Tag: Brazilian jiu Jitsu

Checking in 5 months post-op – 24 weeks

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It’s been a few weeks since I have posted an update and I passed the 5 months post-op mark! I’ve been pretty busy and a lot of things are coming up, so here is what has been happening!

I’m back with my original physical therapist since she has returned from maternity leave, and she has really been amping up with more impact and dynamic movement exercises, working to emulate things I do in Jiu Jitsu class. My therapist has researched and improvised various exercises in order to make them more specific to Jiu Jitsu movement patterns. We start each session with a check in for any tweaks I’ve felt during the week while training in class, a physical assessment, and she makes any necessary adjustments to my program for the day.

I will be seeing my surgeon for a check in next week and PT agrees that he will be very pleased with my progress overall and thinks it is very possible that he will release me entirely from physical therapy sessions (10 days shy from my official 6-month post-op mark). I am scheduled to see her immediately after my appointment with him, if he says I’m free to go I can just come downstairs and bring the good news and cookies.

This past week I had a great class where I rolled as close to all out as I have since surgery. I still feel some rotational restrictions that I’m going to mention to my surgeon, but I think that will just take some more time to work through carefully. It was a good contrast to the previous week where my hip got twisted pretty abruptly in class and I yelled – that caused some inflammation that made me take a few days away from the mats and some anti-inflammatories along with extra home care. My PT checked it of course and agreed that it was just inflamed from the abrupt movement. This was the first tweak/inflammation issue I’ve had of any kind during my entire recovery process – which is pretty stinking good for this sort of surgical recovery.

The only movements still giving me discomfort are quick external hip rotation and compression across the midline. All other movements are fine with a proper warm up before training. I do need to improve comfort and stability at the end of my range of motion, and if I sit for hours without a stretch break it will start aching as well. These are all things I expect to improve in the coming months.

Here’s how training is looking right now:

  • I’m doing most moves in class, just avoiding high impact takedown drills (judo trips and such are ok)
  • Positional sparring rounds in class after drilling: if my pre-selected partners are not available when we change partners I sit a round. Otherwise I proceed like usual.
  • Sticking with familiar training partners for sparring. Since they are partners whose movements I can trust, I don’t have to guard my own self so intently and can therefore progress my own movement confidence safely.
  • I do my own specific warm ups before class which usually overlaps into the group warm up time as well. I do joint mobilization and muscle activation exercises that I use in my PT sessions before getting into strength training.
  • This past week I have started adding more evening stretching before going to bed – in addition to my red light therapy sessions. As training and impact amps up I need to increase recovery measures to make sure the load stays balanced.

Latest PT Session (mostly self-reference):

  • Started with PT check in and warm up on elliptical
  • Stretches: leg box drills adding lean forward over front leg, then back leg clamshell, heel lift, then leg lift (new); kneeling quad/flexor/psoas stretch, tabletop hip isolated rotation (new)
  • Decompress hip by using heavy band anchored to wall around bent leg while lying face up on floor. Pull knee toward chest to decompress joint
  • Activation: Free standing clamshells with band, leaning wall runs with band around feet, squat with soccer ball between knees (hold until feel burn then hold for 10 more secs), hip airplanes on wall, banded sidesteps one foot anchored to the wall at the time, Sidesteps anchored to wall by torso,
  • Strength: hold bear crawl position and slide small plate with toe forward and back 10x, single leg box bridges, 45# v-bar single leg RDL, 45# v-bar squat, Single leg shuttle squat kickback, 45# sled push/pull
  • Other exercises done in previous sessions: Back lunge with cable row at top, Heel elevated kettlebell squat, medicine ball slams (start on two feet, end on one), step off 20 inch box and catch weight on one foot lightly, hop with feet 2 to 1 off and on 20 inch box.

Coming Up

I see my surgeon next Wednesday and am compiling a list of questions for him. Most pressing is to let him know I booked the flights to compete at the European Championships and Tokyo Grand Slam in January since at our last visit he said it was a “reasonable goal”. I’ve also registered for the Europeans and am waiting for registration to open for the Tokyo event – I’ll be flying from Lisbon to Tokyo and doing both events in one big trip.

I have other planned events lining up as well for the year – at least one major event a month (2 more in Feb). The first 6 months of the year I will be competing in 7-9 countries depending on final tournament schedules. I want to be able to enjoy training and learning Jiu Jitsu for the rest of my life, and don’t want to be the stereotype of the old black belt who is too broken to do anything but sit in the corner of the mat with their broken everything. I however do want to get out there and enjoy competing as much as I can while I’m still physically capable of making the rounds at this high frequency. I know with my chronic joint/connective tissue condition I need to be extra cautious about wear and tear on my joints if I want longevity for training, so it’s always a constant game of push and “check in”.

When and if I am released from physical therapy sessions, I will have to continue a structured rehab protocol on my own in order to maximize my full recovery. It will also keep my other hip stronger and useable as my initial assessment done indicated I have the same issue in my other hip (labrum tear/impingement), it’s just not giving me as much difficulty as my right hip was so my surgeon said we would just leave it alone unless it became a functional problem for me.

The Good Kind of Sore – 19 weeks post-op

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Saturday/Sunday

I taught my usual class on Saturday morning, finishing out the week of half guard top position by working some over/under pass variations and concepts. Then I rolled a couple of rounds at open mat. I could definitely feel the progress I have made over the last nearly two weeks of letting myself rest properly after nearly overdoing it. I was moving quite well and very dynamically without too much hesitation – most of my hesitation comes into play when I am in guard and wary of my partner potentially moving my leg and putting stress on my hip. When I play top or neutral position I feel very confident/secure and much as such. After open mat ended I hung out for a little bit and waited for a private client to arrive for an hour session before heading home to relax for the rest of the evening. Sunday as always is my sloth day – I do the bare essential demands so my brain can recharge for the week. I find that this makes the rest of my week far more productive and efficient.

This update is going to cover a few days extra as I’m going to switch my update day to Sundays moving forward.

Monday

I had a surprise substitute physical therapist today, so he asked me if I wanted to change anything about my program and I told him that I didn’t know what he had planned for me and as such I couldn’t make any comments. He said he was going to do the same thing as what I had listed from last week – so I told him that the kettlebell RDLs were very easy and I could probably use an increase. So he took me to the weight room and checked my form on a landmine deadlift with a 45# plate – that became the replacement. Everything else remained the same as last week except that for my straight leg raises I used a larger cone and for my TRX pistol squat I opted to not use the squishy pad as a target behind me and just watched my depth in the mirror to make sure I was getting to the spot I needed to be.

Monday nights we have a 90 minute Jiu Jitsu class at my academy and it is one of our most popular classes of the week. I work from home on days that I have physical therapy but got a ride in from one of my team mates. We warmed up with partner movement drills, then went into our takedown sequence of the month before working on a Jiu Jitsu technique from side control bottom (position of the week). Then we had a good 30-40 minutes of live drills/rounds. I was able to go through the entire class without any modifications to techniques and felt really good in all my movements. I even was able to implement a new passing concept that I sniped our other black belt instructors studying – it wasn’t exact to the way they were practicing it, but it used the same principles in the moment and it worked.

Tuesday

I felt the deadlifts in my upper hamstrings when I work up this morning. Nothing above and beyond, and I was still able to move around like normal, but I could definitely tell I had done them the day before! My blood pressure was running on the lower side of my normal today continuing the trend from yesterday (mid 90s/60s) – so I decided to really focus on extra hydration to see if I could bring it back up a bit. The nice thing about Jiu Jitsu practice is that if my hypotension issues flare up, I’m already on the ground so I’m less likely to pass out except for in between rounds when I stand back up.

Class this morning was fun! One of our black belt instructors reviewed over the technique from the previous evening class with an additional technique that was really stupidly useful (my favorite kind). We got a good amount of live rounds in and I felt pretty solid moving around.

I did a fair amount of mobility and stretching before going into my home PT exercises during evening class as I was still a bit sore. It was just muscle soreness though and my joint felt good so it was okay to work through – I did go a bit lighter with prescribed weights however and only did one set of the single leg (shoulder elevated) hip bridges.

Wednesday

The hamstrings are a little less sore today although my hip joint started getting a little sore. I realized that I was sitting curled up like a gremlin for the majority of the day and it felt better as soon as I stretched out a bit in my big chair that I have set up in the office. I’m still not ready to be hunched over in a standard office chair all day apparently but I’m thankful to my team for setting me up with a comfortable alternative.

I taught some leg framing principles from knee shield half guard tonight (how to activate the core and not just depend on isolated muscles for stability) and then two sweep options depending on whether people are pressuring the knee shield or have their weight neutral/back: a little push/pull dance so to speak. We sparred a few rounds as well and I got to jump in and it has been a while since I did any no gi sparring rounds!

My energy levels had been pretty low this day but since I had gotten my vitamin shots right before class I had a bit of an energy boost and decided to ride it and stay for the gi class afterwards. I got introduced to a new half guard sweep series that I may have to play with a little bit and then got two more light rounds in afterwards.

Thursday

For morning Jiu Jitsu class I was pretty fuzzy headed and had to work hard to maintain my focus and not be a bumbling buffoon during drilling. It was easier during live rolls because that’s more instinctive for me and doesn’t require as much brain power as does focus repetitive technique drilling.

I did my evening PT exercises during the comp class and made it through the full set for the first time this week since the hamstring soreness had died down appropriately enough by this point. It felt pretty good!

Friday – 19 weeks post op

This was typically my work from home day but I had to go into the office after a morning appointment with my therapist as we were down an office staff member. This meant an extra day of sitting which is still a bit more uncomfortable even in the stretched out chair so I had to take extra time to walk and move around during the day.

Saturday

Our morning ladies class is slowly growing and I taught loop choke variations this morning before heading home to relax and take an afternoon nap. I went to see the opera “Carmen” at the Tennessee Performing Arts Center this evening as a special treat and wanted to be well rested for my night out – I really enjoyed the show!

Sunday

That brings us to my new update day. I spent most of Sunday morning doing a deep clean of my apartment and then made a batch of cookies to bring to my PT clinic the following day. Tomorrow will be my last PT session with my current therapist before my original therapist returns from maternity leave to resume overseeing my care – so I figured I would bring some baked goods to see her off. My chocolate chip toffee walnut cookies are always a crowd pleaser!

All in all, I was pretty sore especially toward the beginning of the week in the hamstrings from those deadlifts, but it wasn’t sore enough to cause me to cause me to not be able to move. The main trick I find is that the more choosy I am who I train with, the less guarded I have to be with my movement. In fact this week was some of my best movement thus far. I’m still doing my best to keep the reins on but I can tell I’m getting very close to being where I need to be to get the all clear soon.

Passing the 4 Month Mark

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This week I passed the 4 month post op mark officially (on Tuesday the 17th)!

For a re-cap: I had an arthroscopic hip surgery to repair an anterior labrum tear (4 suture type anchors) and correct a small cam impingement on my femur that also included a bone cyst that reached into my bone marrow. I also have coxa profunda (deep hip sockets) – which seems debatable as to whether it is considered a pincher impingement or not. My surgeon didn’t classify it as pincer impingement as per the chart notes I have read – he did do a little bit of an acetabuloplasty (bone reshaping on the rim of my hip socket) however to give me some breathing room and assured me I’ll be able to have free full range of movement without any restriction or pinching once I heal up. The acetabuloplasty served a dual purpose as well to clean up the rim of the hip socket for the bone anchors as well as to encourage extra blood flow to the area for speedier healing of the labrum. He also did a little clean up in the inside of my hip socket of one of the fatty cushion pads that was shredded and basically useless. I had no signs of arthritis thankfully and my entire time from wheel back to wheel out was about 90 mins – my surgeon described the entire surgery as “unremarkable”.

He did comment (and showed me the photo!) that I had pre-existing scar tissue on my joint capsule that you don’t usually see unless there has been a previous surgery or severe injury. Based on the location it was most likely from when I fell while striking and dislocated my hip causing the initial tear over a decade ago – I think he was lightly skeptical about my tale of the that dislocation until that point.

My recovery process has gone quite well. I think the combination of having an excellent surgeon/care team, being in really good shape beforehand and doing a lot of research on recovery protocols/expectations really helped me in that regard. Additionally I have hypermobility which worked in my advantage in this case because I was able to attain/maintain pain free range of motion and was at 90 degrees flexion within the first week post op – this probably really helped me with keeping my overall muscle and joint usage up and joint stiffness down. I’ve stalled a little bit now in that regard because while I have attained what would be considered “normal” range of motion, it is not normal for me so I’m working on slowly equalizing with my other side. Now that I have reached that 4 month mark it should be safe to start pushing a little more now too – I will double check with my PT before doing anything aggressive of course though.

My I saw my surgeon a couple of weeks ago and he was very pleased with my progress. I told him of my desire to have a solid comeback to the Jiu Jitsu competition scene in January (at 8 months post-op) by doing the Euros and Tokyo tournaments and he is on board with helping me make that happen. He’s still giving me the same precautions to make sure to not overdo training between now and my next appointment in 6 weeks; but approved of the way I have been moderating my mat training since the clinical results spoke well.

Saturday/Sunday

Continuing on last weeks theme of “taking it a bit easy” I taught my Saturday morning class and then skipped out on any live rolling rounds. Instead I did my full home PT routine including all the strengthening exercises for the first time since the previous week of rest. It got my heart rate up and felt really solid! While I of course prefer to be sparring rounds of Jiu Jitsu, I made the right call to skip it for PT exercises instead. Afterwards I went home to rest. Sunday was a day of absolute chill and continued recovery.

Monday – Physical Therapy

I told her how the past week wasn’t my most shining glorious week and what I did to manage. She assured me that as far as bad weeks go, mine wasn’t too terrible and I handled it perfectly by keeping somewhat mobile without overloading myself. Then we got into all the newness.

We changed things up quite a bit this time around in therapy.

  • Did away with my box squats as well as the single leg press machine.
  • Continued my heel elevated squats with a slant board and my PT said they looked too easy so we will increase the weight next week.
  • Continued hip airplanes/twisting pivot single leg squat reps for hip rotators. (I’m slowing these down and focusing on slow controlled movements)
  • Continued side planks and reclined straight leg raises (added ankle weights)
  • Added a TRX strap assisted pistol squat with tapping my free knee to a squishy pad placed behind me (so I can drop lower into the squat).
  • Added lateral step outs: long band around one ankle attached to the wall and I do side steps away from the wall as far as I can do so while controlling the movement against the band – then step back (targeting the adductors). Pretty easy although I was afraid that the band would snap I pulled it so tight, so we will have to use a heavier band or a lot more reps next time.
  • Added RDL with kettlebell – used 20# since it was first time doing exercise in PT but will probably increase next time around. Target muscle group was hamstrings so I had to tweak my form a bit to make sure hamstrings were firing and not being overtaken by glutes.
  • Finished with hamstring curl machine – still at 35# but it was right after doing the RDL with hamstring focus and did not fail, so that is definitely progress!

Since nothing was painful to do, it appears I did well to the previous week to take it more slowly.

My therapist let me know that my original PT will be returning from maternity leave to resume my care in a few weeks. I will have two more sessions before the switch over – so I think I will have to see her off with a thank you batch of cookies or pound cake!

Tuesday – Officially the 4 Month Post-Op Mark!

Back in the office this morning, I went back to my previous routine of participating in our 10:30 morning Jiu Jitsu class including the live positional rounds and did one full five-minute round. I’m of course sticking to specific partners who I know I can work with safely (only ones who I vetted before my surgery).

During our evening competition class I checked out the new home program that my PT uploaded to my app for me to do. It was just 6 exercises, 2 of which being stretches and I was a little disappointed at the minimalism until I hit the second exercise: which was a variation of the hip bridge off the 20 inch box, this one with one leg elevated off the ground (which I hadn’t done before). I then understood why I only had a few exercises, and I took back my previous feelings and instead began wondering what I had done to make her hate me so much. This was of course after doing the standard hip bridge with shoulders on the 20 inch box. The other two exercises are reps of split quats and kettlebell RDLs. I rounded it out by adding in my side plank holds, my hip airplanes for the rotators, and some balance work as well.

I stayed late for the 6:30 fundamentals class which is unusual for me with my current schedule, but one of our newer ladies was present and the rest of the class was all larger new white belt men. It’s a good crew to be sure, but I’m always down to review fundamental movements and figured it would be easier for her to practice them on someone closer to her own size. It was super refreshing for me!

I went ahead and signed up for the tournament in Europe this day since it was the last day for early registration. Unless I have a horrible setback my surgeon was confident that I’ll be good to go by then so I’m staying on theme with how my recovery track has been so far and going for it!

Wednesday

Wednesday evening I taught my ladies no-gi class and we went over my coach’s classic half guard smash pass and then I taught the basic concepts of how to do a toe hold from half guard top and then threw in a rolling finish at the very end just for fun. I stayed afterwards for our advanced gi class which was fun until a chronic issue my partner had flared up quite badly. I sat the rest of the class since we had a high ratio of people attending that class who were competing in the coming weekend and I did not want to insert myself into live rounds when they were focused on prep work. My time will come!

Thursday

I felt pretty good in our 10:30 morning class and I noticed a new pattern that might be emerging in that coach had this Thursday class warm up using comp class drills like he did last Thursday. I opted to do my own PT hip exercises for warm up and avoid the higher impact drills. I was able to do the half guard technique drills as well as the live positional escapes. Coach warned me to be careful who I went with and I told him I had already scouted out three people in class that I could go live with – and I stuck with those three along with coach himself. I did end up with a sudden onset migraine in the mid/late afternoon and had to go home early from work – it was a pretty bad one nausea inducing one so I’m glad I didn’t stick around and try to tough it out!

Friday

18 weeks/4 months post op – it’s been a relatively smooth course as far as surgery recovery goes. At the 4 month mark my surgeon said that is when he considers the tear in my labrum to be healed after he stitched it together, and he said a total of 6-9 months for return to full athletic impact. Now we can slowly start increasing the impact and load and get my hip joint back up to full useability at all angles so that I don’t have to compensate for deficiencies like I have been doing for the past decade while the labrum has been torn. My surgeon and PT are confident and affirming that I’m doing a great job pacing myself for a successful return to the mats and competition!

I booked my flights for competing in Lisbon and Tokyo in January – I figured I may as well since I have been keeping an eye out and there was a good price dip. I used an ecredit that I had cancelled earlier this year to get this surgery. So things are starting to come together slowly – I just have to keep the pace!

Rougher Week – 17 weeks post op

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Saturday/Sunday

Saturday I taught my usual class in the morning and then rolled lightly with a few of my trusted team mates for about an hour. I declined a couple rounds with people, but I explained that I’m only rolling with people who I rolled with before surgery and whose movement patterns I know well. No new rolling partners right now (regardless of rank) for my own safety. Afterwards I hung out for a couple of hours before seeing a few private clients for the first time since surgery since I have recovered enough now for that – so they were happy about that!

Sunday was going to be a bit more of a rest day but I had been struggling with several tasks that had been needing to get done the past week or so. I find that if I wait until “after work” or such then I don’t have the energy to get anything done so I opted to just get up and get things done Sunday morning. I spent two hours giving my dog a new haircut. He sits very well for it, but he is a very small poodle and it takes me some time to get his hair properly shaped and in between his webbed toes shaved properly. After that we took a 2 1/2 mile round trip walk to pick up food from the pet store for him and then stop for an acai bowl (he gets the bananas from it).

The walk was a bit rough on my joints – my left knee started hurting on the way back and my hip started tightening up after that. When I got home I just had to do laundry and then opted to lie down flat for the rest of the day, take my meloxicam, and use my red/infrafred light panel on my joints.

Monday – Physical Therapy

My physical therapist got frisky this week. She must have gotten updated orders to be meaner from the Dr after my visit the previous week. I did inform her that I was a bit sore from my walk the previous day – but the hip was fine after rest, it was the knee that was being a baby today.

We started off with more stretches, focusing heavily on my quads (which will factor in later!) I did discover finally a useful stretch for the quads on my left leg and hopefully maybe I’ll start being able to work some more range of motion into that knee if I’m consistent with those!

Most of my exercises remained the same although I did give myself a little more rest time in between exercises instead of trying to transition quickly from one to the other. I was feeling a little hypotensive again this session. My guess is that since we have been using more weight/intensity it is forcing my blood volume to my extremities more which is causing minor flare ups with my orthostatic hypotension. I’ve started trying to water/electrolyte load before and during sessions but much more and I’ll be running to the bathroom multiple time mid-session – so I’d rather just take a second to just sit between sets and let things settle before moving on.

Back on track to the main event: Why my PT was so frisky when I walked in the door – and why she focused on getting my quads stretched out. At the very end of my usual routine of single leg press, pistol box squats, side planks, bird dog holds, hip airplanes, etc… I was asked: Have you done bulgarian split squats before?

Let it be said, I did not find the bulgarian split squats to be all that terrible. I used the 20-inch box as a foot prop so I could get decent depth. I was actually mostly inhibited by the range of motion in my knee and not the strength/stability in my hip. My PT said “great form! Let’s add weight and do two more sets and do both sides!” Hopefully the inflammation in my knee from the walk will die down and it will be easier to do them next time!

Other thing to note is that for my hamstring curl (machine) I was able to complete all my reps at 35# this time. The previous week I failed at the end of my 2nd set and had to drop back down to 25# to complete my final set after a rest. It sounds like a pithy amount of weight – but I remind myself that it’s a fairly isolated muscle exercise as opposed to a squat or leg press.

I was feeling pretty exhausted by the time I got back home, I went to Jiu Jitsu class that evening as usual but was feeling pretty run down and my hip was really exhausted/borderline painful just from doing the drills. I worked with one of our ladies who was nursing an injury and having to be cautious herself while drilling and we both opted out of live drills/rounds which was definitely for the best for me.

Tuesday

In class Tuesday morning I joined in with some of the drills – It ended up being a game of musical partners because the first move we did involved framing and pushing directly on the hip and I was feeling a bit sore and couldn’t be drilled on so I jumped into an established group of two to just do fit ins. Someone came in late and just assumed we were a standard group of three and grabbed one of the guys while I was getting my reps in and then left my partner without someone to drill on. So rather than try to get fit ins with what essentially turned into a new group of three (which would basically mean far fewer reps for everyone and a stupid configuration) – I moved on to another group to do fit ins on… and while I was doing drills with one of the guys the other guy changed partners with one of the guys who was sitting out from the first group I had been with. Confused yet? I just looked at coach and shook my head while he was giggling. Yea I could have said something as the black belt on the mat and highest ranked student in the class – but I save my rank pull cards for things that actually matter. Me getting fit in reps while I’m recovering isn’t that big of a deal.

I did one light positional escape round with that drilling partner and then called that it for the rest of class. My hip was sore. It was as bad as it has been so far since I’ve started the strengthening/rebuilding phase of recovery.

I opted to go straight home from work and not stay around to do my home PT exercises during evening class. I needed to take my meloxicam and lie flat/give myself some rest.

Wednesday

Wednesday was a bit of a continuation of more resting. I taught my evening no gi class and then went home afterwards instead of staying to drill for the gi class. I have learned that when recovering from an injury/sickness it is better to just straight up rest instead of trying to draw it out. There is a difference between recovery and laziness.

Thursday

I planned to drill a bit in the morning class but it was a bit of an out of the ordinary routine class that threw things off kilter. Long story short: I’ve had a lot of personal things going on, I got frustrated and made a jerk of myself. I did my best to apologize afterwards and had a full blown overstimulated meltdown in my office afterwards as well. I felt better able to focus after the meltdown but the day was basically a wash after that so I left for home right after work instead of staying for evening class.

Friday – 17 weeks mark

I was extra thankful to have Fridays as a work from home day after the events of the previous day and the entire week. I needed a decompression day away from people to help me re-center. It wasn’t my best week as far as recovery, but I did not take any steps backwards because I took the steps necessary to take care of myself when I noticed that I was needing to rest.

So with me feeling more inflamed this week, what I did overall was cut out doing the strength portion of my home PT exercises, as well as live movement drills in jiu jitsu class. Instead I focused on just the mobility portion of my PT exercises and just drilled comfortable movements in class – skipping allowing myself to be drilled on like I had been in previous weeks. I took my meloxicam a few evenings as well as continued the use of my red/infrared light panel.

When recovering from injury or sickness, it is important to take the time to rest when your body needs it. It is not weakness to do so – and if I had forced myself to try to train this week like I had the previous weeks I would likely be in a good deal of physical pain and setting back my recovery process significantly. It’s the difference between pushing pause vs a painful rewind.

Post-Op Visit – 16 weeks post op

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Holiday Weekend

I was an absolute slug all weekend since it was a holiday on Monday in the states and my office was closed. I taught a great ladies class Saturday morning where we worked on side control escapes and then I stayed around for the open mat. I got a few rounds in with people I knew and trusted who needed a light flow round to get warmed up before they proceeded to maul one another. Then I went back home and watched the first three episodes of the new season of Rings of Power that just was released before settling in to play videogames all weekend.

Tuesday – Physical Therapy

Since Monday was a business holiday, I had PT on a Tuesday this week instead. A good portion of my exercises were scaled up to some degree. My single leg press remained the same at 112# and then I followed that by pistol squats to a 20 inch box, and also side plank with top leg extended. We added a 5 second hold to my bird dog rows, increased weight on my heel elevated squats, increased height on my lateral tap downs, added weight to my hip thrust, added weight to hamstring curl. It was a bad hypotension day for me though for this session so I had to sit a few times between some of the exercises to keep from getting lightheaded and falling over. I’ve learned that once you fall over they tend to cancel the rest of your exercises for the day.

I made it back to the office/gym just a few mins late for our 10:30 jiu jitsu class so I was able to jump in and get some drills in as well as positional escape rounds. It was a lot of activity for one morning so I was pretty beat for the rest of the day and concerned about being horribly sore for my follow up visit with my surgeon the next day – so I opted to skip out on participating in our evening competition class and watched instead. I did take a dose of meloxicam when I got home just to be on the safe side too since I had so much activity and did not want to be super sore for the Dr to be testing my range of motion and such the next day.

Wednesday – Surgeon Follow Up Visit

I had my follow up appointment with my surgeon this afternoon. I got an appointment in right after their office lunch break so everyone was fed, happy, and running on schedule. His nurse brought me back almost as soon as I sat in the waiting room (early for my appointment) and did my quick intake noting PT and training progress. One thing I’ve learned is that I start to go into a bit of weird zone out when alone in patient waiting rooms which makes it hard for me to engage when the Dr walks in – so this time I got up to walk around and pace instead of letting myself disconnect during the 10-minute wait.

The Dr came in and opened up with comments about PT beating me up – I agreed but told him that I do like it that way and it’s all in good fun. He did an assessment of my range of motion at all angles as well as comparative hip flexor testing and declared me to be “very strong”. I told him how PT was telling me to “do more” but I wasn’t sure they knew what “more” meant for me, so I was taking video of my movements in class to show what I was doing – he said he loved that and to keep doing it.

All told he said my approach of “slow is smooth, smooth is fast” is paying off in a big way. I still need to stay on that path however as I’m only officially 3 1/2 months out from surgery and have healing still left to do. Same considerations as before to follow: don’t overdo it, stop if anything hurts.

I will be continuing with physical therapy weekly and rechecking with my surgeon again on November 6th which is 9 weeks away. He said that I’m definitely still on track to be competing at the European Championships and Tokyo Grand Slam in January – nothing any sooner than that. I asked about doing the Nashville Open tournament in November which would fall right at the 6-month post-op mark and he made a face then started responding with a sharp inhale and “wellllll” and I interrupted with “It’s all good – if it’s borderline then it’s off the table.” He then went on to explain that it would be definitely pushing it and he wouldn’t want me to try to accelerate my rehab process to try to make an early sports event.

I did check my after visit summary notes and he wrote that I have “full and painless range of motion”, 5/5 strength on all planes of movement without pain, as well as a negative Stinchfield test (I failed that one miserably pre-op).

That evening I taught a small no gi ladies class and then went home afterwards to take some headache meds and relax a bit after all the excitement of the day and still riding a bit of exhaustion from the hard push of the previous morning (in spite of the vitamin shots that one of my nurse teammate gave me before class)

Thursday

I felt pretty good for class this morning where we were working on armbars from s-mount. I was only drilling to one side, modifying actually for my knee not my hip this time since I’m not able to bend my heel to my butt far enough for a proper s-mount on one side (I had a previous procedure that was purposefully healed stiff for maximum long-term stability – it was the lesser evil).

We did positional escapes from mount again – these two weeks working from mount position (top and bottom) are going to be rough since I don’t really have the proper movement to safely do most escapes. So, I’ll just have to hunker down when it’s my turn on the bottom and practice patience and resilience. We did have a couple of full-length rounds in class today which I ended up joining in for this time – it was a little rough at first but with some communication on my end it worked out just fine in the end.

I’ve been neglecting my home PT exercises lately in favor of bjj training. Very tempting to do of course, but probably pretty stupid at this still early phase of my recovery. So I opted to dial it back down and skip out on doing evening comp class in favor of doing my exercises instead. I will keep doing that going forward so that I’m getting the proper strength and stability gains in that I need to be making every week. I have fewer exercises now to do outside of the clinic, but they are more strength focused and higher intensity than before. I’m adding in more stretching and recovery-based things afterwards however just to keep up with the increased demand.

Friday – The week in summary

After seeing my surgeon again I decided I needed to pull the reins and slow my pace a bit since I was starting to pick up speed a little faster that I probably should be at this stage of the recovery process. I haven’t done anything to hurt myself or my recovery, but I was just starting to move toward a direction of a bit more impact than I should be taking at this point.

This isn’t a step back in any way, just putting the brakes on the snowball that was starting to form with my progression on the mats. Still on track and slightly ahead of schedule with my recovery!

Hip Surgery Recovery – 12 Weeks Post Op

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

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

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

In Physical Therapy

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

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

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

In Jiu Jitsu Class

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

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

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

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

12 Week Summary

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

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

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

Hip 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 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.

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!