Tag: hip fai surgery recovery

All Clear and Back At It!

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I just realized that I never wrote an update following my post-op visit with my surgeon last month!

To Recap

In May I had surgery on my hip to repair a torn labrum as well fix an impingement issue and debride a bone cyst (no arthritis! yay!). I also had scar tissue on my joint capsule that was most likely from one of the times my hip was dislocated. It was done arthroscopically and wheels in to wheels out took 90 mins. My surgeon said surgery was “unremarkable” although the scar tissue on my joint capsule was “cool”. I did a lot of research on recovery protocols and made a system for myself that centered on the “slow is smooth, smooth is fast” methodology.

My surgeon is a sports specialist (as is my PT) and I was allowed to start doing highly modified drilling work around 8 weeks post-op mark. That’s may not be typical for someone else so soon after this surgery, but my recovery team determined that with my fitness and sports experience level, it was something I could integrate safely. As I proved that I was able to safely navigate drilling moves wisely without causing myself any pain or inflammation afterwards, I was able to slowly progress.

Post Op Visit:

Getting right to the point, my surgeon gave me the all clear with no follow up appointment! He said that I did a great job graduating and moderating my activity levels properly and had one of the smoothest recoveries possible as a result. From a surgical point of view, I am completely cleared. He had to wait until the 6 month mark as the earliest possible release date to check imaging to make sure there was no calcification forming in my joint post-op (I was good). He left me with a standing PT order that I could do whatever I wanted with, so I consulted with my PT and she agreed that since I do a good job at moderating my activity and have proven good patterns of doing my own adaptations as needed, she is comfortable with cutting me loose as well but gave me her card. If I run into any issues, I can call and schedule for a check in session.

I have spent the last several weeks gradually increasing my Jiu Jitsu training intensity and frequency, while still fitting in hip mobility and strength exercises as well. I have a specific warm up routine that helps me activate and mobilize all the muscles, and then a routine in the evening to check in and address any muscle imbalances or inflammation that might be popping up. As long as I keep up with these things before and after training, I am able to slowly increase training demand.

My range of motion would be considered really good for most people, although rotationally it still is not quite where it was before surgery. Strength-wise I’ve never felt better, and my team mates have told me that they can tell a significant difference from before surgery. It’s amazing how much more efficiently a joint works when the labrum isn’t torn halfway around the socket.

As of now I have about 6 weeks to go until the European Championship tournament in Lisbon, Portugal. I’ve never been one to ease my way into anything – must go full throttle or I might psyche myself out with the small things. I’m currently floating between light weight and feather weight as far as weight classes are concerned so I’m considering dropping a couple kg to make feather for the event. I’ve decided to just wait and see what amping up training over the next few weeks will do to the scale numbers and make my decision based on that.

All told, I’m sparring normally with training partners within 30 lbs of my size. I am looking forward to competing but my main goal is still to continue recovering – the competition is for proving to myself that I am back again after this.

I have a few benchmarks for myself to work toward before I consider myself fully recovered. I’m most definitely significantly better than I was before surgery so it would be very easy to write myself off as “all better” at this point already, but I know there is room for improvement and I’m still at a critical stage for getting those improvements. I won’t settle for good enough when I know there’s better to be had!

All told, I am super happy that I had this surgery and it was worth taking the time this year to have done. I no longer feel like my hip is sliding out of the socket while I’m sitting in a chair, I can train without pain for the first time in a very long time, and actually move in ways that I didn’t even realize that I hadn’t moved in over a decade. I’m looking forward to how this will affect the years to come!

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.

Unraveling a Puzzle – 20 weeks post op

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Monday

The cookies were met with great glee and I had all kinds of changes and adjustments made to my PT routine at the clinic today!

  • Side planks were advanced to: top leg elevated on box (bottom leg hangs) while on forearm on ground, activating adductors along with glutes and everything else. I could hang there all day like a monkey.
  • Deadlifts with the V-bar, 45# plate 3x10s.
  • Smith machine squats with heels elevated on the slant board. I lightly subluxed my shoulder since it was a new movement with a narrow range of motion – but it wasn’t a terrible one and I was able to re-align it to finish the last set without any soreness. PT said we can leave out the slant board next time to allow me better range of motion.
  • Increased isolated hamstring curls to 40# (baby weights I know, shush!)
  • Added box jumps and ball slams for impact training.

When I got done with everything I bid my therapist a farewell and much thanks – she helped me a lot! I’ll be switching to Wednesdays for next week with PT as my original therapist will not be working Mondays.

I checked my phone as I finished PT and discovered that my coworkers were in a panic trying to get in touch with me. Since they had not heard from me all morning which was out of the ordinary for me, they assumed I was in trouble and my boss was currently driving over to my house to check on me. I quickly called to assure them I was fine, had just been at my usual therapy appointment and my phone had been stuck on “do not disturb” from the night before which was why I had not responded to messages like usual. It’s nice to know they care enough to worry – and I ended up going into the office since they were on their way to my house anyhow and there was a lot to get done that might require some extra coordination. I went “full autism mode” to finish a sudden time sensitive project in 2 hours that would usually take me at least a day at a sustainable pace. It’s a glass canon attack which is understood in my office as leaving me basically useless for any other tasks for at least a full day – so I don’t do it very often and usually work at a sustainable pace.

Since my brain was basically oatmeal for our 90 minute evening class, I wasn’t sure how well I would be able to focus for drilling techniques. Thankfully once I got moving around I was able to hone in a bit and pick up some details and be useful. We had a good sized group of our ladies in class this evening so I was able to get a lot of rounds in with them plus I ran across the mat to grab one of our other black belts for a roll as well.

Tuesday

Coach asked me to teach class this morning for him, it’s a first since my surgery. It is back attack week so I went over what we call an MMA choke (an alternative to the RNC that is easier to do when wearing gloves) and then an evil one-armed choke that dislocates the trachea while applying the choke – all while looking like you aren’t really doing anything at all. We didn’t spend too much time on that second one because I didn’t want everyone to be too sore in the neck for the rest of the week – so we spent about half of the class with live escapes and rounds.

I was really really exhausted by mid-afternoon – probably as a carry-over from my “burst” of focus the day before. I ended up not sticking around to do my PT exercises doing the evening comp class in favor of just going home to recharge a bit more so that I could be more functional the next day.

Wednesday

I felt a bit a delayed onset muscle soreness in the hamstrings this morning from the PT session on Monday, but it wasn’t as intense as the previous week. I’m taking that as a sign of making more improvements/gains! I did wake up with a fairly intense headache (hurt to breathe) however and had to take my headache meds first thing in the morning which is unusual for me. I was pretty tired and did end up taking a second headache pill later in the afternoon – again very unusual for me to have to take two pills in one day. I’ve been having more headaches than usual even with my preventive medication – if the pattern continues over the next month I may contact my neurologist for a consult.

I taught my evening ladies no gi class tonight but due to the exhaustion and coming down off the headache I opted to go home instead of staying for the evening gi class.

Thursday

Just before morning class I was introduced to the new physical therapist who is going to be renting an office space at my Jiu Jitsu academy a few days a week. I may be checking in with him periodically for some of my more minor boo boos in the future.

During Jiu Jitsu class Coach played a switcharoo and left one of our other black belts in charge. Drilled as usual and then rolled one light round and one high intensity round before sitting the rest of class. The high intensity round was a bit more than I was anticipating and I didn’t have as large a selection of people to roll with as I usually do in this class. Again, if I were not recovering from surgery I would have been good to roll with the majority of people in class, however I have to be extra careful still even though I’m starting to feel really good while moving around.

Friday – 20 weeks post op

I worked from home and was pretty chill all day. I did decide to try an experiment this evening as the past several weeks have been rather rough as far as symptoms of low blood pressure, asthma-like issues (I don’t have diagnosed asthma), GI problems, dizziness, headaches in spite of my preventive medications, and general feelings of “ugh.” I have always been negative on allergy tests but when I have these sort of flare ups it really feels like my body is reacting to something it doesn’t like (never been able to figure out what either), so I decided to try out an antihistamine (different than what I’ve tried in the past) before going to bed to see if it might help.

Saturday

Grand experiment results are that the antihistamine seems to have worked wonders! My blood pressure is finally back up to my normal levels (it had been dipping down in the low 90s/60s) and I was able to sleep through the night and a good amount of my issues seemed to have balanced out along with my blood pressure. I’m gonna make a note to bring this up with my primary care dr when I see him in a few months for my annual exam.

Morning class ended up being a 1:1 session working on some back taking details which then led into open mat. I started a round and then popped up to chat with a family that walked in to check out the gym before running back onto the mat. All told I got about 20ish minutes of rolling time in and then stretched out a little before heading home.

Sunday

All told, I feel much better after taking that antihistamine and feel all the inflammation that was all over my body dying down. I’m looking forward to the new week without fighting through all the yuck!

My hip has been feeling really good through all my training this past week. Every week I feel like I’m getting more normal with my movements and my range of motion is getting closer to my normal (it has been textbook normal since my first post-op visit with my surgeon).

What I’m lacking for range right now is some compound rotation movement. On my left side I can duck my head under my foot to place it behind my head (hypermobility) while on my right (surgical) I can hug it almost to my chest. Additionally, it’s still uncomfortable to bring it across my midline and when I do gently work it at that angle it is a bit painful to bring it back passively – this is most likely some scar tissue from the labrum repair, but I will ask my physical therapist about pushing this range of motion since I’m this far out of surgery now.

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!