Hip Arthritis, etc.... :(

Triathlon Forum
1

Well, in my quest to figure out what was wrong with my piriformis area and hamstring (piriformis like pain for 2 years and now hamstring tendonopathy for past 5 months+), I finally got into see a sports doc, went for hip/pelvis xrays to start things off, and came back with what seems like a not so great diagnosis of arthritis. She is sending me to see a surgeon, not necessarily thinking I’m at that point, but to discuss with him, and possibly a cortisone shot, not sure.
Xray said:

There is bilateral mild hip joint space narrowing with right more than left CAM type osteophyte formation and loss of sphericity consistent with CAM type FAI. There is also bilateral acetabular overgrowth with discrete subchondral sclerosis.

She said it is a genetic bone growth in there that can lead to these issues, and commonly causes more issues in sports like skating where the hip is being rotated more…

Anyone have any success stories in being able to return to running well with this sort of thing?? :frowning:

2

Sorry to hear that. All I can offer is sympathy. No answers for you. Hang in there. Just been diagnosed with hip FAI and labral tear. Know what you are living through.

3

Thanks. Are you doing any specific treatment??

4

I’m 30,
I’ve had FAI known for about 8 years. I have large cam lesions.
I have 0 acetabular cartilage left at the front of the joint.
I elected not to have surgery. I’m an ex orthopaedic surgeon and now dead against FAI surgery, as it tends to just bring the femoral head forward.

I manage my condition with -
155mm cranks.
Limited run mileage (10-20 a week)
Limited time in aero, unless racing.
I Mobilise my hips daily by deep squatting, lunges, etc.

Success? I’m still around 15 mins for 5k
I place pretty well and national level races and was 20th in last ironman inc. pro field.

So I do ok!
Best of luck

5

Nothing off the charts. The findings have been very conflicting so I opted for conservative treatment and regenerative treatment possibly, later, down the road.
In summary:

  1. I pass clinical impingement test on the table, 5 or 6 times now. I am told people usually wanna leap off the table, I don’t blink, no hip pain. That test is negative.

  2. Hip X-ray, doc walks in after doing it, says, everything looks great. Later, I looked at report, he did state small CAM and pincer type deformity observed…hm? Got me to raise my eyebrow.

  3. I was asked to run after Lidocane/contrast injection. I could not. Hip felt as if the train has hit me. I was limping for the first time. If it is the hip, you are suppose to feel like million bucks and run like nothing happened. Not my case.

  4. MRI reveals multifocal labral tear, anterior and mid superior side…all other assessments look clean. No mention of CAM or pincer lesions, space preserved (no arthritis), no chondral damage noted, normal Femoral Head Alfa, 54 degrees…Number of asymptomatic athletes out there with mildly abnormal femoral neck morphology and torn labrum but no symptoms.

5.Up to arthrogram, two weeks ago, I had no hip area symptoms at all. I had rectus abdominis sharp pain since August 2016. I had dull adductor feeling since June 2016. Again, entire time no hip area symptoms, until they jacked with my hip and injected the contrast. I am still feeling burn at the sight of needle penetration and still feeling pressure in hip as if somebody is still injecting contrast into my hip.

  1. My symptoms are not severe and hardly affect day to day life. Yes, I cannot train 20hrs a week for Ironman as I just did for 2016 IMAZ, but I am not in a rush, I dont make living from racing.

What I am doing, PT for 2nd round, Celebrex as needed, going to continue chiro ART…For now, very light road bike cycling and walking along with prescribed PT work. I am avoiding any potential impingement positions, like riding my TT bike. These treatments are bound to fail if I am truly symptomatic from the hip. At that time, I will entertain prolotherapy, PRP and stemcell treatment. I have no onset of arthritis and joint space is well preserved. I am 46 and may have a little more time to sit on this. Past 50, I likely become a lesser candidate for hip arthroscopy. Will not brake my heart knowing what they do to people during it. I made a mistake researching this to detail. If surgery is the only option to return to competition, I will cave in, otherwise no.
Dr. Phillipon and company around country that specialize in this, they talk about it as if treating an X-ray or MRI. I watched a dude talk about it,"we do surgery at the sign of symptoms, that is good enough reason…"His name is Dr. Brian White, dude is knife happy…It’s a business.
Sorry for such a long answer, I know you were not looking for this.

.

6

You just made my day.

7

Thanks for the info, and its great to hear how well you are doing.

While I accept I may have this arthritis thing, I’m still not sure if it’s the whole story for me.

Just under two years ago I started getting what felt like piriformis type pain while sitting in the car, but not going all the way down the leg. I know piriformis syndrome is rare, and maybe that was in fact the arthritis starting? It is still that hip area that mostly only hurts while sitting in the car. Does that sound right for this arthritis?

So fast forward to this past October, and I started getting pain in the upper hamstring when running. So I immediately stopped running and did massage, ART, dry needle, etc for the past 5 months, and hamstring things have gotten worse, even with essentially no running. The odd very short run, like 3km, still hurts at the top of the hamstring, and the day after, the bottom connection point of the hams, behind and above knee, hurts…

Now…I have continued to bike, as it doesn’t seem to hurt while biking. But I did make a change to the bike in October, that I can’t imagine would do anything, but the timing is the same… I went from using a 172.5 crank with oval chainring, to a 165mm crank with round ring. I adjusted the saddle for it (raised about 4-5mm, moved back a couple mm). Again, doesn’t hurt while biking, but maybe related? I dunno.

I guess in 6-8 weeks I’ll see what the surgeon says. Sports doc figures he’ll order an MRI and go from there.
Oh, and the doc did give me a 2 week script for celebrex. I took it for 10 days, it may have helped the hip/piriformis area pain a bit, but nothing for hamstring, and I’d rather not take it…

So frustrating…

8

Good!

You’ve got to remember that most of the pain and discomfort you feel is actually the muscles clamping down and trying to protect the joint.
Sometimes acetabular tears cause pain but most often its a pinching.

This is why learning to squat to your lowest limit, is important, you need to keep the joint moving and work on control elements around the joint.
Just a bit of bodyweight squatting 2-3x a day when you remember is excellent and keeping the muscles in shape and in the right orientation.

I was due for surgery but then stopped (thankfully) by another surgeon friend. I then flew off to one of the leading centres for FAI (Dublin) and learned how my joint was moving all wrong. Some specific muscle work and daily BW squats has kept me pain free for years.

Last MRI arthrogram I had showed extensive damage. I will probably need a hip replacement in 10-20 years, but having worked in this I don’t see this as a major problem.

9

I was with you most of the way.
I was diagnosed with arthritis in my right hip when I was 24. I’m 56 now. Back then I was skiing and my hip pain was very limiting. It was a factor in making me not ski well enough to progress any further in my ski career. Now I’m 56 and I am in constant pain. Just sitting here typing, I have a bit of a lean on, to relieve the pain somewhat. When I get up to walk to the coffee machine, I limp for several steps until I get going. Not much fun.

that said, I did manage to do 7 IM’s but as a solidly MOP guy.

I’ve never run well, by running standards but except for the past 3 years since retiring from tri, I was able to main almost exactly the same running speed (fluctuations with fitness of course) until into my 50’s. In fact, my IM’s got faster as I aged (I was really crap to start with, and managed to become average)

I too have even greater difficulty and pain with any hip rotation. Over the years it’s slowly spreading throughout my body (my wrists are shot due to it) and my shoulders are a constant source of pain too.

I’m not too worried about it because I’ve heard that it’s just due to a buildup of impure thoughts. I reckon I can stop perving at women any time I want. My wife doesn’t think I can do it. maybe she’s right and I just have to put up with the pain.

But seriously, it’s a pain but you can get through. It’s not life ending or anything. You’ll be able to do most of what you want to do and that’s pretty good. As the Christians say, “Everyone has a cross to bear”. If I didn’t have arthritis, asthma, heart problems and all my past injuries, I could probably win Kona, but as I DO have all those things, I’m stuck MOP.

I suggest you do what you need to do, do what you can do, but don’t jump at surgery too fast, just so you can keep running fast. A buddy of mine did that and it backfired. He couldn’t run at all after the op, has had to give up tri altogether and now only cycles.

10

Thanks for the reply.
I’m 43, and while not a kid anymore, I have no intention of getting surgery anytime soon. Knock on wood, its not the hip stuff that is limiting me now, its the damn hamstring that won’t heal over the past 6 months. Was in to physio again today, we agreed that aside from meeting with the surgeon, etc. I should try my best to strengthen the glute on the bad side. It is very noticeably weaker than the other side, and we think that may be a big contributor to the hamstring getting strained…all hamstring and no glute on that side.

Back to the surgeon…I don’t think the sports doc wants me having surgery at this point either…I think it was more an idea just to get my name in the system, start a discussion with the doc, possibly get a cortisone shot, etc. Here in Canada this stuff can take a long time, will take 6-8 weeks to get an appointment with the surgeon. If he wants an MRI done, that will take 3+ months to get…

Back to you…have you tried something like celebrex?? Hopefully you can find something that can provide some relief day to day!

11

I lived in Canada for 26 years. I loved the OHIP system there. Sure it can take some time if it’s not life threatening but it’s better than Trumpcare!

I’m in NZ and our public system is similar to Canada, but it’s partially funded by the patient. Luckily I have the top level of private insurance so just about everything is covered. My hip is painful, but I’m used to it now, but it is getting worse. I prefer to live with the pain as long as I can. I’m not big on meds or surgery. I do take meds for my heart and my BP and that’s enough for me. I manage to struggle through reasonably well, so I do. After all my skiing, cycling and other injuries,my whole body hurts, all the time, so getting my hip fixed hardly seems worth the bother. :slight_smile:

12

Lol, you’re tougher than me, I’d be downing some tramadol with jack daniels… :wink:

13

hehehe,

I joke that I’m “Strong like Ox, Smart like Tractor” :slight_smile:

My daughter is a bit like me (accident prone). We have both broken our pelvises. Me in a bike accident and her in a snowboarding crash (it would have been an epic jump if she landed it! LOL). We have a big jar of left over tramadol in the medicine cabinet for use as needed. As for Jack Daniels, well, here in New Zealand it’s legal to distill your own spirits (you just can’t sell it ;-). I make my own Bourbon, Rum and Gin (all pretty nice quality actually) so we have all the pain killers we need.

14

This thread takes me back to 2012/13. I completed my first half the Fall of 2012 and then did the 100/100 run challenge for the first time ending in March 2013. I did something like 113 runs and then did a half marathon a week after the challenge ended. A week after that I was out for a 5 mile run, stopped to look at something at a garage sale of all things and when I started my run back up my IT band right above my knee completely locked up. I attempted to rehab by myself for a month or so but the pain got so bad with just normal activities I had to get treatment and I began an almost 2 yr journey of injuries.

It’s a long story and I’m on an iPad now but a few things in the thread stuck out to me. When I first started PT the therapist quickly got rid of the IT pain but the pain immediately shifted to my hamstring. It was very annoying and very persistent. After lots of starts and stops in treatment another PT identified weak glutes as possibly the root cause - lots of very basic exercises, lots of treatment. My son started working out at a new gym that also had a PT working in part of it - on a whim I decide to get an opinion from him, he identifies the issue as generating from the hip (with weak glutes as a factor). I do some treatment with him but get fed up with the very basic exercises and decide to screw the treatment and just work out with the trainer my son worked with. He does a functional assessment and starts me on a full body workout that is heavy on squats, squats and more squats and I haven’t had hamstring pain since.

I was trying to keep it short but failed miserably. When I read the thread I thought “I may have hip arthritis” and “this guy should add squats to his workouts”.

15

Thanks. I’ve just started some very basic glute exercises to try to get the weak glute on that side firing, including some really simple body weight squats (hold good leg up and out, squat down on bad side). Using a tens unit to also aid in getting it to fire…to help me understand which muscle it is I should be trying to engage…
Very frustrating. All started with hamstring prob, and now my hip joint hurts every day too and while riding.
Kid of wish it were September now so that I could just take 2-3 months off the bike and run, try to let things heal.

16

I’m an ex orthopaedic surgeon and now dead against FAI surgery, as it tends to just bring the femoral head forward.

Can you elaborate on why this is a problem and what the potential impacts are?

Thanks!

17

Hip pain sucks, but there are ways to make it better, or less worse.

I would agree with PT, strengthening glutes and the region around in general.

Now, this alone might not be enough (it is a torn labrum after all) so you could do some research into viscosupplementation (look for studies on Synvisk).

http://www.synviscone.com/what-is-synvisc-one.aspx

http://www.webmd.com/drugs/drugreview-151941-Synvisc-One+IAtc.aspx?drugid=151941&drugname=Synvisc-One+IAtc

I had the injection while waiting for hip surgery and it provided relief. It pretty much served as a lubricant, a buffer to avoid bone on bone action.
OA does not go away, but you can move, be active and not be in constant pain.
No damaging effects like Cortisone so no worsening the OA causing the issue.

6 months of relief for me, but we are all different so some research might help.

Look into it and talk about it with your doc to see if it could help.

About $500 here in Canada, usually not covered but some private insurance companies might.

I also bought a portable ultrasound machine and a Twin stim (think simple Compex unit) and they also helped. Ice and rest also provided relief at times but not always.

I found that Advil or any NSAID did not do much for the pain.

Good luck with all that.

18

I have a twinstim gadget too, been using it last few days just to try to activate the glutes a bit.
She didn’t say that the labrum was torn. I don’t think they can tell that from a xray anyway, can they?

The physio has done ultrasound. Don’t know that it helped at all. :frowning:

19

Usually, MRI will show a torn labrum.

X-ray might, I guess, but maybe not with as much clarity or certainty.

For the Twin stim, there are some how-to videos online and after using it you will know how to use it best. Twin usually means you can use it to either alleviate pain (nerve sensitivity from what I gather) or help strengthen muscles.

You could do a session for the pain and one for glutes. High settings usually give me a jolt, which is not compatible with cat on lap activity.

You can also get yourself an ultrasound machine (not as powerful as the one your Physio has usually) and save $.

Easy to use, if you can score some cheap gel in bulk, do it. You will need it. The gel is usually blue and does not work like the twin stim gel (not conductor I guess)

Make sure not to stay on the same area for to long (internal burns). Moving in circles does the trick.

Hope it helps, keep us posted and stay strong.

20

Yup, the unit I have has both the tens and ems settings. Use the tens for pain relief, the ems for the muscle stim. Physi put in the settings for me for the ems.

I had physio’s tell me years ago that my glutes weren’t working properly, all hamstrings, and that I needed to strengthen them. Apparently I should have listened…