Ongoing PSOAS tightness

[Ljpviper]

Hello,

 As my other post I had right hip resurfacing by Dr.Gross in April 2016, all went great. I had a scope on the right and left hip that had failed.

here is my issue, I took what I wrote to a great PT down here in Ft. Lauderdale.

--- Here is the mystery that we need to solve. My Psoas on both sides always seem to be constricting my entire groin whenever I am active. I know cause when I wake up from sleeping overnight my groin area from hip to hip is nice and relaxed. Once I get up and start walking it will want to tighten up. There is no pain with this just tightness. So we have a perfect joint on the right side(resurfaced) and the mildly arthritic one on the left. Also, I do notice that sometimes it will loosen up after some exercises but returns back to a constricted state. Also, as you know once you sit they like to tighten regardless so I am also fighting that.

I don't think its PSOAS tendonitis as I have no consistent pain and my can do a leg lift. It seems like my psoas muscles are protecting my both hip joints, as I have had hip injuries since JAN-09.

Any help/thoughts would be great this is something I don't think Dr.Gross can help me with. Also, I injections are not going to help. My gut feeling is once these psoas muscles quit consistently tightening my gate will be better and both joints should work smoother.

Also, my PT checked out my strength levels in most of my glute/add/abductor they all seem decent

Thanks,

Larry

[John C]

Could you share with us whether you had this tightness before the surgery, or did it start after the surgery.

[Ljpviper]

John, Yes I had it before my HR after the scope, it developed. I need to find a way to release it not stretch it if that makes sense. Years of sitting/injury and 2 surgeries have made it super tight.

I notice when its not tight my entire groin hip to hip is nice a loose and relaxed. My gait is also better.

Last piece of the puzzle.

Thanks,

larry

[vonhouser]

I've read that glute weaknesses can trigger psoas pain. I'm also a years long psoas pain sufferer! Before my surgery, I had platelet rich plasma (very different from cortisol) injections done because I had a torn psoas tendon and it helped a lot.


But it you don't think it's torn, I wonder if it could be over working because of weak glutes? Has your PT tested your glute strength?

[Ljpviper]

Good point about the glutes, they are a lot stronger than before but not there yet as per the PT.

This is the last piece of the puzzle as when the psoas is loose my gait is better on both hips. So many years of injury has shortened them. I am trying different methods to release them that are not aggressive stretching as it does zero good.

I visit the PT on Friday and she will asses my hip/glute strength. I know its not tendonitis as Monday they felt great all day but tightened up again yesterday. Frustrating!!!!!!

Larry

[karlos.bell]

  Larry. Ok been there and done that. Mine now is finally starting to go.  Training or getting them to do work is the key the tendons - muscles need to all work together. That is psoas - ham - quads - or hips flexes, ex-tensors - hammys - quads for flexing and stabilizing. Gluts stabilization. abductors and abductors. Its all in the package complicated and no real one thing will fix from what I have found....
Healing - 1st
The joint has to be healed well...........
Range of motion or movement of the hip - 2nd
Function of the muscles - 3rd
Strength - training 4th (get a good trainer for help and find where it is weak) it can be multiple area's.

I am trying to dream up something on paper that would help people like you to give it a bash so may be you can improve slowly but surely.
Working on it.

Cheers K

[Ljpviper]

Karlos,

  Yes, I don't think my glute max is firing/working hard enough. They are the main muscle is stabilizing the hip joint. I am noticing some reduced psoas pain this week as I am engaging the glute max with hip thrust.

The compensations that your body produces for hip injuries is brutal. Not many therapist understand how all the muscles work together. 

Sometimes its discouraging but you have to deal with it and put the work in to resolve it.

Also, I am sure having a perfect joint in your body the muscles/tendons have to readjust.

Thanks,

Larry

[Luke B]

Hello all,

Looking for some input, suggestions.

I am a 53 year old runner and had my BHR surgery 11-5-2013 by Dr. Brooks and spent the first year basically doing low impact type recovery...Pilates, Yoga, etc.  A year and one week after my surgery, I ran/walked a 50k and have run several marathons, 50ks and even a 50 mile trail race in March '16.  Last October I even ran a Boston qualifying time at the Chicago marathon.

My new BHR has been awesome!  I LOVE IT!  Yes it gets tired sometimes, mostly when I am walking around a mall,  I have not had issues while running....well that is until about a month ago when I started to develop an issue where my groin and hip area starts to tighten up during my runs and I have to stop.  Now I can only run 1-3 miles before my groin, hip and left leg tighten up. 

Doctor visits and x-rays show no issues.  Literally ran 20 miles one weekend and couldn't run 13 the next. Problem started that week while running on trail conditions that were very muddy and unstable, and so I am hoping it is just muscle strain problem, but wondering is anyone has had similar issue and fixed it? 

Current plan is rest, some PT, lots of stretching and continued strength training, but I am going crazy without the running.  Dr. Brooks PT said she sees nothing wrong and suggested psoas issue, but I am not having back issues.


Thanks

[blinky]

Wow! You are my hero.


I don't have any suggestions beyond what you are already doing, really. PT and some ART, think if some muscles aren't firing and need to be woke up and told to do their jobs. My only thought would be if you are so busy doing what you love you have let the maintenance (strengthening of glutes/quads/etc) fall by the wayside.

[Ljpviper]

It seems the psoas injection(2/27) did not really help. The pain source is definitely from the psoas tendon/bursa area as the injection contained both cortisone and naropin(numbing agent). It completely relieved the pain for a few hours.

Its back with a vengeance really tightening my hip and have that annoying pain in the groin. I think I may just stop doing all exercises and just try to stay off my feet all next week. I am lucky I can do my work from home.

Kinda bummed as I am almost a year out and thought I would be done and over. I called Dr.Gross office see if I can speak to him about it. Maybe try another injection with the provider he uses as I know the psoas injections are quite tricky to get in the perfect spot.

I am putting in at least 30 minutes of core/hip exercises almost daily so not sure what else to do at this point.

thanks

larry

[karlos.bell]

  Hi Larry.

The joint has to be healed well........... (about 1 year)

Range of motion or movement of the hip - 2nd  (about 18 months)
Function of the muscles - 3rd  (about 18 months)

Strength - training 4th (get a good trainer for help and find where it is weak) it can be multiple area's. (20 months)

Full strength.  (still ongoing 20 months going)

Groin pain is going.........

Takes 2 years to get a result especially if you have had a scope........
This is my experience as above
Cheers K

[Ljpviper]

Thanks Karlos

[vonhouser]

Karlos,


That timeline is super helpful to hear. I am at almost four months, and my hips are very stiff. Still SO much less pain than before. Lately I especially have pain my upper quad, but my PT says it's not psoas because I can lift my left ok.


I've been strength training, but don't have external rotation back yet on my operated hip so we are mostly doing linear stuff. Focusing primarily on upper body and getting the glute and hamstrings to strengthen.


It's good to know that I can be patients as I have a few more months before the hip and tissues themselves are healed! How did you come up with those time estimates? I have heard that it take six months minimum for the bones and soft tissues to be solid.


Taj

[Shotohips]

Hello - regarding the injection, give it time. I had an injection in my left hip about 3-4 weeks ago and it took a good seven days for me to feel the difference, about 40% improvement. I  just had another one done yesterday in the other lege and don't feel any improvement yet. Did you get one injection, and in the bursa?


I'm with Karlos on this one, give it time. I've been working with a physio for 4 weeks and I see slight improvements. Keep in mind, I haven't had a resurfacing yet, just having issues from the two scope surgeries I had in the the last 1.5 years. Every experience I have ever had with any kind of tendonits or tendinopathy took a very long time to calm down. Each time, it was with  PT and a very slow progression.


Psoas is especially tricky and frustrating. What helps me, is setting my expectations, and knowing it its going to be a long recovery. Easier said, then done..(it sucks)!! Not trying to sound like an expert here, but have your PT try the Thomas Test and see if it is really a flexibility issue. If it is not flexibility, over stretching can really irritate it and slow progression. I've been doing a slow progressing, eccentric excercise that has helped me see the improvements in the last couple of weeks. My PT recommended it and I do 4 sets of 20 and started with very small, slow movements. As soon as I felt pain, I would reduce the range of motion. Eventually this will lead to a full leg raise. Here is a video that will explain it better than I can (I don't use the ball), minute 4:47    https://www.youtube.com/watch?v=nS0BgXdItW8.

[Ljpviper]

Hello all, thanks for all the comments. I went to have the one the year check with Dr. Gross this past week. The joint looks great on X-rays. It just stinks I got the feeling from him my job is done you deal with with psoas issues. Seeing all the people sit on the plane ride home comfortably, crossing there legs really hit home.


2 scopes and a hip resurfacing at 44 you think I would be at least close to normal. Not sitting in pain. Definately a bummer.


Thanks

[Shotohips]

Stay strong, Larry. I understand your frustration. I am 35 with surgery on the horizon after 2 scopes in the last 1.5 years.


Find the best PT you can and do the best you can. You will get there for sure. Maybe at this point, and MRI would be helpful to see what's going on with the tissue. I have been told, minimum 3 months for psoas if I am disciplined. Tough..!


Another suggestion, take a vacation and go relax for a while, you deserve it You have had a tough year!!

[Slinkycarrot]

I have similar problems on one hip.


For relief I would recommend needling and possibly ultrasound/APS as well as your usual manual relief


It all comes down to getting your glutes  to fire and switching off the psoas or rebalancing. I'm really struggling with this even though I'm very aware of the problem.  You need to start with with basic functionality exercises and nail them before you progress.


Have you tried lying on your back with feet against the wall and a light thoroband around your knees. Then try and bring your knees apart without switching on your psoas and just using your butt? If you put your hand on your hip flexor you will feel it fire or not.  This is a good indicator of psoas overactivty.  A Physio I had a few years ago who wouldn't let me progress past that exercise until I could do it correctly as it means all my basic functions I'm gripping with my psoas.


Good luck

[chuckm]

 [font=]Here is what is helping me. I had left hip BHR done over 4 years ago. I am very satisfied with the results but I have always had a tight groin. It never held me back from being very active (soccer, running, etc.) but just walking I felt it every step. It's actually kind of annoying knowing that others have "forgotten" they had their hips resurfaced while I still get reminded of mine because of this tightness. [/font]
[font=] [/font]
[font=]Physical therapy everyone says "build your glutes and external rotators". Do clam shells, use the exercise band side stepping. Then stretch the psoas with all different techniques. None of it did much of anything. Active release therapy did a little but didn’t last long. [/font]
[font=] [/font]
[font=]Then I began studying proper gait techniques for walking and running. I watched many videos on You tube. I learned that when you walk or run, the “push off” leg hip joint must go into “internal rotation” to maintain the proper directional forces. As the back leg extends behind you, that is when the hip must internally rotate. There are muscles along the inside of your thigh that are responsible for producing that internal rotation. But that internal rotation, while extending the leg, will be hampered by the tight groin. [/font]
[font=] [/font]
[font=]So, I get on my treadmill at home and start examining my gait in the mirror. I watch the heel and toe alignment as my BHR leg extends back and I realize that my leg is NOT internally rotating. My natural hip side was correct but on my BHR side, my toe would start to point out as I completed the push off instead of staying straight. [/font]
[font=]My next step was to try and get my heel and toe to follow through in a straight line. To do so it felt like I was twisting my leg inward but I think that was because I was so used to letting my leg twist outward. My next idea was to set the treadmill on an average walking pace and push against the motor of the treadmill while maintaining the straight alignment of the whole gait cycle. I would put my hands against the console and push. The next day the inside of my thigh was quite sore. Muscles I haven’t used much since surgery. [/font]
[font=]It’s been a about a month since I have been doing this. I don’t mean to stand the physical therapy industry on its head but it does make sense and I am getting great results. [/font]
[font=]I know Pat has talked about being careful with the toe to heel push off alignment but it is very difficult with all the attention on strengthening the external rotators and ignoring the internal ones. As my internal rotator muscles strengthen, the groin (psoas) is loosening up. [/font]
[font=]Chuckm[/font]

[hernanu]

Hello all, thanks for all the comments. I went to have the one the year check with Dr. Gross this past week. The joint looks great on X-rays. It just stinks I got the feeling from him my job is done you deal with with psoas issues. Seeing all the people sit on the plane ride home comfortably, crossing there legs really hit home.


2 scopes and a hip resurfacing at 44 you think I would be at least close to normal. Not sitting in pain. Definately a bummer.


Thanks

One thing that helped me greatly with PSOAS tightness / issues was using the foam roller (like this one for example) and using it religiously. If you apply it to your back, eventually to your sides and rear, I found it to be very good for relaxing the muscle.


Remember the PSOAS construct (two muscles) goes from your back through your hips and into the outside of your legs to your knee.  At first, it will be difficult, but eventually your muscles relax.


I did my lower back first, then (careful to get the Ok from my doctor and physical therapist) on the rear and the sides of my legs.

[Ljpviper]

Thanks for the all responces odd after I had the psoas injection, two weeks later my hip felt super unstable, not the normal feeling. I did not take  change and went to see Dr. Gross the xray look perfect. BUT he was concerned with this elevated levels after a blood test on Friday. I hope its nothing, just odd after the injection my hip went to crap and could barely put weight on it.  I had the injection on 2/27. Here is what he wrote.

Well, lets see what Dr. Gross says first.
Your white blood cell count is normal. With infection, this is usually elevated.
The other 2 tests, CRP and Sed Rate, reflect elevation related to an inflammatory process, which could be related to infection...but with the white count normal, probably not. It may just indicate inflammation.
Sorry, didn't mean to worry you.,  My answer should have been accompanied with the explanation.
SO...lets see what Dr. Gross thinks.
Nancy

thanks,

Larry