Acetabular Labrum tear

Looking for some advice.

I am post right hip scope 2003 - labral tear. It didn't take long after this surgery for the problems to recur. I finally found a physician to address the underlying problem. Dr. Clohisy in St. Louis diagnosed another labral tear with CAM impingement. I had surgery in 12-2006 for labral debridement and femoral neck osteoplasty. It was a mini open procedure. It took quite awhile to build up my quads and get my motion back. By 6 months post op - I had begun bicycling about 3-4 miles per day. At 9 months post op, I felt a 'pull' in the front of my leg during cycling. Wasn't too painful, just felt different. My hip joint flared up and bicycling became impossible. Sitting once again was miserable. I had a joint injection with steroids in late November 2007. It has helped some, but sitting still stinks!

My question - how do I get past my reservations/fears of starting to work out again - and WHAT activities should I try? The elliptical seems to aggravate my hip. It is too cold in IA to do any bicycling - I do have a contraption that makes my 'real' bike stationary, but it just isn't much fun to do indoors. The recumbent bikes aren't really too comfortable as there is too much hip flexion. I am just so afraid I am going to do something to aggravate things again (more than they already are) and end up miserable!

We are getting ready to adopt a little boy from China with a leg length discrepancy (he is 2 y.o. and just darling!). He is missing his fibula and his tibia is short and a bit twisted. He will need surgery at some point, so I just don't have time to be feeling bad! Our other 3 kids are 12, 10 and 5. Just too busy to aggravate my silly hip!!

Thoughts anyone on what to do??

Much appreciated!

Wow James you are very helpful on this site giving all this great information to everyone! I will send you an email shortly with my mobile and maybe we could meet up sometime this weekend to have a little chat before you go to Europe, i will be at BDO on the Monday public holiday though! Jean that would be awesume if you ever come down to Melbourne i would love to have a coffee with you and James :-). To Camel it sounds like your recovery is going well also, all the best!

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Originally Posted by Jean M

Dear James,
You've been a busy poster, haven't you? It's because you give such thorough information/advice, which everyone on this site with hip problems, is somewhat starved for!! What exactly did you do when you once mentioned "a background in pilates"?
Thanks for your comments to Camel - they really make sense to me. I've developed the same rule regarding pain. If it starts to hurt, I stop immediately. The exercises my new physio has given me seem to be working. In fact, what she's getting me to do is "re-train" some of my muscles in terms of daily activities.
One question I have, and I think you may be the person to ask, is: should you stretch a muscle that is full of trigger points? Or should you work on the trigger points first, through, say, massage, then work on stretching?
Thanks, and if I get down to Melbourne some time this year to see my sister, maybe I'll join you and Tallblack for a coffee..........................

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Jean I have my own Pilates studio in Melbourne and while I focus on traditional "American Style" Pilates I have done a Pilates rehabilitation certification as well. I also worked as a Remedial Massage therapist for 5-6 years and actually used to work on some of Mr Odonnells post op patients at the sports med clinic I worked at.
Regarding trigger points the answer is generally you should work on the trigger point first.
The trigger point or "contraction Knot" is basically a group of muscle fibers which have contracted to produce a knot in the muscle.This focal point has reduced blood flow leading to the build up of toxins, causing pain and increased muscle tension.The trigger point is often very tender when pressed and/or can refer pain to another area altogether. Often people will experience pain only in the referred area and not actually over the trigger point itself.
Stretching may help but for a number of reasons these fibers are, in my experience usually difficult to release with stretching alone.
One common method of trigger point release is
1/warm up the area with some general light to medium depth massage for 5-10 minutes(sorbolene cream is fine)
2/using your thumb, or elbow apply pressure directly over the trigger point up to a pain threshold of maybe 7 or 8 out of 10 for at least 10 seconds. Back off the pressure slightly (to allow fresh blood flow into the area) for a few seconds then reapply the pressure again for at least 10 seconds.
You could repeat this cycle 3-4 times then do some general massage to the area for maybe another 5 minutes then repeat the pressure/release cycle again if its not too tender.
This process is to "de-activate" the trigger point
3/The fibers are thought to be contracted together because of a chemical reaction inside the cells of the muscle tissue. To release this contraction the theory suggests you have to break down these cell walls with cross fibre friction massage to alter the chemical balance and cause the fibres to release the contraction.
Make sure all lotion is removed or work through a towel so you do not slip off the trigger point. Press firmly over the trigger point then with small back and forth movements (no actual movement over the skin, the skin will move with the thumb) apply friction massage crossways and lengthways to the trigger point for maybe 3-5 minutes.
This can be bery painfull and it may flare up some people.Work in your own pain threshlod.
4/apply genral massage to the area 5-10 minutes
5/Stretch the muscles
OR
Some people get good results just from pressing firmly over the point for 1-2 minutes without releasing the pressure.
I hope this helps.
cheers

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Originally Posted by right hipster

Looking for some advice.

I am post right hip scope 2003 - labral tear. It didn't take long after this surgery for the problems to recur. I finally found a physician to address the underlying problem. Dr. Clohisy in St. Louis diagnosed another labral tear with CAM impingement. I had surgery in 12-2006 for labral debridement and femoral neck osteoplasty. It was a mini open procedure. It took quite awhile to build up my quads and get my motion back. By 6 months post op - I had begun bicycling about 3-4 miles per day. At 9 months post op, I felt a 'pull' in the front of my leg during cycling. Wasn't too painful, just felt different. My hip joint flared up and bicycling became impossible. Sitting once again was miserable. I had a joint injection with steroids in late November 2007. It has helped some, but sitting still stinks!

My question - how do I get past my reservations/fears of starting to work out again - and WHAT activities should I try? The elliptical seems to aggravate my hip. It is too cold in IA to do any bicycling - I do have a contraption that makes my 'real' bike stationary, but it just isn't much fun to do indoors. The recumbent bikes aren't really too comfortable as there is too much hip flexion. I am just so afraid I am going to do something to aggravate things again (more than they already are) and end up miserable!

We are getting ready to adopt a little boy from China with a leg length discrepancy (he is 2 y.o. and just darling!). He is missing his fibula and his tibia is short and a bit twisted. He will need surgery at some point, so I just don't have time to be feeling bad! Our other 3 kids are 12, 10 and 5. Just too busy to aggravate my silly hip!!

Thoughts anyone on what to do??

Much appreciated!

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Have you tried water running? Deep and shallow end

Dear James,
Thanks so much for your detailed advice!
I assumed you were quite the professional, so thought you'd point me in the right direction.
Only problem is: I've read about trigger points, and the need for self-administered massage (using a thera cane or a lacrosse ball) and have tried it for some weeks. HOWEVER, I find it really hard to do, and very difficult because you're actually inflicting pain, as you say.
I really can't afford a masseur, as well as a physio, so I'm going to have to re-think things.
You've actually given me more info than I've read in my self-help book "The Trigger Point Therapy Workbook", so I think I'm going to give it another try. Maybe just start with the general warming up, then solid pressure for 1 - 2 minutes, general massage, THEN the physio.
I truly feel that JUST straight stretching isn't going to work for me. Here I differ with my new physio, who seems to think that a muscle containing trigger points is just a tight muscle that will respond to stretching, given time.
I tend to disagree - it's just my experience. Plus the comments I read on this site (especially yours, James, and Hipster's (since she is a physio herself) have influenced my perspective.
THANK YOU so much for taking the time to explain things so thoroughly.........................

P.S. to James,
My sister is looking for a pilates studio (she lives in Melbourne). If you wouldn't mind, could you email me the name/address of your studio?
Many thanks.

Advice on rehab-

I appreciate the advice on the pool exercise. I am going to have to 'bite the bullet' and give it a try. Many people have luck with it - unfortunately - I hate the water! I will have to learn to like it, I guess!

Regarding trigger points - IT DOES WORK. I have attended a couple of sessions of deep tissue massage and this includes trigger point work. It is amazing how my tissue has responded. It has helped me quite a lot. Fortunately I put some flex spending money (pre taxed money) and this allows me to afford a few sessions. It isn't a fix for all my pain, but any little bit has helped.

I do have access to a pool and am going to try to get some exercise in - I know I need it. Best of luck to all of you!

This is a fabulous site to get some ideas AND a site that shows this pain is not in your head - many people suffer and it just is nice to read about other's experiences and how they rehab and cope!! Thank you all!

Iowa :)

The pain that is referred out into the body from the hip joint is very very real. The problem is, too many practitioners out there are obsessed with "the spine". So instead of being treated for a hip problem, you find you're being treated for a back problem. I had numerous cortisone injections into my back, leg & buttock all to no avail. I was told that the best solution was to swim or cycle (good for my back, see). Scans showed I had no problem with my hips, but I had a buldging disc in my L5. Turned out to be a "red herring".
I continued to suffer until someone finally diagnosed a torn labrum. An MRI followed and then an arthroscope.
I've still got weaknesses, and am now trying to address all the tight muscles in and around the hip (extending into the lower back as well). BUT I"M OUT OF ALL THE TERRIBLE PAIN!! Have been relatively pain free since the surgery 10 months ago.
Please learn from all us posters.....................don't stop asking questions, or changing practitioners. Keep going. Don't give up trying to live a normal life again. Good luck!

Totally aggree! Every time I complained about back pain (have been since 15yrs old approx), the back was only addressed. Only since this surgery have I been told that the hip, sacral & muscles were the main cause of my pain! I never knew that a spastic muscle in the glutes could cause such bad sciatic pain down both legs!

Yep. I'm now working REALLY hard on my glutes. The physio gives me quite painful treatment, but I know I HAVE to endure this if I'm to recover more completely. The quads are another problem area.
Like you, I never realised how a tight muscle can cause terrible sciatic pain (in my case, just down one leg, and INTO the foot!).
I've been scared off exercise for so long, but because I'm finally having success with my new physio, I'm even considering doing pilates at some stage. Once my muscles are not in spasm of course!
Al the best LMS.