FAI (Femoro-acetabular Impingement) & Karate

Not much has changed.  I am in a holding pattern with my right hip.  It feels fine and I am able to do certain exercises so not letting atrophy set in.  My left leg/hip is strong.  I am doing lots of exercise at the physical therapist’s but since I cannot do much with my right leg/hip, there is only so much I can do on the left.  Many of the exercises are very similar; wall-sits, squats, squats holding something for stability, leg-press/holds…all on one side only…  I am trying to focus more on stretching, since walking on my left leg all the time while keeping weight off the right is doing enough to strengthen my left without any extra exercises. The problem is that all this walking with so much weight on my left has a tendency to reduce my range of motion.  Hard to believe I am not even half-way done with my crutch-time on the right side.  I expect the frustration to build further…particularly with the approach of the big karate seminars coming up in less than 2 weeks!

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I went to physical therapy twice this week.  Did some stretching on my right side (2nd surgery) but since it seems that I am already more flexible in that hip than most people ever are, it is probably not worth pushing too hard.  I have been doing stationary biking with my right foot basically just strapped in for the ride. My left leg does all the work.  I have been doing other strengthening exercises for my left leg/hip.  It’s all going well; just frustrating feeling like I could do so much more than I am… I am still using the ice pack/machine a couple hours each night and strap myself into the CPM (automatic leg exercise machine) for most of the night. The problem with this is that “most of the night” for me isn’t much.  I typically do not sleep more than 6 hours/night and the past couple nights I have been awakened by my pager around 12:30 or 1:00am (just after having fallen asleep) to work for an hour or so.  So “most of the night” doesn’t turn out to be much when I’m only in bed for a little more than 4 hours!  Oh well. Better a little than none… I am icing as I write this, by the way.

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My left hip feels stronger and more flexible than it has been in at least a year.  My right hip also feels very good and I am just holding back due to doctor’s orders and the fact that I know he’s right…He poked 15 or 16 holes in my bone and those holes and the surrounding area need to regenerate and restructure and is as yet fragile.  Back to physical therapy tomorrow.

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I went to physical therapy yesterday afternoon.  As people who know me well can tell you, I am generally a very serious person in terms of working hard and not wasting my time, but I also like to bring a smile to people’s faces as I joke around.  So with that in mind, the conversation with my physical therapist was quite interesting… As soon as I saw her, I asked her if she made it to observe any of the surgery. She had told me she was interested and I arranged through the surgeon’s office for her to be able to observe if she wanted to.  She gave me a strange look and said “I can’t believe you are asking me that! We had an entire conversation before you went into surgery!”  Very strange… They had given me a pre-anesthesia “cocktail” while wheeling me toward the operating room.  The hallway started moving in strange ways around me. I guess this is the sort of experience I missed out on back in college because I was always so serious about my studies… Anyway, she told me that she came and was talking with a doctor and that I picked my head up and said “Hey Lisa!  Glad you could make it.  I guess I won’t be doing any exercises with you TODAY!”  So I was joking around coherently and have no recollection of it.  So weird.

<> Anyway, the therapy on my right leg is basically just stretching at this point.  I spent some time on the bike with both feet strapped in, but I was under strict orders to only use my left leg to pedal.  I then did a bunch of strengthening exercises on my left leg.  I have been balancing on that leg for the past 10+ days so it is definitely getting strong again.  Not much pain in my left hip now but I am not really pushing it because I am limited so much by my right side.  While strntching out my right leg/hip, it was noted that the flexibility on that side is almost as the same level as for my left.  So I am sure that once the bone heals in about 6 weeks, I will recover very quickly after that.

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It has been a week and a day since my 2nd surgery.  I visited the Dr today for a status check and to get my stitches removed.  We spoke quite a bit about the surgery itself, the recovery process, etc.   He told me that separating the icing and exercise machine portions of my therapy are perfectly fine; that they are just usually done together for the sake of efficiency, since most “normal” (non-professional/collegiate athletes) do not have the time to do anywhere near what is recommended for each part of the therapy.  He did, however, advise me to stick to the 30 minutes on / 30 minutes off cycle for icing, instead of doing it for up to 2 hours straight.  When he asked how I felt and I responded that I actually feel better on this leg than the other, he said that this was a common reaction.  Somehow, the feeling seems to be better in this version of the surgery than with the lesser version.  But in actuality, the condition of the hip is much more delicate.  He said I should keep to the 8-weeks-on-crutches plan, putting minimal weight on my right leg.  But he said I must keep moving the leg and suggested starting physical therapy visits soon so they could help me with this.

It turns out that the doctor poked about 15 holes in my bone (microfracture), which is basically to fill with marrow over the coming weeks.  I also had a labral tear.  So there was quite a lot of work done.   What was expected to be about 90 minutes of surgery time turned out to be well over 2 hours.

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I am really feeling like my right hip is healing so much faster than the left did the first week.  I am trying to put only minimal weight on my right leg.  But it is frustrating.  I am now up to 100 degrees flexion on the CPM (the automatic leg bender/stretcher device), which I am running for most of the night.  At that angle, the “Game Ready” ice-water leg-wrap gets uncomfortable, as it tends to bind at my hip.  So I am now putting more time into icing at times other than while in bed strapped to that machine.  I think this is a much better strategy.  The only way I could really improve on my current arrangement, I feel, is if I had the icing machine at my office… I had my kids here all weekend.  My mother flew back to NY last night. Chasing after them was not bad at all.  Of course my kids are awesome most of the time anyway. But they really seem to show concern these days, making sure they don’t run into me from a full run like they often have, for example.   Dr appointment will be in a couple days.  At that time, we will discuss the physical therapy plan.

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Day 5 of hip surgery 2: I feel fine, physically.  I really feel like I should be doing physical therapy.  But the doctor told me to hold off for at least another week.  So I am biting my lip, so to speak, trying to move as slowly and carefully as I can, planning to keep these crutches attached to me for many weeks.  I regained my appetite within a couple days of the surgery.  So since I am not able to do almost any exercise yet (I plan to start upper-body workouts this weekend, but many of those can irritate my hip region) I am hoping that I can at least finally push to a new weight record during this rest period.  The most I have ever managed to weigh has been 153lbs.  I am within a pound of that now.  So this may be my chance…

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What I wrote a couple days ago, the night after the surgery, about not being in pain… You can forget that.  I couldn’t sleep almost at all Monday night; less than 2 hours in total.  It was quite bad.  I took 3 of the pain-killers between 3am and 11am and the pain continued through to the late afternoon yesterday.  The good news? I’m feeling MUCH better now.  In fact, it is very hard to believe what they told me at the post-op Dr’s visit today…

I had a microfracture.  That means I am supposed to be on crutches (20 lbs max weight on right leg) for 8 weeks.  I am also supposed to continue to use the leg exerciser and ice for 8 weeks.  And they suggested that I hold off on going back to physical therapy for a couple weeks.  This is obviously going to frustrate me considerably. I am cancelling a family trip, a trip to Japan for Karate and will have to make a few changes  in my plans for my hectic March seminar schedule. Better safe than sorry, though…

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Left hip: 7 weeks
Right hip: 1 day

Got up early this morning (actually later than my normal work day, but 5:40am may seem early to some people) to take a shower with special cleaning sponge supplied by the hospital. Patients going into surgery are required to shower this way the prior night and again in the morning.  The goal is to keep the patient’s bacteria to a minimum, as much for the sake of the other people in the hospital as for the patients themselves.<>  I arrived at the hospital, with my mother who is here yet again to help with driving and various things around the house for a week, by 6:30am.  As last time, various people came to see me to explain the machines I would/might need to use for the next few weeks.  The anesthesiologist gave me  a “special cocktail” on the way to the operating room and I was completely out before I got there.  As last time, I was again very slow to recover.  I did not leave the hospital until almost 5pm.  I did not throw up this time.  But I definitely did not feel great, either.  Last time, I couldn’t manage to eat anything the day of the surgery.  This time, I ate some soup and oatmeal.  I don’t feel the need for any painkillers (yet?).  But they are next to my bed, just in case.  I have already gone a couple rounds with the special wraparound icepack/machine.  In a few minutes, I will strap myself into the leg-exerciser to run it all night, while I go through some more icing for as long as I can take it (it’s really cold in this house so I don’t want to get myself sick).

The good news: this hip actually feels like it is in better shape than the other one was immediately following the operation. The bad news, however, is pretty bad for me.  Anyone who knows me will understand how frustrating this is for me. Before the first operation, they told me that there was a high chance I would need to be on crutches for 6-8 weeks.  But it turned out to be just 2.  This time, the probability seemed to be for just 2 weeks again. But my mother told me that the doctor spoke with her while I was recovering and told her that I will be on crutches for 8 weeks.

Of course I will do what the doctor tells me.  I will be going in for my post-op visit in 2 days and will discuss the recover plans then.  I am confident that I will be able to recover as quickly as possible.  But I am realistic about not pushing so hard that I risk ruining the operation, as I did with my ankle almost 20 years ago.

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My right hip surgery will be performed tomorrow morning. It will also mark 7 weeks since the 1st surgery. I am still feeling some pain and limits in flexibility. But, overall, I feel that I am continuing to improve; just not as noticeably from day to day anymore. Taught Karate in the morning at my dojo yesterday and then at another dojo 2+ hours away in the afternoon. I probably will not be back to the dojo for over a week.

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