Tag: hip arthroscopy recovery

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!

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.