Hip / Groin Pain - MRI Results

Triathlon Forum
1

Before all of the cancellations/postponements, I was training for IM St George putting in a fairly heavy 15-20 hour schedule including 40-50 mile running weeks. Sometime in late Jan/early Feb I developed pain all around my groin and hip - very minor at first, but by the end of February it got progressively worse to the point I could hardly finish my runs.

After reading up on potential diagnoses including a femoral neck stress fracture, I managed to see my doctor and squeeze an MRI right before everything was shut down. Summary results are below (sorry for the medical speak - I dunno what most of it means either).

  1. Nondisplaced tearing of the anterior and superior labrum. 4 mm anterior paralabral cyst. Anterior labral attenuation compatible with degeneration. Early hip osteoarthritis.
  2. Small anterior femoral cam lesion. Elevated femoral neck anteversion.
  3. Mild iliopsoas bursitis.
  4. Mild osteitis pubis with scar thickening of the pubic plate. If an athletic pubalgia injury is clinically suspected, a dedicated noncontrast MRI of the bony pelvis with athletic pubalgia protocol could be performed.
  5. Mild abductor insertional peritendinitis.
  6. No stress fracture.

Since I am presumably not racing until at least July/August, if not 2021, I stopped running and have now only been biking indoors for the past 4 weeks. My doctor told me that I still could have done St George if absolutely necessary but some time off would be best, and I could use pain as my guide.

I currently have little to no pain in my actual hip after 4 weeks of rest, but I still have some nagging pain in my lower right abdomen/groin which is actually pretty significant when I cough. I suspect that I may have an “athletic pubalgia” injury and I am trying to reschedule a tele-appointment with my doc to confirm whether I need another MRI.

Anyone have any suggestions on recovery period and dealing with these injuries? I am reading up on the injury section here and trying to do some PT exercises on my own but any other insight would be appreciated.

2

Before all of the cancellations/postponements, I was training for IM St George putting in a fairly heavy 15-20 hour schedule including 40-50 mile running weeks. Sometime in late Jan/early Feb I developed pain all around my groin and hip - very minor at first, but by the end of February it got progressively worse to the point I could hardly finish my runs.

After reading up on potential diagnoses including a femoral neck stress fracture, I managed to see my doctor and squeeze an MRI right before everything was shut down. Summary results are below (sorry for the medical speak - I dunno what most of it means either).

  1. Nondisplaced tearing of the anterior and superior labrum. 4 mm anterior paralabral cyst. Anterior labral attenuation compatible with degeneration. Early hip osteoarthritis.
  2. Small anterior femoral cam lesion. Elevated femoral neck anteversion.
  3. Mild iliopsoas bursitis.
  4. Mild osteitis pubis with scar thickening of the pubic plate. If an athletic pubalgia injury is clinically suspected, a dedicated noncontrast MRI of the bony pelvis with athletic pubalgia protocol could be performed.
  5. Mild abductor insertional peritendinitis.
  6. No stress fracture.

Since I am presumably not racing until at least July/August, if not 2021, I stopped running and have now only been biking indoors for the past 4 weeks. My doctor told me that I still could have done St George if absolutely necessary but some time off would be best, and I could use pain as my guide.

I currently have little to no pain in my actual hip after 4 weeks of rest, but I still have some nagging pain in my lower right abdomen/groin which is actually pretty significant when I cough. I suspect that I may have an “athletic pubalgia” injury and I am trying to reschedule a tele-appointment with my doc to confirm whether I need another MRI.

Anyone have any suggestions on recovery period and dealing with these injuries? I am reading up on the injury section here and trying to do some PT exercises on my own but any other insight would be appreciated.

Have you played soccer, rugby before?

3

Short version is…LOTS of time off. LOTS of rest. Be ready for a long road with lots of hard work ahead. I had basically all of the same plus bi lateral pelvic stress fractures and a fair amount of Edema. Don’t know how old you might be, or where you are located but find the best Physio (look up FAI fix) you can and start researching and interviewing Surgoens as a backup. I tried Physio for 6 months with no success. Then Surgery. I had a labral repair, FAI Cam Impingment repair and Micro Fracturing. I was 6 months post op before I was back light running and 8 months til something that would qualify as training. The biggest issue I had was with the Ostitis Pubis and the Edema. Last race I did was Boston 2018 and I’m still not 100% although I’d be back racing this summer if the current state of the world were different.

4

You have FAI (femoral acetabular impingement) and a labrum tear. Search on here as there are countless threads on it. Basically, you have a bone spur on your femoral head which is colliding with the the acetabular.

I had surgery for this back in 2015. I don’t wish the surgery on my worst enemy. But most people can avoid it and hopefully you can too.

  • start strengthening your glutes and posterior chain. Find a good PT if you need help.
  • Stop running. You can bike if you have no pain
  • I would give it a good 2-3 months of PT before looking at alternative options.
  • A lot of people have labrum tears and are asymptomatic and don’t even know they have one. It’s more common than you think.

Let me know if you have any questions.

5

Really? FAI surgery helped me immensely. I has issues from a fracture that didn’t heal correctly. Caused multiple issues and decreased range of motion. FAI surgery took my hip back to 100%.

6

Really? FAI surgery helped me immensely. I has issues from a fracture that didn’t heal correctly. Caused multiple issues and decreased range of motion. FAI surgery took my hip back to 100%.

Same. 4 years this month post surgery and I’m good as new.

I do not for a single second regret surgery. Recovery was long, but rehab pre surgery did not work for me, and I’d happily repeat year 1 post surgery year after year than live with the pre surgery pain.

7

Don’t get me wrong, surgery helped me too. I wouldn’t be able to run if it wasn’t for surgery. PT helped me a little but I never could get back to being paint free. The recovery process was long and incredibly frustrating. I think there are too many knife hungry docs out there and there are a lot of folks out there that haven’t had great success with the surgery. Some even come out worse than they were before the surgery. I urge folks to avoid surgery as much as you can because it can be avoided. Hopefully that’s the case for the OP.

8

Have you played soccer, rugby before?

No… that sounds a lot more exciting that swimming, biking and running :slight_smile:

9

Short version is…LOTS of time off. LOTS of rest. Be ready for a long road with lots of hard work ahead. I had basically all of the same plus bi lateral pelvic stress fractures and a fair amount of Edema. Don’t know how old you might be, or where you are located but find the best Physio (look up FAI fix) you can and start researching and interviewing Surgoens as a backup. I tried Physio for 6 months with no success. Then Surgery. I had a labral repair, FAI Cam Impingment repair and Micro Fracturing. I was 6 months post op before I was back light running and 8 months til something that would qualify as training. The biggest issue I had was with the Ostitis Pubis and the Edema. Last race I did was Boston 2018 and I’m still not 100% although I’d be back racing this summer if the current state of the world were different.

Wow, that is a lot of injuries piled on top of each other. The stress fracture is what I was most worried about, although it seems like the other injuries take just as much or if more time to heal. I’m going to go back to my doc and discuss options with him. 4 weeks off running now and my hip and groin are still throbbing when walking around.

10

You have FAI (femoral acetabular impingement) and a labrum tear. Search on here as there are countless threads on it. Basically, you have a bone spur on your femoral head which is colliding with the the acetabular.

I had surgery for this back in 2015. I don’t wish the surgery on my worst enemy. But most people can avoid it and hopefully you can too.

  • start strengthening your glutes and posterior chain. Find a good PT if you need help.
  • Stop running. You can bike if you have no pain
  • I would give it a good 2-3 months of PT before looking at alternative options.
  • A lot of people have labrum tears and are asymptomatic and don’t even know they have one. It’s more common than you think.

Let me know if you have any questions.

Thanks Steve, that is really helpful. I’ll look up those threads on FAI here - I guess I didn’t realize that was what I had based on the results.

I have a good PT but I haven’t been to her in a while. I think they are offering virtual sessions now and I could do the strengthening on my own.

I have not been running for 4 weeks now after it was clear that my Spring races were going to be cancelled. The frustrating part is that I still have aches and pains while just walking around. I am doing some pretty intense bike training indoors because that’s all I can do right now, but biking doesn’t seem to bother it.

I’ll go back to my doc and see what he thinks. Glad I was able to get this MRI in before everything blew up.

11

Really? FAI surgery helped me immensely. I has issues from a fracture that didn’t heal correctly. Caused multiple issues and decreased range of motion. FAI surgery took my hip back to 100%.

Same. 4 years this month post surgery and I’m good as new.

I do not for a single second regret surgery. Recovery was long, but rehab pre surgery did not work for me, and I’d happily repeat year 1 post surgery year after year than live with the pre surgery pain.

When you both say “pre surgery pain” and decreased range of motion - was that while running? Or just doing day to day activities?

I don’t really have any pain during day to day activities, including some long hikes we have been doing recently. But it does have some lingering soreness/aching occasionally, especially in the morning, which is a bit concerning.

12

Really? FAI surgery helped me immensely. I has issues from a fracture that didn’t heal correctly. Caused multiple issues and decreased range of motion. FAI surgery took my hip back to 100%.

Same. 4 years this month post surgery and I’m good as new.

I do not for a single second regret surgery. Recovery was long, but rehab pre surgery did not work for me, and I’d happily repeat year 1 post surgery year after year than live with the pre surgery pain.

When you both say “pre surgery pain” and decreased range of motion - was that while running? Or just doing day to day activities?

I don’t really have any pain during day to day activities, including some long hikes we have been doing recently. But it does have some lingering soreness/aching occasionally, especially in the morning, which is a bit concerning.

Day to day. My pain manifested in the SI joint area and I was always in pain. I couldn’t run at all.

If you are not in constant pain, I’d try PT first. Lots of people have had success with it, and like others have mentioned, lots of people have FAI that is asymptomatic.

13

As some are alluding to- You also should choose your surgeon wisely. This is not a surgery for any swiss army knife type orthopedic surgeon.
I suggest looking up old threads and figuring out who the “go to” surgeon is in your area.

14

Don’t get me wrong, surgery helped me too. I wouldn’t be able to run if it wasn’t for surgery. PT helped me a little but I never could get back to being paint free. The recovery process was long and incredibly frustrating. I think there are too many knife hungry docs out there and there are a lot of folks out there that haven’t had great success with the surgery. Some even come out worse than they were before the surgery. I urge folks to avoid surgery as much as you can because it can be avoided. Hopefully that’s the case for the OP.

I think this is good advice. Surgery should always be last resort, and if you have to have it, be very careful about who you trust to do it. I had a really good experience, but I did my research on the surgeon and faithfully did 100% of my PT in rehab. Also was very slow to return to running.

15

The stress fracture being ruled out was a biggie. Most of the other findings are pretty common findings on MRI…for both symptomatic and asymptomatic individuals (if you read the data on MRI findings on asymptomatic patients…especially labral tears)

Sounds like you’ve got things to calm down and that’s great. I’m biased of course, but with some guided rehab/PT from one who works with runners and triathletes often should help…the resting was important, but gradual loading with exercise and a smart return to running program is key.

I’m no ortho doc, but it looks like this can be managed conservatively. There are good conservative rehab protocols for “athletic pubalgia”

Good Luck!

16

Have you seen a sports medicine doctor, or a sports ortho? If not, you probably should. There’s the best qualified to actually diagnose these types of injuries. The lower abdomen and hip musculature is a complex structure. My SportsMed said exactly the same thing as PTinAZ, those findings show up in lots of people with and without symptoms—they don’t necessarily mean anything definative. You need a good clinical exam from a knowlegeable Doc. Once you have a good diagnosis from a qualified Doctor, you can determine the right course of treatment.

If you have Athletic Pubalgia or any of the similar variations of lower abdominal strains…My experience was as follows:

I had Athletic Pubalgia a few years ago. I ran through it for about a month or so, in training. Then I pulled a groin the night before my race, and raced with both. After the race I was NOT in good shape.

AFter the race I went to see a SportsMed doc, and was eventually diagnosed with Athletic Pubalgia. I was successfully treated conservatively as PTinAZ suggests. I’ve written about that experience before. I was off SBR for two months. I was in PT for 3 months (3x per week). I resumed running at 5 minutes per day starting at the 2 month mark, and grew that 1-2 minutes a week, as tolerated by pain. I continued the PT protocol on my own after 3 months out through the 6 month mark. At that point I was back to running 30 minutes a day, and resumed a barryP style program.

I continued to have mild discomfort in the general area for about a year…typically at the end of long runs. I don’t really remember when it went away. I just remember one day realizing that I couldn’t remember the LAST time that it had bothered me.

17

I have seen a sports ortho, but as much as I like the guy, he didn’t give me any actionable steps to take other than “rest” and “run as pain allows”. Ruling out the stress fracture was critical in terms of not having to use crutches, etc. but after 4 weeks of no running I still feel like there is something wrong in my abdominal area and some dull aching pain still in my hip joint.

I got a good recommendation from someone that suggested a knowledgeable doc/PT at HSS in NYC which is a very well-respected institution, so I’m going to reach out and see what my options are to get a 2nd opinion.

In terms of whether or not I have Athletic Pubalgia… the area of pain seems comparable to what the typical symptoms are, and it hurts the most when I cough, but it otherwise generally unnoticeable except for when I move sharply in certain directions. But what is also weird is that running never aggravated it - sometimes swimming did (dolphin kicking) - it just seemed to develop on its own and was separate from the hip pain (almost as if they were 2 unrelated injuries that occured at the same time).

Anyway, I appreciate the advice from all of you - I’m going to try and get a 2nd opinion and the silver lining in all of this COVID mess is that I have time to rest and strengthen.

Have you seen a sports medicine doctor, or a sports ortho? If not, you probably should. There’s the best qualified to actually diagnose these types of injuries. The lower abdomen and hip musculature is a complex structure. My SportsMed said exactly the same thing as PTinAZ, those findings show up in lots of people with and without symptoms—they don’t necessarily mean anything definative. You need a good clinical exam from a knowlegeable Doc. Once you have a good diagnosis from a qualified Doctor, you can determine the right course of treatment.

If you have Athletic Pubalgia or any of the similar variations of lower abdominal strains…My experience was as follows:

I had Athletic Pubalgia a few years ago. I ran through it for about a month or so, in training. Then I pulled a groin the night before my race, and raced with both. After the race I was NOT in good shape.

AFter the race I went to see a SportsMed doc, and was eventually diagnosed with Athletic Pubalgia. I was successfully treated conservatively as PTinAZ suggests. I’ve written about that experience before. I was off SBR for two months. I was in PT for 3 months (3x per week). I resumed running at 5 minutes per day starting at the 2 month mark, and grew that 1-2 minutes a week, as tolerated by pain. I continued the PT protocol on my own after 3 months out through the 6 month mark. At that point I was back to running 30 minutes a day, and resumed a barryP style program.

I continued to have mild discomfort in the general area for about a year…typically at the end of long runs. I don’t really remember when it went away. I just remember one day realizing that I couldn’t remember the LAST time that it had bothered me.

18

I got a good recommendation from someone that suggested a knowledgeable doc/PT at HSS in NYC which is a very well-respected institution, so I’m going to reach out and see what my options are to get a 2nd opinion.

Anyway, I appreciate the advice from all of you - I’m going to try and get a 2nd opinion and the silver lining in all of this COVID mess is that I have time to rest and strengthen.

If you have the ability / choice, somone who sees a lot of hockey players is a good option. As far as I understand, injuries in this area are extremely common in hockey players and skaters. I saw (one of?) the hip/abdominal specialists for the Dallas Stars.

19

I have seen a sports ortho, but as much as I like the guy, he didn’t give me any actionable steps to take other than “rest” and “run as pain allows”. Ruling out the stress fracture was critical in terms of not having to use crutches, etc. but after 4 weeks of no running I still feel like there is something wrong in my abdominal area and some dull aching pain still in my hip joint.

I got a good recommendation from someone that suggested a knowledgeable doc/PT at HSS in NYC which is a very well-respected institution, so I’m going to reach out and see what my options are to get a 2nd opinion.

In terms of whether or not I have Athletic Pubalgia… the area of pain seems comparable to what the typical symptoms are, and it hurts the most when I cough, but it otherwise generally unnoticeable except for when I move sharply in certain directions. But what is also weird is that running never aggravated it - sometimes swimming did (dolphin kicking) - it just seemed to develop on its own and was separate from the hip pain (almost as if they were 2 unrelated injuries that occured at the same time).

Anyway, I appreciate the advice from all of you - I’m going to try and get a 2nd opinion and the silver lining in all of this COVID mess is that I have time to rest and strengthen.

Have you seen a sports medicine doctor, or a sports ortho? If not, you probably should. There’s the best qualified to actually diagnose these types of injuries. The lower abdomen and hip musculature is a complex structure. My SportsMed said exactly the same thing as PTinAZ, those findings show up in lots of people with and without symptoms—they don’t necessarily mean anything definative. You need a good clinical exam from a knowlegeable Doc. Once you have a good diagnosis from a qualified Doctor, you can determine the right course of treatment.

If you have Athletic Pubalgia or any of the similar variations of lower abdominal strains…My experience was as follows:

I had Athletic Pubalgia a few years ago. I ran through it for about a month or so, in training. Then I pulled a groin the night before my race, and raced with both. After the race I was NOT in good shape.

AFter the race I went to see a SportsMed doc, and was eventually diagnosed with Athletic Pubalgia. I was successfully treated conservatively as PTinAZ suggests. I’ve written about that experience before. I was off SBR for two months. I was in PT for 3 months (3x per week). I resumed running at 5 minutes per day starting at the 2 month mark, and grew that 1-2 minutes a week, as tolerated by pain. I continued the PT protocol on my own after 3 months out through the 6 month mark. At that point I was back to running 30 minutes a day, and resumed a barryP style program.

I continued to have mild discomfort in the general area for about a year…typically at the end of long runs. I don’t really remember when it went away. I just remember one day realizing that I couldn’t remember the LAST time that it had bothered me.

I was looking for another thread and ran across this one. You have to go to some who primarily does labrum repair.

This is not a bad surgery if the right person does it. I’m 12 weeks out and I’ve been running with no pain.

I’ve had both done by a surgeon out in Colorado the second one I had been in PT for 4 months because of knee surgery. The doctor did the hip in the middle of that recovery. It’s still not 100 percent from a strength perspective but I’m going to hit probably 35 miles running this week.

Don’t just have any ortho surgeon do it, you’ll be in a bad place after.

20

I’m 39 and have had 2 instances in the last 2 years where, after running in slippery conditions, woke up the next morning with pretty intense pain radiating into my groin and glutes on my right side. Was able to rehab my way, along with taking a number of months off running, back to fairly pain free. This year I aggravated it again running in the snow and after not being able to rehab it back I got the injection, which has helped for a few months, but it has been wearing off. Throw in some pretty painful SI/low back pain because of compensating, I have been pretty miserable. Finally got the MRI and Xrays, turns out I have a labral tear from 11o’clock posteriorly to about 3 o’clock anteriorly. In addition I have a cam impingement on the right side as well as the tear. Just had my appointment with the surgeon yesterday, will be getting my pre-op CT scan Monday and surgery is looking to be in the next couple of weeks. Just waiting on a concrete date. Did my research and my surgeon works with a B10 as well as NFL football team, as well as the NBAPA, so I feel like I am in good hands.

I know rehab and recovery is going to be a bitch, but I am in good shape and seem to be a pretty good candidate based on what the MRI and X-rays showed in terms of very little to no arthritis. Keeping my fingers crossed that the right side goes well because as I have been dealing with the right side, my left side has started bothering me as well. My doc, as well as the research, indicates that I have the same issues on the left side, so if the right side goes well, I will be looking at the left in the next 18-24 months as well.