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.

What's really going on?

I have been asking myself for months now what is really going on in my body? What's really causing all this pain? I visited another doctor and I got another answer. My chiropractor believes that all of the symptoms I've described, including the clicking and stiffness in the hips, could be explained by muscular imbalances and tightness in my hip and rear areas -- particularly the Psoas.

But what about my MRI? It clearly shows a tear and FAI. Well, according to him, that may have been what started all of this, but given the extent of the muscle tightness I've got and the fact that I've lived with this pain for roughly 1.5 years now, he thinks there's a good possibility that if it was a small enough tear it could have healed over or that, even if it didn't, it's not what is causing the pain.

It's not the first time I've been told about this possibility...isn't that the point of Dr. P's interest in trying to isolate the problem by using a shot of Kenalog (sp??). To see if it's the hip or if it's really something else that's causing the pain?  But I don't see him for another few months and in the meantime, I'm not sure what that means for me.

I'm definitely better on days that I do yoga, pool exercises, gyrotonic, or bike. Sitting or standing for long periods of time always triggers the pain. 40% of the time when I stand up, I still get that sharp shooting pain in my inner groin area in both hips. BUT, if I've been sitting for a while and try to stand up, that percentage is more like 95%.

I'm having a hard time mentally dealing with the hip limitations. There's a concert I really wanted to attend this week that I ended up passing on because it's standing-room only and I knew my hip would be screaming within 30 minutes. I haven't gone for a hike or a jog in so long. I miss it so much and I'm itching to give it a try.  But I'm pretty sure I shouldn't yet. This month has been particularly tough. Last year this month, I ran the Nike Women's Half Marathon and, despite fleeting and occasional pain, still felt on top of the world.  I'm having a hard time accepting that I'm not running at all anymore. Since that race, I think I've only logged about 4 miles -- all of which triggered excruciating pain. I was only a "runner" for a fleeting 9 months. How can I miss it so much?

On the other hand, I've come a long way from where I was a few months ago when I started this blog and had difficulty walking through a parking lot. I'm exercising about 5x/week, even if it's not particularly high cardio stuff...though I'm trying to build up my stamina.  I've lost weight and am still losing. I've learned a whole lot about the human body and the many muscles that stabilize our hip and help us move our legs. I've learned quite a bit about nutrition and have discovered some very different but complementary methods of cross-training. I've gotten slightly less neurotically focused on running and have gained a whole lot more respect for the body.

I want to throw my hands in the air and say, fine I surrender universe -- I accept it's not in my control. I'll keep doing what feels good and seems to make me healthier, but I will be grateful for all the blessings in my life and the fact that what I'm going through is hardly a big deal compared to so many people out there who are going through much more serious and upsetting problems. I really want to do that. But I'm having a hard time letting go. The irony though is that I'm not actually holding onto control. I never had any. So what am I holding onto so tightly?

Tempting Fate?

I have been very concerned with jinxing my progress by explaining how much better I'm doing, but I've decided to tempt fate and share it. 98% of my day I have no hip pain. That is HUGE!!!!! The other 2% of the time is when I stand up from a sitting position. And it doesn't happen all of the time. I'm still trying to figure out how to avoid the pain when I stand, because I assume it has something to do with the angle of my leg, hip, etc. But I feel like a completely different person than I felt when I started keeping this blog a couple of months ago.

Physical therapy is a gift from God. It has to be. I've been able to exercise pain-free, and I'm able to see just how strong I'm becoming. I have been increasing the intensity of the exercises (larger fins for resistance, increased number of squats, faster walking/running). And the water exercises have the added benefit of working my abs and arms also. That sense of accomplishment I got from running -- the pushing beyond my own mental and physical limits -- I'm getting that again, but in the water. And I'm even starting to enjoy the water. It's been hot here -- over 100 degrees each day this week. The water is a wonderful way to workout.

I'm still following Noell's 6-week eating plan (http://pickorstab.blogspot.com/) and I'm not really sure how many inches I've lost or how many pounds, but my clothes are getting very loose. I'm wearing a shirt today that I haven't worn in years (literally). Same with my pants. I even bought a new pencil skirt 3 weeks ago that was quite form-fitting, and I wore it yesterday and it was baggy in places. So, I assume that the reduced weight is helping relieve the pressure I'm putting on my hips also. 

I still haven't really resumed much activity beyond the pool-based, so that's my next challenge. Can I maintain this level of comfort and reincorporate some of the other activities I so dearly want to do -- bike, pilates, walk, yoga? I won't tempt the fates with running. I'm sad about that. There's a Keith Urban song, Till Summer Comes Around, and he's basically frozen in this place where he had a perfect summer love and hopes she'll return each year...she doesn't. He can't leave. I kind of feel like that's me and running. I fell in love, head-over-heals, and (due to my hip), running has said goodbye. I'm still wishing for it turn return to me, to give me the clarity of mind, the release of my over-busy head, the sense of accomplishment, etc. But I think I need to come to terms with the lost love and learn to love again. I'm seeing some shimmer of hope for a long-term relationship with the water.

I still don't know whether or not I'm going to end up requiring surgery. I know that the exercises I'm doing are not actually fixing my labral tear or FAI. They are just allowing me to function with minimal pain. I have a real concern that by not fixing the real underlying cause, I'm just postponing the inevitable, and when I do ultimately get the surgery, I'll have frayed more of my labrum, and caused much more damage to the joint. That is what is driving me to still meet with Dr. P and hopefully gain some more perspective. But at a minimum, I know that losing weight and strengthening my body is the best thing I can do pre-op anyway.

The rest is out of my hands. There isn't anything that this world can throw at me that I can't find a way to endure and of all of the possible things, this truly isn't that bad. Am I tempting fate? Maybe.

Prescription PT

I decided to try Dr. Klapper's suggestion and do a water-based physical therapy program. I met with the physical therapist last week for the initial evaluation where she put my legs through a variety of strength and range of motion tests. Not quite surprising was the fact that my right leg was weaker and had less range than my left in nearly every aspect. I was given 5 land-based stretch/strength exercises to do on a daily basis. I am finding that, if I do the exercises correctly, they're challenging. If I cheat and use other muscles than the intended ones to accomplish the result, they become very easy. That tells me that I've really been compensating for some muscle deficiencies (but they're still there).

I've been watching what I've been eating with particular care this past week. I had been seeing a nutritionist who gave me guidelines to a healthy diet (which I had been getting increasingly less careful following), until last week, where I coupled my nutritionist's advice with a 6-week challenge, courtesy of Noell (http://pickorstab.blogspot.com/), whose challenge essentially mirrors the advice I've been given from my nutritionist! With the combined burst of motivation from the challenge, and some helpful accountability from my nutritionist, my sister and my hubby, I lost 4 pounds last week! And (maybe coincidentally), I haven't had much true hip pain this week. Only a few twinges. The discomfort I have felt this week has been entirely muscular -- things are so tight, especially my IT band.  But the muscle pain is actually much preferable to the joint pain because that means there is something I can do to make it better! I believe that PT will help me strengthen and lengthen the muscles around my hip (and hopefully all over). 

I'm so ready to start my pool-based therapy, but my first in-pool session isn't until Wednesday. Grr. But, in the meantime, in addition to my land-based exercises, I went swimming on Saturday for 20 minutes. The public pool was packed for a swim meet, so I ended up driving to the gym and using the pool there. But that pool didn't have any pull buoys, so I had to constantly remind myself to take it easy with the excessive kicking. But I didn't remember not to squat and kick off of the sides of the pool, so about 18 minutes in, I realized that I probably did more damage from that repetitive motion than I did from any kicking of water. Darn. But I got an incredible massage that evening to help loosen the muscles in my butt and hip and outer thigh and I think it helped a lot.

I feel really good today. Not just because my hip is not hurting (though it doesn't feel quite normal), but I have a lot of energy and I'm just excited. I don't know why I'm excited, but I think it's the first time in a while I truly feel hope. I also feel fear of feeling hope, but that's not really productive, now, is it!?!

I think that my biggest challenge this month will be sticking to what I'm instructed to do, and not overdoing it and pushing it. I walked my dogs yesterday, and it was a relatively short walk (though the first I've done in a while). I felt good and I wanted to keep going and thankfully, Noah reminded me that I should stop when I feel good, not when my hip is throbbing. So I did. And today, I feel like I can do it again. Maybe I'll add on another minute or two. But I don't seem to be good at self-moderation. Hence, my injury in the first place.

But I have a new healthy admiration of the human body. And I want to treat it with the respect it deserves and not treat it like a trash can I can throw whatever junk I want into and expect it to run properly. I have this amazing vessel I've been given in which I can explore and experience this life. And, in a weird way, I'm grateful for the hip injury. It is the only thing in my life that has really given me pause to truly think about the body I've been given, not as simply a superficial how-do-I-look kind of thing, but as a gift. Had I not injured my hip, I may still be running right now. But I'd otherwise be continuing down the same unhealthy lifestyle. I have a feeling that, for the long run, my hip pain may have been the wake-up call that saved my life.

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!