July 19, 2012

Femoroacetabular Impingement (FAI)

Something to smile about.. a diagnosis?

This week I read what might be the most clear medical diagnosis for my hip (and lower back) pain I have to date,"....CAM type femoral acetabular impingement,"  which was in my radiology report. (See below.) (Info. links at bottom of post.)

Dr. Scott Martin  (Brigham and Women's Hospital) described my hip pain as a "shredded labrum" versus "torn labrum."  He said, "You do not need surgery...yet." (With emphasis on the word, "yet.")  I followed his strong advice to NOT run nor do more than regular daily activities. This was not a problem because I had already stopped (wog/hiking) after the work I did on the trail for the TARC Spring Thaw Race in March. 

After the hip injection (over a month ago), I still did not run, even though I felt pain free. I had forgotten what that was like!  After about four weeks, the ache came back a bit but not as intense as before.  The unfortunate thing is that hip area injuries/problems like this will not heal heal in time; they need help (injections, PT, surgery...). All the time off and rest in the world will not make this condition better. If I want to avoid surgery I must kiss athletics goodbye, which I am not willing to do! So these last weeks I have experienced such INTENSE lower back pain that I am not smiling as much as I usually do. If I seem down it is just the pain. When I lie on my ice packs, I think about Dick Beardsly's book Staying the Course and his presentation before MDI marathon few years ago. He spoke about his addiction to pain killers —and his fight back to sobriety—after a life-threatening accident with a piece of farm equipment. A tear-jerker of a book; I recommend it highly!

For my pain, I am not even taking Advil nor Tylenol regularly. It is very important that I still be able to feel when some action causes me pain. Pain is my guide right now. Well, to be holistic, happiness is my genuine guide. Yet, when it comes to what I can and cannot do right now, I am supposed to listen to my body and stop when I feel any hint of pain (in the hip and lower back). Sound like a plan for soft wusses? No. Not when I am trying to heal and keep the long view in mind. I am rolling with it!


Last week I was evaluated by my new Physical Therapist, Clare Safran-Norton (PT, PhD, MS, OCS) through Dr. Martin at BWH. She is in high demand given she books over a month out! What I learned from Clare is that I am asymmetrical (pelvis is twisted), extremely tight in my lumbar and thoracic regions of the spine, and still "very very strong." That's funny, I don't feel strong; I feel like a marshmallow peep. Still, she has me empowered and focused on this next chapter of recovery (and/or pre-op...). Clare is helping me further strengthen my pelvic girdle, loosen my back, protect/heal the pain generating area(s). BALANCE!

Goal is to strengthen areas around hip and lower back with NO pain or aggravation of the hip joint(s). Another goal is that I hope to avoid surgery— but if I hope to ever return to the level of activity I enjoyed in the mountains and running with my trail buddies, I will probably need surgery. Dr. Martin is a leading surgeon for arthroscopic hip surgery in the Boston area. A colleague of mine had both hips successfully operated on and corrected by Dr. Martin. Thank goodness for this reference from my colleague! And, Thank goodness I live near Boston!

Here is Dr. Martin's site with lots of juicy details and photos:

".......What is FAI? Femoroacetabular impingement or FAI is a condition of too much friction in the hip joint.  Basically, the ball (femoral head) and socket (acetabulum) rub abnormally creating damage to the hip joint.  The damage can occur to the articular cartilage (smooth white surface of the ball or socket) or the labral cartilage (soft tissue bumper of the socket)...."

This link is nice and scientific: 
"....Nonsurgical treatments include modification of activities and avoidance of specific movements that elicit symptoms and non-steroidal anti-inflammatory drugs. Intra-articular steroid injections and physical therapy with hip strengthening exercises may reduce symptoms. Hip stretching exercises such as yoga usually make symptoms worse...."


Dan said...

Hi Em
Sorry to hear you are still in pain but it sounds like you have a strong team working to get you better. Good luck and stay focused.

Unknown said...

Physical therapy is really one of the best treatments. We can reduce our any kind of body pain easily through this therapy. Physical therapy