Let's talk about my Hip

Dec 7, 11 14:58

Post #1 of 36 (9344 views)

Let me take you back to 2008. I was coming off a good year of racing in 2007 and was finally beginning to figure this sport out.

In January of 2008, I herniated a disc in my back (L5-S1). I took some time off but unfortunately came back a bit too soon and never allowed myself to fully recover. How this is related to my Hip issue is uncertain, all of my disc symptoms were left-sided, my hip issues are right-sided. In December of 2008 on a group ride, I was dropped from the group due to a sharp pain in the outside of my right hip (hip flexor, piriformis, QL) that shut me down. I took some time off and then began A.R.T treatment.

My racing in 2009 was terrible. I couldn't ride for more than 2 hours on my TT bike without my hip pain flaring up, which forced me to not only struggle to finish the bike leg of races, but end up walking during the run leg. I began PT on the hip/lower back and this would cause a delay in the flaring of my symptoms, but not eliminate them completely. The end of the road was Ironman Louisville 2009. I had a good swim and bike but was flaring near the end of the ride. By mile 8 of the "run" it felt like I was being stabbed on the outside of my hip and couldn't even drive with my leg-as if the muscles no longer belonged to me.

I stepped away from the sport completely and focused on cycling. In 2010 and 2011 I only road raced. The pain in my hip was no longer prohibitive, the best way to describe it is a growing pain-just a dull ache. It never went away, but it became somewhat of an afterthought.

I love Triathlon, and although I had moderate success on the bike these past 2 years, I had to come back. I began running very conservatively, following BarryP's plan and starting at 10 minutes-which meant each week I was running 5-6x no longer than 30 minutes but mostly 10-20 minutes. My running was getting better, but I couldn't ignore the reality that my hip symptoms were returning.

I've reconnected with my chiropractor, and he's ordered an MRI to test for a torn hip labrum, just to start the process of elimination. The pain is always constant, either in my piriformis/glute, lower back, outside of my hip (TFL?) or top of my hamstring. I won't return to triathlon and try to race with this injury and go down that path of 2 years ago, it's too draining physically and emotionally.

So I'm asking you, Slowtwitch reader, for advice. Advice, opinion, internet diagnosis, etc. Sorry for the long explanation, thanks for your reply.
E

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 15:19

Post #2 of 36 (9310 views)

i've torn the labrum/impinged both hips and have had a total of 3 surgeries to fix them. i never had the stabbing pain that you describe so my guess is that you have something else involving a nerve (possibly the sciatic one?) i, like you, spent years working with ART guys. what i have learned is that chiros never address the underlying problem and only put a band-aid on it by making the symptoms temporarily reside (none will tell you this) and the surgeons are only useful if you need surgery. there is a massive void in the field of sports medicine in the nyc metro area with respect to someone who can diagnose injuries AND figure out how to fix them.

my best experience has been with rob maschi who used to be a PT at HSS but who moved to philly this summer. he has been the only person to have gotten my right hip to work correctly (my left hip is not working correctly right now but that's another story). feel free to PM if you want to discuss this in more detail.

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 15:41

Post #3 of 36 (9294 views)

I have labral tears in both hips and impingement in my left (cam). The pain related to these problems is not typically felt as you describe. Usually it is felt in the crotch/ pubic bone area.

Check out sacroiliac disfunction and trochanteric bursitis. I have these too and while these two are far less serious, they are far more painful.

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Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 15:41

Post #4 of 36 (9294 views)

Your pain does not sound like my pain which has been MR'd and diagnosed as a torn labrum. Sometimes I have discomfort in the same areas you describe, though, but it is something that is only developing over time as my labrum goes unrepaired, awaiting insurance coverage for surgery. I have only recently started experiencing lower-back tightness and issues in the piriformis region. The hip pain with my torn labrum is right up front deep in the groin. The region around that tightens whenever I use it for extended periods (which at this point are defined as walks over 1 mile....).

The MR will give a definitive diagnosis IF there is a torn labrum, though. Can't hurt to have one done, especially if the procedure is covered. My ortho asked if I wanted one done and I said, "Hell yes...it's only going to cost me $12 to find out for sure if that's what is wrong. Let's did it yesterday!"

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 15:46

Post #5 of 36 (9289 views)

Everyone likes to have 1 cause for symptoms, but maybe not. I am 4 months into BAD hip pain and the first 6 weeks it was all posterior--in fact based upon past injuries I was SURE it was high hamstring or piriformis. Well, I saw sports med, PT, chiro, another PT who specializes in ART. Quit running, then had to quit cycling. I can say each one who saw me was not even close to sure what was wrong (ie "not hamstring because we can't reproduce the pain by palpation, but where you say it hurts is the hamstring,so lets work on strengthening your glutes and hamstrings" ) Finally after 2 months, i''d had enough and convinced them to order MRI--which led also to an MRA, and now i am fighting to go to a good surgeon to get my FAI and labral tear fixed. During the last 6 weeks, my pain has gradually and almost completely moved to the front and side, rather than low and back where it was when i started. I can tell you if i try to do things i know aggravate me (even jumping on the rower for 400m, the low rear pain comes back, as well as worsening the newer side/front).
In hindsight, i think like a heart attack being felt as jaw or arm pain, my brain is just not good at understanding the pain signals from my hip, and i do know my piriformis was tight in response--because the graston definitely freed it up a bit--the pain continues, but i know now it is not muscular so just ignore that message.

In short, if you told me your symptoms 4 months ago, I'd say it sounds like ITB stuff up high (rather than typical knee-centric) or some combno of ishio-gluteal or trochanteric bursitis. Now I'd say make sure your hip JOINT is good. They also ruled out my lumbar spine as a source of the pain, and assume you have as well

good luck. i used to dread hamstring pulls and always worreid about high hamstring tendonopathy and now i'd pay good money for either

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 16:03

Post #6 of 36 (9271 views)

Go to an orthopedic surgeon. Now. After dealing with it for this long without success, you really need a professional opinoin

---------------------------
''Sweeney - you can both crush your AG *and* cruise in dead last!! 😂 '' Murphy's Law

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 16:05

Post #7 of 36 (9269 views)

eganski, I've been down your road, both symptoms and treatment. I've been pain free now for about a year, running/biking more and playing hockey as well. Aside from stretching a little more and doing some specific lower body strength training (typical movements you get from PT) the biggest change I made was I dropped the saddles on both my road and tri bikes significantly (inch to an inch and a half) I think the root cause of all my pain was years of riding aero (started triathlon in 1987) with my saddle too high...I shit you not...not sure if this applies to you, but might be worth looking at.

"one eye doubles my eyesight, so things don't look half bad" John Hiatt

Re: Let's talk about my Hip [moneydog59] [ In reply to ]

Dec 7, 11 16:08

Post #8 of 36 (9262 views)

Thank you-

I can't imagine it's a fit issue, but before this "comeback" I lowered my saddle and raised my bars just to make sure my position wouldn't exacerbate my symptoms. This was done by a professional fitter whom I trust.

Sweeney, I am seeing one on the 22nd. My old Orthopedic specialist turned into a prolo/PRP needle jockey who just wanted to inject me. I have experience with this new one and I trust him.

Thanks a lot guys, this means a lot.

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 17:16

Post #9 of 36 (9229 views)

The SI joint dysfunction suggestion is a good one. Are your hips in alignment? The SI joint can kind of "pop" out of place a bit and cause all kinds of issues. Do you have a leg-length discrepancy?
I'll be interested in the MRI results. Make sure it's done with contrast (they'll inject dye so they can see the hip socket).

You said you have an orthopedic surgeon; if you need a second opinion, PM me - I can get you names of people in Portland ME and Boston.

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
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Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 17:23

Post #10 of 36 (9220 views)

Jerk.......................You kicked my ass that bad and you were injured. Hope you get better so we can race again. Maybe this time you can introduce yourself. I will still be wearing your wetsuit :0)

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Re: Let's talk about my Hip [Bmanners] [ In reply to ]

Dec 7, 11 17:38

Post #11 of 36 (9205 views)

I only raced 2 more times after that. That was near the end for me. I will be back to that race, but only if I can fix this.

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 18:02

Post #12 of 36 (9167 views)

I will be doing it this year. I am even still trying to shame KLehner into it. He keeps telling me he is not 12 years old and the old double dog dare will not work. I hope to see you there! You know Dave Greenfield knows a lot about muscle imbalance, deficiencies, muscle pains and sport physiology stuff maybe give him a call.

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Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 18:49

Post #13 of 36 (9122 views)

I struggled with dull hip pain and tightness for 10 years. I'd periodically go to doctors, chiros, massage therapists to work on it and then give up when it didn't get better. This summer I got a new bike and the bike fitter was checking my flexibility and measurements. He asked if I slept with my right leg bent, which I did. Apparently sleeping with a bent leg shortens the hip flexor which contributed to tightness and the pain I was having in my hip and occasionally knee. Slept with my legs straight that night and amazingly the hip pain and tightness was greatly reduced (as well as lower back tightness). I can't believe in 10 years of appointments no one asked me and the fix was so simple. It's worth a shot if that could be contributing to your issues.

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 7, 11 23:32

Post #14 of 36 (9060 views)

Instead of your hip, I'll tell you about my hips. Mine started on the right side like there was a string around my right ball that pulled ever stride on the run. My balls were killing me. I went to a couple of internists, a urologist, chiropractor, and acupuncturist. No good. Finally I asked the doctor who I saw for a colonascopy about it and he said ''you need an orthopedic surgeon''. All it took was one xray to see what was wrong; my right hip socket was all arthritis and the left was starting. Two and a half years later, now with another orthopedic surgeon, a hip resurfacing specialist, I now have two new all steel hip joints and I'll be running again in June.

So, yea, you need an orthopedic surgeon but you need the right one.

---------------------------
''Sweeney - you can both crush your AG *and* cruise in dead last!! 😂 '' Murphy's Law

Re: Let's talk about my Hip [Sweeney] [ In reply to ]

Dec 8, 11 4:06

Post #15 of 36 (9029 views)

Interesting, thank you. The more I'm reading, the more I'm thinking it's not a torn labrum? None of my symptoms are in front or anywhere near the groin (hehe). In fact, the pain manifests itself differently depending on whether I'm running or biking.

If it's not a torn labrum, hopefully the ortho will be able to figure it out.

Thanks again.
Mike

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 8, 11 4:58

Post #16 of 36 (8999 views)

eganski wrote:

Interesting, thank you. The more I'm reading, the more I'm thinking it's not a torn labrum? None of my symptoms are in front or anywhere near the groin (hehe). In fact, the pain manifests itself differently depending on whether I'm running or biking.

If it's not a torn labrum, hopefully the ortho will be able to figure it out.

Thanks again.
Mike

My left hip had a torn labrum (confirmed by contrast MRI and during surgery). The symptoms were that I would sometimes stand up and my left leg would "collapse." This was explained to me as my body compensating for the pain by relaxing the muscles that held the hip socket in place. There was also a marked lack of flexibility in my left hip compared to my right hip. I never had any pain in my groin, leg or anywhere else. Surgery (by a guy in Freehold who is not only board certified but is one of the board certifiers for orthopedic surgeons) last March alleviated that pain completely, and the range of motion has improved to about the same as my right hip.

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Re: Let's talk about my Hip [moneydog59] [ In reply to ]

Dec 8, 11 5:20

Post #17 of 36 (8981 views)

moneydog59 wrote:

eganski, I've been down your road, both symptoms and treatment. I've been pain free now for about a year, running/biking more and playing hockey as well. Aside from stretching a little more and doing some specific lower body strength training (typical movements you get from PT) the biggest change I made was I dropped the saddles on both my road and tri bikes significantly (inch to an inch and a half) I think the root cause of all my pain was years of riding aero (started triathlon in 1987) with my saddle too high...I shit you not...not sure if this applies to you, but might be worth looking at.

This worked for me too. I was on a road bike for about 10 years (that I was never fitted for) exclusively until 2010 and had always had that lingering piriformis dull ache. I recently got fitted and he dropped my saddle a full inch and the pain has largely gone away. There are some stretches I do that also help.

I hope you get it figured out. I know how frustrating it can be.

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 8, 11 6:10

Post #18 of 36 (8954 views)

MRI is exactly what you need at this point and then you'll explore your options.
Highly recommend this guy for a second opinion: http://www.docnet.org/...ios.aspx?phys_id=108

10 years ago he brought me back from nearly incapacitated. PM me if you'd like details. Good luck.

Re: Let's talk about my Hip [eganski] [ In reply to ]

Dec 8, 11 6:27

Post #19 of 36 (8937 views)

I think mag900 hit it on the head - it's hard to find a balance between physios and surgeons. Also, I think a lot of the more athletically inclined docs aren't necessarily the best ones at evaluating complex problems.

Since you live reasonably close to NY, I'd suggest going to see Dr. Kristjan Ragnarsson at Mt. Sinai. You can look him up on the Mt. Sinai website. He's the head of the rehabilitative medicine at Mt. Sinai. Remember the NY Jet Dennis Byrd? He's the doctor that helped him walk again.

I had very bad back problems about a decade ago. I couldn't really run for 12 months. I saw five or six doctors and did PT to no avail. A personal friend who's a doc at Sinai recommended that I see Dr. Ragnarsson. In one visit he figured out that I didn't have a back problem and that it was my piriformis. He set up a PT program and within a day I was pain free and within three days I was back to running regularlyHe's very comprehensive and I think he's got a great balance between what an ART guy will want to do (come see me 2x a week at $90/session to work out tightness in your hips) and what a surgeon will want to do (let's do a spinal fusion).

I've referred a couple other people and they've all felt he was very helpful. At a minimum, he'll spend time evaluating you and talking with you.

Re: Let's talk about my Hip [moneydog59] [ In reply to ]

Dec 8, 11 7:57

Post #20 of 36 (8893 views)

moneydog59 wrote:

Aside from stretching a little more and doing some specific lower body strength training (typical movements you get from PT) the biggest change I made was I dropped the saddles on both my road and tri bikes significantly (inch to an inch and a half) I think the root cause of all my pain was years of riding aero (started triathlon in 1987) with my saddle too high...I shit you not...not sure if this applies to you, but might be worth looking at.

had a very similar experience this summer - bloody well crippled myself doing a crit and then a 100k ride the following day on my CX bike with the saddle too high (i measured to the wrong spot, and it was about an inch out). SI joint and hamstrings locked up, chiro visits didn't help, and i ended up doing a half ironman 2 weeks later unable to turn a pedal without feeling like i was being stabbed in the hip. gave up riding the 'cross bike entirely during those couple of weeks.

after the race, i lowered the saddle on the CX bike and it was like magic - riding the same bike that crippled me actually rehabbed the injury. i did some exercises my chiro gave me as well, but they did precious little to loosen the joint up in the week i did them prior to the HIM. combining them with riding the bike with the saddle lowered, i was completely fine within a week.

that said, i didn't have any pain while running. i can't explain that one, since it hurt like the dickens to bring my right leg forward at all - trying to put a sock on my right foot was near enough to put me in tears and the top of the pedal stroke on the right side was absolute torture - but running was just peachy.

cheers!

-mistress k

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ill advised racing inc.

Re: Let's talk about my Hip [klehner] [ In reply to ]

Dec 21, 11 12:03

Post #21 of 36 (8738 views)

Got the MR/Arthogram done today. I have yet to see the report but just got off the phone with my doctor, turns out I've been dealing with a partially detached torn hip labrum.

Has anyone had a tear and detachment? My doc said he's never seen one but the doctor he is sending me to-Dr. Kelly in New York, is solid.

2.5 years of dealing with this pain, happy to have a firm diagnosis and looking forward to getting back to 100% Thanks for you replies.

Re: Let's talk about my Hip [tigerchik] [ In reply to ]

Jan 9, 12 13:19

Post #22 of 36 (8575 views)

Ok, update time!

I have 2 injections on Monday and have been diagnosed with SI Joint dysfunction and Piriformis Syndrome.

It turns out the radiologist saw indications of a possible tear/detachment in the labrum, but the 2 hip specialists I saw disagree, though one more definitively than the other. I trust smart doctors who aren't afraid to say "I'm not sure" so the 2nd one is the one whose guidance I will follow. He agrees that the 2 injections are a good start, but if my pain persists then a therapeutic/diagnostic injection directly into the hip joint will be the next step. To paraphrase, sometimes a tear won't necessarily show up on an MR/Arthogram.

This is incredibly frustrating, but hopefully the injections will make the pain go away. Treatment, rest, ART have all been helpless to treat the problem. So fingers crossed for next Monday!

Dr. Nazarian at Jefferson University is doing the injections under Ultrasound guidance, if anyone has experience with him. Thanks again for your replies!
E

Re: Let's talk about my Hip [eganski] [ In reply to ]

Jan 9, 12 13:38

Post #23 of 36 (8535 views)

Fingers crossed for you.

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

Re: Let's talk about my Hip [eganski] [ In reply to ]

Jan 10, 12 11:21

Post #24 of 36 (8420 views)

I have/had a detatched labrum on my right hip. I have had three scopes on my right hip as well, the last one being a graft. All three lasted only a few months pain free. Unlike a torn labrum mine also came with FAI. It seems that torn labrums that are reparable do better with scopes than mine. I had several injections, lidocaine with a derivative of cortizone. they gave me relief but not enough to run further than five miles. I am getting my hip resurfaced in march so hopefully i'll be back to racing soon. best of luck and don't mess around with the hip, they have a tendancy of going bad fast.

Re: Let's talk about my Hip [eganski] [ In reply to ]

Jan 10, 12 11:25

Post #25 of 36 (8417 views)

Good luck Eggy;0)

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