissue work especially on the anterior entry portal incision on Friday (the two-week mark)

Typically, I would see the surgeon at the 6-week mark, but he is going to be out, so I will instead see him at the 7 1/2-week mark. I have another 2 weeks on crutches while everything keeps healing.

How It’s Going Otherwise

This week has gone pretty well other than the cabin fever. I have still been working from home and have completely weaned off Tylenol. I am staying on the Mobic/meloxicam once a day for the first month – it is an anti-inflammatory and the surgeon’s office said it will help to reduce the amount of post-op scar tissue I build up as well. I’ve been sleeping with the ice machine on more out of habit than necessity for the last several days and decided to skip it last night, woke up feeling just fine. I think I’ll keep the ice machine out just in case I have a flare up day, I’m sure one will be coming as I have been known to overdo things on occasion and I would personally rather try ice first over taking meds.

I did take a walk outside on day 12 because it was super nice out and I wanted to go to a neighborhood cafe – it ended up being a half mile round trip walk. I did not get in trouble with PT however since I treated it as a mobility exercise instead of an impact exercise and used my crutches: keeping my weight on my hands instead of my operated hip. It does feel really good to move – I’m just being cautious about any impact. I have started sleeping a bit on my non-operated side well bolstered with a pillow between my legs (not allowed to let my operated leg cross my midline) and that feels amazing!

Speaking of PT, I’ve been tempted with a promise of possibly being allowed to do some shallow wall sits next week. She moved me up already in ankle weights and reps for quad extensions and I think she is starting to trust that I’m not too much of an idiot. I did point out to her that I’m turning 40 next year and can’t really afford to be too stupid if I’m gonna be able to do the things I want to do for the rest of my life.

Monday I will be having my 5th PT session in the morning and then going in for my first day back in the office since surgery. I won’t be able to sit comfortably at my desk or any standard chair, but one of my coworkers has a nice comfy overstuffed chair that he said we could move into my office. It will be nice to be around people again as the longer I stay isolated the more I feel myself losing what few social skills I had to begin with – plus my dog will appreciate having more than just me around to beg food from!