Front crease discomfort (psoas?)

[curt]

    Passig 12 weeks now and no clicking or clunking, and presently not freaking about metalosis, but have been experiencing a mild to moderate discomfort in the front crease above my quad where the hip flexes up.
    Like everyone, had weakness in flexion following surgery, but the ache in the front part of my hip has increased in the last few weeks.  Might be from the increases ROM and distances walked, but it feels eerily like OA used to feel - stiff and sore with the first steps after waking up or when rising from seated positions.  Doctor Gross's staff gave me more exercises for post 6 weeks, and it includes the psoas stretches.  The stretching feels great, but the aches and stiffness continue.
     I shouldn't complain (considering where I was pre-op), and the pain is non-existent when I get going but I would think it has to be soft tissue around the iliopsoas since I have no more OA there to worry about.  I intend to continue working on strengthening those muscles, but has anyone had similar "pains" during their recovery?

Curt

[Dan L]

Curt, 

I'm also at about 12 weeks and I am stiff when getting up from seated position, but it goes away after a couple of steps.  It does not occur when getting up from a prone position.  It is a tiny bit sore when first getting up from seated position, which goes away quickly as well.

I had pain in the crease area the first week or 2 after getting off crutches, but not since to any degree.

Hope it helps,

Dan

[hernanu]

I think it is, curt - I had "gitup" pain until about 8 months went by, a few steps and it went away. It's gone completely now, so you may need more PT type exercise ( I use ankle weights to add to the usual exercises), but I think it may just be time.

[ScubaDuck]

I definitely experienced pain in my hip flexors for weeks.  I think this is very normal.  And as several people here said, it seems worse after sitting for a long time.

I worked hard to strengthen that area.  It really hurt at times but paid off.

Best Wishes.

Dan

[curt]

      Thanks for the input guys...I'm starting to realize that I'm not a very good doctor for myself.  I have neglected hitting the flexors and their associated strengthening as hard as I could have, and let walking be my main focus.  As my adductor exercises today can pitifully attest, its easy think you're done with the work just to find out "oh no you're not!".
       Walking has been very much a straight ahead deal and has gone great.   I have NOT been a good boy in the lateral strengthening and think I am now paying the price.  I'll crank out the exercises for a few weeks and see how it goes.  Appreciate the advice.

Curt

[Kiwi]

Curt, Your description of the hip flexor pain is the same as what I am getting and I also thought it was similar to the pre-op OA pain. I don't think I could ever exercise those muscles properly pre op for years due to the intense OA pain, so might explain continued stiffness & lack of ROM. Definitely worse after sitting & exercising for me too.
I visit my PT tomorrow and are intending on getting exercises that help target this issue & my gluts as they seem to be suffering too, but my gluts only post op.
Keep us posted on this one.

[curt]

     Kiwi, pls share any thoughts your PT has for "easy" strengthening and stretching.  I'm using leg lifts only right now, and whatever ROM comes from regular activity and walking.

Curt

[hernanu]

     Kiwi, pls share any thoughts your PT has for "easy" strengthening and stretching.  I'm using leg lifts only right now, and whatever ROM comes from regular activity and walking.

Curt

Hey curt, there are several exercises that the PT gave me that helped a lot in sideways strengthening early. The exercises I think are described in the pre and post op exercises on this site, but they use exercise bands like these:

http://www.amazon.com/Aylio-Fitness-Exercise-Anchor-Medium/dp/B0026PMD70/ref=pd_sim_sbs_sg_5

The exercises are:

• Clamshells - open legs outwards knees bent, bands on the knees for resistance.
• 4 Way standing legs. Put the band around the leg of a desk or table, pull in all four directions with one leg, then the other.
• Sit with legs dangling, put band around ankles hold knees together and move feet outwards to limit.
• Put band around ankles while standing, step sideways with knees bent, keep the top body even (no swaying)

Always use the lowest resistance band first, only extend to what allows smooth motion and you shouldn't have to struggle.

I'm sure there are more. As to the leg lifts, the PT advised isolating the muscles by bending the off knee and never lifting the leg beyond parallel with the bent leg.

Hope this helps.

[Luanna]

Hi Curt,
I'm experiencing similar discomfort and my new PT did an assessment. She has not mentioned psoas yet.
Her early conclusions:
1. Hip capsule is extremely tight and needs to be stretched and loosened.
2. Scar tissue is deep and needs to be loosened.
3. Gluteus medius has atrophied and strenth and tone must be increased.
4. Abductor muscles are shockingly weak.

Once these things are addressed I should be a much happier camper!

Just had one session and she gave me 2 exercises to start with:
1. Clamshells - make sure your body is lined up and knees are in line with your chest and head. Hold your operated hip with you hand to be sure that it does not move. Slowly lift your operated leg and bring it back down. This is a small motion. Keep your ankles together. 1 set 10 reps 2X per day. I was doing them wrong all this time and not working the abductor muscles.

2. Stretch hip - get on both knees. Use pillow under knees if needed for comfort. Have table or chair at your side to hold on to and to keep your upper body straight. Put your unoperated foot out in front quite a distance and then stretch your front leg forward. Keep knee over foot but do not let knee go past your foot. Keep upper body as straight as possible and even lean back a bit to get more of a stretch. Hold for 30 seconds. Do both hips twice.  2x per day.  It's like a lunge but you start out with both knees on the floor.

I'll let you know what else she says. I'm seeing her again tomorrow. I'm so glad to have switched to a PT who works with hip resurfacing patients. My first PT was afraid to do too much and treated me as though I'd had a THR. Now we have to start from almost square one.

Luanna

[curt]

      Hern and Luanna, thanks for the exercise tips.  I'm headed in the right direction, and since I'm sure its the soft tissue that bothers me, I can push it a little more without hurting the actual joint/implant.  I've spent so much time enjoying the positions and exercises that don't hurt (including fast and slow walking) that I've screwed up and bypassed needed activities that DO hurt.
     After just a few days starting to feel a liiiiittttle progress in strength with the adductors.  Like a very big, very fat baby learning to walk correctly.

Curt

[Kiwi]

Curt, My PT gave me these "easy" exercises to start with for the next two weeks. Note I'm only just 6 weeks post op.

STRENGTHING PRONE HIP EXTENSION
LYING ON STOMACH, TIGHTEN MUSCLE ON FRONT OF THIGH, THEN LIFT LEG 8-10 INCHES FROM FLOOR, KEEPING KNEE LOCKED.
REPAEAT 10 TIMES X 2 SETS.

BRIDGING
LYING ON BACK WITH KNEES BENT, SLOWLY RAISE BUTTOCKS FROM FLOOR, KEEPING STOMACH TIGHT.
REPEAT 10 TIMES, 2 SETS

UNILATERAL ISOMETRIC HIP FLEXION
LYING ON BACK WITH KNEES BENT, TIGHTEN STOMACH MUSCLES AND RAISE KNEE TO OUTSTRECTCHED ARM. GENTLY PUSH, KEEPING ARM STRAIGHT AND TRUNK RIGID.
HOLD 3 SECONDS, REPEAT 10 TIMES ON EACH SIDE.

Easier to understand with pictures, so hope this makes sense.

Just one session per day for these for the next two weeks which is we I see my PT again. I hope too have progressed a bit by then & she'll no doubt give me [more] challenging exercises then.

Cherz
Kiwi

[tennisgirl]

I too am still having pain in my groin, top of my leg and buttock area...I think I may have have done this to myself.  I joined a gym last week and started using the elliptical (slowly) and stationary bicycle, plus some gentle stretches...I checked with Lee Webb and she told me to back off the elliptical.  Straight leg raises are out too (even tho it's on my phase two of exercises, I'm obviously aggravating my leg, so I'm just doing ab work and stretches the rest of the week.

I also pulled out my polar care ice machine and have been icing on and off all day.

[curt]

    Tennis, hope your discomfort eases up.  Mine has dropped considerably, thank God.  Combination of weakness and trying too hard and just plain healing I think.  Back to a mixed regimen of phase two leg lifts, swimming and cardio machines.  It was a little frustrating, but doing less has apparently achieved more.  Good luck with yours.

Curt

[aries]

 I too am about 12 weeks (lost count now  past surgery and the pain in that crease has increased in that I find it hard to stand straight and clench my buttocks (trying to improve glute strength!)

I too have clamshells and bridging exercises as well as my hip flexor strengthening

I too suspect scar tissue in the anterior capsule side and I have tight abductors from walking funny with my drop foot (from the operation- lucky me got a complication)

I am also getting acupuncture in the area and starting to get deeper tissue massage

So- reading this, it seems within the realms of 'normal' at least

Rachel

[hernanu]

Sounds normal, Rachel - keeping good thoughts for you on the foot.