Tag: Hip Labrum

Hip Labrum Repair Surgery – 5 weeks post op

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It has been a big milestone week!

I started Monday morning in PT with my usual therapy routine and at the end we added weight bearing tests. First I stood at the edge of the table and just slowly shifted my weight from foot to foot “until it felt ok”. The first one felt like waking my hip up a bit but the second one felt pretty normal so then my therapist told me to do longer holds on my right (surgical)side. After a few reps of that she watched me while I changed to shifting my weight to my right foot and then lifting my left foot off the ground. At the first rep she said “Oh perfect! No hip drop at all! Do 10 reps and hold for 10.”

After that I did step throughs at the edge of the table. Which is basically just walking one step forward and then backwards next to the table, while making sure to use heel to toe foot impact pattern. That took a lot of focus since I’m usually a toe walker myself (bad I know!) I did 20 of those and my therapist announced I was definitely ready to be walking this week. I also did standing straight leg kicks forward, to the side, and back at an angle on both legs – very minimally of with the hip extensors of course and with no resistance.

She told me to go down to one crutch in the meanwhile and if I do well with that I would be able to drop that and be free after my session on Thursday. That first night I felt pretty good but decided to fire up the ice machine for sleep just in case. I probably did not need it, but I decided any time I do a big new thing I will add ice pre-emptively for the hip flexors to help keep the savage beast soothed. The approach seems to be working so far as I woke up feeling just fine!

Adjusting to just one crutch was weird at first and I just slowed myself down to about a quarter of the speed I had been going at with two crutches and then I was fine. Just like drilling Jiu Jitsu moves, I had to practice the movement slowly first to make sure I do it correctly – and as I gain the muscle memory/dexterity/strength, the speed is coming back slowly on its own. Pushing speed first is how injury and pain happens.

Tuesday/Wednesday: in the office

I went back into the office again on Tuesday and Wednesday. I was super slow moving around of course and I allowed myself to stretch out in a more comfortable position as well for the day. I’m still going to be sticking with the pattern of working from home on days I have physical therapy just in case I end up having a really exhausting session and just need a lie down afterwards.

The walking practice does definitely exhaust me. I’m not sore at all so far but I’m definitely really wanting to nap by mid-day. Hopefully I’ll build my stamina back up soon but I’m doing my best to reign myself in so I don’t overdo it and flare anything up when things have been going so well so far!

My boss picked up some supplies for me from the hardware store to repair my old wooden cane, so that’s going to be my project for the weekend! I took it into the back of our warehouse and got it structurally sound again, but now I need to sand it down and figure out what I’m going to do to finish it out and make it pretty again.

Being in the office these two days means I get to pop in on the daytime Jiu Jitsu classes again as well which has been nice! I’ll be planning the same itinerary for next week as well since it seemed to work out pretty well this week without too many hiccups.

Thursday:

Back at physical therapy again today, my therapist said we that I looked really good walking in on my one crutch and that when I did my one-legged stands and movements my balanced looked rock solid on my surgical side. So she okayed me to walk without my crutches a little bit in my apartment this weekend if I felt up to it. She additionally told me that we could start pushing a little bit more range of motion and a tiny bit of external rotation (she specified TINY). I translate that information to: I’ll move myself as far as she moves me during her passive range of motion work but I’m not pushing anything on my own.

She also mentioned that she might be starting me on the stationary bike soon for session warmups. That got me all excited about getting back into outdoor biking and she slapped me back down pretty quickly from that – but said I might be able to get back outside before the weather gets too gross for it.

I also got to add on sets of shallow bodyweight squats to my routine as well today – those felt pretty good! Basically, activating muscles and moving around makes everything feel good, so it’s just a matter of reigning it in and riding that fine line of enough to let it heal, but not overdoing it or causing anything to flare up.

Friday:

Today ended up incidentally becoming a work from home day as well because my coworkers were unable to pick me up this morning. So everyone missed out on the momentous moment that was me being able to put on leggings for the first time since surgery! Since my PT said I could bend a bit more, I decided to see if it was comfortable to bend far enough to put on leggings, and I didn’t feel a stretch at all in my hip even to straighten my socks! Now having shorter legs probably comes in handy a bit here; but still!

This made me realize how much my legs need the biofeedback of compression leggings. It’s a small thing but it really does help me feel so much better after spending over a month wearing baggy shorts. I have a lot of sensory issues that go along with my autism: temperature regulation, touch, etc. – and they are a protective barrier in that regard. I also get episodes of orthostatic hypotension, basically a circulation/blood pressure issue where they tell you to watch your fluids and electrolytes levels and I also tend to get swelling in my legs a bit – compression leggings help with the swelling. Finally, I also have a connective tissue disorder that affects everything, and the little extra bit of outer layer just sometimes feels like it’s just the tiniest ease of that burden.

Anyhow, that all said, I love my compression leggings. In fact, I just ordered some more because why not?

What’s Next?

I see my surgeon again on the 8th which will put it in my 8-week post-op update. Depending on how news is flowing I may then switch from weekly updates to every other week or monthly updates on surgery recovery. The goal is for this series to just naturally morph into a training log back to the tournament podium.

Hip Surgery Recovery – 4 weeks post op

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Note: 4 week healed incision photos in this post! Well, I made it to that first milestone marker that my surgeon laid out for me! He said the first 4 weeks would be the most restrictive on crutches (50% weight bearing), no hip flexion past 90 degrees, no external rotation of the hip, no isolated activation of hip flexors, and no crossing the midline with my leg.

That said, I’m not going to suddenly drop the crutches and do all the things I wasn’t allowed to do for the past month. From reading and researching post-op issues, it seems to me the common thread for setbacks when you’ve had a well-executed surgery, is that people start feeling really good and then push forward too quickly. This inflames the soft tissue around the joint that is trying to recover from the trauma of the surgery. The hip flexor in particular is the main culprit for this sort of complication and I’ve been very careful to not put extra strain on it over the past month – especially taking note of where my surgeon had to make his main usage entry portal as you can see in the photo below.

4 weeks post-op – the larger of the three incisions was apparently where most of the movement of the surgery took place based on the scar tissue I feel under/around it

Thankfully I have a very experienced physical therapist who told me yesterday that her plan for getting me off crutches is gonna be a gradual process. I will start with weight bearing exercises this coming Monday and we will just take it one session at a time – not in a rush at all. At least with the crutches I look like a stereotypical injured black belt sitting on the sidelines during Jiu Jitsu training sessions – without them I’ll just look like some lazy rando creeping on class. I’ll have to break out my cool cane or something later to balance it out.

As you can see from the photo above, I was able to remove the steri-strips finally. I have always had some minor issues with delayed wound healing, most likely from my hypermobility. I’m starting to get some more sensation back in the area and have started some light scar tissue mobilization work on the two smaller incision areas as well as some lymphatic work to help with circulation. The larger incision is not healed enough for even light scar tissue mobilization – it needs the stability right now to continue to heal the surface skin layer. I look forward to working on it when it’s ready because I can feel the scar tissue below it pulling a bit already. My decade+ of Myofascial massage specialty is paying off for myself!

Additionally in PT this week my therapist added straight leg bridges with my heels dug into a large physio ball, and my physio ball crunches got a crunch “up” variation added on as well for more core activation. Those ones are super fun! She also did some light manual release work on my glutes and hamstrings for the first time this week as well in addition to the usual quad/IT band release and passive range of motion work. In total my PT sessions are tipping over an hour in time now and I’m not even adding in the Game Ready ice therapy option yet (let’s see how weight bearing goes next week!)

I have worked from home this entire week, which has definitely been very beneficial for my hip recovery! I was also picked up twice to pop by the bjj academy for an evening class for some enrichment time as well.

Next week I do plan on returning to the office for a couple of days if my hip allows. This time I plan to use the couch either in our office, or in the bjj academy next door in order to keep myself stretched out as much as possible and avoid the pinchy issue I had last week. I’m still planning for PT days to be work from home days though since it takes up a decent chunk of time and then wears me out. I will play by ear with my plan however – if weight bearing training makes me feel sore and I feel like I need to sit on my ice machine at home I’ll do that instead. I am very fortunate to have a supportive work environment, as well as a job that CAN be done remotely.

Thoughts on Returning to Training

I’ve been chatting a bit with several people who are in various phases of injury recovery and rehab and there’s a common thread among everyone of being nervous about getting back to training and having to start over because you suck now. And it’s gonna be true for a while. Depending on how long you are out, you lose your reflexes. Depending on what sort of injury and/or surgery you had you may have to re-learn how to move certain body parts completely.

I say embrace the suck. Let go of the feeling of having to measure up right away, and just enjoy the fact that you are able to train again. You will eventually surpass where you were previously but why frustrate yourself during that process? Yes, always strive to improve every day, but in order to improve you need to accept what your current state of being is. And the state of being when coming back from an injury is – it sucks.

I’m gonna lean into it when I’m allowed to train again. I’ll work my bad side (since my dominant side was my operated side anyhow!) I’ll practice the techniques I never thought I could make work – the 12 yr old labrum tear and subsequent joint instability was likely causing a movement deficiency and I want to see what I can actually do when I’m not having to compensate for it. I’m gonna think of myself as starting Jiu Jitsu all over again and just see where it takes me when the “the suck” passes.

Arthroscopic Hip Labrum Repair Surgery – 3 weeks post op

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And now I’m at 3 weeks post op! For context: my surgery was on a Friday – so my weekly benchmarks logically fall on Fridays.

I’ve had a busy week comparatively speaking – I actually got to get out of my apartment to DO things.

Last Sunday I met up with a friend at the cafe in my neighborhood to grab a treat – there were no seats there I could use comfortably so we just strolled back to my apartment building and chatted for a few hours. After that I was picked up by some of the ladies so I could hang with them during the Sunday ladies BJJ class. I told them to start jogging for warmups and they unanimously rebelled against my authority – presenting the logic that I’m going to be pent up and angry when I get back on the mats anyhow, so it doesn’t matter if they make me mad at them now or not. I respect the logic and therefore am not angry. It was really nice to get out and see people I care about again after being locked away for two weeks!

Monday I had physical therapy and told her I had a concern about my incisions. I had been told when my stiches were removed the previous Tuesday, that they were putting the steri-strips on just for a couple extra days and then they could be removed. That seemed a bit off from how I remembered steri-strips working, but I always follow directions, so I removed them from the lower less angry incision that Friday evening. That one looked good but when I went to remove them from one of the upper ones it was still open – so I covered it back up quickly but was worried that I had messed with the integrity of it. My physical therapist confirmed that my lower incision was closed up nicely and said that the upper one that I had tried to remove tends to take longer to close up because it’s an area of more movement – it was also a lot more swollen and a larger incision since it was one of the primary entry portals. She made sure there were no signs up infection and reapplied fresh steri-strips for me. We are just going to leave those on until they show signs of wanting to fall off on their own this time.

Monday afternoon I got a text message from my coach to let me know that he had gotten back into town from the Jiu Jitsu world championship and was going to promote my teammate, Ray, that evening in class. I have known Ray since I first started training (he was in our kids’ program), and I told coach that if he didn’t find a way to get me over to the gym I would be severely upset and never let him forget it. He was super busy but knows I don’t raise a stink very often, so made the trip out to pick me up before class. It was pretty exhausting hanging around, but one hundred percent worth being there to celebrate. Congratulations Ray!

Tuesday was my first day going back into the office after over two weeks of working remotely from my apartment. The hardest hurdle for being in the office is trying to figure out how to handle the 8-5 office hours schedule when I’m not supposed to be sitting for extended periods of time – and I can only stand for so long really. We decided to try this setup using a comfy chair from a coworker’s office. It worked pretty well for the first half of the day but was getting pretty achy on the hip for the second half of the day and I ended up needing to be taken home a little bit early.

Here’s where it gets a bit tricky for me. Even pre-surgery I can’t drive myself due to a permanent disability. So, in order to get into the office, I need to get a ride into work. Usually, it works out to where a coworker or my coach is able to pick me up on their way in and then I hitch a ride home afterwards usually after evening jiu jitsu training since the academy is in the same building. I live fairly close by and seasonal biking is great when I’m uninjured! On off days I take an uber. Currently I’m unable to ride uber to and from work because I have to ride in the front seat (due to hip movement restrictions), and I am unable to juggle my crutches and my dog while safely getting myself in and out of an Uber. A friend driving me won’t mind holding Dmitri – but a random uber driver might not be so chill about it. So, I’m highly dependent on someone consistently being able to pick me up and drop me off for work.

Tuesday ended up working out okay although a bit uncomfortable, so I spent some time stretched on my stomach that evening and decided on a plan for Wednesday.

Wednesday, I asked a coworker to place an extra cushion on the chair so that I could sit a bit higher and at less of an angle for my hip. This definitely helped from the start, and I also tried walking around a bit more as well, so I was hopeful! It was unfortunately still too much culminated sitting time that I think snowballed onto the sitting time from the previous day. I hid my discomfort as well as I could and tried to see about finding a ride home when the office closed at 5, but it was a very busy evening unfortunately for everyone, so I ended up stuck which was quite frustrating and it did make me break down for the first time since surgery (I’m sure there will be others coming). My Jiu Jitsu academy is in the same building, so I waited around for the 5:30 class to end at 6:30 and one of my teammates was able to give me a ride home. I loaded up my frozen water bottles in my ice machine for the first time in over a week to wrap up my hip and went to sleep like that.

Thursday was a physical therapy day. I had established that PT days were going to be work from home days because of the logistics of interrupting coworkers’ workflow to get them to come pick me up after my sessions when all my work can be done from home anyhow. She checked in on my incisions and said they are looking good still. I mentioned the past two days in the office to my therapist and her professional recommendation was to work from home as much possible until I’m at least off crutches and have some better range of hip motion for sitting. Thankfully my workplace is extremely accommodating and has given me the green light to take the time I need – especially since my work can be done from anywhere. I do prefer to be in the office for efficiency and communication purposes, but recovery is important so I’m going to rein myself in here.

Speaking of PT:

I haven’t gone into much detail on what that is looking like so I’ll summarize a little bit. I did a lot of reading and research and noticed that most post-op therapy schedules were all variations of the same theme. Some have you using stationary bikes right out of surgery, some have you using resistance bands, some have you non-weight bearing, etc. The similarities are that the first few weeks are all about keeping the muscles moving, preventing adhesions/controlling inflammation response, and protecting the surgical repair work while it heals. The differences are in how they approach these goals and you should follow the protocols laid out by your surgeon and his team – you trusted them enough to let them do surgery on you, you should trust that they know how their work will heal best. Disclaimer: discomfort is to be expected, but if you’re in pain bring it up of course.

My PT clinic is attached to/downstairs from my surgeon’s office, and they can even read each other’s notes in my file which is very nice for communication. So far it appears that my first 4 weeks is a very strict table work only protocol – no weight bearing in PT since I’m strictly 50% weight bearing on crutches for the entire 4 weeks regardless of how I feel. I’m told that after next Friday we can start working on weaning down to one crutch and if I’m doing well, we can work off to none at all, but it will be very slow so long as I’m not limping or having any other gait issues.

My table work generally starts with doing some warmup mobility work. Heel slides don’t do much for me since I was comfortable with 85 degrees flexion in my hip in my first day in PT and am not allowed to flex past 90 yet, hip internal rotation reps (not allowed any external rotation yet), prone quad stretches which feel amazing, holding cobra pose which also feels amazing. For strength I currently have a base lineup of isotonic glute squeezes, quad squeezes, hamstring digs into the table, adductors against a ball, abductors with a strap around the thighs. In the past week we have started adding some more movement in the shape of hamstring mobility curls on one of those large exercise balls (only flexed to 90 degrees of course and no lifting of the hips), and then using the same exercise ball braced against the knees to crunch against while on my back to maintain my 90-degree limitation while still getting to activate my core. I also get to do quad extension reps with an ankle weight while sitting with my leg dangling off the edge of the table.

One of the new exercises we added yesterday was prone hamstring curls with the ankle weight. That one felt good on my quad since I have the mobility to get a counter stretch on my quad as well as quad activation at the top before handing the muscle activation back to my hamstring. The other exercise we added in that my PT was very happy I did well with was bridges – I knew it was coming eventually and she had me do 20 with a 3 second hold at the top.

At some point in the middle of all of this my therapist will do some manual therapy on me as well. She is usually overseeing 2-3 people at the same time with the help of 1-2 assistants. Currently manual therapy for me consists of passive range of motion with her moving my leg around and feeling for any restrictions in my range of motion and then checking my quad and IT band to make sure I’m not developing any tightness that could be a sign of things to look out for. This part will probably get more uncomfortable for me in a couple weeks when I’m clear of the majority of my hip movement restrictions – but for right now I don’t really feel anything besides a very slight pull at most extreme of allowable angles. She was already comfortably flexing my hip at 85 degrees 3 days post-op and again at 90 degrees my following session.

All together therapy generally lasts about an hour. I have the option to use the game ready ice machine at the end as well for a bonus 10-15 or so minutes but I haven’t taken them up on this offer as of yet since we aren’t doing anything really inflammatory at this stage of rehab. I’m anticipating things getting spicy later on once my post-op protective restrictions loosen up.

Other Closing Tidbits

I’ve now met my out of pocket maximum now with my insurance provider which is super nice and means I should not be paying any more medical expenses for the rest of the year thanks to an insurance plan with excellent coverage. I’m really thankful to have great insurance coverage through my employer – he makes sure we have high quality coverage! I was able to pay for all surgery and associated costs with less than one paycheck thanks to that – certainly a far cry from the financial hole my knee surgery put me into (I’m still paying off some if it!)

So for today, Friday, I was working from home. In Nashville it is CMA fest weekend as well as several other big events in town, so we are going to be cancelling our usual ladies’ class this weekend because navigating the city is going to be a nightmare. I already had groceries delivered and am stocked up for the weekend. I have one more week of being guaranteed on full usage crutches – I was worried that I was wearing out the tips, so I bought some new ones. A friend of mine loaned me the crutches and I didn’t want to give them back to her entirely mangled so I figured she would appreciate them being a bit prettier than just standard gray.

I see my surgeon again in about 4 weeks on July 8th. He told me originally that his plan for me was to have a very staged 3-4 months time period of physical therapy and then I’d be released back to doing whatever I want 6 months after surgery – which would be in November. I plan to ask him his thoughts about me competing in the European Championships in January now that they are finally back in Lisbon. I imagine he will probably tell me to wait and see how I’m doing a little closer to the date, but I do so like to have a concrete goal to help keep me focused on the process.

Of course, I do also know that a surgeon’s release to activity essentially just means that I am no longer in danger of ruining the reconstruction work that he did in my joint. There will still be a longer rebuilding and recovery process that will take some time afterwards. When I had my knee surgery it took a solid year after my surgeon gave me his “return to play” release before I really felt like I was back to full functional useability again. I have similar expectations for this process, and it seems to ring true with what I have read online about other people’s experiences.

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Arthroscopic Hip Labrum Repair Surgery – 2 weeks post-op

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Today is my 2 weeks anniversary of surgery!

I have so far had four physical therapy sessions, gone off all pain meds other than my Mobic/meloxicam, had my stitches removed at my post-op appointment, and been given the all clear to begin doing some fascial work on my incisions to limit scar tissue formation.

Post Op Appointment

Day 11 was my follow up appointment with my surgeon’s PA. I was first x-rayed and then we went over concerns to make sure I didn’t have any residual nerve issues (none) and he asked about the hypotensive episode I had a couple of days after surgery. Then he gave me an assortment of photos from my surgery and thanks to all of the pre-op research I did, they actually all made sense to me. He pointed out I had some rather unusual scarring on my joint capsule itself that the surgeon cleaned up for me at the start of the surgery since it was in the way anyhow.

As far as my labrum goes, it was super floppy and required 4 suture anchors to be hammered into the edge of my hip socket to secure it in place. My surgeon first did a light shave of the bone around the area to encourage blood flow and therefore improve healing. Once the sutures were in place you can see in the photos how much more secure it looks (no more flappy-floppy!)

After the labrum was secure, they took a quick trip inside my hip socket to clean out some old leftover fatty tissue debris that he said was just hanging out back there, so they usually clean it up while they are there. Now of course I want to know what it’s leftover from, so I’m going to do some research and if I don’t find an answer before I see them next visit I will ask!

Now they were free to let the traction off my leg so it could slide back into the socket and check that the seal of the labrum was secure (apparently it was!) and address the issue that is the head of my femur.

I had a small bone overgrowth on the neck of my femur, right on the growth plate that the surgeon said most likely formed during adolescence. This was what caused the tear in my labrum since the bone didn’t fit quite right when my leg would move a certain way – and is also why the conservative measures I had taken to address the issue could only help me so far. I could get the inflammation to die down, but it could be easily re-irritated by that overgrowth/impingement again. It was a very small one, and my hypermobility gave my hips a lot of leeway for movement around it, but this latest episode tore it worse and there was no point repairing the labrum without addressing the stick that was poking it.

The surgeon filed down this area of the bone and sculpted it to fit properly, typically this assisted by x-ray scans and then is then also checked by moving the leg through range of motion while watching through the operating camera to make sure that the bone is no longer catching on anything.

Additionally, I had a bone cyst that had formed underneath this area – reaching into the marrow (from what I can see from the photos). After confirming that the impingement was corrected, my surgeon debrided the cyst. He said that these sorts of fluid filled cysts are not entirely uncommon and while this one was a bit larger than what they typically see it will scar over just fine now that it has been cleared out.

They rounded out surgery with a capsular closure (stitching the joint capsule closed after they opened it to do all this work). I ended up with three entry ports: Anterior, Anterior-lateral, and a modified anterior-lateral.

I got my stitches removed and replaced with steri-strips to just continue the incision support for a few more days – and was told to start doing some aggressive scar tissue work especially on the anterior entry portal incision on Friday (the two-week mark)

Typically, I would see the surgeon at the 6-week mark, but he is going to be out, so I will instead see him at the 7 1/2-week mark. I have another 2 weeks on crutches while everything keeps healing.

How It’s Going Otherwise

This week has gone pretty well other than the cabin fever. I have still been working from home and have completely weaned off Tylenol. I am staying on the Mobic/meloxicam once a day for the first month – it is an anti-inflammatory and the surgeon’s office said it will help to reduce the amount of post-op scar tissue I build up as well. I’ve been sleeping with the ice machine on more out of habit than necessity for the last several days and decided to skip it last night, woke up feeling just fine. I think I’ll keep the ice machine out just in case I have a flare up day, I’m sure one will be coming as I have been known to overdo things on occasion and I would personally rather try ice first over taking meds.

I did take a walk outside on day 12 because it was super nice out and I wanted to go to a neighborhood cafe – it ended up being a half mile round trip walk. I did not get in trouble with PT however since I treated it as a mobility exercise instead of an impact exercise and used my crutches: keeping my weight on my hands instead of my operated hip. It does feel really good to move – I’m just being cautious about any impact. I have started sleeping a bit on my non-operated side well bolstered with a pillow between my legs (not allowed to let my operated leg cross my midline) and that feels amazing!

Speaking of PT, I’ve been tempted with a promise of possibly being allowed to do some shallow wall sits next week. She moved me up already in ankle weights and reps for quad extensions and I think she is starting to trust that I’m not too much of an idiot. I did point out to her that I’m turning 40 next year and can’t really afford to be too stupid if I’m gonna be able to do the things I want to do for the rest of my life.

Monday I will be having my 5th PT session in the morning and then going in for my first day back in the office since surgery. I won’t be able to sit comfortably at my desk or any standard chair, but one of my coworkers has a nice comfy overstuffed chair that he said we could move into my office. It will be nice to be around people again as the longer I stay isolated the more I feel myself losing what few social skills I had to begin with – plus my dog will appreciate having more than just me around to beg food from!