My Labral Tear Saga: Hamstrings, Adductors, Obturators–Oh My!

from Giving the Glory

 

 

This week marks 10-weeks post-op labral tear repair surgery and two-and-a-half years since this “injury” began.  I figured now would be a good time to recap my entire injury saga in hopes that someone else fighting this battle can relate. I’m not a doctor, nor an expert in hip, hamstring or adductor pain, but I will share my experiences in hopes that someone out there might find it helpful.

 

NCAA 1500m 2013

Senior year NCAA’s

Back in the beginning of my Senior year of track at FSU it started as pain in the high hamstring. I battled it the whole season with everything from massage, graston, P.T. exercises and A.R.T., continuing into USA’s which was further than I probably should have pushed it. Post-season I had my first MRI done which showed no signs of major damage to the hamstring, so the doctor labeled it as high hamstring tendinopathy (tendonitis).

 

The following fall I took several weeks off before I began working out with the NJNY Track Club. Although I would still have “twinges” of pain here and there, thanks to the help of my awesome P.T. at the time, Mike Mullaney of Mullaney & Associates Physcial Therapy in Matawan, NJ, I was able to manage it and even return to full-strength racing and running PR’s. From January to April my symptoms were nearly nonexistent, and I thought I nipped this hammy problem in the butt, but then my “butt pain” came back. Thus, May and June became a repeat of my 2013 season and by USA Outdoors I was once again barely able to get through the race.

 

After that season I took several weeks off, and my new coach, Juli Benson, was careful to very gradually increase my mileage when I returned to running. I was just getting my hopes up to run a turkey trot or potentially Club Cross when the pain came back–AGAIN!

 

Now if you’ve ever dealt with a chronic hamstring injury, you may already know they have a high rate of reoccurrence, (according to this article 2/3 of runners who strain their hamstrings will suffer re-injury within one year), and so I wasn’t completely surprised when the pain returned. However, after another non-conclusive MRI and the opinion of more doctors and therapists, I was told that the area of pain I pointed to was actually my adductor rather than hamstring. This totally threw me off…had I been treating the wrong muscle all along, or did the pain move? From that point forward I slightly shifted my therapy to focus more aggressively on glute and abductor strength, minimizing strain on the adductors (similar to the exercises mentioned in this article by Runner’s Connect).

 

Throughout the fall I worked with multiple physical therapists on improving hip and core strength as well. In terms of treatment–I tried EVERYTHING: extracorporeal shockwave therapy, A.R.T.(Active Release Techniques) deep tissue massage, RockTape, dry needling, E-Stim, ultrasound, laser therapy, the McKenzie Method for my lower back pain, neural stretching, and more. While some of these treatments offered relieve, the overall pattern was one step forward-two steps backwards. As the pain began to increase again to the point of easy-runs becoming a dread, we finally decided to shut down for another complete break over the Holidays.

 

Over Christmas I helped take care of my younger sister who had just undergone arthroscopic labral tear surgery. At the time, I hardly considered that we could be dealing with the same issue since her symptoms were more in the hip flexor region. During that busy week I was lucky to squeeze in MRI #3 at the advisory of my chiropractor. This time we decided to check the lower back to eliminate a possible herniated disk or other spinal issue. Thankfully the back looked fine, but so did the hip. You’d think that would be good news, but any undiagnosed runner knows you’d rather have them find some sign of damage than waste a whole year trying to run through mysterious pain.  After that I visited FSU for what was supposed to be my “warm weather training trip” but turned out to be another series of tests, evaluations and ultimately resulted in a PRP injection into the gracilis muscle of my right adductor. At this point, I was optimistic that I could still return in time for outdoor track. However, the problem with PRP is that it isn’t an instant fix. Thus began the waiting game which took me into late spring.

 

Deep 6 muscles-quizlet.com

Deep 6 muscles-quizlet.com

The more time that passed the more convinced I was that PRP had not resolved the underlying issue. Meanwhile, my massage therapist had identified the “deep six” muscles, particularly the obturator muscles (stabilizer and rotator muscles of the hip ) as a major source of my pain. I’m not going to lie, getting treatment for this muscle is tricky, and was probably the most pain I’ve ever endured in my life. During one treatment session I recall feeling such sharp pain it felt like someone was driving a nail through my bone. I began to wonder if it was actually the bone beneath the muscle that was causing the pain, perhaps a stress fracture. My pain had also become more of a constant, dull, achy one that would often keep me up at night. And so I decided to see another orthopedic to rule out a stress fracture/reaction.

 

If you’re still with me reading through this, suffering from a long, frustrating, undiagnosed injury, I encourage you to try what I did next. I walked into another hip specialist’s office for the first time with a blank slate. I didn’t tell him I had three previous MRI’s, knowing that he would instantly label me a hypochondriac and fail to give me a proper diagnosis. Instead, I let him prescribe MRI #4 and willingly went back into the tube, listening to classical music and nearly falling asleep as I often do in MRIs (yes, I know its strange I find the loud banging and clanging quite soothing!)

 

Here is what the report stated:
MRI Report #4When I first read it, the word “labrum” immediately jumped out at me. Although it said “minimal fraying,” I was still worried considering my sister’s labral tear didn’t even show up on a regular MRI (she was eventually diagnosed after an Arthrogram/MRI with dye). The doctor who prescribed the MRI said the fraying wasn’t a big deal and concluded that I had a stress reaction in my acetabula bone. I wasn’t sure how to handle that, especially when I was told to just “run through it but back off if the pain gets worse.” Unsettled with such a vague answer, I took the imaging to TheSteadman-Hawkins Clinic in Denver for a second opinion, and I thank God I did…

 

Within the first half-hour of my appointment I finally had a clear diagnosis:

 

Femoral Acetabular Impingement and Torn Labrum

 

Henry Gray (1918) Anatomy of the Human Body via Wikimedia Commons

They gave me this nifty hand-out which explains it well. Basically when the head of the femur bone rubs abnormally in the hip socket the hip becomes impinged and the labrum (which forms a gasket around the socket) is prone to tearing.

 

After hearing this, I was thinking, “Cut me open right now and fix the darn thing!” Instead we tried a cortisone injection before jumping into a surgery which would take 6 months to fully recover from. After all, 70% or so of the population live with a torn labrum at some point in their life and most do not require surgery.

 

Unfortunately, my little labrum did require surgery. I went to the Steadman Clinic in Vail to have the procedure done by Dr. Marc Philippon who is internationally known for performing the surgery. It turned out I had both a Cam and Pincer deformity which Dr. Philippon took care of by shaving down the bone, and he repaired the labrum with several anchors.

 

So how did it take so long to diagnose this? You might be surprised to hear that on average it takes two years for a torn labrum to be diagnosed. That’s what made me want to get on and write all of this; not to scare you into thinking you tore your labrum, but to show that this injury can present itself in the form of many different symptoms. The theory my doctors and therapists have concluded is that my torn labrum caused my hip to be unstable, therefore forcing my hamstring, adductor and rotator muscles like the obturator to overwork.

 

So that brings me to where I am now, sorting out all of the imbalances by regaining the strength in my hip. Although the comeback from this surgery takes awhile, I’m  grateful to finally have answers and be moving forward.

 

I look forward to any feedback from other hip/hamstring patients out there. You have my sympathy and I thank you for reading 🙂

 

If you’re a runner dealing with a torn labrum and considering surgery, I found the following blogs quite helpful: Nick Willis’ Labral Tear Surgery , Camille Herron’s Blog and April’s blog: My torn labrum – hip surgery with Dr Marc Philippon

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6 Comments

  1. 1

    Hi Amanda,

    I came across this blog post and was blown away at how similar your long journey to diagnose this injury has been to my own. I ran in college as well and while I got hurt about 8 years later from running/crossfit, the pain and length of time it took to figure out the injury was very similar. I am about to have surgery for my labral tear and would love to hear more about your recovery and whether it was helpful. I know this post is a bit old, but still thought I would reach out. Thanks!

    Julia

    • 2

      Julia, I am also suffering from high hamstring pain, which has been quite bad for 5 moths. I am starting to wonder whether the problem is actually in my hip, as there is a clicking sound. Would like to exchange thoughts and hear more about your sotry! Hope you are doing well now.

  2. 3

    Just came across this blog and I also have had high hamstring pain for the past couple years. I’ve tried everything and it didn’t seem to go away. I’ve gone from running marathons to not even being able to run a 10k. I went in last fall because the pain finally ended up in my hip joint and although it didn’t hurt much during the run, for a couple days after a hard run I can barely walk. The doctor believed it might be a labrum tear and has ordered a dye MRI. I’ve had issues for 9 years with my left leg from IT band to knee, to hamstring accompanied by lower back pain. This blog makes so much sense that it has probably been a labrum tear all along. Honestly I’m a little nervous because I understand without treatment it can lead to a hip replacement and I’m now 37 and logged a lot of miles on a bum leg. Thank you for sharing your story! Hopefully if I need surgery, it’s a speedy recovery!

  3. 4

    I am NOT a runner, but I’ve been suffering with high hamstring pain, pain in the left groin and excruciating pain in the lower back. I’ve been through 2 MRIs and STILL have no diagnosis. My pain doctor is now talking about “total hip replacement”, which is terrifying to me at the age of 42. This pain is debilitating, keeps me up at night & has severely affected my mobility and activity tolerance. I totally understand your frustration with having no clear diagnosis. They don’t have one for me either & are already discussing a surgery that is tantamount to a medieval torture technique. Ugh!

  4. 5

    Hi there,

    This story is also somewhat similar to mine. I also thought I was dealing with high hamstring pain, as the pain was always pretty much isolated to what seemed like right under my right butt cheek. I went through over 6+ months of physical therapy for hamstring, and still no progress. I finally got an arthrogram MRI a couple weeks ago, which showed labrum tearing. I just received the cortisone injection two days, and felt immediate relief, which should suggest the hip labral tear was causing the pain, but 2 days later, I’m starting to feel some stiffness/mild pain in the old area again. How long did the cortisone injection provide you relief? I’m wondering it’s more beneficial to just get the hip labral surgery now? I’m also still mildly afraid that there is actually hamstring injury that could be at play that surgery would not be the solution for. Any thoughts would be so appreciated!!!

  5. 6

    Thank you for your experience as I am now dealing with my labral tear. My PT has tried to add some lateral weight bearing strength exercises but it really aggravated my hip. I have a surgical consultation July 2. My big difference is I am 59 years young & very fit. My sport is bicycling long distance but I’ve only been able to ride 15 miles due to increased groin pain. I will keep reading stories like yours to know I’m not thinking too much into my symptoms. Thanks again & continued good recovery!

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