Tag: hip femoroacetabular impingement

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.

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!