HELP!

[paullavis]

Morning All

I am 17 months post op after having a double Birmingham Hip Replacement at the age of 29.  This was due to wear in my socket joint that has worsened over the years through playing sport (mainly hockey). My surgeon John Hull was fantastic and I am now back playing hockey but with some difficulty.  My physio and I have been working on my issues for the past 12 months and although they are very slowly improving I am wondering if there is anything else I can do to improve my condition

Initially after about 5-10 mins continous exercise (this could include slow jogging) I would develop a nerve pain all the way down the side of my left leg around the IT Band. It seemed to start up around the scar area and deaden my entire leg so I would have to stop exercising.  If I stopped exercising for a few mins I would then be able to start again but the period would get shorter before this pain would come on.  Further continuous exercise would see me in a lot of nerve pain afterwards and struggling to sleep.  It would be fine the next morning.  Alongside that I would get groin pain across the front of my hips, seemingly psoas tendon. 4 months ago I went to see Dr Hull and he suggested Cortisone which I had pretty quickly in both joints.  The immediate affect was brilliant but within days I seemed to be back to normal and struggling. During the last 4 months the groin pain has accentuated with the nerve pain not coming on so quickly.  I am stretching daily which hasnt helped at all (increased flexibility only)

The main issues I am having difficulty with now are the groin pain and stiffness during the week (I play sport 3x pw).  I am trying various exercises and glute strength has improved dramatically over the past 12 months.  I really struggle with my speed and turn of pace, and getting low as its stiff and sore across the psoas tendon.  I desperately want this back as I am finding it incredibly difficult to play at the level I was playing.  I am trying to remain as positive as possible as I know there have been elite athletes return to sport but obviously its tough as the soreness remains. 

Am I asking too much, or are there some answers that myself and physio havent accessed yet??

Thanks

Paul

[halfdone]

Hi Paul.  I'm am sorry that you are experiencing these problems - I hope that you find a good way through them.  I am neither an expert nor have I experienced the issues you have described, but my instincts if I were in your position would be to try 2 things:
1. Stop playing for a while and re-start a progressive PT regime aimed at strength and flexibility in the trouble areas, and breaking down residual scar tissue.  Then return slowly to playing.
2. Have a gait analysis done by an expert and get orthotics if needed.  Perhaps there are some subtle mechanical differences with your new hips that you may need a little extra help adjusting to?
Good luck
PS It may seem a long time since surgery, but there are plenty of hippies who have continued to experience improvements even beyond 2 years post-surgery.  See for example this from John C.
http://surfacehippy.info/hiptalk/index.php?topic=2224.msg14790#msg14790

PS In case it's helpful
http://orthopedics.about.com/cs/sportsmedicine/a/itbs.htm

PPS I was guessing/assuming that you play field hockey rather than ice hockey.  You might want to clarify your post as the Brits may read it one way and the Americans another.

[hernanu]

Hi Paul, I had some IT band issues after my first HR. It seemed like the stronger and more flexible the left (operated) leg got, the more the IT band would tighten, especially when going up stairs. I had the second procedure, the PT worked with me on a stretch for my left leg (and right), where I would do a cross stretch (carefully, with support from a stretching band) to stretch out the band. It worked great, getting that IT band loose, and preventing the same thing on the newly operated right.

I did it under the PT's care, with continual vigilance by her until she was satisfied, but it worked fine. Yours may not be the same, as mine seems to have been just muscular, but thought I'd let you know.

[paullavis]

John

Right, that interesting I will read the links provided thankyou!  

Our season finishes in a month so I will look at a PT regime and in the meantime gait analysis.  My gait has improved but I know its changed dramatically from pre op so its worth looking in to.

Yes field hockey now, although I did play ice hockey up to 21, but to clarify its now only field hockey.

Thanks again John your help is much appreciated.

And Hernanu,  just received your post.  Yes we have been concentrating more on the Psoas tendon, I will suggest the IT Band stretch to my PT when I see her next, thanks

Paul

[obxpelican]

If that were me, I would totally take off anything that will stress your hips for at least 2 weeks, I would ice and take it easy, ibuprophen is good for inflamation if you are allowed to take it.

I would take it easy, I've seen many times that people have full comebacks with no problems after a few weeks.  The most I would do is do some minor stretches.

If you are have sharp shooting pain down your leg or in your back or sharp pain in your groin I would seek out a 2nd opinion complete with x-rays.

Personally I would have avoided the shots, but that's me I like to treat without much in the way of drugs.

YMMV--- again, just my opinions.


Chuck

[ScubaDuck]

Paul-

I have struggled with IT band problems since my early 20s (30 years).  I have done various stretching which has done some good.

In trying to find something to address my hip pain (I had yet to be diagnosed with osteoarthritis) I found a system called TriggerPoint.  It is a set of tools that help you do self massage.  It is very effective on the psoas and IT band.  I bought and was trained at my local running shop.

Good luck.

Dan

[steven bn]

that's an interesting story, mostly because it is somewhat similar to mine.
I had left hip resurfacing at age 54 (2008) after almost 40 years of competitive running (high school, college, then 10Ks, marathons, etc.).
Recovery went very well but exactly three months later I slipped on a wet foot bridge on a golf course (I was playing without any pain by the way) and fractured my right ankle.  Had surgery, then it got infected so had hardware removed and six weeks of IV antibiotics.  Long story short, I had an extra four months or so for my hip to heal without any real exercise. 
Then I started back on treadmill and elliptical and the hip felt fine.  I was able to get my 10K time below 50 min over the next six months!  All of a sudden though, I developed groin pain on the side of my hip resurfacing which was about 14 months post op.  Despite time off, stretching, cross training etc., it would not go away.  A distinct pattern developed where I could run for about 15 min and then the pain would start and get increasingly severe.  It radiated down my leg to my knee and sometimes beyond.  It was very difficult to pinpoint the exact location where it was starting from.  My whole upper thigh/groin seemed to hurt.  And it could be excrutiating.  And bad enough to last a day or two after.  But I could do everything else without any pain at all (bike, elliptical, swim).  I FINALLY went to my surgeon who said the prosthesis was fine and that I probably just had tight hip flexors that should get better with physical therapy.

I started some PT and I was able to get my running up to an hour but with a lot of pain still.  I learned that I could actually make the pain go away for a few minutes just by stretching my quads (heel to butt stretch). Saw another sports medicine doctor who had no idea what was wrong with me and said i should go back to PT.   I recently went back to physical therapist and on the first day after an hour and a quarter of PT I went on his treadmill and ran 30 minutes almost pain-free (6.1 up to 7.0 mph).  I then realized I had not stuck to the program the first time around -  after it started to get better I was stretching only before my runs.  And that is obviously not enough.  Now I am trying to stick to both stretching AND strengthening exercies as prescribed.  DAILY. Lo and behold I ran another 30 min yesterday virtually pain-free. 

So if you have not seen a physical therapist, I suggest you do and dedicate yourself to adhering to their program and see what happens!
Good luck.

[Rolls]

All good reading.  I have been battling tight upper thigh pain, down to my knee pain, and buttocks and groin pain for 4 yrs post op on my RBHR.  I tried PT and am still trying anything and everything.  The best relief I get is with Yoga.  After Yoga sometimes I am pain free, and I don't know why, I try to replicate something, anything when the pain returns and I never catch it.  Right now...I did my Spring burning of brush in the yard over the weekend, some bending, nothing strenuous, and my right knee is all swollen, pain behind the knee and pain where the surgery was.  Just resting and working, icing and popping Advil.  I meet with Dr. Marchand (RI) tomorrow to discuss my options for my left hip and hopefully what is going on with my right hip.  I still read about all the success stories out there but I also believe there are a lot like me who are trying to get back to normal but take one step forward and two steps back.  I am very frustrated and there is not a moment in the day I don't think about the pain...and that is just not healthy.
"HELP" is a great topic.  Take care.