I’m just going to say it, it’s been a shitty summer. I know it could be a lot worse, there were some amazing things we accomplished: we spent five days in Paris, we walked the Camino Frances across Northern Spain, we have enough money saved up to not have to work most of the summer. Really I am so incredibly lucky to be able to do this all. But, on top of having to cut our European trip short to come back home and put our dog down, it seems I have sustained a Labral Tear in my right hip on the last day of our Camino hike, requiring us to cancel our plans to hike the Great Divide Trail or the Appalachian Trail this summer. This includes all the plane tickets and campsite reservations, I think about $1000 in nonrefundable reservations and plane tickets.
On the last day of our Camino hike, what started as a small discomfort in my right hip grew into full hip pain and limping by the end of the day. The next day was just as bad. But after that, the pain went away. Granted I didn’t do any walking for two weeks as we were dealing with our dying dog. With our dog put to rest, we decided to heal our emotional pain by going back out on the Pacific Crest Trail for a few weeks. My hip felt fine. In fact, I forgot about the pain in Santiago de Compostela and we made arrangements and bought food to be out on the PCT for 17 days. Mat’s dad drove five hours round-trip to drop us off at Belden. Ten miles into our hike, the small discomfort in my right hip came back. By the end of our 15-mile day, it was really sore again. Luckily we had cell reception at our campsite and it was only five miles to Bucks Lake where we could get picked up again. The next day, we (“I") hobbled into Bucks Lake where Mat’s dad, once again, drove five hours round trip to pick us up. So grateful he was able to do that for us! I stayed off my leg as much as possible for the next month without improvement; in fact, it felt like it was getting more painful. Even sitting was very uncomfortable. The only comfortable position was standing without walking or laying flat. But after a few weeks, even those positions didn't make the pain go away. I started taking 800mg ibuprofen every eight hours (always with food!) to decrease the inflammation. Sometimes it helped, sometimes it didn’t.
So what is a labral tear? The Labrum is a ring of cartilage surrounding the hip socket of the pelvis, increasing the depth of the socket to better stabilize the ball of the femur. We have the same ring of cartilage to deepen the socket of the shoulder. The labrum can be torn most often from twisting sports such as soccer or hockey but it also plagues long-distance runners. Considering thru-hiking is walking 20-30 miles per day, I would assume thru-hiking is very similar to long-distance running. The Camino was further problematic because it was mostly flat, very repetitive walking on either roads or groomed walking paths. Walking on backcountry trail requires one to constantly change gait to avoid roots, rocks, etc. The groomed walking paths of the Camino made for very repetitive walking. Additionally, I chose not to bring my trekking poles for the Camino because I didn’t want to check my luggage for the flight from California. If I knew then what I know now, I still would have opted not to bring my own trekking poles to save that hassle but I should have purchased cheap trekking poles in Europe before starting the trip.
Here are the symptoms of a torn hip labrum according to the website Move Forward Physical Therapy (www.moveforwardpt.com):
- "A deep ache in the front of your hip or groin, often described by the "C sign." (People make a "C" with the thumb and hand and place it on the fold at the front and side of the hip to locate their pain.)”
- Painful clicking or "catching" with hip movements. This creates the feeling of something painful stuck in the hip or blocking hip motion.
- Pain that increases with prolonged sitting or walking.
- Sharp pain in the hip or groin when squatting.
- Pain that comes on gradually rather than suddenly.
- Weakness in the muscles surrounding the hip.
- Stiffness in the hip."
I do OK when squatting, and I don’t have weakness in the muscles surrounding the hip (although the muscles do tighten up and quiver multiple times throughout the day) but everything else on this list is spot on: hip stiffness with gradual achy pain arching in a C-shape around the front of the groin, exacerbated by sitting or walking.
I do not have an official diagnosis yet. We planned to be international until October so we bought insurance that would cover us internationally but doesn’t work in the U.S. Currently we are trying to get a contract to work so that I can obtain health insurance so that I may get a diagnosis and treatment. But, working as an ER nurse, I walk 5-6 miles per day at work and I’m worried that I’ll be doing further damage to my hip by working before I get proper treatment. I guess I have no choice, and I’ve read peoples’ blogs who have dealt with this condition for a year or more before seeking medical help.
It appears that the typical treatment of this condition is to go to physical therapy for 12 weeks. If there is no improvement, then surgery the next step. A labral tear is difficult to diagnose with imaging. An x-ray may be done to rule out bone structure abnormalities such as a stress fracture. When that is ruled out, the next step is the expensive MRI, most likely with contrast. I’ve read that people sometimes get the MRI right away but, if one has classic symptoms, one can forgo the MRI until they’ve completed 12 weeks of PT without improvement. And apparently, most states will allow a person to go to a physical therapist first to diagnose a problem through positioning tests and symptom description, allowing one to bypass the week or so it takes to get into a primary care provider, or even longer for a specialist’s referral or MRI (although insurance may require a physician’s order for PT to pay for the therapy). Ability to see a physical therapist before seeing a doctor is called Direct Access and varies by state, check to see if your state allows Direct Access to physical therapists.
From my reading, smaller tears can be managed with Physical Therapy and most people can return to their baseline activities, even strenuous ones, after three months of treatment. For larger tears, physical therapy can only do so much and then surgery is required to cut away unhealable tissue and stitch the tear back together. There is typically a two week period immediately after surgery where the affected hip is "non-weight bearing" aka you must use crutches. And three more months of physical therapy should be initiated immediately after surgery. It appears that outcomes from surgery are not better than just doing physical therapy alone, but that could be the nature of a large tear just not healing no matter how many months of PT is done. If the tear is big enough, the injured cannot get back to baseline and must readjust life accordingly.
Hiking is my life. I've camped since I was 10 weeks old, backpacked since I was 10 years old. I've spent the last 12 years setting up my life in a way to be able to do long-distance hikes every year. My plan is to find a physical therapist that specializes in orthopedic conditions and sports medicine, preferably with lots of experience with hip injuries. Not only do Physical Therapist's specializing in sports medicine see and treat sports-related injuries more often, they also understand how important being active is to your wellbeing and quality of life so they focus on getting you back to your baseline rather than just getting you to a pain free state and expect you to change your hobbies. Same goes for ortho surgeons if surgery is required. I plan on finding a sports ortho surgeon, preferably one that specializes in hips.
With all this being said, I will have to wait and see what will happen. Even with all this knowledge, I'm still super stressed out. It doesn't help that I struggle with anxiety that causes my brain to automatically jump to worst-case scenarios about everything. And the two things that relieve stress for me are no longer available: I can't go walking, and the only soul who would of love to have me laid up on the couch for months had to be put down last month. At least I have my wonderful husband but I struggle with feelings of guilt that he's had to cancel big hiking plans so that we can go back to work and get me some health insurance. I feel pretty dang miserable right now, even though I know things could be worse.
So here are my concerns right now:
- If I take advantage of Direct Access to get a diagnosis and initiate PT treatment out of pocket without having health insurance, will the health insurance company try to get out of covering further PT and even surgery once I obtain coverage? Probably not since health insurance is not allowed to deny coverage for pre-existing conditions anymore.
- If I start working in order to get health insurance, will walking 6 miles a day at work cause more damage to my hip, possibly pushing me into needing surgical intervention?
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