Anterior Femoral Glide Syndrome

UR DOING IT ALL WRONG

I can't believe it's been three years since my hip surgery. I basically stopped writing about what therapies I was doing because nothing seemed to be working. Now, looking back on posts it seems like I was so desperate for anything to be the answer. The active release therapy worked to help relieve the tightness in my hips but the pain was still happening. (As you'll find out, this wasn't a failure of ART, but a failure of addressing the mechanical issue causing the pain.) I eventually gave up going after months of treatment. At the end of last summer I was still in so much pain that I started to believe I needed to have surgery again. I was so clueless, and every doctor seemed to be so clueless as to why I was still in pain, that it seemed surgery might be my only option.

I decided to reach out to the physical therapist I had way back in the beginning, Keith at Quinnipiac Physical Therapy & Sports Medicine. Before surgery, he had helped me with my shoulder when a trip while running sent my shoulder straight into concrete. The swelling had limited my range of motion before I did Swim Across the Sound. He found the issue, which I was actually quite impressed by. There was swelling in my chest from the fall that was radiating up to my shoulder, limiting movement. With manual therapy and some exercises I was better in a few days, just in time for the long day of swimming. Looking back, I have no clue why I didn't see him after my surgery. I don't like having regrets, but I can't help but regret not going to see him before/after my surgery. Sigh.

Anyway I reached out to him and had an evaluation. He spent a lot of time looking at my range of movement, posture and talking about the pain issues. When he told me that he thought he could help me and that he didn't think I needed surgery, I burst into tears. I wanted to believe him, but I was also so scared of putting all my hope into another treatment and not actually getting better. For the first time in 2+ years I had a name to put to this pain, "Anterior Femoral Glide Syndrome". If you want a detailed explanation of AFGS I recommend this post over at Eric Cressey's blog. In basic terms, the head of my femur is too far forward in the joint capsule, which was responsible for the constant burning pain I was experiencing. The other issue behind AFGS is that the hip flexors are activating when the glutes should be. So to correct this issue one has to train their body to activate the glutes instead of the hip flexors.

Now, I'm obviously not a physical therapist so I'm completely limited on knowing much about the AFGS debate - or even if there actually is a debate about it. All I can figure out from the lack of information out there on the internet is that not everyone recognizes Anterior Femoral Glide Syndrome. If you are reading this blog because you are searching for answers to your hip pain, I have some not so awesome news for you. You might have a hard time finding a PT that will recognize this issue. I don't know anything about the hows or whys to this, but I can say that it's incredibly infuriating how many people on the Hip Impingement Awareness (FAI, PAO, THR) Facebook group have seen/are seeing PTs that don't recognize this issue or take them seriously when they bring this issue up.

All that I can say is that Keith at QPTSM knows his stuff and is the rare breed of PT that actually cares to figure out problems. I know first-hand that Keith and his staff will discuss patients issues, bounce ideas off each other and work as a real team to solve problems. During my first session with Keith I was so affected by the pain that I was a mess. My posture and gait were so bad that I was basically a sad diagonal line, my body was pulling to one side. Through joint mobilizations and other manual therapy solutions he had me walking upright again and reduced the pain significantly.

Over the next few months of sessions my pain began steadily decreasing. Thanks to his exercise protocol and joint mobilizations I could perform on myself, my flare-ups decreased in time. I can say with confidence that this was the biggest issue that was creating my pain. I hope to write a post detailing the exercises I did to help this issue. But I want to stress right here and right now that HIP OPENERS are detrimental to anyone suffering from Anterior Femoral Glide Syndrome. That means, NO PIGEON POSE. If you look back in my posts, I was doing lots of yoga. I was convinced hip openers were helping me. Especially pigeon pose, because that's a pose my original PT recommended I do, and DO OFTEN. Multiple times per day! Turns out that was making things worse. So I would have a bad flare up, get on the mat and do the exact thing that pulls my femur even further back into the wrong position and only MAKE THE PAIN WORSE.

NO!

Do I still have flare ups? Yes. But I will say that for the first time in 3 years I have had several weeks in a row, on multiple occasions, with no pain. That's huge. Also huge is that often, if I do my PT, flare ups STOP. Instead of going on for full days or weeks or more, if I push through the burny pain and do my exercises and self joint mobilization the pain subsides. Finally I have a real cause/effect/solution to this pain. I'm also going to a massage therapist to work on the residual scar tissue and tightness - which also seems to be helping. I'm not 100% yet but I feel like I'm actually making progress for the first time in years. More posts about Anterior Femoral Glide Syndrome to come because there's a lot more to it, I haven't even gone into the sciatica or exercises, stretches you can do, or anything like that. That will come in time, because now, due to the lack of information out there, I feel the need to be an Anterior Femoral Glide Syndrome evangelist.

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First Week Post Labral Tear Surgery

Day 1 Post-Op: After what seemed like an eternity, 8am arrived and so did breakfast. It was gross eggs and gross Cream of Wheat so I didn't eat much. I remember crying at one point because I was just so stressed out and in so much pain. The amazing nurse Steve sat down with me and talked to me for awhile. He said that it was understandable I'd be crying after such a rough night and especially after such little sleep. He also said the pain meds don't help with emotions either, which I've definitely found to be true in the past. He told me about his ACL surgery and how there will be downs but there will also be ups, and recovery will happen though it seems so far away and overwhelming right now. Steve is an incredible nurse, to take the time to sit down and talk to me made me feel so much better.

Some random doctor came in to take the epidural out of my back. It was a quick pinch but my back was so sore it hurt just to lean over so he could take it out. Then my doctor came in to check up on me. He told me I could get on a stationery bike the next day as long as I pedaled with my good leg and left the other leg resting on the pedal. I laughed at that because I was in so much pain I couldn't imagine pedaling. Even a week later I feel uncomfortable with the idea. There's no way I'm getting on my bike (on the stationary trainer) until my hip feels better.

I was barely lucid when physical and occupational therapists came in to teach me how to use crutches. First of all I thought they were insane having me move in the amount of pain I was in. I was on the verge of passing out the entire lesson which consisted of me crutching down the hallway, up a little model of stairs and down, and back to the room. Voila, the entirety of my crutch training. The OT helped me learn how to use the bathroom and put on clothes. At this point I'm allowed to put 20lbs of pressure on my left (operated side) foot, which is basically just touching the foot to the ground.

Soon after they left Scott arrived and nurse Steve came in to answer any of our questions before discharge. Scott grilled Steve on all the medications and everything I (we) should be doing this first week. So glad Scott was there to be so assertive and ask everything. I'm not really good about asking medical staff questions, although I am getting better at it. Also I was still on the verge of passing out so having him there to write things down and clarify was essential. After that I was discharged and a nurse wheeled me out of the hospital.

Most of the day was spent in pretty awful pain and keeping myself from blacking out. From my waist down was still waking up and I was paranoid I was peeing all the time. I couldn't really feel my stomach but I was bloated from all the fluids and meds. My hip was obviously quite swollen. Some lady dropped off the CPM machine at my house, which I talked about a couple posts ago. It moves my leg really slowly from straight out to 45 degrees. It's important to do this (4 - 6 hours a day!) so that my leg doesn't get all knotted up and stiff. Controlled movement helps keep things loose so that I don't have permanent damage. I slept on the couch that night so Scott could have the bed to himself, he was completely exhausted as well. I woke up a few times to the room spinning around and to use the bathroom, which seemed to take a half an hour each time.

Using my CPM wearing the sweet double-sided tread socks the hospital gave me.

Day 2: Wednesday was a good day. I felt pretty positive and was already feeling a bit more mobile. The worst part that day was still feeling bloated from the Percocet. It's gross to talk about but seriously, it's important after surgery to drink a lot of fluids (although getting up and down is a serious pain) and take in fiber, probiotics, fruits & veggies and if necessary a laxative. It's the icky side of surgery that I was grateful other people blogged about, so there you go. I wish I saw this post from Susie at Goodnight Nobody before surgery.

Throughout the week Scott slept at my place so he could make me breakfast and make sure I had what I needed for the day. That usually involves making sure I took my morning pills, leaving a glass of water (or my favorite, coconut water) around my bed and feeding my cat. He also biked over from his job during his lunch breaks to make me lunch. I'm still in awe of how much he's helped me this past week and I don't know how I would've gotten through this without him. He definitely helps to keep me positive and I'm sure that without him I would be a depressive, bitter mess. Later that day my friends Kelly and Jason stopped by to visit me. It was so great to see my friends! Kelly had me laughing so hard I thought my stitches were going to burst.

Day 3: Spent the morning being miserable. For some reason I thought I would be feeling much better than I was. It seemed like before surgery the doctor and other people I had talked to acted like I'd be fine in a few days. I still felt pretty terrible and wondered if I was just being a baby or if its normal to feel so bad. I guess everyone is different when it comes to these things. With a lot of things in life I'm prone to wondering if I'm handling things "okay". Feeling quite helpless has had a way of amplifying my already self-conscious nature.

Scott gave me a massage during his lunch break. My body felt so scrunched up, twisted and gnarled post-surgery. The stress, the actual surgery itself, the epidural and then having to mostly lay in bed left my body so sore and my muscles tight. I started crying it felt so good. Since then I've noticed my body in general has felt a lot better. I highly recommend rubbing sore muscles with Arniflora and Triflora, which are natural topical gels that I've had much success with. I also love the fact that they don't smell like IcyHot or other muscle rubs, they have a light herbal scent. The Arniflora contains arnica and witch hazel. The Triflora contains comfry, poison ivy (yes weird I know, but it shouldn't cause a reaction) and wild rosemary. These two gels also help with bruising. I've been using them since before the surgery and I've noticed my hip usually felt achier if I've forgotten to apply them in the morning. The bruising from the surgery hasn't been so bad. Usually I bruise quite easily and expected my hip to be a purple and black mess, but I've only had light greenish bruising.

Later that day Scott brought me to my first post-op physical therapy session. I am back to going to Excel Physical Therapy in Hamden. I was happy to see my PT again. First thing she said to me was "No wonder you weren't improving!" and she said how happy she was that I got a second opinion and how she knew I wasn't going to stop trying to figure out what was wrong. Scott sat in on the PT session so he could learn along with me what I can and can't do. It's so great to have his active support in my recovery. I was still woozy that day and started to realize the Percocet was causing me to have acute nausea throughout the day. Not enough to make me completely sick, but enough to make me miserable. Anyway, it was great to have Scott there because I still wasn't feeling lucid enough to remember everything my PT told me. She reviewed my crutching and said I was actually doing really well. I was sure I was doing it wrong. I went home feeling really hopeful and positive about my recovery.

Day 4: I was upset once again that I wasn't getting any schoolwork done and was feeling pretty scared about returning to "normal life" in a few days. Avoided the world by watching a lot of stupid TV shows on Hulu. Took my first shower since before the surgery (they wanted me to avoid changing the dressing and showering as long as I could) and felt sort of human.

Day 5: My parents came down to visit. We all went to brunch down at my favorite diner in West Haven. My parents took me to the grocery store and I got to ride the motorized cart. I felt like a jerk when I passed an old woman going the opposite direction in the dairy aisle who was somehow controlling a walker as well as her cart and looked like she was about to fall over. Whatever the cart is as fun as it looks. My parents cleaned around the apartment while I fell asleep, the events of the day had worn me out. Most of the day was spent feeling nauseous from the Percocet, even though at this point I'm only taking one at night and dealing with the pain during the day.


Day 6: My parents stayed at a local hotel so they could see me two whole days in a row. We went to lunch and my parents proceeded to clean even more of my apartment while I rested and used the CPM. Finally did some schoolwork that night and started to feel better about returning to "normal life". Decided not to take a Percocet before bed so I'd feel better about driving the next day. Took a Benadryl because I've been spending a lot more time with my cat Björk this past week. I slept pretty well for the first night since surgery, I think the Benadryl helped.

Day 7: I went to my second post-surgery PT session in the morning. My PT says I'm already showing increased movement and I'm doing well. We went over my exercises again and she answered some questions I had. Called my doctor's office complaining about the Percocet. Now I have a prescription for Vicodin, so I will be taking my first one tonight. Hopefully it will treat me better. I have been in pretty significant pain most of the day. When my parents were here they gave me their TENS (Transcutaneous Electrical Nerve Stimulator) machine. My PT uses one on me, but the one I have is a little consumer model. It's the size of a beeper circa 1997 and it connects to little electrodes I have to stick on myself. "A TENS unit is an electrical impulse generator that is used to relieve post-operative, acute and chronic pain," reads my instruction manual. I'm hoping I can use it during the day and then only take pain medication at night. Apparently they're not completely sure why TENS works and there are limited studies about its effectiveness. I will say that when it is running I feel the buzz sensation of the machine and it does seem to "block" the actual pain I'm in, which is a deep, burny pain.

More about TENS from my machine's manual:
How does TENS work?
"TENS, or Transcutaneous Electrical Nerve Stimulation, means the transmission of small electrical pulses through the skin to the underlying peripheral nerves. TENS is thought to work in two different ways.

First, "high frequency" continuous, mild, electrical activity may block the pain signal travelin to the brain. Brain cells perceive pain. If the pain signal does not get through to the brain, the pain is not "felt".

The second way TENS is thought to work is by stimulating the body's own natural pain-control mechanism. "Low frequency" or short bursts of mild, electrical activity may cause the body to release its own pain erasers, called beta endorphins."

I'm getting better at crutching, definitely moving faster than Day 2. I feel a lot more mobile and my bruising is already gone. I was happy that I finally got out to drive myself around, and I'm feeling more confident about going back to work and school. Like I said, I'm still in pain but it is manageable, then again I've been "managing" life with pain since last October. It's hard to believe that at this time a week ago I was lying in bed at the hospital completely miserable. Feeling much more positive compared to that experience!

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Surgery Day

On Sunday I turned 26. On Monday I had hip surgery.

I got up at 4:50am and took the last shower I knew I was going to fully enjoy for quite awhile. I took my time and shaved and just stood there in the scalding hot water, relishing it. We got to the hospital for 6am and I tried my best to keep it together. We got to the SurgiCenter and a very sweet nurse took me to my pre-op area. She would be the first of many amazing nurses I'd come across at Milford Hospital. She saw how nervous I was and did her best to calm me down, she didn't talk down to me (like a lot of medical staff tend to do) and put on extra blankets because I was already shivering. Scott came to say goodbye but the anesthesiologist doctor decided it was time to do my epidural and Scott had to leave. I started crying and that bought me a few more minutes with Scott. I vividly remember looking up and him, sobbing, scared and just wanting to be held.

The spinal was awful. I don't care what the hell the Russian doctor and over enthusiastic assistant he had tried to tell me. That shit hurt. Even on the Valium or whatever he put in my IV to calm me down I just wanted to rip the assistant's throat open with my hands as she braced me, repeating in a sickly sweet fake voice "SEE it's not so bad!?!" while the doctor shoved a needle in my spine. After that I met my anesthesiologist nurse and I was rolled down the hallway to the operating room. I looked up while people in scrubs walked around me and it was just like the movies. So surreal. I remember entering the OR and looking over at the "table" which was really a bunch of platforms and the foot braces that they would lock me in. I looked up at the giant lights and I thought back to alien abduction movies. Then I looked over to Dr. Schachter setting up the video screen for the camera. "So you gonna record it for me?" I asked. He said something about taking stills of the best shots or something and then...

I woke up in the recovery room shaking uncontrollably. One nurse there, who knows what I said to get her to like me so much, but she really took a shining to me. She piled warm blanket after warm blanket to get me to stop shivering. I always shiver after anesthesia but never this bad. Then I realized my throat was so sore. Not just sore but it felt like there was glass in there every time I tried to talk. She kept giving me sips of ginger-ale through a straw. She talked to me, asked me some questions. I told her how I lived in New Haven and we talked about restaurant week. I remember her telling the nurse upstairs who'd be taking care of me that I was "just a kid" several times and that I was a triathlete and made sure my boyfriend was in my room. When they wheeled me out she said something about how rare it was to get such a sweet kid in the recovery room and wished me the best of luck. I wish I knew a way to tell her thanks for being so comforting.

I was wheeled into my hospital room and I was so relieved to see Scott there. He was equally relieved to see me. I found out it was 3pm and I had been in the OR for 5 hours. That was two hours more than I remember them telling me it would take. Scott, my parents, his parents had all been worried because they expected me to be out much sooner. The tear was bigger than expected and I would find out later, bigger than average. Usually it takes 2 - 3 staples to repair a tear, mine took 4. My doctor said that when they put the camera in, the cartilage was flapping around in front of the camera. As promised, he took stills of the video for me. It looks like fish and the "staples" look like the plastic twine you use to tie down a pool tarp. My friend Kelly said the stills look like "a whale's vagina". Enjoy that image.

After I had finally stopped shivering, the worst symptom from the surgery was the sore throat from having the tubes put down my throat. I was drinking water, ginger-ale and chewing on ice chips trying to make my throat feel better. Scott went for a walk and came across a Carvel and brought me icecream. :) I didn't think I'd eat the whole thing but I did, it was so sweet of him. The nurses also gave me lozenges but nothing seemed to help my throat.

A few hours after surgery I realized that I was allergic to the epidural medicine. I couldn't stop itching. I couldn't feel my hip at all but the sore throat and the itching were too much to bear. There were even places on my skin where I had broken out in hives. The nurses gave me Benadryl but nothing seemed to help. I would try to sleep but I was overwhelmed by crazy, fast-cut editing visions of nonsense that freaked me out. I would look over to the wood cabinet in the room and it would swirl, warp, become fuzzy in places. I thought I was going insane. I would "fall asleep" and wake up hoping an hour had passed and it was only 15 minutes. I remember being so incredibly lonely.

After dealing with the extreme itchiness and sore throat for several hours I just broke down in tears. The nurses asked me what was wrong (like I hadn't been complaining for hours) and I could barely speak, all I could say was "I'm... so... fucking... miserable... I'm.... so... itchy, my throat... I can't... sleep..." Finally they called a doctor who recommended they stop the epidural drip. I spent the rest of the night watching TV, checking Facebook and Twitter on my phone and just hoping for the itchiness to subside and for 8am to come because that's when I knew I'd get breakfast, people would be coming to give me PT or whatever, and most importantly Scott would be there soon.

Next post will be about Day 2 and hopefully after that my successful recovery.

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Labral Terror

So after my last whiny post a lot has happened. I wrote that post on a Wednesday night and by Friday I had an appointment set up with a new orthopedic doctor. This was the doctor my coworker recommended to me months ago, but for some reason didn't go to. Now I wish I had, but hindsight is always 20-20. Dr. Schachter realized my problem right away. It was NOT "snapping hip syndrome" but most likely a labral tear. As defined by the MayoClinic: "A hip labral tear involves the ring of soft tissue that follows the outside rim of the socket of your hip joint. This ridge of cartilage, called a labrum, works a little like a suction cup to help hold your hip joint together."

Guess what sports are attributed to such a tear? Well among them are running, biking and kickboxing! Yay! We're thinking the combination of my naturally deep hip sockets with all the sports caused this tear to happen. An MRI confirmed the tear, and while they put contrast in my hip joint to show on the MRI better they also gave me a cortisone shot. It was SO worth the giant needle in my hip for 10 minutes. On one side of me was a doctor putting in the needle and on the other side was the x-ray image of my hip. The image would refresh every minute so I got to watch the needle go in deeper and deeper, then feel the fluid going into my hip and then watch the screen show the fluid dispersing. It was a highly unnerving experience. Also nobody tells you how LOUD an MRI is!! The protective headphones hardly masked the crazy sounds the machine made. I thought MRI's were these highly advanced silent machines but I was wrong.

So what happens next? Surgery. The day after my birthday to be exact. Last year on my birthday I rode 25 miles to celebrate my 25th year. This year I get crutches. I went to Dr. Schachter today for my final visit before the surgery. He explained that there is some hip impingement so along with fixing the labral tear they will do some very minor bone shaving. I actually got really lucky because in some cases of FAI there needs to be some significant alterations done to the bone. (Read more about FAI here.) I found out today that I will be staying in the hospital overnight because my doctor is worried I'll have adverse reactions to the anesthesia and get sick. Also, unlike my first and very shitty orthopedic, he has taken my gastritis into account.

When Dr. Schacter first told me I would probably need surgery I Googled the bejesus out of FAI. Instead of scaring me I actually found a lot of relief. I found my symptoms described in perfect detail. I found people who went on to do Ironman triathlons. I found a lot of encouragement and I also felt so much better! This post at www.understandingfai.com describes the writer's experience with her symptoms and I felt a weight of guilt lifting off of me when I read it. She too had intermittent and sometimes unbearable pain. I felt guilty because I thought that "snapping hip syndrome" could be fixed easily and that I must be doing something wrong because it wasn't getting better. I also felt guilty because some days it feels fine and other days it burns so bad, so I thought that the pain must be in my head. I must be the one making it out to be worse than it was. Chronic pain is an emotional roller coaster, and I'm ready to get off and enjoy the things I love to do again.

The recovery includes: 3 weeks on crutches and two weeks of this baby:

Look! She's loving it! And soon so will I! PT sessions probably twice a week for a couple of months and the doctor says I should be able to train again in about 4 months. I was hoping I'd be able to do a September triathlon but it looks like I will just have to wait until next year. The doctor wants me to be very careful and to "cool my jets" for awhile. A lot of people have seen the recovery A-Rod has made (who has this exact surgery... and I still think a douche bag) and think they can go back to running around in 6 weeks. Unfortunately since A-Rod exists had this surgery people have been increasingly getting tendinitis because they're pushing themselves too soon.

Despite the fact I need surgery I'm pretty optimistic. From what I've seen on blogs, people have gone to five or six orthopedics before finding a doctor that recognizes what this is. It is often misdiagnosed as snapping hip syndrome, hernia and other issues. Because it's a relatively new procedure there aren't that many doctors who do it. There's one guy in New York I keep hearing about, who is highly recommended except for the fact he takes CASH ONLY, UP FRONT. Um, sorry but I don't have $20,000 just hanging around. The other doctor who is "the best" is Dr. Philipon out in Vail, Colorado. Since finding out I need surgery I've had everyone giving me other orthopedics they've heard about. While I appreciate it, I'm happy with my current doctor. My coworker's brother-in-law is an orthopedic doctor who knows Schachter very well and I like that he is very thorough and cautious and treats me like a human being, which I've found to be a rare quality amongst doctors, especially orthopedics.

*It should be noted that "labral terror" is my boyfriend's amazing pun, not mine. I like to give credit where it's due. More of his amazingness can be found at this site.

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