Hip Q&A: Postsurgical Positional Hip Pain
Question from Lydia:
I’m 7 months labral repair via scope. Here is the short story:
I was sitting on chair with good right foot under the left buttock unconsciously – while paying bills. I couldn’t get up and needed help to walk. I could not put any weight on the scoped leg at all. I had groin hip and lower back back. About an hour after was finally able to bear weight but this morning real sore and shaky. I am still very sore 10 hrs after the incident. I was 100% prior to sitting on foot (stupid move). What happened? Cramping, spasming. I took Aleve, Celebrex, & Xanax to calm everything down. I’m walking with so much tenderness. Should I try to stretch it out/ cycle or rest or use TENS? Any suggestions please. I’M NEVER SITTING INDIAN STYLE AGAIN.
Answer from Ginger:
Hi Lydia,
First, I am so sorry to hear of your recent hip troubles. There are a bevy of post-surgical woes that are not (yet) written about “in the post-surgical hip labral repair brochure,” so to speak, if you get my drift. Most important, there is no way I could fully appreciate or understand these woes if I had not been both a hip labral patient AND a PT.
Here are my questions for you?
- Is the pain “old pain” or “new pain”?
- What aggravates the hip and where is the pain during the aggravating activity?
Lydia:
The pain was old for hip and new for groin. My post-surgical PT had told me I may have spasm or crapping if I put myself in a bad position with a rapid twist and stand. This has happened only after scope in groin. I had a labral tear that required 3 anchors to repair. I had no pain in the position just getting out of the position.
Once early PO getting out of car I couldn’t walk into PT but they helped me walk w/massage and stretching. Last night I had uneven sitting 20 min. and I went to get up and had cramping and pain and I was unable to walk or weight bear. I was helped to the couch but the pain was constant until 30min. afterward. Then it was mild after lying still and rubbing the groin & outer trochanter area. This morning I started walking and stretching with only slight stinging in the outer hip.
I am a bit worn out. Went to get some health food. I’m better after using ice & heat on the heat. Thank God it’s better. Scary! Rule: sit correctly, stand straight, look before walk & don’t twist. Thank you for responding.
PS I also forgot to mention I had a bursectomy and am 7 months PO on both procedures.
Ginger:
First, if it is new pain – then it is likely not related to the repair, which is good news.
Second, my immediate thoughts are to screen for:
- Sacroiliac dysfunction – since you had low back pain after the incident.
- Ask about any pelvic floor pain or discomfort.
- Ask if this incident occurred during ovulation or late luteal phase (1-4 days before menstruation).
- Test all muscles surrounding the hip to make sure they are all strong enough to support the hip – BUT also check to see if they are firing in a proper pattern. If they aren’t, this can sometimes lead to malalignment of the femoral head in the acetabulum – which would cause the pain you described.
- Check for fascial integrity, mobility, and the presence and depth of scar tissue in the area. These issues can be a devil of a problem to work through – and if I had to guess, I would name that as a likely culprit in combination with, or acting independently of, all the other issues I mentioned.
Of course, I can’t know for sure what the issue is since I haven’t done a physical examination. But let me also say that nutrition and movement are equally important considerations in preventing post-op reinjury. Anti-inflammatory eating – http://www.gingergarner.com/…/anti-inflammatory…/ is very important, as is knowing what movement the hip is capable of – according to what surgery was done. For example, some folks with capsular plication may have a longer recovery time for ROM, some folks with dysplasia may always need to avoid certain angles in the ROM, and then there is scar tissue and fascia – which are two bears of an issue that are invariably implicated after surgery and almost always affect the hip both proximal (near the hip) and distal (other areas away from the hip, like the respiratory diaphragm, pelvic diaphragm, and trunk muscles).
My main recommendation would be to get the hip evaluated by a PT who specializes in hip preservation – which means the PT has been trained in fascial work, hip nonoperative and operative rehab, and pelvic rehab, preferably with a biopsychosocial approach. I would ask them to pay special attention to patterns of scar tissue, including any visceral, pelvic, or related fascial issues that could be causing the muscles to fire in a nonoptimal way (which could also contribute to some of the pain you felt after rising from the FABER (hip flexion, abduction, and external rotation) position. That ROM commonly causes problems for hip labral and FAI patients, especially if any dysplasia is present. I would also have them screen the areas I mentioned above.
Hope this helps Lydia!
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