Hip Arthroscopy

February 9th 2017 I went into surgery to repair a torn labrum, and correct the FAI in my right hip.  You can read my back story in a previous blogpost found here.  Unfortunately for me...I ended up having the same surgery on my left hip Feb. 8th 2018, so I kind of feel like I'm becoming a pro at this whole "recovery thing".  Throughout the last year I've had a lot of people reach out to me regarding surgery, what to expect, what helped me, and any other tidbits of info.  Surgery is scary, you're trusting a complete stranger to "repair" you, in the hopes you'll be better, stronger, and in less pain.  That's the goal at least, right?  I decided one big blog post about everything would be a great place to point someone who had questions.  I don't need to discuss every detail of every week or month from surgery.  You can find the following posts from my first surgery regarding my thoughts, where I was at physically and mentally here:

Full Disclaimer: this is MY experience, what I did, what helped me, and my surgeons protocol.  I've discovered a lot of surgeons are very different with their protocols and what is allowed versus what isn't allowed.  I'm going to give MY opinions and mine alone.  You will most likely experience something very different than me, and will have your own varying opinions, and thats okay.  Do not compare yourself to me or anyone else you know who has undergone this surgery.  Every body is different.  I was and am very lucky to not currently have a job (aside from bike racing) that I need to get back to.  The time I would usually put into training I was and am able to put into rehab and recovery, as it feels like a full time job on it's own!  For this, I know I am lucky.  I also hold a BS and MS in Exercise Science, I understand the body very well, and I am highly in tune with my own body.  I know when something feels off, so I can discuss with my PT an appropriate plan of action to help it.  

Lets get to it!

If you stumbled upon my blog from Google because you googled "labral tear", stop the Googling.  Thank you for reading, but seriously...stop googling, it will only frighten you more.  That's the #1 thing I tell someone who just learned of their diagnosis.  You're going to read peoples nightmare of a story, you're going to find people who tell you to stay away from surgery and why surgery is so bad and you shouldn't do it.  I didn't want surgery after learning of my diagnosis, I know people who had undergone surgery and I saw the struggle of recovery, and no way, no how was I going to put myself through that (well..I did...twice).  The thing with surgery is, if you're dedicated, follow through, and LISTEN TO YOUR SURGEON, the outcomes can be very positive.  1 year out from my first hip and my range of motion and strength is greater than pre-op.  

I find it very important you trust your surgeon, you feel confident in their abilities, and you guys are on the same page with your recovery, your goals, and what you expect from the outcome.  Do your homework when it comes to finding a surgeon.  You want a surgeon who is competent in hip arthroscopy, not a general surgeon who also just happens to do them.  Find a hip specialist that understands HOW to perform the surgery and has done loads of them.  Like I said, trust your surgeon.  Find a surgeon who is realistic with recovery.  If a surgeon tells you you'll be good to go at 3 months, seek a different opinion.  The reality of this surgery is, yes maybe at 4 months you'll be ready to push it a bit, but your hip is still recovering from the trauma of surgery and it will be for awhile.  I was told 1-2 years for a full recovery, and being 1 year out from my first hip, it's true.  Yes, I was back out there racing at the top level of my sport 7.5 months PO, and my hip was very capable at this point, but I was still lacking in ROM in areas, and I still couldn't sit cross legged on the ground (which drove me crazy).  My hip still flared up at this point every few weeks, and I still did my daily PT for my hip.  Surgery doesn't just fix your hip, you need to put the work in for the outcome YOU want.  

My surgeon has a very conservative protocol, and honestly, for that I am grateful.  The first 4 weeks does NOT include any strength work or any active range of motion for that matter.  It is however, aggressive in passive range of motion.  As in, someone else is moving my leg for me during specific exercises, along with a CPM machine, AND stationary biking.  He also consistently put fear into me that if I did too much or pushed it too much my hip wouldn't heal.  He ingrained in me the importance of backing off when things didn't feel right and to not push through ANY pain.  Not every surgeon has this outlook, I've discovered some are very aggressive in their approach to recovery.  As my surgeon said to me when I've asked him about it, there isn't a lot of research out there as to what is better, so he sticks to what works for him and his patients and doesn't see a need to change it.  I can't argue with him either when at 4 months PO I started running again, racing at 7.5 months PO, stood on 7 podiums, won 2 races, finished 4th at Nationals, and was one of 6 selected to the World Championship team, all within less than 1 year post op.  I took the time to let my body heal during those important early post-op phases, and it paid off.  I didn't push anything, I didn't do too much, I literally spent 2 months on the couch just letting my hip heal (besides PT).  

I made a few mistakes early on with my first recovery, that I discovered were very important, mainly because I didn't listen when people recommended them to me.  I can be stubborn and competitive, and wanted to be the best...***face palm***.  I highly recommend (or had to use) the following items for Post-Op use.

  • Toilet seat riser.  My Dad has 2 fake hips, so he had one of these and recommended it to me, but I said "I'm so much younger than you Dad, I don't need it".  After about 3 days (after my first surgery) of my husband lowering me down to the toilet and lifting me up, I called my mom to bring it over.  This thing was a serious life saver after that.  Not only could I go to the bathroom on my own, I used this to get my pants on, since I couldn't bend over to put them on myself.  If gave me a bit more independence so I didn't have to rely on my husband for everything.  
  • Shower Chair.  I didn't have this for my first shower with surgery #1...I should have.  My husband planned to help me in the shower, since I would basically be standing on 1 leg and knew I would have a hard time with everything.  We did great...until we didn't.  Towards the end of the shower I almost passed out.  I thought I was going to throw up all over the bathroom, he ended up having to carry me sopping wet to the bed so I could lay horizontal.  I was afraid to shower.  We then acquired a shower chair, and showers were very uneventful after that, but I did have my husband help lift me into the shower, it just makes things that much easier.  
  • Spin Bike. Most protocols require spinning on a bike.  As a cyclist, my surgeon told me I could use my bike on a trainer and that would be perfectly fine.  He wanted me on the bike within 3-4 days post op.  So, after my first surgery I hopped on my bike 2 days post op, and it was disastrous.  The bars were too low, my hip was stiff,  and I couldn't even move the pedals in circles.  I made it maybe 5 revolutions and had Chris lift me back off.  I didn't ride the bike after that, and was reprimanded for not being on the bike yet at my follow up 1 week post op.  So...I acquired a spin bike, and it was SO MUCH BETTER!  The goal isn't a work out, the goal is to move your hip in circles for range of motion.  The spin bike accomplishes just that since the fly wheel is weighted, once you get it moving, you basically don't have to do anything as it will just keep moving on it's own with no resistance (since you aren't supposed have resistance anyways).  
  • Ice Machine.  I've heard amazing things about the GameReady.  I didn't use it for either of my surgeries...I said I swore I was going to use it for my second one, but I already had the simple machine I purchased for my first hip and it worked just fine, I didn't need to spend another $200-$300/week on another machine.  Click the link on the IceMachine title and it will take you to the machine I have.  It's wonderful, and worth its weight in gold.  
  • CPM.  Continuous Passive Motion machine...I hated this thing with a passion, and I tried to negotiate many times with my surgeon about not using it.  Not all surgeons require this, but mine did, and I hated every hour I spent in it.  You're supposed to lie flat when you're in it, and you can't accomplish anything.  I was required to be in it 6 hours/day for the first 2 weeks post op (I split it into 3, 2 hour sessions).  My first surgery I made it ten days before it started to irritate my hip and caused significant burning (oh the burning...it was awful).  The second hip I said since I only used it for 10 days the first surgery that was all I was going to use it for the second surgery.  I made it 12 days, and then called it quits.  I couldn't find any way to get comfortable in this thing, it really really hurt my butt, and was killing my sacrum and SI joints after my second surgery.  According to my surgeon, "everyone loves the CPM".  I haven't spoken to a single person who "loves" the CPM.  
  • Pillows.  A lot of pillows.  I sleep with 7 pillows currently and I'm about 9 weeks post op my second hip.  My husband calls it my pillow fortress.  Prior to my second hip surgery I was using 4 pillows at night since my last surgery.  You're going to want a couple pillows either under your knees if you sleep on your back, or a pillow between your knees if you're a side sleeper, plus some pillows to prop you up for support post op.  I was also using pillows to keep my leg from externally rotating during the first 3 weeks post op.  It also doesn't hurt to bring some extra pillows with you to surgery for your drive home.  I live about an hour from my surgeons office, and the anesthesia puts me in a coma, so having the pillows in the car so I was comfy and able to pass out, was a plus for me.  
  • Netflix.  Books.  Hulu. Oh My.  Any form of entertainment to keep you busy.  You will most likely be in bed or on the couch for awhile.  You won't realize how much your hip is involved with everything you do, until you can't use it.  Take the time to chill out and relax.  I found it was hard to read while on pain meds, so I just stuck to Netflix.  
  • Stool Softeners.  Start on those right away!  My first surgery was the first time I ever took narcotics, so I was unaware of their unfortunate side effects.  Five days post op and I was so insanely bloated and in pain.  My second surgery I was on top of this, and it helped significantly. 
  • Help.  Never underestimate the use of good help.  If someone offers to help you, please take it.  My husband has been my nurse and seen me through these surgeries.  From lifting me in and out of bed, on and off the toilet, to making sure I took my pain meds (He's a pill pusher :-P).  My particular protocol says I'm not allowed to do ANY active range of motion for the first 4 weeks.  The first 2-3 weeks are the hardest and I suggest getting help with these simple benign tasks during this time.  Plus, you're on crutches so you can't do anything anyways.  You won't be able to carry your food, you cant grab anything for yourself.  You can't even dress yourself.  You won't be able to bend down for awhile (the pinching...ohhhh the pinching), so putting on socks and shoes will be troubling.  Unless of course you live somewhere sunny and you can wear flip flops all the time, I however, do not.  I have been known to slide my husbands shoes on when no one is around to help me get my own on.  Also, if you're surgery is on your right hip, you won't be able to drive until you're off crutches.  So...you're going to need loads of help and drivers, Ubers, and good neighbors and friends.  Other things to keep in mind when it comes to help, is most of your early post op exercises are passive, as in someone else does them for you.  These exercises are done to regain range of motion in the hip and also break up and prevent the building up of adhesions in the joint. If there is one consistent thing I have seen amongst protocols it's the circumduction exercises, known as "circles" in our house.  It's 20 minutes of spinning my leg in circles at different heights and in different directions.  Chris hates them, I don't mind them, since I just lie there playing games on my phone.  
  • Compex/TENS Unit.  A little e-stim to help with pain relief, and when it's time to get those muscles strong again, a little muscle stim hasn't hurt anyone!  I used the Compex Unit during my recovery after my first hip, and I swear by that little thing.  It helped get and keeps things firing.  I upgraded my Compex Unit to a wireless with TENS for this surgery, and LOVE it.  You can start using the TENS pretty early on, as it's for pain relief only, where as the Compex is actual muscle contractions, so that needs to hold off for a few weeks post-op.
  • A PT you trust.  Never underestimate the quality of your PT.  If you feel you aren't getting from your PT what you need for YOUR recovery, don't hesitate to find a new one.  This is your body, you only have one.  
  • Compression Socks.  Keep that blood circulating.  Plus they're good for the whole blood clot prevention thing.  I use CEP Compression, and love them! 
  • Massage Table.  Totally and completely not necessary but super helpful.  During my first surgery my PT lent me her massage table for my husband to do circles on since the bed was too low and awkward.  It turns out, I LOVED having the massage table, so I purchased my own off Craigslist.  During my first recovery I couldn't even IMAGINE trying to get down onto the floor to do anything, so this gave me somewhere outside of the bed to get PT done.  It gave me somewhere to lie prone during those early post op days, gave me somewhere to do my isometrics, gave me somewhere to lay when using the Compex, and was a great place to do other PT exercises once I was further along.  Like I said, not necessary, but a luxury I use every day.  

Other Tidbits.

Some other things I did/do post op that I found beneficial for ME.  As I mentioned at the begining of this novel, this is my experience, and everyone is very different. 

  • Massage and Acupuncture.  I highly recommend both throughout your recovery.  Your body goes through so much during surgery and your muscles endure a lot of trauma.  You're going to be so awkwardly stiff. During my first hip I went to acupuncture 2x/week for the first month to help with pain relief.  My first hip hurt and ached a lot more than my second hip.  This time around I've been going to acupuncture 1x/week.  Massage I've been going every 3-ish weeks.  That soft tissue work is so vital!
  • Pool.  Use it!  If you have a pool close by, this tool can be your very best friend.  I HATE swimming, everything about it, but I stuck to the pool once I was allowed to, in order to do range of motion exercises, and a little bit of laps (with a pull buoy because you can't kick).  It always felt good on the hip, no matter how bad I hated going.  
  • Work your scar tissue.  Apparently not everyone builds scar tissue, but when your PT tells you to do scar tissue mobilization around your incisions...you do it. I didn't listen to my PT after my first surgery because I thought "oh that will just go away, I'll have my acupuncturist poke it and all my problems will disappear", plus I hated the way it felt.  It really grossed me out.  Well...I seriously paid for it because I had A LOT of scar tissue around those incisions, and they got so so so tight.  This second surgery I started gentle scar mobs before my first PT session, and here I am about 4 weeks post-op and my scar tissue is SO much better than it was at 2 months last year!  
  • Journal.  Journaling isn't for everyone, I realize that.  I'm an athlete, so I have some level of OCD ingrained in me, and keeping a detailed journal (and calendar of how I spent my hours) of how I felt and what I did, seriously helped see and measure my progress.  There will be days when you want to cry, you'll be frustrated because you feel like you aren't making progress.  Having my journal to look back and see how far I had come was an extremely powerful tool for me, mentally.  It has come in even more handy now as I recover from my second hip surgery, I can look back and see exactly how I felt each day Post Op from my first hip.  I can see now that I was in a lot of pain with my first hip, and it was very limited.  I can see what is normal for me at each phase, and it's been so insanely useful.    
  • Hip Flexion.  Careful how much active hip flexion you do.  Another thing my surgeon has ingrained in me, is the fear of Psoas Tendonitis, it is very debilitating thing that can happen post op with this surgery.  Some surgeons don't mention it to their patients, as maybe they don't see it being an issue?  Because of this, my surgeon has a very strict protocol of NO active hip flexion for 12 weeks (3 months).  That means every time I get in and out of bed, in and out of the car, on and off the couch (okay you get it now), he suggests I use either my hands to lift my leg OR my opposite foot to move my surgical side.  Is this extreme?  Maybe, but hey...I don't have any Psoas pain or problems from my first hip, so I'll keep following it.  
  • Take it easy.  Before heading into my first surgery I talked to at least a dozen people who had undergone surgery and I asked their advice and what they did.  Every. single. person. told me to "not do too much too soon".  I took this piece of advice to heart and basically spent 8 weeks chilling on the couch.  I would get up to do my PT, ride the trainer, and then plopped myself right back down on the couch to rest and heal.  If I felt ANY aches or pain in my hip I used it as a "don't do that much next time".  I'm not saying you have to do what I did, because there are plenty of people who I'm sure pushed it early and are JUUUUUUSSTTT fine.  To me though, it wasn't worth the risk of not healing. I wasn't about to spend all the money and time into my hip, only to have it not heal.  I look at everything as a risk to benefit ratio.  Is the risk worth the immediate benefit?  
  • Be Positive.  I cannot push the effects of being positive.  I am a strong believer in positivity, and there were many days with my first recovery that I had to remind myself to smile and stay upbeat.  My PT even sent me over an article about the power of the brain and recovery, and how positivity can help you heal.  There are days you might feel like you're living under a dark cloud, you might feel like you're never going to heal.  I promise, keep your head up, smile, surround yourself with people who keep you happy.  You WILL get better, this time is only a chapter of your life, and in 1 year it's going to feel like a blink of an eye.  

Some things I experienced post op.  

I was 20lbs weight bearing for the first three weeks, progressed to 50% weight bearing during the 4th week, with a gradual increase to 100%, down to 1 crutch for a few days after the 4th week and then back to walking.  For both surgeries I was able to lose the 1 crutch pretty quickly.  I attribute a lot of this to pre surgery fitness and strength, and A LOT of dedication to watching myself walk in a mirror.  I strongly believe if you aren't ready to walk mentally or physically, you should stay on your crutches.  From a neuromuscular standpoint, why would you teach your body to limp?  If you're walking with a limp and don't work to get rid of it, you're training your body to walk that way, and it's going to be significantly harder to lose the limp 2 months down the road, than it would be at this early phase.  Put in the effort to learn how to walk properly.  Once you can walk, you're going to realize just how stiff your hip is!  This is completely normal, talk to your surgeon and PT about what stretched will be right for you.  

What I noticed with my first surgery, and once again have learned this with my second surgery, is don't be alarmed if you have some pre-surgery symptoms post-op.  During the second week after my first surgery all of my pre-op symptoms came back, and I had a total melt down.  With my first hip pre-surgery all my pain was front of the hip and into the groin, when I woke up from surgery all my pain was in the front of the hip and in the groin.  With my second hip most my pain was lateral pre-op, with random aches and throbs in the groin.  Guess what, ALL my post op pain with my second hip was lateral.  No groin pain this time around in this hip.  So don't be alarmed if those pains aren't completely gone when you wake up, just because you're labrum has been stitched back together and your bone shaved off, doesn't mean you're magically fixed and healed.  

If you have both hips operated on, don't be alarmed with your second surgery if your first hip flares up.  I'm still struggling with this one, because even 1 year between the two surgeries, my first hip has flared up and all my poor muscle patterning has come back, and I did HOURS upon HOURS of PT to get that hip strong.  Which brings me to, if you've had hip pain for years, you probably have a lot of compensations and motor patterns that need to be corrected.  Surgery won't fix this, you have to put the time into it.  I now know with my first hip that my QL pain and tightness for 5 years prior to surgery was compensation from my glutes being slackers, and even thought I spent months correcting this, when I have trauma back to that hip (like crashing on my bike or having another hip surgery) my body wants to go back to what it knows.  It had 5 years to learn these patterns, 1 year isn't going to fix it.  Surgery is not a quick fix, and shouldn't be chosen lightly.  If you aren't willing to put the work in pre-surgery, you probably shouldn't have hip surgery.  Sorry to be blunt, but that's how I feel.  

For the Cyclist.

If you're a cyclist reading this, there are things you can do to help your pain and keep your hip healthy pre and post op.  Remember you are injured and your body has changed, this means your current fit needs to change.  I highly recommend a new bike fit, and finding a fit with a PT who is knowledgable with hips and familiar with FAI and labral tears.  I go to Annalisa Fish at Endurance PDX in Portland, OR for all my bike fit needs. She's about a 4-5 hour drive from where I live, but I trust her with my life when it comes to my fit and my hips on the bike.  When it comes to your fit on the bike, you want to open up that hip angle, right?  We want less impingement while pedaling.  Some adjustments you can make:

  • Raise your bars.  Look like a grandma...or grandpa.  It's okay, I'm 32 (eeeek, almost 33) and I ride like a total grandma.  
  • Saddle Fore/Aft.  Try moving your saddle forward to open up that angle. 
  • Crank Length.  I've been told I need to go to 165, I'm on 170's currently, but both Annalisa (my fit'er) and my surgeon would like me to shrink my crank lengths.  SO, think about shorter cranks...open up that hip angle!
  • Bike.  There might be a time where you can't get comfortable on your favorite bike.  I found my hips were happiest on my mountain bikes..obviously since that's where I'm most upright.  With that being said though, my first hip was not happy on my 5inch trail bike. Not sure if it was the seat angle or what, but it only liked my XC bikes.  I haven't been on my road bike in over a year, it's aggressive position frightened me post op, so I just stuck to my cyclocross bikes on any road rides.  

As I mentioned at the beginning of my post, surgery is really scary, there are horrible things about this surgery out there in the internet world, and thats even more terrifying.  If you do your homework and find a qualified surgeon (who does their job properly), follow their protocol, be patient, relax, do your PT (for life), I don't feel there shouldn't be a reason you can come out on top.  Believe in yourself, trust the process, and don't forget to smile.