Anterior Femoral Glide - PT Exercises

Starting this off with a huge disclaimer. I am not a physical therapy professional - I'm just someone who has gone through a lot of physical therapy. The only license I hold is a driver's license. I have a masters... in Media Studies, so I'm prone to calling muscles and bones the wrong name. These exercises are only to educate people on what has helped me with anterior femoral glide syndrome post arthoscopic hip surgery (due to a 4cm labral tear). I cannot stress enough that you should consult your physical therapist/ortho/doctor before doing these exercises. The main reason I'm posting this however is that many out there do not have PTs that recognize anterior femoral glide syndrome. My last post covers my background with AFGS and the lack of information out there. Lastly, no complaints about the image quality. I really don't have time to do an awesome job because this isn't my job! I got websites to build and money to make! Alright, now the exercises...

First part of my regimen is doing some stretches. My hamstrings are always super tight thanks to my job as a freelance web designer and front-end developer. You can use just about anything that is long enough to do these stretches but I found it worthwhile to buy a cheap yoga strap on Amazon. I hold these stretches for about 30 seconds each, for a few rounds.

In my last post I talked about how you have to be really careful with hip stretches if you have AFGS. This stretch is a good way to stretch the hip - by lying on the ground the hip can't go forward and thus push the femur forward. Have the strap around your foot, and then take the slack and put it over the opposite shoulder, holding onto it while propped up on your elbows. This is a bit more stabilizing while still getting a stretch. My PT also had me just lay like this for five minutes with my legs down and propped up on my elbows. I had some issues with my low back and sciatica - these two stretches as well as the laying helps with my sciatica too.

Next up is what my PT called "lion drills". I do this for about 10 reps. It's quite simple. Kneel on hands and knees with your knees 8 to 10 inches apart, hands directly under your shoulders, and arms and back straight. Keeping your arms straight, slowly lower your buttocks toward your heels and tuck your head toward your knees. Hold for 15 to 30 seconds. Slowly return to the kneeling position.

Next is a simple leg raise. I had to be aware of my back and my PT had me arch my back ever so slightly because I have the tendency to sway my back. Also bring awareness to your hip, keep it straight, no twisting and don't bring your leg up too far up. Remember, you're trying to keep your femur stable, and avoid pressing it forward.

Bridging helps with core stability as well as strengthening the glutes. Remember part of AFGS is that the glutes aren't firing properly and strengthening them is part of the solution.

Once you've gained enough strength you can move forward to bridge single-leg raises. Start in a bridge position, then straighten one leg and then extend your leg up so that it's perpendicular from the ground. As you can see, I have a lot of trouble keeping my leg straight. Do the best you can. This is an exercise that I found needs your full attention. Keep your bridge high and your abs tights. Make sure your hips are level and your leg is straight at all times. You might experience some clicking from your hip - I know I do. When I focus on my abs and keeping my hips straight I experience less clicking.

Everyone's favorite! Clamshells!! I had to do clamshells as part of my post-op protocol. I thought I was doing clamshells right, but apparently I was not. I was still using my hip flexors and not my glutes. Make sure your back is completely straight when you're setting up to do clamshells. Put your thumb right over where your hip flexors are, yeah that's right, all up in your groin. (First pic, I'm over emphasizing where to keep your thumb.) Focus on firing with your glutes and not the front of your hip. If you feel your hip flexor bulge out STOP, reset and try again. The aim of this exercise is to strengthen your glutes and train your body to fire with the glutes. Your first time your glutes will be on fire! That means UR DOIN IT RIGHT! Once you got this down, use a theraband tied around your thighs to add extra resistance.

This is a handy exercise I do a lot, it's easy to do anywhere. I find it's best to have something to hold on to, just to make sure your posture is good. Stand straight, with your foot turned out. Simply bring your foot behind you, keeping the foot turned out. Due to the angle of how the camera is it looks like I'm bringing my leg out to the side, but I'm not. Just bring it behind you. Also, focus on keeping your hips straight - I'm obviously not, but by this time I was over the whole video yourself while doing PT thing. This is a glute and hip strengthener.

Lastly, not an exercise but a joint mobilization. This has been the most helpful thing I've learned to stop the burning pain on the front side of the hip. The first image is just to help show where to put your hands, which is on the very top of your leg. You want the heel of your hands to be on the top of the muscle where your abdomen and leg meets - there's a lot of muscles all up in there. To me, when I'm pushing down, it feels like I'm pushing down a slab of meat, (which I sort of am) sexy!

Keep your back straight (even though you'll lean forward a bit) and push down with the heels of your hand. Press down with the weight of your upper body. I push down as hard as I can while keeping mostly upright and my back flat. Make sure you are doing this on a chair that is high enough that you don't have to hunch over but not so high that it's hard to push down. The chair I'm using is the perfect height for me. Also make sure that the chair will not move easily! You don't want to lose your balance or slip and fall! Hold this for about 10 - 20 seconds, repeat if necessary. I try not to do it too often in one day but the relief I feel after is euphoric. Especially if I'm having a particularly bad flare up.

There you have it, my PT exercises for Anterior Femoral Glide Syndrome. I have found so much relief from these exercises, I am extremely grateful to my PT for his help. One other exercise I do but didn't add was squats, mostly because I am a lanky weirdo and I just look completely wrong doing squats and I'd rather not post something that looks wrong. Ask your PT if you are seeing one on how to best to perform squats. Also, part of my PT program was that my PT did a lot of manual therapy and joint mobilization. He basically had to rock/jam my femur backwards, it was always so far forward. I'm sure doing it on your own is helpful but nothing beats having someone that actually knows what they're doing performing manual therapy and joint mobilizations.

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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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9 Months Post-Op

Three months have passed since my last post, and not that much has changed. The cortisone shot that I had didn't do anything. Bad News: I received no relief from the pain. Good News: That means the pain isn't coming from my hip joint. It was good to know that I could stop worrying about the actual hip joint and focus on the muscles around my hip. Through regular massage via the amazing Jessica (intuitivelotus.com) and tennis ball humping I was as close to pain-free as I've been since before the tear. A week or so before Thanksgiving I was feeling so much better that... I started running. Yes! Running! I ran a mile in 15 minutes or so, ok... that's not running that's "jogging" or whatever, but in any event I was going in a forward direction faster than walking. Muscle memory is incredible. Although I hadn't ran in a year I felt my body moving as though only a few weeks had passed. I had to keep slowing myself down. My whole body tingled with glee on that first "run". I ran again that week, two miles in one week after almost a year of zero.

On Thanksgiving, with my boyfriend's family acting supportive but worried, I went out into the freezing rain and ran a mile. It felt awesome although it was simultaneously freezing. Unfortunately the next day I went to the gym, and I pushed myself a little too far. I'm not mad at myself. I have to relearn my boundaries every day. Every day is a test of what I can and can't do. There is no clear forward/linear direction in this healing process. (I will get to more of that later.) So I overdid it at the gym not running (I stopped when I was starting to have the old shooting pains, my hip had had enough.) but with tiny stupid weights. I was trying to strengthen my back and triceps to prepare for swimming again. I am completely useless in the water unless I have built up my arms and back. I ended up pulling the muscle that runs along the bottom of the scapula; so badly in fact that I had to take muscle relaxers and sit with a heating pad on my back for a week. After several days of using the heating pad, then doing the yoga pose plow, my back returned to normal – but my hip returned to a near constant state of pain. I'm sure the fact that I pulled a muscle that is right next to where my psoas connects to my spine did not help my situation.

I went to a follow-up appointment with my orthopedic a few weeks ago. Luckily (or not so luckily) the pain in my groin was flaring pretty bad that morning. I made my doctor feel where I was experiencing the pain. The thing with orthos is, no matter how great they are, they are concerned with bones and joints, that's it. The surrounding muscle and fascia could be on the moon for all they care. Once he felt where the muscle was pulling he had a very surprised expression on his face. "It's... it's like a cord! That's... impressive!" "That's not impressive," I responded, "it f*cking hurts!" He decided to refer me to Dr.Orefice at Active Health. I went to my first appointment with Dr.Orefice last week. He decided that he will mostly be using ART or Active Release Techniques to help my psoas calm down and break up scar tissue. I really hope that this is finally the procedure I need to break up the sh*t residing in my hip. During the first visit, even though it was painful I felt that he was getting to the major sources of my pain. OK, so what is ART and how does it work?

From Active Health's website:
"ART providers utilize highly developed tactile skills and knowledge of physiological symptom patterns to locate scar tissue adhesions on and in between muscles and nerves. A precise hand or thumb contact is applied to the correct area (tension to the tissue) and the recipient is directed to move the effected region of the body through a specific range of motion (muscle is shortened then lengthened). This causes the muscles to slide under the ART providers contact. This technique has proven to rapidly break up scar tissue and yield recovery of many types of soft tissue pain conditions found in the work place and in sports."

2010 was a long and frustrating year. I've decided that this year, in order to better deal with my pain and anxiety issues I will try to be a more faithful yogi. I came across the book "A Year of Living Your Yoga: Daily Practices to Shape Your Life" by Judith Hanson. As I was searching to see if there were any blogs that reviewed 'A Year of Living Your Yoga', I came across a blog called Yoga Dork. Yoga Dork is just one of the blogs trying to practice yoga daily and put into practice Hanson's daily insights to approaching life and yoga. So I will be trying to do yoga every day, on days where my psoas/hips are really tight I will be practicing my new favorite type of yoga: yin yoga.

I've been doing home practice since most of the yoga classes in this area (at times I'm available) are vinyasa. Though every teacher is different, I've found that most vinyasa classes move too quickly. I've always preferred slower paced yoga, being able to stay in poses and really enjoy their full benefit. I've noticed great improvement in my flexibility since practicing yoga regularly a month or so after the surgery and now. Practicing has made me grateful for how far I've come. Even though I still experience pain, my hip has more flexibility and is able to do more poses without modifications.

I set up an account with MyYogaOnline.com so that I can practice using their videos. MyYogaOnline provides videos of a wide variety of yoga styles. Classes range from a quick 15 minutes to longer hour and a half sessions. They also have pilates videos and guided meditations. This year, besides continuing with grad school, I hope to make further progress in my recovery. It is my intention that through regular yoga practice I can learn to be more patient with my body and regain a higher awareness of its ups and downs, and learn to respect whatever it may be able to do day by day.

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8 Weeks Post-Op

I feel this obligation to say, "I'm sorry, I wanted blog more often..." It would have been a great resource to blog every week about my progress, but honestly, I wasn't up for the emotional toll. A few friends have asked why I haven't been blogging more. The answer is that I've been focusing much of my free time on getting better. When I do have the time to take it easy, I do. Writing isn't easy when there aren't a lot of fun things to talk about. I don't want this to become a place to vent and seek pity. That being said, the weeks that have passed since I last wrote haven't been easy.

As much as Twitter seems like a useless social arena, it will definitely be helping me write this post. According to my "tweets" May 21st was the first time I got into the pool post-surgery. I felt bad getting to the pool a month after surgery. My doctor and my PT wanted me in there as soon as my stitches were out. I just wasn't feeling up to it. I was exhausted and miserable. It took me about 5 weeks to get off the crutches, a little longer than expected. Everything involving this healing process has been slow and patience has never been one of my virtues. So, I'm making it one. I've been making a lot of changes in my life these past few weeks. I'm trying to be more positive and focusing less on the end goal of doing triathlons again, and more on the present.

Three weeks ago I started doing yoga again. I did some Instant Watch yoga DVDs from Netflix. Then I downloaded a yoga app for my iPod Touch called Pocket Yoga. I figured spending $2.99 was better than spending $15 - 20 a session on a yoga class. It was difficult at first to do a 30 minute session. I remember taking things very slowly, and even a simple pose like "Child's Pose" was hard to do. Since then, yoga has become easier and I'm noticing improvements in my flexibility. Even my PT has noticed added strength as well as the flexibility. The yoga has been great for me mentally as well. Not only does it help to alleviate some of the massive amounts of stress I've experiencing, but seeing the little improvements as well as doing something physically active (albeit slow) makes me feel like I'm making progress.

After Pocket Yoga, I kind of went app crazy. My iPod Touch has now turned into my iZen. I have several different yoga apps on there. The best one is Hatha Yoga which is a pricey app at $9.99. It is the most authentic/traditional yoga app available. You can customize your own yoga sessions, the stop-motion video of the woman doing yoga are well done, and the audio instruction is very good. I have customized the standard session to have more poses that are beneficial for opening my hips and taken out the ones that are too hard for me right now. The yoga has also helped with the back pain I've been having from the epidural.

I have also downloaded some apps to help with meditation. My favorite being iSamadhi which is a meditation timer and journal. I started practicing meditation after I realized that the emotional after effects of this injury and the surgery were becoming too much for me. I was letting the pain and the negativity overwhelm me, own me. I have felt a large range of emotions in dealing with this. A huge part of it is guilt. There are people out there in far worse circumstances than I. Why does this feel so huge? So terrible at times? I'm not paralyzed, I can walk and will most likely be able to go on to doing triathlons again. I feel stupid and selfish for feeling so upset at times. I know I have a history of depression, which is usually just letting myself consume me. Does that make sense? Depression, for me, is letting my sad emotions overpower happiness or even just simply being. I give more importance to the depressive feelings than any other feelings. I feel they must be dealt with, but in the past I've dealt with them just by rolling around in them for weeks, months, years at a time.

Meditation gives me a break from focusing on those emotions. Just 10 minutes or so spent focusing on my breath, on the present has made such a difference. I have been interested in Eastern... well... everything ever since I was a child. Yoga is something I practice, then let go of, then return to. While I don't consider myself a Buddhist, I do like to read about it and about practicing mindfulness. There are certain negative stigmas attached to meditation and yoga... perhaps you're thinking, "Shit, Heather's gone all hocus pocus." If I could I'd show you 11 year old Heather off in the woods burning leaves and calling herself a Wiccan, I'd say: "No. That's hocus pocus Heather." Also, you can be an atheist and still believe in the benefits of meditation and mindfulness. (Shout out to Stephen Batchelor.) In any event, I'm feeling a bit more positive about things, even when I have setbacks.

My current setback is a "groin pull". YAY! Another opportunity for me to say "groin"! You know how I love to say it. Anyway, these past few days my walking has been going downhill. As much as I tried to hide it, a couple coworkers asked me if I was okay. I've been having trouble starting to walk after sitting, then I had trouble walking at all. I hoped a trip to the pool yesterday after work would help, but alas after swimming, doing my water walking and hip exercises I hobbled to the hot tub. When I went to PT today I had to have another therapist because my usual one is at a conference (One part of the conference is focused on my surgery, that's how common it's becoming). I told the assistant PT about how bad the pain and walking has been, and so the PT took a look.

She touched the spot where I've been having the most pain and exclaimed how tight it was. She started to massage it, and I started to do deep breathing exercises. It was incredibly painful. She took me to a private room, and continued to massage the tight areas. I had tears streaming down my face as I focused on my breath. Yeah, it was painful but it had to be done. After ultra-sound and ice, my walking was already improved. I'm to ice 3 - 4 times a day for the next week and lay off exercises, even yoga for a couple days. I'm relieved that the pain wasn't from my surgery, like it was failing or I did something wrong. The worst days have been the ones where I've been scared of a pop or pain and worried that the surgery didn't "keep".

Besides the hip, I finished my first semester of grad school with As. I'm quite proud and feeling confident about that part of my life. I'm currently taking a summer course online which is overwhelming right now. I'm hoping I get used to the format in a couple weeks. The above picture is me ripping the dance floor up to Lady Gaga at my friend Maura's wedding. It's hard to tell from the back but she looked absolutely gorgeous. It was the best wedding I've been to. Congrats again you two!

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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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On the Mend

The new year is here and with it a lot of changes. As I briefly stated in my last entry, for the past few months I've been dealing with a hip injury. It started after my last triathlon. I was running more on the treadmill, trying to squeeze in workouts as best as I could. Hip pain would flare up soon after a run. I would stretch all sorts of ways, but nothing could stop the pain or burning. An hour or so after running on the treadmill 4mi I was limping so badly I could hardly walk. The next day I called up my physical therapist.

After a month of seeing no improvement I went to an orthopedic. At first the doctor told me to go to a gynecologist because he thought I had a hernia. He seemed to be taking guesses for a diagnosis. (BTW - he's a horrible doctor and I wouldn't recommend him to anyone.) He was about to leave when I asked, exasperated that I was losing my one chance at getting a physical therapy prescription, "WHAT ABOUT THE SNAPPING?!" He came over and said he didn't feel any snapping. So I rotated my leg the way I had learned that makes it snap, and it did, painfully. My eyes shut and my face tightened in pain. He looked down at me, unamused. "Ok. You have "Snapping Psoas Syndrome". Uh. What?

Well he was no help really explaining it so I did a ton of Google searching after I left his office. The smart explanation via http://emedicine.medscape.com:

(photo from : www.arthroscopichipsurgeon.com)

"The most common cause of a snapping hip is the iliotibial band snapping over the greater trochanter. This may be associated with trochanteric bursitis or with increased varus of the hip. The finding of a tight iliotibial band is common. Sudden loading of the hip (eg, landing after a jump) may reproduce this sensation of the iliotibial band subluxing over the greater trochanter. With sudden loading, the hip typically is flexed, causing the iliotibial band to move anteriorly followed by the tendon snapping backward as the individual recovers and extends the hip."

Basically, there's a muscle in my hip snapping over another muscle. The causes of SPS (BTW - Snapping Psoas Syndrome is also known as Snapping Hip Syndrome) are varied. My amazing physical therapist over at Excel Physical Therapy in Hamden, CT had the same injury from running and training for half marathons. Mine is an overuse injury as well. It's a bitch, but with a lot of work, is treatable. The added bonuses I had to make this ordeal more painful was 1. Hardly any hip flexor strength, and 2. Scar tissue developed in my groin to make up for the lack of hip flexor strength. I can think back over the years and remember all the times I stopped or skipped an exercise that dealt with hip flexor strengthening. Every time I tried these particular exercises my hip felt like it was grinding and snapping, the feeling made me nauseous as it was so strange.

It seems logical when you feel pain or grinding/snapping you would respond by stopping. Stopping turned out to be the exact wrong thing to do in this situation. I should have pushed forward, built up some hip flexor strength and I wouldn't be in this mess. Hindsight = 20/20. So I've been building up strength, little by little, and the snapping is less persistent. The constant burning feeling (which was bursitis) has lessened a great deal. My PT has broken up the scar tissue over the past few weeks with ultrasound and scraping (yes, scraping) at my groin with an object that looks like a wrist bone. As much progress as I've made, I still have to keep working at strengthening and stretching my hips before I can run. I have been going on the elliptical and today started a month trial of Bikram yoga.

Other than all that, this week is my first week of grad school. I'm going to the New School in New York City to obtain an MA in Media Studies. For now I will be staying in New Haven and commuting once a week into the city. My job has kept me on part-time, and I can't say enough how thankful I am that my company has been supportive of this decision.

Great blog post on helpful tight psoas exercises:
Low back pain while running... a real pain in the butt

Yoga Journal article 'Get Hip' which goes over some hip stretching poses, such as pigeon (shown above).

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