ValleyRunner/Laura,

I know this response is late (I'm responding to your post 6th December) but your story hits home with me and I wanted to reach out quickly even though much or all of what I say is now out of date. Of course I also sincerely hope your situtation has at least held up if nor improved.

First, take a sigh of relief as far as your planned surgeon is and all this stuff about being 'experimental.'  Philipon is one of the finest in the world.  He can't talk much because he is awful busy.  But he is an expert on labral tears.  The main problem is the rest of the orthopedic profession has yet to catch up on hip arthroscopy, though it's gaining.  Doctors consistently MISSED this injury until the early 90s and too many of them still do.  So many of our fellow athletes go through OS after OS, PT after acupuncture or this or that, to no avail.  Labral tears do NOT show up on radiographs and are USUALLY missed even by MRIsthat's right, and even MR artrhrograms, which are pretty good, can miss 'em too.<br /><br />I feel your agony because my situtation is similar, though my tear is a small one that started and grew insidiously.  But like you I am an avid workoutaholic.  I'm not a pure runner, I've had to relegate it to a minor supporting role to my predonimant cycling and swimming.  But my workout routine was central to my life for some 25 years and I only missed on rare occasions until finally, on January 9th, I decided I better shut things down completely, the first time in my life I ever did something like that.  Huddled over my computer in my cold dark house I too was in both tears and disbelief, searching one of my few companions, the internet, for answers.  There are no qualified OS types out here (Mojave desert SE CA.)  I don't have health insurance either.  I felt by staying in that superb shape and health I might not need health insurance but now about the only thing I dare do is go 'crutching' and as you might well imagine that's not easy plus your legs aren't getting anything meaningful.<br /><br />Laura, until your surgery you simply must stop doing what you were doing.  Our bodies are not immortal machines.  To runand running is a lot harder than cycling or swimming and I've read many stories from runners who mess themselves up--we have to have enough parts functioning or some of us might destroy ourselves.  It sounds like you were in pretty bad shape by Dec. 6.  You may have more injuries than just one tear.  You may have underlying abnormality: the first thing you must investigate is whether or not you have impingement or dysplastia but by going to Philipon that will be taken care of.

I very much understood you when you said you canNOT tolerate lying in bed taking pain killers. I too cannot sit still. I'm learning to play the piano (although it's uncomfortable sitting on that bench) and, of course, endliessly searching the internet where you'll always find more than you expect if you know how to dig. But you must begin to build brand new routines slowly and carefully, remembering we all must crawl before we walk and respecting the rule of physics and health. We are not alone, I've found several people like us and I can direct you to other threads if you want.

I hope you're doing better and take care.

Brownie 'Cool Runner'
brownehn@yahoo.com

I can’t thank you enough for taking the time to respond to my desperate posts—I’ve pretty much given up talking to some of my friends who don’t hold the running and athletic mentality as highly as I do, not only in terms of physical, but mental, emotional, spiritual. I haven’t so much as touched a dumbbell since the ER incident—my muscle have turned to play-do. These last two weeks have been hours a day trying to just figure out this system with health insurance, PPT codes, in-network/out-of-network, etc. But, I’m going to do it. I am scheduled for the labral repair and ‘rim-trimming’ on Feb 8th with Phillipon. I had no idea how much his procedure requires in terms of the PT, five weeks for five ours a night in a passive movement machine, rotational boots, bracing—I’ve pushed as far as I can trying to extract information from insurance and I’ve decided to just go ahead with it and pray on the finances. I can’t get clear answers and the surgery and PT and machine rentals will easily go into a 35,000$ range. In theory, I’ll only be responsible for a few thousand, but that’s not something I’m delusional enough to believe. I figure I’ll be paying off graduate loans for the rest of my life anyway.

I just can’t imagine my life without running—my original goals were ultras. On Wednesday I thought that the insurance wasn’t going to work with me at all and I drove home, holding back tears, and then saw a runner out in our Colorado snow and knew his feeling—running ‘against the wind’ and I lost it….


It sounds like right now you don’t have insurance? It’s only because I easily see this being a brief stretch in my life when I do have insurance, I feel I must take advantage of it. I know that if I didn’t have health insurance, this wouldn’t even be an option to consider—It’s an absolute that getting this surgery done would be a death-wish if you go to anyone outside of the eight surgeons in the US who do this. I foolishly had bought into this idea that since the labrum is torn from one acute incident, that I could continue to run on it without worsening it—so over the next six months I ran two 1/2 marathons and one full and kept up hard-core with the weight training, and the pilates, which is a great strain to the hip-flexors. So, yes—if you’ve got this and can’t, for now, get a surgery—it does seem to bring us to the crossroads of: What else? You mentioned playing piano and I’ve also had folks tell me that I need to find something else that gives me what running did. I also loved middle-eastern dance and obviously can’t do ‘hip circles’ without even more pain than running would bring. In theory, I’m a ‘writer,’ and I’ve been trying to re-focus energy there, but it’s a whole different outlet. Still—I think any ‘art’ is the alternative. I’d love to hear how that’s going for you.

Anyway—I go up to Vail on the 6th, a full day of pre-op stuff on the 7th, and then three days of surgery and PT before I come home with my ‘machine’ and daily PT here. I’ve focusing on hydrating, supplements, juicing, and Epsom baths… My other concerns have been this anti-biotic resistant infection epidemic, but Steadman said they had one infection out of 4,000 cases. Additionally, because this is a ‘new’ surgery, there aren’t long term studies and I can go into a lot of fear about a ten-year affect on the body, but—I’ve certainly played higher stake games in my life before, so here I go.

I’d love to hear more—You mentioned other threads?  I can’t express how much I appreciate the support I get on this forum and the hands outstretched. Hopefully I'll be of service to others after I go through this processI just hope I have a positive outcome to report...<br /><br />I'm finally out of 'insurance' mode and just getting really scared of this surgery, and the choice I'm making with my body in Pillipon's handsless than two weeks...
Best, Laura

Hi:

surprised there is no one in the Boston area on your list--is there anyone you'd recommend?

Quote:

Philipon - Vail, CO (Steadman-Hawkins)
Bryan Kelly - NYC
Byrd - TN
Surina Baharam - NYC?
Kevin Mansmann - Paoli, PA
Sampson - SF
Klapper - LA (Cedars-Sinai)
Lawrence Dorr - LA

Good luck.

H. Browne aka 'Brownie' on 'Cool Runner'
brownehn@yahoo.com

Buzz,

How sure are you that it was a labral tear?

If it was--that is just fascinating, and I don't doubt that conservative treatment can work better than is generally credited here based on papers I've read; but my own experience, plus that with my torn knee meniscus, shows this process requires considerable time and rest, something inconceivable to most Americans let alone die-hard runners.

One other thing: you and your daughter might have an underlying congenital condition. She should check for impingement and dysplasia.

Brownie

OrthopodRunner,

Thanks so much for getting back. You have no idea how I appreciate it.

I need to know what, exactly, PT means. Also what you mean by cross-training. Scaling back I've already done, to an extreme. Here's what I've done so far.

Originally I only cycled, about 205 miles per week.  Without medical help I can't say what the exact details of the tear are but judging from some of the agony here and what I've read, it's probably anterior-superior and small.  Generally what I felt at its worstlate December early Januaryis a slight irritation which grows into a more annoying irritation; or if I hyperextend, sharp pain; if I abduct with flexion, that irritates and hurts out at the far end (80,90 degrees.)  But I've stopped doing these things and COMPLETELY shut down, staying on a walker or crutches most of the time, since Jan. 8, except for crutch-gallops, crutch-walks, and a little cycling on an ATB (not a racing or road bike) around the neighborhood.I have those little pedal-thingies but I only used them one day.

First my left knee started to tell me it can't take on the tough job of being the gallop leg so I stopped that (my left knee's torn meniscus is really what started this whole mess in the first place but after 6 months it had gotten back to maybe 75 or 80 percent.)  Then somehow my RIGHT knee woke up swollen and painful one morning.  Both feel like ligaments have been strained (makes sense though?)  The right leg is getting weak (also makes sensebut should we allow that?)<br /><br />My hip felt like it was improving,.  It's hard to objectively describe something so subjective, but it seemed to be almost like re-gluing itself and grew less severely irritablesomething I dunno. but I remained careful, staying within my limts, until today.  I went for a total of 9 miles cycling but also put weight on it walking a bit (to go to a meeting, run errand, etc.) and with a 20-lb. backpack.  It wasn't until I got back that I realized it's gotten worse a little, gone back to being irritable, sitting, etc.  I'd been ramping up the activity thiis week.

I can't say for sure I do or don't have OA issues in there but I can say I seem to have full ROM and then some (almost 180 degrees flexion, I didn't test the extension, sorry, at least 45 degrees lateral rotation, etc.) OPR, it's just that certain motions hurt or irritate and I avoid some now as a matter of course. I probably had at least a little OA before the injury, coming on fairly recently, like within the last 3 years or so and I only say that because I would feel a little looseness in my right hip when I would get up after sitting extensively--but that was the extent of it.

OPR I'm desperate to hear your analysis! Thank you so much!

BROWNIE

Ryan,

I am very pleased to meet you and feel free to venthaven't you read the rest of this thread?  Also I have at least two other threads full of storiesand lots of missed, incorrect diagnoses too.

First of all Phillipon is probably the premier OS for labral tears in the world. Many of the topnotch names reported are disciples or colleagues of his. You are in good hands with him; i.p. he will also check for underlying conditions that may predispose you to this type of injury.

My injury is right on the borderline and, like you, I have been trying to heal on my own for about four weeks now, because I don't have health insurance and a really qualified hip arthroscopist is probably nonexistent around here where I live, the CA desert.  Like you I'm an avid cyclist, also swimmer, and had been an occasional runner; like you, I like to push things and be fit although I don't do it fast or competitively at least in recent years.  You ask a great questionprobably now moot if you're going to see Phillipon, you really should if you can afford it, at least get his expert diagnosis.  It's really unfortunate what that one OS told you about the wheelchair etc., he is probably wrong but it might be believable if a patient were to keep going to all these OS's who don't know anything about labral tears.  I have read over 30 papers now and the bottom line is, this injury was CONSISTENTLY missed until the 90's and still is not widely understood nearly on the same level as other injuries.  These threads tell story after story of OS's telling people stuff like you heard.  Labral tears are much more common than previously suspected: a recent study in Europe found that ONE FIFTH of athletes presenting with groin pain had a labral tear.<br /><br />My tear developed insidiously.  Actually, it really begins with tearing my left knee medial meniscus.  For ten weeks I over-favored the left leg with a kind of peg-legging walk which put a lot of stress on the right hip, also I usually wore a 30-lb. backpack.  Shortly before I stopped favoring the left leg my hip had developed this slight irritation, which became rather noticeable Sept. 8th when I went to a dinner party; the hip had developed a slight ache by the next weekend; but after I stopped favoring, it seemed to slowly improve but never completely recovered.  I would especailly feel irritation when abducting the leg with some flexion (which lends a clue to the location of the tear.)  Then I started favoring the left side again though not peg-legging and it started to get worse again.  Then I had an episode where two thugs chased me on my bike (resolved peacefully), I did a lot of aggressive riding and had a minor crash; it's also possible that riding my ATB was slowly tearing it, what with lots of leaning of my thigh on the bar etc.this was early December. I was still so focused on the knee, which had improved but was still not 100 percent, that I didn't heed the hip until about 12 days after that chase it took a turn for the worse, more and easily irritated, even more bothersome while sitting in chairs, able to feel a little bit walking, etc.  Over the next 3 weeks I struggled to maintain my schedule, switching to swimming every other day but the swimming also probably worsened it, going from just irritating to painful and introducing a side pain in the buttock etc. etc., getting worse, kind of developing its own schedule as has been much documented by other sufferers in these pages.  I tried doing everything more and more carefully, toward the end trying to eliminate abducting moves, etc., walking slowly and carefully, etc. but finally on January 9th it seemed to me it was worse yet, with small occasional clicking and me avoiding any pivoting moves on the femur and so on, so out of fear and desperation I completely shut down for the first time in my life, after 25 years of hardiness, heartbroken and terribly alone, searching for answers on the internet.  Talk about venting, aye Ryan. .

Studies I've read are not very encouraging for 'conservative' treatment.  One reported 13 percent of his study did in fact pull it off successfully; however I also read a paper from a clinic in Switzerland that actually said if you don't have other issues, such as a paralabral cyst or OAI swear I'm not making this upsurgery is actually unnecessary.  I have made a lot of effort trying to ask these guys what their conservative treatment consists of, that could be incredibly valuable but so far have not heard back.  Believe me, you can't do better than Phillipon.  And studies, though recent, on success of the surgery, although in these threads we probably get the least fortunate exceptions, are very promising and now they are starting to actually repair the labrum much as they can with certain kinds of meniscal tears.  For example, I am quite confident a competent hip arthroscopist COULD fix me up in a jiffy, my tear is borderline.

But right now that is out of reach.  I'm trying to learn how to conservatively treat this injury (you may have noticed I've been asking OrthopodRunner) and so far it hasn't gone too well.  For one thing, I probably shut down too much, the lack of exercise is making my right leg weak and my knees aren't functioning properly.  At first I figured I could work out on the crutches.  NOT!  My left kneethat's the one that wasn't 100 percent to begin withcan't take it, I think I've got several ligament strains (ACL, medial, and even a little lateral) and it is telling me in no uncertain terms.  My righ knee also swelled up and suffered some ligament strain for some strange reason.  I just decided to dump the crutching; how in the world I figured that if I couldn't CYCLE, I could do THAT, which is almost as bad as running (the gallops), shows my ignorance for sure.  But by the 4th week it really did seem to be improving: more and more comfortable sitting, able to keep it quiet more and more, the symptoms growing kind of ghostly.  So what mistake do most people make?  I started ramping up the activity, cycling my ATB twice, walking on my own with my 18-lb. backpack on Saturday, a two-hour walk on Sunday. .and late Monday (yesterday) it was clear it had suffered a setback, again irritable and feels like that piece is loose and stuck somewhere.  For the life of me I can't say exactly what motions did it in, if any, although I'm beginning to suspect it was stupid not to use my road bike instead of my ATB, road bikes are the best, the purest motion.  Something about that ATB, probably my knees bowing to the side, intoduces just a slight side pull and I don't think I need that.

I am learning the hard way. . .

Brownie

Thanks OrthopodRunner,

You do at least make one good point. I'm not an expert and have NEVER experienced anything like this, so how do I know for sure it is just a labral tear. I'm a little leery of anybody in this place and I certainly don't want to go in there telling him what I think it is before he forms his own opinion, eg asking him 'can you diagnose labral tears?' I don't even know if they could do an MRa here--hm, maybe down in Antelope Valley probably, I could go there.

But I am curious, what other possibilities mighy you be thinking of?

BROWNIE

Orthopodrunner -- Thanks for being here on this forum.

I have an erie similarity in injury history to the above poster --
Knee meniscus injury followed by rehab and 18 months later a hip injury. Looking for advice on hip injury diagnosis and recovery/rehab.

RUNNING HISTORY -- Age 49. Runner for 28 years. Ran 10 miles, 3 times a week, 30 mpw for 27 years, very few injuries. Was a heel striker. Tore lateral meniscus playing volleyball, running sidelined for 7 months. Recovered and came back to gradually relearn to run differently in 2006, using Pose Method.

OLD KNEE INJURY

I originally had a torn lateral meniscus in July 2005, at first displaced for 10 days and could not extend to within 30 deg. of full extension. After 10 days tear slipped back, but went out off and on over 6 weeks until that was last incident.

However, still had ROM only to within 3 degrees, anterior joint line pain if force on top of knee to try to fully straighten or if accidentally tried to fully straighten while standing. That gradually went away over 6 -8 months (full ROM now).

Right after knee injury, I got an appt. for one of best OS in area. Scheduled earliest exam date for 6 weeks to see OS, at which time OS ordered xray and MRI, then radiologist confirmed oblique tear to outside of lateral meniscus. At the OS followup visit he said I had 3 choices - since tear wasn't in imminent danger of getting worse, I could either (1) wait and see if it got better on its own; or (2) get arthroscopic surgery. He said if it didn't get better, it would probably be a "heck of a nuisance" to live with it.

KNEE REHAB / RETURN TO RUNNING:

Well, knee did get better over next 6 months, got back full ROM eventually. Meanwhile, kept up 3 days per week, 100 min. per session of front wheel drive high resistance elliptical. Began 3 days per week jogging an easy 0.3 mi. X 5 sets on treadmill at month 2.5 post injury. But when I increased distance to 0.8 mi. x 4 sets at 3.5 months post injury, right away I had harsh bone-on-bone contact pain from deep inside joint near planar contact area of tibial plateau and femoral condyle, lasting for 3 to 7 days after. each time I tried running the heel striking way. Gave up running from month 3.5 to month 7 (did only 3 X 100 min./wk. elliptical).

In Jan. 06 started to learn to run on ball-of-foot by Pose Method. NO KNEE PAIN SINCE THEN. Running only 3 days per week, gradually worked up from 1/3 mi. X 3 intervals to 3 mi. continuous runs (by 4/06) to 5 mi. (by 8/06) to 6 and 7 mi. (by 12/06). All this time kept doing elliptical, but as running volume increased I cut back elliptical, ending up in Dec. 06 with 2 X 80 min./wk. elliptical sessions and 3 X 6 mi. runs each week. Throughout progress, I held mileage constant for every 3 - 4 weeks, then increased by only 0.5 mi. for each run. Also, with Pose Method, before each run I did 20 min. of intensive impact drills -- rapid foot drops, two 60 second sets each leg, and forward-weighted leg rapid lifting/dropping 45 second sets (more impact intensive than running).

RECENT HIP INJURY:

On 12/31, ran 6.7 mi. Not during the run, but starting 30 minutes AFTERWARDS, I developed strong pain with each weight bearing step, located in anterior of hip, feeling seems focused only to approximate location of femoral head or iliopsoas bursa and only the moment of weight bearing touchdown. Felt crippled like a 95 year old. BUT, NO HIP PAIN with any other activity --- either standing weight bearing while motionless, or sitting and rotating or flexing hip, or pressing on hip or groin, or when standing and lifting knee up.

Jan. 1 2007, first day after injury, pain in same area upon each walking step, serious but less severe. 3rd day, pain almost gone, just slight ache. 4th day, ran 6 mi., after which pain returned exactly as before, but less intense, lasting for next 2 days. Then ran 6 mi. again, 6 days after the initial injury, but once again pain came back as before for next 3 days. Rested 10 days, no running, just a couple days of elliptical and couple days of walking 2 miles. Very slight achiness when walking in anterior of hip. 10 days after that last run, on Jan. 17 I tried to run a slow and easy 3 miles. No pain during run, but strong pain developed 1 hour later with each weight bearing step. Serious pain next day or two. Stopped all activity and traces of pain/achiness in hip completely gone by 5 - 6 days.

Saw Primary HMO Dr. Jan. 19, he advised rest for 1 month, but didn't order xray or refer to OS for MRI or bone scan. Didn't "think" it could be a femoral neck sfx because I could walk without significant pain and pain was not all the time. He said I should NOT try any core strenthening exercises for a month, after that OK to try. But he wanted me to wait at least till 6 weeks before even trying a run, and even then limit it to less than 1 mile.

Right now I am only swimming and doing upper body weights, waiting for any elliptical or core strengthening workouts until I reach about 4 weeks after my last attempt to run.

Meanwhile, I am looking for advice on this hip problem -- should I ask my primary Dr. for an ortho referral even BEFORE attempting to run again so I don't further set myself back -- for example, to get the ortho to order diagnostic steps such as MRI or bone scan to rule out femoral neck sfx or show areas of edema or swelling near iliopsoas bursa, etc. Or maybe even order MRA if labrum is possibly indicated.

HMO may not grant me an OS referral if my symptoms are no longer active after 4 weeks rest since it went away by stopping my running. But if I restart a gradual progression of ellliptical, then drilling, and then short runs and the problem returns, I have just wasted a long period of time and set myself back to square one for recovery time. Not to mention if it is femoral neck sfx then there is a danger of possibly making a stress reaction or stress fracture worse.

[http://This message has been edited by rru2s (edited Feb-09-2007).|http://This message has been edited by rru2s (edited Feb-09-2007).]