T Nation

Post-ACLR Hip Problem


#1

This has been only a minor, nagging issue throughout my recovery from ACL reconstruction (hamstring graft), but it has become a bit more troublesome the past 1.5 weeks. I have noticed that my right hip (surgery side) clicks and feels like it moves out of its normal movement pattern whenever I walk. The other hip does not do this, and I had never noticed this before surgery. I'm not familiar with the anatomy of the hip, but the clicking seems to come from where my femur inserts into the socket of my hip.

I am currently just under 8 months out of surgery.

I didn't think much of it at first, just that maybe my hip flexor, glute, etc., on that side were weaker due to the loss of strength following surgery. I also thought maybe overtraining had something to do with it since I do 2+ more sets on my right side for all single-leg exercises (Bulgarian split squats, single-leg RDLs mainly).

However, the issue has not gotten better, and now my hip hurts when I get into a deep squat (deep being below parallel). The pain isn't significant, but it's enough that I can't squat as much weight as I'm capable of. I'm now worried that my gait is screwed up, and that's what's caused the initial clicking and now pain.

Here is what my lower body workout consists of (do this twice per week):

Back squat
Hang clean
Bulgarian split squat (+2 sets for recovering leg)
Single-leg RDL (+2 sets for recovering leg)
Glute-Ham raise (pre-fatigue recovering leg with leg curl before each set)

I also have 1-2 days per week of running, cutting & plyos:

Half mile jog warmup
Full-court sprints (basketball court)
Cutting drills with basketball (make 3 trips around large box on court, both directions)
Dribble up court, cutting L-to-R with ball
Box jumps
Triple jump over boxes of varying heights
Single-leg box jumps (front-back & lateral)


#2

Can you remind me how far along post-op you are? Also, can you mark on a picture exactly where you feel the pain? Here is a photo to use: http://www.netterimages.com/images/vpv/000/000/001/1968-0550x0475.jpg

Is the pain/clicking only during a deep squat? At first glance, I would guess it might be a volume issue as you have quite a bit of volume for your legs (especially if you are doubling up sets for your R leg). You may just be over-fatiguing your smaller hip musculature, causing inflammation to the tendons around the hip joint which then causes the pain and clicking during a deep squat. Have you tried dialing down the volume a bit?

Also, with overuse of the hip (especially if there are mobility and strength deficits), you can often develop trochanteric bursitis. I'd look at your hip mobility, especially with internal rotation.


#3

Thanks...I circled the area in question in the attached photo. I am approaching the 8-month post-surgery mark. Everything is fine with my knee, save for a bit of patellar tendonitis, and I feel almost 100%.

EDIT: The clicking does not occur during a squat, at least not that I notice. It only happens when I walk, and I notice it when propelling myself forward with my right leg just as it moves backward and lines up parallel with my other leg.

I have been lifting on an upper-lower split for 6 weeks now with 2x upper and 2x lower body days on Mon-Tues and Thurs-Fri. On Wednesdays, I do the running/plyo/cutting exercises outlined above. I have also run some sprints on the track and felt really good. Not that I was burning up the track beforehand, but my 100m times are back to what they were pre-injury.

Volume could be the instigator, but I have felt this clicking sensation for at least the last four months. I have never really given myself a rest, so maybe that is in order. As far as reps/sets go, they change every week with this routine. I'm following "The Stair-Step Approach to Muscle" program on this site because I had good results with it before my injury. I have adjusted it to include more posterior chain work, however, to avoid future quad imbalances. That basically means I substituted back squats for front squats and added in one extra glute/hamstring exercises per leg session. The link is below:

http://www.T-Nation.com/free_online_article/sports_body_training_performance/the_stairstep_approach_to_muscle


#4

The program looks solid, as I would expect. But take a look at what you say: " I have adjusted it to include more posterior chain work, however, to avoid future quad imbalances. That basically means I substituted back squats for front squats and added in one extra glute/hamstring exercises per leg session." Substitution is fine, but I think that you just added too much volume to the program with not only adding an extra exercise, but also having the two separate plyo days.

I'd say you are due to take a "deload" week or two and see how your body responds. From the location you circled on the photo, I don't see it being a acetabulofemoral joint issue, but more than likely an IT band issue "snapping hip syndrome". My recommendation would be to take 1-2 deload weeks, add in some extra mobility drills, and focus on some good soft tissue work on the hip and thigh (foam roller, LAX ball, etc). Bumping up fish oils, circumin, ginger, and other natural anti-inflammatories will probably help as well.


#5

Thanks for the advice. I took a deload week two weeks ago as part of the program, but did not feel any better. Maybe another is in order, although it feels ok at the moment. I never thought about it being an IT band issue. I'm due to see my PT in a couple weeks, so I'll get with her about way to resolve it. Thanks again, big help as always.