jhartman's FAI & labral repair

[jhartman]

This thread explains the background: Femoral Acetabular Impingement question

The goals of this log are to log rehab and training after surgical repair of a labral tear and femoroacetabular impingement, aka FAI. Hopefully this will be useful to anyone having similar surgery in the future. I was having pain in the front of the hip when climbing stairs, hiking, running, using the toilet, etc plus a nasty crunching sensation. Squatting hurt like hell above 215 lbs or so and caused pain that lasted for weeks afterwards. Friday, November 18th I had surgery on my left hip. The surgeon (Richard Gayle) performed a femoroplasty, which is basically shaving down my femur to remove a CAM lesion on the bone. Additionally he repaired the labrum in the hip with a plastic anchor (the source of the crunching). I will be non-weightbearing on crutches for 3 weeks. Surgeon says that full rehab takes 6 months and sometimes as long as nine months so it seems I'm in it for the long haul.

Best 5rm prior to surgery:
Squat: 235 lbs
Deadlift: 315 lbs
Bench Press: 195lbs
Press: 110 lbs
Clean: 150 lbs
Weight: 202 lbs
Height: 6'4"
Age: 31

Due to pain and life I haven't trained in 3 months and am back down to 185 lbs before surgery. Don't know what the lifts are now.

Day 1:
The anaesthesiologist used a block on my femoral nerve. I had no sensation or ability to activate my quad all day. Spent the day on the couch with dad and wife fetching things. Bending my leg at the knee was quite painful and it's difficult to move. Crutches were hard to use since half the muscles in my left leg don't work. I was on painkillers all day and basically did ankle pumps to promote blood flow. Hip actually doesn't hurt too bad after the surgery, maybe a 5/10 pain. Iced the hip every couple of hours. I didn't sleep very well.

Day 2:
Significantly better. I could move around pretty easily and had some control over my quad in my left leg now that the block was wearing off. Left leg spent the whole day twitching, which was annoying. My wife is a physical therapist and explained this is called fasiculations. Yes, having a PT for a wife is immensely helpful after surgery. She borrowed an e-stim unit from her clinic and used it on the leg which seemed to help the fasciculations a little. Pain in the hip is down to maybe 2/10 and is actually a little worse in the knee and thigh. I watched college football, read Starman Jones (Heinlein), and Once Upon a Time in the West.

I didn't take a single painkiller and I'm now on indomethacin. Indomethacin is an NSAID and it's very important to take it after hip surgery because it dramatically reduces the chance of osteophyte formation in the cartilage muscle tissue surrounding the area. It would suck to have hip surgery and then wind up worse off because there are chunks of bone everywhere.

The bandage is pretty nasty looking, lots of fluid built up. I also have a really tight sleeve on the leg to prevent blood clots. It's not fun and restricts the movement a lot.

I slept well from about 8PM to 2AM and 3AM to 8AM. Still no painkillers after the first day!

Day 3 (today):
I have full control over my leg now and the fasciculations have stopped. I've been taking magnesium supplements which are supposed to help. Pain in the hip is 1/10 with it hitting maybe 4/10 when I move. I've been shuffling both legs and doing leg lifts as exercises. The left leg is a lot weaker now and leg lifts are hard. I really wish I were allowed to walk - pressure on the hip doesn't seem very painful but I'm supposed to avoid it for 3 full weeks so that there isn't a fracture around the anchor.

Finally had a successful bowel movement. Another reason I'm glad I moved away from opiods quickly after the surgery. I had to hold the left leg out straight and try to push the right knee out to give "clearance". I was pretty nervous number 2's would be a problem before the surgery and I'm glad it hasn't been as bad as I expected.

Very excited today. I get to:
1. Change the bandage (it's gross and large)
2. Take a shower (I smell pretty bad)
3. Get out of the house and see Doctor Strange

I think I start official PT tomorrow.

[BarbellJunkie]

Subbed. Very interested to follow this log as I'm waiting for the same surgery!

[jhartman]

Thanks BarbellJunkie. I hope this is useful to you and that the surgery goes well. If they don't repair your labrum your post-surgery experience will be a lot easier. It was a gametime call for my surgeon.

Day 3, continued

Changed the bandage. It was full of blood. I took a shower (it was glorious) and I let soap and water wash over it, but kept the steristrips on. I covered the steristrips with some kind of plastic bandage my friend gave me. Still icing 4-6 times a day.

Getting into the shower is HARD. Also I was incredibly lucky that my wife ordered a shower stool. I don't think showering without one would be possible. Nor do I think anyone could shower easily by themselves. To anyone who ever reads this MAKE SURE YOU HAVE FAMILY AND A SPOUSE AVAILABLE TO HELP.

Day 4, Mon Nov 21
Swelling has reduced dramatically today.

Had physical therapy. I'm only allowed to do isometric exercises so far. Butt squeezes, quad squeezes, and sort of pulling into the ground with my hamstrings at different knee and hip angles. Hip angle not allowed to pass 60 degrees. Everyone is very afraid I will mess up the plastic staples holding the labrum together. My PT also warned me against squatting after rehab and said I would likely not be able to go to parallel or I would have to consider another squat variant like front squats to keep the hip angle open. I might have to ignore his warning on this one

My leg itches like crazy.

Day 5, Tues Nov 22
Took another shower. Definitely still need my wife's help in there. I kind of tripped getting out and wound up supporting a good chunk of weight on my left leg. Oops. Didn't hurt though so I guess I lucked out. I picked up an application for handicapped parking.

Day 6, Wed Nov 23
Bruising on the hip is actually a lot worse today. Stitches itch. Hip joint is sore but doesn't hurt at all. I decided to get out of the house and go to the park to look at birds. It hasn't even been a week and being forced to spend week off my leg is driving me insane. So I must have gone about a mile on crutches - oh my. Crutches are surprisingly tough to use and I was huffing and puffing. I feel like my neck, shoulders, and triceps are getting an incredible endurance workout.

Still icing (3-4x daily), but not probably as much as I should. Swelling is coming down nicely but as I said the bruising is much worse and the stitches hurt a little.

[jhartman]

Day 7, Thurs Nov 24
Awesome Turkey day. I was actually exhausted from walking around on crutches the previous day. I didn't move much, just football watching and eating.

Day 8, Friday Nov 25
Still very tired. Bruising getting a little bit worse.

Day 9, Sat Nov 26
Feeling a lot better today. Caught up on work, which I intend to restart on Monday. I am a software engineer so I think this will be fine.

I took the stocking off. WOOHOO! Note on crutches - I've gotten pretty good with crutches and using the wall to prop myself up so I can be somewhat useful. I'd recommend to anyone with this surgery to get some kind of satchel so you can carry things around.

My left foot was an odd color after I moved around to get to bed and it felt a little funny. I was immediately concerned about a blood clot but things went normal after laying down for a few minutes.

Day 10, Sun Nov 27
My hip is now entirely green and black. Now I'm about to talk about something gross so you can stop reading if you want. For the last few days I've noticed red blood when wiping after a #2. Called a friend who's a doctor and he thinks it's likely an internal hemorroid. Perhaps I strained something in one of the bowel movements - it's not super easy to go when one of your legs isn't supposed to be externally rotated.

[jhartman]

Day 11, Mon Nov 28

Post-op with the surgeon's PA. He said that when they scoped inside the capsule it was obvious that surgery would help a lot. There was a good sized tear and the labrum had come quite loose and was sliding around. Additionally they found a pincer lesion as well. So during the surgery they removed both cam and pincer lesions and put in 2 anchors to fix the labral tear. Frankly the hip feels great. The PA was quite adamant that I stay non-weight bearing and that even though I feel much better I need to take the recovery very slowly because the site is fragile.

I had two incisions and he removed the stitches from both. One of them hurt a good bit and is rather gnarly looking - I think I pulled the stitches open a couple times. It's healing from the bottom-up which isn't ideal. Hopefully it doesn't scar too badly.

I also had another session of PT. I'm not allowed to do standing leg exercises, plus I can go prone and strech out my quad, which is extremely tight.

I went to work today for the first time. It went pretty well, I just try to lean back in my chair to keep a fairly open hip angle. No pain and it's nice to be out of the house.

[jhartman]

Day 13, Wed Nov 30
PT today. Now doing leg lifts. 3 variations - prone, supine, and on my side. I did sets of 10, the leg has lost a lot of hip flexor, quad, and abductor strength. We also spent a long time stretching my quad. At start of session I could flex the knee 85 degrees while prone, and at the end got to about 125. Did a lot of contract/relax stretching where I would lay prone & push the knee down while my ankle was connected to a stretching strap that I was holding to give resistance.

Day 14, Thurs Dec 1
Definitely did too much at work. I was very tired at the end of the day and the hip was sore. Did standing exercises during the and 2 sets of stretching and exercises right before bed.

Day 15, Fri Dec 2
PT again. Strength is up, I am now doing sets of 20 for leg lifts. Quad is still tight. PT spent a good 20 minutes just massaging it out and doing tack stretching. Feels a lot better and I can now get the knee to about 135 degrees prone. We think the quad tightness is a result of the nerve block the surgeon chose to administer before surgery. I think next week we probably toss in clams and bridges.

I decided to take the day off from work to give everything a rest.

[jhartman]

Day 18 Mon Dec 5
Decided to start linear progression on ankle weights. 2 sets of 15s front, side, and back leg raises with 5lb ankle weights and 2 sets with 2 lbs. More quad stretching.

Day 20 Wed Dec 7
Leg lifts with 7.5lb ankle weights. 2 sets of 15, and 2 more sets of 15 with 5 lb weights. Lots of quad massage and stretching. Starting to feel good. After a session we can get same range of motion with both knees.

Day 22 Fri Dec 9

Woohoo I'm weightbearing now. My quad and calf are so weak though - I'm not even close to walking. I can stand still however and give a little support while going on crutches. PT today consisted of:
- Shuffling weight back and forth between legs in different planes
- Single leg glute bridges and glute bridges where I alternate raising a hip
- Calf raises. My calf is no longer strong enough for a single-leg calf raise
- My ankle weight LP. 2 sets of 15 for leg raises with 10lb ankle weights followed by 2 sets with 5lb ankle weights.

I wish we had done some work for quad and calf earlier. PT said that was pretty much impossible without stressing the hip.

[jhartman]

Day 23 Sat Dec 10

My cane came today and I switched to the cane! Now I can carry things in my hand! The hip is very weak and using the cane is definitely necessary.

Day 24 Sun Dec 11

I'm much stronger walking with the cane today. Went to a Christmas party and stood for quite a while. Was a bit tiring but I can get around well now.

Day 25 Mon Dec 12

PT Today. I walked around a little in the morning without the cane - I have a very definite limp.
- Tack & stretch on the quad. Still tight!
- Step ups onto a box (6-8" i'd guess). 3 sets of about 25 reps.
- 3 sets of 10 single leg glute bridges
- Ankle weight LP. 2 sets of 15 leg raises (prone, supine, and side) @ 12 lbs ankle weights followed by 2 sets of 15 @ 7.5lbs. Getting hard - will be switching the LP to 1 lb jumps!
Calf raises throughout the day. Very tired after PT, the step-ups took a lot out of my quad

[jhartman]

Day 28 Thurs Dec 15

PT today, with a new therapist. It was WAY harder than previous sessions. I was neurologically smoked the rest of the day.

- Single leg bridges while therapist pushed on quad
- Side lying leg raise while therapist pushed on abductors & external rotators
- Clams with leg elevated
- Balancing exercises where I'm in a pushing position. I elevate the good leg and resist the therapist pushing on it in random directions, stressing the joint that was operated on
- Slow step-downs from a box focusing on eccentric control
- Calf raises
- Quarter squats while therapist pulls on me with a band
- Walking back and forth with 1 foot in front of another and eyes closed, focusing on balance. Super difficult.

That afternoon my wife and I headed to San Francisco Airport to catch a flight to Salt Lake City. It was a nightmare. Our flight was delayed 4 hours, then cancelled. United rebooked us on American. We waited in a huge line only to find out that for some reason the American flight was leaving from the International terminal and the guy wouldn't print our boarding passes. I had my wife run ahead to American and get boarding passes, and for some reason they couldn't get her TSA pre on the boarding passes and we had to stand in line. We didn't get into Park City until past midnight and my hip was pretty angry with me.

Day 29 Friday Dec 16

Very tired today. Iced hip in morning. Went out shopping at the outlet malls for a couple days and got caught in a snowstorm. Took several hours to go 4 miles. Walked to dinner in the cold. Super hard on the hip and I went to bed at 8pm.

Day 30 Sat Dec 17

Stuck up for myself a bit and resolved to not do so much. Iced the hip in the morning and stayed at the hotel while everyone else shopped. I joined them to watch Rogue One and walk around a bit. Hip is sore today since I do so much the last two days. Got in the hot tub which felt good. I still need my cane for longer distances and to avoid limping but I can feel myself getting stronger and steadier each day.

[jhartman]

Day 33 Tues Dec 20

Yesterday was post-op appointment. The PA said I still have limitations on external rotation and hip flexion for another week and a half.

Hip is doing well and I can almost walk completely normally. Additionally I can now do single-leg calf raises on the affected hip, so that calf has gotten back strong quickly. PT today,
- Stretch and manual work on quad
- Manual work on iliacus
- Manual work on external rotators
- 2 sets of 15 single leg glute raise
- 2 sets of 15 side lying leg raise, pushing against PT
- 2 sets of 15 clams with foot in mid-air
- Walking forwards & backwards with eyes closed. Hard!
- 3 sets of 10 step up and down with single leg, focus on eccentric
- 3 sets of 10 box squats, 10 seconds eccentric
- 2 sets of 5 pullups. Starting to get some upper body work in again. PT says I should do pushups every other day.
- 1 set of 10 single-leg calf raise, super set of another 20 with both legs. Both from a ledge