Hip Impingement Surgery Recovery

Day 1 Post Op

I've seen a few posts related to the subject of hip impingement on here over the past few weeks and want to share my experiences with it. I started noticing pain in my left hip about 5 years ago, primarily in end range motions (squatting, middle splits, etc.) However, there was no one incident that I can remember causing it, it just seemed to pop up out of the blue. Fast forward a couple years later, and the pain began to show up in everyday motions (running, sitting for long periods of time, sleeping on my back). Around this time, I also began to feel the same type of pain in my right hip. Because of the ever-present hip pain, I became less and less active, and started gaining weight. I went from a lean 195 to 230 in about two years. It was at this time that I thought I should see a doctor. It may sound silly that I waited so long to see a physician, but since the pain increased so gradually over such a long period of time, and also since until recently it hadn't affected my daily activities, I had never considered it to be anything but a pulled muscle or tendinitis.

I scheduled an appointment with a hip specialist in Denver, who performed a X-Ray, and an MRI with contrast. My diagnosis was CAM and Pincer impingement on both hips, with bilateral labral tears. Due to personal concerns about the success rate of this type of surgery, I tried to go the conservative route at first. I did several rounds of PT, which didn't help at all. Stretching, strengthening, yoga, pilates, hip mobility work from F1/F2, I tried it all and nothing gave me lasting relief. 

After speaking with my hip surgeon a second time, I decided to go ahead and get the surgery. My doctor (Omer Mei-dan) is one of the authorities in the field of hip preservation (performed approximately 1000 of these procedures in the past few years), and was convinced I was a good candidate for the surgery. Based on his opinion, I scheduled a bilateral operation, where he went in and operated on both hips at the same time.  This was yesterday  (3/13) so I am officially one day post-op. During the surgery, my doc found no cartilage damage in either hip, just labral tears and bony impingement which he repaired. Interestingly, even though my left hip was by far the most painful, it turns out my right hip was much more structurally damaged. 

I am going to update this post sporadically with my recovery, so anyone else who has had this problem can follow along and see what the process is like. If anyone has any questions, feel free to ask.

Day 12 Post Op

A couple things to report. First,I got my hands on my surgical report, which I didn't receive until a couple days after the surgery. I found out that I actually did have a slight bit of cartilage fraying in both hips. In my left hip, I had 1 anchor placed to repair the labrum, CAM (femur) impingement shaved, and micro-fracturing for Stage 1 cartilage fraying. In my right hip, I had 4 anchors placed for the labral repair, CAM impingement shaved, and micro-fracturing for Stage 1 cartilage fraying.

Second, I had my first PT appointment a couple days ago. My PT routine is very simple at this point: restore muscle function and gently regain range of motion. To that end, I did some prone quad/glute/TVA activation, as well as some Cat/Cow and Quadruped Rocks. The ROM on these was very restricted as I have a 90 degree limit on hip flexion, complete avoidance of external rotation, and 35 degree limit on abduction. My therapist also spent some time gently moving my hips around in small circles. 

An integral part of my rehab process is cycling. Starting day 1 post-op, I had 2x5 minute sessions on a stationary bike, with no resistance. This is a daily endeavor, slowly increasing up to 2x30 minute sessions by the six week mark of my rehab.

Third, other than finally getting my hands on my surgical report and beginning PT, overall I am feeling worn down. I have some discomfort in my hips, quite elevated from my pain levels before the surgery. I was told this would happen, as the hip joints are torn up from the surgery and need time to heal. Ice, Tylenol, and myself have become fast friends.  

Finally, I have my first post-op appointment in a few days. Here's hoping for good news!

interesting and a bit depressing as I'm currently busily ignoring similar pain, I have been doing all the stretch courses for the last nine weeks and my pain level has dropped, but not gone away completely. I'm in Boulder so it good to have a recommendation if, after say a year of GST I decide that stretch and strengthen isn't the complete solution. I have a physiatrist that I work with but that has mostly consisted of PT and prescription anti-inflammatories. 

Please keep posting on your progress.

Damn, I am sorry to hear that. For the longest time I kept trying different things, hoping my hip pain would resolve but eventually I had to bite the bullet and see a pro. I really hope yours gets better. 

Have you had X-rays done? That was how they identified my impingement. Also, on the plus side for you if you need it, Denver has some of the best hip preservation docs in the US.

2 hours ago, Brandon Voss said:

Damn, I am sorry to hear that. For the longest time I kept trying different things, hoping my hip pain would resolve but eventually I had to bite the bullet and see a pro. I really hope yours gets better. 

Have you had X-rays done? That was how they identified my impingement. Also, on the plus side for you if you need it, Denver has some of the best hip preservation docs in the US.

 

I had an MRI which showed a lot of inflammation; lumbar spine, SI joints, distal and proximal attachments of Gluteus medius and minimus. I'm hopeful that the stretch series will be very helpful. I tend to snicker in the FS video when coach talks about people who cannot get their glutes away from the wall, I'm still trying to get my quads loose enough to get my gluts to the wall,(quads) then I'll worry about getting them back away from the wall (hip flexors and quads)

Day 29 Post Op

My post-op appointment went well. I had my stitches pulled, and was told the moderate amount of pain I'm feeling is normal and completely expected. I am definitely more comfortable than I was a week ago, and much more comfortable than two weeks ago. I don't need any type of pain medicine any more, and only need to ice every couple days. My surgical incisions have almost completely healed and I will be able to begin aqua therapy in a week or so. At this point, I am glad I had the surgery performed.

Thus far, my recovery has been characterized by an almost-imperceptible decrease in pain and ROM on a daily basis, but a definite improvement from week to week. It's interesting to see how much my hip pain fluctuates daily and doesn't feel like it's decreasing, but if I think back to several days ago and how I felt then, I notice a trend of consistent improvement. I've had a few scares where I've accidentally exceeded my ROM restrictions, but thankfully these don't seem to have set me back. My PT has described my progress as average, and I expect to be off my crutches in two weeks. Running is still a ways off (probably around week 14-16), and a return to sports is (obviously) even further out (probably week 20-24). 

Per my PT protocol, I am now cleared to begin external rotation at my hip. My daily rehab routine includes narrow-stance, shallow squats, basic bridge work (think simple double leg bridges to neutral), glute squeezes, crunches, gentle ROM work, cycling, cycling, and more cycling! My therapist has told me that while shallow squats are great for me now, deep squats may never return simply due to the anatomy of my hip sockets and femurs. Even though the femoral impingement was removed and my labral tears repaired, my hip sockets may simply be too deep to allow me to get a deep, butt-to-calves squat without impinging on the repaired area. However, only time will tell. 

Finally, to close on a side note, I am doing PT at a clinic with several therapists. Typically I work with the same one, but recently I had a session with a new therapist and really connected with her. I've heard you need a therapist who gets you, and understands what you want to get out of rehab, but I've never experienced that connection until I worked with this particular therapist. It was a very refreshing experience, to say the least. It really goes to show that it may take a little "shopping around" until you find someone you click with, if you are looking for a healthcare provider. 

Day 44 Post Op

As of two days ago, I am finally cleared to ditch the crutches! I forgot how nice it is to just walk around without having crutches jacking up my shoulders. My hips are the feeling the best they have since surgery, but the pain still has not dropped below pre-surgery levels. I've been a little apprehensive about this but according to my PT, this is totally normal. Pain levels from this surgery tend to fluctuate, and most people feel 'back to normal' 4-6 months down the road.

Most of the time my hips feel good, and pain is only there when I am transitioning from standing to sitting and vice versa. This is a huge change from the first couple weeks after my surgery when my hips were aching all the time, no matter what I was doing with them. 

I've also been given a slightly more aggressive stretching routine. One of life's small pleasures is stretching your hamstrings after not being able to for six weeks. Pure bliss. 

In retrospect, I am still glad I had both hips done at the same time, but there are definitely some unique recovery challenges. My ROM is not returning as quickly as it would have if I had only one side done. That said, I am improving! Slow and steady wins this race. I am excited to do resume Foundation training but I still have a few weeks before that happens. 

Finally, an unexpected benefit to following the GST protocol is my familiarity and understanding of anatomical terms. For example, regaining and working on hip extension is a big part of my rehab. When my PT tells me to extend my hip, it is clear to me what she wants me to do. Very cool!

This is great!  

How are your hips doing, Margaret?

They are feeling so much better after three consistent months of all of the stretch series. I've no idea if the inflammation has gone down but my level of pain is much less. Just starting get get everything loose and not clamped down in a protective reflex is helping tremendously 

Day 75 Post Op

I am approximately 15 weeks post op. My pain levels have reduced dramatically. My PT is going exceptionally well, and I have returned to hiking and light jogging. My PT routine has taken on a much more intense flavor. I perform different squat, lunge, and plyometric variations. I am also cleared to begin light barbell movements as long as I don't go into deep hip flexion. 

My surgeon told me the healing process will be ongoing for the next 12-18 months, but I am progressing as smoothly as can be expected. I should be able to start climbing again in about two months, provided my recovery continues going well. 

Overall, I am satisfied that I've had the surgery. The awful deep hip aching I used to regularly get following exercise has all but vanished. I still don't have full range of motion in my hips yet but I get better every week. This will probably be the last post I make on here until I return to climbing but I hope I've provided some insight for anyone who has FAI or a hip labral tear and is thinking about the surgery. For anyone in this position, my parting advice would be:

1. The recovery is long, involved, and requires a great deal of effort and time on your behalf. While this can probably be said for any orthopedic procedure, I feel it is doubly true for hip surgery. You won't be running or doing the splits a couple of months after the surgery. Expect a full recovery to take over a year, if not two. Be honest with yourself about your expectations. 

2. Make sure you get the absolute best hip surgeon you can. FAI/labral repair is still a relatively new procedure and only a handful of surgeons are well-versed in it, and even fewer perform bilateral repairs. Make sure you find a surgeon who performs a high volume of these surgeries (200+ year). My surgeon, Dr. Omer Mei-Dan, has done over a 1000 of these.

3. Make sure you find a PT who knows how to rehab FAI patients. I've said this before and I'll say it again: I went to two other PTs before I clicked with the third. I am firmly convinced if I had stuck with either of the first two PTs, I would not be where I am today.

I hope someone got some use out of these updates. Feel free to ask any questions, or look up the Labral Tear Recovery facebook group or the Hip Impingement Awareness group. There is a ton of useful information on those boards.

Thanks for reading!