Author Topic: Hip Impingement was Re: Inguinal Hernia  (Read 8590 times)

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #75 on: 10 August, 2021, 01:29:24 pm »
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
I guess the question would be about the purpose of physio sessions.
For me, it's a post-injury thing to allow me to resume sport, so I'm going to do the exercises until that point. Hopefully the sport (and the training thereof) will provide enough activity that I don't revert, and if it doesn't I'll have to do some sort of maintenance regime. For my current injury, the alternative seems to be surgery (if possible), so I'd rather try non-invasive treatments first, and if they fail then hopefully they will be effective pre-hab.

Chris
I know you are a hand specialist - do you prescribe physio for patients? If you do, what outcomes are you looking for? And are there any circumstances where you would choose to go see a physio yourself?

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #76 on: 10 August, 2021, 01:39:22 pm »
Chris
I know you are a hand specialist - do you prescribe physio for patients? If you do, what outcomes are you looking for? And are there any circumstances where you would choose to go see a physio yourself?

I prescribe therapy all the time.  I have 3 reasons for prescribing therapy I think:
To get the patient out of my clinic whilst I think about their problemsm
To assess the patients pain or disability in a more formal fashion and for a longer period of time than I can in a clinic (in order to plan appropriate treatment strategies)
To show the patient exercises or movements that will allow them to carry on with their job by altering the way they do things (activity modification)

I generally go to a chiropractor I know and trust when I get my bad back (every 4-5 years). I do a regular Pilates class either online or in person for my core.  I have added in micro-workouts in the last month which I think are helping with overall strength.

I do think that physio is really good for showing exercises and stretches when people do not understand their own anatomy.  I like Pilates because it is in my experience more functional and seems to have slightly higher expectations of people.  Pilates seems to look at everybody as a ballet dancer if they want to be and being private if it does not work people do not go back.

I love my physios but recently they seem to just be proliferating with little benefit for patients.  If you can deliver physio perfectly well by video, do you actually need therapists?

rant over

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #77 on: 10 August, 2021, 01:44:58 pm »

I love my physios but recently they seem to just be proliferating with little benefit for patients.  If you can deliver physio perfectly well by video, do you actually need therapists?

rant over

I think so. After her second hip replacement, my wife was, uncharacteristically, struggling.  She went to a local physio (one affiliated with Halton Tennis Centre). He was able to test her issue, give her exercises, and demonstrate improvement - this involved an air bladder under the back of her kneee that she had to press onto.  A pressure gauge showed the force she was applying, and of cousre the improvement she made over time.  That can't be done over video.

In addition, like you, my wife does Pilates. She's working a lot harder - and more correctly - now they're back in the studio and her teacher has eyes on.
We are making a New World (Paul Nash, 1918)

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #78 on: 10 August, 2021, 01:48:15 pm »
Agree with all of that.  I've been doing Pilates for 16 years and have no doubt it's had great benefits.  It really should be available on the NHS for those willing/wanting to try it as it could head off debilitating immobility later in life.  Most exercises can also be done by almost everyone, albeit at different levels of intensity.

Perhaps this could be funded by diverting some of the current physio budget, which I suspect has poor outcomes in many/most cases (not the fault of the therapists themselves!).  I'm sure it can work for those motivated like Duncan (and me!) but I sadly I think it may be the minority.
The sound of one pannier flapping

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #79 on: 10 August, 2021, 03:12:03 pm »
Agree with all of that.  I've been doing Pilates for 16 years and have no doubt it's had great benefits.  It really should be available on the NHS for those willing/wanting to try it as it could head off debilitating immobility later in life.  Most exercises can also be done by almost everyone, albeit at different levels of intensity.

Perhaps this could be funded by diverting some of the current physio budget, which I suspect has poor outcomes in many/most cases (not the fault of the therapists themselves!).  I'm sure it can work for those motivated like Duncan (and me!) but I sadly I think it may be the minority.

All of these things work for the motivated and do not work for the unmotivated.  If I have back pain I have difficulty riding my bike, doing my work, etc so i am motivated to exercise. 

If i have a belief that work causes all my problems and that I am an innocent bystander in my life then i am not motivated to work and will get a sick note.  Pain and disability to a large extent really are biopsychosocial phenomena.

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #80 on: 26 September, 2021, 12:56:54 pm »
I've been doing all my physio exercises regularly (though I got fed up with the pilates I tried, so I've not pushed that as far). Today I went on an exploratory bike ride and it was basically the same (no surprise - it's the same in the car or sat in a chair as well).
I have physio again on Tuesday, a bike-fit at Bicycle Richmond on Wednesday, and a consultant appointment a week Wednesday, so it will be interesting to see what the outcomes of all those are. (I need to book an appointment at the podatrist as well.)

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #81 on: 29 September, 2021, 03:49:10 pm »
The physio was happy with the strength progress I'd made. He has given me different exercises to continue to work the glute medius and assorted surrounding muscles.

The bikefit was really interesting. Lots of questions to start, then measuring/mobility checks, then lots of riding the jig, adjusting it, riding it, adjusting something else etc. We spent a fair bit of time on the shoes/insoles as might be expected. End result - new insoles, cleat wedge, new saddle, bars, stem. Changed saddle height (down a bit and forwards), and shortened reach with the bar/stem change. All these changes basically meant my pain went away, so while we tried a different crank length, it wasn't deemed necessary to spend the money - might be worth trying the 170mm cranks if I still have issues riding outside. The video was pretty clear about how my original position was sitting me too high, resulting in me leaning to my left and over-extending my right leg, so much of the initial saddle adjustment was about correcting that before anything else.

Oddly, while the pain had arrived after a bit of pedalling, and was gone after the saddle adjustments, it came on after about 20 minutes in the car going home. Gonna continue to do my physio exercises and try riding my bike with the new setup on the weekend.

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #82 on: 29 September, 2021, 04:07:33 pm »
Sounds encouraging  :thumbsup:
The sound of one pannier flapping

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #83 on: 04 October, 2021, 09:37:29 am »
Bike ride yesterday, no groin pain during. :)
I could feel the glute on the right working, and the position still feels a little unfamiliar (and also I can't really turn my heel in like I used to). As well as the absence of pain, I was more comfortable as well (saddle better, hoods closer).
I got a few twinges in the hour or so afterwards, so I guess I need to stretch more and keep doing my physio exercises, but I remain kinda hopeful.

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #84 on: 06 October, 2021, 11:41:38 am »
I saw (another) consultant today. That's 5 now, never the same one back-to back.
The appointment today was really short - she listened to my tales of improvement from bike fit, today checked out my hip movement and then basically said she didn't think that they could do anything for me, it sounded like I was moving in the right direction, and so they were going to discharge me with the ability to re-open the case if I get worse. And that I should continue with the physio until they discharge me, which is separate.

I think I'm in that annoying intermediate stage, where surgery is way too extreme, but the non-surgical stuff can't fix the problem entirely, so they don't really know what to do with me.
She did say I can ride my bike more, and also do some running or other exercises if I want, just build up slowly. We'll see how it goes I guess.

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #85 on: 06 October, 2021, 10:52:38 pm »
It is highly unlikely you have seen 5 different consultants. If the clinic visit  has been on the same day of the week then you may have seen 1’consultant and 4 trainees or 5 trainees.

You have been given an open appointment. This basically means “get lost, I have no idea what to do” but they cannot be bothered with all the emotional angst of actually discharging you.

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #86 on: 07 October, 2021, 09:09:44 am »
You are right, I have seen 3 consultants (of the 4 in the team) and 2 registrars. Different days, spread over more than a year.
And yeah, I understood the subtext. I was wondering if the physio would have stopped if they had discharged me, whish is why they didn't, but it makes very little difference.

Kim

  • Timelord
Re: Hip Impingement was Re: Inguinal Hernia
« Reply #87 on: 07 October, 2021, 11:47:20 am »
I thought people got discharged automatically these days.  Certainly barakta's had letters to the GP to the effect of "We're discharging her cos policy, but please re-refer immediately because the physioterrorism was just starting to work."

Lurking on a consultant's list ad infinitum because you've got a condition that's clearly going to flare up or deteriorate eventually doesn't seem to be a thing any more.  I blame metrics.

Auntie Helen

  • 6 Wheels in Germany
Re: Hip Impingement was Re: Inguinal Hernia
« Reply #88 on: 07 October, 2021, 12:14:14 pm »
Yeah, I was signed off my consultant’s list after 24 years 3 years ago. Of course, I was now living in a different country, but had kept the appointments once per year after moving.

Getting signed off was not a relief but a cause of anxiety - where do I go now if something is up? Having an official link to the Royal National Orthopaedic Hospital was a good feeling. I have no idea who in Germany would be the best for my situation. So hopefully I won’t need it!
My blog on cycling in Germany and eating German cake – http://www.auntiehelen.co.uk


Re: Hip Impingement was Re: Inguinal Hernia
« Reply #89 on: 07 October, 2021, 02:42:13 pm »
With my hip injury I had an open appointment after I recovered from the arthroscopy. However when I had a flair up 5 years later I found that the open appointment expired after 3 years and I had to go to my GP and get a new referral.

barakta

  • Bastard lovechild of Yomiko Readman and Johnny 5
Re: Hip Impingement was Re: Inguinal Hernia
« Reply #90 on: 07 October, 2021, 10:33:04 pm »
I was promised an open appointment with RNOH for the shoulder, but when I tried to use it, it didn't exist anymore and would have been an out of area referral. Thankfully Birmingham also has good local ortho stuff so I've done OK.

Helen: I imagine if there are issues your GP or similar would know how to find suitable German expertise which must exist.

Auntie Helen

  • 6 Wheels in Germany
Re: Hip Impingement was Re: Inguinal Hernia
« Reply #91 on: 08 October, 2021, 06:10:43 am »
I think there are some good places, possibly Uniklinik Duisburg which is about 40km away, but I don’t know and no-one I know does as it’s very specialised.

I visited the local orthopaedic surgeon here for a report on my arm (as I am officially registered as disabled in Germany, there is such a thing - but only Behinderungsgrad 20 so that doesn’t get me anything extra; if it were 25 I would get one extra day’s holiday per year!!) and I didn’t like him AT ALL - trad old school know-it-all guy with no bedside manner. Seeing as my chap at the Middlesex hospital is now surgeon to the Queen and was brilliant I have high expectations! But I don’t want the local guy to be my link. If I really need advice I can probably get some info from my Krankenkasse (health insurer) but of course if it is an emergency that all takes too long.

The RNOH was excellent for me and they did say they could find me someone in Germany so perhaps I should ask them sometime.
My blog on cycling in Germany and eating German cake – http://www.auntiehelen.co.uk


Re: Hip Impingement was Re: Inguinal Hernia
« Reply #92 on: 02 November, 2021, 10:14:57 am »
I saw the physio again yesterday. He's pretty happy with the progress I'm making and has given me a series of new exercises.
I went to the gym today for the first time in months, it was super hard, but feels like progress again. Coupled with the bike fit, it feels like my hip is functional.

I actually went to see the doctor about abdominal pain a week or 2 ago and she thinks I have a "weakness" next to the giant scar from my surgery years ago, so I have an ultrasound scan booked in a few weeks for that (echoes of the beginning of this process, except in a different location). I'm not going to push the gym really hard or look to get back into training properly until that is resolved, but if things carry on improving as they are, maybe I can in 2022.

Re: Hip Impingement was Re: Inguinal Hernia
« Reply #93 on: 26 November, 2021, 12:23:11 pm »
Ultrasound today - showed no issue with the abdominal wall, but did show gallstones. Will wait and see what the doctor says, but I suspect that we'll just wait and see if they flare up.