3 weeks postop- abandon PT due to pain?

[jsblock11]

I'm 3 weeks post-op for my BHR, and I know it is early but I'm having a hip flexor issue and curious on opinions.  My same old hip flexor pain from before surgery (centering around the TFL area, the tendon where the pocket of your jeans would be) has been pretty intense since beginning basic post-op exercises (heel slides, glute squeezes) and seems to get worse each day. Since 12/4 (day 3 post-op) when beginning the exercises, I have experienced the same hip flexor pinching, impingement and pain when doing any type of mostly flexion, but also extension and adduction.

I eventually discovered that if I put two fingers worth of pressure on the tendon attachment point at the ASIS, which is the bony bump on the front of the pelvis, it relieves the impingement and allows me to flex to 90 degrees and perform extension exercises as well.  After a week of doing this "trick", I have a ton of pain and inflammation in the TFL area from doing hip flexion, but also the entire hip flexor region and I am back on the crutches as it is too painful to walk.  Should I abandon the exercises and just rest for the next 3 weeks until my post-op appointment? or better to force through the soft tissue pain so that the artificial joint can heal with good motion?

Now granted I did have an arthritic hip but over the last 12 years I've seen 6 MD's and 4 PT's and never has anyone mention that some (or most) of my hip pain and impingement could be from this hip flexor issue rather than arthritis. Now after two surgeries, it seems like a pretty big miss so I'm a bit bummed out that I could've/should've been focusing on fixing the soft tissue stuff if I could have ever gotten a diagnosis.  I guess most MD's just rely on xrays for diagnosing hip pain these days, even when I attempted to steer them toward the hip flexor pain area over the years. Guess they all thought it was from the arthritis, but now it would appear not to perhaps not be the case.

[Ljpviper]

I would tread lightly on anything that aggrivates the psoas/hip flexor. It becomes chronic and its almost impossible to get rid of.


What does your surgeon say?


Good luck


Larry

[jsblock11]

3 more weeks until my 6 week post-op appt with the surgeon. 

Chronic is the word I'm worried about, since it has been this same hip flexor pain for 12 years I'm starting to worry that the soft tissue was always, and will continue to be the main problem and that I just might've had an unnecessary joint replacement surgery. Everyone always thought the arthritis caused the soft tissue pain and impingement, but maybe not the case 

[Ljpviper]

In have it for like 7 years. I got it after my first scope, but it returned after my HS. I rested it for like 6 weeks, did nothing came back wit a vengeance.


I wish I had better advice for you I feel your pain, trust me.

[imgetinold]

Some surgeons (like Dr. Gross) doesn't even recommend PT post-op.  He says just to walk.  Limited to under 1 mile for 6 weeks, then as much as you want.  I know that there are others who say this is nonsense.  However, I would just stop if it hurts.  I can say that regardless of the opinions others hold about the "walking only" advice from Dr. Gross, I did that and I am perfectly fine today.


So, you have nothing to lose by stopping and just walking except pain.


Just my $0.02.

[Yesstrevor]

Coming up to 4 months since your bhr now and I'm curious to know if those hip flexors settled down? I received a bhr 2.5 years ago then went ahead and broke my other hip a year later, which required a few screws to fix. Ever since, the hip flexors just don't want to quit, causing a lack of sleep regularly. It has been suggested that eventually I'll need my broken hip replaced or resurfaced due to arthritis and so, my concern is the same as yours, will a bhr solve my hip flexor pain once and for all? FYI, I regularly stretch and do yoga classes on top of skiing and snowmobile.

Thanks, Trevor

[jimbone]

Hi Trevor-

You probably missed that this thread was started a couple of years ago but as it is a common symptom that challenges a lot of people, I thought I'd comment on my own experience.  Prior to surgery, one of my symptoms was a painful "crimp" in my hip flexor when in flexion- more on the left than the right.  I asked my surgeon about soft tissue issues being the underlying problem and wondered if the orthopedic surgery would solve it.  He indicated it would.  After surgery on the left the flexor pain declined rapidly, on the right side after the second hip surgery the flexion pain increased and took 3-4 months to really get under control.  At just past 6 months now after the right hip was done, while still not equal to the ROM I had in my 30s and 40s, flexibility is continuing to improve and develop.  My sense of it is, with the proper approach to recovery exercises I will continue to improve.  By proper I mean correct for each individual as determined by their pre surgical physical abilities and pain thresholds.  I have come to think it is critical to be gentle with ourselves for whatever time period it takes to heal, that we need to learn to push ourselves only so far, consistently and patiently and be willing to accept some level of frustration given that the body will heal at its own pace and not our pre determined schedule. 

Exercises I found helpful to relieve flexor pain were lap swimming with fins [fins stretch out the foot and put a healthy resistance to the flexor- feels great], standing extensions with resistance bands, bridges and marching bridges and a foam roller [but carefully and for me not before week 6-7].  Applying pressure to an area/point as mentioned by another poster is a trick my PT emphasized.  We are re-training neural circuits after surgery, if the applied pressure allows a movement/exercise to be done without pain it's the bodies new way of doing it.  This also works well for buttock pain.  A tennis ball tucked under the butt muscle/s that are hurting while doing heel slides/abductors/tailors or bridges can relieve the pain and provide relief.

When I asked at a seminar before surgery why I experienced soft tissue pain because of an orthopedic problem I was told the orthopedic weakness/lack of alignment/instability ennervated the nerves and overworked the soft tissue in ways they were not meant to be used.  Could be your arthritis is impacting your flexors more than you realize. 

[Yesstrevor]

Hi Jimbone,

Thanks for the info. Yeah, given I was told that I'll eventually need a bhr in my other hip (while at the same time removing the screws) due to arthritis that, from what I understand, will disappear once both hips are done. Its just been going on years now with tight hip flexors and it band making it hard to sleep. And I use every tool in the book to try and settle them down after a day of activity, which is a process in itself. I kind of jumped the gun on this inquire as I need to get current xrays along with schedule an appointment with a couple surgeons to advise the next step. I was just hoping I had a few more years as the 2 surgeries I had a year apart took a lot of work to heal and be active again. Really hoping there's light at the end of the tunnel and my hips will settle down once and for all. And that is why I reached out, to find out, after years of tight hips and pain, will that symptom/pain go away?

[jimbone]

Hi Trevor,

I get that-the question of whether the pain will go away, probably a question most all of us have.  I certainly did.  Speaking from my own experience only I'd have to say yes.  I no longer suffer any arthritis pain in my hips [both done last year now at 6 months/ 10 days on the second].  I was in decent condition when I went in for surgery but had lost a lot of strength and ROM in the final 2-3 years prior to surgery.  Regaining that capacity has really been a happy adventure that continues bringing me a great deal of pleasure and satisfaction.  I wonder how much the broken hip- with arthritis- is holding back your recovery and causing the tight flexors.  It is pretty common for one problematic limb to cause other difficulties.  The broken hip causing other problems?  Have you asked your doctor anything along these lines?  Best of luch,