Hip Arthroscopy, Training

Different Hip – Different Recovery From a Hip Arthroscopy

????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????On 28th Jan 2015, I underwent my second hip arthroscopy, on the right hip, to alleviate the Femeroacetabular Impingement (FAI) due to a Cam type impingement. This is where the head of the femur isn’t round enough to be able to rotate easily in the socket. Having shown signs of recovering well and fairly quickly following the left hip arthroscopy on 22nd October 2014, my surgeon established that we could proceed without there being too much of a detrimental impact on the left hip, or the recovery process (click here to read about my left hip arthroscopy). The day before surgery, I was able to front squat “ass to grass” successfully with a loaded bar, and I was over the moon about how quickly I was able to get back to squatting again. I was still experiencing difficulties with keeping my trunk upright when back-squatting, but I was happy to have regained my front squat.


Second time around, the surgery was a very different experience. While the surgeon was the same, the hospital, anaesthetist and supporting staff were not. Therefore, it was a completely new experience. Previously, mine was the first operation of the day. However, this time, I needed to wait until 12pm, not having eaten or drunk since midnight the night before.

The operation went well: the labrum was torn and needed to be repaired, and the femoral head was successfully re-shaped. It was more straightforward than the left hip surgery as there were fewer labral tears to fix. After the first oper  ation I woke up upset and was given morphine. As a result of this, I experienced extreme nausea for the rest of the day. This time, I asked only to be given painkillers if I requested them, and warned them that it was normal for me to be upset when coming round from surgery. My right quad was numb on the surface and I had a severe burning pain down the entire leg. I had to ask for painkillers whilst in the recovery room and again when I was back in my room mid-afternoon. Unfortunately, the hospital staff were not as professional as the staff caring for me previously, which caused a high level of stress during recovery.


I have recovered much quicker this time, despite only being 14 days post-operation. I was only on crutches for the first day. I was able to walk up/down stairs unaided on the second day, and was then able to take two steps at a time on the third day. I was able to get dressed and shower by myself on the third day. I dropped something on the floor on the fourth day and was able to squat down to pick it up without any problems.

I have had numbness in my right quad since the operation but the sensation started to return from the fourth day and there has been improvement every day. I only have superficial numbness now in the area around my IT band. This could be down to the amount of time that my leg was in traction and it is highly unlikely that there will be long lasting nerve damage, so I will need to wait a little while longer to regain full sensation.

My stitches were removed on the 13th day but, unfortunately, I woke up the next day to discover that the right incision had popped open overnight. I didn’t feel anything when I woke up and only realised something was wrong when I looked at the area and then looked at my stained sheets. I made an emergency appointment to see the nurse at my GP practice and she covered the incision with steri-strips. It wasn’t possible to stitch the incision given the amount of time it had been exposed to air and possible bacteria. I was asked to monitor it overnight and return the following day. I was also asked to be as still as possible over the coming days to allow the incision to reseal.

Overall, this has been an easier recovery and a more motivating one as I am quite far ahead of where I should be on the recovery chart and am able to do some things that I couldn’t do for weeks or months after the left hip surgery. I put this down to how physically active I am, which I have managed to keep up throughout my first recovery, and to the fact that I do my physiotherapy exercises religiously every day. It takes an hour every morning, but in the longterm, this is the only opportunity I am going to have to allow my body to heal correctly and develop the right muscle groups so that I am balanced when I return to my heavy weight training.

Lifestyle, Nutrition, Training

The Importance of Weight Management in Sport

Scale Weight.When discussing weight management in sport, it is important to discuss not only the physical importance of weight changes but also the mental effects they have on athletes. Weight loss is used in sport usually to qualify for a competitive weight category or to enhance performance. In order to lose body fat, the athlete needs to be expending more calories than are being consumed. This works best through a combination of diet and exercise as opposed to one or the other, and over a gradual period of time as opposed to through a quick crash diet. If we give the body time to adapt to the weight loss then there is a better chance that we will be able to maintain the weight loss, as opposed to if the weight loss is sudden, which can create secondary health issues.

Sumo wrestlerWhile a certain amount of body fat is important in order to survive, most sports require a loss of body fat in order to enhance performance. Carrying around an excess of fat can slow an athlete down (such as in explosive sports that require the athlete to move their body weight or a loaded bar quickly, as mechanical efficiency and power are reduced), it can affect their endurance (as an increase in fat can increase fatigue) and strength. One of the only sports where an increase in weight (typically body fat) is considered advantageous, is Sumo wrestling. While in most sports where being of a larger size allows for an increase in the momentum required for throwing an object or knocking an opponent over, Sumo wrestling is the only sport where the weight increase is generally fat as opposed to lean tissue; Strongman competitors, for example, are usually heavier but this is typically muscle mass as opposed to fat.

Woman holds fat fit silhouettes on a scale symbol of Diet WeightThere are 2 types of fat: essential fat and storage fat. Essential fat makes up around 3% of our body weight and is present around our organs to protect against damage, our brain tissue, cell membranes, nerve sheaths and bone marrow. Women have an additional sex-specific fat which makes up a further 5%-9% (usually around the hips and breasts) and aids with oestrogen production. As soon as a woman’s body fat starts to fall below 15%-20% there can be an impact on menstrual function. This is especially important to take into consideration with sports such as bodybuilding, where there is a requirement to have extremely low body fat percentage and hydration levels in order for the muscle bulk and fibres to be more visible. Storage fat is used as an energy reserve and is usually located subcutaneously (under the skin) and intra-abdominally (around the organs). Fat loss can occur from any area of the body and it is not possible to target one specific area for the fat to decrease as our fat utilisation patterns are based on our genetic make-up and our hormonal balance. Exercising (especially weight training) can help with increasing the muscle mass of that area but it will not affect the fat storage in that area as muscle and fat are two separate types of tissue and are non-interchangeable.

Bodybuilding fitness gym iconsBodybuilding is a good example of weight gain and weight loss in sport, as there are 2 phases that the athlete goes through in order to prepare for a competition: there is the bulking phase (also known as off-season) which lasts a couple of months (although there is no set timeframe) and then there is the cutting phase that usually happens in the months leading up to a competition where the aim is to lose body fat without jeopardising the muscle gains too much. During the bulking phase, the emphasis is on increasing the calorific intake (normally from an increase in lean meat, complex carbohydrates and healthy fats) versus expenditure so that the athlete puts weight on and more specifically muscle mass (as opposed to fat). This is the time where the athlete makes 95% of their improvements in their physique and therefore the right nutrition is required for this. While protein is usually used to build and maintain muscle mass, carbohydrates are especially important post-training as they increase the insulin levels and help the muscle to absorb the glycogen. Fats are also essential in building muscle, reducing cortisol, providing energy and increasing testosterone levels (the higher the testosterone levels, the more muscle mass; the more muscle mass, the higher the testosterone levels).

Back Of BodybuilderThe bulking phase can be a mentally difficult phase for the athlete as the emphasis is on putting muscle mass on but it is impossible to do this without putting on body fat also. This can sometimes cause the athlete to start questioning themselves and adapting their nutrition to not include as much fat or as many carbohydrates as are required to build muscle, given the visible increase in fat. If the athlete cuts too soon, they risk losing the muscle mass they have worked hard to put on. It then becomes a question of whether the athlete can cope mentally with their larger appearance whilst they wait for the cutting phase.

Bodybuilding. Man and womanDuring the cutting phase the emphasis is on reducing the body fat percentage while losing as little muscle mass as possible. While some muscle mass loss is expected, the diet is changed to decrease the carbohydrate intake and increase the protein intake (in order to save muscle mass) but having a carbohydrate-depleted diet can create a lack of energy which can also be mentally draining for the athlete who is trying to still exercise at the same level of intensity but with nowhere near the same amount of nutritional support. The cutting phase is also equally mentally challenging for the athlete, as while they look at their strongest because their muscle bulk and fibres are becoming more visible, they are actually at their weakest because their bodies are depleted of nutrition and their body fat is approaching dangerously low levels the closer they get to competition time.

Man sees other self in mirrorThis type of lifestyle can be rewarding for a short space of time after all the hard work, however, there are also health risks, both physical and mental. Constant yoyo dieting can increase heart disease, because when the athlete’s nutrition starts to normalise, the fat is usually re-deposited intra-abdominally (and therefore closer to the liver), rather than peripherally (the hips, thighs and arms); yoyo dieting can also cause a loss in lean organ tissue, which can damage the heart muscle. So while bodybuilders need to ensure that they are as lean as possible for their chosen sport, it can come with risks. It is, however, not only physical risks that can be associated with bodybuilding, but also emotional and mental issues, as the constant yoyo dieting and changing in body size can cause the athlete to start changing the way that they view themselves. This is known as body dysmorphic disorder and can be suffered by both men and women, where they are unable to see the true image of what they look like. They are not satisfied by their physical appearance and are in most cases unable to see the muscle bulk increase or body fat loss that the people around them can see. This causes them to keep pushing the boundaries and in some instances either develop an eating disorder or consider taking performance enhancing supplements to reach the next level; except that they will never reach the next level because of this disorder.

Female Resting With Intense WorkoutAny competitive sport is difficult to train for and excel in, as it is a combination of training periodization and the right nutrition that will give the athlete the tools to be able to prepare their body for competition day. Weight management plays a huge role in whether the athlete will make the necessary weight category, whether they will have enough strength to overpower their opponent, or whether their muscles will be more defined and symmetrical than the next competitor. The right nutrition can give an athlete the edge that is needed to reach the next level, however, yoyo dieting may not necessarily be the key to optimum health, given the mental and physical risks associated with it. It is therefore always preferable to manage weight in a more steady manner that allows the body to acclimatise to it and maintain the changes.

Hip Arthroscopy, Nutrition, Training

Road to Recovery After a Left Hip Arthroscopy

On Wednesday 22nd October  2014 I underwent a left hip arthroscopy because of the femoroacetabular impingement (FAI, mixed impingement) with labral tears that were diagnosed following months of pain, an MR Arthrogram and a CT scan.


hip1The operation was a success but the hours following the operation were awful because of the anaesthetic and the morphine. I was awoken from the operation in tears (I was confused and couldn’t formulate a sentence – the nurses thought I was in pain so they gave me more morphine). While patients are usually discharged after 4 hours, I had to wait 8.5 hours because of the nausea (which prevented me from having the mandatory pre-discharge physiotherapy session). The morphine had relaxed my bladder muscles therefore I wasn’t able to pass urine. Any hip pain wasn’t really that apparent – I would occasionally get some instant and sharp pains if twisted or moved into an awkward position but my main focus was trying to ease the nausea. I was sick a few times in the afternoon, which allowed my body to start getting rid of the drugs from my system; I had my physiotherapy session at 6pm and I passed urine at 7.15pm.

My surgeon came to see me mid-afternoon to explain what he had done but I was so high and nauseous I barely remember the conversation. I do remember seeing pictures of the destroyed labrum and the cartilage that had started to peel away.


hip2While I breezed through the physiotherapy exercises on the day of the op, the 1st day post-op was quite tough. I slept beautifully but woke up feeling like a bus had hit me. I couldn’t move well, I was still groggy and incredibly nauseous. My sister helped me to shower – I dropped the soap and just looked helplessly at it as I couldn’t bend down to pick it up or wash my lower body. I needed my crutches for everything, even just to shuffle a few steps, as my leg was too heavy for me to be able to lift unaided.

I managed 1 flight of stairs, with crutches, using the method the physiotherapist had taught me: bad foot down to hell, good foot up to heaven – operated leg first when walking down stairs (so that it remains straight) and non-operated leg first when walking up stairs (so that the operated leg remains straight again).

On the 2nd day post-op I was moving a lot better and felt as bright as a button when I woke up. I still had to stare at the soap when I dropped it (again) but I could walk (as opposed to shuffle) around my flat most of the day without my crutches. Putting socks and pants on was difficult because I couldn’t bend the leg or my body to reach down properly so I was glad I had someone around to help me to dress and shower.

On the 3rd day post-op I could walk and do stairs unaided. I didn’t drop the soap but I still needed some help washing and drying my ankles and feet. Overall there was significant improvement in my mobility for every day activities. The physiotherapy exercises were becoming easier so I increased the reps, modified the exercises so that my foot was hovering above the floor and I added some other exercises that I knew would help to strengthen the hip joint without fatiguing the supporting muscles too much. While rest is important I do also think that the body needs to be challenged in order to keep improving – but at no point did I feel any pain from these modifications.

On the 4th day I was finally able to wash/dry my ankles and feet unaided. I was a little concerned about some hip clicking that I had also experienced pre-surgery (due to the labrum being torn) but my physiotherapist assured me this was common as it was most likely post-op fluids and the inflammatory process happening in the joint and that it could be expected for up to 3 months post-surgery.


pregabalinI was still experiencing some nausea after 3 days and after investigating the medication I was taking, I was horrified by the list of side effects for Pregabalin (Lyrica) that I was expected to take for 2 weeks for nerve damage. I came off it after 5 days (with the surgeon’s blessing) as I had no nerve damage (I can’t fire up my left glute properly but I have a sport tens machine to help with that). I am taking Celebrex for 4 weeks to prevent bone forming in the muscles and I didn’t need painkillers for more than a couple of days.


physio exercisesWhile the improvements were quite significant initially (for every day activities such as walking, going up/down stairs, bending/squatting down to pick something up), I have seen fewer obvious improvements since then and am now primarily focusing on improving my internal and external rotation. I can squat properly (with a Swiss ball between the wall and my back), I can bridge very well and have increased the intensity by elevating my feet and using a resistance band around my knees but I can’t do bent knee fall outs without pain at the end of the movement because of my lack of rotation. I am swimming to move the hip joint more (only crawl; can’t breaststroke yet) and using the upright cycle. Any other cardio machine will put too much pressure on the hip joint with the repetitive movement.

I had my initial post-surgery physiotherapy session after 9 days and my physiotherapist was pleased with my progress as I can already do exercises from the 4-6 week post-op section of the rehab chart. I put this down to how physically active and mobile I was pre-op and the quality of my nutrition. My focus is to improve my lower body mobility as much as possible so that when I have my left shoulder arthroscopy at the end of November I will still be able to exercise my lower body whilst my upper body recovers in time for my right hip arthroscopy at the end of January 2015.


tensI have a gym bench at home and some dumbbells so I created a little upper-body circuit of seated exercises (so as to not put any pressure through the hip joint) as I am a little concerned about the effect that this no-exercising is having on my muscle mass. The tens is helping to stimulate the muscles but I’m worried about losing all of the muscle mass that I have built up over the past couple of years. Even just doing a little bit really helps to keep my motivation and positivity up as mental attitude is extremely important when recovering from surgery. It’s easy to become deflated by the lack of progress, putting weight on through inactivity, giving in to the pain – exercise helps to stimulate the blood flow, the mind and get the serotonin pumping through your body.

Not being able to exercise properly has required a mental adjustment as I used my interval training to lose body fat and my metabolic weight training to maintain muscle mass. I am now relying on my nutrition to save as much muscle mass as possible and also not put on too much body fat – my carbs are low (max. 80gr/day), my protein is high (around 220gr per day) and my fats are reasonable (max. 30gr per day). I am keeping my weekly sessions with my personal trainer as it is important to have a focus and he has weighed me every week since we started training together in order to ensure that I am on the right track. While our training over the coming months may be very different to what I’m used to given my physical limitations, there is no reason I shouldn’t be able to stay on top of my fitness and my nutrition with some discipline and a positive mindset.