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Old 04-03-2008, 04:43 AM   #11
Steven Low
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Re: Rehab Help? Two Questions

Oh okay. That makes more sense.

Yeah vastus intermedius is smack dab under rectus femoris which kinda sucks especially if you have significant leg hypertrophy.
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Old 04-03-2008, 09:46 AM   #12
Jerimiah Childress
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Re: Rehab Help? Two Questions

From my experience, if you use phono and it doesn't work, there is something else going on, not just inflammation. If that's the case then no phono would not help.
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Old 04-04-2008, 05:46 AM   #13
Bryan Veis
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Re: Rehab Help? Two Questions

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Originally Posted by Jerimiah Childress View Post
From my experience, if you use phono and it doesn't work, there is something else going on, not just inflammation. If that's the case then no phono would not help.
I start phono on Monday, so I guess I'll know better after a few sessions.
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Old 04-04-2008, 02:07 PM   #14
Bryan Veis
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Re: Rehab Help? Two Questions

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Originally Posted by Steven Low View Post
Oh okay. That makes more sense.

Yeah vastus intermedius is smack dab under rectus femoris which kinda sucks especially if you have significant leg hypertrophy.
Well, that isn't a problem for me anymore after 5 months of hardly moving.

Now that I think about it, maybe that's where those 25+ pounds went. If you want to lose weight, kids, just have hip surgery. I went from ~180 to under 155 in the two months after my surgery. Not that losing a little weight was a bad idea, but this wouldn't be my first choice for a weight loss strategy. It was highly effective, but at a significant cost.
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Old 04-08-2008, 05:17 AM   #15
Bryan Veis
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Update

I had my first PT session yesterday. It was mostly evaluation with no phono. The PT found that my right hip has been pulled out of line (forward) compared to the left. In addition, having an unerring instinct for finding the most painful places on my body, she found that I seem to have some significant adhesions around the origin of my sartorius. I gather that may be pulling the hip forward, and that that may be affecting the vastus intermedius. She spent a good solid 15 minutes working on the sartorius adhesions. Then she started working on my back. She also noted that I don't have much of a lordotic curve in my spine.

I go back on Thursday for session 2. In the meantime, I have a few exercises to work on. There is still comparative weakness on the operated side in terms of adduction, abduction, flexion, and extension of the hip. As far as the surgeon's post-op instructions, I have "graduated," because I have long since exceeded the 10-pound goal for those hip movements. (I stopped when I hit 20 pounds for 3 X 10 reps.) Apparently, though, the relative imbalance is still problematic. I had assumed that once I got to that level, that they would get enough work actiong as stabilizers for other exercises. I guess not. (I foresee a lifetime on the hip-and-thigh machine at some Globogym. )

In the meantime, I continue with assisted lunges and full-range bodyweight squats, albeit at much reduced reps for now. This week I am at 2 X 6.

Any thoughts?
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Old 04-09-2008, 05:30 AM   #16
Jerimiah Childress
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Re: Rehab Help? Two Questions

Sounds like so far you have a pretty good therapist, my best advice is to continue what your doing and be patient. She may find different things that you need to tweek, but for the most part you are on the right track and it will take several months.
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Old 04-11-2008, 05:05 AM   #17
Bryan Veis
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Re: Rehab Help? Two Questions

Second physical therapy session yesterday. More myofascial work on the sartorius and then on the vastus intermedius. The PT says my pelvic alignment seems to have improved. Then we worked on my back -- she put me on McKenzie table for a few minutes to work back extension. We got up to about 60 degrees. When I walked out, I felt fairly good, although I have some pain this morning. Apparently, there is some kind of holdup in getting the hydrocortisone for the phonophoresis, so that has been delayed.

In the meantime, at home, I have ditched the support on lunges. I'm up to two sets of 6 with no assistance. The same with bodyweight squats. In addition, I'm doing the assigned PT exercises, as well as some pullups, pushups, and situps.
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Old 04-11-2008, 01:34 PM   #18
Steven Low
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Re: Rehab Help? Two Questions

Nice. Like Jerimiah said, looks like your PT is good. Keep us updated.
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Old 04-16-2008, 04:20 AM   #19
Bryan Veis
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Re: Rehab Help? Two Questions

Third PT session yesterday. Finally started on phonophoresis. It took a surprising amount of effort to get the 10% hydrocortisone cream. Apparently, this has to be compounded at the pharmacy, and most pharmacies in my area don't compound, or claimed not to have all the ingredients. (They were all chains, of course.) The fact that the surgeon's office is not local didn't help, but eventually, the prescription went to an independent pharmacy, and they whipped it up over the weekend. The PT treated both the origin of the sartorius and the origin of the vastus intermedius. There was no implant-associated pain from the ultrasound.

In the meantime, I'm up to sets of 7 reps, unassisted, on lunges. The pain seems to be somewhat reduced, especially in my back. I continue to do several different back stretches. The pain in my hip is most noticeable when I walk up an incline. The PT suggests that may be the result of "false extension" of the hip joint when I push off with the injured leg. I go back Thursday -- no phono, then, though; it will be manipulation and exercise, with more phono next week.
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Old 04-18-2008, 03:00 PM   #20
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Re: Rehab Help? Two Questions

Fourth PT session yesterday. The PT started off with phonophoresis. Then we moved into hip mobilization. She said she suspected that at least part of the problem was capsular contraction. Interestingly, she is the first professional in more than 20 years of osteoarthritis to measure hip extension. My rheumatologist looked mainly at internal and external rotation during annual checkups.

It turns out that I have about 20 degrees of extension (i.e., movement to the rear) in my left leg, but only about 15 degrees in the right. After establishing that, she put a bolster under my right thigh, just above the knee as I was lying on my stomach. Then she started putting downward pressure high on the back of my leg. I felt a major stretch exactly where my pain is (and has been for 20+ years), so she kept it up for a while. I don't know if that stretch was the vastus intermedius or the capsule, or what, but it was definitely the right place. She suggested that I find a way to duplicate the experience at home. (It is definitely not something I can do for myself; I will probably get a foam roller and a few towels and impose on my wife to abuse me. ) She also moved the hip joint in a couple other directions that I have a hard time describing (one involved a belt, some pillows, and her full body weight pulling on my bent leg, sort of outward and down). I'm kind of sore today, but (I think) in a good way.

Not that I'm into pain, or anything, but I do look forward to these sessions. The PT is really committed to figuring this thing out. She goes back and hits the books between sessions as we discover new things about what works or does not.

Of course, it helps that she describes what she is doing with me as "Sports Medicine," as compared to her "rehabilitation" patients. It sounds so much better that way. It's the OLD ones who need rehabilitation, don't you know.

My home exercises seem to be going okay. I'm taking it really slow on the exercise progression. This week was 2 X 7 lunges and squats, plus various stretching exercises, and some general hip strengthening things like low cable ankle cuff extensions, adductions, flexions, and abductions. I'm bumping that up to 25 pounds next week.
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