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Thread: Training round hip injury waiting for MRI

  1. #1
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    Jul 2010
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    Default Training round hip injury waiting for MRI

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    Rip,
    Male 31
    Texas Method
    Current stats: Squat 5x5 382.5
    Bench 5x5 260
    Deadlift 1x5 440
    Press 5x5 185
    Three weeks ago I injured my hip mid way through my second set of 5 at 385. I just hit parallel and I screwed up, let my hamstrings relax and there was a pop in my hip flexor in the crease of my hip. I managed to finish the squat, but within about 30 seconds I felt the area stiffen up and getting into a quarter squat without the bar was excruciating. I feel like a complete idiot. I’m prepping for a big meet in a few months and this has been a real setback.
    I went to see a PT, only because it is necessary to have seen one here before your doctor will refer you for an MRI. After some begging and pleading I now have that referral and will wait 4 weeks to get the MRI.
    The hip is very painful when I open it out, and I can’t squat with any weight at all.
    I have taken anti-inflammatories as per your protocol and this has helped some. But I am still unable to squat. My PT has advised against deadlifts because it “will pinch on the tendons”. But he was unable to give me a diagnosis. From what I have read on here I think my screw up at the bottom probably let my knees shoot forward and I’ve knackered a tendon. Hopefully nothing more.
    My question is this; is there any value/harm in me doing some GHR, leg curls and extensions to maintain muscle mass in the legs whilst I wait for the MRI. Deadlifts don’t hurt during or after, so I’m also wondering whether or not to ignore the PT and keep doing them?
    Thanks for your time,
    Chris

  2. #2
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    You can do anything that doesn't hurt. This is an interesting injury, in that it's not an adductor muscle belly tear, and I've never heard of a tendon avulsion in this area. There is a remote possibility that you have injured your femoral neck, but that would almost certainly require a pre-existing lesion. I don't think a labrum tear presents this way. Perhaps Sully has some input.

  3. #3
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    Rip, thanks for taking the time to look this over. I'd value your input Sully, though I completely understand it is difficult to diagnose this sort of thing on the web. I will let you know what the MRI shows. It's damn depressing as my squats were progressing well and I was hoping to have a good crack at the meet. Worst case I'll have to bench and deadlift and pass the squat.

  4. #4
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    Quote Originally Posted by Mark Rippetoe View Post
    You can do anything that doesn't hurt. This is an interesting injury, in that it's not an adductor muscle belly tear, and I've never heard of a tendon avulsion in this area. There is a remote possibility that you have injured your femoral neck, but that would almost certainly require a pre-existing lesion. I don't think a labrum tear presents this way. Perhaps Sully has some input.
    First thoughts: You don't describe pre-existing pain in the area; a degenerative cause seems unlikely. The circumstances of injury and the "pop" you describe would seem to indicate an acute structural failure. You're too old for slipped capital femoral epiphysis. Given the location of pain and the limitation on ROM, I think a labral injury probably belongs in the differential. Obviously this will show up on MRI, as will a tear of the ileofemoral ligament (which I've never seen diagnosed either, but I'm not an orthopod). Injuries of the iliacus, psoas and rectus femoris are in the differential but they will heal without specific therapy, MRI or no MRI.

    But the most important point is Rip's allusion to a bony injury. Femoral neck stress fractures do occur, and they can have an unfortunate natural history if not diagnosed and treated. I have seen a good number of hip avulsion fractures, although your pain doesn't sound like it's in quite the right place for an ASIS avulsion. Less likely, as Rip suggests, a pre-existing lesion (congenital bone cyst, osteoma, etc), could predispose to a pathologic fracture. The point being: MRI is a great tool, but my first diagnostic step would be plain films. Did they get them? If so, what did they show? If not, why the hell not?

    Usual caveats pertain: I can't examine you, I'm not sports med or ortho, this is not a medical consultation, etc, etc.

    Rip is right; this is curious, and I'd like to know what they find. Please let us know how this pans out.

  5. #5
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    "You're too old for slipped capital femoral epiphysis."

    I have this, I have pins in both hips. It has not affected my squatting so far, is there a chance that it will?

  6. #6
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    Quote Originally Posted by rumblefish View Post
    "You're too old for slipped capital femoral epiphysis."

    I have this, I have pins in both hips. It has not affected my squatting so far, is there a chance that it will?
    This is something that happens to kids before their growth plates close. If correctly reduced and pinned, it shouldn't be a problem, although some cases can progress to AVN even after reduction if I'm not mistaken. You'd be the first to know. Of course there's a chance that it will affect your squat. There's also a chance you'll get hit by falling Russian satellite debris while squatting, but we just can't cover all the bases in Life. If it were me, I'd just squat away and worry not.

  7. #7
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    This may be diagnostically useful: in the last 24hrs the pain has shifted somewhat. When I woke up this morning, I had a poke around whilst lying on the unaffected side. The pain on movement was still felt in the front of the hip flexor at the proximal end, but when I palpated the area there was some swelling and certainly pain on massage extending around to the ASIS area. This is the first time I have felt the pain radiating out from there.

    No plain films were taken yet, but I checked with my GP and he said that he has asked the clinic to do them too. So for now, I wait.

    Really grateful for the feedback Sully. Will have to buy you and Rip a drink someday. My wife is from the US so I'll be planning a future visit around a seminar, or will just take the drive from Long Island to W.Falls next time we are over there.

    Will be in touch after the scans.

  8. #8
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    " There's also a chance you'll get hit by falling Russian satellite debris while squatting"

    That must be the reason people keep telling me to look up when I squat.

  9. #9
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    Quote Originally Posted by rumblefish View Post
    " There's also a chance you'll get hit by falling Russian satellite debris while squatting"

    That must be the reason people keep telling me to look up when I squat.
    It may be. But even if you saw the fireball coming you couldn't get out from under the bar in time. Better to look down, be immolated during a perfect squat, and Live Forever.

    Let us kow what the xrays show.

  10. #10
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    Quote Originally Posted by Sullydog View Post

    But the most important point is Rip's allusion to a bony injury. Femoral neck stress fractures do occur, and they can have an unfortunate natural history if not diagnosed and treated. I have seen a good number of hip avulsion fractures, although your pain doesn't sound like it's in quite the right place for an ASIS avulsion.
    Sully/Rip, if I may put a question to you if you have a moment...

    I had a femoral neck fracture about two years ago, which was repaired through surgery. 40 yo now. I have three screws in my hip and a decent scar where they had to cut to access the fracture. By all accounts, it healed normally and I was cleared to go about my business. In general it is fine, minus having sorta "lost my first step" if I was a ball player, and it being a good barometer. I had done no dedicated strength training prior to the break, and came to squatting and deadlifting after some basic PT and haphazard workouts to regain normal strength in my hip.

    The idea of stress fractures in the femoral neck is worrisome to me. How much extra attention should I pay to bone/hip health as I move up in weight? I am progressing pretty slowly but steadily - my best singles so far are about 250 squat/320 DL - but am continually (and dedicated to) working my way up in weight. Would it be, in general, a good idea to go get new films once I am doing a certain multiple of body weight? Or just sorta go by how I feel (which is pretty ambiguous when it comes to bones...). Or is it a case of unless I am doing like 400+ squats don't worry about it, in general, if there is no specific issue. FWIW Rip - I train with Jeremy and Margie in Bklyn, so I am under adult supervision.

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