Adding In Sparring – 14 weeks post op

It was another busy week and I just reached 14 weeks post op for my FAI/Labrum repair on my right hip. I have really focused on slow steady progress and the patience is really starting to pay off at this stage of my recovery. The fact that I went into surgery in peak physical condition gave me a leg up, and my underlying hypermobility also meant that I did not have to fight for range of motion at early stages of my recovery and instead focused on stability and managing early inflammation.

Here are the Dailies!

Saturday

I taught our first 8:30 morning ladies’ class and it went quite well! We reviewed the techniques that were taught at the seminar the previous weekend and then the class piggybacked into our 9:30 open mat training session. One of my blue belt teammates asked if I would be willing to do a light warm up round with him and I decided to just go for it since I know he is a good, controlled training partner who would stop and freeze if I told him to. I felt my coach giving me side eye the entire time, but nothing felt off or uncomfortable and I felt like I could move pretty normally – although I did of course avoid any movements of my leg across my midline and my usual guard game and only did the one light round. I felt some stiffness in my hip flexor after cooling off, so I made sure to stretch well and found that the red/infrared light therapy tool that I got the previous week really does seem to help with relaxing the area so it is now part of my evening wind down routine.

Sunday

Total rest day! I had no pain from my flow round the previous day but did do more stretching focused on the hip flexors. Jiu Jitsu moves focus on a lot of core contraction motion which is something that I need to watch to make sure doesn’t end up turning into any chronic inflammation complication after this surgery – not when I’m this close to feeling myself again!

I have been using the red/infrared every evening on my hip at various angles. Additionally I have found it to help give me some immediate relief from inflammation in my elbow. My elbow has been a bit unstable at the radial/ulnar joint – not from any sort of training injury, it’s related to my systemic hypermobility issues. The problem is that when I went through my kinesiology nerd out phase I apparently glossed over elbow and as such don’t seem to really be able to figure out how to stabilize the area myself into working order. I may need to check in with the Dr for some assistance once I get my hip cooled off a bit. All my joints are wonky so I don’t expect perfection ever, but I’m usually able to get balanced out to a form of homeostasis once I figure out some method of adaption.

Monday

Physical therapy clinic day! My routine didn’t change much from the previous week although my single leg press weight was increased again, and hip flexor stretches were added. I also learned that the hip flexor strength exercise I tried to describe last week has a name in their system – they call them “hip airplanes”.

I reported about doing my light round on Saturday, and since I had no pain the day after my PT said she wants me to keep pushing to do more. As long as there is no pain in my hip during activity, and I can get out of bed the next day without wincing from hip pain, she said I’m doing okay. I’m barely sore just in my muscles as of right now and definitely no hip joint pain (we just don’t talk about other joints – hypermobility is super fun)

This was my last physical therapy session covered by my insurance plan. Starting next week, I get to pay out of pocket but thankfully I budgeted ahead for it!

Monday night in class I was able to participate in all the drills including learning a new grip setup for a drop seoi nage, and working chokes from side control top position. I then decided to do a couple of the live positional escape rounds before sitting out the 5-minute full rounds. “Doing more” like my PT said and all.

Tuesday

More drills in class that morning, and I once again did the positional escapes and skipping out on the 5 minute rounds. I requested an updated app PT routine on Monday but that had not gone through yet so I just did my usual adapted session with my pistol squats, elevated heel squats, hip airplanes, etc. during evening comp class. We had a new lady come in to try out the late evening class after that so I stayed late to help out a bit afterwards – I fit in a few extra movement reps as well.

Wednesday

I taught no gi ladies’ class this evening at 5:30 – we went over my favorite side control top style of “kill position” and then one of the ladies really wanted to roll quite badly. I figured “why not?” expecting a chill round and she came at me like a bat out of hell – it was super fun! She would have dialed it back if I had asked her to, but we were having fun and I didn’t feel any discomfort or danger, so we kept at for probably about 10ish minutes.

I was intending to stay for the gi class after the no gi class, but I hadn’t been planning to roll like THAT. Since it was something new, I opted to go home, stretch out, and rest to make sure I didn’t let the adrenaline and friskiness overload my hip.

Thursday – Joining Comp Class

Woke up Thursday morning feeling just fine after rolling the previous evening, no soreness and wasn’t even feeling any flexor tightness. I opted to press my luck a little bit further and in class that morning I drilled and then sparred rounds (with the same person from Wednesday evening class) for about 15 minutes. I avoided playing my usual guard game that would put extra work on my hip flexors, but it was still full live sparring rounds, just avoiding certain movements and positions.

Coach saw me sparring and moving safely and conceded to let me attempt to participate in our Thursday evening competition class. I had proven last Friday that I could safely do all but one of the usual movement drills and could substitute in a different move for that one. I have enough body control and experience to be able to protect myself, and there were enough skilled people in class that were not preparing for events that I could partner with for safe training. Basically, the stars were aligned.

Our competition class has two parts. The first half is usually high intensity partner drills: think of it as Jiu Jitsu circuit training. The second half is live matches, usually starting with 1-minute positional escapes and then progressing to full length rounds from standing. The whole session lasts an hour. No breaks are allowed for water, and if someone is moving too slowly the entire class gets to do pushups. In this class you only sit out if you have an injury or some other medical consideration that coach is aware of. We currently run it twice a week.

That all said, I let my training partners know to avoid forcing my leg across my midline aggressively, but other than that told them I’m game. We just agreed that I would tap if at any point I felt myself in an awkward or uncomfortable position for my hip – then I could reset in a more secure spot and continue. I never ended up in a bad feeling position during the entire class (hip wise that is!)

Friday – The Aftermath/14 week mark

Bringing us to today, I woke up this morning feeling just fine even after the training of the previous day! I’m officially at the 14 week post-op mark now and feeling more and more like myself since I’m getting more involved with my Jiu Jitsu training!

What I am watching for is the day after slight tightness in my hip flexors/deep abdominal muscles on my operative side. This seems to creep up every time I amp up my activity/intensity levels, but as long as I respect it and do proper stretching and recovery exercises, the same level of movement is leading to less tightness the next time I do the activity. With this pattern, I’m slowly building the endurance back up without causing that nasty hip flexor tendonitis complication that I’ve read about.

I doubt I could trust a less experienced version of myself to be able to move around safely enough on the mats to be able to do as much as I am doing right now. Thanks to a combination of super amazing teammates who have my back, and over a decade of training experience (body awareness!) I was able to feel pretty comfortable training this past week at a moderate level. I adapted my movements and avoided positions that could possibly compromise my hip (no real aggressive guard play for me for a bit!), and it is feeling great.

I did take some video of the more aggressive matches in our competition class to show my physical therapist for the next time she tells me to “do more”. The ones where folks look like they are actively trying to fight for that last point with one minute to go – you know, those kinds of rounds. That way she can know how far “do more” can scale up for me.

Fun bonus note to close with: my father is currently in Australia – he will be racing this weekend at the Ironman/World Multisport 70.3 Triathlon representing Team USA. He worked really hard to qualify for this spot and took the trip out along with my mother. I’m looking forward to his race report and will be following his progress on the race tracker app!

After the race they are spending some time visiting around various spots in Australia as they have never been before (neither have I either, it’s on my list!) I’m really excited for them to have this trip together!

Hip Labrum Repair Recovery – 6 weeks post-op

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 Surgery Recovery – 4 weeks post op

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.

Training Partner Profiles – Categories

I’m starting a series of Training Partner Profiles where I’ll go over the types of training partners I run into at the gym, and how I work with them to achieve benefit for both of us! I’m going to start off explaining how I categorize everyone I roll with. These categories are fluid and I mentally move people around in them as I observe changes in behavior and training habits.

And yes, I know I am not the perfect training partner. If you ask 100 people who I have rolled with where they would classify me, I’m sure the results would put me into every category. It seems cold and calculating I suppose to assign people a category, but that’s how my brain works.

Category Definition:Moral-Question

Golden List: Ideal training partners!
I perk up when I see these special people in class. It could be the prospect of a good toe to toe battle, learning a new trick, or the smack talk during a roll; but they are the people I gravitate toward when partners are chosen.

White List: Good training partners for a good roll!
The majority of people are in this category. These are the people with whom I don’t feel any hesitation to bump fists with. The vast majority of my team mates are a part of this list.

Gray List: Okay to drill and roll with defensively.
The big thing that is involved here is usually the almighty Ego. They will roll nice until I start trying to attack and then they go into “hulk smash” mode (not in a good way!) – usually resulting in sprained fingers, bruised ribs, etc. This could also be a newer person who doesn’t know the proper way to move resulting in me having to pay close attention to keep both of us safe.
I can still have a good roll with them if I focus on defensive tactics only. I’m not at a size or skill level where I can help beat the ego out of them, so I will use this opportunity to practice my survival skills.

Black List: Do not roll with under any circumstances. Use caution with drilling.
This is usually a very short list and usually just a transitory placement. These are the people whom I feel will injure me beyond having a sore spot or a bruise the next morning. My first year of training I suffered many injuries that were due to rolling with people I should not have. It is very rare this is due to any maliciousness or ill intent! Most often I think it is due to a lack of experience and poor body control.

Over the next few posts, I will go over:

The Big New White Belt

Your Twin

The Spaz

The Upper Belt

The Lower Belt

The Judoka or Wrestler

The One Trick Kid

I will likely add more, this is just what I have in my head at this very moment!