In the spring of 2013 my left gluteus felt like it tore while running. Next came plantar fasciitis. Before that for a year or so it felt like my left lower waist would ‘give out’ toward the rear when sitting. Getting out of a car was increasingly difficult, as getting out of my Aeron chair after working all day. My pelvis felt twisted, as well. Increasingly running, which I’ve done almost everyday for over 30 years, was getting difficult. Rather desperate, I checked on the internet for answers, as well as consulted with doctors and so received MRIs of my left hip and back.
The MRI of my hip said that I have moderate arthritis there, with a small tear in the labrum, and of my back, some degeneration. I saw three hip orthopedists that summer and fall: the most famous, it seems, told me to cut back on the running if it hurts, but otherwise do what I like to do because there is a genetic component to arthritis and no evidence that it is caused by ‘wear and tear.’ The second one told me to completely stop running or I would need a hip replacement in five years. The third, a specialist with FAI, said that the advice of the second was silly because there’s no way to predict the progression this surely, but he said that I did have FAI though he wouldn’t operate because of the arthritis, so he sent me to physical therapy.
For the next two years I went to many physical therapists, chiropractors, and active release specialists. These people were pretty hit or miss, I think, and mostly miss. It was costly, frustrating, and tiresome.
Since I work as a professor at a research university, I am fortunate to have a very good library, and since I was in pain much of the time I had a lot of incentive to look up a lot of research literature on hip pain and FAI and hip osteoarthritis and try to learn what I could. What has struck me from the research literature are four impressions: first, how poor much of the research seems to me to be; much of it is review literature of previous literature, and many primary research studies use very small groups or even case studies. Control groups are largely non-existent. Second, in terms of osteoarthritis, how little seems to be known about how pain occurs in this disease and about the disease’s progression, even though it has been known since antiquity. Third, though I wasn’t surprised, how much the literature follows without question the line of thought of previous literatures, despite the methodological dubiousness of the previous literature and sometimes the uncertainty or ambiguity of the findings. And fourth, in terms of FAI and hip labrum tear: my impression is that these are diagnosis that have, at best, uncertain clinical significance; my doubts arise because of the prevalence of labrum tears in cadaver studies, of hip pressure laboratory studies with cadaver pelvises (an outstanding University of Michigan study comes to mind with this), world-wide studies of FAI (a disease of “affluence” one study stated), and other factors.
In the spring of 2013 when I first began this odyssey, I accidently found Matt Hsu’s Upright Health videos on the Internet. Though the exercises in them have been valuable to me, Matt’s videos encouraged me to continually challenge what I was hearing from some of the doctors and other professionals. While I am still fighting this problem (with increasing success, I might add—it seems from what my current PT says that the problem is a lower back and waist issue—which I had at first suspected—from sitting too much in soft chairs and other such issues—it came on when I was writing a book…), I am also running still. This summer I had some near 70 mile weeks (I am 56 years old), and the past two days I’ve done two 11 milers straight. (I run anywhere from seven to 10 minutes per miles, depending on the terrain). I continue to run every day as I’ve done for more than 30 years. The one or two weeks I took off during the past few years just resulted in more pain, not less, than when I ran. For me, bicycling is actually much more painful, and when I sit too much in soft chairs. (Running itself is not really painful; the hip just feels stuck in the piriformis, medius gluteus area, etc.)
I think that Matt is very brave and very generous in engaging the FAI debate and in running Upright Health and in making his videos available to others. I am very grateful for his work. But also, I am writing this piece in order to tell others who may not have the literature I have benefited from to be cautious in making hasty decisions regarding the reasons for their condition. Hip replacements, as any surgical intervention, have real risks during and long after procedures, not least because what is cut and what is replaced may not be as good or as specific to the individual as what nature made over time, and in younger patients new parts may not last. A recent study just appeared which found that hip arthritis is often evident on MRIs with the absence of patient pain, and conversely, that hip pain is often present without hip arthritis. What I have learned is that the pelvis is extraordinarily complex in terms of muscles and tendons and nerves, so that pain from further up the abdomen can be felt in muscles in the leg. The interaction of all the parts of the pelvis, hips, and adjacent regions, and the pelvis’s bilateral nature and its junction position between the upper and lower parts of the body make diagnosis very difficult and more complex, it seems, than with joints such as the knee. I would also urge others not to give up on finding a solution to their pain: to keep seeking out literature and to use the Internet and others, including medical professionals of course, for advice. And most of all I would encourage others to keep exercising.
I would like to thank Matt for his interest in my case, and for all that he’s done. I admire what he’s done for his patients and for those of us in Internet land. Though I am not a medical professional, from my own ability to understand the literature and from my own experience with my physical issue I believe that he is on the right track with FAI. And I wish all those who are reading this the best of luck with their hip or other physical issues and I admire their desire to be fit and active in their life.