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Old 11-13-11, 07:53 PM  
Lucysql
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Question Any acetabular hip fracture experiences?

I'm seeing my doc on this too, but also wanted any real-life experiences.

Long story short, I'm in my late forties and had a severe car accident in my teens. Ended up with an acetabular hip fracture/dislocation that was successfully fixed with closed reduction and three months in skeletal traction.

My leg length difference is 1/2" and I wear an insert when I run because without it, I was experiencing ankle pain on the UNinjured side (great example of how pain often doesn't show up where the real problem is found!).

My ROM is really limited - very little external rotation and I cannot bend over like regular folks to tie my shoe, for example.

I run, but limited mileage - probably 12 - 15 miles/week total - plus elliptical, bicycle, and strength. So I'm in good shape and at a very good weight.

I'm consulting my sports medicine/PMR (physical medicine/rehab) doc as we speak - but I also wondered:

Does anyone here has any experience themselves with this kind of injury and the really-long-term results regarding range of motion, pain during activity, etc.

95% of these injuries are in the very old, so it's really hard to find anyone my age who both HAD a similar injury AND is very physically active. And even my doc's not that helpful, because he doesn't have much experience with that combination either.

And I've noticed a couple of problems lately:

1) Sometimes when I'm running, I'll feel like something in the back of my hip has slipped over something else (no clue anatomically what any of this might be). It feels sort of like a pop, although there's no sound at all. But it HURTS. Sometimes it keeps hurting for awhile even though I've stopped running instantly, sometimes not. Sometimes it happens 5 - 6 times in just 5 miles, sometimes it doesn't happen at all.

2) I don't normally have any hip pain during a normal day, but what I've been noticing recently is that at about the 2.5 mile mark, I really feel pain in my hip. It feels like it's 'inside' the top front of my leg, towards my inner thigh.

Hard to describe, but it doesn't feel like muscular pain at all. And it only hurts when I land. If I stop and walk for a few feet and then start again, it'll briefly be fine, and then it starts hurting again every time I land.

3) The other thing I've noticed when I'm running is that my hip feels - again, hard to describe - but a little wobbly or unstable on that side by the time I get to ~5 miles. Although it's hard to tell whether that's causing the pain, or because of the pain. Chicken and egg problem.

And I've always experienced pronounced progressive reductions in ROM on runs, just in the time it takes to complete one run. But that's nothing new.

Appreciate any and all thoughts and experiences - but don't tell me to see my doc, because I'm already in that process!

lucysql
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Old 11-13-11, 11:39 PM  
EnglishIvy
 
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First of all, I'm really sorry you have to deal with this. As a fellow enthusiast of all things movement, I feel deeply when I hear about pain limiting someone's activity. I'm not sure if my post will be useful but I'll offer up a few ideas.

Without more detailed information, my first suggestion out of the gate (based on your report) would be to investigate snapping hip syndrome or possibly a Hip Labral Tear. Here's some info that might help you:

There are 2 major types of snapping hip syndrome

Lateral snapping hip is felt at the outside of the hip and is caused by the Tensor Fascia Lata (TFL) or Gluteus Maximus flicking across the greater trochanter (bony protrusion on the upper part of the femur/thigh bone). The clicking feeling is often not painful.

Internal snapping hip (more closely matches your report of symptoms) is most often caused by the Iliopsoas muscle as it flips across the Iliopectineal eminence (front part of the pelvis). Internal snapping hip syndrome can also occur by other mechanisms:

* The iliopsoas tendon also may produce snapping with sudden movement over the anterior inferior iliac spine or possibly the bony ridge on the lesser trochanter.

* Less common causes of internal snapping hip syndrome include movement of the iliofemoral ligaments over the femoral head or anterior capsule of the hip. Though this is less common in general, your history of dislocation would put you at a higher risk for this form.

Though the name implies that a snapping sound might be present, the internal form often produces no audible snapping sound. Patients will more often report a sense of "movement" (they sense the sudden displacement of the tendon) and associated pain. Targeted stretching/strengthening is the typical treatment. On an interesting note, core strengthening is important because it keeps the hip flexors (psoas) from over-working. An over-worked hip flexor is tight and more likely to contribute to "snapping".

Labral Tear

Capsular laxity or hypermobility of the hip (in relation to your injury as a teen) can result in injury to the labrum down the road. When ligaments are stretched beyond normal ROM (as with trauma), they may not regain the same degree of "tightness" after healing. That means less joint stability (laxity). The laxity allows more play in the joint during repetitive motion (running etc) and can cause wear/tears to the labrum. PT (to strengthen the hip) and/or arthroscopy (similar to the knee version) are common treatments.

Your past injury does leave you more vulnerable to certain types of injury but it's also possible that you have simple soft tissue injuries related to activity. If you are not intimately familiar with foam rolling and trigger point work, I cannot suggest that strongly enough. People are often shocked when they start mapping out trigger points and pain patterns. You will undoubtedly find pain in surprising areas. Body awareness and recognizing your own patterns can really lead to more complete healing. Your doctor may or may not be able to enlighten you about what is going on in your hip. IMHO, in order to get truly comprehensive treatment, you'll need to do some exploring/mapping on your own. I really HTH.
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Old 11-14-11, 12:26 AM  
Lucysql
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Thank you so much for the useful and relevant suggestions - I really appreciate it. It's tough to be "an experiment of one" in this area

What type of professional would you suggest I look for to get some help developing more body awareness, awareness of movement patterns, etc.?

Because I had a cornucopia of other injuries including fractures, I have issues on both the left and the right side that make it very challenging to pinpoint "root causes."

Not complaining, I'm grateful every day to be here and able to do stuff and enjoy life, just explaining.

lucysql

PS Hadn't thought about trigger point therapy in connection with this, but that's a very good idea. I've seen excellent results from it for my DH's shoulder problem.
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Old 11-14-11, 01:59 AM  
EnglishIvy
 
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Quote:
Originally Posted by Lucysql View Post
Thank you so much for the useful and relevant suggestions - I really appreciate it. It's tough to be "an experiment of one" in this area

What type of professional would you suggest I look for to get some help developing more body awareness, awareness of movement patterns, etc.?

Because I had a cornucopia of other injuries including fractures, I have issues on both the left and the right side that make it very challenging to pinpoint "root causes."

Not complaining, I'm grateful every day to be here and able to do stuff and enjoy life, just explaining.

lucysql

PS Hadn't thought about trigger point therapy in connection with this, but that's a very good idea. I've seen excellent results from it for my DH's shoulder problem.
There are some good home references that can get you started. The Trigger Point Therapy Workbook has a very helpful chapter on hip pain. Jill Miller has a Hips & Buttocks CD as part of her Tension Tune Down Series (guided instruction for rolling out trigger points in the region). I have that CD and would be happy to loan it if you pm your address.

You really don't have to worry about pinpointing the problem. With the type of past injury you describe, it's likely that the entire hip region would benefit from foam/trigger point rolling. Once you get started, it will probably fall into place fairly quickly. Describing it can make it sound more confusing---- feeling the patterns and connecting the sensations will turn on the light bulb for you. Once you learn to roll the region (the workbook will give you the basic guidelines), you'll probably just know what you need. There are different qualities and depth of pain that can help guide you to understand the connections.

Soft tissue injuries are still largely ignored in modern medicine. Back when you had your injury, they wouldn't have even been a consideration. Orthopedists like to treat broken bones and torn ligaments. Trigger points don't show up on an x-ray or MRI so they get little attention. But as you witnessed with your husband's shoulder, they can make a big difference when it comes to treatment. I would start with home exploration because you are the best potential expert when it comes to your body. But if you would like a consult, there are trigger point specialists. In a clinical setting, a doctor will often treat/inject trigger points with local anesthetic rather than use manual pressure or rolling techniques. These physicians tend to work in pain clinics or sport's medicine settings. You have to be specific in asking about these techniques as they are the exception rather than the rule. There are also massage therapists that specialize in trigger point therapy. I don't have time to collect the links right now, but youtube has some excellent videos related to general and massage therapy techniques for trigger points.

I would like to point out that many of the "issues" related to past injuries can be directly or indirectly tied to trigger points/ myofascial contractures that were never addressed during the original injury. It's not unusual for patients to incorrectly assume that certain pains are just permanent leftovers from the injury. I don't know the extent of your injuries but I hope you will be pleasantly surprised as you explore these new techniques.

ETA: Pinky balls are great trigger point tools -inexpensive and effective. These are essentially the same balls that Jill Miller uses in her program. I get them for about $1 at the local toystore.
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Old 11-14-11, 09:15 AM  
jaj999
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The pain you describe sounds like the pain I had when I had a stress fracture in my femur. It was in the part of the femur that goes across to join to the pelvis. See a doctor - if it's not a soft tissue thing, trigger point therapies won't help.
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Old 11-14-11, 10:46 AM  
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It sounds like you are on the right track with being aware of ROM and seeing your doc. Dr. Louis Pack is a podiatrist who sits on a Rheumatology board and works with a lot of athletes and patients with similar issues (diff in limb length). He wrote a book called The Athritis Revolution which I am currently reading for my SO who has lots of joint and Athritis issues.

Sorry to hear you going through all this but I also have to commend you on your strength and courage to keep working through and recovering from a tough accident. You are very inspiring and a wonderful role model . I hope the doctor has some good news for you. Keep us posted.
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Old 11-14-11, 11:34 AM  
EnglishIvy
 
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Quote:
Originally Posted by jaj999 View Post
The pain you describe sounds like the pain I had when I had a stress fracture in my femur. It was in the part of the femur that goes across to join to the pelvis. See a doctor - if it's not a soft tissue thing, trigger point therapies won't help.
The OP has made it clear that she IS seeing her doctor to rule out more serious conditions. It would be unusual for a sport's medicine doc to miss a a fracture in the femoral head or a labral tear. These injuries show up readily on diagnostic imaging and will likely get sorted out for the OP right away. So just to clarify, no one is suggesting that she ignore proper medical attention in favor of home care/trigger point therapy. But given her medical history, she may benefit from addressing soft tissue problems either way. Soft tissue injuries often accompany traumatic injuries. While the fractures and tears are immediately addressed, the other problems are too often ignored. Since injuries rarely happen in a vacuum or stay within the strict confines of a single medical diagnosis, a more comprehensive approach can help with a more complete recovery.
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Old 11-14-11, 01:26 PM  
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I have no suggestions, other than to take all of that information to your doctor when you go. If he hasn't tried to help you in any way for these newer problems, I think it's early to pre-second guess him.

It's like that you have a number of issues due to the length of time it's been since you had your initial injury and the compensations your body has made over the years as a result. If your doctor's worth your patronage, he'll help you with as much of this as he can, and refer you on if he can't.
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