Training Log

Starting Strength in the Real World


Hip Pain and Rehab Case Study After Arthroscopic Hip Surgery

by Matthew Moore | February 15, 2018

In this article I will outline my experience using barbells to successfully recover from arthroscopic hip surgery to repair a torn labrum and remove bony lesions in the hip socket, and what happens when you decide to make your body heal rather than wait for it to heal. In just over 6 months post-op, I was able to get my squat up to 405x3 for a huge all time PR with no hip pain using the Starting Strength linear progression.

Background/Injury

In April of 2016 I was working through my squat warmups when I felt a pop in my right hip. This resulted in a sharp pain deep in the hip which quickly moved to the anterior region of the hip joint. I couldn’t walk without a limp; and even laying down in bed was painful the first few days. I waited about 4 weeks to get back to training. After the injury I could still train the deadlift, but I would always feel something “catch” in my hip while in the bottom of an squat, so I just trained around the injury for the next year.

By April 2017 I had x-rays and an MRI done on my hip. I met with a surgeon in Fairfax, Virginia who specialized in hip arthroscopy. He said I had a classic exam for Femoral Acetabular Impingement (FAI) syndrome, and my imaging showed that I had both “cam” and “pincer” lesions in the right hip – abnormal growths of bone that build up over time around the femoral neck (cam) and an overgrowth of the socket of the acetabulum (pincer). I’d likely had these bony lesions for a long time, and the pain I felt in April 2016 was the result of the spurs pinching on the labrum until it finally tore from the acetabulum. Following the surgeon’s recommendation and tired of dealing with the pain for over a year, I opted for surgery on May 16, 2017.

The Surgery

According to the surgery report, no chondral damage was found on the femoral head, and no loose bodies were found in the hip. They found some synovitis throughout the hip capsule and performed a partial synovectomy. After evaluation of the labrum it was shown there was a significant tear from the 11 o’clock to 1:30 position. They shaved down the pincer lesion with a burr, and then used 2 anchors to reattach the Labrum. Finally, they used a burr to remove the large cam lesion.

Since there were anchors placed into the bone to hold my labrum down, I was required to take 6 weeks off of training to allow the anchors to properly set and integrate with the acetabulum. To aid my recovery at home I was prescribed a continuous passive movement machine (CPM) and a really cool ice and compression machine that was almost always attached to me.

I spent a lot of time in the CPM since I didn’t have much else to do and I knew it was good to keep things moving. I started at 30 degrees of flexion the day after surgery and was told to increase flexion by 3-5 degrees daily. After my 6 week follow up I was told the labrum repair should be clear to start progressing my rehab, and the Surgeon gave the green light to accelerate the rehab schedule. Of course my Surgeon’s Idea of PT schedule and my plan forward were two very different things. Now the real fun began.

A Return to Training with Limited ROM

The approach I took during this phase was simple. I started squatting with an empty bar to a high box, added weight each session, and lowered the box height weekly. I didn’t arrive at this approach solely on my own, however. I got some good advice from SSC Beau Bryant to use this approach. He mentioned that he had used the same approach with lifters in his gym and even used it to rehab one member who had the same surgery. In the same manner, I progressed my deadlifts by initially pulling from pins right above the knee, added weight each session and lowered the pins weekly as well. For the rest of the lifts I followed the Starting Strength Linear progression as written.

squatting progression to box

I started with a box height of about 21 inches. I used a set of pulling blocks, 45-lb bumpers and layers of stall mat to make up the height and lower the box by about 2 inches each time. For the sake of simplicity and concision (as much as possible anyway), Table 1 details the squat loads throughout the rest of my recovery process. All weights are recorded in pounds using (weight x reps x sets) notation.

Week

Day 1

Day 2

Day 3

Box height

Notes from training log

 7

45x20x3

65x20x3

85x20x3

 21"

hip flexor a little tight this week. Nothing major

 8

95x15x3

115x15x3

135x10x3

19"

Hip felt "crowded" and a little tight on the 3rd workout this week 135 didn't feel great. No sharp pain, but I shouldn't have gone up 20 pounds

9

115x10x3

125x10x3

135x8x3

17"

No pain recorded this week. Words like "My Hip feels great" fill my training log this week

10

145x8x3

155x8x3

165x8x3

15.5"

Noted tightness in the hip flexor but no pain

11

175x5x3

185x5x3

195x5x3

14.25"

No pain this week

 12

205x5x3

210x5x3

215x5x3

N/A

NO PAIN AND NO BOX

Building Strength

I had pulled a lifetime PR deadlift of 500 lbs before I had my hip surgery. At the time of the deadlift PR I hadn’t been able to squat for over a year, and I had never successfully performed a 4 plate squat. I had never run a LP before, and as an aspiring Starting Strength Coach I wanted to use the opportunity to run through a Starting Strength linear progression for myself so I would be better suited to guide clients through their NLP. It also had the added benefit of allowing me to set PRs on all my lifts. Table 2 is my progress on the squat in the same format as above.

Week

Day 1

Day 2

Day 3

Notes from training log

13

220x5x3

225x5x3

230x5x3

 

14

240x5x3

245x5x3

255x5x3

Noted some tightness in the hip flexor this week. But hip always felt beter post workout

15

260x5x3

265x5x3

270x5x3

Best feeling week yet. No tightness in hip flexor.

16

275x5x3

280x5x3

285x5x3

 

17

290x5x3

 

300x5x3

My other lifts moved onto intermediate territory around this point. I chose a 4 day split to better suit my scheduling needs and kept my squats/deadlifts on LP

18

315x5x3

 

325x5x3

Couldn't resist the jump to 3 plates this week….but it felt good.

19

335x5x3

 

345x5x3

Decided to jump by 10 lbs for a few workouts because I could make progress without bar speed taking a dive too much. Greedy? Maybe.

20

350x5x3

 

355x5x3

 

21

360x5x3

 

365x5x3

 

22

370x5x3

 

 

 

23

 

 

375x5x3

Had some weird travel days and missed 2 squat workouts. Still decided to go up 5 lbs because I'm stubborn

 24

380x5, 345x5x2

 

385x5, 350x5x2

Switched to top set plus backoffs

 25

390x5, 355x5x2

 

 

 

26

 

 

405x3

Traveling around thanksgiving got the best of me. But decided to end my LP with a turkey fueled PR of 405 for an unknown number of reps. Called it at 3.

michael moore 405 squat

If you are currently dealing with hip pain, considering surgery, or already had surgery like me, I hope this was informative to you. My advice would first be to rule out any possible form issues in your squat and read “the active hip 2.0” article. Go get your form checked by an SSC – ideally in person but perhaps by the Staff Q&A board on the Starting Strength forums, or by the coaches at Starting Strength Online Coaching. Best of luck with your rehab.


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