FAI Hip Impingement (Femoro-acetabular Impingement)

FAI Hip Impingement Awareness facts - It is estimated that approximately 15% of the young, adult population have hip impingement, so who do you know that might have it?
Hip impingement causes painful labral tears within the hip socket.
Hip FAI symptoms are misleading to the average medical professional, as FAI hip impingement pain frequently presents as low back pain and interesting only 10% of back pain is ever clinically diagnosed and cured... Which begs the question what percentage is actually caused by hip FAI or hip impingement, as its otherwise known.
The more active you are, the more likely you are to trigger hip impingement symptoms, so busy mums and gym bunnies beware... but at least you're in good company as many premiere league football players have also suffered FAI hip pain.
Hip impingement is diagnosed through x-ray and labral tears are diagnosed through MRI arthograms - but both need to be read by hip consultants specifically trained in FAI hip impingement.
There are 60,000 hip replacements every year in the UK and it now appears that FAI hip impingement, over the years, could be the leading cause of hip osteoarthritis. A silent epidemic.
Hip arthroscopy can reduce the hip impingement and reattach the torn labrum to the hip socket. This surgery can eliminate the pain and disability caused by FAI hip impingement and divert the need for hip replacement in later life.

Also please feel welcome to join in our help and advice forum for support. We have 3 advising FAI expert hip surgeons, 3 PT/physios and a sports medicine doctor as well as the largest international FAI hip impingement forum on the net:

Wednesday, 30 September 2009

hip arthroscopy recovery 11wks 5 days reflections 2009 mum and daughter

Almost sick with excitement today as for the 1st time in 2 months I am looking after Izzy 'by myself'.. Only for the morning, then nursery. I'm hoping to gradually phase in looking after her without pushing myself and so hindering my slow hip arthroscopy recovery. I have missed her desperately and am gutted every time she holds her hands in the air to be picked up by others, because she never holds her hands up to me!
Its good that babies have such a strong survival instinct, knowing who will look after them, but the amount of times I've been desperate to say I WANT to pick you up I just CAN'T! Shes 11 months almost to the day.

This whole year has flown, in a haze of hips..1st in February Izzy's hips, when I recognized she had hip dysplasia (God knows how, but thank God either way!)
I had no idea hip problems ran in the family, I myself wasn't diagnosed with a hip problem until 2 months after Izzy, later in April, after 6 years of misdiagnosed pain.

The doctor wouldn't believe she had a hip problem and just refer her for scan. Finally I said to him that I had had almost 6 yrs of undiagnosed pain and never want her to go through anything like that! That I needed to know 100% that her hips were fine and I could only get that with a scan, that I'd pay, anything, just authorize it!! Thank God he did because he was wrong and she did have hip dysplasia on her left hip. Discovered any later and she would've needed a series of operations. I was so mad! At 4 and a half months she was put into a pavlik harness for 6 wks.
Success of a pavlik harness much depends upon catching hip dysplasia early. She fell through all the baby screening for hip dysplasia and had I not caught it she would've been picked up for it when she crawled and dragged one leg, or later walking with a limp they said. I noticed it initially because she had a leg length discrepancy and would only put weight on the longer leg and she looked a bit twisted.

After 6 weeks she had only made a one degree change and her hip angle needed to deepen by 10 degrees. They said things weren't looking good. That she may well need surgery, that the pavlik harness mainly works if put on before the baby is 6 weeks old! She had been 4 and half months old. We were horrified with surgery on the horizon for our baby!

At around this time my new physio at Physio Cure Cookridge, Leeds started saying she thought my problem pain could be coming from my hip and that it needed further investigation. After MRA and Xray I was diagnosed with hip labral tear and severe FAI pincer abnormality. But I couldn't proceed with my op, until I found out whether Izzy needed her op. Your babies come first every time!

By some miracle in the next 5 weeks of her wearing the pavlik harness Izzy's hip actually improved by the whole 9 degrees! I put it down to the fortunate timing of another growth spurt and the chance that someone somewhere was looking after us! I cried in the scan when they said she was better. I had prepared myself to have to go through the horror of hip surgery with her. I'm not a religious person particularly but I found myself doing alsorts of deals throughout her treatment, culminating with I'll have to have a hip operation instead of Izzy, weird stuff... anyhow that's exactly what happened, no sooner had she recovered, as I was been prepped for theatre!

This year had been dominated by Izzy's, then my recovery from our hip deformities. Seemed to be always trust up in harnesses, or have the clatter of crutches in the background.
So it seems somewhat ponient?? today that this'll be kind of one of the first days when I look after her, with us both (Izzy more than me) healed!

I know I am not yet fixed, its a long road ahead and I am still taking anti inflammatories, but this is a positive step forward, after what has been an 'Annis Horriblis' or whatever it was in Latin that the Queen described as a horrible year!

One thing I think is important for others is that I was told they know of no connection between hip dysplasia and Hip impingement. 'But' when Izzy was diagnosed I was also told it was congenital and had come from someone.
I find it a huge coincidence that the two conditions are opposite sides of the same coin. Hip dysplasia is under development of the hip socket. FAI, or femoral acetabular impingement is over development of the hip socket, I find it hard to believe the 2 aren't connected, esp as the haven't worked out if FAI is congenital or developmental. All I'm saying is if you have babies, get them checked by ultrasound scan. Especially, though not exclusively, if they are female.

Was ok looking after Izzy, though she's very heavy. I can hold her just standing and I can hold her and walk a little. But holding her and doing the bloody stairs just twice gave me 3 hours of pain, mainly deep ache in butt, bit thigh pain, limp flirted with returning and then pain around the hamstrings insertion into sit bones. Unsure whether it hurt my hip or hammys, but am pretty sure (cockney accent) "it was the stairs wot did it Gov!" Has calmed down now, though be interesting to see if night pain returns?! And I know if I looked after Izzy regularly, like I'm supposed to be able to, I'd be totally buggered! There goes leaving my husband then!
I'm not sure these male Docs/consultants quite get how physical it is looking after a wiggling 24-26 pounder! Dumb bells don't thrash around, I reckon they're way easier to lift than a fighting, heffer 11 month old!


Sunday, 27 September 2009

Hip Arthroscopy recovery 11 wks, 3 days

Hip Arthroscopy for FAI pincer and labral detachment is still going so slowly. The improvements are almost inperceivable. They are however improvements. I think that thanks to aqua exercises I am losing my limp. I spend half and hour every odd day, as of last week, literally walking forwards, backwards and sideways in a pool. Adding in some 90o leg raises and internal external rotations. I actually feel looser when I get out of the pool. No idea why it works but it works. I would have done it sooner, but was anxious to be pool side on slippy tiles fresh out of an op. Thou a tip, wear your crocs, they're great for stopping slips on wet tiles.

After only a week of this I am able to walk faster, further and much more even strided. In fact yesterday I went shopping for 4+ hours which is a first in a long time! I was delighted though paying for it today, with both my credit card and pain levels!
I also had/suffered those delightful hamstring bursa injections, immediately after with the local anesthetic my hubby said I was walking much faster.. So that could be a factor, although it hasn't yet stopped the sitting pain much. I think in the initial days it made my sitting tolerance a little better and I noticed that I had less pain the the bum sitting and more traveling down my legs that I could feel...but I'm waiting for the steroid to have chance to kick in before drawing too many conclusions.

I've done a bit of research since and a forum contributor said he got better post hip arthroscopy in all but sitting and was given from his doctor a supplement called Acetyl L Carnitine for sciatic pain and that after 1 week his sitting pain just stopped and that IF the pain is sciatic that this will work.
I looked up various research papers and found that like he says 'Acetyle L Carnitine', not just L carnitine, has huge success in relieving neuropathic pain and more so if combined with Alpha lipoic acid. The dosage for eliminating neuropathic pain is said to be 500mg ALC & 200 ALA x 3 x times a day. There don't appear to be many side effects, but that if you are to take any supplement, at any dose, do your research, better still ask a health professional.
I want to try this, but only after I've had a month to give the steroid a chance to do it's thing. I still think my piriformis might be trapping/pressing my sciatic nerve when I sit mainly.
The other route is that hamstring trigger points can masquerade as sciatic pain and as from this week will ask my physio Louise, if she could work on those triggers, she's very good at myofacial work, though its very uncomfortable at the times, there's often immediate relief.

So in short, I am feeling a much better range of movement in my hip and my related movements. I suspect over the 6 yrs clinical and ?? years sub-clinical my body has compensated and consequently caused muscle imbalance and strains on tendons and SOME of the pain is taking longer to subside.

Wednesday, 23 September 2009

hip arthroscopy recovery 11 million weeks. Injection into my arrrrrrrse.

I'll keep it brief! Mainly as I am still traumatized by today and have now had 2 glasses of wine and could be forgiven for saying anything after today, except no, a blog is like a puppy, not for Xmas, but for life! Here for everyone to see, FOREVER!

Went for Ultrasound, showed something, nothing horrific, just some crappy changes, though doubt that was the technical term he used!

The surgeon again cut to the chase and recommended the litmus?? test of anesthetic and steroid injection into Hamstrings where they meet the sit bone, hmmm nice! Wide eyed I agreed.

So half an hour later, knickers around my knees, in a doughnut of a CT scanner I find myself holing onto one of the lovely nurse's hands (a bit too tight) screaming FUUUCCKK! as I have a needle drilled into each butt cheek to reach each hamstring.. Those of you who follow know I am no wuss at these painful things and I have NEVER screamed or said more than shit! OMG! That was the most painful treatment!
I feared the needle first going in, all I could think was I wish I'd dieted because a) I am covered in towels, with nothing but my newly fat ass sticking out and 2, no B) (alcohol!!) That the needle had further to travel thru the layers of chocolate blubber!
First placement of needles fine, followed by further CT to ascertain correct position and I'm not allowed to move a millimetre! Once position confirmed THEN they go in further, to where the tendon meets the bone and I went from thinking, nah this is fine, I can handle this, to FUUUUCKK!!! (childbirth flashbacks!)
Anyway, its a positive thing and all done and dusted.
I think I then had a meeting with Surgeon (but it was a post adrenaline blur) and could neither speak, nor comprehend his words at all. I suppose its one way of shutting me up!

But I walked away thinking that in summary he'd said: He's seen FAI and hamstring injuries together before. If not hamstrings then he'll keep looking. I am walking better. Suck it and see, we'll know in 4 wks if its helped. It could be like phantom limb things where your nerves are so screwed you just THINK you feel pain..... err I THINK not! Just wait and see, which is fair enough.
I do though trust this specialist,he seems different to other consultants I've seen, conscientious and genuinely after making you better. Thank the lord!
Anyways.. in summary, it hurt and we'll see..

Monday, 21 September 2009

hip arthroscopy recovery 10wks, 3 days

Generally my recovery from this hip arthroscopy is much the same. VERY slow and small improvements, almost undetectable. I have started been able to sleep on my front a little again. My limp has lessened provided that I don't walk far, that I take small steps (feel like a geisha!) and walk at a slow pace. I must consider each step as one leg has a fair distance heel strike and the other can't reach half as far, hence the limp.
I realize I was limping before the hip arthroscopy op also, just not so easily provoked.

I'm still taking the 2 x meloxicam, but this week, only one night has needed night time extra meds.
I had a lot of pain though yesterday and purely as we had guests for lunch and I sat eating for a while, easily under one and a half to 2 hours, but its clear to see how a sit down job would be impossible! Grrr God I miss journalism!

As I am sitting now, both sers of my toes are tingling and I have pain in my operated hip's bum cheek. Having read a little on hamstrings, it appears they can trap the sciatic nerve and mimic true sciatica which could explain a lot; as well as the bottom pain.

Wuhoo gotta go, 2 great phone calls, appointment for Ultrasound re hamstrings, then see Surgeon.. Please let this be the final missing piece of my pain jigsaw discovered on Wednesday by Surgeon??? ..and house viewing in 1 hour and I hope someone buys this gorgeous stair hell I live in!

Wednesday, 16 September 2009

Hip Arthroscopy recovery 9wks, 6days some results in every way!

The last few days I have had some kind of definite improvement. I have not required top up paracetamol or any heat patches over my hip at night. I am though still taking 2 x 7.5mg meloxicam/mobic everyday, as I believe my problem is inflammation though I'm unclear why at this stage.

I received the results of my MRI scan today. My sacroiliac joint is fine, prob the 6 years of therapies have fixed it, boom boom! OR there was never anything wrong with it as I suspected!! Hmmmm, however the surgeon is correct again and there is a problem with my hamstrings. The MRI was not clear enough to say why, other than that there appears to be oedema (I knew my growing ass after this hip arthroscopy wasn't all down to chocolate!!) and inflammation, which indicates something, though unsure what yet. The surgeon is, I understand, going to arrange an ultra sound for a clearer picture of the situation. I look forward to getting the hamstrings resolved.

There must be improvement on my operated side as I would normally feel considerable pain despite the medication and I am still feeling pain in my "good" hip, which as you know isn't really good, so this kind of pain easily breaks through medications and isn't causing much pain on my operated side.
Also I have been able to sleep on my front twice, only for half an hour at a time, but that's a first in 6 yrs and also I can open my legs to equal distance now after the hip flexor exercises retrained my muscles.
I DO NOT think I am out of the woods yet at all, I scarcely dare post this in case I jinx myself! But I think these are positive signs, that may become a trend, that may become a recovery!!
My good side is very symptomatic still, I think it may have eased a little with the steroid, but right now its pinching the hell out of my groin and giving me a pain in the bum cheek!
I am religiously doing my bridge exercise, all my hip exercises and one with a theraband. I am stretching my psoas hanging one leg off the bed and lightly stretching my hamstrings. I do this particular set of exercises as they really feel to help. And I aim to start aqua stuff within days, as I really felt such benefit on holiday from doing these.
The house officially goes on the market this afternoon so bye bye stairs (bit premature in this market!) but I will miss the house as its JUST how I want it, but I will not miss 30 stairs from top to bottom!

Friday, 11 September 2009

Hip arthroscopy recovery 9 wks, MRI scan

Well I am with the fairies tripping... serious MRI phobia. Took 5mg diaz as left home... nothing! took ano half so 2.5 more, then at the point it he told me it would go in up to my head and take an hour and a half and need a dye contrast injection I took another 2.5mg = 10MGS!!!!!! Off my trolley. And it took ages, half way thru to work.
They're looking to see if they've missed anything obvious causing the sitting pain, aside from my hip, but related to my hip. Apparently with hip problems you can get a triad effect (no, nothing to do with machete wielding Chinese men!) but it can knock onto the hamstrings and sacroiliac joint and I asked for the glute bit. So when all was done the whole thing took 2 hours.
I was trying to explain the horror of MRI scanners to my mother, who isn't the most compassionate person and has no medical experience to draw from.. I said its like been locked in a lift so small your nose touches the door and then having a bunch of lunatives whacking the metal lift with dustbin lids to make it really noisy and scary.

She just rolled her eyes and said, "Lou do you have to be so graphic!?" I said just trying to get you to picture why its so scary and perhaps get a smidgen of sympathy."Alright, she said "I'd hate it too!" Hmm thanks, that's my Mum been all warm and fuzzy!!!

Anyway I am alive, off my face and awaiting results with little anticipation, if nothing then just a bloody slllooowww recovering hip, it something its more grief is it even fixable? Poor Bupa! They have, so far been fantastic.

Well, going house hunting tomorrow, because there are 30 stairs in my house to get from the entrance to the bedrooms! Exciting to view potential new home ..but you know whilst most people can't wait to get into the kitchens and bathrooms, I'm going to be heading for the staircase, doing a stair count and checking step depth, its tragic...
why don't I just send myself an 80th birthday card, move into a bungalow and have done with it!!!

Wednesday, 9 September 2009

Hip Arthroscopy recovery 8wks 5days

Pain up and down. Today fairly ok, yesterday had me crying and still in both hips

I'm fast coming to the conclusion that I am overdoing it. Not by excess, but simply by standing so long. I still can't sit for very long comfortably, I won't sit for more than 10 mins, unless driving...which means I am on my feet most of the day and I'm GUESSING thats too much, most people sit for 8hrs just at work and watching TV.
My only rest is to lay down and that is preeeettty antisocial! and when I'm out impossible, so I think the standing, thats how I'm overdoing it. Still why can't I sit?

I am going for an MRI scan on Friday, boooooo scary. Professor Schilders ordered it. He wants to see if I've hurt my hamstrings where they join the bone and check out my sacrolliac joint and I've asked if they can check my glutes... there was a time when I used to quite like it when men checked out my ass, but not for this reason!!!
I know my glutes and hips keep spasming, just now the problem is gone, I no longer know why?!

Have put my house on the market this week. I love this house, I have it just how I like it, but the stairs are well, too many! Its 3 stories, so up and down and up and down all day, its killing me!! That and we're in the countryside and I need to be in the suburbs because everything is too far to drive to. This is me resigning to the pain and that it may be ongoing. The op hasn't/isn't going to just whisk the pain away and it need the other side doing yet! Ah well, least we can afford to trade up a little too.

Anyone else recovering quite this err crapily?

Sunday, 6 September 2009

hip arthroscopy recovery wk8, day 2, water baby!

Hip has noticeably improved in the last week.
I took a weeks holiday, inspired by the ever helpful PA of Professor Shilders. I went to Majorca, Spain, a very quiet beach, warm waters, gentle shelving into the calm sea. Hot weather, no stairs and everything close by.

I noticed the difference and realized my own lifestyle must antagonize my hip, making recovery more challenging. I still had a couple of really down days when I got pain flares and it seemed prompted by one day climbing 2 flights of stairs (at home I do that just to get in and out of my house!) and one night sitting in a bucket style chair. I have to say now when it flares I seem to go into despair quite quickly.. I think I'm afraid I'll never escape it all! But, I've had a few good days and am feeling quite positive and I now also know there's a direct link with activity and setting back rehab. SO, yes exercise, but if you're quite an active person also, then watch out for over doing it!

I felt REAL benefit from doing aqua exercises, I think in water you can stretch and move so much more. The exercises I was doing in water felt very remedial, but I swear have helped more than I could've imagined, so now I need to join a local pool and do this more. I simply walked forwards, backwards, sideways. raised my hip/knee to 90 degrees, also did the same but reaching to touch my foot behind me. Also raising my leg 90 degrees then crossing my foot over the opposite knee.
Also tentatively swam breaststroke and it all felt good to do... though actually I must've looked v strange!!

The sand was also amazing. I lost my limp in the sand, walking felt great, real heal toe walking.
The other thing I did was my core exercises on the sunbed, esp the bridge and hip flexor exercises. And one last thing that I feel helped was standing with my legs a couple of feet apart and GENTLY rocking from one hip to the other. Normally this action should be a smooth one, but for me its smooth one way then like going over a painful hump the other way...again this got easier and easier in the sand and now much smoother. As I'm sure you can imagine I wanted to stay a month and get myself right!!

I cried in the airport as from day 2 on holiday I didn't need my crutches at all for the whole of the holiday, it was like a miracle, but on my return Majorca has a big airport and I needed my crutches again. However I have been home 2 days and not needed them so lets see how this week pans out.

I have started taking mobic or meloxicam 7.5mg per day to help with inflammation, but trust me, if I get bad the pain easily gets through, so I think I might be doing okay!

One other thing I have started doing is massaging my glutes and hips with a tennis ball against a wall, to try reduce the muscle spasms and trigger points that I am still suffering with. I don't know why still the muscle spasms on the operated side, what does it think it's protecting?? Its a bad pain muscle spasm and mine seems to irritate my sciatic nerve too, so this aspect has to go. I want to calm the whole area, joint, muscles, nerves in the hip down.

Still very much day by day small improvements, but I think and hope I'm getting passed that 'wall' that people talk of and that I'm on the up again.