hip flexor and adductor tendonitis

[Ryan]

I recently underwent a right hip arthroscopy which is where an orthopedic surgeon used a scope and very small instrument to reattach a tear in my labrum to the bone. Today is 10 weeks post-op. Total recovery time can take up to 4-6 months. Over the last couple weeks I've developed hip flexor and adductor tendonitis, which according to the protocol, can be common problems after a labral repair.

So with my orthopedist's permission, I'm taking 2-4 weeks off from physical therapy and will report back to him later, giving hip an update of my status. I'm meeting with my physical therapist on Wednesday to discuss possible options to address these issues.

I have no weight bearing or ROM precautions except that I'm not to do forced (through pain) or ballistic stretching. Other than that he told me to let pain be my guide.

Suggestions so far: anti-inflammatory meds, icing, and kneeling hip flexor stretch. He also suggested that I cut down on the passive hip flexor (knee to chest) ROM as well (I'm still stuck at about 140 degrees).

Does anyone have suggestions or have dealt with these issues (hip flexor and adductor tendonitis)? Or does anyone know of any supplimental or secondary modalities. Anything suggested by anyone here, I'll clear with my ortho MD and Physical Therapist, but just thought I'd ask!

Thanks for any suggestions!

[Joseph David]

Ryan,
Your symptom may be as simple as residual muscle tension on your lesser trochantor. Have your physio do some palpation work there and see what direction that leads. You may just need to reset the GTO there, or counterstraining the attachment. Your physio should know what these terms mean.
:)

[Ryan]

Just so I know, can you explain to me what you're suggesting and what those terms mean (i.e, reset GTO, palpation of lesser trochantor)? I don't my Physical Therapist's background, so I don't know what modalities she is accoustomed to.

Thanks for such a quick reply!

[Joseph David]

Just so I know, can you explain to me what you're suggesting and what those terms mean (i.e, reset GTO, palpation of lesser trochantor)? I don't my Physical Therapist's background, so I don't know what modalities she is accoustomed to.

Thanks for such a quick reply!

Sure :)
Lesser Trochanter: The attachment site for the illiopsoas on the femur

GTO: Golgi Tendon Organ: The mechanoreceptor responsible for communicating load. Resetting the GTO requires deep transverse friction, a modality of connective tissue manipulation.

Strain Counterstrain: Positional release to reset the muscle spindle.

[JasonE]

What Joseph said - excellent advice!

Also, ask about an alternative to the kneeling hip flexor stretch. There are a number of good side-lying alternatives that allow the hip flexors to be stretched when they aren't under load. My personal favorites can be found in books on Active Isolated Stretching, such as Specific Stretching for Everyone (http://stretchingusa.com/searchResults.cfm?proCategory=Books)by Aaron Mattes.

If your PT is familiar with Strain Counterstrain, she may be able to show you some techniques you can perform for yourself. It's very gentle and can be an excellent way to help tight muscles relax prior to activity or stretching. It has been extremely helpful for some of my clients, especially those with ongoing hip issues.

Hope that helps!

[Ryan]

I went to my physical therapist today; she didn't mention any of the above things. She reiterated rest, anti-inflamitories, and ice. Can you guys describe any of these things your referencing, send pictures, or suggest anymore resources? Are chiropracters familiar with any of these things as well?

My passive ROM is still stuck and about 130 degrees. My therapist stated that it will simply take lots of time (months) before it will return to normal levels. I haven't done any Flowfit since the time I noticed the labral tear in Janurary. Since nothing in Intuflow was on the therapy protocol, I haven't been doing that either. Any suggestions on any of this to help with the passive ROM?

Thanks everyone.

[Joseph David]

Ryan,

If your therapist wasn't familiar with manual manipulation techniques, you may want to look for another member for your health team. A physician that specializes in manual therapy is a good place to start. Some chiropractors are well versed in connective tissue therapies, others just stick working on the bones, or the inner bag. If you can find an AK chiropractor that does reactive muscle work, that's golden. DO's, Doctor of Osteopathy are another great resource if they specialize in manual therapy.
Hope that helps leads you in the right direction :)

[JasonE]

Ryan -

My post above has a link to the Active Isolated Stretching books. That site also has a partial list of practitioners that you may find helpful.

Strain Counterstrain is an osteopathic technique. Unfortunately, the primary text on it (by Dr. Lawrence Jones) is not user-friendly unless you have a background in therapy. The technique may be practiced by physicians, osteopaths, chiropractors, physical therapists, or bodyworks/massage therapists. There is a similar method called "Positional Release" that is commonly used in Neuromuscular Therapy. If you can find a bodyworker/massage therapist certified in Neuromuscular Therapy (NMT) by the NMT Center (www.NMTCenter.com (http://www.NMTCenter.com) - sorry, their online practitioner locator isn't great), you may be in luck.

As Joseph said, the people you see are each a part of your health care team. You are in charge. If you find another person that needs to become a part of the team, you'll know it.