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.
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