Pam Ayres' teeth, my glutes

I’m in 3 different Facebook groups for Hippies and one thing that seems to crop up fairly regularly is the topic of groin pain.  Many people have this pre-op, especially if there’s things like labral tears which was my case.  But there’s also a number of us who’ve complained about it post op.  I just thought I’d use this blog as a way of sharing my experience, to maybe help people think about how they might get themselves sorted earlier or avoid getting in the state I’m in altogether.

I had posterior THR on my right leg in February 2016, and am based in the UK where we use crutches from the start, not walkers.  I had also gone private so had access to physio which isn’t always the case for people on NHS.  After the pretty rough first couple of weeks most of us have, I got into quite a good routine.  I know I hit my first 10K steps on Day 11, though that wasn’t by any means regular occurrence but I was getting out for a couple of decent walks pretty much every day.  I was on 2 crutches until 4 weeks; I did try dropping to one earlier but limped so stuck with 2 and worked on my walking.  Then at 4 weeks I walked with one and by 6 weeks I was crutch free and limp free.  So my walking was great, I loved just being able to get out there and not hurt.  From day 1 I’d also had exercises to do, very simple ones for the first few weeks, then moving on to bring in the delights of clamshells and bridges.  I was pretty good about it, always found time to do them diligently. 

Once I did start the other exercises I noticed the groin pain more.  I knew that at first there’s all kinds of aches and pains and wasn’t worried, just figured it’d all settle in time.  I was walking great and in no pain other than that.  I was on restrictions until 12 weeks so it wasn’t as if I was doing anything drastic anyway.  I’d gone back working from 6 weeks on a very gentle phased return, not full time until 12 weeks.  But once I was working more it was harder to find time in the day to do all the exercises and the walking that I wanted to do.

From 5 weeks out I’d been having hydrotherapy and occasional land-based physio.  I’d often mentioned the groin pain and was given different exercises for my hip flexors, along with assurances that it wasn’t uncommon and would settle in time.  I did really work on them, and tried to keep up the walking and realise now I’d sacrificed the glutes exercises somewhat around this time.  But when you consider that some people never even get given any exercises to do surely that wasn’t so big a deal.

After my restrictions were lifted things did go kind of as I’d hoped.  I went on holiday to Morocco and got my first running test crossing a road in Marrakech where it was a case of run or die! I went to Barcelona and clocked up well over 20K steps each day we were there.  I did a steps challenge over the summer and averaged 12K steps a day, not bad considering I was working much of that time in a desk based job.  I walked on smooth and rough surfaces, I climbed steps, all was fine.  I even returned to my dancercise class at 5 months and though I was unfit I had little trouble with the moves, only occasionally did I twinge.  And I also got back on a horse for a short very gentle session. But through all that I had this wretched groin pain.  Never constant just niggling away on certain movements.

I saw my surgeon in August at my 6 month check and had an x-ray which showed everything looked fine.  He suggested I drop the riding and dancercise and to try taking a course of anitinflammatories.  So I armed myself with omeprazole to protect my stomach and hit the ibuprofen 3 times a day.  This coincided with our cruise holiday.  We did a load of walking, again no problem at all.  I also wore heels and got drunk and danced in the evenings a couple of times. No problems. And I also got to rest up a lot of our days at sea.  But if anything the groin pain was starting to get worse.  It was always worse on waking and when doing things requiring me to lift my knee, so stepping in my knickers, once a source of great excitement, had once again become near impossible.   Even getting in the car and driving was starting to hurt, bearing in mind it’s my brake and accelerator leg.  So late on in October I went back to my surgeon.

He had talked before about steroid injections which I have never been keen on, having had bad experience when I had them in my hip pre-arthroscopy.  I’d also had another doctor tell me that while they can often be curative in elbow and shoulders (and I had an elbow one that worked brilliantly), he said in lower limbs they usually only buy time.  I actually felt I’d rather go straight for keyhole surgery but that wasn’t an option.  I can understand why but he said he wouldn’t do surgery without having tried the injection option.  I said I didn’t want the injection without having tried more physio so I went back for a course of 8 weeks with a physio who I have had work on me many times before and who has worked with my surgeon on THR patients.  In this course of sessions she got more hands on, massage aimed at releasing things in the psoas, some electro treatment, a form of ultrasound.  She also advised me to work more on my glutes and gave me some additional exercises which I was good at doing.  But over the next few weeks things got worse. By week 7 she said that she was out of ideas and said I really should go back to my surgeon which I did last week. 

I had another x-ray and an MRI scan.  On the plus side the x-ray was great; the downer was that the MRI showed I have tendonitis and bursitis in the psoas.  His view backed up that of the physio.  It seems that the walking I did early on would have been fine apart from the fact I tend to walk quite briskly and stride out well (my husband says I stomp!). That means I give the hip flexors quite a bit of a workout.  Because my glutes were weak they were not supporting my hip flexors.  Over time this meant that there would have been some forward movement with the muscles to the rear not working as well as they should and there has been rubbing in the area of the front of the capsule.  This has contributed to the tendonitis and bursitis.  By the time I was at the physio this was likely too well established for me to do anything about.  I did point out how it seemed a bit unfair as I know many people have never been given exercises at all so it’s not like I was the world’s worst exerciser.  He agreed and said I have been unlucky.

Now I am possibly in more pain than I was pre-op, mostly low level but with some bloody severe spikes.  It hurts as I lie in bed, rolling to either side can be uncomfortable.  I’ve almost given up trying to step into pants in the regular way but instead I let them dangle so I can do a low step into them.  Getting in the car I sometimes have to actually use my hands to lift my leg in.  So now I am 2 weeks away from a steroid injection, and if that doesn’t work then I may be looking at keyhole surgery.  In the meantime I am back with a vengeance on working the glutes.  I’m to keep active and walk as long as it’s not painful which suits me fine.  I don’t think anybody has at any time ever been at all negligent in giving me information; I honestly don’t think anybody could’ve have foreseen how this was going as generally I was doing so well.  All through this I have had great movement in terms of range and the amount that was pain free. 

But right now with the benefit of hindsight if I could go back in time I’d spend more time working on those pesky glutes.  Hence the title of this blog post.  Brits of a certain age will have heard of a lady called Pam Ayres.  She used to be on telly regularly reciting her comedy poems.  And one of those was a little ditty called ‘Oh I Wish I’d Looked After Me Teeth’ from the perspective of somebody  wishing they’d paid better attention to cleaning their teeth as they now have false ones.  I kind of feel the same about my glutes.  For anybody else with groin pain, while working on hip flexors makes total sense and may even be the answer to problems, don’t neglect the glutes.  And don’t assume that being active means you’re healed.  Sometimes now I see people who are doing loads really quickly and want to warn them not to be complacent but it sounds then like I’m pissing on their chips to use a lovely quaint British expression.  Or that I’m bitter and jealous.  I’m not, though I do admit to a degree of envy.  But when people say they’re doing things but then admit they still hurt or limp or whatever, that’s when I really want to scream at them to take things easy.  In a few weeks I will be one year out and this isn’t how I saw myself.  But I’m determined I will be there.  I still don’t regret having the surgery, just wish I’d done things different after it.