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!