I have a problem that can be “fixed” with surgery…why should I bother with physical therapy?
Many individuals have evidence on imaging of hip impingement or possible labral damage, however not everyone has pain and some may never know that they have these findings. It is crucial to correlate the imaging findings to the clinical exam findings for proper patient selection for hip arthroscopy.
Many patients with hip pain, positive imaging findings, and correlating clinical exams also have substantial extra-articular (outside of the joint) pain and dysfunction as well. These problems are not corrected with surgery and may in fact be the bigger problem in some patient cases. Examples of these extra-articular problems include but are not limited to soft tissue pain and restriction, hip weakness, core stability dysfunctions, and lumbar/pelvic dysfunction.
In cases where patients present with both joint pain and pathology (such as FAI and labral tears) as well as these outside the joint problems, it is critical to address the non-joint problems prior to surgical interventions (also known as “prehab”) to allow for the best possible outcomes. A complete examination by a physical therapist with experience in treating hip pathology is a very important step in the diagnostic process. This can allow for a proper physical therapy program to be designed to either prevent or prepare for surgical interventions.
I have had injections before and they never work. Why should I do one now?
The role of ultrasound guided diagnostic injections is two-fold. These injections are used for diagnostic as well as therapeutic purposes. At times a diagnostic only injection may be performed depending on the individual patient scenario. It is important that you understand and appreciate the role of each component of these injections. First, a numbing medicine is part of what will go into your hip joint or the localized area of damage/pain. This is a fast acting, but short lasting medicine that should give close to immediate relief of any pain that is originating from the joint or tissue in question. The pain felt with activity and clinical examination prior to the injection should be evaluated following the injection – this is the diagnostic portion. How you feel in those initial minutes to few hours following the injection is the closest estimate of how you would feel with a successful surgical intervention (after completing a proper rehabilitation program) if it comes to that. The pain that remains after injection would not be resolved with surgery alone and should be addressed prior to a surgical intervention. Often this pain is coming from other areas of the body (such as the lumbar spine), or from the soft tissues around the hip.
The second medication that is commonly injected into the joint is a corticosteroid. In comparison to the anesthetic (numbing medicine), the steroid takes up to two weeks to start working fully and the overall affects are highly variable. Some patients get a substantial amount of long term relief of pain (several months or more) while others get none and many in-between. The benefit of using this medicine is the ability to address soft tissue pain/restrictions, weakness and inhibition, and other non-hip related pain and dysfunction while the hip joint is not hurting or less irritable.
Some patients will do very well with conservative treatments (medication, therapy, etc.) and activity modifications while others will ultimately undergo a surgical procedure. Either way, the injection allows for both diagnostic information to be collected as well as the opportunity to prepare an individual physically for the best possible rehab experience post op.
There seems to be a lot of surgeries, labral repair, PAO, total hip, etc.…If I can’t get better with injections and therapy what kind of surgery will I need?
There are a lot of factors that go into the decision making regarding the best surgical option for hip and/or pelvis pain. Your visit with our team will include multiple clinician interactions including our nursing staff, physical therapists, imaging, and physicians. There is intentionally overlap built into the system to be sure that you are well cared for during your visits with us and that your overall long term outcomes are the focus of our attention and decision making.
Our physical therapy team is here to assist in not only evaluating you, but also preparing you for the long-term expectations and timelines related to any procedure or surgery. Being a specialty clinic, our therapists have extensive knowledge and experience in the evaluation and treatment of individuals undergoing both conservative and surgical management of hip and pelvis disorders.
How long will I be on crutches and what are my restrictions after surgery?
The answer to these questions can be highly variable and is dependent on the surgical procedure(s) you will undergo. Limited weight bearing/crutch use varies from 7-10 days upwards of 2+ months. Weight bearing as well as any other range of motion or activity restrictions are specifically assigned based on the healing time of the tissues/structures involved as well as the amount of stress those areas endure in daily activity. It is important to also remember that with the longer restricted weight bearing status comes increased time to regain enough strength to tolerate the demands of activities such as walking, stairs, and athletics therefore having the guidance of your PT team will be crucial in the full return to activities of daily living and athletics.
Our physical therapy team will typically visit with surgical candidates prior to their procedures to prepare them for the most likely restrictions as well as other possibilities. In addition, those who undergo an outpatient surgery will have therapy within the first 1-2 days post-operatively in our office, and those who will be staying in the hospital will also have Physical Therapy within the first 24-48 hours with the St. Thomas Inpatient Physical Therapy Staff who have worked directly with our surgeons, nursing, and PT team to best care for our patients while in the hospital.