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| Neliah2507 |
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I will look for you. I have a week of vacation starting Friday and am going home to visit family so I'll check through the work I have there. To be a bit more clear, I am not trying to say that the positioning of the femoral head is the only thing creating ROM issues, but I think it's extremely under appreciated. My goal was to help make more sense of biomechanics for runners who are complaining of concerns such as coordination, loss of stability during the impact phase, problems with hills, and also faster paces. I am a firm believer in always taking the conservative approach and attempting to fix any simple/obvious weaknesses (i.e. weak hip abductors, pelvic alignment, core, etc). But there comes a point when for some individuals, that's not going to fix the issue and they inevitably get worse. Essentially, I'm trying to bring about a few ideas that haven't been mentioned so if anyone on here has been struggling for a diagnosis or feels they need a 2nd opinion on imaging they have had they can use these ideas for reference. I don't think you are "screwed." The key is to find the main reason the mechanics of the joint are being compromised and where the decrease in stability is coming from. There is a lot of discussion on here about external factors -- which is GOOD. Many times that is the case. But rarely does someone discuss intra-articular problems. I'll check back on here in a week or so and hopefully my parents haven't moved around too much of my papers. |
| Neliah2507 |
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Sorry, I forgot to reply to your last part. It's rare that I see a PT or especially an orthopedic actually MEASURE hip ROM using a tool to find the degrees, such as a goniometer. Have you been measured before/after your hip problems? These norms are approximately: flexion: 120-135 extension: 15-20 abduction: 40-45 adduction: 25-30 internal rotation: 35-40 external rotation: 40-45 I'm not saying if you aren't on the dot that you have a major problem. These numbers are applied to a very general population. Each person will vary. But I will say from personal experience, as a collegiate runner I never sensed a range of motion problem. I was unaware that I had about 100-108 degrees of hip flexion at best. I also had extremely limited internal rotation (about 18 degrees if I remember correctly). I literally had no conception this was becoming a problem. I was racing well (although I knew something wasn't right). I trained year round with an on/off hip problem (no real pain but just very intermittent bouts of dysfunction) for about 2.5 years. I didn't start to go downhill until NCAAs my senior year. My hip flexion was only 95 degrees just before I was forced to have surgery. I have these measurements from my surgeon who examined me multiple times before we made a decision. I have a close friend who is rehabbing from a fairly serious hip problem (bilateral). Recently he's been complaining to me of pain/stiffness during hip flexion. I asked him how his hamstring flexibility was and he said "very good." According to literature, healthy/normal ROM is around 90 degrees of flexion at the hip joint while lying supine (indicates hamstring flexibility when the lower leg is kept straight). I got him to about 70 degrees before his hamstring was pulling at his hip/lower back and he would have had to rock off the floor to gain more movement. Many athletes assume if they have stiffness during hip flexion then their "hip flexors are tight." It's usually the opposite issue occuring -- the extensors are overly tight and keeping the hip from obtaining it's full ROM of flexion. He had been stretching the heck out of his iliopsoas and quads when the major issue was his glutes and hamstrings. Anyways, sorry again for the lengthy post. You may very well have "healthy" ROM. But if you are unsure or only assuming, I would definitely see if you can find a way to get measured. It's one of the first places to start when attempting to figure out where your mechanical issues are stemming from. When you identify the differences in ROM from your "healthy" side with your "bad" side it can really bring forth some good clues. |
| TDF |
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Very interesting thoughts Neliah. I have been on this thread forever it seems, but not as long as I have been dealing with my left leg issues. I learned about labral tears here and had surgery last July. While many people's complaints on here sound similar to mine, they never quite exactly matched. I also found out over the past two years that I do have femoral anteversion and tibial torsion (to the outside) on my left leg, so it is interesting that you are mentioning that as I do feel that they contributed to my labral tear and the postioning of my femur in the hip joint. No muscular therapy seems to fix that as they are a structural problem. Strangely enough, I saw this blog post last night saying some of the same things that you say: http://www.bettermovement.org/2012/skeletal-structure-movement-function/#comment-13277. I also saw an article http://recoveryourstride.blogspot.com/2012/03/world-champion-kirani-james-and-his.html on World Champion 400 meter runner Kirani James where he mentions his (and his dad's)funky left legs that he describes as working in the same way that I have described my left leg working for years, "Our hips face inwards so our knees face inwards, and the leg sways outside — just to explain that in a nutshell." He goes so fast it is hard to see what his leg really does, but it sounds like femoral anteverion and tibial torsion to me. |
| frustrated runner |
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I guess what I'm getting at is...say somebody's problem IS femoral version-related. Then what? It doesn't sound like there's any way to fix that. *** Also since I am having surgery in 3 weeks now (and am having all of the concomitant worries about what I'll be doing "after"--or NOT doing, as it were...) I just remembered that I had a CT scan to check up on all of my femoral stuff a while ago. Looking at it, the only things that are even close to "abnormal" are on my LEFT side--the good one! Anyways here's the raw data, if you can make any sense of it. Don't read too far into differences of a few degrees, since I'm sure the margin of error is several degrees at least. All numbers are degrees. Measurement.......................Right.....Left Lateral Center Edge Angle.........31^........34^ Anterior Center Edge Angle........60.........58 Acetabular version .....1 o'clock....................9 antev....14 antev .....2 o'clock....................7 " "......15 " " .....3 o'clock...................12 " "......18 " " femoral neck-shaft angle........135^........138 femoral version angle.............7^.........9^ alpha angle .....max..........................59........59 .....extent........................2-3 o'clock 2-3 o'clock beta angle........................66........81 measures marked ^ are ones I have validated as "normal" with some research. Also they must have used a different version of the beta angle, since everything I've seen has them in the 40-degree range. Of course (just to fluster me) that's the only thing that's significantly different side-to-side, except for the acetabular version. The only thing noted by the radiologist was the alpha angle, not anything else, so I'm assuming nothing else is glaringly abnormal (<55 degrees for the alpha angle is "normal"). And by just looking at the 3D CT scan, my femur looks pretty darn normal compared to some of the really messed up ones you see in the scientific papers. Anyhow, see if you can make any sense of it and see if it backs up your theory or not. I'm working on understanding the femoral version stuff more, but haven't seen anything to convince me that this is "the answer" any more than any of the other flavors of the week--or rather, whether it's a significant advance over the "FAI/labral tear" theory in a useful sense. |
| Neliah2507 |
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How old are you and are you male or female? I tend not to worry about a few degrees as much as unilateral differences. Nothing is popping out as dramatic to me. I am going to check three of those numbers though and get back to you but it would be better to know your gender first. Also, who is doing your surgery? Have you been diagnosed with cam/pincer impingement? Are both of your hips being looked at or just one? I don't want to over complicate your situation and have you worrying about specific degrees and numbers. I did give degrees and numbers in my post but it was more for a reference for everyone to get a general understanding of what I was referring to. Having a base/norm to refer to when trying to understand the joint mechanics makes it easier. When I look at your numbers they aren't 100% symmetrical or perfect but as you have already hinted, that doesn't mean they aren't within the norm. I'd like to take a step back and share more of a personal opinion about surgery and not get too medical related for a second... Surgery is not for everyone. I don't want every poster to think I advocate for it (especially hip surgery). What made me finally decide to go through with it was the fact I had no quality of sleep, NO type of progress in terms of PT/rehab, my pain level was a 6 even during normal daily activities (walking/squatting/stairs/sitting, etc). Sometimes worse. I literally avoided having sex because I was terrified of feeling tight/sore for days later. I hadn't run in 12 months and could no longer even do elliptical or pool run. Even walks hurt. For 27 years old that is not a great quality of life in my opinion. I knew something had to change. I also knew I was young enough to recover well if I found a good surgeon and even if I never was 100% normal I had faith that I would have dramatic improvement. I have had dramatic improvement. I am able to run (although not train competitively at the moment). I'm only 16 months post-op. Many athletes are not 100% until 18-24 months. Some sooner. I do not want you to be scared or anxious any more than you should be normally. It's important to have faith in what you are going to choose to do. No matter what your measurements say now, they cannot 100% predict your outcome. It could be way better than you hope, or slightly worse. You never know. What I do know is if you are strict and patient about your rehab, have a good surgeon you can trust, and have good health, you are going to DO WELL. Since you are getting surgery in 3 weeks, if you ever want to chat about physical therapy or rehab difficulties, what types of things help a return to running, etc...feel free to e-mail me. I like sharing ideas because usually it's where I learn the most. Books and articles leave a lot out. |
| Tumor |
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A couple of years ago I started to develop some scuffing in my left foot. I also found myself tripping while I ran in the trails. I would also find that my big toe would tingle or occasionally go numb. I also had three stress fractures occur in my left shin two years ago. The doctor took an MRI of my lower back two years ago and they felt it was a pinched nerve at L5. Fast forward to this past summer I found myself scuffing and an increasing pronounced foot drop. I asked to have another MRI and all looked good. The doctor agreed to take another MRI further up my spine and they found an egg sized tumor in the upper thoracic spinal canal. I went in for surgery to have my tumor removed and thank god it was not cancerous. I was left paralyzed from the waist down and rehab has been going well and there is hope I may be able to walk and possibly run again. My recommendation to anyone with loss of coordination is to make sure you advocate for yourself. The neurosurgeon told me that if I had not pushed for the another MRI of the upper spine I might of had only another month and it would of left me completely paralyzed from the waist down. I remember going to this thread many times trying to figure out what might be my issue along with numerous dr. appointments and endless pt and massage sessions. |
| TDF |
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whoah-glad you pushed and found that tumor. I really hope you get to walking and running again! |
| gloworm110 |
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could be venous reflux. is checked with ultrasound. venous hypertension can occur in absence of varicose veins. also sacral subluxation can cause problems in venous return. |
| Neliah2507 |
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That is terrifying! I am sorry to hear about your experience but definitely glad you are OK. How long have you been rehabbing for? My uncle had a very similar experience although caught the tumor earlier I think. Really hope to hear you are walking again soon. |
| TDF |
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Double Whoah- Tumor, I just saw the article in the local paper this morning and you have to be AD as this is exact the same story as in the paper. I have been out of the local running scene with my own injuries, so I had no idea you were struggling like this. Knowing that you are one of the most knowledgeable running guys around and very strong, I know you'll pull through this and I hope you get back to being able to run some day in the future. Best wishes! You'll figure out who I am from a link above. You coached my son in HS. |
| kang6789 |
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I'm the person who was diagnosed with a labral tear by an MRI-A a couple weeks ago. I got a cortisone shot in my right hip on Monday and took off til Saturday to let it take effect. I ran 6 yesterday and felt kind of awkward due to not running for a few days. My right leg is always worse after time off and it felt a little bit "off" during the run but that's also because I was thinking about it a lot. Today I went for a tempo run to test out the leg. I tried to make it a perfect storm of elements which would bring on the loss of coordination symptoms; I wore trainers instead of flats, I didn't do a dynamic warmup (only a 20 minute jog), and I stuck to the roads. I ended up making it the whole 5 miles without my leg "going"! It felt a little bit weird at times, and I definitely wasn't smooth, but that's the farthest I've made it in a tempo run without the leg totally "going" in probably a year. I don't know my exact pace during the tempo run, but probably around 5:30 pace. I sometimes go a little faster in my tempo runs, but after the couple days off this felt right for "tempo" effort. There's a chance 5:30-5:40 pace is not fast enough to make the leg "go", but I've had it "go" on runs as slow as 6:00 pace so this is definitely a good sign. |
| gloworm110 |
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Is there any literature that mentions labral tears causing loss of motor control while running but that also doesn't present with pain? trying to get doc to give me tests for labral repairs but know I need to be prepared when he asks why I have no pain. |
| gloworm110 |
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Is there any literature that mentions labral tears causing loss of motor control while running but that also doesn't present with pain? trying to get doc to give me tests for labral repairs but know I need to be prepared when he asks why I have no pain. |
| frustrated runner |
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Hi gloworm, There is scant to no scientific literature that deals with this issue. I have done a ton of reading on labral tears/FAI and here are a few relevant snippets from a pretty good article that might help explain a bit of what's going on: From "Hip Arthroscopy: current indications, treatment options, and management issues." Kelly, Williams, and Philippon, American Journal of Sports Medicine, Vol 31, No 6.
I think the "functionally/physiologically weakened gluteus medius" is a phenomena that most of us have experienced, as well as the torso moving over the bad leg in an effort to "drag" it through the stride. And the feeling of instability is definitely something I identify with, and could possibly explain the loss of coordination. However, it's important to note that pain in the joint is still the "hallmark" sign of labral tears/FAI, so even if this turns out to be the problem for most/all of us, it will represent a very small subset of people with labral tears. I'm still not convinced that we can pin the blame on the labrum for people who've had this issue for months or years off and on who don't really get much worse. My own experience is/was a lot more severe than a lot of people in this thread: my loss of coordination came on pretty rapidly and even bothered me on most easy runs. I could fake it for a while on trails or going easy or doing short intervals, but that imploded pretty quick with my stress fracture. When it returned about 6 months later, it was fast and affected pretty much any running. If you can't find any answers through PT/strength/stretching and the usual examination for nerve issues (lumbar MRI or whatever that may entail), definitely push for the MR-arthrogram and the diagnostic numbing injection of lidocane or similar. Your doctor will probably be skeptical, and rightfully so, since even if this does turn out to be the issue, it will be a very abnormal presentation. *** On a more personal note, my surgery is on Tuesday. I'll update on here whenever I have the chance, but I'll also update this twitter account: https://twitter.com/#!/JDruns on a daily-ish basis during my recovery so people can keep tabs on me if you'd like. I was using it as a mini-running log back in August/September because I was too discouraged to keep a "real" running log, and I've left that up so you can get something of an idea of how things were going for me back when I was still trying to run. As I've said before, I didn't decide to go ahead with surgery until I started getting legitimate hip pain, even when I wasn't running. I'm trying to set my expectations pretty low: my doctor will probably chalk my surgery up as a success if I'm able to live an active life without pain. And of course I'd LOVE to be able to run competitively again, and that's probably my "secret" goal. But even if that happens, it will be a long time from now. I'll also know more about how bad the damage in my hip is after surgery. Once I get through with the surgery, I'll have a clear path forward in terms of rehab: working back towards being able to walk, being able to use the exercise bike, the elliptical, and so on. So that's what I'm focusing on now, not if/when I'll be running big miles again. Best of luck to all. |
| lizard king |
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Good luck with the surgery. Please keep us updated on your progress. Also, who is the doctor doing the surgery? |
| another one |
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Good luck for your surgery frustrated runner! I thought I'd give a quick update from myself... I've been dealing with this problem for around 6 or 7 months now. After lots and lots of PT and no improvement I had an MRI of my hip which showed a labral tear. So I went in for a cortisone injection but wan't allowed to run for 2 weeks (so I didn't get to test out the effect of the local anaesthetic). That was around 5 weeks ago and I've been trying to run for 3 weeks but I don't think the cortisone did very much :( Not sure where I'll go from here... given that I don't have any pain and don't have anything to confirm that the hip is the source of the problem I don't think I'll be pushing for surgery. |
| Trollist |
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How many of you guys have been checked hamstring tendinitis or tendinopathy? |
| TDF |
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Why weren't you allowed to run after the cortisone shot? I have never heard anything like that before. It is not supposed to cure you. When you run after the cortisone shot, you should be able to run without the pain. I ran two days later, had a couple perfect pain-free runs and then on the 6th day I had to stop running midway through an 8 miler. That was a sign that I had a labral tear. Usually you feel good for a few days or weeks and then the pain comes back. After that I got the MRI with contrast dye confirming the tear, and then eventually the surgery. I have heard of a few people where the cortisone shot did have long- lasting effects, but the point for confirming a labral tear is checking for the temporary relief (which you never got to check for). |
| another one |
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Everything I've read says that it takes a few days for cortisone to start taking effect and up to 2 weeks for it to reach maximum effectiveness. I'm not sure why I wasn't allowed to run sooner though. The doc was pretty insistent that I didn't, and at this stage I'm sticking to doing what I'm told. I'll ask next time I see him though, as its interesting that the relief can happen so quickly (as in your case and others) and also be short lived. I think that perhaps there has actually been some slight improvement since the injection, as I ran for 15 min on the road yesterday without the leg totally losing it... which I couldn't do before. Its pretty difficult to know for sure though when I have no pain, maybe I was just having a good day. If my leg doesn't improve or gets worse I might try to get another injection and try running sooner. Although as I said before, even if the labral tear is definitely the cause I'm not sure about surgery... however from reading this thread it appears that it would eventually lead to pain anyway so maybe it would be better to get it done early before I cause more damage! |
| frustrated runner |
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Very strange that your doctor did not let you run after your cortisone injection. For me they injected cortisone AND a short acting numbing agent and had me run IMMEDIATELY after. For what it is worth I got some relief with the numbing injection but little/none from the cortisone. I had my surgery done and am rehabbing now. It is no joke of a surgery I will tell you that. I have a long and substantian recovery ahead but at least I have goals and markers now. I am going to tr.y to get a copy of the surgical report but I was told my doc saw what he expected: a tear in the labrum and moderate cam impingement. |