FAI (Femoro-acetabular Impingement) & Karate

I visited my doctor yesterday.  I had been telling him and my physical therapists the past few months that I have felt like I was not getting any better and thought I might actually be getting worse.  In the past couple weeks, I have felt almost as bad as I did just prior to my operations almost a year ago.

The doctor had a look at the latest Xrays and told me that the condition of my left hip had deteriorated significantly.  It was now pretty much bone-on-bone.

After some discussion, he called over another doctor from the clinic across the street (both of them are highly respected members of Stanford Hospital / University) and they both agreed that a total replacement may be about the only option available, other than continuing to suffer through the
increasing pain and extremely limit my physical activity (normal walking causes me pain most days now).

I am thinking it over now.  But I will most likely visit the doctors again very soon and may schedule the operation for around the end of December.

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I feel now as though I am in almost as much pain as I have ever been.  My range of motion is also horrible.  It seems as though the past 10 months may have been wasted.  I fear I will need to have at least my left hip completely replaced very soon.   I certainly cannot continue as I have been much longer.  I took Xrays a few weeks ago but the Dr has yet to return my calls.  I finally made an appointment to see him in a couple days.

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I have noticed no real change in my condition over the past couple months. This is very frustrating. The pain is better than it was just prior to my surgery last December, but probably not much better than about a year or so before that. In my last visit to the doctor, he wrote me prescriptions for Synvisc and/or Cortizone shot. I need to get back to take another Xray to get an updated opinion from him. But it seems to me at this point (and apparently to the doctor and therapists as well) that I am not going to recover much more than I have within the near term without some sort of alteration. Hopefully I can find time to get the Xray before too long…

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I do not feel as though I have made any improvements in the past few months.  I have better mobility and less pain than just before the operations.  But probably not much less than, say, about 10-12 months before.   Hopefully, as a result of the surgeries I will not get much worse anytime soon, as the bones seem to be fitting together better now.  I suspect that my right side should be OK for possibly several decades but my left will likely require a total replacement before retirement age. :-(  There just isn’t all that much cartillage left, particularly on my left side.  There is going to be pain no matter what I do, at least until I get a replacement.  Hopefully there is more I can do and my condition will somehow improve.

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I have been so busy recently that I have not been able to keep up with my therapy appointments.   I have been doing my homework – replicating exercises I had done with the physical therapy staff.  But I really need someone to twist me around and help me stretch out properly…

I biked 10 miles yesterday in preparation for my 50 mile charity ride in 10 days.  My hips do not hurt, per se, while riding.  But I definitely feel weak, particularly on my left side.

The insurance company contacted me unexpectedly to tell me that they want me to pay over $30K for part of each of the 2 surgeries.  Excuse me?  Do you think I would have had these operations if I had thought I would need to pay that much??  The doctors in the US are, in my opinion, still the best.  But the insurance system is horrible.  I do not know what is going to come of this.  But I cannot imagine having to pay that much for something that I did not agree in advance to pay.

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I visited the surgeon a couple weeks ago.  He basically said “keep up the good work.”  I have definitely made improvements but I feel like I should be much further along than I am.  My left side is definitely worse than my right, more in terms of flexibility than strength but also in terms of pain levels.  There are two main reasons for this:

1) During the time I was supposed to be getting into my later-stage therapy on the left side, I was recovering from my right hip surgery.  So I couldn’t keep the pace I had been on and ended up losing flexibility as I spent so much time supporting all my weight standing on the left side while minimizing the weight on my right leg.

2) I do not have much cartilage left on either side but much less on my left.  So I will never be completely without pain in my left hip.

I have been gradually increasing the length and intensity of my karate workouts and have been doing a little more biking.  I will be taking part in a fund-raising 50-mile bike ride in about a month.  So I will be riding more in the coming weeks to prepare for that.  As it stands now, I feel the reduced strength on my left side  and also pain in my left hip but it is not bad when riding at a medium pace (faster than normal/casual riders but not as fast as those who bike every day and have bikes that cost 10 times what mine is worth)  for < 10 miles.  We will soon see how things go when I increase to 10-15 miles per ride within the next week…

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My therapy has been progressing fairly well.  I am definitely experiencing diminishing marginal improvment (less marked improvement each week).  But I continue to get better.  My physical therapists have been having me do mostly combinations of exercises with very little rest between sets.  Just the way I like it!  My strength continues to improve, although by now I have almost as much strength as I did pre-surgery.  But my range-of-motion continues to be the problem.  And although I am strong in the shallow squat-type exercises, when I bend my leg more I definitely lack the strength and control that I wish I had again.  It will come with time, I am sure.  I am just impatient.

I have been biking leisurely with the kids quite a bit lately.  And I rode my bike to/from work one  day a couple weeks ago.  I played some volleyball with coworkers last Wednesday, in preparation for the charity tournament next week.  I have been doing a little more of the workouts with my karate classes when I teach.  I am still not doing all of it.  But last night I did everything but about 2/3 of the kicks (which was just 10 minutes of the total 1 hr 45 minutes of class time).  As is tradition at my dojo the evening closest to my birthday (I turned 41 today), we perform repetitions equal to – or multiples of – my birthday.  So we did 41 of a lot of different techniques; some in place and some stepping.  Then we did Heian Shodan and Tekki Shodan each 41 times.  41 each of 4 strengthening exercises rounded it out.  I feel great today.  I had planned to bike into the office today but decided at the last minute that I would rather have the extra 10 minutes of sleep.  I biked wth my son after work for a while.

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I have been pretty frustrated with my recovery almost the entire time since my surgeries, particularly after the 2nd one.  But when I stop to think about it, I am still way ahead of expectations for just about everyone but myself… A couple days ago marked 5 months since my 1st operation in December.  My 2nd operation was less than 3 1/2 months ago.  And I have officially been off crutches following surgery 2 for just 6 1/2 weeks.  So that I cannot do everything yet is understandable.

The physical therapists have had me doing some very tough exercises, which I love.   Some of the worst (I say “best”) include such things as squating down to where the hips are almost as low as the knees and then lift up one leg and try to go lower on the one leg that is supporting all the weight.  As personal trainers give me a funny look while they pass by I ask “Can YOU do this?”  To which the answer is often “No.”  Ha!  My range-of-motion is coming back slowly.  My strength is fine, in general.  But I lack strength, balance and stability when I am at a point of major flexion.  Basically, I still have work to do that the physical therapists are working almost as hard as me on.  I had to quit therapy a little early on Thursday, however.  Not because of anything in my hips but rather because of sharp pain in my lower back.  Bad form…

<> I participated in “bike to work day” last Thursday.  It was about 15 minutes (drive usually takes about 7) in in the morning.   Near record heat.  But since it was just after 5am, it wasn’t too hot.  But when I left physical therapy at about 3:30pm, it was really hot and with the increased traffic it took me about 25 minutes to bike home in the hot sun.  My hips were fine with that ride.  The question is, can I do the 100-mile bike race in July that I am tentatively planning to do for charity with some of my coworkers…

<>I do feel some pain (I call it “discomfort”) in my left hip.  I am quite sure that this is primarily due to all the lost cartillage that cannot really be regenerated.  I think I’m stuck with this feeling, although it certainly is not any worse than it was 6 months ago; not even close, actually.

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I have been doing “circuit training” the past couple times at physical therapy.  I run through 6-7 exercises without almost any break, then repeat.  Lots of good stuff.  I am doing a lot of strengthening and stability exercises on my own as well, but just as importantly spending a lot of time stretching.  I continue to feel that my strength and control are coming back quickly but my range-of-motion is not improving quickly at all.  Stretching definitely makes a difference.

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Physical therapy is moving along.  New exercises every time.  Karate classes are still mostly limited to teaching with some partial demonstrations.  But that is getting better as well.  I am not moving quickly.  But I am continually  improving my strength and range-of-motion.  My physical therapists’ main job is still to tell me “No,” “Slow down!” etc.

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