Hip Impingement was Re: Inguinal Hernia

[DuncanM]

One week on - I think the hip is basically back to how it was before.  Slightly less clunky, but slightly more groin pain (which is my main symptom). I didn't ride on the weekend as I wanted to take it easy after my covid jab. Hopefully the weather will be good this weekend and I can try it then (though given walking hurts I'm not hopeful).

I saw the physio today - he has essentially run out of stuff for me to do! My hip flexibility has improved, the various things I'm supposed to strengthen are stronger, my balance is OK, so he's essentially going to wait until the docs have seen me and decided what they want to happen next.

[DuncanM]

I sent an email to the docs asking if they wanted to bring my appointment forward, given the injection had been. They declined.
In other mixed news, I'd not done much except my physio exercises all week, and I was beginning to feel like my hip was actually OK.  A short (3000 steps or so) walk with my daughter disproved that, and now it's sore again.

[DuncanM]

They encouraged me to ride my bike and see how it was, so today I went for a half hour ride (first time on a bike since November).
No change really - the hip flexor got a bit tight but then seemed to loosen off, the groin got more sore as the ride went on and it and the lower ab are still sore a couple of hours later.

I'm utterly fed up with the whole process. If it were just cycling, I'm at the point where I'd give up and do something else. But walking etc are just too fundamental to stop.

[chrisbainbridge]

Duncan I wonder if you have seen this? https://cyclinguphill.com/personal-experience-of-fai-what-worked/ sounds very similar to your pain and obviously the same area.  Might give you some extra ammunition to push towards trying something different.

[DuncanM]

Duncan I wonder if you have seen this? https://cyclinguphill.com/personal-experience-of-fai-what-worked/ sounds very similar to your pain and obviously the same area.  Might give you some extra ammunition to push towards trying something different.

Thanks for that link - I hadn't seen it. It sounds very similar to my situation and diagnosis, except I have no labral tear. I'm actually seeing the same group of doctors at the Nuffield, and reading between the lines I've been following the same path as Tejvan (MRI, physio, hip injection). I'm really not keen on the surgery, and I'm still unconvinced that the cam is the root cause given I can basically trace the start of my symptoms to resuming training after a significant foot injury, but I will wait and see what they have to say at my appointment in June. I'm going to continue with my physio exercises, though I don't think they will help with the FAI they should make me stronger and more flexible (it's basically the same as going to the gym).
There are loads of resources out there about FAI, some recommending surgery, others not - this one seems one of the most vociferous about treating it as a muscle issue rather than a bone structure one https://www.thefaifix.com/ I've watched a lot of their videos with the requisite seasoning, but their mindset meshes with the way I think about it, so I may explore their program before surgery if that is what is suggested as the next step by the consultant.

[chrisbainbridge]

It is not an area of the body I know anything about but I have followed Tejvan for quite a few years through his pain and now out the other side. He seems very approachable from what I read.
Good luck.

[DuncanM]

Thank you.
I'll definitely read out to Tejvan and see if he can give me any pointers. He only posted that yesterday, so that explains why I didn't see it in my googling earlier this year. Reading between the lines in the conclusions it sounds like he tried the program I linked to as well.

[barakta]

Hip stuff does seem to be prone to mixed diagnostic outcomes. I have FAI associated with hip dysplasia and my surgeon suspects I have a labral tear on the right side at least. Many of the folk in my FB hip dysplasia community (amazingly well moderated, so not shit) have had years of issues, various misdiagnoses etc and only when they got sent to young hip specialists did anything get untangled.

Matches my experience, I've had classic symptoms my ENTIRE life but they have been missed by several clinicians including orthopods and physios (admittedly arm specialists x2 who really ought to have sent me to leg bods). Young adult hip service in Birmingham's ROH were very quick to spot the issues, helped by them reading my pre-provided history and probably a sneaky (encouraged by me) google of my syndrome.

[matthew]

I agree, my hip issues started in circa 2004, there is a family history of hip problems and my joint became very clicky and sore. Initial investigations were cursory and inconclusive but because I had coping strategies it went no further.
When I had a further flair up in 2010, I finally managed to get to a orthopod who was comparatively young and got the MRIs, FAI and a suspected Labral tear. By the end of 2011 conservative management had failed and I did have the arthroscopy. Surgery showed that there was no Labral tear but I have to say that removing the cam and cleaning out the joint was highly successful.

I agree that subsequent issues have probably been caused by overly tight muscles and are a good reminder to continue the various stretches and core exercises.

[DuncanM]

Tejvan sent a 1 line email back giving the name of his surgeon - I assume he was busy.
I checked with the physio, and he was happy for me to join the local gym and push the exercises further. I had massive DOMS (mainly hamstrings and adductors) for a couple of days after my fist gym session, and my hip was OK, but since then I've been back twice, and while I no longer have DOMS, my groin hurts again. I reckon this is the same phenomenon I noticed when I hurt my back earlier this year. I've got a month before my next consultant appointment, so I'm just gonna hit the gym, try some swimming (can't breast-stroke anyway because it hyper extends my knee), keep up my stretching, and see where I end up.

I'm also wondering if I should try an e-bike and see if that would allow me to commute by bike even with my hip causing issues.

[DuncanM]

I tried riding again on Friday because it was such a nice day. It's just about OK if I pootle along at no mph, but if I have to go uphill or try to go even vaguely quickly it hurts.
The gym exercises are going OK and I'm getting stronger, but it's not making any difference on the bike. I've not been in the pool yet, due to motivation issues.

Consultant appointment is on 9 June, which is one year (minus one day) since my first in-person appointment at the OxSport clinic.
 

[DuncanM]

Video consultant appointment today.
He said there was basically 2 routes available:
1. Referral to the hip surgery team to see if they could do something for me. There is some wear and tear in the hip, so that might not make me an ideal patient for them but that would be something for them to look at.
2. In person appointment together with X-Ray to see more clearly the bone issues in the hip and also with the lower back - the connection and potential for referral is significant (he said that rowers often complain about their backs when it's hip restrictions that are their problem).

I've gone for option 2, because I really don't fancy the surgery unless it's necessary. I'm going to continue going to the gym, and he suggested I could try pilates and swimming to see how it reacts to those (and pilates in particular can help me control the small muscles in the hip area). He also suggested I could take painkillers and ride my bike and see how that goes (not long term, but to see how it works).

I'm thinking I might subscribe to TheFAIFix and give that a go over the summer.
On a slightly tangential note, I've had lower back issues on my right hand side since I was a teenager - I wonder if that's when the hip impingement started.

[Tynan2]

Yikes, good luck fella, keep trying and going.

[mrcharly-YHT]

Tejvan sent a 1 line email back giving the name of his surgeon - I assume he was busy.
I checked with the physio, and he was happy for me to join the local gym and push the exercises further. I had massive DOMS (mainly hamstrings and adductors) for a couple of days after my fist gym session, and my hip was OK, but since then I've been back twice, and while I no longer have DOMS, my groin hurts again. I reckon this is the same phenomenon I noticed when I hurt my back earlier this year. I've got a month before my next consultant appointment, so I'm just gonna hit the gym, try some swimming (can't breast-stroke anyway because it hyper extends my knee), keep up my stretching, and see where I end up.

I'm also wondering if I should try an e-bike and see if that would allow me to commute by bike even with my hip causing issues.

I'm not surprised you are sore if your gym session was all about fisting.

[DuncanM]

Physio appointment today. He gave me an extra stretch for my foot, and also suggested adding side plank raises into my gym routine, but is otherwise basically out of suggestions. I asked him whether it was worth trying shorter cranks to crunch my hip up less - he was intrigued but hadn't seen it done to help people with hip issues, only on people who have knee problems (or even prostheses).  Also, he's moving jobs, so I'll have another physio next time I go.
I may see if I can get a go on a bike fit jig and try shorter cranks. Road cranks from the major brands don't seem to go down below 165mm, and everything else is significantly more expensive, so I don't know if it's worth shelling out the money to see if it makes any difference.

[Kim]

I may see if I can get a go on a bike fit jig and try shorter cranks. Road cranks from the major brands don't seem to go down below 165mm, and everything else is significantly more expensive, so I don't know if it's worth shelling out the money to see if it makes any difference.

You can get bolt-on crank shorteners, at cost of an increased Q-factor.

[Auntie Helen]

Or you can drill secondary holes for the pedals in your existing cranks - this was done for my velomobile.

[Kim]

Or you can drill secondary holes for the pedals in your existing cranks - this was done for my velomobile.

That's approximately as expensive as getting cranks shortened thobut.

And, at least on an upright, you probably wouldn't want to use the original holes again afterwards.

[DuncanM]

The existing (road bike) cranks are Hollowtec. They have enough trouble staying in 1 piece without someone drilling holes in them (and none of the professional units will touch them for that reason). It's possible to get Shimano 105 in 160mm as well as 165 and up. They are about £160 though, and that's a lot of money for guesswork experimentation.

I have 2 sets of 165mm cranks, but both are square taper, and that's not going to work with the pressfit BB shell. I've been considering turning the fixie (which has one of those 165mm cranksets) from it's TT spec back into a general purpose machine, but I don't really want to find myself out on a ride with hip pain on a fixed. I guess I could stick the other 165mm cranks on the MTB - that has square taper. It's not a very well designed experiment though - the Q factor, saddle, and bike position will be radically different.

I've booked a fit session with BikeFitJames from bicycle.Richmond 'cos he seems to understand both bike fitting and unusual feet. Sadly, the first one available was in September.

[DuncanM]

Well that went well. 
I got my MTB out, put a saddle on it, set the seat height and checked that it all worked properly.
Then I took the pedals off (I learned my lesson about doing that before I take the cranks off), took the current 175mm cranks off,  and,  they are not square taper.  They are some random Truvativ splined system with spines on both the drive and non-drive side. So that's no good for me to experiment on either.

[DuncanM]

I've been to the gym once in 3 weeks now. My hip is unchanged. I am feeling a complete lack of spoons to go, if it makes no difference.

[DuncanM]

I finally signed up to The FAI Fix program, and did the introductory videos and the testing. They basically get you to test flexion, extension, adduction, abduction and internal and external rotation. I failed 2 of them noticeably, and most of the others I was meh at. Later I'll see what the exercises prescribed for the 2 I failed (extension and internal rotation) and give them a crack. It will be interesting to see how different they are to the physio provided ones.

[DuncanM]

New physio, new exercises.
He didn't seem impressed with my choice of Internal rotation exercises from FAI Fix, said they would irritate my hip. I'm not sure how one is supposed to get better at internal rotation, if you don't exercise it though! The extension ones basically match (though there are subtle differences on the physio side to avoid using hamstrings/lower back).
Typical NHS physio program - "how many exercises do you want?". My answer is as many as you can give me, but surely that's the wrong question. I guess it's because most of their patients don't follow the plan, so they would rather give 3 exercise that people will do than 6 that people won't. 
Will do them for a couple of weeks and report back.

[toontra]

Typical NHS physio program - "how many exercises do you want?". My answer is as many as you can give me, but surely that's the wrong question. I guess it's because most of their patients don't follow the plan, so they would rather give 3 exercise that people will do than 6 that people won't. 

I've always thought that being an HNS physio must be very dispiriting, suspecting that 90% of your patients will not do the exercises you prescribe.

[chrisbainbridge]

I have no expectation that people will do exercises.  We all do remedial exercises until the pain eases/settles to an acceptable level for us then we stop.  Life is too busy.

The correct question is actually "Is physiotherapy of any economic value?"

I know of no study which shows a true economic benefit to physiotherapy.  I think physio is really helpful after certain operations where a controlled level of exercise (usually painful) is required.  For most other things physio is an expensive placebo effect.

Extended scope therapists are incredibly inefficient compared to a doctor but do increase the overall number of patients seen by a small amount