Day 47 (Week 6): Snarky Psoas Shutdown & the Importance of Social Support (Post 12)
If you haven’t been following the entire series, get it here:
- Post 1 – https://gingergarner.com/resurfacing-hip-labral-surgery-post-1/
- Post 2 – https://gingergarner.com/hip-labrum-postsurgical-musings-post-2-2/
- Post 3 – https://gingergarner.com/post-surgical-musings-days-4-5-post-3/
- Post 4 – https://gingergarner.com/hip-labrum-postoperative-rehab-day-6-post-4/
- Post 5 – https://gingergarner.com/hip-labrum-postop-integrated-rehab-day-7-mantras-edema/
- Post 6 – https://gingergarner.com/yoga-hip-labral-rehab/
- Post 7 – https://gingergarner.com/days-11-18-a-turning-point-hip-preservation-post-op/
- Post 8 – https://gingergarner.com/post-op-days-19-27-hip-labrum-rehab-milestones/
- Post 9 – https://gingergarner.com/5470/
- Post 10 – Day 35, Week 5 – Tough Tissue a Great Teacher
- Post 11 – https://gingergarner.com/day-40-5-weeks-sharp-shooting-dry-needling-begins/
- The First Month – https://gingergarner.com/hip-arthroscopy-post-op-rehab-the-first-month/
This week welcomes the 6-week mark, and I am motoring forward with steady progress. This week’s challenges include shutting down a snarky psoas and gaining the social strength necessary to keep pushing forward. You can never underestimate the power of a holistic approach to hip rehab, specifically a biopsychosocial approach that includes yoga.
Let’s get down to business.
Don’t Let the Pigeon (er Psoas) Drive the Bus!
How to Shut down a Snarky Psoas
Anyone who has experienced hip pain, which can include pelvic and back pain, knows what that snarky psoas is like. It keeps you from sitting, standing, walking, or generally doing anything without a tugging sensation (what I call “fist in the low back”) or pain in the groin or nearby areas.
Deep tissue work in the psoas today revealed at an area of scarring attached to a very old appendicitis scar. I felt there was also involvement of the GI (gastrointestinal) area as well. I consider this finding significant, as it could have influenced additional exacerbation or even the initial onset of hip impingement pre-surgically.
To address this, medial post-inferior glides with active iliopsoas (IP) PNF (proprioceptive neuromuscular facilitation) contract/relax pattern was used, which successfully shut off the IP and immediately decreased impingement pain. In addition, dry needling was continued around all scars and the IP, and videos were made of posterior needles in the gluteus medius (GMED) and minimus (GMIN). Myofascial release was applied in conjunction with needling, and with that I felt tugging on the most lateral hip scar, which created concomitant pain in the GMED/GMIN.
Overall, ROM (range of motion) increased from 90 to 125 passively with kinesiotape applied in medial to lateral direction to inhibit the psoas. Active ROM isn’t yet possible without eliciting impingement pain. After treatment today, impingement sensation also improved.
The therapist and I moved on from passive work to active work, and brainstormed on a few exercises to shut down the IP:
- Supine hook-lying self passive ROM to shut off IP by mobilizing soft tissue at groin and anterior joint laterally. IP successfully shut off and impingement pain decreased.
- Prone over MFR (myofascial release) ball – try IP hold/relax PNF into ball and then hip extension using gluts to see if IP will remain off.
- Bridge with hip rotator cuff/lock engagement and shut down IP with dorsiflexion of ankles and use of GMAX but not hamstring (yet).
Social Strength
I Get By With a Little Help From My Friends
I want to encourage you if you are on this journey – you can make it through to success! But I will say this also – it’s really helpful to have a little boost from your friends now and then. My friends frequently checked in on me (mostly digitally), and I have to say it made a BIG difference in my morale.
Here are a few excerpts from my exchanges with them.
“Ginger, how are you doing?” ~ Valerie
Well, this week, actually today!, is my 6 weeks post-op mark. It has been a turning point for me physiologically, in that I am now trying to bear more weight through that leg – that means occasionally playing with a single crutch. Hey, soon I’ll have progressed enough to use a cane! (How’s that for feeling young and spry?) 😉 But seriously, I don’t know how folks recover from major orthopaedic surgery without some kind of background in medicine. There are not really any advocates in our health care system FOR the patient. They all advocate for the healthcare system. And PT is very expensive for many people, so much so that it puts a full course of rehab out of reach. And, rehab protocols, though important, are mere suggestions. There’s no way I could rehab just by following a protocol. I really need my PT background to navigate recovery. Bottom line: if you don’t know how to get well already, then you are in trouble from the start. (that’s definitely a blog post there)
Overall, sleep is better – and you know, that’s really critical for healing. So I feel like I can see a tiny light at the end of this long tunnel.
On to the future – I have learned so much already from this experience – I am cutting back on my workload, taking a break on projects that aren’t critical, and am feeling good about these decisions.
This surgery has been a great opportunity to retool my perspective. Doing everything from the disabled side of the fence is very – well, actually, very horizon expanding. I am grateful for the experience.
And one more thing: having no time off in 2 solid years – is one of the many reminders that this surgery has brought to the forefront. In the midst of it making me entirely dependent on others and completely debilitated – it has given me the clarity and the strength to take my life back.
And to Kelly ~
I’m officially 6 weeks post-op today! The 3 and 6-week marks are definitely turning points in the recovery process.
I am working fulltime this upcoming week (my second week in 6 weeks) with the BIG assistance of the TA (teaching assistant), but one thing this surgery has done is teach me the power of disability and dependency. Two typically “negative” terms have brought positive results. Among those is permission to feel the freedom to take my life back and create the path that truly is a BEST plan – not that that is simply full to overbooked with events and engagements that are good, but not part of the BEST PLAN.
Clinical Pearls
- See the needling, MFR, and exercise section. I am not promoting these techniques or prescribing them, but as a PT and patient, they worked for me in this specific case.
- With psoas mobilization at the proximal insertion point I felt twinges of scar tissue tugging and creating pain in the GMED and GMIN. I consider this a cool finding and will continue to treat this issue with care.
- VIDEO – My right calf was sore from my one-crutch gate training in the house and at PT yesterday (with no pain/soreness in hip.) Success!
- Tap your buddies to check in with you on a regular basis to make sure you are okay, not just physically, but emotionally. It can make ALL the difference in the world.
- Embrace your disability and your dependence on others. It doesn’t make you weak, it builds relationship and resilience; to allow for vulnerability, opening, and transformation.
“One thing this surgery has done is teach me the power of disability and dependency. These terms we usually think of as negative, but brought positive results in my life because they helped me cull the good to reveal the BEST.
Next up, progression to quad cane walking and walking with no assistive device! Life is good!
Resources
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This and all blog posts related to yoga and/or physical therapy on www.gingergarner.com are not a substitute for medical advice and are not a prescription or program for individualized physical therapy. You must seek the advice of your health care provider and, only after a thorough physical examination and clearance, participate in any movement or exercise program.
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