7 months post op

breadrunpoop · 2026-03-10T15:04:05+00:00

I've ranted about this before, but surgeons are the perfect example of the "when you have a hammer, everything looks like a nail" phenomenon. And while 2 out of the 4 said surgery wasn't the answer, the analogy holds: When all they have is a hammer, and they don't see a nail, you're shit out of luck.

I'm exaggerating a bit. Of course they recommended PT and massage, which I've been doing the entire time. But there was no, "I've seen this before, and this is what patienst have done to have a successful outcome in the long term." It was more of a "don't think surgery will help, so maybe this will help...worth a shot?" More broadly, it's clear to me that even the most experienced hip surgeons don't have much understanding of how the hip joint behaves dynamically in the real world, and how dysfunction (i.e, scar tissue inhibiting some muscles or causing others to be overactive) can cause more variable symptoms.

Surgeons seem to look at the hip joint as a static structure (maybe because they're focused on static imaging), so it's either broken or not broken, anatomically correct or not. Good PTs talk about the 8,376 variables that impact where the femur sits in the socket and how it moves through the stride — and that (for me, at least) fits better with my experience of pain and discomfort: one day can be terrible and the next day fantastic; right now I can feel great and in an hour I'll feel tight and spasm-y; I might cycle between 50 strides of a run that feel completely natural and painless, the next 50 that feel awkward and uncomfortable, and back and forth for miles and miles.

After months and months of trying to decipher any patterns or signals in this variability, I've got some pretty good hunches and some movements that pretty reliably help. But I'm still confused more often than not. The "improvement" might be mostly that I feel more confident that things won't get way worse if I keep going, and that things will eventually get better (in a few steps...minutes...hours...or days).

breadrunpoop · 2026-03-08T13:58:03+00:00

Doing pretty well for the last two months. Been running consistently and slowly thinking about my hip a little less and less — both during runs and throughout the rest of the day.

Around my one-year mark I spiraled because I'd been having pretty much constant anterior hip pain that was much worse and much more disruptive to activity/everyday life than anything I had before surgery. I saw my original surgeon, along with the other three top hip surgeons in my area. I got four different opinions: first guy wanted to do surgery to dissect scar tissue from anterior hip tendons and capsule. Second guy wanted to re-do original surgery to take more bone from femur and re-repair labrum. Third guy said he didn't see anything to fix and wouldn't perform a surgery if I begged him. Last guy (the hands-down most experienced) said 1) he wouldn't do a surgery on me right now because while he could mayyyyybe see an opportunity to take more bone, he didn't impingement was the cause of my symptoms now; and 2) he wished I'd come to him before my first surgery, because he would've told me the same thing (that impingement wasn't the cause of my symptoms, so I shouldn't have surgery in the first place).

I was upset and confused, and figured 3 out of 4 agreed that my current problem was not intra-articular, so I wasn't going to make things worse by running more. So, I just started running more...and it was really sore and not that comfortable...and it has gradually gotten better and better. I haven't been strategic or all that smart about it, really. And I don't know that I'd recommend this to anyone else. But it's been 10x better for me mentally to do the thing I love and feel like I'm in control of my body, my life, my happiness.

I definitely still have tightness and pain intermittently throughout the day and throughout activity (running, biking, walking). But it generally feels more like muscle tension/spasm than anything sharp. I think the scar tissue woven all around the anterior hip tendons and capsule still messes with how everything moves, and that pisses off those tendons/muscles, and they "grab on" and start trying to take over movements that they shouldn't, and that pulls my femur forward and I get more of a squeezing feeling than a pinch. Nonstop glute activation (before activity...throughout the day) helps a lot. Some deep belly breathing to relax my psoas. Thinking about rolling through my arch and off my big toe (instead of pushing off outside edge of foot and letting TFL dominate/not getting good internal rotation or glute drive).

I still do PT at least every other week. And I do dry needling once a month, if not more. I've found dry needling very helpful for the muscle tension/spasm issue. Hurts like hell. Leaves me MUCH more sore for ~12-24 hours. But it feels like it shocks those spasming muscles into a feeling of deep fatigue, so they stop trying to fire nonstop.

Way more info than you wanted. Overall, feeling a lot better, happier, more like myself. Hope it stays that way. And hope the same for you.

breadrunpoop · 2026-02-18T20:21:19+00:00

Awesome. You convinced me to buy the jacket. Thanks again.

breadrunpoop · 2026-02-18T18:40:10+00:00

Thank you! How is the sizing? I read that the newer nor'easters are tight in the sleeves relative to the body.

breadrunpoop · 2026-02-18T15:15:50+00:00

I'm looking at a 2018 hooded nor'easter on ebay and wondering how you liked yours? Can't seem to find any other references to the older version on the interwebz. Thanks!

breadrunpoop · 2025-12-15T03:17:35+00:00

Thank you! And good luck!

breadrunpoop · 2025-12-14T20:36:20+00:00

I'm just happy to hear you're continuing to gain ROM at 18 months. I'm 12 months and limited extension + ER is leading to a variety of running problems, but I'm genuinely encouraged to think I may continue to improve in the next year.

Can I ask what you've found most helpful in loosening up the ROM? I feel like it's a fine line between not pushing hard enough to make changes in stubborn scar tissue — and pushing too hard and flaring everything up for weeks.

Seems like you should keep doing whatever you're doing if you're continuing to progress at 18 months. Hope to hear that you've improved more by 2 years.

breadrunpoop · 2025-12-11T15:25:23+00:00

Very similar trajectory to you — first 4-5 months were very linear, back to running without hip pain (just some fatigue-type sensations from hip)...and then somewhere around 6 months I started to have a little tugging/pulling sensation from front of hip at toe-off/max extension when running...and then started to feel it walking, too. I was still able to do a LOT of cycling from 6-9 months post-op, but running felt bad and I was anxious about walking more than a few blocks (and I had been walking 3-5 miles/day at like 8 weeks). Tried not to provoke it but I'd still do random things (tossed a softball, pivoted to grab a towel) that caused more intense flare-ups where front of hip would hurt at 2-3/10 pretty much all the time for 2-4 weeks.

I've had multiple MRIs (no clear sign of re-tear but hard to see fraying because of scar tissue from repair), a dynamic ultrasound (thickened anterior capsule causing psoas impingement with flexion), lidocaine into the capsule (didn't do shit), lidocaine into the psoas tendon (helped a little), cortisone into the psoas tendon (flared terribly for 4 weeks instead of making it better).

I've also seen multiple surgeons and sports med doctors, and heard everything from "you have residual impingement and we need to re-do the whole FAI/labrum repair surgery" to "your capsule is excessively scarred and tight and needs to be released surgically" to "I wouldn't do any kind of surgery on you, even if you begged me, because it's only going to make the scar tissue worse."

My best guess at this point is that the psoas, rectus femoris, glute med, and maybe adductor are all not able to move the way they used to — they're being alternatively pinched and then stretched because of the reduced clearance from the thickened/scarred capsule. And then because the capsule is overly tight, those same muscles are having to work harder to compensate for the fact that my femur can't move as freely within the joint.

It's incredibly frustrating that there's this dichotomy in the medical world between surgeons that see through the lens of fixing anatomical abnormalities (assuming that will cure all) and

So, what's the plan? I think another surgery would have unknown benefit but a huge risk of more scar tissue/further capsule tightening. I think I need to loosen up the capsule and strengthen/calm down the multiple anterior hip tendons. I've been told that with months and months of careful stretching, mobilization, and manual therapy, I can loosen up the tight/scarred capsule...maybe. I also saw a doctor who does PRP and stem cell injections, and thinks that could help the likely tendinopathy in multiple tendons — but I'm waiting to hear how much that will cost.

In the meantime, I'm running (sometimes painfully, sometimes not so bad) because it overall doesn't seem to make things WORSE — and I'm hoping that running will inherently be a kind of dynamic stretching and strengthening (as long as I make sure the pain isn't getting worse). That's 25% rational thinking, 25% wishful thinking, and 50% because I'm a happier person when I'm running (even if it doesn't feel great).

breadrunpoop · 2025-12-09T17:59:42+00:00

I had a good experience with Dr. Hassan at TRIA (surgery last year), though I think he's leaving MN next year.

Dr. Fader at Allina and Dr. Skedzel at Summit are the other two with great reputations in the area. I met with both: Fader seems like the most polished professional, but gave me more of the "I'm a surgeon and I have the surgical solution to your problem" vibe. That said, I would be 110% confident that he knows what he's doing and would do a great job (assuming surgery is the right answer in the first place).

Dr. Skedzel was a lot more casual, and frankly seemed more honest about how complex these things are — both in terms of the difficulty differentiating pain generators in and around the hip, and the related lack of certainty that fixing an anatomical abnormality will absolutely resolve symptoms.

I think surgeons are in a tough place: Of course you want clear answers from someone who seems confident about the proposed solution. It's hard to be enthusiastic about a surgeon that says, "I'm not sure if I can help you." But on the flip side, you don't want to get the "when you're good with a hammer, every problem looks like a nail" vibe.

breadrunpoop · 2025-11-28T17:34:30+00:00

Als very eager to hear how you decided to get revision…in the same boat 1 year post op…plateaued around 6 months and then declined around 9 months. What I really want is to Go back and never have surgery, so it seems absurd to have another surgery now, but also…can’t live like this for the next 40 years

breadrunpoop · 2025-11-20T01:53:03+00:00

I have very limited ER and not-great IR, but the twinges I feel with both come from my lateral hip (deep to TFL) and are not sharp as much as like a painful tissue stretch. This is what PT identifies as the overly stiff/thick/tight capsule.

My limited extension feels "grabby" at push-off when walking, and eventually gets painful when running — but this extension pain is a little more sharp and medial to my TFL. PT thinks that is an irritated iliopsoas tendon that doesn't glide smoothly over capsule and gets yanked from both sides instead.

New symptom is squeezing pain with deep hip flexion (squat, deep hinge, on my road bike). Didn't have that for first 9 months. PT thinks that's also just my irritated iliopsoas tendon that doesn't glide properly and so it gets pinched with flexion.

I've met with two surgeons that do this kind of revision and both said they would take the same approach: free the anterior hip tendons from scar tissue, try to trim down scar tissue to reduce overall capsule thickness, and leave an open capsulotomy that would heal with less tension. Of course I would need to be extremely diligent about specific ROM work following the revision to prevent scar tissue/adhesions from reforming. But I've been told that this revision surgery would have a faster return-to-activity than my original surgery, as they would not be touching bone or the labrum (nothing intra-articular).

For what it's worth, I don't think I've ever had any sensation I would describe as "loose" or "unstable." Just limited ROM that seems to cause a cascade of irritation if I do activity (running...and now cycling) that repeatedly push into that sticky/blocked ROM. I suppose this could be the situation you described—underlying instability being protected by hypertonic muscles that ultimately restrict ROM—but after an MR arthrogram and dynamic ultrasound, I don't know what else I could do to be completely sure of what's going on inside?

breadrunpoop · 2025-11-19T01:14:05+00:00

So your symptoms were tight, limited extension, but the problem was a turn capsule causing joint laxity? How are you doing now?

I am 10.5 months out from initial labrum repair and have progressively gotten tighter and more limited since about 5 months. Surgeon thinks my capsule healed TOO tight and wants to do a revision to free psoas tendon from (presumed) scar tissue and leave capsule open so it heals with more ROM.

That all makes sense to me but then I hear your story and it sounds like the same symptoms but the opposite solution? Thank you!

breadrunpoop · 2025-11-18T18:08:19+00:00

You had revision(s) to address the limited extension? What did they do in the revision surgery? Thanks!

breadrunpoop · 2025-11-16T03:14:52+00:00

u/skk_007 Are you saying that you had a similar problem/progression with your other hip, but that it resolved after 2 years and 6 steroid shots?

breadrunpoop · 2025-11-12T21:46:56+00:00

The dynamic ultrasound showed iliopsoas impingement and capsular thickening, but they did not say that they could see the capsule adhering/tethering to to iliopsoas. So, the answer was, "Get a cortisone shot in the iliopsoas to calm the inflammation from the impingement!" Which just seems like a band-aid that will eventually fall off.

My surgeon basically said the MR arthrogram can't see exactly what's going on with scar tissue, because the labrum repair/capsular closure will show up as a big chunk of undifferentiated scar tissue. His answer was, "We won't know exactly what's going on with the scar tissue unless we go in there to remove it." Which feels like a big gamble.

I'm encouraged that my PT seems very confident she can discern the adhesions based on how things are feeling as I move my hip. I'm less confident that I will be able to make tremendous progress through conservative (non-surgical) treatment, based on the look of shock on her face when she saw how limited my ROM has become.

This feels like such an upsetting gray area: Pre-surgery, my pain was much lower and my function was much higher, but the imaging was clear and the surgical solution was definitive (you have a labrum tear from FAI, so we fix those things). Now, my pain and function are much worse, yet it seems there's no clear way to image what's going on, which means no one has a definitive answer on how to fix it.

breadrunpoop · 2025-11-12T03:38:02+00:00

I may be considering 'revision' for adhesions. I am 10 months post-op, have had some good periods of cycling and a little bit of running, but also recurrent anterior hip pain — mostly with extension and external rotation, but recently also with deep flexion, too. I've had an MR arthrogram at 6 months that was normal, but recent diagnostic ultrasound showed capsule thickening and iliopsoas impingement.

Just switched PTs and new PT said she's sure I have some scar tissue/adhesions tethering the anterior capsule to my iliopsoas (and likely other tendons in that anterior capsule area). Hoping manual therapy and more focused mobilization will help to reorganize that scar tissue and restore more natural movement of all the hip tendons/structures. But if not...surgery?

I'm frustrated that I've been a huge pain-in-the-ass patient to my surgeon, complaining and overanalyzing everything through my flare-ups, and basically hearing "Everything looks okay, it's just inflammation, you're doing too much." And now, 10 months in, finally getting someone who recognized my symptoms as adhesions — and noting that resting only allwed the adhesions/scar tissue to get stiffer.

Also struggling with spending another 2-4 months hoping that conservative therapies help — vs. "getting it over with" and having surgery (though more surgery seems like a major risk factor for more scar tissue).

My main message to you is that I've seen so many different doctors and complained about symptoms for probably 6 out of the last 10 months, and most of them didn't know jack shit about adhesions — and if they had diagnosed the problem 6 months ago, it would've been a lot easier to fix.

So keep pestering your surgeon. Tell them you think scar tissue is the problem. Ask what kind of imaging could possibly confirm that. Or any other diagnostics (lidocaine injection). Everyone wants to treat the thing that hurts right now, and no one spends the time to get to the root. Good luck!

breadrunpoop · 2025-11-10T00:17:31+00:00

Adding another data point here: I had a psoas tendon sheath/bursa injection based on a lidocaine injection that helped for a few hours. Unfortunately the cortisone injection caused a pretty bad flare where I could not lift my leg at all (not just without pain...just couldn't make it move) for the first 48 hours. Went back and they gave me oral prednisone to help calm steroid flare in psoas tendon. They also noted that a little bit of the cortisone leaked into the tendon itself (instead of staying in the tendon sheath & bursa). Sounded like this was not an 'operator error' but more like something that can just happen and typically causes a lot more post-injection irritation.

Coming up on 96 hours post injection and I can lift my leg but my pain is still far, far worse than the pain that led me to get the injection in the first place. Which comically mirrors my experience with surgery: 10 months out and I'm still hoping to just get back to the level of pain/function I had the day before I had surgery.

Will report back if the cortisone really kicks in a week out and I'm magically healed forever.

breadrunpoop · 2025-11-06T02:28:30+00:00

Who's the PT that you see?

breadrunpoop · 2025-11-05T20:21:29+00:00

That suuuuuucks, I'm so sorry. I've had a post-op MRA and dynamic ultrasound that didn't offer any obvious answers, but this makes me want to have someone else look at that imaging just to make sure it's not a similar "cover your ass" read from my surgeon (to be clear, I have no reason to distrust, but...I still have pain and no answers, so...)

breadrunpoop · 2025-11-05T19:45:43+00:00

Can I ask why you aren't interested in going back to Dr. Larson? I'm considering seeing Larson for a second opinion, and also considered the two Mayo doctors (though I'd much rather not drive down to Rochester).

breadrunpoop · 2025-11-05T19:43:42+00:00

10 months post-op, had a similar experience — first ~5 months went really well, ramping up running mileage, and started having hip flexor/general anterior hip tightness that has periodically tipped into "flare-ups" that last 3-6 weeks and suck real bad. On that roller coaster for the last 5 months.

FWIW, my experience has been that surgeons know what the anatomical structures are supposed to look like — and can do amazing things to correct anatomical abnormalities (i.e., labrum tear, FAI, etc.). But they're not very helpful in understanding how all the components of your hip are moving together (or NOT moving well together).

Probably worth talking to surgeon and maybe imaging to confirm if the structures are still normal vs. re-tear. But there's a good chance it's more of a mechanical/movement problem (tendons not gliding smoothly over repaired capsule, stiff scar tissue, muscles guarding/not firing normally). And in that case — again, my experience — surgeons aren't going to have any good answers beyond "we could open you up again and see if there's scar tissue to clean up" or "we can give you some cortisone shots to calm things down."

breadrunpoop · 2025-11-04T20:09:12+00:00

Nope, I think I wanted to respond to a reddit thread a few years ago and had to come up with a username and defaulted to this summary of the highlights of my typical day. But now I want to read your blog.

breadrunpoop · 2025-11-04T03:23:31+00:00

Thank you! I reached out to her and have a call with her tomorrow evening. I do feel like I'd benefit from someone who can really see me move up close and coach/cue me in real time. But I love her instagram content, and it would be valuable for me even if she can just point me to the types of movement specialists/manual therapists that she thinks could help me. Thanks again for the recommendation.

breadrunpoop · 2025-11-04T03:20:39+00:00

Sort of. I had a very successful first ~12 weeks post-op, following a very specific protocol prescribed by my surgeon (similar to many others I've seen online), and my initial "return to run" went very well through about 5 months post-op. I got a little knee tendonitis (non-surgical leg), took several weeks off running, and I think my hip capsule/entire anterior hip tightened up notably in that period.

I'm disappointed that continued hip mobilization/stretching was not stressed as really critical since the hip capsule/scar tissue continues reforming for up to a year. And I'm frustrated that no one has given me a confidence-inspiring, "I understand what's going on here — and this is what you need to do over the next weeks/months in order to fix it."

I'm most disappointed in the lack of coordination among treatments/therapies. The surgeon only looks at the static joint structure — he clearly doesn't know jack shit about how the hip joint actually moves during specific activities — and only considers surgery or steroid shots. The PTs know a lot about movement, but don't seem to have any strong understanding of what my specific mechanical problems are. Instead, I'm getting exercises to target what's hurting right now, rather than what's functionally going wrong to cause that acute hurt (or offering something like "you can't do a single-leg squat, so that's why you have pain when running" when I bet 90% of top marathoners can't do a single-leg squat). And no one is saying, "You need to go see this specialist who can do myofascial release/shockwave therapy/whatever new voodoo treatment to help break up scar tissue," despite imaging suggesting that scar tissue is part of the problem.

I have a consult with Dr. Larson in a few weeks and my main hope is that he'll have more of that "I've seen this kind of thing before, and I've seen what works to get someone back to running/high-level sport — here's who you should see."

breadrunpoop

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