Tag: hip surgery recovery

All Clear and Back At It!

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

To Recap

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

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

Post Op Visit:

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

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

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

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

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

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

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

Checking in 5 months post-op – 24 weeks

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It’s been a few weeks since I have posted an update and I passed the 5 months post-op mark! I’ve been pretty busy and a lot of things are coming up, so here is what has been happening!

I’m back with my original physical therapist since she has returned from maternity leave, and she has really been amping up with more impact and dynamic movement exercises, working to emulate things I do in Jiu Jitsu class. My therapist has researched and improvised various exercises in order to make them more specific to Jiu Jitsu movement patterns. We start each session with a check in for any tweaks I’ve felt during the week while training in class, a physical assessment, and she makes any necessary adjustments to my program for the day.

I will be seeing my surgeon for a check in next week and PT agrees that he will be very pleased with my progress overall and thinks it is very possible that he will release me entirely from physical therapy sessions (10 days shy from my official 6-month post-op mark). I am scheduled to see her immediately after my appointment with him, if he says I’m free to go I can just come downstairs and bring the good news and cookies.

This past week I had a great class where I rolled as close to all out as I have since surgery. I still feel some rotational restrictions that I’m going to mention to my surgeon, but I think that will just take some more time to work through carefully. It was a good contrast to the previous week where my hip got twisted pretty abruptly in class and I yelled – that caused some inflammation that made me take a few days away from the mats and some anti-inflammatories along with extra home care. My PT checked it of course and agreed that it was just inflamed from the abrupt movement. This was the first tweak/inflammation issue I’ve had of any kind during my entire recovery process – which is pretty stinking good for this sort of surgical recovery.

The only movements still giving me discomfort are quick external hip rotation and compression across the midline. All other movements are fine with a proper warm up before training. I do need to improve comfort and stability at the end of my range of motion, and if I sit for hours without a stretch break it will start aching as well. These are all things I expect to improve in the coming months.

Here’s how training is looking right now:

  • I’m doing most moves in class, just avoiding high impact takedown drills (judo trips and such are ok)
  • Positional sparring rounds in class after drilling: if my pre-selected partners are not available when we change partners I sit a round. Otherwise I proceed like usual.
  • Sticking with familiar training partners for sparring. Since they are partners whose movements I can trust, I don’t have to guard my own self so intently and can therefore progress my own movement confidence safely.
  • I do my own specific warm ups before class which usually overlaps into the group warm up time as well. I do joint mobilization and muscle activation exercises that I use in my PT sessions before getting into strength training.
  • This past week I have started adding more evening stretching before going to bed – in addition to my red light therapy sessions. As training and impact amps up I need to increase recovery measures to make sure the load stays balanced.

Latest PT Session (mostly self-reference):

  • Started with PT check in and warm up on elliptical
  • Stretches: leg box drills adding lean forward over front leg, then back leg clamshell, heel lift, then leg lift (new); kneeling quad/flexor/psoas stretch, tabletop hip isolated rotation (new)
  • Decompress hip by using heavy band anchored to wall around bent leg while lying face up on floor. Pull knee toward chest to decompress joint
  • Activation: Free standing clamshells with band, leaning wall runs with band around feet, squat with soccer ball between knees (hold until feel burn then hold for 10 more secs), hip airplanes on wall, banded sidesteps one foot anchored to the wall at the time, Sidesteps anchored to wall by torso,
  • Strength: hold bear crawl position and slide small plate with toe forward and back 10x, single leg box bridges, 45# v-bar single leg RDL, 45# v-bar squat, Single leg shuttle squat kickback, 45# sled push/pull
  • Other exercises done in previous sessions: Back lunge with cable row at top, Heel elevated kettlebell squat, medicine ball slams (start on two feet, end on one), step off 20 inch box and catch weight on one foot lightly, hop with feet 2 to 1 off and on 20 inch box.

Coming Up

I see my surgeon next Wednesday and am compiling a list of questions for him. Most pressing is to let him know I booked the flights to compete at the European Championships and Tokyo Grand Slam in January since at our last visit he said it was a “reasonable goal”. I’ve also registered for the Europeans and am waiting for registration to open for the Tokyo event – I’ll be flying from Lisbon to Tokyo and doing both events in one big trip.

I have other planned events lining up as well for the year – at least one major event a month (2 more in Feb). The first 6 months of the year I will be competing in 7-9 countries depending on final tournament schedules. I want to be able to enjoy training and learning Jiu Jitsu for the rest of my life, and don’t want to be the stereotype of the old black belt who is too broken to do anything but sit in the corner of the mat with their broken everything. I however do want to get out there and enjoy competing as much as I can while I’m still physically capable of making the rounds at this high frequency. I know with my chronic joint/connective tissue condition I need to be extra cautious about wear and tear on my joints if I want longevity for training, so it’s always a constant game of push and “check in”.

When and if I am released from physical therapy sessions, I will have to continue a structured rehab protocol on my own in order to maximize my full recovery. It will also keep my other hip stronger and useable as my initial assessment done indicated I have the same issue in my other hip (labrum tear/impingement), it’s just not giving me as much difficulty as my right hip was so my surgeon said we would just leave it alone unless it became a functional problem for me.

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.

Rougher Week – 17 weeks post op

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Saturday/Sunday

Saturday I taught my usual class in the morning and then rolled lightly with a few of my trusted team mates for about an hour. I declined a couple rounds with people, but I explained that I’m only rolling with people who I rolled with before surgery and whose movement patterns I know well. No new rolling partners right now (regardless of rank) for my own safety. Afterwards I hung out for a couple of hours before seeing a few private clients for the first time since surgery since I have recovered enough now for that – so they were happy about that!

Sunday was going to be a bit more of a rest day but I had been struggling with several tasks that had been needing to get done the past week or so. I find that if I wait until “after work” or such then I don’t have the energy to get anything done so I opted to just get up and get things done Sunday morning. I spent two hours giving my dog a new haircut. He sits very well for it, but he is a very small poodle and it takes me some time to get his hair properly shaped and in between his webbed toes shaved properly. After that we took a 2 1/2 mile round trip walk to pick up food from the pet store for him and then stop for an acai bowl (he gets the bananas from it).

The walk was a bit rough on my joints – my left knee started hurting on the way back and my hip started tightening up after that. When I got home I just had to do laundry and then opted to lie down flat for the rest of the day, take my meloxicam, and use my red/infrafred light panel on my joints.

Monday – Physical Therapy

My physical therapist got frisky this week. She must have gotten updated orders to be meaner from the Dr after my visit the previous week. I did inform her that I was a bit sore from my walk the previous day – but the hip was fine after rest, it was the knee that was being a baby today.

We started off with more stretches, focusing heavily on my quads (which will factor in later!) I did discover finally a useful stretch for the quads on my left leg and hopefully maybe I’ll start being able to work some more range of motion into that knee if I’m consistent with those!

Most of my exercises remained the same although I did give myself a little more rest time in between exercises instead of trying to transition quickly from one to the other. I was feeling a little hypotensive again this session. My guess is that since we have been using more weight/intensity it is forcing my blood volume to my extremities more which is causing minor flare ups with my orthostatic hypotension. I’ve started trying to water/electrolyte load before and during sessions but much more and I’ll be running to the bathroom multiple time mid-session – so I’d rather just take a second to just sit between sets and let things settle before moving on.

Back on track to the main event: Why my PT was so frisky when I walked in the door – and why she focused on getting my quads stretched out. At the very end of my usual routine of single leg press, pistol box squats, side planks, bird dog holds, hip airplanes, etc… I was asked: Have you done bulgarian split squats before?

Let it be said, I did not find the bulgarian split squats to be all that terrible. I used the 20-inch box as a foot prop so I could get decent depth. I was actually mostly inhibited by the range of motion in my knee and not the strength/stability in my hip. My PT said “great form! Let’s add weight and do two more sets and do both sides!” Hopefully the inflammation in my knee from the walk will die down and it will be easier to do them next time!

Other thing to note is that for my hamstring curl (machine) I was able to complete all my reps at 35# this time. The previous week I failed at the end of my 2nd set and had to drop back down to 25# to complete my final set after a rest. It sounds like a pithy amount of weight – but I remind myself that it’s a fairly isolated muscle exercise as opposed to a squat or leg press.

I was feeling pretty exhausted by the time I got back home, I went to Jiu Jitsu class that evening as usual but was feeling pretty run down and my hip was really exhausted/borderline painful just from doing the drills. I worked with one of our ladies who was nursing an injury and having to be cautious herself while drilling and we both opted out of live drills/rounds which was definitely for the best for me.

Tuesday

In class Tuesday morning I joined in with some of the drills – It ended up being a game of musical partners because the first move we did involved framing and pushing directly on the hip and I was feeling a bit sore and couldn’t be drilled on so I jumped into an established group of two to just do fit ins. Someone came in late and just assumed we were a standard group of three and grabbed one of the guys while I was getting my reps in and then left my partner without someone to drill on. So rather than try to get fit ins with what essentially turned into a new group of three (which would basically mean far fewer reps for everyone and a stupid configuration) – I moved on to another group to do fit ins on… and while I was doing drills with one of the guys the other guy changed partners with one of the guys who was sitting out from the first group I had been with. Confused yet? I just looked at coach and shook my head while he was giggling. Yea I could have said something as the black belt on the mat and highest ranked student in the class – but I save my rank pull cards for things that actually matter. Me getting fit in reps while I’m recovering isn’t that big of a deal.

I did one light positional escape round with that drilling partner and then called that it for the rest of class. My hip was sore. It was as bad as it has been so far since I’ve started the strengthening/rebuilding phase of recovery.

I opted to go straight home from work and not stay around to do my home PT exercises during evening class. I needed to take my meloxicam and lie flat/give myself some rest.

Wednesday

Wednesday was a bit of a continuation of more resting. I taught my evening no gi class and then went home afterwards instead of staying to drill for the gi class. I have learned that when recovering from an injury/sickness it is better to just straight up rest instead of trying to draw it out. There is a difference between recovery and laziness.

Thursday

I planned to drill a bit in the morning class but it was a bit of an out of the ordinary routine class that threw things off kilter. Long story short: I’ve had a lot of personal things going on, I got frustrated and made a jerk of myself. I did my best to apologize afterwards and had a full blown overstimulated meltdown in my office afterwards as well. I felt better able to focus after the meltdown but the day was basically a wash after that so I left for home right after work instead of staying for evening class.

Friday – 17 weeks mark

I was extra thankful to have Fridays as a work from home day after the events of the previous day and the entire week. I needed a decompression day away from people to help me re-center. It wasn’t my best week as far as recovery, but I did not take any steps backwards because I took the steps necessary to take care of myself when I noticed that I was needing to rest.

So with me feeling more inflamed this week, what I did overall was cut out doing the strength portion of my home PT exercises, as well as live movement drills in jiu jitsu class. Instead I focused on just the mobility portion of my PT exercises and just drilled comfortable movements in class – skipping allowing myself to be drilled on like I had been in previous weeks. I took my meloxicam a few evenings as well as continued the use of my red/infrared light panel.

When recovering from injury or sickness, it is important to take the time to rest when your body needs it. It is not weakness to do so – and if I had forced myself to try to train this week like I had the previous weeks I would likely be in a good deal of physical pain and setting back my recovery process significantly. It’s the difference between pushing pause vs a painful rewind.