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Life From the Other Side of the Treatment Table

By: Kate Zanoni, LPTA

If you’ve been in the clinic over the past few weeks, you’ve probably seen me around, except not in my usual capacity. I temporarily traded in my clinician hat for that of a patient’s following hip surgery. In September 2017, I was diagnosed with femoroacetabular impingement (FAI), greater trochanteric bursitis and a labral tear in my left hip. Fortunately, I don’t have any crazy story explaining any mechanism of injury because there wasn’t one. It happened quietly and painlessly over time, so there’s really no telling when the bony changes in my hip joint began.

FAI is a condition of unknown etiology that occurs when extra bone grows along the acetabulum (hip socket, called pincer FAI) or the femur (thigh bone, called CAM FAI), giving the hip an irregular shape. This causes the ball-in-socket joint to rub together improperly during movement, affecting normal hip biomechanics and range of motion. I was unlucky enough to have bony changes on both parts of my hip joint, known as a combination pincer and CAM FAI.

As an avid athlete and yogi, I first experienced a slight pinching sensation in my left hamstrings with external rotation of my hip during warm-ups, workouts and cool-downs, especially when moving into pigeon pose. The discomfort was more of an annoyance than anything and it never kept me from my normal workout activities, so I didn’t think much of it.

As I continued my usual activities such as yoga, running, high intensity interval training, and pole fitness pain free, the repetitive friction of the bony abnormalities in my hip were grinding on the cartilage and caused the connective tissue along the rim of my hip socket (called the labrum) to fray and tear. Over time, this snowballed into an increase in inflammation of the fluid-filled sac (the bursa) along the lateral portion of my hip where my gluteal muscles insert, finally leading to an onset of pain, a loss of range of motion and a stop to all my regular workout activities.

The flare-up of symptoms occurred in August 2017 following a cross-country flight from Las Vegas to Washington, D.C. The day after my flight, my left hip hurt with weight bearing, I couldn’t lie on my left side (which was particularly detrimental as a side-sleeper) and I had severe pain with every step I took. I had a positive FABER, FADIR and Scour, which are special tests used by physical therapists for hip pathologies. Despite stretching, strengthening and icing, the pain didn’t subside. I tried several rounds of dry needling to ease the muscle tightness in my gluteals and hamstrings, but it only exacerbated my symptoms and sent searing nerve pain down my leg into my left foot.

Since conservative measurements weren’t providing any relief, I knew I had to consult an orthopedic specialist for further investigation and a definitive diagnosis. X-rays and an MRI confirmed my self-diagnosis: I was positive for combo FAI, a small labral tear and greater trochanteric bursitis. With surgery on the horizon, I began six weeks of “prehab,” pre-operative rehabilitation, to strengthening my hip in preparation for surgery to ensure a better post-op outcome.

Following six weeks of prehab at LSTC, I continued strengthening on my own until my surgery date on December 4. I began post-op PT several days later, three times a week, and I was able to walk with minimal discomfort 10 days after my surgery, although I still followed my surgeon’s protocol to use a crutch to limit the stress on my newly contoured hip joint and allow it to heal properly.

I still have several months of post-op therapy ahead of me until I reach my prior level of function as an athlete and a runner, but I’m leaps and bounds further along than I would have been without my stellar team at LSTC in my corner.