In this post I am sharing my story with chronic hip pain, being diagnosed with a labral tear and femoroacetabular impingement (FAI) and how I’ve successfully reduced pain levels and avoided surgery for nearly a year post-diagnosis.
THE BACKSTORY + ONSET
My right hip started hurting at mile 16 of the Marine Corps Marathon in 2010. Fast-forward to 2020 and I have now been dealing with varying degrees of chronic pain in that hip for 10 years. Prior to the onset of the pain during the MCM, I had no history of hip pain or injuries although I had experienced a few running injuries such as knee bursitis and achilles tendonitis.
At the time of the initial injury I was marathon training (running 25-35 miles a week), practicing power and ashtanga yoga 4-5 times a week and teaching BodyPump and group strength classes 2-3 times a week. My yoga practice was such that I was commonly getting very deep assists in hip opening poses like foot behind the head. I also had a fairly aggressive back bending practice. Looking back, I was definitely pushing my body to its limits physically but I was also 26-27 years old and mostly unaware of the amount of stress that I was putting my body under.
I spent years seeing various doctors, chiropractors, massage therapists, acupuncturists and body workers seeking answers and relief. I was always told it was muscular which was good news but also frustrating because nothing really seemed to help long-term. The pain was bothersome and constant but I learned how to live with it. My hip pain never prevented me from running, practicing yoga or lifting weights although I did experience varying degrees of discomfort while doing some of those activities. Yoga always seemed to exacerbate it more than anything else.
The only time in 10 years that I experienced consistent relief from the pain was during pregnancy in 2017-2018. It was the craziest thing but my hip pain all but disappeared. This has perplexed some of my doctors but I attribute it to the hormone relaxin that is increased in pregnant women. I also wonder if maybe something about carrying a baby slightly shifted my pelvic alignment or something like that.
It was not a surprise that as I recovered from childbirth and began to increase my activity levels that my hip pain came back. This is also a good time to note that my activity levels these days are NOTHING close to what they were in my 20s and early 30s. I have greatly reduced the load and stress that I put my body under over the last few years.
GETTING A DIAGNOSIS
In 2019 I had to have emergency toe surgery due to a freak accident. This meant that I met the deductible on my insurance (which was quite high) so I decided to take advantage of that and finally get an answer on my hip. I was committed to seeing whatever specialists that I needed to and doing whatever testing necessary in order to get a diagnosis.
My first step was seeing a sports medicine doctor. I made an appointment with Dr. Keith Anderson at the suggestion of a friend. He did an examination and took an x-ray of my hip. He predicted that I had a femoroacetabular impingement (FAI) and the x-ray supported that. Dr. Anderson said the next step would be an MRI to get more information on the joint and the state of my labrum and cartilage. Dr. Anderson ordered an MRI arthrogram and referred me to Dr. Kenneth Weeks at OrthoCarolina.
The MRI process was more difficult than anticipated. I had it done at Novant Health Charlotte Orthopedic Hospital. With an MRI arthrogram, you receive an injection of fluid directly into the joint before the MRI. This allows the radiologist to get a lot of information about the lining of the joint and the labrum because they can see it so much more clearly. Let me just tell you that it is not comfortable to have fluid injected directly into your joint via a long needle. Getting prepped for the MRI and receiving the fluid injection was pretty quick. I’d say I was in the prep room for under 10 minutes. The actual MRI took about 45 minutes.
I was not prepared for the amount of pain I had after the fluid injection. It woke me up in the middle of the night and I had to get up and take ibuprofen. I was later told that this is super common because the fluid irritates and inflames the already irritated and inflamed joint so much. Some doctors won’t order these types of MRIs because they can be so uncomfortable.
The MRI results were returned quickly and these were the findings.
- The superior and anterior acetabular labrum are diffusely degenerated and torn. There is a small focal region of linear fissuring of the articular cartilage of the anterior superior lateral margin of the acetabulum adjacent to the base of the labrum.
- Morphology of the right femoral neck which predisposes to cam impingement.
- Large amount of tendinopathy of the right hamstring tendon origin with adjacent stress reaction within the right ischial tuberosity.
I read the results in my online chart and felt a lot of fear and uncertainty. I tried not to freak out before I met with Dr. Weeks but it was hard not to go down the doctor Google rabbit hole and to stay out of worst-case scenario thinking. I did reach out to a yoga teacher/physical therapist friend of mine to talk through the results and she had encouraging things to say. She also suggested I schedule a consult with another hip specialist in Winston-Salem at Wake Forest Baptist, Dr. Alston Stubbs.
WHAT IS FEMOROACETABULAR IMPINGEMENT (FAI)?
(source) In FAI, bone overgrowth (basically these are bone spurs) develop around the femoral head and/or along the acetabulum. This extra bone causes abnormal contact between the hip bones, and prevents them from moving smoothly during activity. Over time, this can result in tears of the labrum and the breakdown of articular cartilage (osteoarthritis).
Here’s a photo of a healthy hip where the femur fits nicely into the acetabulum.
And here’s a photo of impinged hips. I have the cam type of impingement, which you see in the middle photo.
WHAT IS A HIP LABRAL TEAR?
(source) A hip labral tear involves the ring of cartilage (labrum) that follows the outside rim of your hip joint socket. Besides cushioning the hip joint, the labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket.
Athletes who participate in sports such as ice hockey, soccer, football, golf and ballet are at higher risk of developing hip labral tears. Structural abnormalities of the hip also can lead to a hip labral tear.
Now, the fascinating thing about labral tears is that they are very prevalent and often asymptomatic so it’s important to determine if your pain is actually being caused by the labral tear or if it’s other factors. I was told by both specialists that I saw that you can do an MRI of a lot of 30+ year old hips and find labral tears. It’s frequently not the cause of hip pain but unfortunately it can be hard to know if it is unless you try fixing it, especially in cases of chronic pain where PT and activity modification haven’t had great results.
I met with two different hip specialists/surgeons after my MRI. Both seemed to be great doctors and I was impressed by the amount of time that each spent with me but I emerged from those two consults feeling very confused and conflicted. Each doctor painted a different picture of my condition, the surgical process and the recovery journey. I had a hard time reconciling the two in my head because they were so different. I almost felt like I needed a THIRD opinion.
Dr. Weeks at OrthoCarolina told me that I had no signs of osteoarthritis (Tonnis grade 0) and that the surgical process would be hip arthroscopy where he would repair my torn labrum and smooth the head of my femur to correct my FAI. Recovery would look like a few weeks on crutches, biking by 4 weeks, elliptical by 6 weeks and a jogging program by 8-12 weeks (of course with tons of PT in there). He was very honest about surgery not being a guarantee to “fix” my hip but assured me that I was a good candidate for surgery. He didn’t push it and I left that appointment with a plan to pursue activity modification and to revisit surgery at a later date. He told me to avoid deep squatting and lunging and I was fine to keep running.
Dr. Stubbs at Wake Forest Baptist had a different take on things. First, I have to say that he spent at least an hour with me doing an examination, reviewing x-rays and my MRI and talking through various scenarios. During the course of the appointment he told me that he wants to write a book about yoga and hips because he’s seen so many yogis in his office in recent years.
One thing that brought me some level of comfort was that he told me it’s not my fault that I’m in this situation. He said there’s a reason why these injuries are so common in gymnasts, cheerleaders, dancers and yogis. We naturally gravitate towards these activities because our bodies are structured in a way that the range of motion that they require comes more easily to us. Dr. Stubbs said that my hip condition isn’t due to one thing that I did but likely a combination of my natural body anatomy and the way the ways that I’ve been moving my body for so many years.
Dr. Stubbs said that I had beginning signs of osteoarthritis (Tonnis grade 0-1). He was super honest about surgical outcomes. He told me I had a 2 in 3 chance of having a positive outcome and that the recovery process would be very long. He told me I would be on a traction machine for about a month and non-weight bearing for a couple of months. Additionally, I couldn’t lift anything over 10 pounds for four months. He said not to think about resuming anything close to normal activity levels for six months.
His surgical plan was MUCH more involved than Dr. Weeks. I took a screenshot for you because it’s so shocking. IT band graft and reconstruction!? Psoas release!? Glute tendon repair!?
While Dr. Weeks gave me a lot of freedom around making a surgical decision, I felt very pushed to schedule surgery while at my consult with Dr. Stubbs. They had me meet with a surgical scheduler who tried to get me to commit to dates in the coming month and also with his research team to do a pre-surgical survey. I did not schedule surgery because obviously I had a lot to consider and digest.
MAKING A DECISION ON NEXT STEPS
I was not in a great place after these consults. I was feeling so confused and really down. There was no way that I could rush into surgery given that a) I am a single parent to a small child and b) the way I earn a living involves the ability to move my body.
I decided to press pause on everything and to gather more information and opinions. In the coming months I had conversations with two physical therapists (Kari Shenck and Libby Hinsley), my chiropractor and a friend who is an orthopedic PA.
I identified two main goals.
- Preserve the integrity of my hip joint to avoid a total hip replacement for as long as possible.
- Not be in pain all the time.
I decided that given where I am in motherhood and with my career, there was no realistic way that surgery could happen in 2020 so I’ve been doing everything possible to take care of my hip and accommodate my impingement in the meantime.
MANAGING MY FAI NON-SURGICALLY
I am about 10 months out of the MRI and surgical consults and I honestly cannot believe how good my hip is feeling all things considered. The number one most helpful thing that I’ve done is to see my chiropractor regularly. I see Dr. Douglas Bradberry at Greenapple Sports and Wellness.
At the start of the year I went every single week and I’ve now worked my way up to bi-weekly appointments. He does a manual adjustment to release my impingement (this was recommended by my physical therapist, FYI) as well as active release therapy on tensor fasciae latae (TFL), psoas and glute medius. This combination of treatments has seriously changed my life. I’ve had a couple of flares where I’ve thought to myself, “this is it….I’ve done it….I’m going to have to have surgery” but Dr. Bradberry gets me back on track. I tell him every time that I see him that it’s magic (and he is magic!).
In addition to regular chiropractic care, I have also accepted activity modification as a necessary means to avoiding surgery. This includes:
- Reducing running frequency and mileage. I would rather be able to run 3-5 miles a couple times per week than push it and not be able to run at all. I am at peace with the fact that I may never run a long distance race again.
- Tons more walking. 99% of the time walking makes my hip feel better, even if I’m experiencing a flare).
- Modifying my yoga practice to avoid extreme internal and external rotations of the hip as well as avoiding things like deep side lunges and malasana squats.
- Avoiding deep knee into chest movements like mountain climber or stork pose (especially when experiencing a flare).
- Avoiding straight leg boat and leg lifts.
- No squatting below parallel when strength training. Also reducing the depth of lunges and shortening my stance a bit.
- Listening to my body and truly following “if it hurts, don’t do it.”
- Focusing my own work on glute activation. My PT recommends lots of two leg RDLs and alllllll the glute bridges. She also has me doing lots of locust variations for spinal strength/integrity.
So far the combination of regular chiropractic care and activity modifications have resulted in a significant reduction in daily pain as well as improved function of my hip. While I still have “background pain” most of the time, it’s extremely manageable and something I can live with for now.
WHAT DOES THE FUTURE HOLD?
I’m not sure. I think I’ll probably end up having surgery at some point in the next few years but I am also open to non-surgical management of my condition if it continues to go well. In the meantime, I have been reading and researching things about labral tears, femoroacetabular impingement, hip arthroscopy, hip preservation surgery and more. I’ve also followed the surgical process for a few friends/acquaintances and found that to be super interesting. And now that I’m starting to share my story online and on social media, I look forward to connecting with others who have had similar conditions and hearing about their outcomes.
Surgery is a big deal and not something that I want to do unless it’s 100% the best choice for me. Both my physical therapist and chiropractor support surgery when I reach the point where it’s worth it from a pain and function standpoint but I’m just not there yet. I feel like I know what I’ve got now with my hip and it’s manageable…but I also know that it can (and likely will) change. Again, my number one goal is to preserve my hip joint and avoid needing a total hip replacement for as long as possible but both of my doctors assure me that I’m not on that path anytime soon.
Okay, that was over 2,500 words and I could keep going for another 2,500 more. I will continue to share on this topic. Let me know if you guys have any specific questions or things you’d like for me to address.
Have you dealt with a long-term, chronic injury or condition?
Any others with labral tears and/or FAI?
How do you do with activity modification?