Tag: hip arthroscopy

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!