I've decided to start this blog (rather than simply adding injury-related posts to my marathon training blog) because it looks like I'm in for a lengthy, physically and emotionally exhaustive process. But as I've been struggling for answers online, I realized how helpful I found other individuals' blogs and message board posts, and my hope is that the information I share will provide someone else out there with a bit of solace and information.
Here's the abbreviated version: I injured my right hip at some point during my training for a marathon. I went from a pretty unactive 27 yr old to a marathoner in 4 months, overdid my training, didn't properly focus on stretching or cross-training or strength training, and ended up with excruciating hip pain. The orthopedist I saw ruled out a stress fracture, and the MRI suggested a possible labral tear but given how my symptoms were presenting at that point, tendonitis seemed the more likely cause of the pain. The MRI also revealed a huge cyst in my right ovary that might have also been possibly causing referred pain in my hip. I went through physical therapy, which helped a great deal, and I got the cyst removed. Ultimately, the pain persisted though it became very erratic and not always in the same exact location. It is severe sometimes when I get out of a car and put my weight on it, or when I go from sitting for a while and stand up. I had resumed running, and though it didn't hurt while I ran, it hurt more a few hours later. So I went in for an MRI-Arthrogram which revealed the labral tear. I don't have a medical degree and I haven't studied any science since high school, but from my discussions with my doctors and from google, as I understand it, the labrum is the protective cartilege in the hip socket. The tear doesn't repair itself and the pain comes from the piece of cartilage sticking out that's rubbing against the other side in an uneven way, wearing down other areas of protective cartilage. My tear appears pretty small and because my orthopedist doesn't specialize in the surgery, he referred me to a local surgeon who does -- Dr. Carlos Guanche. I haven't met with him (couldn't get an appointment until the middle of next month), but given that this is my only right hip, I decided it would be a good idea to do some research and find someone to give me a second opinion. That's where I'm at currently. I haven't met with any surgeons yet, but I'm in the process of figuring out who will be the surgeon I want to operate on my hip and arthroscopically repair or remove the torn labrum.
Here's some background for those unfamiliar with my story:
About 16 months ago (at age 27), I began training for my first-ever marathon. Prior to this, I was an occasional exerciser and certainly not a particularly athletic or fit person. But I love challenges and I was doing this marathon to raise money for blood cancer research so I was highly motivated on both fronts. Training went pretty well and I found I was most comfortable with short intervals of three minutes running, one minute walking. I never had any hip pain while I ran. But I did notice something unusual for me. After sitting for prolonged periods of time, occasionally when I would try to stand up, or when I'd shift my weight to get out of a car, as soon as I put weight on my right hip, I felt an excruciating jolt of pain that would last for a few seconds and would dissipate as soon as I caught my breath and started moving. Because the pain never occurred when I was running, I simply didn't associate the two events and because the pain went away so quickly, I just ignored it.
By the time we got into the really high mileage, I had missed one of our long runs due to the flu and when I tried to keep up with the training schedule, I decided that I could push the mileage higher than recommended, so long as I walked. So I did that. My hips hurt when I walked, but not the same kind of pain. Just the pain of having walked for 4 hours straight on sometimes hard and uneven surfaces. By the time the marathon day arrived (after 4 months of training), I felt strong and I chose to walk the entire thing with friends. It was such an amazing feeling to cross that finish line that I was hooked and signed up for a half marathon in the fall that I aimed to run.
So two months post-marathon (I tried to take it easy but may have taken it a bit too easy), I started to amp up my practices and added strength training and cross-training (which, of course, I should have been doing during my initial marathon training). I was determined to run/walk the half marathon and beat the time from my previous half marathon that I did during my initial marathon training.
Two weeks before the half marathon, I made some pretty bad choices with my training. I did a nice 9-miler on some big hills at Griffith Park and really felt the impact going downhill but ran through it anyway. A day or so later, during my strength training, by the end of my circuit workout I had completed approximately 200 squats and 200 lunges. The following morning, I did a vigorous 5-mile hike with walkers who were much faster than I was and I tried hard to keep up. Knowing I had 13.1 miles to do about 10 days later, I figured I would just rest my legs and do nothing until race day. Brilliant plan. So that's what I did.
Of course, race-day didn't go as planned either, and I ended up in the wrong pace to start and basically sprinted the first half mile. I ultimately beat my time by 45 minutes (yay) but then I did something even more brilliant. I sat in a car for 6-7 hours. Needless to say, I could barely move when I got out of the car.
This was October 18, 2009. I had signed up for another half marathon in early November, but due to the fact that I was in so much pain, I opted to cheer instead of run. My first actual good decision!!! But I had also signed up for a half marathon at the end of January, so I wanted to get back into training. I tried. And I was in such excruciating pain, I literally couldn't do it. The pain woke me up. It hurt when I sat, when I stood, when I moved and when I rested. Painkillers weren't strong enough. I was miserable. Not to mention, grumpy because I couldn't do my favorite stress-relieving exercise.
So I saw an orthopedist in November. He ruled out a stress fracture with x-rays and he sent me for my very first MRI ever. I assume that normally an MRI isn't a painful experience but given that they had to tape my toes together to keep my hips in alignment (and given that everything hurt my hips at that point), it wasn't my favorite experience. But it didn't seem as though the MRI showed a whole lot. There was inconclusive evidence indicating a possible labral tear, but the MRI did conclusively show a cyst in my right ovary that was 5.2 cm big. YIKES! So my orthopedist thought that given the way my symptoms presented (and the fact that I didn't have any popping, clicking or catching of the hip), the labral tear wasn't the likely culprit and that I probably had tendinitis and should work with a physical therapist. He also recommended I follow up with my OB/GYN on the cyst.
I worked with the physical therapist regularly through the end of February, and I felt a lot better. I still had pain in certain positions, and still had those unpredictable moments of sharp agony when I stood up or got out of a car. But I could bike, use an elliptical, and even started running again (with longer walk intervals and shorter run intervals). Meanwhile, I worked with the OB/GYN to remove the cyst non-surgically, but I ended up having the cyst removed arthroscopically at the end of March. That put a damper on my physical therapy progress, but I eventually resumed it and started running again.
The hip pain worsened, and at some point, physical therapy didn't seem to be improving it, so my physical therapist referred me back to the orthopedist for a follow-up. He suspected a labral tear but referred me to a different orthopedist, so that orthopedist ordered both x-rays and then an MRI-Arthrogram of the hip.
The arthrogram was pretty scary to me. I'm particularly uncomfortable with needles and the idea of injecting some sort of dye into my hip socket grossed me out and intimidated me. But given that I really can't stand the hip pain and how it's limiting my activities, I bit the bullet and got the arthrogram. It confirmed that I had a labral tear. It wasn't obvious and I believe that the fact that I had an incredible radiologist (Dr. Resnick in San Diego) really helped with the detection.
That's great, but what's a labral tear?
I don't really know. I haven't studied science since high school. I've never studied anatomy. I hated biology. But from what the doctors have explained and from what I have been able to find via google, my understanding of it is this: Inside of the hip socket, lining the meeting place of the ball and the socket, is really slippery protective cartilage. That's the labrum. When that stuff rubs away, you get bone on bone action, which is arthritis (again, I think, but I don't know). But when that cartilage gets a tear, it's known as a labral tear. There's a more specific name depending on where exactly the tear is, but that's beyond my simple google knowledge. From what I can tell, the cartilage doesn't naturally regenerate the way muscle does. I think it's because blood doesn't flow into it. The tears don't always cause pain. Apparently, I'm an exception (though it seems not nearly the only one). It appears the only way to fix it (if physical therapy to sufficiently strengthen the area and stabilize the hip doesn't eliminate the pain) is to have someone surgically remove the portion that's torn and sticking out, or repair it. From what I've been finding on message boards and through google, it seems as though the surgery is done arthroscopically and relatively few surgeons regularly perform this surgery.
So what now?
I'm trying to get as much info as I can about the tear, about the surgery and what reasonable expectations I should have for the entire recovery process, about various surgeons, etc. My orthopedist referred me to a local surgeon (Dr. Guanche) who apparently performs this surgery regularly (and according to an article I found online did a similar surgery on Barry Manilow), but he doesn't have any availability to see me until mid-July. I found two other surgeons in Los Angeles via lots of googling that look promising...Dr. Snibbe and Dr. Klapper.
In my online research (which I should clarify only generally consists of googling terms like "labral tear hip" and "team orthopedist MLBPhilippon, a surgeon in Vail, CO, who apparently performs these surgeries on a regular basis and who performs surgery on high profile athletes. For instance, apparently, A-Rod had his torn labrum repaired by Dr. Philippon, and Dr. Philippon's profile mentions that he's performed surgery (doesn't specify exactly what surgery) on other notable athletes such as Greg Norman, Peter Jacobsen, Mario Lemieux, Priest Holmes, and Louis Castillo. I'll admit, I'm a bit impressed :-)
Actually, one of the most interesting things I found during my internet research was a blog by a woman who traveled from Indiana to Colorado just to have this surgery with Dr. Philippon: http://aprilcz.blogspot.com/2009/03/march-26-4-weeks-pre-surgery.html
So I spoke with his office and he is willing to take a look at my films and radiologist reports and let me know what he thinks. I hadn't seriously considered the possibility of being able to actually have him perform the surgery, but it turns out that he is covered under my insurance plan (supposedly). So I'm now waiting on meeting with local surgeons and I will be sending him my images. I think there are definite drawbacks to having the surgery in another state from where I live (including the fact that I wouldn't be able to stay in CO for more than 2 weeks probably so I'd have to do the bulk of physical therapy and rehab in a different state from the doctor). That scares me. But on the other hand, this is my only right hip. I'd travel to the moon if it meant I could look forward to enjoying good painless mobility for my next hopefully many years.
One thing I'm certain about. This is going to be a lengthy process. But instead of focusing on that, I'm trying to take advantage of this time to make myself as healthy as possible so I can go into surgery with the best odds of a smooth recovery. I'm working with a nutritionist to help me lose weight in a healthy informed way, and I'm doing some gentle yoga to help stretch the area and keep it from stiffening up. I've been doing pilates (which I'm still not sure if it's good or bad for the hip, but I'm trying to avoid positions that I know will aggravate it). And I'm trying to do low/no impact cardio (swimming, biking) to strengthen my heart and keep me in shape.
This week the pain has been pretty bad and pretty constant, so I'm just trying to take one day at a time.
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