Tag: hip impingement surgery

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 Surgery – 7 weeks post-op

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I had a bit of a switch over in therapy this past week. My therapist said that due to my pre-existing hypermobility, I’ve really gotten my range of motion back in record time and she doesn’t want me really working on pushing any more range of motion for the time being. Instead we are going to focus on stability and strength and let my joint capsule have a break to recover a bit. “Why put strain on it when we don’t have to at this point?”

Exercises progressions are as follows: increased band resistance for standing hip flexion/extension/abduction, added band resistance with bird dog, increased reps of staggered bridges, increased reps of single legged timed balance on squishy pad, increased reps of reclined straight leg lift. Added new exercises of dead bug, holding shallow squat on balance board for time, and slow step ups on a 4 inch step.

Next week the plan is to start me on the elliptical trainer instead of the bike. That will be after seeing my surgeon earlier that morning as well so I’ve been writing down a bunch of questions to ask him. My PT suggested I ask him what would be a good timeline to start integrating sport specific movements into physical therapy. Jiu Jitsu is a very different type of movement than the typical sport and she wanted to make sure she had everything lined up as well as possible in my notes. Next week will be my last week working with her as she will be going on maternity leave – if she makes it that long!

My therapist said that I am right on track with my recovery – and trending a bit ahead of schedule even. I do only get 20 PT visits covered by insurance and I’m pretty sure that is a hard limit, but I will budget to pay for additional myself as I want to make sure I’m able to recover properly (I did send an email to my insurance rep and he is doing some research for me to see if I have any wiggle room). My PT said since I’m so good at doing my own work at home I’m a good candidate to just be in the clinic once a week and be on my own the rest of the week.

I’ve reached the point where I’m starting to really normalize a lot of my daily movements. If I didn’t have the cane in hand most people wouldn’t know that I had a hip surgery such a short time ago based on how I’m moving around. (I don’t use the cane except for when I’m outdoors or walking a lot like when I went to the farmers market this past weekend.) I’m looking forward to the push to regain strength and power with stability because while from the outside it looks like normal movement, it is with very conscious thought and focus still. I have one speed setting: casual amble – and I need to level up to gain more settings safely. Yes this is 100 percent a video game character build out.

Future Jiu Jitsu Training

I had a thought for my future Jiu Jitsu training that has gotten me quite excited. I have been training now for almost 13 years, and the past 8 or so years has been focused primarily on variations and offshoots from open guard and half guard that started developing when I was a white and blue belt. The one thing I was never able to integrate in was shin or butterfly guard techniques – I just could not for the life of me get the positions or sweeps (in particular butterfly) to work for me. Now I have an inkling of why.

The orthopedic surgeon showed me how the type and position of this injury that I have – which happened right before I really got into Jiu Jitsu training – caused instability in my hip joints and subsequent muscle weakness right at the angle and position I would need to properly execute most butterfly guard maneuvers. I’ve been able to work around it for most other moves and techniques but this was a specifically targeted move that I just could not find a work around for.

I’m excited to revisit trying to work butterfly guard into my game once I get the all clear from my surgeon. Now that the injury has been repaired, I want to test if I can make it work for me now with a functional hip. Even just this short of a time out of surgery it already feels like the most stable joint in my body.

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!