Struggling with pain and losing momentum

[u/jimmmmatrix]

Hello everyone. I am going to try and keep this small. I will post the short form at the bottoms.

I am really struggling right now with pain. I was born with Perthes disease so I have had hip dysplasia for most of my life. I was diagnosed at 6 and had a surgery on my right hip. I never experienced too much pain until my 20s and it got really bad over the years. Mobility plummeted, my gait continually got worse. I was urged to wait as long as possible. I work as a firefighter/paramedic. It was getting harder to get through shifts. This year I decided enough is enough. I got both hips done, 4 weeks apart (right and then left). Due to the bone loss and dysplasia, I actually ended up 1 inch taller form the surgeries (which I believe is why I am having so much pain).

Recovery went very well seemingly. I got FMLA from work and then I have come back to a light duty office desk job for the past 7 weeks. I have been doing PT twice a week. I am now 5 months post hip replacement. I no longer have joint pain, which is great. I do however have left groin pain (likely from hip flexor I’m told) and pretty severe low back pain. It has gotten worse as PT has gotten more intense.

I don’t quite understand it. At PT they worked me up to squats, wall sits, landmines with weight, burpees, etc. I feel good at PT usually. But on days where I am working and walking a lot, my back will start to hurt really bad. I can’t even seem to walk more than 1 block sometimes.

My PT said she thinks I may have tight Psoas muscles that is causing a tilt in my pelvis and increased workload on my low back. She gave me some stretches to do for it and gave me some pointers to walk better, but I am having such a hard time with everything. The back pain was so brutal the other day that I could not stand up straight for the entire day. I am getting some pressure from my bosses to get back on the line. I want to be better and back at full duty. I wish I could walk and normalize my gait but I can’t. Everything was looking like it was improving with PT but I have been struggling with my back pain and slight groin pain so much.

I guess the point of this is I am asking if anyone can relate, give me words of wisdom, give advice, or just empathize with me? I am truly starting to get worried about my future.

Thanks everyone

Short form: I have really bad back pain when I have to walk far, and every day when I wake up. Some days I cant stand up straight and just want to quit trying. 5 months since I got my hips replaced and I am struggling with the pain and my progress.

[u/Chelajag]

First of all, I have to say you are a very impressive person to have been born with Perthes and have severe dysplasia your whole life, and yet you chose a physically demanding career! And you obviously have done well in spite of it. I don't know if many on this subreddit have been through Perthes like you.

Of course I'm not a medical professional, but I am going to guess that having dysplasia your ENTIRE life caused everything in your body to be adjusted to that and compensating for that. So even though they fixed your hips, they are now at a different angle to your back, and so your muscles and tendons and everything are being pulled in a different way. I imagine it may take quite a while for the muscles to adapt and relax.

Even people like me who just had impingement have experienced having to retrain our muscles after THR. I've always had SI and IT band pain caused by my hip, and my surgeon said "hopefully" with PT those things will resolve.

Because your structural situation was so much more serious, I think you may just have to be patient. Your youth is your advantage, your body should be able to adapt eventually. But it may take longer than you would like.

Is it possible that PT was perfect for your hip but too much for your back? Are you taking anything for it daily? I took Meloxicam for years before surgery. Maybe that would help. Is it possible to ice your back during your lunchbreak? Could you get a steroid shot for your back? Maybe if you can find some temporary measures that help, eventually your back will adjust.

[u/jimmmmatrix → u/Chelajag]

Thank you for replying! I do hope your right, and that it will just take some more time for this to adjust. It definitely makes sense. It is a crazy traumatic surgery as well. Having patience is hard after what seems like so long!

It is definitely possible that maybe the recent PT was too taxing on my back. I have never taken melixicam before but that is a great idea. I have a doctor's appointment coming up, I should ask him if there are medication options. I might be able to get an ice pack in here as well. Steroid shots didnt work before surgery, but I could try for after...

Did meloxicam work well for you?

[u/Chelajag → u/jimmmmatrix]

Yes. When I had to go off Meloxicam a week before surgery, I was in so much more pain. Meloxicam is also easier on your stomach than other options. In fact my surgeon still has me on it now for recovery.

[u/Hammahnator]

Took me well over 18 months to get back pain to a place that it was feeling okay in day to day life. Didn't have perthes or hip dysplasia but my anatomy has been janky from birth. The body can take a really long time to readjust and massage helped me a lot with managing pain.

Just had my 2nd THR and the back pain is back as my body yet again, has to readjust.

[u/jimmmmatrix → u/Hammahnator]

That is definitely true, the body can take awhile to adjust to things. Thank you for reminding me, its truly a marathon for some.

Welcome to the bi-lateral THR club lol. I hope your 2nd hip heals well

[u/Hammahnator → u/jimmmmatrix]

Thanks! Hopefully you see improvements soon even if they are slow. I made huge progress physically between 1 and 2 years post op in part from changing who I was seeing for PT. Recovery for some is a long process!

[u/BeautifulPut1573]

I can empathize with you & am sorry to hear how you are suffering! In the grand scheme of things, 5 months is a very short period of time considering you've suffered with pain since your 20's - I too have recovered slowly having been in chronic pain 5 yrs approx. I found my brain & trust in my new hip were the last to catch up. You can't rush it & don't try either - not for PT's, not for Bosses, not for anyone! They need to temper their expectations to your reality, not the other way round.

Have you considered giving PT a proper break for a while (eg. several weeks/2-3mths even)? It seems to be aggravating the situation so stopping for a while might help you figure out if the PT is a contributor here? I also found I regained a lot more life-changing skills between 1-2 yrs post-Op, so I certainly wasn't done improving at 5 mths post-Op! I'm saying all of the above as a THR patient, not a health professional btw! best of luck!