Adductor pain. Need advice.

[Johng]

Hi All, hoping to get some advice. I am 5 months post op bilateral with Dr. deSmet. At three months I went to PT hoping to improve my gait and to reduce adductor pain. She put me on a pretty intense strengthening program and,although I feel stronger, I am experiencing adductor pain which is effecting my sleep and my general functioning. I expressed my concern to the physio and she assessed my range of motion. My external rotation is 35 degrees and thirty one degrees. I asked myself why it took her two months to look at ROM.
Dr. D looked at my 3 month X-rays , said both hips look great, and he suggested that physio would not help, that time and walking would resolve the muscular pain. I am trying to figure out how to proceed. Should I be challenging the hips in order to break through? Will I fail to progress if I back right off as Dr D suggests? Sorry if this is rambling but I am exhausted. Advice appreciated. Best regards, John

[Pat Walter]

Hi Jon

I am a De Smet patient and have read a very large number of his patient stories.  In my case, as others with me back in 2006, he told us to walk, walk and walk.  Some bodies heal much slower than others.

In my opinion, and I am not a doctor, I would listen to his advice - walk.  Sometimes pushing things against the bodies wishes, can cause more problems.  Might doesn't always make right.  Try his advice for a month and back off the PT.  See how things work out.  If not, you can go back to PT.  Normally people should be pretty well healed at 6 months, but not completely.  That's why most surgeons want you to wait 12 months before high impact sports.  I know some people that took a year or even more to get completely healed.  I don't believe it is surgeon error, it is because we all have different bodies.  Some people are back to normal in a couple months.  Healing just varies and it is difficult to push it.  Listen to your body.  It sounds to me like it needs some tender loving care and walking.  Just my opinion.

Good Luck.

Pat

[Johng]

Thanks Pat.

[Dessay]

Hi John-


I'm 2 months out with Dr Gross and I'm on the slow recovery protocol. He asks us all to do a 6 week evaluation with a PT, have the PT fill out a questionnaire and send it back to him. Other than that, Dr Gross doesn't think PT is necessary unless you have lingering issues at 6 months.


I like the PT who did my eval a lot, but he talked me into coming back. I went back for one visit, and he tried to put me on a bike. If you're on a slow protocol with Dr Gross, this is a no-no. I flat out refused.


He also did some deep tissue massage of my abductor that ended up making it feel worse for a couple of days. So I told him I was just going to do the exercises Dr Gross prescribed for me and that if I needed him, I'd be back at 6 months. He was a little put off, but I can't worry about it.


I'd listen to Pat on this one. Everyone's different, but personally, PT made me feel worse. Could be what's going on with you, too. Keep us posted.


Cheers!
Cara

[Johng]

Hi  Cara, I am trying to look at this as just a set back. The volume and the intensity of the physiotherapy increased substantially over a month and I tried to push through the pain. I am up nights with intense burning sensation in the legs. Dr DeSmet is a great guy, assuring me that time will take care of this. So I have backed off and it helps to hear from others who have experienced HR. Thanks.

[chuckm]

I started on PT after four weeks. They were nice people and started me on the "boiler plate" rehabilitation exercises for hip injuries. The exercises included straight leg lifts and psoas stretching. At one point they were having me "bounce" on a psoas stretch which really left me sore. That was the first week.

After that first week I did research on this site about the psoas and the next time I went to PT I told them I would not do anything related to exercising it. I explained to them that hip resurfacing is very traumatic to the psoas and the bursa. And that trying to exercise and stretch this area while it is healing can lead to long term problems.

They really had no clue.

I left alone the psoas area entirely for another month. No stretching or lifting. Suddenly, a month later, it didn't hurt to lift at all. It used to hurt every morning to rise out of bed. Then on morning out of the blue it felt normal. And it was fine every morning after that.

Chuckm

[LMS]

That's good to know Chuckm... now I hope I remember this when the time comes. 

[Johng]

Thanks Chuck.     Chuck did you carry on walking when your psoas was acting up. I've been feeling pressure to push through the discomfort by a young pt. I am wondering if any hippies out there had leg pain before HR and whether the leg pain continued for a time post op. I am really hoping that my adductor muscles got short and tight when my hips were failing and that they just need time to lengthen now that the hips have full range of motion. Any thoughts? 

[Juno]

I would like to echo the same thoughts.  I asked Dr. Gross for a PT referral at 6 months post op thinking this would speed up my strength recovery and enhance my ROM. I did it for about 3 weeks and realized that everything they were doing I could either do at the gym or better yet, just WALK. So I just kept walking (nothing crazy -- 2 miles a day) and slowly increased my strength training work, added my yoga back in. I personally don't feel I saw my external rotaters really start to get stronger and fire at even 80% until at least 18 months out. Now 3 years later, I still see improvements every month.


Stay at it, rest and listen to your body.


A yoga teacher once told me "The body is wise and knows, it is the mind that causes the confusion" -- don't overthink it...do what feels best for the body.

[chuckm]

Johng, at 3 - 4 weeks out I was doing quite nicely walking around the house and at work. It seemed like I was ready to start raising my activity level. 
So at 6 weeks post op I tried to begin a walking routine for rehab. But after just a few walks (a few miles on a track) my groin (psoas) was sore. And it was sore the next day.
 
For me, walking for exercise at 6 weeks post op was NOT fun. The hip was sore and the groin was sore. And it would be sore the next day. It didn't make sense to me to keep at it. So I just stopped altogether. 

Another six weeks went by where I avoided anything that put pressure on the psoas. No walking. Basically no exercising whatsoever. But I did STRETCHING.

It wasn't until the first week of the fourth month post op that I went back outside and took a walk around the neighborhood. I felt great. The next day my psoas was NOT sore. So I walked again two days later. Then it turned into walking four times a week.

Suddenly I had been walking for months several times a week and it felt great.

All I can conclude is that I waited for enough healing before I added a walking routine. Once walking was comfortable my recovery exploded forward.

I returned to playing competitive soccer at 6 months post op even though I didn't really start even walking regularly until the fourth month.

My example shows that a fast recovery does NOT require one to get really active right away.

Chuckm

[blinky]

These are good points and a good reminder that it takes time to heal and we can't force it, as much as we would like to.


I am wired to want to do more, to work harder. If i can't do something, I think it is a failure of will. Recovery doesn't work that way. Sometimes rest and waiting are better. Yeah, it's hard. Even though I have had the same experience of not being able to do something, waiting, then voila I can do it, I still struggle with wanting to do more More MORE.


Juno, I appreciate hearing about the rotators coming back on line at 18 months. Mine are pretty sluggish.

[Pat Walter]

Juno

Love your yoga teachers advice:

"The body is wise and knows, it is the mind that causes the confusion" -- don't overthink it...do what feels best for the body.

Thanks for sharing.

Pat

[Juno]

Blinky --- keep it up. It really does take some time for the small external rotatiors to heal and start firing again. Stay patient and allow yourself to marvel at it when it happens!

[Johng]

Juno, wise counsel.  Well meaning people ask me why I am not running yet and, like Blinky, I feel a sense of failure taking rest five months out. I am surprised by a mild depression...very unusual  for me. It really helps hearing from hr folks who know the territory. I feel like I have permission to just heal. Thanks

[Dessay]

Blinky, I'm a lot like you- I'm normally a whirling dervish who hits 3 grocery stores on my way home from work. Recovery has been a huge test of my patience so far.


I'm only 2 months out and I'm still on crutches, but I definitely feel a kinship here- I think my op side external rotators are going to be weak for MONTHS. I can tell I'm not ready to walk yet- I'm still looking at a cane for 4 weeks anyway, so maybe it's better that my body is forced to go slow. I was happy to hear about the 18 months thing.


I think I remember reading somewhere that those specific muscles recover slower in HR than THR patients. I'll see if I can find the link.

[Dessay]

Ok, here's that link that talks about muscle recovery between HR and THR:

http://www.ncbi.nlm.nih.gov/pubmed/21749928


But it seems to me that surgical technique plays a big part here, and they're talking specifically about the detachment of the glute meds. I checked my surgical notes, and I think Dr Gross splits the fibers, but doesn't detach the muscle. I don't know about other surgeons. Would be interesting to look into. It seems there might be confounding factors.

[chuckm]

To perform hip resurfacing the surgeon has to release some muscles (cut and reattach them). Even with the direct anterior approach there are muscles that get partially released and repaired.
With the posterior approach, (which Dr. Gross uses), the small exterior rotators have to be release in order to dislocate the hip. But before they get that deep they split the fibers of the larger outer muscles to gain access.
Most everything gets sutured back together.
The skill of the surgeon to cut and repair the soft tissue is often not talked about.

Chuckm

[catfriend]

J - We're close to the same amount out from our surgeries. I wouldn't worry too much. If things hurt, then rest. Early on in my recovery I was advised to back off the walking because my gait was so poor, and continuing to walk that way was reinforcing poor gait. I needed to correct my gait first, and then ramp up the walking. So I slowed up my long distance walking a couple of weeks. So what. It's the long term that counts.

I think it's very easy reading stories of what appear to be rapid recoveries and expect that you, too, will recover just as fast and well, if not faster. However, not all bodies are the same, and just because someone's abilities come back quickly doesn't mean they don't still experience soreness, stiffness, and other difficulties. They just might not be talking about them. In my case I can do so much more than before the surgery: walk for a 2-4 miles or more at a pop (haven't tested limits), swim at a good clip for 45 mins (more if I needed to), stand for a while, etc. Yet I still have deficits, and it's frustrating. Despite all the exercise and leg lifts my operated leg is still weak. I really notice this on hills. I can't use the ladder at the pool yet, I still use the lift. Believe it or not, I still can't tie my right shoe lace yet! My PT and I have been working on getting that ROM back, and it's almost there, but not quite yet. Most people can do this at this point. After a long walk I'm sore. My iliotibial bands still need work. Etcetera, etcetera, etcetera. It's like I'm a blend of things that improved rapidly, and others that just haven't. You're probably the same, with your own set of things that have improved along with things that are taking their time. Remember: recovery is not a race!

If your PT isn't working out for you, find another one. If some exercises are too much, just say no. Just don't forget that stretching and strengthening the muscles back to normal does hurt.

[Johng]

I think because my adductors were always sore before the surgery I started to worry when they flared up post op. These posts have helped me get back on track.  Thanks for the reassurance catfriend. Much appreciated.