Testimonial from Dr. Caroline Withall
When I decided to write about progress of my hip arthroscopy rehab, I promised to be truthful and real about my experiences. Without a doubt, this last month has been exceptionally tough, particularly mentally. As ever, there have been more of the extreme highs and lows that really do seem to be the nature of recovery from this particular injury.
That doesn’t sound like a lot, but it is! The test assesses what, if any, discrepancy you have between the right and left legs and their reaches in varied positions around the star. Obtaining physical evidence of improvement is such an important psychological win, a real boost and motivator to keep going. Add to that some successful trips out, such as visiting Jane Austen’s house in a little Hampshire village in the pretty Autumn color to inspire the soul, and all was seeming rosy…
This month started fabulously when I set up a star excursion balance test to compare how I was doing against the scores I recorded when doing this test with Dr.Ginger in her office – I was absolutely delighted that my average score on my bad hip had come down by a whole three centimeters!
Problems and Mistakes Arise
Problems soon loomed over the horizon. First up, I made a mistake. Since I was feeling good, one day I decided to try a longer drive than normal. Nothing wildly ambitious, just 20 mins each way to an appointment. But I wore the wrong footwear and paid the price as my right obturator internus needs no excuse to get a bit grumpy and it really lost its temper.
I also kept faltering with core exercises. I know that I once did have a strong core. After the birth of my daughter, I did some personal training to get back into shape which resulted in being probably as strong as I had ever been. However, in my early forties, my hip labral tears and impingement wreaked their special havoc.
Past Influences on my Hip Arthroscopy Rehab
It was several years before I achieved a diagnosis for the pains I had been having on my right side, then added to that a failed surgery. By the time I underwent revision surgery I was dealing with five years of muscle compensations and poor motor patterning. Two surgeries on the right hip and one on the left. Meaning that my hips have been surgically dislocated three times in just over two years.
All of this has unfortunately taken its toll on my core muscles. Whenever I try to address this issue, I tend to flare up very badly in my abdomen, particularly my obliques.
When working with Dr. Ginger in the US, we developed a little sequence that we hoped could address the problem slowly, but alas it was still proving a trigger. Add to that the difficulty I find in performing iliacus and lateral abdominal wall releases on myself, soon made for a recipe for snarky psoas soup. It became apparent that I was going to need to adapt the program because something just wasn’t feeling right – a continual see-saw between the oblique area and the obturator internus.
When In Doubt…Start with Core?
Logically, core strength seemed to me to be the most important rehab step, so I tried dropping other elements of the program to focus solely on this. It didn’t help! Worse, I then felt I was losing ground with areas that I had achieved progress in, such as waking up the glutes. I just seemed to be getting more and more congested in the psoas/top of the thigh area with continual obturator flares.
Even something seemingly as simple as doing kapalbhati breath was very aggravating. I have since learned that just because it is breath work, does not necessarily mean it is “simple.” In fact ,this type of breath work, if you have a problem with your abdomen, can be triggering). Another lost at sea moment, the fog so dense I couldn’t see any clear path…it was time for a consult with Dr. Ginger.
Continuous Learning via Hip Arthroscopy Rehab
Part of rehabilitation is experimentation and an acceptance that sometimes things need to be adapted – and we set to work on this. You have to dig deep and try not to view it through the lens of failure, but instead see that you are continually learning about your body and listening to the information it is trying to give you. Upon reflection, we realized that focusing only on core work was actually making the problem worse.
We had to then think through that problem, why was this the case? It was especially puzzling as the left side of my body has responded really well to my program, and has made vast improvements. The right side of my abdomen just does not feel the same at all, the whole area feels permanently congested.
Once again Dr. Ginger’s wide knowledge is invaluable as we discussed whether something else could be making mischief – the role of functional medicine in your recovery should not be underestimated, particularly in my demographic – females over 45 recovering from hip scopes are likely to also be facing hormonal challenges, but I also learned that sometimes surgeries and their resulting pelvic issues can impact other aspects of your system, such as digestion.
These things are complicated and nuanced, and take time to work through. This can be very frustrating when you have already been out of action for so long, but you only have two options – throw the towel in, or keep putting one foot in front of the other, keep curious, keep advocating for yourself and keep going.
This is hard, no question, and you will have days when you don’t feel you can keep doing that, but I am never going to choose the former, at least not until I have explored all avenues.
Effects of Hormones on Hip Arthroscopy Rehab
In my previous blogs I talked a bit about the hormonal aspects, and how we were addressing it with vitamin/supplement changes has helped. I decided this month to also try some hormone replacement therapy, as several different doctors have suggested over the course of the last couple of years that it could aid my recovery.
I was reasonably reluctant since I did not feel my “ordinary” symptoms of a woman my age are particularly bad enough to consider taking medication, but there is some thinking that it can improve joint pain. So I decided it was probably sensible to try it. Otherwise I could always be wondering, “What if?”
Once again, I had to adapt my plans – but it didn’t take long to adapt them again! Alas it did not prove right for me, with two side effects that inadvertently gave me more clues about my body. The first came very quickly. It did not agree with my stomach. While some bloating is to be expected, it seemed to exacerbate existing digestive issues tenfold and did not settle down. Thus giving me a pointer that perhaps these symptoms can no longer be downplayed and I need to investigate.
The second effect was that my bad right hip started to give way! It was completely random and not even during times of movement – for example, I was standing with a cup of coffee in my kitchen and it suddenly spasmed. In all of my troubles, this has never happened, and it was a very unwelcome development, and it kept happening.
Support from Dr. Ginger is Invaluable
When I conferred with Dr. Ginger she explained that sometimes if your metabolism is not working properly, too much estrogen can make matters worse as it makes connective tissue more supple – hence the basic premise that it can ease aches and pains – BUT if you have a hip with micro-instability, such extra laxity may not be a welcome addition – we know from my Dutch test that I have an issue with methylation. Therefore Dr. Ginger speculated with an analogy that I may be filling up the bathtub, but not draining the water.
After two weeks I decided to stop the medication, stick with supplements and diet to support hormones and turn my attention to organizing a visit to the gastroenterologist for my next detective mission. We also discussed some other possibilities that could be causing my persistent abdominal pain but I will save those for my next blog once I have more information from the gastroenterologist’s investigations.
I now have a new adapted program, to go back to glute work, some nice relaxing medical therapeutic yoga poses to soothe my sore obliques, and concentrate on ujjayi breathwork for the core (although even this can be uncomfortable during bad flare ups). This may perhaps sounds too simplistic, but even the most gentle therapeutic exercises can still help to build up some strength.
My Current Rehab Plan
Dr. Ginger also reminded me that during my everyday activities I am always using my core – such as doing the laundry – it is just that it is core work my body is used to and tolerates – the challenge is to encourage it to try something new! As well as being calming, ujjayi breathing is also a way to try coax it towards this.
I’m still working hard on acceptance that this is still going to take some time yet to unravel. It’s no coincidence that I do best with progress when I lean into this and stop trying to get to my destination too soon. I am also coming more and more to the conclusion that one of the single most effective things you can do when rehabbing is really watch what you eat, the effect can be quite dramatic and while I could never completely give up chocolate and cake, I do notice I feel brighter when I eat really well.
To end this month on a positive note, it is always good to have outside perspective. I saw some people I have not seen for a couple of months and without any prompting from me they immediately remarked that I was visibly a lot better than when we last met. That was a really timely insight to give me the energy to keep going.
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