My hip labrum tear and FAI story

This is my story. I’m choosing to tell it because there isn’t a lot of information out there on pain from a hip labrum tear and FAI.  My “journey” has been a challenging  and frustrating one, with many days filled with pain and the mental downward spiral that many people in chronic pain experience… “Will this ever get better??” “Am I going to feel this way the rest of my life??” The irony is that I treat pain for a living, and nothing I tried helped.

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My daughter, Guinevere, was born on December 11th, 2013. It was the most incredible day of my life, and such a great experience giving birth to a little human. I had a perfect pregnancy – no headaches, no real back pain, no morning sickness. I gained a few more pounds than I should have, but regular exercise kept me mobile and relatively pain free as a pregnant massage therapist. Because I had a physically demanding job and was on my feet for 8+ hours a day, I was diligent about stretching, wearing compression hose, sitting between clients and putting my feet up, and doing yoga at home and attending prenatal barre class on the weekends. I ate well and took organic prenatal vitamins. And I ate a lot of Thai food.

My delivery was great, no issues  at all. When I finally dilated to 10cm, I pushed for about 40 minutes and she was born! But in the weeks after I started to notice a few weird things in my body that didn’t feel right. Granted, I had never had a baby before, and had never experienced that trauma. I thought every woman had experienced what I was experiencing. I had incredible lower back pain in my lumbar erector spinae (spinal) muscles – they were in spasm and felt like rods. My left front thigh (Quadriceps) was in spasm and I had an intermittent burning pain down the front of my thigh, lower leg and top of my foot, but it was only when I was in certain positions. I had no stability in my back or left hip – I clearly remember around week 2 or 3 kneeling down with my daughter in my arms to pick something off the floor, and I couldn’t get up. I had no strength and my hip felt wobbly. When I finally did get up, I almost fell to the floor. At that point I assumed that my ligaments were still lax from the relaxin hormone in my system with pregnancy and delivery, and it made sense that my body was still put together with what felt like wet noodles. I mean, how else does your pelvis split apart to let a watermelon pass by??

After a few months of having the same instability and burning sensation in my leg, I decided to start physical therapy. Over the next few months I worked on strengthening my glutes and decreasing the spasms in my anterior (front) leg and pelvis and bilateral (both sides) lower back. We strengthened and dry needled, I received Neuromuscular Therapy and acupuncture treatments to help with the spasms, and yet the pain continued. Once I had finished with my PT sessions, I continued to do my exercises at home and continued receiving regular acupuncture sessions. I also began strength training sessions with two personal trainers who focused on functional movement. Since my body was clearly dysfunctional, and they had come highly recommended by my PT, I thought it was a good fit. And it was, they were awesome. But my body was not. Every time I pushed myself with exercise, my back and leg pain would flare. I would sometimes have incredibly weakness in my left leg and spasms so intense that it felt like my muscles were made of metal, so back to PT I went.

At one of my OB/GYN appointments (about 9 months post-delivery). I mentioned that I had been getting hot flashes and sweats and my doctor ran a hormone panel. Even though I was in my later 30’s with my first child, my tests indicated that I had used up my hormone reserve, and my symptoms were likely peri-menopausal. I decided to try supplemental hormone therapy and she started with testosterone bio-identical pellets. (who knew I would be starting HRT at 38…!) Magically I felt like the Energizer bunny with new batteries – a dry bunny, with no hot flashes who could sleep well and whose mind was clear. It was great!

Over the next few weeks I noticed that my strength was returning. I had fewer back spasms and fewer burning pain episodes after workouts, or after long days working with clients. I continued with PT and NMT and acupuncture. In PT we uncovered another major contributor to my burning leg sensation  – an extremely tight psoas muscles. The psoas is the primary hip flexor in the body – it attaches to the front side of the lumbar spine, weaves through the pelvis diagonally and attaches onto the upper, inner portion of the thigh. When the muscle contracts, it pulls the hip into flexion and brings the knee toward the chest. Just like the traditional labor delivery position…. ding, ding, ding!!! And also pulls the lumbar vertebrae forward when tight. And guess what? The femoral nerve of the leg runs right under it, and the nerve pattern was the same sensation as I was experiencing. Intermittently. With movement. Ah-ha!!

Our next few months of PT concentrated on releasing psoas and quads, on improving hip joint mobility and again strengthening glutes to support my pelvis and restore proper gait and movement. I once again felt strong enough to start strength training again, and even felt strong enough to try some of the functional group classes the gym offers. And again, because I felt a lot better, I pushed myself again… and again I started having leg weakness, pain and burning and muscle spasms. And then, I started having pain deep in my hip joint -in the front and on the side and sometimes in the inside close to where my adductors attach. Some days it was tolerable and some days depending on movement the day before it would be a sharp, wincing pain that made it difficult to walk. The Neuromuscular Therapist in me started wondering if my hip had structural problems – my internal rotation at the hip was very limited and the pain had started interfering with my work and exercise. I also started remembering the basic principles of pain perception… the brain can only process so much pain at once. It only senses the most acute layer or two, and even though you may have pain in other areas you are likely not to feel it as much . And so it makes sense that as my psoas and Quad muscles began to have less pain that I would start feeling pain somewhere else.

Before returning to PT, I decided to go see a Physical Medicine physician that I knew well and get her opinion on my scenario. She did a functional test of my leg and evaluated my nerve and neurological response and ordered an arthrogram of my hip, which is a contrast MRI where they inject dye directly into the hip. “I think you have a labrum tear, but we’ll see what the MRI has to say.” Yikes. The labrum is the o-ring and suction-cup cartilage that lines the inside of the hip socket and provides protection of bone on bone movement in the joint. It is commonly injured in sports where there is deep hip flexion. But childbirth with deep hip flexion is a sport too, right??

Sure enough, the MRI showed a small labrum tear and also femoroacetabular impingement (FAI). FAI is a congenital bony defect in either the acetabulum (pincer type) or shaft of the femur (CAM type), or combination of the both. Lucky me, it appears from the MRI that I may have a combo, but the CAM type appears to be small. So, good news/bad news…. Good news: I now have a really good idea why my hip has been unstable for so long and why I’ve had muscle spasms in the psoas and Quads (muscle contracture trying to provide stability around the joint). Bad news: It requires arthroscopic surgery, so she referred me to an Orthopedic Surgeon who she trusts implicitly and who has extensive training and experience in this procedure. Why is that important? This surgery is relatively new (under 10 yrs) and not everyone does it. It is technically challenging for the surgeon, and some insurance companies still consider it experimental. The surgeon closes the labrum tear with a hook and loop stitch and then anchors the string with what looks like a plastic drywall anchor into the pelvis. To correct the FAI, they take what looks like a dremel and shave down the extra bone. All done through viewing with a microscopic camera inside the hip joint!

I met with the orthopedic surgeon the following week and he took detailed X-rays of my hip in his office. He explained the tear and also the type of FAI I have, and also told me that I have a retroverted acetabulum, meaning the hip socket is positioned further back than normal, but not deep. An article online called it a form of hip dysplasia (which my 18 year old cat has!). In my 14 years of Neuromuscular training and experience, I had never heard the term, but apparently it poses some challenges with activities in hip flexion. He did not force me in to surgery, he could inject some cortisone in the joint to decrease pain for a few months, but it was a band-aid. He recommended having the surgery sooner rather than later, especially being I have had this tear for almost 2 years. The longer I wait, the more risk I run of degeneration starting  in the joint, which would set me up for a hip replacement earlier in life. And, if I’m planning to have Baby #2 in the future, I will need a C-section. 

I went home, talked with my husband, did more research and watched some YouTube videos on hip labrum and FAI surgeries, and decided to get surgery scheduled sometime in December. The recovery is difficult – no weight bearing on the leg for 2-3 weeks (crutches), no driving for 2-3 weeks, PT 3 x week for a while,  and no work for 6-8 weeks minimum.  Full recovery happens within 3-6 months. While I’m not excited about having surgery, I am very happy that there is a solution, and I’m hoping this is the missing key I’ve been needing to get back to the things I love, and to not be in debilitating pain.

I am scheduled to have surgery in two weeks, on December 15th. I will be blogging about my experience with surgery and recovery because there really isn’t a lot of information out there, especially from the aspect of childbirth. I have every confidence in my surgeon and my after-care PT/NMT team to help me recover and progress as quickly and as well as possible. Stay tuned for more updates!

~ Rachel Carroll

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15 thoughts on “My hip labrum tear and FAI story

  1. We’re all pulling for you Rachel and will be anxiously awaiting your post-surgery updates. Sorry that you’ve been through so much and have been in pain this long while simultaneously doing everything you possibly can to relieve your clients’ pain… I had no idea the extent of it. Thanks for sharing your story!

    1. Thank you, Leslie. This was new news to most of my clients. As a professional treating pain, I made an effort to never bring my own pain complaints and challenges to my sessions. I appreciate all the support, and will certainly be posting my progress for all to learn from.

  2. I know it’s been awhile since this post but thank you for this!! 2016 was a horrible year that began with an injury no one could figure out. Just finally getting to the bottom of it all. I have Ehlers Danlos Syndrome (joint hypermobility) and the injury to the labrum caused my loose SI joint to start slipping (and I have a mild bulging disc). These covered up the hip injury which was the “real” underlying cause of the other. What a disaster! Nothing we tried worked, just like you! Finally will be scheduling surgery to fix the FAI and labral tear. I will have a complicated recovery due to the EDS pulling the SI joint out and the disc bulge doesn’t help. Thanks for your frustrating story to figure it all out. It hits home for me!! At this point I am ecstatic to have something that is surgically fixable! Excited for surgery…yeah, you probably understand that.

    1. Casey, Thank you so much for sharing your story! It can be a frustrating journey, but thankfully there is a surgery now for this type of injury! I am doing great 13 months post-surgery, I hope that gives you comfort! Honestly, having the best surgeon, the best PT who is well-versed in rehabbing this surgery, and soft-tissue muscle work is your best combo for a quick recovery. Please keep me updated, and best of luck to you!!

    2. I also have FAI and a torn labrum. Nothing non-surgical has worked for me, and the pain is excruciating and life limiting. I am only 36 years old. Because of my Ehlers-Danlos Syndrome, Aetna is refusing to pay for the surgery. They are the only major insurance company that excludes all EDS people from getting this surgery. I am devastated and feeling hopeless.

      1. Hi Carrie,

        Thank you for sharing your story – I’m so sorry to hear that you are going through this. I work with several people with EDS, and I know how challenging the syndrome is, and I can’t imagine the pain you are in with your hip on top of the EDS. Have you tried a PT that specializes in functional physical therapy (SFMA approach)? Or can I help find a Neuromuscular Therapist for you to work on the soft tissue? Please let me know.

        ~Rachel

  3. Hi Rachel, Thank you for your post. I am interested to know if your surgery has helped the burning symptoms down into the lower leg and top the foot? Did it also resolve the back pain? I hope you had great success with your surgery. Cheers

    1. Tracey,

      Yes! Surgery resolved all burning pain down the front of my leg and foot, likely referral from the labrum or impingement with nerve. It also resolved the back pain, but it was most likely biomechanical – erector spinae group and multifidus were overworking and trying to stabilize my back and pelvis because of an unstable hip joint. That’s my best guess, anyway. And No lower back pain since surgery and rehab with PT. Thank you for asking!

      ~Rachel

      1. Hi Rachel,

        I know it’s been a long while since your surgery but glad I found your blog! I have had excruciating back pain for a decade and increasing hip pain. A dr finally figured out I needed FAI and labrum tear surgery with bone spur shaving and arthritis damage shaving. It’s been 4 months and I’m still in agony in my lower back.

        Judging from what you said about hip instability probably causing back pain, it makes sense that might be what’s happening to me too. I’m wondering what I can do next to help my back pain (I have FAI and tear on opposite hip too no surgery yet). I’m 48 now and wondering also if THR might be the solution for me at this point. I can no longer sit for over an hour and work from home now PT. This is a life-changing disorder!

    1. My surgeon was Tim Bert, MD. He was at Hedley Orthopedic in Phoenix but has since taken a position at Mayo Clinic in Rochester, I believe. Jimmy Chow, MD is now doing the hip labrum repairs at Hedley now, and he is an amazing surgeon.

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