Rehab Help? Two Questions

[Jerimiah Childress]

Wow, sounds like you do have an excellent therapist. You are approaching this the right way and you will slowly continue to improve. Keep us posted on your progress.

[Steven Low]

Hmm, sounds like every other hip flexor stretch out there. Possibly iliopsoas

[Bryan Veis]

No, it's definitely not the iliopsoas -- it's in the area of the vastus intermedius, and apparently very hard to get to. I've been doing martial arts stretches for 30+ years, and this was definitely different than any hip stretch I have ever done, almost like the joint starts to pull apart a little. I suppose that may be the capsular contraction aspect of this diagnosis.

[Steven Low]

So lower down in the capsule, eh? Interesting.

[Bryan Veis]

Today I started week 3 (session 5). It started with phonophoresis and then moved into hip mobilization. The PT did the same thing as last time, thigh on bolster, pressing down on the back of the leg to stretch the capsule. In addition, she informs me, my sacrum is out of alignment, and I have issues with my piriformis. Apparently, I am more of a twisted old man than I knew. Anyway, after about 25 minutes of being expertly poked and prodded by someone with an inerring instinct for finding the most painful spots on my body, I got up from the table feeling pretty darn good. I'm still pretty skeptical about phonophoresis, but this stretching and "mobilization" seems to be pretty good stuff.

[Bryan Veis]

Yesterday, I reached the halfway point in this round of rehab -- session 6 of 12. We started again with phonophoresis, moved to some myofascial release work at the origin of the sartorius and the origin of the vastus intermedius, and then worked on hip joint mobilization. The therapist remarked that there seems to be less resistance in the joint capsule when she presses down on my leg.

It's up to me whether to continue with the phonophoresis, as I understand that by this point, it should have had some effect if it is going to. I seem to be making some progress, although the pain is still there. I figure I might as well continue at least for a couple more sessions -- I've already paid to have the hydrocortisone cream compounded, so I might as well use it up.

In addition to the vastus intermedius pain, I find that I still have hamstring and back pain when doing either lunges or squats, but especially squats. Even being very conscious of pulling my abdomen in, I find that after 4 or 5 bodyweight squats, I develop pain in my lower back radiating up from my hamstring.

I'm taking it very slow in terms of exercise progression -- this week I did 2 sets of 8 reps for all my hip related exercises (excluding stretches). Next week, I intend to move it up to 9 reps and to 10 reps the following week. After that, I will drop the reps to 6, raise the sets to 3, and start to work up to 10 reps per set.

The therapist remarked that she might perform a sacroiliac manipulation next week. She said it is sometimes effective for low back pain. As I noted earlier, my sacrum is out of line. Any thoughts on that?

[Duke McCall]

Have you tried a Deep Muscle Stimulator in your therapy? I started PT this week and the therapist used the DMS, which provided a lot of relief to me.

[Bryan Veis]

Originally Posted by Duke McCall

Have you tried a Deep Muscle Stimulator in your therapy? I started PT this week and the therapist used the DMS, which provided a lot of relief to me.

No, we haven't done that -- yet. Looking at the FAQ's on the manufacturer's website, though, makes me hesitant to seek that therapy. It would be used very close to my implant, so the therapist and I would have to consult with the surgeon before using it. How, if at all, does the this differ from a vibrating massager?

[Corrinne Haskins]

I would think that a good orthopedic acupuncturist could get to this no problem. While I haven't treated this problem specifically, I note that acupuncture is one of the best ways to treat Sciatic Pain due to Piriformis imbalance and subsequent pressure on the Sciatic nerve. It is useful even when this is a secondary problem brought on by disc herniation as it brings down inflammation in the area of herniation.

Obviously acupuncture is a functional, not structural, medicine but it is very useful for orthopedic issues especially when combined with other therapies.

[Bryan Veis]

Week 4, Session 7: Started out with cross-friction massage at the origin of the sartorius and the vastus intermedius. Once again, she found the most painful points almost immediately and bore down hard. After that she did a sacroiliac manipulation on both sides and then worked on the external rotation of the affected hip, which is pretty tight compared to the non-affected hip. That included a new adductor stretch. Finished up with more phonophoresis.

On my own, I have increased my daily leg exercises to 2 sets of nine reps and bumped the low pulley weight up to 27-1/2 pounds for my four-way hip work (extension, adduction, flexion, and abduction).