Paradigm Shift

Last night I experienced somewhat of a paradigm shift in how I've been looking at my hip issue.

Until now, I've been trying to exhaust my options of things I can do on my own to heal my hips (or at least the parts that I can heal, such as the muscle tightness and the strength imbalances) so that if and when I need to undergo surgery, I'll be in a good place mentally and physically. I know that, if I undergo surgery, I'll have a long recovery process, but I anticipate that (unless something goes wrong) I'll eventually be "healed." This way of thinking has been frustrating me because I am feeling increasingly frustrated with the pain and waiting around for it to go away. After all, I've been doing so much!

So a wise person asked me, what if there is no "end" to the hip pain? What if I think about "managing" the pain rather than erasing it?

My first reaction was to reject this idea completely. Of course. Why else would I even think about surgery unless I believed that I wouldn't be forever doomed to have hip pain.

But, I thought it through a bit more. From what I've read, it seems like even in "successful" surgeries, there can be some residual weakness and pain that will require physical therapy, stretching, or some other way to keep strong and limber. And not all surgical patients end up pain-free. It's my understanding that doctors consider the surgery a success if the pain goes from a 10 to a 3. So if I were that patient, I'd still be in the position of having to manage the pain long-term.

A life filled with yoga, gyrotonic, swimming, biking, stretching...all to stay strong, increase joint mobility and reduce pain. Is that really so bad? Would I really even want to give that all up if I woke up and found myself "fixed"?  (Granted, I'd really love to add the running to that list, and I'm hoping I'll be able to add that back into my routine at some point.)

The best part about thinking about pain management instead of pain elimination is that I instantly stopped waiting for the day when I'm healed, but rather, gained a measure of peace in knowing that I'm making a difference on a daily basis.

I'm definitely not ready to throw in the towel on the possibility that the surgical route could correct the underlying issue that is causing my muscles to be all out of whack. But I'm also not ready to throw in the towel and say I've done everything I can do to manage the pain and I'm ready for someone else to fix me. I am going to focus on whatever pain management I can do now, and cross the surgery bridge if and when I get there. I've realized that the activities I'm doing so that I can manage my existing pain are also going to help me prevent pain from developing in other areas of my body.

Too Good To Be True?

Ok, this is going to be a long post. This morning I met with another local orthopedic surgeon, Dr. Klapper, who is the Director of the Joint Replacement Division at Cedars-Sinai here in Los Angeles. I had an idea of what to expect from him because I read the book that he wrote entitled Heal Your Hips, in which he advocates non-surgical approaches to hip recovery and hip well-being. He only advocates surgery when the conservative approach fails. But what I like is that his conservative approach seems to be a joint pool and land therapy program. In his book, he discusses the downward cycle of hip pain, how it causes people to move less, and that lack of using the hip joint (and replacing the fluids in the hip) actually causes the hip to stiffen and results in more pain, when thus, makes you even less active, etc.

He looked at my films and the MRI and arthrogram reports, performed a physical examination of both of my hips to see at what point in the range of motion I have pain, and then he showed me on my x-ray where the extra bone portion is located and explained to me how that is bumping into the labrum. He said that it is FAI. BUT, unlike the other surgeons who have looked at my films, Dr. Klapper did not believe that I have mixed-FAI. He saw the evidence of it only on the ball, not the socket. If he's correct, and the portion of the socket were shaved down, there's no question it would make my hip unstable. So who is correct? YIKES! And ultimately, I'm not sure anyone can be 100% sure what's going on simply by looking at these films. I assume once I'm cut open, it's a whole other world and they'll actually see what is what.

But Dr. Klapper said words that I didn't dare to hope to hear:  "I don't advocate surgery for you, and definitely not yet."  Given the fact that this past week I've been nearly pain free and given that I have almost full range of motion, he suggested that I learn the pool therapy exercises and see if we can keep the pain from returning while slowly reintegrating activity into my life. He said that my labral tear was small and that although some surgeons will scare the crap out of me, tell me they need to cut sooner than later or I'll end up with early on-set of arthritis, they simply don't have the conclusive studies on that. Will I get arthritis? Maybe. But can I make some modifications to my lifestyle now to postpone it for many years? Possibly.

But Dr. Klapper said the words I dreaded -- that running is the best activity for mood, stress regulation and weight loss, etc., but the absolutely worst activity for your joints. He wants me to give it up completely. No running ever, unless I'm being chased.

At first, I immediately rejected that suggestion. And then I really thought about it. I'm not a professional athlete. Until last year, I wouldn't have even called myself an amateur athlete. A little over a year ago, I'd have never even considered running to be enjoyable. Now I adore it. Maybe I could feel that way about a different sport that is less taxing on my joints. I love to exercise outside. Okay. But I can swim, walk, and bike outside.  (Once I'm feeling better). I absolutely LOVE pilates. The mat work, at least, is not high impact. (Actually, I don't think it's impact at all, it's just the bending motion that was irritating my hip). If I want to do marathons or half-marathons, many of them allow you to walk. And I know first-hand, walking 26.2 miles or 13.1 miles is no easy task. What is it that I want long term? To be a fast runner? To complete Boston? Or to have a lifetime of mobility, activity and good health?

I keep hearing horror stories of complications from surgery. If you dislocate a joint, it's my understanding that that joint will always be a little less stable than it was before the dislocation. But that's what they'd do (to some extent) to get into the labrum to repair it. There are simply no guarantees with surgery, no matter who is doing the cutting.

Is it realistic for me truly to live a life with FAI and a small labral tear with minimal pain and moderate activity? Who knows. It certainly seems like I've got nothing to lose by trying. The pool therapy sounds like a really good idea to try because it's non-impact and I'll have someone trained to explain the exercises and watch me to make sure I've got the right form.

He wants to see if I've got any improvement in the next 6 weeks. Either way, I wasn't planning on having surgery then, so I don't see why I shouldn't give it a try. And if I ultimately need surgery, I'm still waiting around for a call from Vail to set a surgery date. And if I don't end up needing it, I don't end up needing it. Still, I don't want to get my hopes up. But if I could have a week like this week every week for the rest of my life (and I mean that level of comfort while doing activity, not while sitting around), I would definitely forego surgery.

But two conflicting ideas are swimming through my head, both trying to answer the question of why was this week so much better than the last bunch? 1) I did very little activity of any sort this week. That makes me concerned that once I kick up the activity level, I'll go right back to the pain. 2) I ate better this week than I have in months. No added sugar, no alcohol, no processed foods, regular healthy snacks and small healthy meals. Lots of water. I'm sure I've lost a few pounds. Maybe my excess weight is really a huge factor that the surgeons are awkward about calling my attention to. I know that FAI and the labral tear won't go away. BUT, maybe without the extra body weight, the pain would go away. There's only one way to know for sure, and it's about time I shed this fat!