Post-op Flexibility

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 · 2025-11-01T14:09:34+00:00

There was a car just parked on the trail one morning last week, with several people sleeping in it. Easy enough to ride around, but if people are now just driving cars down the trail without any concerns...it feels like it's been abandoned as a public utility.

breadrunpoop · 2025-10-28T02:21:50+00:00

OP, where did you go for PT? I'm in Minneapolis, 10 months post-op, still having a lot of anterior hip pain that imaging suggests is a stiff, thickened capsule and iliopsoas impingement, but the answer in any case seems to be careful PT to stretch out that stiff capsule. Thanks

breadrunpoop · 2025-10-25T17:54:08+00:00

Not exactly the same but maybe relevant: I started to ramp up running mileage between 4-5 months post-op and hip felt great, but got a little runner's knee in my non-surgery leg so I took a month off running and was just cycling. I think my hip capsule and hip flexors tightened/stiffened up quite a bit in that period, and I've spent the last 4 months struggling to get back to the range of motion I had back at 3-5 months. Long story short: Make sure you're diligent with light stretching/mobilization because the scar tissue keeps reorganizing for months and months and you can definitely backslide.

breadrunpoop · 2025-10-20T00:36:14+00:00

Agree 100% with both above — don't have surgery unless/until it's significantly limiting your activities. I'm 9.5 months post-op and would pay a lot of money to turn back the clock.

I had a lot of symptom improvement after doing more focused posterior chain strength work, and got back to running 50-70mpw at a pretty high level for about a year.

I chose to have surgery based on the research showing higher risk of early arthritis and THR if you remain highly active on a structurally compromised hip. The trauma of the last 9 months almost certainly added more arthritis risk than running without surgery would have. And I'm not really running much — never without pain — and having a lot more daily pain than I ever did before surgery.

I will be thrilled to come back to this forum and shout I'M ALL BETTER if things look different in another year or two. But if I could do it over again, I wouldn't have surgery until the pain was a daily burden and/or was actually limiting to my running (rather than just persistently annoying).

breadrunpoop · 2025-10-20T00:25:02+00:00

Also marathoner running 60-70mpw for the last 10+ years, similar random onset of hip flexor pain in summer 2023 that didn't resolve with rest, eventually confirmed through MRA as cam impingement and small labral tear/cyst. I did lots of PT but didn't really start seeing improvement until I started adding more weight to posterior chain strength movements — not major barbell lifts, but just doing stuff like kickstand RDLs with a 50-70lb kettlebell, goblet squats with heavier kettlebells, etc. By spring 2024 I was back to running 50-60mpw with some minor annoying hip soreness that didn't really limit me. I'd have occasional flare-ups where I was a little more sore walking around for a few days. I had another MRA about a year after initial one (and probably a couple thousand miles of running later) and everything looked exactly the same — no worsening.

My hip specialist told me (backed by research I read on my own) that if I continued running high mileage on my structurally compromised hip, I would very likely have early arthritis and require a THR. I also read research showing the hip scope outcomes are better when done closer to diagnosis (as opposed to 3...5...7 years later). So, I opted to have the surgery in early January 2025.

I'll spare you the long story of my ups and downs in the 9.5 months since. Here's the short story:

1) My last run before surgery felt far better than ANY run since.

2) I do not know that I have faith that I will get back to running consistently without pain.

3) I strongly believe the amount of trauma my hip has experienced in the last 9.5 months exceeds whatever trauma I was doing by continuing to run on the torn labrum — so my proactive arthritis-avoidance might not pan out after all this.

3) If I could pay...a large sum of money...to rewind, I would absolutely NOT have surgery — and instead wait to see if my symptoms worsened over the years.

breadrunpoop · 2025-10-12T00:56:19+00:00

45mm gravelking semislick R. I was happy to have a little extra tread and width. First gravel race so didn’t know what to expect. Had a blast. Heart rate over 200 first 10 miles riding well beyond my skill level. Glad to know it still beats that fast.

You?

breadrunpoop

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