T Nation

Training w/Torn Labrum/CAM Lesion/FAI Impingement?


#1

I received my MRI results last week and the doctor found that I have a torn labrum in the left hip with a CAM lesion and FAI impingement. Surgery is set for June 16th. Basically, when I squat, it doesn't exactly hurt, but it is sore afterwards. I'm more concerned with the fact that over time (I've had this injury for a couple years now), my right leg has learned to compensate due to the injury and lack of mobility in my left hip.

Any suggestions on what to do for legs until surgery? Any help would be great!


#2

Maybe not squat?

If squatting leads to soreness, then don’t squat. Do what doesn’t bother it. Lunges, RDL’s, leg press, single leg press, leg extensions, leg curls, deadlifts. Run some sprints. It’s 2 months man, I would give them up for now.

For the record, I had impingment, torn labrum, had surgery. I can’t squat now, or deadlift, or RDL. I can lunge, leg extension, leg curl so that’s what I do.


#3

Staystrong, I know we’ve talked about this before, but I had some ART don on the muscles around my hip and I’ve been able to squat pain free about 95% of the time now.

Also, OP, if you have any questions about the surgery, recovery time, etc, ask away.

Don’t squat anymore if it bothers your hip, you’ll only do more damage that way. Do anything that doesn’t bother it (lunges, pulls, Partial movements etc.)


#4

[quote]nkklllll wrote:
Staystrong, I know we’ve talked about this before, but I had some ART don on the muscles around my hip and I’ve been able to squat pain free about 95% of the time now.

Also, OP, if you have any questions about the surgery, recovery time, etc, ask away.

Don’t squat anymore if it bothers your hip, you’ll only do more damage that way. Do anything that doesn’t bother it (lunges, pulls, Partial movements etc.)[/quote]

Related to OP:
Basically, as both of us said avoid it if it bothers the hip. It bothers you for a reason, think about what that reason is.

nkkllll:
I remember talking about it. I’m seeing my original PT right now trying to see if something can be done. Given my own observations about what causes the pain I’m still not optimistic, but the PT is convinced I’m a mess. Left (opposite side) adductor doesn’t fire really, my body hates shifting my right hip forward/left back, and I have a lot less abductor ROM and strength on my right (surgery) side. Was going to try banded (around my knee) squats to see if the increased abductor activation pulls the femur head more into place or something. Haven’t got around to it though. Been going to my PT for about 5 weeks now, no real improvement in squatting but my posture’s improved. Not my goal, but that seems to be the PT’s goal so I’m going to have to talk to him next week about that.

Could you go into a little more detail about what your issue was (i.e. abductor tight, weak, flexors short, whatever) and how ART helped? And how long you did ART? How did you find a provider? Everyone who does ART around here is a chiropractor and I only personally have worked with 1 guy 40 miles away about 2 years ago, though I know there are a few within 8-10 miles I don’t know how to determine who I should go to. My issue seems more like a joint thing, like the missing cartilage in my hip is the issue. I don’t know how any PT or ART would help.

I’m a little hesitant to go to an ART guy while I’m going to a PT. Seems like 1. a lot of money and 2. kinda interfering with each other. Do you have any thoughts on this?


#5

[quote]staystrong wrote:

[quote]nkklllll wrote:
Staystrong, I know we’ve talked about this before, but I had some ART don on the muscles around my hip and I’ve been able to squat pain free about 95% of the time now.

Also, OP, if you have any questions about the surgery, recovery time, etc, ask away.

Don’t squat anymore if it bothers your hip, you’ll only do more damage that way. Do anything that doesn’t bother it (lunges, pulls, Partial movements etc.)[/quote]

Related to OP:
Basically, as both of us said avoid it if it bothers the hip. It bothers you for a reason, think about what that reason is.

nkkllll:
I remember talking about it. I’m seeing my original PT right now trying to see if something can be done. Given my own observations about what causes the pain I’m still not optimistic, but the PT is convinced I’m a mess. Left (opposite side) adductor doesn’t fire really, my body hates shifting my right hip forward/left back, and I have a lot less abductor ROM and strength on my right (surgery) side. Was going to try banded (around my knee) squats to see if the increased abductor activation pulls the femur head more into place or something. Haven’t got around to it though. Been going to my PT for about 5 weeks now, no real improvement in squatting but my posture’s improved. Not my goal, but that seems to be the PT’s goal so I’m going to have to talk to him next week about that.

Could you go into a little more detail about what your issue was (i.e. abductor tight, weak, flexors short, whatever) and how ART helped? And how long you did ART? How did you find a provider? Everyone who does ART around here is a chiropractor and I only personally have worked with 1 guy 40 miles away about 2 years ago, though I know there are a few within 8-10 miles I don’t know how to determine who I should go to. My issue seems more like a joint thing, like the missing cartilage in my hip is the issue. I don’t know how any PT or ART would help.

I’m a little hesitant to go to an ART guy while I’m going to a PT. Seems like 1. a lot of money and 2. kinda interfering with each other. Do you have any thoughts on this?[/quote]

I saw a sports chiro that specializes in soft tissue manipulation. He’s one of my teammates on my weightlifting team and sees me for free so that is definitely a plus, but with the relief I had I definitely would have paid for it.

I’m not entirely sure what my problem was, only that it appeared to be manifesting as either trochanteric bursitis or ITB tendonitis. So he worked on a few things, the first visit, he worked on my glute, glute med, TFL, QL, and ITB. Doing those things gave me a tremendous amount of pain relief and kept me out of his office for about 7 weeks.

Then, after a bad day of cleans the pain flared up again and I went back in to see him. After looking back over those same things, he did a bit of work on my glute med and TFL, but the thing that really changed it was him working on my rectus femoris up near my pelvis area. It was incredibly painful and super uncomfortable but afterwards I could squat and lunge and go into weight bearing abduction (been a problem since my surgery) without any pain.

A week later I hit a PR back squat at 150kg, PR snatch at 90kg, PR clean and jerk at 111kg, and a PR front Squat at 135kg. With no pain at all.


#6

Interesting. The past hour or so I’ve been googling art people in my area have one in particular that played football in college and wrote a lot in his bio about sport specific interests so I’ll give him a call. Id rather have someone with significant experience with weightlifting work with me and from what I can tell he has the most.


#7

[quote]staystrong wrote:
Interesting. The past hour or so I’ve been googling art people in my area have one in particular that played football in college and wrote a lot in his bio about sport specific interests so I’ll give him a call. Id rather have someone with significant experience with weightlifting work with me and from what I can tell he has the most. [/quote]

You wouldn’t happen to live in Southern California would you?


#8

[quote]nkklllll wrote:

[quote]staystrong wrote:
Interesting. The past hour or so I’ve been googling art people in my area have one in particular that played football in college and wrote a lot in his bio about sport specific interests so I’ll give him a call. Id rather have someone with significant experience with weightlifting work with me and from what I can tell he has the most. [/quote]

You wouldn’t happen to live in Southern California would you?[/quote]
I wish! Nope, I live in the middle of the Midwest.


#9

How you doin OP? Any changes?


#10

Curious what your surgery entails.

I have one confirmed decimated hip labrum, only reparable though a labral reconstruction or total hip replacement. I know there are a lot of surgeons performing hip labral repair with less than successful results. Based on my research and conversations with two top surgeons in the field, I believe there are only a few doctors in the country who are really proficient at truly fixing the issue.


#11

[quote]kpsnap wrote:
Curious what your surgery entails.

I have one confirmed decimated hip labrum, only reparable though a labral reconstruction or total hip replacement. I know there are a lot of surgeons performing hip labral repair with less than successful results. Based on my research and conversations with two top surgeons in the field, I believe there are only a few doctors in the country who are really proficient at truly fixing the issue. [/quote]

I’m not a hip surgeon but a labral repair is a pretty common procedure among athletes and they come back from the injury just fine. I myself had a labral repair last year along with a femur and acetabularplasty. I’m squatting, pulling, snatching, sitting, standing, running, jumping just fine. I have pain in some ranges of motion but that is to be expected when altering the structure of a joint.

Not to mention the vast difference between a labral reconstruction and a total hip replacement. From my understanding of hip anatomy, those two surgeries are YEARS apart. Sometimes decades. I was also under the impression that total hip replacements are seldom done for most people anymore, they prefer to do hip resurfacing for younger, more active patients because it allows for about the same amount of time between touch up surgeries and preserves more bone integrity.

Looking online, it certainly seems that your numbers are off. Off a quick google search it appears that about 80% of people who have had FAI surgery (which usually includes either a labral repair or debridement) are happy with the results 1 year post-op, 15% experience no change, and 5% experience a worsening of symptoms.

The surgeries you are considering are far more invasive and cause far more trauma than what any of us in this thread had.


#12

[quote]kpsnap wrote:
I know there are a lot of surgeons performing hip labral repair with less than successful results. [/quote]

You also have to keep in mind that after the surgery is done, it is entirely up to the athlete to rehab correctly and not come back too soon. It takes a minimum of 3 months after a labral repair (not reconstruction, two different operations) for the hip capsule itself to heal, not to mention the the labrum and any other tissues damaged by the surgery. Even walking too early can cause the entire operation to be a failure. Bending the leg too much after surgery, sleeping wrong, etc. These are all things that can ruin the outcomes of a otherwise “successful surgery.”


#13

Glad to hear that my data may be off and that basic labral repair has a good success rate.

And just to clarify, I am not considering any surgery. I can live with my condition at this point.

My gymnast daughter had labral repair surgery last summer. It was wildly successful. We were fortunate in that the surgeon we chose did both repairs and reconstruction so that if the quality of her labrum was poor (too damaged) he could do a reconstruction on the fly. He told me that many of his patients were people from around the country who had had unsuccessful labral repairs the first time around.


#14

To answer the original question, no leg exercises that would cause your hips to approach 90 degrees of hip flexion until after the surgery. You can do partial movements or just exercises that specifically target quads and hamstrings (knee extension or knee flexion). Because of your hip structure, you are literally bumping your femoral head into your acetabulum which is causing the labrum tears. The more you can avoid this, the better. Plus your body will thank you for it by remaining pain free.

As for the comments on ART, I am happy for the user that has had such great results with it. Unfortunately for the original poster, it sounds as if this is truly a structural issue (CAM lesion) and not a muscular issue so ART may not be as proficient since it targets adhesions within the muscles, tendons, ligaments, etc.

Good luck.

DPT


#15

[quote]mattf3213 wrote:
To answer the original question, no leg exercises that would cause your hips to approach 90 degrees of hip flexion until after the surgery. You can do partial movements or just exercises that specifically target quads and hamstrings (knee extension or knee flexion). Because of your hip structure, you are literally bumping your femoral head into your acetabulum which is causing the labrum tears. The more you can avoid this, the better. Plus your body will thank you for it by remaining pain free.

As for the comments on ART, I am happy for the user that has had such great results with it. Unfortunately for the original poster, it sounds as if this is truly a structural issue (CAM lesion) and not a muscular issue so ART may not be as proficient since it targets adhesions within the muscles, tendons, ligaments, etc.

Good luck.

DPT[/quote]

I realize it’s been 2 months, but my comment about ART was not towards the OP. It was towards another person on this forum that has already had FAI surgery and labral repair and is still experiencing pain. I was encouragin him to try ART because 90% of the pain I still experience after my surgery is remedied by soft tissue massage and ART.