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. 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. 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.