Category: Injuries

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 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!

Arthroscopic Hip Labrum Repair Surgery – 1 week post-op

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Today marks one week post-op from arthroscopic surgery on my right hip.

My right hip has been an ongoing problem for over a decade since I slipped and fell, dislocating it back when I was still a white belt. I had no health insurance at the time so of course I never got checked out, but it was months after that incident before I could raise my leg without pain or instability. I’ve had issues with it flaring up and causing me pain and problems since then. While I have always been able to rehab and strength train it back into working order – each time seemed to take a little bit longer and be a little bit worse.

This time I flared up badly over the holidays and my usual measures would not put a dent in getting me any relief, I had added instability that really worried me as well. It was progressively getting worse to the point where not only training, but just sitting or standing was constantly miserable and I wasn’t able to sleep because of it either. Pain I can handle, but misery is a no go.

I’m very fortunate to have access to a group of orthopedic surgeons who specialize in working with athletes. I’m going to breakdown the process I had from first appointment to today. I should state at this point I already knew that whatever I had going on was going to be surgical, if they told me anything else I would have been absolutely floored.

The Pre-Op Days

My first appointment was with the surgeon’s PA. First they took my x-rays then a nurse took my history (the fall, my pedestrian vs car incident, etc), then the PA came in and said he expected to see worse on my x-rays based on my history but they didn’t look bad at all. Of course he said he expects the physical exam to show a different story. I said my best-case scenario is just him telling me I’m being a little baby about some tendonitis and that I need to get over it, but that’s not very likely. I did tell him that I had an event coming up that I had until the following Monday to withdraw from, so I think he put me on the fast track for getting me all my tests and info because of that.

I had positive physical testing signs for labrum tear in my right hip, as well as in my left hip. He said that it’s very common especially in women to have functional labrum tears and since it’s not bothering me we will just ignore it. I had a very “hot” reaction to the test in my right hip so he wanted to get me in the MRI as soon as possible. Thankfully they just happened to have a cancellation that morning – so I went out in the waiting room for about 20 minutes and then got called back again for the MRI.

They called me later that afternoon to confirm the labrum tear and to schedule me a follow up with the surgeon for a couple days after to discuss the results and plans going forward. I was told over the phone that based on the scans the recommendation would be for either surgery or a steroid injection to get me through the jiu jitsu events I have planned for the year – the doctor could discuss the details with me at the appointment. I definitely appreciate the advance information so I could have time to collect my thoughts before going in.

Meeting with the surgeon I also learned I had a “very small impingement” on the neck of my femur. He said it probably formed in adolescence since it’s right on the growth plate, and he would take a few mins in surgery to smooth it down so it’s not rubbing on the fresh repair work when he’s done stitching my labrum back together. I also learned I have deeper hip sockets as well – just a fun little anatomical tidbit to file away (built for power yo!). One additional thing that I learned that I was not prepared for was that they would have to stretch out the joint capsule during the surgery and because of my hypermobility it may not tighten back up all the way afterwards, so I may have a slightly increased risk of dislocation in the future. I decided the pros outweigh the cons and ended up scheduling the surgery for 4 weeks out. Additionally, my surgeon also ordered a pre-op CT scan with 3D reconstruction of my hip, just to plan out a little bit better in advance how he was doing his surgical approach.

The next 4 weeks were a flurry of planning and prep work. I filled 14 pages of a word document with research, I watched so many videos of surgery, PT, OT, anesthesia, recovery vlogs, etc. I got bored of it all. I stocked my apartment with everything I thought I might possibly need, since I live alone I was really concerned about being able to take care of myself with limited mobility. I knew I would not be allowed to bend at the hip past 90 degrees or rotate, and would be on crutches for four weeks post-op; so I moved food and daily items onto my counter and even got myself a booster seat for the toilet (yes, it is definitely needed!)

Surgery Day Pre-Op:

My surgery was scheduled for 10:30 so I got to the hospital a little before 8:30 with a teammate who was also going home with me as my post-op babysitter. I had the same pre-op bay as I did for my knee surgery, the nurse said they usually keep the ortho patients in the same 4 slots and it was just luck of the draw for me. Different OR this time though, I had #1 last time and this time they said I was in #4.

First off, I got changed and then settled in the bed to go over my intake paperwork with the nurse. They hooked up my warm air blanket and checked vitals. At this point my friend was able to come back and hang out with me for the rest of the time until the wheeled me back. Eventually the anesthesiologist came by to ask about my last experience with general anesthesia. I told him as far as I’m concerned, I had a very nice nap although I was told I took a while to wake up and I was pretty trashed afterwards – although probably because the surgery lasted an hour longer than planned. He scrolled through his notes (I was at the same facility for my knee surgery and made a nod), confirmed a few more things, started up my iv in the back of my hand (with lidocaine thankfully), and then told me “I wish you a forgettable experience!” before bidding me farewell to go handle an induction in another room.

Next to visit was my surgeon, he came by to confirm that we were operating on my right hip, signed my leg, and assured me he had a fantastic plan in place. I should state that even with just saline in my iv I was very chill and relaxed – so when he signed my leg, I told him he should go ahead and write “later” on my right knee. I additionally told him I was quite ready to have my brain turned off so I could get stretched out and skewered. He also wanted to make sure that my medications and such had been sorted (there had been a mix up at the pharmacy), and that my friend was all set with the info she needed for proper care and feeding of me afterwards.

Finally another anesthesiologist and nurse came to fetch me for go time! They gave me a dose of propofol into my iv in the bay then started wheeling me out toward the OR – I remember saying “Oh that’s spicy!” when it hit the vein and getting a bit fuzzy by the time we reached the OR. Near as I could tell I had an all female prep staff in there with me which I registered and appreciated in the moment (due to the nature of the prep area for the hip surgery) as I helped scoot myself from the bed onto the much more narrow operating table. I had several people helping to secure me in place and a mask on my face and I remember trying to ask a question that they couldn’t understand with the mask in place, so they removed it to hear me.

That was the point I decided to just shut up and let them work. I might have said that out loud, there might have been a jedi hand wave while saying that out loud. But that was my last conscious memory “I’ll just shut up and let you work” before I work up in recovery. What happened between that memory and waking up in recovery will be forever sealed in the annals of time!

Surgery Day Post-Op:

I woke up a lot faster than I did for my knee surgery, and a lot more clear headed this time! I likely didn’t have to be put under as far as I did since it wasn’t nearly as intense of a procedure. I was asked if I was in any pain and there was some so I said yes, and also asked if I wanted my friend to come back so I said yes. So my friend was brought back and I was given some pain meds in my iv and apple juice. My friend said she got the text that I was out of surgery only 15 mins before she was called to the back, so I really did wake up quickly this time!

I chatted a bit and went through a bottle of apple juice and some saltines before I decided to use the bathroom – this was when I learned I was allowed to stand with my weight evenly distributed between my feet. My nurse was very surprised at how alert and articulate I was with the level of medications I had in me, she had ended up giving me about 3/4 a syringe if dilaudid and offered to top it off but I declined, instead opting for another bottle of apple juice to help me finish off the crackers and get the plastic tube taste out of my throat. Speaking of medications, my prescriptions had somewhat been sorted out and were getting picked up by a coworker who was then coming to pick us up from the hospital and drop us off at the front door of my apartment building. I was still missing my prescription anti-inflammatory but we could substitute aspirin while we waited for that to get sorted out and we had my prescription pain and nausea meds, so we were good to go.

When we got word that the meds had been picked up by my coworker, we got pulled together and headed downstairs to go meet her. When I got home I settled into my air mattress that I set up on the floor (my bed is really high) and really just tried to chill as much as I could and unpack the whole day and experience.

Since then the days really have blurred together. That first day (Friday) I took the strong pain meds as prescribed, 1 every four hours on a timer just to stay ahead of any post op pain. For my knee they gave me straight oxycodone and that knocked me out pretty hard – for this surgery they gave me oxy/acetaminophen which thankfully I found I could stay standing while taking which was super important for me since I live alone and need to be able to take care of myself while on crutches.

Saturday

The next morning as per the doctor’s instructions I took off the large bandage that was covering the surgical site and clean the incisions using Q-Tip’s dipped in a half and half mixture of peroxide and water. He told me he was okay with me showering after 24 hrs. – he just wanted me to let the stitches dry and then cover them with band aids to keep them from rubbing on clothing and getting irritated. I have three entry port areas, from what I was researching before surgery it looks like he used the standard anterior-lateral port as well as the anterior port, in addition to a modified anterior port to help with placement of anchors for suturing my labrum in a more anatomically secure angle (I read about it in a research paper). There was (and still is) significant bruising around the two upper port entries and very little around the additional access port. I started out Saturday spacing my pain meds out to every 6 hours to see how the pain felt. It was a little achy but nothing terrible so I decided to keep it that way. My friend went home this afternoon so it was just me and my puppy in the apartment

Sunday

I took the prescription pain pill at 5 am and decided that if the pain wasn’t bad at 11 that I would try switching to Tylenol, with the escape that if it got bad, I’d go back on the prescription medication 4 hours after that if needed. I ended up not needing it and just stayed on Tylenol (still have been since). I still had a little oozing from the stitches so I cleaned the incisions again with the peroxide/water mixture, let them dry, then covered again. I had a hypotensive episode that really frightened me this afternoon, I nearly passed out and was very close to calling 911 for myself. I checked all my pulse points and verified that it did not hurt my lungs to breathe so I made my way to my bed and created a pillow nest to call the weekend on call line for my surgeon’s office, I additionally called a team mate of mine who is a nurse who deals with similar issues. Overall consensus being my mild orthostatic hypotension must have gotten mad triggered by the anesthesia and I just had to take it really easy for the next couple of days and use up all the electrolyte powders I had bought. I had planned on showering that day but decided with that excitement that I didn’t want to risk trying to stand up for that long again and would try again in the morning before my PT appointment.

Monday

Joy of joys I made it through the shower! Being able to stand with my weight evenly distributed, and having a walk in shower without a tub made it a pretty simple affair – it was just exhausting. Then it was time to get ready for my first physical therapy session! It was at the same PT clinic I went to for my knee and my newly assigned therapist recognized me from all those visits – I told her I just missed everyone so much I just had to do something to come back and see them again! PT is going to be all table work for a while since I’m 100% crutches for the first 4 weeks. She did a lot of passive range of motion movement and was very happy that my hip could already flex to 85 degrees before she felt a slight bit of resistance. My max of course is 90 degrees and I’m allowed internal rotation but strictly zero external rotation. Also, no active hip flexor activation or crossing of the midline with my surgical leg. Basically, none of the movements that I really want to do right now. I have PT homework too that consists mainly static muscle squeezes to just try to keep the muscles firing while the joint isn’t allowed to move dynamically quite yet.

Tuesday

Not a whole lot going on for Tuesday really. I’ve been working remotely since Monday and am planning to do so for the first two weeks post-op. This is mostly because of the movement restrictions and my need to periodically hook myself up to my ice machine during the course of the day. I highly recommend getting one of these continual ice machines if you’re having any orthopedic procedure, it really makes a huge difference for pain and inflammation in these first few weeks! I keep frozen water bottles in the freezer and just rotate them through the little ice box and it will keep the wrap on my hip chilly for several hours at time without me having to worry about it getting too cold. I sleep in it every night – they have the new version that does compression as well as cold therapy but I’m good with just the cold.

Wednesday

Second PT session was today! Had a repeat of the first session except she bent me to 90 degrees during passive range of motion and I didn’t even feel a stretch, so I’m gonna tentatively say maybe I won’t have too much trouble getting range of motion back from this surgery. She also added two new exercises – one where she assisted me with rolling to my belly for a good stretch there, and then the other was a core crunch using one of the large exercise balls to keep me from actually breaking my 90 degree flexion rule.

Thursday

Thursday was basically a repeat of Tuesday although I noticed that I’m starting to get more yellowing bruising spreading out around my hip and the swelling is really starting to go down. I slept in a more flat position as opposed to having my leg and head elevated and it seemed to really have helped the fluids to distribute a bit more evenly at this stage of everything (I was headed into BBL territory for a bit there).

Friday/Today

And that brings us to today, one week post-op. Other than the movement restrictions I currently have in place I already feel so much better than I did before surgery. I’m a bit more sore in the mornings right now because I’m sleeping through the night: which I wasn’t able to do before the operation. Once I do my limited PT exercises I’m feeling good. My plan has been to work from home for the first two weeks which has been working out okay so far and my dog Dmitri has been doing a stellar job at guarding my hip for me.

To my knowledge I have 3 more weeks at 50% weight bearing, meaning I can stand unassisted at the counter to make food, then gotta reach for the crutches to walk myself to the next location. My post-op appointment Tuesday morning, so I’ll get to hear the details of what exactly went down while my brain was turned off in the OR, see pictures, hopefully get the video (I have the one from my knee!), and see if any adjustments were made to my recovery plan as the result of what was done in surgery.

Back in the Groove

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Man, it has been a crazy last few years.

There were quite a few long stretches of time where I basically quit mentally with my training and came within a hair of quitting physically as well. Between losing all my training partners due to academy drama, covid, and then my knee blowing out sideways – it was a lot.

Through it all, I gained an excessive amount of weight of course. I went from walking around comfortably around 140 lbs up to 192 lbs at my peak after surgery when I was immobilized for months. The extra weight puts pressure on my already wonky joints (I have hypermobile EDS), as well as caused an increase in overall inflammation/pain, shot up my cholesterol, and just made me feel like a washed up has-been. Having a significant amount of body dysmorphia and old history of an eating disorder did not help with that either.

March of last year is when I was able to start moving around a bit (3 months after surgery). I had a lot of limitations and twice weekly rehab since I was basically learning how to walk and use my leg all over again. There was a lot of nerve damage due to the extent of the damage to my knee and it was months before I could consciously flex my quadriceps muscle group. In summary:

2021: Awarded black belt in March, knee injury happened 3 weeks later in freak training accident. I knew it would put me down for a while but wasn’t sure how long – surgeon wanted to wait and see how much it could heal on its own before he did any surgery. It was frustrating going from 6 week appointment to 6 week appointment without a concrete recovery timetable answer – all while paying out of pocket for therapy twice a week (no insurance of course). In December the surgeon determined it had healed as much as it could on my own and did a 3 hour long reconstructive surgery.

2022: My sports orthopedic surgeon was happy with the outcome and promised me an eventual return to full usage. I’d never had a stiff joint in my life but he purposefully wanted it to heal stiff so it would be as strong as possible for all the impact I would put it though. This translated to many tears in PT when it came time to work on pushing the range of motion and I was on the watch list for a second procedure to clear out extra scar tissue. (Better that option than for it to heal too loose and have to get the whole procedure done over again.) March is when I hit that peak with my weight just as I was starting to be allowed more movement and could start working my way back down slowly. 6 months after surgery I was allowed to start moving around lightly on the mats with a special made sports impact brace to protect the healing ligament grafts. In December of 2022 I got the all clear to return to training without any restrictions – he said it would take another 6-8 months for me to feel fully recovered but I wasn’t in danger of damaging the reconstruction work he did. So I signed up to compete in January at the Europeans.

2023: So far I’ve competed at an event almost every month. It was a fight to get my weight down to make medium heavyweight (163.6 lbs) for Europeans, but it felt like a huge accomplishment to have a chance to be back on the mats and I was just tearing up in the bullpen as well as before/after all my matches. Honestly I feel pretty emotional and grateful at each event I’ve been to so far. I know I haven’t been training at my optimum in order to expect to win events, but the only way I will recover my movement and proper mindset is to just keep pushing myself and embracing the suck.

Currently:

I finally reached a place where I feel confident using my surgical leg without being on guard at all times – so that means I’m ready to get serious with my training again. I have most of my training partners back thanks to my coach opening a new academy where we can feel welcomed again, plus I’m now working a job that is a supportive environment for both jiu jitsu training/competing and my autism quirks.

I decided it was time to make the push to get back to my light weight division (141.6 lb) for the Master Worlds tournament next month. It’s a lot of hard work, but with support from my team mates I am able to keep my focus and am reaching or exceeding my weight goals each week. Self-motivation is a thing, but knowing my team and coaches have my back gives that motivation a solid foundation. Working from that foundation I feel my confidence and drive returning again, like I haven’t felt since my mid/upper purple belt days!

With a little extra push I’ll be able to make the goal of light weight early in time to compete in another event a few weeks before master worlds – then I can coast and let my system stabilize before the big event. I would just prefer to not have the first time I manage to make weight be at one of the biggest tournaments of the year.

I love seeing the camaraderie of our academy and all the new people coming in almost every day. After some dark times, the new chapters going forward are looking bright!

Goals Achieved!

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I’ve never been one who sets New Year resolutions. I don’t like the idea that some random start time for the year is what you wait for to make a change in your life. I tend to choose personal life events as benchmarks for progress goals – and it works for me that way. This year my life events have synched up pretty well with New Years so I figure I may as well get on the bandwagon for a change!

At the end of 2021 I was scheduled for knee reconstruction surgery (my fibula was basically torn off from all upper attachments and PCL was shot) and I decided that since I would be down and out for a significant amount of time, I would make the most of it. I did not like where I was stuck in life and had been unhappy for quite a few years, so the forced “stop” of everything seemed like my cue to shake things up and rebuild.

First step: I got myself into regular therapy in the fall of 2021 (a few months before surgery). I wanted to try to sort out what was wrong with me that I couldn’t just accept things as they are and be happy. I highly recommend anyone who feels stuck or at a transition point in their lives get a good therapist who is trained to help with the process!

I had been in a financial hole for a long time. Chronically underemployed my entire life (as is the tale for many other autistic adults), I’ve learned to live on very little and just try to keep a positive “make the most of it” outlook. Around the time of my surgery, I received a job offer from one of my team mates to work as a project manager for his company. This would be something completely new and different from how I have lived my life previously which is a terrifying prospect. However, what I had been doing wasn’t working for me anymore, so I decided to go for it. What I found was a perfect fit for me, with great coworkers and a supportive work environment.

I also decided that a total break from my old training academy was needed. This was super hard to do as I had invested over a decade of my life into that place, but as time went on things changed and it was no longer a system in alignment with my or my coaches’ ideals. Coming to that realization meant I had to give up on it and admit that I had failed in my goals to be that person who could help keep things together. Continuing to struggle against a system not aligned with what I want out of my jiu jitsu journey would just lead to more stress and tension for all parties.

I left with no idea where I would be training once I returned after surgery, but I had reached a point where I could even see myself not going back to bjj at all. Shortly after I left, things happened resulting in my coach dropping them from the team and immediately starting the planning process of opening a new academy. It was a slower process than anyone wanted, but now we have a gorgeous new facility with coach teaching the majority of the classes and pretty much everyone in class is someone who I have enjoyed training with for years.

These three changes: Therapy, new job, and leaving the old academy have brought about so much positive change! When visiting with people I had not seen in a few years they commented unprompted that I had my sparkle back.

I now have excellent health insurance through my new job. I have been without insurance for over a decade and went in with quite a list to dump on my new PCP. So far, I have been officially diagnosed with hypermobility syndrome which explains a lot of my chronic pain and injury history, as well as a few other ongoing issues (the echocardiogram for that was fun!). I see a dermatologist in the spring and the geneticist is offering to do a DNA screening for autism markers that any inquiring family members could check for.

My insurance also (amazingly) covers my official neuropsychological screening that I completed last week. I will see the doctor in a few weeks to go over the results of that. At my intake session for that in October she said she could confidently diagnose me as autistic without testing, but since insurance covers it she ordered it for more insights.

Having an official autism diagnosis has done wonders for my mental health as well. I’ve “known” for a long time, but to have the professional assessor agree with me really validates everything. I’m feeling more free to be myself on a daily basis and am learning how to take better care of and be kinder to myself.

Stepping Forward

So now I’ve got a solid foundation to work with again! I have a good job that pays well and is fairly flexible for training and competing, training bjj directly with my coach once again and getting reconnected with the vibe that got me hooked so many years ago, ongoing therapy and official diagnosis for how my brain works to help guide me going forward, and I was able to move into my own apartment and be able to build a homey retreat for recovery.

I signed up to compete at the European championship tournament next month. I’m still trying to drop the surgery weight so I’m competing in the medium-heavy division. Coach said I’m strong enough to do heavy weight if I wanted to (thank you year and a half of physical therapy), but I’d rather work my way back down to middle or light weight since I move better in those divisions. Who knows? Maybe I’ll move up permanently – I’m just happy to be getting back out there! I want to see what my baseline is, so what better way than to just dive into a huge tournament? My surgeon said it would be another 6-8 months until I get back full functionality in my knee, but that it is safe to do full impact now and would heal more quickly and completely with more usage.

I get several weeks of PTO per year but I am trying to save that up for trips to Brazil and Japan, so I’m attempting to do Europeans as a “work from home” option and bring my work computer with me. If it works out well, I may be able to do that for other events. I am also signed up for the Atlanta Open and Pans already. I plan to hit the Abu Dhabi pro circuit once I have found my stride a bit more.

It is going to be a fun process moving forward in life with official diagnosis for my physical issues as well as my autism. Knowing where I have deficiencies, I will be able to work and strengthen around them easier instead of just guessing. It also gives me slightly more confidence to advocate for myself when needed. Just because I CAN push through doesn’t mean I have to, especially when the recovery period for my “push through” is so much longer than it is for others and affects more than just that moment. Affording myself that grace to recover properly as well makes my “on” moments much higher in quality as well!

In a nutshell: 2022 was all about tearing down and rebuilding my foundations. 2023 and on is going to be about building a structure on that new solid foundation. Mentally, physically, emotionally, and financially I am in probably the best balance of my life and I am excited to see what I can do!

Recovery Process

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I am currently a year and 8 months out from a major injury that has put me off the mats and out of training for the majority of that time. Each phase has been difficult for different reasons and I have gone through all stages of grief multiple times!

Immediate Aftermath:

Lots of denial here. I at first just tried to shake it off and was going to ride my bicycle home and “rub some dirt in it”. I am used to getting banged up after 10 years of training. I have dealt with chronic pain my entire life and honestly the pain from the injury was less than what I’m used to feeling on a daily basis of just existing. What was different this time was the joint instability.

Admitting I needed outside help was a big step for me. With no health insurance I had always just played the “let’s give it some time to see how it does” approach and was lucky up until this point. Even at the doctor’s office I was talking myself down, telling myself I was overreacting and would regret the money I was wasting on the visit.

After the MRI, I went back to see the doctor and he said he needed to put me in a brace and re-evaluate in a few weeks. I’ve worn knee braces before so I figured it would be no big deal – next thing I know I have two nurses strapping me into a full length leg splint that I was to wear at all times to keep me from bending my knee… It started to feel a little serious at that point.

I was still able to hobble around with a cane, and made it a point to put a positive face forward for the students. I kept telling myself: “I heal fast, this is probably overkill but it’ll be fine.”

The Wind Down:

So began my cycle of physical therapy twice a week with a dr check in every 4-6 weeks. I had no concrete recovery timetable because my pre-existing hypermobility condition made it difficult to determine how much of the joint instability was from the injury and how much of it was my functional instability. I continued improving each week with physical therapy and doctor check ins. He said my recovery would plateau at a point and that is when we determine if I was functional enough to train again, or if surgery was needed to get me back on the mats.

This was the depressed/frustrated/angry zone. People would wish me “speedy recovery” and I had to bite my tongue to keep from snapping at the platitude. Being around Jiu Jitsu gave me no joy and in fact made it worse after months of just watching as everyone moved on and left me behind. There are blue/purple belts who have never known me at my peak potential, and that was frustrating since I don’t want to be an instructor who just yells from the sidelines. I want to lead by example and have not been capable of doing that for a long time. What kept me sane in this time was the students who gave me a reason to keep going when I didn’t even want to get out of bed.

The Light at the End:

After 8 months of being in “surgery or no surgery” limbo, the surgeon assessed that I had stopped improving significantly between checkups and would need to do the reconstruction. At that point I was unable to walk down stairs unassisted so it was still a significant impairment just for daily life. It was a relief honestly! I wasn’t nervous at the thought of my first (and hopefully only) surgical procedure. I knew I had done everything possible up until that point, and knew I had the best possible surgical team to put my knee back together again. Apparently once I was knocked out my knee was as stable as warm jello without my muscle tonicity to keep it in place.

Post-Op Struggle:

Post op has been a new challenge. It was such a massive reconstruction job that I had to learn how to walk all over again. I had so much nerve damage that I couldn’t feel my foot for weeks afterwards and whole muscle groups were unable to activate and even now almost a year later there are still patches of numbness that probably will not recover sensation. It was still easier than those 8 months pre-op because there was no more “surgery or no surgery” limbo, just a forward momentum of improvement.

Improvement with strength came fairly quickly: what was/is hardest for me is mobility. The surgeon knows what I do for training and told me specifically that he wants me to heal more on the stiff side with more scar tissue to help stabilize everything. We ticked that box and then some – for a while I was on the watchlist for a second procedure to remove some of the excess scar tissue. Every PT session I would cry and whimper while they tried to passively force flexion back into my joint. I had multiple injections of different things in attempt to reduce inflammation and pain.

This was another low point as I started to wonder “is this just gonna be my life now? Is this as good as it gets? Have I gone through all that and still find myself unable to train?”

Current Day:

I’ve been training in classes at my new academy (with my old coach) on a regular basis again and man it feels so good! I am of course everyone’s rest round, and there are a lot of movements that I have to re-learn how to do. The hard part right now is trusting that my knee is okay. The surgeon told me a couple of months ago that he is okay with me doing whatever I want for training, so long as I am careful with new movements. I see him next week for my final 1 year post op check up and release to compete again.

Learning to trust again is the struggle at the moment. I have been super conscious about my knee for close to 2 years now, so just letting go mentally is really difficult. I panic anytime my knee is compressed, whether it hurts or not, which then makes my training partner nervous and unwilling to put the pressure on me that I need in order to actually improve. It will take time, but I’m fast tracking myself by signing up to compete at the European Championship tournament at the end of January. Meaning I have about 8 weeks to push myself and I work best under that kind of pressure!