As you all know from my last post, I underwent surgery for FAI (Femoroacetabular Impingement) about eight weeks ago. My journey with FAI began almost two years ago when I was in a cycling accident while training for the Muncie Half Ironman. After the accident, I continued to train for and race (and finished with a very good first time of 5:37 if I may say so myself) the Half Ironman and went on to train for and race the Chicago Marathon in October of 2010. One week after the marathon, I was doing an eight mile recovery run and at the end of my run I felt some sort of pain in my left hip. It was below my actual hip bone, on the side of my left leg.
Never being injured before I “ran through it”, as most athletes do, and continued to do my regular workouts. The pain didnt’ going away so after a couple of months I went to my general practitioner who diagnosed me with Bursitis in my left hip. My treatment options were a cortisone injection or physical therapy (PT). I asked to be sent to a sports specialist to get a second opinion and after seeing him and having x-rays taken, was told I had bursitis and to rest, take ibuprofen and complete a PT program. This was now January 2011.
Taking the physician’s advice, I started a PT program and continued until May 2011. I had made progress and was back to a run program where eventually I was able to run 3-5 miles without pain. My PT had video taped my running gait, worked on strengthening my core and glute muscles and more. I felt like I was back to normal so I began training for triathlon season.
I was able to run, bike and swim without any hip pain. Then, one afternoon I did a mile time trial and afterwards I felt a new hip pain- but this time it was in a different spot. It was almost in the crest of my left hip- near my pelvis. I continued to once again “run through it” except this time I was running, biking and swimming since I was training for triathlons. Knowing a Half Ironman was out of the picture with the pain I was having, I stuck to low mileage and ended up competing and racing in three sprint triathlons in Indianapolis. This is a great tri series by the way if you’re in or around the area.
After each training session or race, I would be in pain. My hip would hurt me to the point that it was hard to sleep on it at night and when I would sit for long periods of time (ie. in the car or at my desk), my left leg would give out if I put weight on it when I stood up. The peculiar part was that while I was running or biking, my hip wouldn’t hurt- it was only when I was done with my exercise that it would give me pain. It would hurt the evening of the training or race and for about a day afterwards, then the pain would dissipate.
I went to see another PT in Indianapolis that summer who was great. He did an athletic assessment on me and gave me strengthening exercises to work on various muscle imbalances I had. I did my exercises diligently which is a challenge for anyone who knows me- I am not a patient person so doing 45 minutes of PT exercises before my workouts each day was a challenge. Still, I wasn’t getting any better.
At the end of the summer, I had pretty much accepted my pain and was only doing minimum workouts- bootcamps, strength training and running occasionally. I was planning and preparing for my wedding in October 2011 so needless to say, my mind was busy with other important things. I decided to wait it out and see what happened.
Finally, in February 2012 I went to another sports specialist in Bloomington and explained my story to him. He recommended I see another PT (this would be my 3rd) and if my program wasn’t working after four weeks, I would get an MRI. I agreed and began PT at a new location with a new program. This PT was also great. They worked on core and hip strength among other things. While doing my assessment, they thought that I might have a pelvic floor issue so I ended up seeing a Women’s Health specialist in Greenwood and going through two weeks of internal vaginal massage. Yep you heard that right, internal massage! After two weeks I told them that this therapy seemed silly (they thought so too) because my hip pain had only gotten worse and my right hip had actually started hurting throughout the process.
After the four weeks I went back to the specialist and they did an MRI. I was told I had FAI CAM Impingement resulting in a torn labrum and torn cartilage in my left hip. Finally, a diagnosis! I had no idea what FAI was or how it was treated, but at least I had a diagnosis.
From there, I was sent to Dr. Maiers at Methodist Sports Medicine in Indianapolis and he assessed my hip. My options were to live with the pain (not an option for me as I am only 27), try an injection (would only work for a few months or so) or have a hip arthroscopy. In the meantime, I had an MRI done on my right hip because it had been giving me the same pain for the last three months or so. An MRI confirmed FAI CAM Impingement on my right hip resulting in torn cartilage, but no torn labrum…yet. After much deliberating and praying, I decided to have the surgery on my left hip on May 22, 2012.
I prepared to take two weeks of Family Medical Leave (FMLA) from work, planned on staying at my parent’s house while my husband was out of town, cleaned everything in my house from top to bottom since I knew I would be laid up for a while and packed enough spandex and yoga pants to last me for two weeks.
The surgery went well and Dr. Maiers was very pleased with how my body reacted. Once they got into the surgery, they discovered that my labrum was more badly torn than they had been able to see on the MRI and I had much more detached cartilage as well. That itself affirmed my decision to have the surgery. I had an overnight stay at the hospital and was able to go home around 11am the next morning. Here is a photo of me in the hospital the morning after my surgery.
Once we were home, I pretty much slept and watched TV for a week straight. I took my medications on a rotated schedule and did my exercises on a daily basis. I went home with an IceMan and it was my saving grace. It is a little cooler full of ice that compresses and ices your hip at all times. It helped emmensly with the pain and swelling- although I will say that sitting for over a week straight will make your body retain fluid like you wouldn’t believe. Every part of me was swollen. It didn’t help that the pain meds gave me GI issues and I wasn’t able to go to the bathroom for almost a week. Just an FYI, I would definitely recommend taking a stool softener or laxative while on the pain meds.
After about a week and a half, I started feeling better. I was able to go to Target, go to dinner and get out and about a little bit. I even went to Kilroys with my husband on my crutches so he could get his $3 Thursday t-shirt!
One week post-op, I started PT twice a week. I started with very limited exercises. Mostly just moving my leg up and down while standing on my crutches and flexing my glutes, quads and doing ankle pumps. Each week I was able to add in a few more exercises such as bridges, stretching, clamshells and more.
Although each FAI surgery recovery is different, I wanted to share just a few finess tips and training exercises that I thought would have been helpful to know before my surgery. Note, I am not a physician or a physical therapist so please consult your physician before beginning any exercise or fitness routine.
1. Strength Training
It was important for me to maintain muscle mass during my recovery. Although you are limited in the range of motion or movement you have within the hip, there are many strength training moves you are able to do. A big thank you to my husband and Force Fitness and Performance for putting together an effective strength plan that utilized my upper body and core.
By elevating the upper body, I was able to take some of the demand off of my hip in the plank position. It also didn’t require me to get up and down from the ground, but was still challenging. I did 2-3 sets for 40 seconds each.
Inverted Rows with TRX
An inverted row is like a push-up for your back. This kept a balance between my chest and back while recovering. Using the inverted row also kept me from having to get up and down from the ground. I did 3-4 sets of 8 reps.
At first, I was able to only push-up off of a box or a bench primarily because I couldn’t get down to the ground and back up. This kept my chest and arms toned throughout my rehab. I did 3 sets of 8 reps.
TKE (Terminal Knee Extension)
TKE is a challenging exercise that allowed me to work my lower body without a lot of movement. It works your quads in a way that actually helps with knee injury prevention. It’s much harder than it looks in the photo. I did 2 sets of 5 reps.
Although glutes are an extremely strong muscle, most people are lacking in the ability to effectively use them for everyday exercise. Training with bridges teaches your body to call on the glutes for more activity, taking the strain off of your hip flexors and quads.
Pull-up or Chin-up
Is there really much to say for this one?! It’s a great upper body exercise for your upper and middle back. I did 2-3 sets of 5 reps.
Incline Bench Press
This was a great exercise to work my chest and arms. Similar to a push-up, I used the bench press to maintain a tight core while remaining seated. I did 3-4 sets of 8 reps.
Band Anti-rotation Press
This is a very challenging exercise that I didn’t incorporate into week three of my exercise because it was too difficult at first. This exercise works your core- specifically your internal and external oblique by challenging your body to resist the natural rotation that the band creates. I held each side for 30 seconds.
Partial Range of Motion Squats
This was really important to do after a few weeks so that I could gain range of motion in the hip. Specifically, with hip external rotation and hip flexion which were both difficult at first. I squatted to a bench for the first couple of weeks and then to a box which was a little lower. I did 2-3 sets of 8 reps.
This was something I was able to do within the first week and a half post-op. Granted, it was only for about 5 minutes with no resistance, but it is something to get the hip and legs moving. Each week I was able to increase 5 minutes and at week 5 I was able to increase the resistance on the stationary bike. I am now able to cycle for about 20 minutes and can ride outside on flat surfaces.
Yoga was the activity I tried after strength training and cycling. I went to a basic yoga class about 4 weeks post-op and the ladies at Vibe Yoga were great. I told them about my limitations and they gave me modifications. Some poses that have given me trouble and include internal or external hip rotation are Child’s pose, Standing Forward Bend pose, Forward Lunge pose, Frog pose, Happy Baby pose and Eagle pose. Listen to your body and know when you’ve reached your limit.
I first tried swimming in a family friend’s pool that was only 25 meters in length. I wasn’t sure how I would do and if I could even flutter kick, so I started very slow. I was able to do my stretches and exercises in the water and could use the kick-board at about 5-6 weeks. I can now swim consistently twice a week for about 20 minutes each session.
I know this doesn’t count as a workout tip, but I thought it was important to mention. When your body isn’t moving like it normally does or you’re not working out as you normally do, your metabolism slows down. I am not used to sitting on my butt for weeks at a time and I quickly realized that my body composition was changing…and not in a good way. I began to watch my diet much more closely. Make healthy food choices and try to eat foods high in fiber that will help with digestion.
I hope you found my story and my recovery tips helpful and insightful. Again, please share this post with anyone you feel like might be dealing with hip issues. I hope you are also able to use some of the workouts I provided also- they are great to do even if you don’t have hip issues.