FAI/LLD

[Rob I.]

Hi all,
I was diagnosed the other day with FAI in both hips via a CT scan; it is more prevalent on the left side. I have been dealing with this for over 2 years: The pain starts around the ischial tuberosity and radiates back up the sacrum in hip flexion/IR/adduction. It also shoots down the legs.

For reference- I’ve had bulges at L3-L4, L4-L5, and L5-S1 with foraminal stenosis at L4-L5, and L5-S1 for over 8 years (MRI). MRI last year showed no change - I had always been largely asymptomatic. After one doctor brought up that my sciatic nerves were inflamed (1 year ago), I assumed disc issue and tried PT to no avail.
I met with a spine doctor last week. He said spine has normal wear and tear, acknowledged the stenosis at L5-S1, and said symptoms were not “stenoic”. He suggested CT’s on the hips to check for retroversion, since putting the right foot down on the ground with even slight internal rotation generated functional scoliosis (He confirmed no structural scoliosis via xray, MRI, as did previous MRI’s).

Over the past 7 years, two PT’s mis-measured an LLD when treating me for mild low back/groin pain, and ended up giving me a 1 cm heel lift for the longer leg by mistake, which I ended up wearing for 5 years without knowing. Here’s info from the scanogram:

• Left femur: 47.4 cm
• Right femur: 45.5 cm
• Left tibia: 35.8: cm
• Right tibia: 35.3 cm
• Femur + tibia: left = 83.2cm, right = 80.8cm
• Leg totals: Left = 84.4 cm, right = 84.2 cm.

I am assuming leg totals is apparent leg length, where as tibia + femur yields true leg length? The doctor would not clarify this for me and just said talk to hip doctor.
The biggest issue is that the body keeps twisting/rotating to the right immediately on ascent of the deadlift and descent of squat, impinging the hip with the hips and knees flexing and extending at different times. This twisting also occurs on the descent of the bench. Any attempt to "straighten out" and correct this leads to the impingement, unless I let the right foot roll off to the outside of the foot.

I have stopped training to prevent further damage to labrum and low back. Rest usually makes all pain go away in everyday life, but regardless of time, it comes back with squats and deads. I am 28 years old, 5’11’’, and was training at 180lbs. Before the onset of the injury 2 years ago I was squatting 405, deadlifting 450, and benching 270. At this point, walking, and general bending aggravate it.

If anyone could offer answers to the following questions, I would be very grateful:

1.) How long would you rest this?
2.) In his article, Rip says the magnitude we correct for LLD depends on the significance of the LLD and the time it has been around (at least 8 years I am assuming, based on running coaches pointing out the obvious asymmetry in my gait). Even with the staggered stance (for femur difference), standing/bending on the full 2.4 cm “twisted” the pelvis – should I just try half the length, ¾’s, and go from there?
3.) Should I look into any particular treatment, or is shim with a good coach the best avenue?
4.) Do we do anything with everyday shoes for this kind of LLD, or just adjust posture to accommodate it?

Thank you in advance for any input and recommendations.

Rob

[Will Morris]

Hi all,
I was diagnosed the other day with FAI in both hips via a CT scan; it is more prevalent on the left side. I have been dealing with this for over 2 years: The pain starts around the ischial tuberosity and radiates back up the sacrum in hip flexion/IR/adduction. It also shoots down the legs.

For reference- I’ve had bulges at L3-L4, L4-L5, and L5-S1 with foraminal stenosis at L4-L5, and L5-S1 for over 8 years (MRI). MRI last year showed no change - I had always been largely asymptomatic. After one doctor brought up that my sciatic nerves were inflamed (1 year ago), I assumed disc issue and tried PT to no avail.
I met with a spine doctor last week. He said spine has normal wear and tear, acknowledged the stenosis at L5-S1, and said symptoms were not “stenoic”. He suggested CT’s on the hips to check for retroversion, since putting the right foot down on the ground with even slight internal rotation generated functional scoliosis (He confirmed no structural scoliosis via xray, MRI, as did previous MRI’s).

Over the past 7 years, two PT’s mis-measured an LLD when treating me for mild low back/groin pain, and ended up giving me a 1 cm heel lift for the longer leg by mistake, which I ended up wearing for 5 years without knowing. Here’s info from the scanogram:

• Left femur: 47.4 cm
• Right femur: 45.5 cm
• Left tibia: 35.8: cm
• Right tibia: 35.3 cm
• Femur + tibia: left = 83.2cm, right = 80.8cm
• Leg totals: Left = 84.4 cm, right = 84.2 cm.

I am assuming leg totals is apparent leg length, where as tibia + femur yields true leg length? The doctor would not clarify this for me and just said talk to hip doctor.
The biggest issue is that the body keeps twisting/rotating to the right immediately on ascent of the deadlift and descent of squat, impinging the hip with the hips and knees flexing and extending at different times. This twisting also occurs on the descent of the bench. Any attempt to "straighten out" and correct this leads to the impingement, unless I let the right foot roll off to the outside of the foot.

I have stopped training to prevent further damage to labrum and low back. Rest usually makes all pain go away in everyday life, but regardless of time, it comes back with squats and deads. I am 28 years old, 5’11’’, and was training at 180lbs. Before the onset of the injury 2 years ago I was squatting 405, deadlifting 450, and benching 270. At this point, walking, and general bending aggravate it.

If anyone could offer answers to the following questions, I would be very grateful:

1.) How long would you rest this?
2.) In his article, Rip says the magnitude we correct for LLD depends on the significance of the LLD and the time it has been around (at least 8 years I am assuming, based on running coaches pointing out the obvious asymmetry in my gait). Even with the staggered stance (for femur difference), standing/bending on the full 2.4 cm “twisted” the pelvis – should I just try half the length, ¾’s, and go from there?
3.) Should I look into any particular treatment, or is shim with a good coach the best avenue?
4.) Do we do anything with everyday shoes for this kind of LLD, or just adjust posture to accommodate it?

Thank you in advance for any input and recommendations.

Rob

I can understand the motivation to stop training, as you believe continuing to be active will cause further damage to your spine and hip. But, if I may suggest something, what damage does a sedentary life do to the entire organism?

[Rob I.]

Will,
Thank you for your reply. This is a good point: being sedentary won’t help blood flow, range of motion, and it certainly won't address underlying mechanical issues.

All the doctors and PT’s I’ve seen with regards to disc/hip issues have essentially said “if its not completely pain free you can’t do it”. While I understand their concerns, each of them have essentially said they don't lift, so I don't know how well they understand it.

When it comes to FAI’s, labrums, and discs, have you found that guys just end up dealing with the pain that can arise from heavier sets of squats and deadlifts?

Thank you