I Have An Injury and It’s Sorta Big

This post is personal.

I have a hip injury. It happened in October. For the most part, I have been pretty low key about it all. Most students and clients know that I hurt my hip, but do not know the extent of the injury.

The people I work for–the studio owners–know and they have been gracious enough to offer any help they can. They’ve even offered to get someone to be my teaching aide.

I haven’t taken them up on that offer because for the most part, I don’t do a lot of demoing of aerial skills in my classes. I generally roll around on the floor–“Floorials” as we like to call it–or I pantomime while standing to demo skills.

It’s an art really in and of itself–finding creative ways to demo a skill without actually getting up in the air. It’s something I’ve really gravitated towards in my teaching as I have gotten a bit older and the need to be warmed up to demo skills is more a necessity now than it was when in my 20s.

Sadly, with only so much time between classes I don’t always get the warm up I need for my body to be safe demoing all of the skills. (’cause sometimes you just need to pee and shove a protein bar in your face while another lovely instructor is warming up the class and you change the equipment to meet the needs for the next time slot of classes.) Also I don’t think every skill has to be demoed in the air-but that’s whole other can of worms. 

But I digress…

So what is my injury?  I have a labral tear in my left hip.

(Exhales loudly, thinking…..I said it out loud and now everyone knows)

That admission is hard for me. It seems silly I know–I am not the first person to have a labral tear in their hip. I am not even the first aerial instructor with a labral tear in their hip. But there is this thing in my head that’s like,

“You’re the instructor! You can’t be hurt!”

Silly, I know, but that doesn’t stop the irrational brain.

As I have been told by numerous doctors and physical therapists, hip labral tears are quite common, especially in dancers and gymnasts. But no matter how many times I am told this, it doesn’t stop the voice in my head that says

“How the hell did this happened to you! You are a strong individual who strength trains outside of your aerial and circus training. You can’t have such a big injury. You are strong! …Or maybe you are not. And maybe you are a fraud.”

Because I am also a strength coach who focuses on injury reduction for circus artists at both the recreational and professional level and I have become injured. AND now I’m injured.

“I must be a fraud.” my irrational brain chimes in again.

This is what I have been thinking since December when I found out what was causing all the discomfort.

The voice continues:

“A labral tear, but I wasn’t doing anything when IT happened. I was just demoing a skill that involved a straddle split. Sure it was on my off leg, but really I wasn’t doing a drop to this hip. WTF, I am not that fragile!”

And the big one….

“I refuse to believe it’s because I am now over 40. I refuse to believe that 40 means quitting time. That I am old. That some number means I am no longer strong.”

So this is where I am at.

At first I thought it was an adductor or hip flexor strain and when it didn’t clear up in  two weeks, I saw my PT. He gave me some exercises to help the adductor calm down, because IT WAS strained, but mostly in response to the labral tear causing pain which in turn caused all of the muscles around the joint to seize up…which forced me to only move my leg in small ranges of motion in an effort to avoid causing any more pain.

After a few weeks of the exercises, although I saw some improvement, there were still a lot of positions that were uncomfortable or that I couldn’t do at all and random rotation movements that caused excruciating pain. The kind that catches your breath in the middle of your movement and has you stop dead in your tracks as you try to recover.

Yup that was me. That’s when I admitted to myself that something must be really wrong. Sitting in a straddle pancake didn’t really aggravate it, but adjusting myself on the couch or in bed or pivot-turning off that foot caused eye-watering discomfort.

I went back to my PT and he assessed me again and said he thought it was a labral tear. Way in the back of my brain I knew he was right, but I didn’t want to believe him. My body knew that something pretty significant was wrong, but my mind did not want to believe it.

I made an appointment to see a doctor through the dance program at Boston Children’s Hospital. We did x-ray’s (see the lovely photo at the top of this post, that’s my pelvis) and they told me that my sockets are shallow. I already assumed this since it’s never been very hard for me to do straddle oversplits and my front splits weren’t square to the floor, but pretty darn close.

I was sent for an MRI. Later when I met with my doctor, she said the MRI confirmed that I have a labral tear. She was so gentle in telling me. “I am so sorry, no one wants to hear that they have a labral tear.” She went on to say it’s a small tear and that I should get a second opinion and also consult with a surgeon. I should also set up an appointment for a cortisone shot in my hip. (My brain immediately went eek as it thought about the huge needle that would  be needed to get all the way to my hip joint.)

I made all the appointments. Thankfully the cortisone shot didn’t kill me as I thought it might. The needle wasn’t as long as I’d imagined (but still kind of long). You get to watch it on the screen as they poke it down through your layers of skin, fascia, muscles and into the joint capsule. So that part was cool. I could feel it happening as the doctor pushed through the layers of muscles, but not the pain because they had numbed the area. It was weird to watch what was going on on a screen, but be removed from it.

The doctor was excellent and she wanted me to know that she’ll do anything she can to make sure I don’t need surgery, that she’s seen many dancers be fine with a cortisone shot or two and PT and they’re back to doing what they love. (I’m still everyone’s first aerialist).

When she left the room, I burst into tears and cried big tears thinking I needed to have the cortisone work, because I couldn’t go through another surgery (having had ankle surgery in Dec 2016 and still working on regaining all I had lost from that surgery). Surgery would mean it’s ‘serious’ and ‘big’ and I just wanted to be fine without the big event that hip surgery would be. I just wanted to get back to my normal and have no one the wiser that I had sustained an injury. (Back to listening to that irrational voice agin)

The Big Question Now

To surgery or not to surgery, that is the question.

Sadly, it is not as simple as go in and repair the tear. This is for many reasons.

I have found out about all these reasons by seeing a laundry list of doctors, specialists and having many more tests, which included a second very specific MRI to check the cartilage heath in my hip joint and a hip joint instability test.

Thankfully, the second MRI showed that my articular cartilage is in great condition. I haven’t lost any cartilage from the head of my femur or in the acetabulum. I do have labral thinning, due to my huge range of motion and the laxity in my joint, and of course, the tear. So that felt like a win–currently I don’t need a hip replacement–which I might have needed had the articular cartilage been junk.

The hip instability test I failed. My words, not theirs. I had a feeling I would. I really, really wanted to ‘pass’, because that would mean much better options for me, but I knew with the laxity in my joint that I would be a mess. And I was.

I think this was the most frightening of the tests I have been through. It’s an ultrasound while they make your legs go into different positions and watch how the femoral head moves in the socket. Since I have shallow sockets and my joint capsule is very lax, basically every time I hug my right knee into my chest while lying on my back, my left leg almost dislocates. Not a comforting feeling and definitely not a comforting thing to watch on the ultrasound screen.

Because my hip is very unstable I am no longer a candidate for the arthroscopic surgery, which is minimally invasive and has a relatively quick recovery time. This is because of my lax joint capsule. The doctor can’t just cut into it to do a quick repair because this would leave my already lax capsule even more unstable. Creating a big future risk of me dislocating my hip.

What they would need to do is open hip surgery. This involves joint resurfacing–basically sanding down my femoral head to make it smaller to fit in the shallow socket better. They would also need to reposition my femoral head in the socket so it’s not so turned at an angle in the socket.

Recovery would take a year. And they said it may end my aerial career. They said they can’t be certain, but they had to share that possibility.

They can’t promise me that I won’t need a hip replacement some time down the road. I may never need one (whether I do this surgery or not). If I do the surgery, I still might need a hip replacement. This may be a somewhat easier choice if it meant I wouldn’t need a hip replacement, but there are no guarantees. Not good.

There are so many possibilities for me to consider in deciding whether to have the surgery or not: like, will I be able to do aerials or partner acro again? Will having two different hip sockets mess up my back because I’ll end up with different walking mechanics on each leg? If I opt for surgery, will I recover fully–back to being able to do what I was able to do before? Will I forever feel a pinch and some pain at the front of my hip every time I sit on the toilet or in a chair if I decide not to do the surgery? I don’t want that because that’s what I am living with now. It doesn’t feel good. And yet pulling over into a front balance feels fine. But now straddles and straddle pancakes feel horrible.

I want to be able to move. I want to be able to do partner acro again. I want to do aerials. I want to be able to lift heavy in the gym again. Do a jumping jack.

I am ok if maybe I am not able to do splits again or a straddle pancake. I would miss it of course, but it’s not the end of the world. It would make aerials a little hard, but I am creative. I could choreograph with different skills.

It’s looking like whether I do the surgery or not, drops on silks that involve wraps around my leg or leg and pelvis are something I probably shouldn’t do again. And if I don’t do the surgery, probably never again on the left leg because of how shallow my socket is and the instability of the capsule.

However, this could change and it all depends on so much.

But currently they are out.

My Medical Team

I can’t praise my medical team enough. They all have my best interests at heart and they all communicate together. They all know that surgery might be what I need, but also are very  concerned about how that may change my life and my ability to do my job. They do not push me into anything. Not even when the additional MRI and the instability test were suggested. My surgeon has said numerous times that he would rather see me recover without surgery.

Now that my surgeon can’t perform arthroscopic surgery, he is putting me in touch with an open hip surgeon. He said there are several highly-ranked surgeons in Boston. This appointment will be to continue to learn all I can about what it best for me, my hip and my life.

My PT–whose focus is rehab for dancers–is excellent. We’ve been working together since January. Up until recently she felt I didn’t need surgery and that I was making great strength gains and progress. Then the cortisone wore off and I have taken a few steps back and feel that pinch in my anterior hip as I try to sit on the toilet. I seem to be staying at status quo.

About 2-3 weeks ago she said, “Maybe you need the surgery. If we’re not making progress and you are experiencing pain with several movements throughout your day, surgery might be best for you.” After having been such a big proponent for the non-surgical option, hearing her say this crushed me. I did my best to hold back tears as I thought of the implications of this. That maybe she was right, maybe I needed to do this big surgery. That I didn’t want to be in pain just to go about my daily life-without even adding circus to the mix.

Where Are My Thoughts Currently

I waver back and forth about what the best option is for me. I waiver between listening to the irrational voice in my head and telling it to shove off. That I am strong and I will get better without surgery. That it’s ok that people know I am injured-hence this post. That I don’t need to hide it or feel ashamed or like a fraud. That I am human and accidents happen.

Currently I await my appointment with the new open hip surgeon. I continue to do my PT 6 days a week trying to get as strong in my stabilizers, rotators and big muscles as I can to help center my femur in the socket, so as to not cause the femoral head to track wrong and cause discomfort.

There are moments when I think maybe I should do the surgery, but those are fleeting. I don’t want to do the surgery. I don’t want to have to do the surgery. But there are so many things up in the air.

And this is where I’ll end.

If you have stayed with me after this many words, I thank you. Thank you for coming along on my hip journey. My ongoing journey, through fears, tears, hopes and tons of feelings. I’m in limbo, hoping that strength will prevail. Hoping and thinking of healing happy thoughts.

~Theresa

 

 

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