Sunday, April 6, 2014

The Mystery Injury Solved: Labral Tear and FAI

My pain first started in June 2012, at around mile 15 of a 100K trail race.  It was a very dull ache in my left groin that was mild, but nagging and annoying.  I don't think the distance had anything to do with bringing on the pain; I think it was just a coincidence.  Had I not run that 100K, I think the pain would have started during a routine run later that summer, but luck has it that it started for me at the beginning of a day I was going to run for 17 hours.  I had run a 50K just three weeks before with no issues and about a month before that had finished a 50 mile race feeling great.  So while it would be easy to blame the distance, I honestly believe it was just strange timing.  The 100K was my big race of the summer, and I finished it, despite running for the next 47 miles with an ache in my groin that would turn out to never leave.

Later that summer I took time off, hoping rest would be the cure for this annoying ache in my groin.  It was probably 4-6 weeks of very reduced activity and I started to feel better, so I resumed running in August.  I was scheduled to pace a friend at her 100 miler in September and needed to get my mileage back up.  I don't have a whole lot of memories from that time, but I must have felt a little better because I continued to run.  I ended up pacing for approximately 12 hours for my friend, but I popped ibuprofen a few times during that run to quiet the ache in my groin and I stopped earlier than I wanted because of the pain. In October I ran a 50K, paced at 24 hour race over night, and finally ran a half marathon the first weekend in November.  The half marathon was ugly and painful.  I knew it was going to be my last run for a long time.  I limped for a few weeks after that race.  For the next 4 months, I would not run at all.

I finally broke down and saw my doctor in December 2012.  She sent me for X-Rays of my pelvis area and referred me to sports medicine.  At the time, I was told my X-rays looked "normal."  When I saw the sports med doc, he was concerned I had a femoral neck stress fracture and ordered a regular MRI and gave me a pair of crutches to use until we got the results from the MRI.  I did not feel I had a stress fracture (no symptoms, no acute pain) and specifically asked for the MRI with contrast dye to check for a labral tear.  He told me the contrast dye MRI wasn't necessary and to use the crutches in the meantime.  I threw the crutches in the trunk of my car and didn't touch them.  A few days later I had the results of my MRI -- no stress fracture.  He told me it looked normal and gave me a diagnosis of tendonitis and shipped me off to PT.  I tried PT from January 2013 - April 2013 with absolutely no results.  They had me doing a lot of glute strengthening with the theraband.  Despite 4 months of rest and PT, my pain levels had hardly changed.

The one thing that actually did help was finding a sports minded chiropractor.  In late February I started seeing him and having both Active Release Therapy (ART) and Graston done.  These sessions were pretty damn painful, but I did finally get some relief.  Looking back now, I think he manipulated so much soft tissue around my joint, that it was able to move smoother.  Unfortunately, these gains were short lived.  I had maybe a month of hope and some mostly pain free shorter runs before the pain came back.  In June of 2013, a year after my initial pain started, I had a run so terrible that I wound crying from the pain and took the shortest way home possible.  I gave up.  I was tired of going to the doctor, to PT, to the chiro and running around town going to all these appointments and paying co-pays and fees, etc.  I decided I would stop trying to run and just bike over the summer and give myself a break and go back to the doctor in the fall.  I was convinced there was something seriously wrong with me.

That summer I started bike commuting to work, dropped my injury weight, and felt stronger.  But biking isn't really my thing and I wanted to run.  Whenever I ran, I still had the same pain.  Some days were better than others, but it just never went away. I went back to sports medicine in November and saw a different doctor.  He ordered the right MRI (MRA) and I was finally diagnosed with a torn labrum in my hip and femoral acetabular impingement (FAI.)  In simple terms, FAI is when you have too much bone on your femur and/or hip socket and the extra bone starts damaging your cartilage in the joint.  When all of the conservative treatments fail (and for most people they do), the only options left are surgery or nothing.  Here is a better explanation:

I scheduled surgery for March 3, 2014, due to conflicts with my work schedule and not wanting to be on crutches through the worst of winter.  My surgeon would be Dr. James Keene in Madison, Wisconsin. From all the research I did about this, I learned that surgeon selection is very important. You don't want just any ol' ortho to operate; you want someone who deals specifically with hips and has a large number of these under their belt.  Dr. Keene studied with Dr. Byrd of Nashville (one of the pioneer surgeons behind hip arthroscopy) and has preformed over 1000 of these surgeries.  After meeting with him, I was very comfortable with him and trusted him and his expertise. 

I will try my best to continue to blog through this process and detail my return to running ultras.  There's not a lot of good information out there on this surgery as it's still fairly new, so I hope to record my return and help others who have suffered through this as well. 

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