Thursday, April 11, 2013

Under the Knife


On Monday I will have surgery on my right hip and two/three month’s later will likely have the same surgery on my left hip. It has been a long and painful road to get to this point, but hopefully this is my final path to becoming completely well again.

I have been dealing with pain in my groin and hip area for about 18 months. I’ve been to several doctors and followed a very conservative approach to fixing what was wrong. Unfortunately the hips and pelvis are an extremely complex area and it is very hard to properly diagnosis the source of pain, especially when there could be multiple pathologies. I would not say that I was misdiagnosed; it just took too long to find the proper cause of the problem. My initial diagnosis was osteitis pubis, which is extremely painful and was what first led me to seek medical advice. However, osteitis pubis was an effect not the cause of my problems. So after very conservative treatment of rest, PT and core strengthening did not show much improvement I received a very powerful steroid shot to the pubic symphysis (yeah ouch!!!). That was this past winter and it immediately took away quite a bit of the pain.

After the shot, and a bout with strep throat and the flu, I was able to run again. I started building up the miles and complementing it with biking and core training. I finally thought that I was starting to overcome my problems, when I woke up one morning with shooting pain in my lower back down to my upper hamstring. It hurt to simply walk. One of my doctors thought it was SI Joint inflammation, so I followed the standard conservative protocol. But not only did it not get better; the pain in anterior hip and groin was coming back. After doing some research I found a hip specialist who has treated many professional athletes including marathon runners and went to see him for an opinion.

He ordered another MRI, this time an arthrogram (where they inject dye) as well as a cortisone shot into the hip joint. The MRI revealed a deformity known as a Femoral Acetabular Impingement (FAI) caused by a CAM deformity; basically the ball of my femur in my hip joint is shaped funny and has an extra knob of bone on it. This was causing chronic labral tearing. Additionally, my sacrum, which is the bone next to the SI Joint had a fracture. According to the doctor, my impingement was causing strain around the entire pelvis – pulling it apart in the front leading to the osteitis, and compressing it in the back leading to the SI Joint pain and stress fracture. Not very good news, but at least I have a diagnosis.

CAM impingement ,Saint Louis, Missouri
This is basically how my hip is shaped, they need to shave down the extra bone

I basically had to limit all activity to allow the fracture to heal and scheduled hip arthroscopic surgery to reshape the hip joint, remove the impingement and repair the damage to the labrum. I will likely have to have the same procedure done on the left hip as soon as my right hip is recovered enough. Unfortunately, they cannot do both at the same time because you have to have one stronger leg to properly rehab.

After the second surgery I will have at least 10 weeks of intensive physical therapy in order to re-teach my body proper running mechanics. I have been dealing with this for so long and overcompensating for the injury that they will have quite a bit to fix. The good news is that my surgeon has a 95% success rate in returning athletes to competition. So baring any setbacks, I should be back running by the Fall and slowly begin to regain my fitness.  

This has obviously taught me quite a bit. Hip and groin injuries are nothing to mess around with and there are very few experts in this area. You really have to do your research. The body will only let you compensate for so long. Being an ultra runner you get used to pain; dull, achy pain is very common in this sport so it is easy to overlook the beginnings of a much larger problem. I had to go and actually break my back before I finally found out what was wrong.

I really have to thank my family, especially my wife, for putting up with me through all of this. Yes I get cranky and a bit nasty when I can’t run, but I am even worse my activity is completely limited. I have a million interests and lots to do, but nothing brings me peace and balance like running. I also have my two boys who can’t wait to go running with me again. I am confident that I will be able to run again and hopefully at the same level I was at before. Sometimes the path is hard; we can either dwell on how hard it is or put our head down and push through. To borrow a phrase “it never always gets worse.”

This is a running blog and obviously with my lack of running I have not had a lot to post, but I will periodically post about how my recovery is going. Also I have done a lot of research on the hip and groin (pretty much read every scholarly journal on FAI, hip impingement, groin disruption, osteitis pubis, sports hernia, and athletic publagia), so if anyone has any questions or thinks they might have an injury, I’d be happy to share what I’ve found out – email jeremy.pade@gmail.com


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