Yet Another Cycling Forum
General Category => The Knowledge => Health & Fitness => Topic started by: DuncanM on 02 December, 2019, 01:05:23 pm
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Ultrasound scan says no hernia. Back to the GP whenever I can get an appointment - wonder what the next step is.
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Ultrasound scan says no hernia.
That happened to me a couple of years ago. Swelling, constant low level pain and a slight feeling of nausea like a aftermath of taking a knock in the nuts. Ultrasound showed a collection of what they thought was fluid. I was told "it is not going to kill you, so the choice is yours" (this was going private). I went for surgery where they found a benign deposit of fat. After removal, recovery was quick and all my symptoms went away.
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Ultrasound scan says no hernia.
That happened to me a couple of years ago. Swelling, constant low level pain and a slight feeling of nausea like a aftermath of taking a knock in the nuts. Ultrasound showed a collection of what they thought was fluid. I was told "it is not going to kill you, so the choice is yours" (this was going private). I went for surgery where they found a benign deposit of fat. After removal, recovery was quick and all my symptoms went away.
They didn't find anything strange at all. Saw another doc today - he's somewhat confused and is taking the "don't know what's wrong - lets get some more data points" approach and signed me up for a bunch of blood tests. I find it unlikely that will provide any more information though.
I figured I might as well go see a physio too. He took the "there's no hernia" for granted given the ultrasound and gave me a set of exercises. He thinks I've been compensating for weak abs and an old foot injury by over using my hip flexors and groin muscles and has given me some stretches and exercises (and told me to put arch support in my bike shoes). He also suggested I raise my bars as being crunched over will make the hip flexors more crucial. I guess we'll see how that goes as well. Maybe I should finish my recumbent (or redesign it so that I can get a 26" wheel on the back so it can go on the turbo). Presumably that would unload the hip flexors...
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Blood tests show nothing interesting.
I've persuaded the doctor to refer me to the Sports Medicine team at the Nuffield Orthopaedic Centre. I'll probably give them a call on Monday and see how long it would be before I can see someone through this referral. I can't imagine it would be quick, so might have to see if I can speed it up by going through the parallel private clinic. ::-)
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After much pestering, I got a letter giving me an appointment on 8 June.
Gonna go to the same people at their private clinic in mid March.
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Bah! Mid March would have been OK. The actual date was yesterday, so it's been cancelled because they don't know when they can reschedule it for. Also, my WFH setup is not good for my hip flexors. :( I think it will restrict me from getting very much Turbo work done on lockdown as well.
I know, first world problems... ;)
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Bad luck Duncan. I'm sorry to read about your delay. It isn't to be made light of, your mental and physical health is valuable.
Think of it that you're being community spirited in your ration of NHS goodness is being used to save lives.
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Surprising news on this - I had a phone call today from the doctor who I was due to see on 8 June (also the same doctor that I would have seen privately if it hadn't been cancelled and refunded). I've been referred for an MRI for a proper view of what's going on, and hopefully it won't be too long a wait as all of those got cancelled and are now being re-booked.
And I've completed my WFH setup so now that's much more ergonomic, and I'm back on the turbo (though taking it easy and doing traditional base).
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The doctor who referred me for an MRI said she thought that my issue was one caused by compensation for an issue somewhere else. That made sense, because 3 or 4 months before it started happening, I tore a ligament in my foot, meaning I couldn't walk properly for a while, and my right foot still has a lower arch than my left. Today, when I mentioned this to the physio (first physio appointment via video), he did some stretch and strength tests, and our conclusion is that I'm using the outside of my right calf loads more than the rest of it. This means that the groin muscles then have to take the burden of straightening everything out again. So to treat my groin problem, I'm doing calf raises focusing on using my big toe!
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Yay, MRI appointment last Friday due to cancellation. :thumbsup: Now 2 weeks wait to see if it found anything.
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Saw consultant (different one to who they told me it would be on the phone, so had to do my history again, only without my notes). He did all the usual leg wiggling tests and made my hips pop incredibly loudly.
The MRI shows a cam on the femoral head consistent with FAI, but he couldn't get it to impinge when manipulating my leg. His conclusion was that it was muscular, and that my super tight hip flexors are the problem (and the foot injury compensation idea is a red herring, it was just the straw that broke he camel's back). So yet more physio, this time with the head guy at the Nuffield Orthapedic Centre who is interested in FAI and hips in particular. Dunno when that will be though, or if it will amount to anything.
I've stopped riding completely as getting 15 minutes into a ride, everything tightening up and having to stop was too depressing. The turbo is packed up for now, the garage is getting a long overdue clear-out, and I'm thinking I'll stick a project car in there instead.
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I called the Nuffield yesterday and asked about physio. They aren't even able to say how long the wait time is they are so far behind. Also, they are only doing online physio (which is odd given I had to go on prem to see the consultant).
I'm going back to my private physio tomorrow, and we'll see what he says given my MRI results (if he can see them).
Not ridden a bike since May. I've stopped missing it, though I do get a pang when I see cyclists out training.
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Update - physio couldn't see the MRI stuff, I just had to give him the letter from the consultant. He did some work on my foot/calf and hip flexor, and encouraged me to keep up my exercises. I've been doing them and loads of stretching regularly, but it seems to make no difference. Beginning to wonder what the point is. Still no bike riding. :(
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Letter from the hospital arrived yesterday with an online appointment to see a physio. For today! :o And not the physio that the consultant had requested. ::-)
I remain unconvinced how a physio is going to be able to assess my hip mobility over zoom. He's going to have to be pretty spectacular, given 2 other physios have been unable to fix it over the course of months, even with in person appointments. I'm missing riding my bike again now, and my fitness must be terrible. Also, the local gym still hasn't opened, and I can't see that happening any time soon given we keep dipping into the amber Covid region.
Edit - actually, it was useful, and he seemed properly focussed on getting me back on my bike. More exercises and stretches, but with the aim of doing more contract-relax stuff than simply just trying to make the muscle stronger/longer, which makes loads more sense.
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I had another virtual physio appointment yesterday. I'm clearly getting loads stronger, as I can do more reps even though using a swiss ball has made them more difficult.
However, it doesn't feel like my hip/groin has got any better. :( As a result I now have an in-person appointment in 2 weeks.
I might try riding my bike if the weather isn't crap this weekend and see if it's as bad as I think it's going to be. I no longer miss riding them, every so often I consider selling up, but it's not like I can do some other sport if my hip is like this.
The most frustrating thing is that after over a year, 2 GPs, 2 consultants (one virtual), 3 physios, an ultrasound and an MRI - still no-one has an explanation. Makes me wonder if it's pain referred from somewhere else that they haven't looked at. I'll see what the physio thinks of that idea when I see him.
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I tried a gentle pootle of a ride yesterday.
It was nice and sunny, the views were lovely and the wind didn't bother me too much. :) My hip/psoas did though - initially just over 200W, and toward the end of a 30 minute ride if I was over 150 for any length of time. :(
I can't ride like that - it's just soul destroying to shift down and crawl up little rises that I want to just blast up in the big ring. I don't know exactly how much fitness I've lost over the last 5 months (I didn't do any efforts at all), but it doesn't make much difference at this point. And just to emphasise the point, it bothered me for the rest of the day. :(
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Sorry to read this Duncan.
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I tried a gentle pootle of a ride yesterday.
It was nice and sunny, the views were lovely and the wind didn't bother me too much. :) My hip/psoas did though - initially just over 200W, and toward the end of a 30 minute ride if I was over 150 for any length of time. :(
I can't ride like that - it's just soul destroying to shift down and crawl up little rises that I want to just blast up in the big ring. I don't know exactly how much fitness I've lost over the last 5 months (I didn't do any efforts at all), but it doesn't make much difference at this point. And just to emphasise the point, it bothered me for the rest of the day. :(
I'm in the same boat, but kayaking rather than cycling. Last year; good sprint speed, good endurance. Now? Absolutely pathetic.
We need to give ourselves time for the fitness to come back. It will return faster than it took to originally build up, but will take time. I'd encourage you (me?) to stick to tempo rides for a month.
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I tried a gentle pootle of a ride yesterday.
It was nice and sunny, the views were lovely and the wind didn't bother me too much. :) My hip/psoas did though - initially just over 200W, and toward the end of a 30 minute ride if I was over 150 for any length of time. :(
I can't ride like that - it's just soul destroying to shift down and crawl up little rises that I want to just blast up in the big ring. I don't know exactly how much fitness I've lost over the last 5 months (I didn't do any efforts at all), but it doesn't make much difference at this point. And just to emphasise the point, it bothered me for the rest of the day. :(
I'm in the same boat, but kayaking rather than cycling. Last year; good sprint speed, good endurance. Now? Absolutely pathetic.
We need to give ourselves time for the fitness to come back. It will return faster than it took to originally build up, but will take time. I'd encourage you (me?) to stick to tempo rides for a month.
I can live with being slow and building up the fitness, but the fitness is not the problem (at no point was I breathing hard). I stopped riding in May because it felt like it was making my injury worse (even Traditional Base), and it's still the same 5 months of physio later. I have an in person appointment a week tomorrow, so we'll have to see what the next steps are at that point.
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Physio appointment this morning was in person, so actually useful!
He was able to recreate the pain I get by providing resistance for me to pull my knee against. After some other physical test and a little discussion, he was then able to do the same thing, but applying extra force to hold my hip in the middle of the join - this meant that I could do the same thing with no pain!
So I have to continue the stretches etc, but I have more specific exercises to strengthen the glutes, so they can pull against the hip flexor and hold the head of the femur in the middle of the hip socket. It's the most believable theory about what is going on so far. So fingers crossed my exercises will actually make a difference and when I go back in January it will be improved.
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That's good news Duncan.
My wife recently tore her gluteus medius (badly enough to warrant morphine, and a green and yellow taxi to A&E for assessment) It's the hip adductor muscle, which sounds similar to your injury. Subsequently she's had physio (fortunately paid for by my company health insurance, and all face to face at a sports physio practice) to strengthen her glutes. The supposition is that, post hip replacement 15 years ago, she avoided painful exercises (no shit, Sherlock!) which has led to systemic weakness.
The good thing is that she gets a consultation every three weeks, and the physio gives her a new set of exercises to stave off boredom. Plus she gets to do "oyster" in her usual weekly Pilates class, no more slacking!
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More not hernia stuff - Mods - can you spin my posts from March 2020 off into a Hip Impingement thread so as to stop polluting this one?
Video call with consultant today. He seemed to think the idea of muscle tightness pulling the hip forward was plausible, but he wasn't sure whether it was the hip or the muscles that were the primary cause. He also said that the MRI showed an old muscle tear, which I didn't know about. I've got to get to see this MRI at some point! Anyway, he said I should continue with the physio and have a follow up with him in February. If things haven't improved by then he thinks it's worth having a steroid injection into the hip to see if it will bring down the inflammation (and also because the local anaesthetic would mean they can test the things that normally hurt and see if they still do).
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Duncan, this is all very familiar to me so you have my sympathy. I also developed hip pain when cycling or walking, at it's worst I was using a walking stick and unable to walk half a mile without significant discomfort. My hip also became very clicky. I first went to the medics in 2004 aged 23,
At first the physio suggestion was a difference in leg length and a heal raise mitigated the walking issues. Reoccurrence when I got new shoes without an insole reinforced this idea until 2011 when after a long flight I couldn't keep up with a 65 year old when walking round a sewage works.
On return to the UK my GP finally referred me to orthopedics and investigations started, ultra sound to rule out a reoccurrence of childhood hernias, CAT scan to measure leg length, MRI and then contrast MRI. Eventually the diagnosis from MRI was FAI and a possible tear of the acetbular labrum. In 2012 I had an athroscopy to remove the Cam and definitively diagnose the labrum which wasn't torn. Recovery was good and I had about 6 years without problems and then it started again, click and sore hip unable to ride my best bike etc.
This time round it was also associated with back pain and like you the Psoas muscle was implicated. I found the basic exercise of sitting on a kneeling stool while doing embroidery was a good core exercise and strengthening which alleviated issues. With regards cycling I was always able to ride my more upright bikes and commuting but the lower the front end and the more rotated my hips were the worse I found either power or distance. I also have found that I get more issues when I let my weight increase.
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Thanks for posting that Matthew. We tend to think of hip issues as being something that old people get, it must have really sucked to get them in your early 20s (I'm 43 and still think I'm too young for this sort of thing). I'm not keen to go down the surgery route, so I'm kinda hoping that strengthening and flexibility work will make some difference. One other thing I'm thinking might be worth trying again is a recumbent - have you had a go with that? The most upright bike I've got is an MTB, but that's still quite long and low, and I have pretty much everything I need to construct a recumbent. I need to do some more regular exercise other than 20 minutes physio exercises every couple of days - I weighed myself this morning and discovered I'm the heaviest I've been in something like 10 years. :(
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I got told by my GP in 2018 when I finally went for a hip clinic referral here in Brum that the average young (under 65yrs old) person with hip issues suffers for 10-20 years before getting help. I was unable to walk at this point but had been told my Xrays were normal so...
I did try and get help 6 years before in 2012 with private physio which just hurt like hell and 10 years before that in 2008 when also unable to walk for months on end. But my London GP was shit, barely looked at me, wouldn't listen and while she sent me for an Xray it was a fob-off. The radiologist was clearly not told of my medical history (which was actually relevant) so said "Xray normal" so serious issues were missed.
In 2018 seeing the "young adult hip service" with my medical history DEFINITELY read by doctors (who admitted to a sneaky Google) combined with my NOT normal Xray and my walking, the hip surgeon immediately suspected 'mild' hip dysplasia and femoral anteversion. I also have impingement as a as well and scans have since confirmed all those things. And cos I have to be awkward, my dysplasia is the rare way round and hip physio says I've got about contrasting issues going on.
I'm quite pissed off my issues were missed cos my range of motion is WILDLY out and I had legs issues as a child and all the classic signs. Even if they didn't know my syndrome has "dysplastic joints" as a general issue.
I hope you can both get your legs behaving better. I'm looking at major ortho surgery as nothing else is helping and I'm not a candidate for arthroscopy and if I do have a labral tear that'll be additional surgery cos it can't be done at the same time as the stuff I need.
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That puts things in perspective - I'm just grumpy because I can't ride my bike! :-\
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Duncan, I have no experience of recumbents. The first thing I had to do was move from my Van Nic to my fixed wheel commuter. The difference is about 5cm in height at the front end and about a similar amount of reach. With poor core strength and flexibility it means my pelvis is rotated much further forward. At it's worst I went out for a 100km ride and at the furthers point I had to bail to the trains home.
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I hope most people have a happier time of hip problems solutions than I am having. I would definitely experiment with options and stick with your physio and hope they can narrow stuff down. Don't be afraid to ask for 2nd opinions either.
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I hope most people have a happier time of hip problems solutions than I am having. I would definitely experiment with options and stick with your physio and hope they can narrow stuff down. Don't be afraid to ask for 2nd opinions either.
Second opinion is pretty easy - so far I've had 3 consultant appointments, and all 3 have been with different people! I'm definitely keeping going with the physio and logging how I'm going - I'm definitely getting stronger! I'm not sure how to measure/log my stretching progress though. Any ideas?
The only vaguely upright bike I have is my MTB. I'm not sure if that would make a huge difference though as walking for an hour or so causes hip pain, so I don't think the cycling position is a specific issue.
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I hope most people have a happier time of hip problems solutions than I am having. I would definitely experiment with options and stick with your physio and hope they can narrow stuff down. Don't be afraid to ask for 2nd opinions either.
Second opinion is pretty easy - so far I've had 3 consultant appointments, and all 3 have been with different people! I'm definitely keeping going with the physio and logging how I'm going - I'm definitely getting stronger! I'm not sure how to measure/log my stretching progress though. Any ideas?
The only vaguely upright bike I have is my MTB. I'm not sure if that would make a huge difference though as walking for an hour or so causes hip pain, so I don't think the cycling position is a specific issue.
Walking a short distance was more of a problem for me than cycling for the same amount of time as long as I remained open and at a touring pace. My physio suggested the lack of impact from cycling and the benefit of keeping the hip mobile was a reason to keep cycling. I also had to be careful on rough ground (not hill walking was tough) though level soft ground was fine.
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I went for a walk with my family yesterday. About half an hour in the hip started to get sore. I basically limped the other half to get home again. While it eased during the afternoon/evening, going up stairs still hurt, it's still sore today, and my knee is sore as well (under the kneecap - I've had typical kneecap tracking issues in the past). I don't know if it's because the quad is tight (possible caused by the hip flexor being unhappy), or whether actually it's the kneeling to stretch the hip that is setting off the knee.
Maybe I shouldn't have done the physio exercises (a couple of hours) before going for a walk, but that feels like another crappy restriction. Grrr. :(
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Grrr, it's not nice to think of but I found a walking stick beneficial even if it was pinching my mothers after she had her hip replaced! early 30s and a walking stick was a bit of a shock to the office but it worked and meant I could still commute by train.
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I'm hoping that it won't come to that. Either that or I'll make a staff and pretend I'm Gandalf! ;)
I have finally made the "sit/stand" desk I got in March go up and down. This will mean that I don't have to (always) sit down at my desk - hopefully this might help the hip flexors get used to being longer.
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Get a stick and do it up. I have rainbow tape on mine (a £5 walking pole from go outdoors) and get lots of positive comments from people AND it's noticed. As useful for a balance assist device as 'walking stick'.
Although I have finally got through the nest of telephonic tyranny and email-numpties at the hospital to see physio and OT to look at walk proper walking aids I can physically use when each of my legs is zero weight bearing for umpty months...
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A fold-up walking stick can be concealed rapidly and packed away in most small bags.
Suggest getting or fitting a wrist strap so you can use the hand when carrying a stick and using a ponytail hair elastic to keep a folding stick folded.
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Walking over the holiday period has been fine - I've been going out pretty much daily, but doing shorter routes when I've done my physio exercises.
I was supposed to see the physio a week today - I've just had a phone call to say that he's been redeployed to a different hospital so it's been changed to a virtual one on the 15th of Feb. Sigh.
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I did a physio workout and followed it up (later in the day) with >8000 steps yesterday. It's no worse than it was the prior day, so that's not bad. Most of my walking was at "conversational" rather than "exercise" pace, and it was on the flat, so maybe it's not all that much of a test.
I wanted to use the appointment that was supposed to be today as a waypoint. It feels a bit aimless when it gets put off (and I have no confidence of the February appointment actually happening (or being useful, seeing as it's gone back to virtual)).
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Potential data to back the theory that it's all muscle imbalance related.
I was watching some Youtube stuff so as I could vary my routine without input from the physio, and out of curiosity tried some "clamshells". They are supposed to target the glute medius, and I have heard that's a muscle that cycling doesn't really do much for. On my left leg (the good one) it was easy to activate the muscle and use it to move my leg around - on the right leg, no matter how I was positioning myself, I either got groin involvement, lower back involvement, psoas involvement, or some combination of all 3. So I'm adding clamshells or other glute medius exercises, with the aim of firing that muscle and getting it working properly again - hopefully that can take some of the load off the stuff that's causing me pain.
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Still no change to the hip (I guess maybe I should be happy it's not getting worse). I continue to get stronger.
I'm fed up enough to loan my turbo trainer out for a couple of months, but holding onto enough hope that I didn't just sell it (and bikes)!
I realised the other day that I have 4 bikes, 3 of which I've not ridden since mid 2019. :(
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Surprise call from the hospital today offering me a consultant appointment for tomorrow. I guess they have had a cancellation and are filling the spot. This means I've not had a physio appointment since my last consultant appointment (though that one was virtual), and my next physio is a virtual one on Monday (in theory - I'd best check that's still happening). I wonder which consultant I'll get this time. :)
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Yet another Doctor today (that's 4 so far, from 4 appointments). Today's was a registrar - she was really good and I felt a lot more listened to than the previous in-person appointment. The normal range of motion tests, plus a couple of different ones. Balance and strength pretty good, ROM a little reduced on the right hip - all as expected. Offered a ultrasound/Xray guided steroid injection into the hip, sounds like the next step, but I'm going going to wait until I've spoken to the physio (next week) before I book it. The theory behind the injection is that it will offer confirmation that the hip is causing the pain, and hopefully allow further progress with rehab exercise than would otherwise be possible.
Diagnosis is FAI and hip flexor overload together.
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I talked to the physio today. The main benefit of the injection seems to be diagnosis and pain management - I'm not restricted from doing rehab exercises at the moment. /So I'm gonna have a serious crack at doing proper intensive rehab for a month and then make my mind up. I've only ever had a few exercises and a few stretches from the physio - I think they don't want to overload people and favour compliance over theoretical work. So I'm going to build my own list and then get confirmation from him - I'm fully prepared to spend an hour a day doing the work (rather than 20 minutes of exercises 3 times a week plus 10 minutes a day of stretching).
I was really fed up with the whole thing over the weekend, but now I feel like I'm in control again and I've got the bit between my teeth. :)
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The physio seems happy with my plan. I've been doing 40 minutes a day - either foam rolling and stretching or a whole series of exercises. It still means I only do 3 workouts a week, but they are longer and harder, and I have structure behind the stretching as well. I've also started re-reading "Becoming a supple leopard" because movement patterns matter and I want to get them right.
I'm also becoming more convinced that the problem is only tangentially connected to my hip. The rotation restrictions that I have are inward on my right hip and outward on my left, and they are more significant that the inline restriction that they think is caused by the cam. I think it's my back that's driving everything, which also explains why months of physio exercises working on my glutes and quads really didn't make much difference. We'll see if my new, more rounded workout regime makes any difference in a month (and at that point if it hasn't, I'm definitely going onto the injection waiting list, just for clarity on my theory).
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The good news is last week I had a couple of days without any of my hip pain.
The bad news is that this was down to the fact I had major back ache! I don't know whether the reason the back locking up killed the hip pain is down to the hip pain signal being over-ridden, the physical effect of the back movement restriction, or the hip pain actually being transferred from somewhere else in the back. My back is improving (though I had to sleep on the floor last night as I couldn't get comfortable on the bed!) and my hip pain has returned. Physio appointment next Tuesday - given my back theories I think I'll be requesting the steroid injection after that.
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Physio agreed with me that the back/hip interaction was interesting, and also that it was probably worth doing the injection as a diagnostic alone. I'll contact them later to request it, and then see how long it takes before it can be arranged.
I also have some new exercises to work on core and put me in a position where I don't have to use my hip to compensate for my back (or my back to compensate for my hip). Going back in a month to try to assess progress (I have also extended the loan on my turbo trainer for a month so it's not just picking up dust).
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It feels like it's a bit better after working hard on my physio exercises, but maybe that's just me getting used to it. Will talk to the physio next week - the gym around the corner opens up again, so maybe I can push the workout regime a bit further.
I have an Xray guided injection into my hip scheduled for 7 May, and a consultant appointment a month later, so hopefully that can help give me a diagnosis on what is going on.
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Phone call today - hip injection moved up to Monday! :thumbsup:
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Phone call today - hip injection moved up to Monday! :thumbsup:
Good luck, hope it helps and is not too painful!
(Mine was virtually painless if useless)
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It hurt quite a lot, mainly because the muscle they went through is super tight! Will have to see how it feels over the next few weeks.
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I tried doing some exercises yesterday, but they hurt much more than usual so I stopped.
Today it's almost made it back to "normal" - will re-try my exercises again tomorrow. I'm wondering if a short bike ride on the weekend would be a good test to see if it's got any better - Sunday would be 6 days after the injection. I guess it depends on how it feels over the next few days.
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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.
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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. :(
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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.
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Duncan I wonder if you have seen this? https://cyclinguphill.com/personal-experience-of-fai-what-worked/ (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.
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Duncan I wonder if you have seen this? https://cyclinguphill.com/personal-experience-of-fai-what-worked/ (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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Yikes, good luck fella, keep trying and going.
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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.
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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.
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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.
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Or you can drill secondary holes for the pedals in your existing cranks - this was done for my velomobile.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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?
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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
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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.
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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.
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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.
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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.)
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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.
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Sounds encouraging :thumbsup:
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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.
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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.
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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.
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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.
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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.
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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!
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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.
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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.
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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.
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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.
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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.
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Eat less fatty food was the totality of the advice from the doc about the gallstones.
Riding my bike is OK providing I remember to point my toes when climbing (I suspect of I drop my heels and slide back on the saddle then I overextend it again), but since Christmas it's got worse in regular life. Physio on Monday, which will be interesting, given the way that I think the exercises I have make it worse not better!
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Sympathies Duncan. I only know what it's like to have relatively mild injuries (pulled hamstrings, achilles, ITB's, etc) which mend themselves within a few weeks or, at worst, months. That's bad enough, but what you've been going through must be pretty rough.
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Physio did as expected - checked that I passed all their strength tests, said I'd probably have to deal with some discomfort at times but to avoid internal rotation, and discharged me.
In some ways it makes sense - if they think they can't get me to 100%, then getting me to 90% and getting on with the next patient is probably good use of NHS resource. And I can ride my bike.
I think I'm going to have a hunt around for a sensible personal trainer who can give me some time in the gym to work out what I can do, what I can't do, and more importantly what I should and shouldn't be doing. I don't mind working hard, and I want to get back to training, and I don't think physio is the right tool to do that. I'm fortunate enough that I have the cash to be able to do that. If anyone has advice about how to choose a personal trainer, I'd be all ears (maybe I should create a new thread).
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I found a PT who is all about movement and establishing new memories (muscle and mental) about moving your body as a means of recovering from injury or just moving better. I've signed up for 4 weeks to see how things go, the first session is on Tuesday. The bike doesn't really fit in with his philosophy of movement, but he's happy for me to do my thing there, and work with me on the rest. My hip has been sore in the car the last few days, so I can't wait to get started and find out what it's going to be like!
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Session 1 was interesting, and then a family member became seriously ill and he had to go back to Spain! :(
So I moved to a different PT and have been doing a session once a week with her, and started Trainer Road again. The sessions are more strength based, but they are interesting and involve lots of single arm/leg stuff with the core resisting/helping the twist.
Irritatingly, the hip has flared up in the last couple of days, and the ab pain that preceded it came back too, so gonna take it easy and see if we can get a more accurate diagnosis on the ab issue as a result - maybe that can enlighten us as to the cause of the hip issue. Or maybe it shall remain a mystery and I'll have to stop TR again. :(
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That flare up went away, and I've been happily doing TR and PT sessions once a week, until last week when I aggravated it again when lifting the trap bar. :(
I guess I've got to go back to the endurance stuff again on TR, which is frustrating because I was wanting to kick it up a gear in preparation for riding cyclocross this autumn. Will have to see if it will quiet down enough to make CX possible. It's sooo frustrating.
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Update - it quieted down, so I did a CX race on the weekend. I worked hard, but used my gears a lot, and I couldn't feel any issue during or immediately after. However, I think the 1.5 hour drive home was not the best, and the groin, and especially the muscle that runs from groin to under my ribs on the right is really tight and sore. It doesn't really like me sitting down, which is a bit annoying!
I'm gonna skip the CX this weekend (also involves a 3 hour round trip in the car) and ride gently on the turbo and stretch/roller like crazy and see how it goes. Probably start PT again next week, and see if they have any bright ideas.
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I've ridden a bit, and I've done my weekly personal training, and while it's better than it was after the CX race, it's still not better. It's hard to have any mojo to go train when it means I ned up sore and sleeping badly as a result. :( So I'm probably not riding any more CX this year, I'll try to get/maintain a bit of fitness, and keep going to the gym, but something has to change at some point.
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After my last update, I have been doing gym stuff and very little riding. I got back on the bike toward the end of March, but kept it low intensity and short, and it was going OK. I did a reasonable gym session on Tuesday and finished feeling really good and motivated, and then Wednesday morning onwards, either my ab or my hip is really painful. It's a bit better if I stand at my desk rather than sitting, and if I stretch and roller, I can relax it a bit, but then the painful area just moved to the next bit that's tight (and then it goes back).
I have a phone physio appointment on Wednesday, but I'm just so fed up - I was thinking it was time to stop just doing the odd turbo session and get back to a 3 times a week schedule, and I can't ride at all at the moment. :(
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A couple of weeks of not riding turned into a month, and then the garage flooded (a couple of inches) and the bike and the computer table got buried under junk, so I've not ridden since. The sad bit is that I've not missed it. I need to find some other form of exercise beyond a gym session a week and some physio exercises most days (partly just to ensure I maintain some fitness, and partly because without exercise I'm slowly gaining excess weight), and riding would seem the obvious way to do this seeing as I have the equipment and knowhow, but I just can't be bothered.
Still going to PT, and I've got physio in July, so we'll see what that brings.
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Physio was useless, and I've still not been on the bike. :( The gym is going really well, and I'm definitely improving both my strength and my movement skills, but I don't think it's improving my hip.
However, I've been to see a massage therapist person for my foot, and when she was squishing it it was triggering the painful muscles around my hip. So I feel like that is proof that my hip injury is a result of my foot injury (mostly through changing motor patterns to protect the foot). Only thing is, I've no idea how to resolve the foot!
Maybe one step (no pun intended) forwards at last?