Friday, November 4, 2011

Moving Right Along

Life, that is.  I have officially defended my dissertation and earned my PhD (!!!), the semester nears its end, Sara Jane is about to run an awesome race in NY, I'm loving having a (spectacular!) running coach, we're buying a new car (as in...actually NEW), and something hurts.

It's all good apart from that last bit.  So, if you remember, I developed some hip pain last May.  Like, a LONG time ago.  When I say hip pain, I mean more like groin pain.  But I know it's coming from my hip.  Anyway, it was diagnosed as a hip flexor strain with resulting tendonitis.  I rested it, and had a lot of Graston done by the fabulous Penny.  I also strengthened my glutes.  It seemed to help, but the pain would only go away for a short time, then come back.

During taper for Chicago, it got really bad.  It's not that it was that bad while running, but it ached ALL THE TIME, especially in the car or going up stairs.  I did not feel it at ALL during the marathon (might have been because everything else hurt so much).  And I really didn't notice it the few days after the race (again, probably overshadowed by the back and quad pain).  Anyway, I took two weeks totally off of running.  During that time, I could feel it...especially at Disney World where we did a lot of standing/walking.

Last week, it got worse.  After all that rest, it got worse.  All along, I've kind of thought this was not tendonitis.  People--I've had a lot of tendonitis.  It is worse in the morning (this is best in the morning), doesn't hurt at rest (this is worst at rest), and might hurt at the beginning of a run, but then fades (if it bothers me running, it's always later in the run).  Also, it radiates into my quad and knee.  Not typical of tendonitis.  So I decided to go to a sports medicine doctor--a new one.  I had been seeing Dr. Weidenbener, but he seemed content to just let this go, and also didn't believe me about my piriformis syndrome (and that's what it was!), so I'm going to a new sports medicine doctor--Dr. LaGrange.  I LOVE him.  He's a fairly new doctor, but I think that works in my favor.  Sports medicine is cutting edge, and he knows all about the new stuff/changes.  He also seems to have a lot of passion for athletes.

So, I went to see him on Monday and explained to him the whole hip issue.  I also told him that Dr. W had had a bone scan done to ensure that I didn't have a stress fracture, but that that was totally normal.  "No, it wasn't totally normal," said Dr. LaGrange as he pulled up a copy of the report.  He told me that, while there was no stress fracture, I had increased uptake of the contrast dye in my pubic bones (bottom of hips).  This indicates inflammation (i.e. the bone is trying to heal).  Even though I don't have pain in THAT part of my hip, it's a piece of the puzzle.

So he did a very extensive exam of my hip, and asked me what hurt and what didn't.  I recognized that he was doing the "impingement test."  He told me to sit up, grabbed a model of the hip joint, and said "It's one of three things, and I am leaning toward one of them."  He explained that he thinks I may have something called Femoral Acetabular Impingement Syndrome (why do I always have SYNDROMES?).  The hip joint is a ball and socket.  FAI occurs when the ball portion pinches the labrum which is located in the socket.  It's not a serious injury--but it hurts.  It also commonly causes radiation down the thigh and to the knee.

He said option two was a sports hernia.  That one surprised me.  I know what they are.  He explained that they cause groin pain.  However, he said, they don't usually go into the knee, and they are most commonly associated with abdominal pain (of which, at this point, I actually have none). The final option, he said, would be iliopsoas bursitis/tendonitis.  But he doesn't think that's the case given that it's been going on so long and that it radiates down my thigh and into my knee.  So he was still voting for FAI.

FAI can only be diagnosed by a test called an MR Arthrogram--like an MRI but with dye injected into the joint.  A key part of the test is that they numb the joint before they give the contrast.  If this gets rid of the pain, there's a pretty good bet that it's coming from the joint.  He told me that the test is kind of painful, so that we could start by doing a steroid injection into the hip joint.  If it worked, great.  If it wore off or didn't work, then we would do the MRA.

However, I wanted the MRA now.  Why?  Deductible.  It's been met for us for this year.  If I get the steroid injection, it works for six weeks, then wears off, I'm going to have to get the MRA anyway.  At that point, it'll be 2012, and we'll have to shell over the $2500 for the test.  No, thank you.  He understood, and agrees we should go ahead with the MRA.  It happens next Tuesday.

Here's the good news--I can still run.  He's not at all concerned that continuing to run will cause any damaged.  It's a structural (pinching) problem, and running won't make it worse.  That's awesome.  The bad news--most people require a surgery (though it's minimally invasive) to fix this problem for good.  We'll cross that bridge if we come to it.

Good luck to all my friends racing this weekend!

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