The Injury. The Answers.

Although I was confused shortly after surgery, over the last few weeks I’ve visited with doctors, physician’s assistants, and physical therapists. We’ve gone over the surgery pictures, examined how my body has responded to surgery, and finally been able to find some answers.

As you can see in my injury history, I had been looking for answers for a long time. We looked into several potential diagnoses, ruling them out one at a time. Since I’ve been blogging along the way, I’ve received numerous suggestions on what it could be, most of which were well informed and definitely possible. It’s amazing that after all this searching, with a help of a few surgical instruments, all my questions over the last 1.5 years were answered.

In the diagnosis phase, there was one thing that kept popping up that was a possibility – a torn labrum. There were plenty of symptoms, the most notable being that my hip would audibly pop. We had four MRIs. Yes, four, and none of them showed a major tear. One of them did show a minor tear, not one that was serious enough to require surgery.

In reading the surgeon’s report, it’s clear that he didn’t know what he would find. He just knew that my condition had deteriorated enough that surgery was the only way to get answers.

He found a torn labrum and a lot of messed up cartilage, and he corrected it. More on that in a moment.

The torn labrum was probably there from the very beginning. The only real question is how it materialized in the first place. Could it have happened on Grandfather Mountain? Could it have been a combination of all of my big riding in 2012? Could it have been there a year earlier and only started bothering me with heavy riding? We’ll never know the answer to that question. All we know is that it was exacerbated as a product of cycling.

He said that the stress fracture and the torn labrum were two different things, but they are clearly related on some level. The labrum protects the bone, and with it torn, it probably made me susceptible to a fracture. I’m lucky I didn’t get another one.

After the stress fracture healed and I was able to train again, I still had the torn labrum, even though I didn’t know it. What he found during surgery was that there was a lot of beat up cartilage. That was probably due to me riding on the tear. The doctor showed me all of the damage on the pictures (which looked like cloudy planets), and it was pretty severe.

What’s interesting is that the torn labrum wasn’t the cause of any the pain. The labrum does not have any sensation. It cannot breath, and that is why it can only be healed with surgery. The pain was all the cartilage damage, and that would reoccur later.

As I continued training and riding harder, the popping would be more frequent. At times it would hurt quite awhile after. At some point in September, anytime I tried to ride, it was pure pain. It felt like I had a pebble in my hip, and the strongest of the strongest could not have ridden through this. Now I know why.

Remember that this is an unscientific description, and I’m translating what the doctor told me that I barely understand. Somehow because of the bad cartilage, the torn labrum and the instability of the bone, things became out of alignment. It caused a pinching every time I moved my hip flexor. That meant with every pedal stroke, it would pinch. The more I pedaled, the more it would hurt.. It came to a point that after every ride, I would have to take a few days off just to let the pain subside. Then I would ride again, hoping it had healed, and repeat the cycle of pain.

The pain became so bad that I had to get off the bike completely and walk with a cane for the majority of the winter. If I walked regularly, I would engage the hip flexor and feel pain. I had two cortisone shot and one iliopsoas shot, neither of which gave me any relief.

When the surgeon found the tear, he had to make a tough decision. Would he debride or repair? He decided to debride, which means he removed the part of the labrum that was torn. I wish I had a say in the matter, because I would have asked him to repair it. He expects me to make a full recovery, but whether I can achieve the same athleticism that I had before and more, is still up in the air. Without a full labrum, I could be susceptible to the same sort of problems (stress fractures) that I had before. Or maybe not. It depends on a lot of things, and that’s a conversation we still need to have. Right now it is about recovery.

I mentioned already that he performed a microfracture on my hip. That means he broke the bones so that my labrum would heal correctly. As he subtly put it, “we poked a few small holes in you.” He also performed what’s called a chondroplasty, which is pretty much like the microfracture, but instead of breaking the bone, he dug in and broke the cartilage.

The bone and the cartilage will normally take 8 weeks to heal. Right now I’m at 6.5 and I’ve made improvements, but the challenge is that it is difficult to not bear weight on a hip. Even when sitting down, I am putting a little bit of weight there. A few weeks ago it seemed I was ahead of schedule. As of now, it feels like I’m behind, so it could be another few weeks on crutches. The great thing is that the doctor thinks my body has healed enough for me to take anti-inflammatory drugs, which make a world of difference.

At this point, recovery is up in the air until the surgery wounds heal. That’ll probably be the subject of another post that will focus more on the physical therapy techniques to rebuild strength and expectations on when I can return to exercise.

I know this all sounds like a downer, and I’ll admit that it has been trying on my patience, but I’ve actually enjoyed my downtime. I have dedicated my time to some other interests, and found that being a couch potato is not all that bad. I just have to keep reminding myself that this is temporary, and that soon enough, maybe sooner than I think, I’ll be back out there.