hip fai info!

here are two very good links for hip fai...read and watch......

http://www.hss.edu/hip-pain-center-frequently-asked-questions.asp#1


http://www.youtube.com/v/qzEkZXNRpvA?f=videos&c=ytapi-iLikeInc-iLike-1493oebb-0&d=AbzsdEu9A2kwQxMBPfYLdoQO88HsQjpE1a8d1GxQnGDm&app=youtube_gdata

Hip FAI with or without labral tears and sports hernias

ok, so this has been studied for a while now. if you know you have a sports hernia, you should still be checked for hip fai. they can and often do go hand in hand. it may be the case that your fai could get operated on and you may not need the sports hernia done.
if you have had sports hernia surgery and are not improving, there is a very, very good chance it is your hip. fai with or without labral tears can refer pain into the inguinal area, trochanter, gluteals, and si joint along with lumbar spine.
keep in mind that a labral tear is usually caused by hip fai!!!
if an ortho tells you that "i could go in there and take care of the tear," but doesn't know of the cause, nor does he have a ton of experience with treating fai, then get a second opinion.

there are lists of good fai docs out there, you should do some google searches and find one or 2 in your nearest city.
the best known are in vail, nyc, nashville, and san francisco.

FAI MUST BE EXPLORED ALONGSIDE THE SPORTS HERNIA prior to treating either.

revisiting the blog for a bit

i have been away for a long time. i had to take care of some other business with lyme disease, which went misdiagnosed for 8 months, thanks to an infectious disease clown of a doctor in kingston, ny. the bite, rash, and symptoms simply were not enough for him to warrant treatment. therefore, i had to put my healing from the sports hernia syndrome on hold for over a year!!!!!!

i will tell you, a case of lyme (mine was pretty bad) is worse than a sports hernia. a sports hernia, although painful and all-consuming, doesn't really threaten your life. but, i have been there, guys and gals, and i know how bad it can suck!

so, back to the physical injury.

i am convinced, and i have run this by some sports hernia and hip specialists, that hip fai and sports hernias can go hand in hand.

during my battle with lyme, i did get a diagnosis of bilateral hip fai. symptoms do in fact mimic sports hernias. in my case, i have bilat fai with cam style impingement, and both cam and pincer on the other hip. both sides have labral tears. it is very rare that there is fai without labral tears, and vice-versa. in my case i also have pieces of the acetabular rim (socket) broken off and floating around in the sockets. and i have arthritis starting, due to the extended time frame of not getting diagnosed.
i have big bumps/cysts on my femoral heads.

so i am heading to surgery this fall. probably both hips at once, for resurfacing. i am only 38, and want to get back into sports.

the good news is that yes, the sports hernia surgeries i had with dr muschaweck were successful. i have had my groins scanned by her machines even recently and all is in tact. good to go. just the hips need to be tended to.

my main words of advice---
do not stay local for doc visits because if convenience, if you are still in pain. that is plain stupid. go out of plan if you have to, but GO SEE A SPECIALIST IN A MAJOR CITY, ONE THAT SEES MANY, MANY PRO ATHLETES!!!!!!!!!!!!!!!!!!!!!!!!!!!

just because a doc went to hopkins, doesn't mean a flying crap to me; it doesn't mean that he or she is right. sports hernias and fai do exist. it just takes an EXPERIENCED doctor to find it.

sorry i have been away from this blog. i will be away longer...

sorry i haven't been posting nor checking this blog for a long time till today.
i have had too many days of pains and confusing symptoms and reviewing everything has been kind of a bummer since i still have issues.
i got diagnosed as having lyme disease over a month ago, after being bitten by a deer tick last september. at that time i had the rash and all the lyme symptoms. but, like sports hernias, the lyme diagnosis can also be elusive due to 1) lack of knowledge 2) lack of good testing, and 3) doc egos. despite the obvious, my doctor said i didn't have lyme because the blood tests weren't "positive enough." this is very hard to believe. things were getting better for me as far as the sports hernia recoup was going, then i was bitten. within a few months my shoulders were killing me, then things continued to spread and get worse. finally, in march, i was diagnosed as having lyme.
so i think that perhaps the lyme has halted my sports hernia healing. the past 8 months have been very gloomy. with that, i decided to cool back from posting.

now i need to point out the importance of labral tearing. it has been posted, even in one of my earlier posts, that such tears can be underlying causes of or perhaps results of sports hernias. i did get diagnosed with a left labral tear 2 months before my sports hernia diagnosis. now that it is almost 2 years post-op, and i still have that pain in my gluteals and groin on that same side, i am going to get it checked out again.

so please pardon my absence from updating this blog for a good while in the future. but i will start it up again in a number of months.
daniel, feel free to link this blog to yours.

i seriously hope that this blog has been helpful to people out there. i genuinely hope that all of you feel better and can return to normal lives without pain in the groin.
i am also working on a book that will basically be memoirs of this battle with not only the diagnosis and treatment but also the doctors and medical system that i strongly feel has turned our battles from what should be simple into long journeys. this has left me financially ruined, often depressed, yet much wiser. i hope that when my book is done, it will also serve as a positive influence for anyone suffering with similar battles.

if you want to get in touch with me, post your email or a way to get in touch and i guarantee i will at some point.

best wishes

john (sports herniac)

Sports Hernia Surgeons

Here are the names and contact info for some sports hernia/AP surgeons. There are more out there than I have posted here but I don't know their info nor history of their work.

Dr. Ulrike Muschaweck- Munich, Germany. info@hernien.de is the best way to contact her. Her staff is very friendly and will get back to you in a timely fashion. She has performed the most of these surgeries over anyone else, by far.

Dr. Brown- Montreal, CA. From what I understand, he is more or less retired but still does occasional sports hernia surgeries. His office# is 514.935.4888. His assistant is also the assistant for Dr David Mulder, who is the surgeon for the Montreal Canadiens, and she is very pleasant to speak with and is also knowledgable.

Dr. Meyers- Philadelphia, PA. He has performed thousands of these surgeries. Marcia or Trisha can help you, they both are very knowledeable and friendly. Office # is 215.762.4157.

Dr. Cattey- Mequon, WI. He also has performed many of these surgeries. He uses a laproscopic approach. Office # 414.961.3254

others??? please feel free to post info to help people decide where to go!!

hip labrum and fai along with sports hernias

this is in a debate of sorts. there are many people who have both labral tears (either due to femoroacetabluar impingement, or perhaps the fai is a result of labral tear) and sports hernias.
which came first? some say the sh can lead to labral tears, some say the other way around.
either way, many people out there have labral tears and no symptoms. i myself had a labral tear in one out of 2 mris and a ct scan and nuclear bone scan showed nothing wrong with the hip.
the hip specialists as well as other sports docs said to leave it alone.
i had the sh surgery done 1st. as i am still recovering over a year later, i wonder if it is the hip. but then i know that if i undergo more sugery before my muscles are restored in strength and balance, the hip surgery would only screw things up.
anyhow, here is an article on hip fai...
http://www.hipfai.com/
who really knows the connection to sports hernias. there are so many soccer players who have had sprots hernia surgeries, you'd figure that there would be a few dozen labral tears in the mix as well. but they are good to go after surgery. it might be also important to note that these athletes are most often diagnosed very early, thus are in good shape when they go into surgery, perhaps leading to an easier recovery.

muscle imbalances and the si joint

the sports hernia, if left alone, untreated, for a long time, can very easily lead to muscle imbalances in and around the pelvis.
as one of the keys to our cores, the transversalis muscle is injured and can go into spasm as a result. this in itself can cause a domino effect of muslce imblances which can lead to great pain and dysfuntions. without the t.a. muscle to help support your lumbar spine, other muscles must become hypertonic to take over. linked to the t.a. via fascial connections are the pelvic floor muscles, the quadratus lumborum, and the gluteals, not to mention the obliques and rectus in the abdomen.
sometimes this imbalance or imbalances can lead to issues with the sacroiliac joint. si joint dysfunction is common yet, like sports hernias, is often missed when coming to a diagnosis for pain near the joint itself as well as the hip, groin, lower back, buttock, and tailbone.
if the muscle imbalance that occurs locks up compartments such as psoas, the pelvis can rotate which can in turn affect the si joint. si joint dysfunction can be severely painful in itself, and probably cannot be permanently corrected without the treatment of existing sports hernia(s).
it should also be noted that trigger points left untreated can also lead to a viscious cycle where the shortened, tightened muscles can not be stretched or lengthened due to these painful trigger points. once these are addressed, the position of the si joint can be addressed.

here is a link to a brief article that shows the nerves that can be irritated in the sports hernia

its an article on groin pain with some fairly weak graphics for description, yet they are so good since they are very informative. i have mentioned before the entrapment of the ilioinguinal and iliohypogastric nerves, as well as the genital branch of the genitofemoral nerves, and how scar tissue from injuries like the sports hernia can form in the inguinal area and cause nerve pain. these neuromas can form from microtears and can cause chronic pain.
http://www.capitalherniacenter.com/groin_pain.htm

more pics

http://www.sportnetdoc.com/injury/09-02.htm

a great, detailed article on the groin anatomy

this one is very detailed, hard to read, but explains a lot of the terms you read about when researching groin pain and sports hernias.

http://www.medscape.com/viewarticle/420354_2

good article on sports hernia variations

here is a link to an article that explains the variations of sports hernias, ie slapt shot gut, disrutption, and the like.
in the article, tears in obliques, conjoint tendon, transversalis fascia, and more are discussed.

http://64.233.169.104/search?q=cache:OdWYwh4cI3sJ:www.smbs.buffalo.edu/ortho/journal/sportshernia.pdf+mri+to+diagnose+hernia+lipomas&hl=en&ct=clnk&cd=10&gl=us

i'd really like to see some comments and/or posts

i'd like to know that this blog is serving a purpose. it gives me drive to post more often.
as i do this research i am thinking of all the people out there with similar groin pain. i really am doing this in order to help educate people who are in need of solving this pain when the doctors don't know what to do. in my own injury, if i hadn't done all this research i'd still be screwed because there were no doctors that were able to help. some were not even willing to help since they thought that my condition might have been psychsomatic, which we all know is a heap of crap. any doctor who doubts that the sports hernia exists is only fooling themselves and showing us that they need some continuing education.
so, please post some comments or questions or complaints or whatever. it costs nothing to register to be able to post, and takes only a couple of minutes. to those that did post, i thank you for doing so, it makes me feel like this blog is worth my time by being able to lend a hand to those who need it.

inguinal ring and oblique tearing

in tearing the external oblique aponeurosis, the ilioinguinal and/or iliohypogastric nerve(s) can be entrapped in scar tissue or may simply be irritated by the layers of muscle sliding across one another during movements. think about it- two layers of muscle, fairly thin, with nerves not only passing through the muscle itself but also in between the two layers. each layer is responsible for your torso moving/twisting/bending in unique ways; the grain of the muscle fibers run in different directions for each layer.
note the inguinal ring's location along the obliques. think about how that ring can be stretched or even torn. note the nerve bundle and veins that pass through that ring. when that ring is physically altered, don't you think that that vascular and nervous bundle would also be alterted and irritated?
incidentally, that bundle also contains the spermatic cord. under the cord is the genital branch of the genitofemoral nerve. naturally, an injury in this area can cause nerve irritation which equals pain in the pathways of those nerves and the spermatic cord.

nerve pathways and how they relate to your groin pain

this is a very good article that informs the reader, with great images, of specific nerve pathways in the pelvis. i found this to be a good tool for understanding the nerves that are indicated in sports hernia and related or co-injuries.
http://www.pelvicpain.org/resources/2004Presentations/Peripheral%20Subcutaneous%20Stimulation.pdf

nerve pathways

many people with this condition feel pain along the pathways of these two nerves. in the ap injury, the genital branch genitofemoral nerve (not pictured here) is also injured and inflamed.

torn external oblique aponeurosis

sometimes in sports hernia injuries, the sufferer can also have an injury to the aponeurosis of the external oblique and/or the muscle itself. this happens most often in hockey players, and has been termed "hockey groin syndrome." the tearing of the tissue can cause scarring and entrapment of the ilioinguinal nerve.
i am not sure if some methods of ap surgery can actually see this tearing in addition to the transverse fascial tearing that is always tended to.
the ilioinguinal nerve has been the cause of chronic groin pain for many people. the path of the nerve passes right down to the pubic bone and branches off from there....if it is entrapped and irritated enough, there can be nerve cross-talk in the area which can only make matters worse for the sufferer.

anatomy view of pelvis and abdomen

note the nerve pathways

and the muscles. the psoas can play a large part in the pain and dysfunction associated with long-term sports hernia.

a good picture of the transversalis fascia and surrounding structures

the transverse fascia is what is stretched and/or torn in the sports hernia. sometimes the oblique aponeurosis is as well.

visceral manipulation for buildup of scar tissue around groin

this is an osteopathic approach developed by respected osteopath jean pierre barral of france. he has spent over 30 years working on this manual therapy as a way to relieve a person of chronic pains and ailments. it is essentially osteopathic manipulation of the organs in the abdomen, pelvis, and chest. it can work wonders for those who have suffered extensive damage during a long-term sentence with a sports hernia. it can help undo some of the nerve irritation and then some.
http://www.iahe.com/index.jsp for more info.

scar tissue as cause of chronic pain in sports hernia injuries

the sports hernia involves stretching and possible tearing of soft tissues in and around the groin.
unfortunately, there is often a period of time between the actual injury onset and the treatment of this condition in which compsenatory patterns and strains develop within those involved muscle groups. these strains that happen can cause microtearing of the tissues that are being strained. tendons, periosteum, muscle fibers, fascia, can all be damaged through movements that cause strain. the result is scar tissue.
scar tissue is well known to cause pain in bodies that have suffered damage whether it be from injury or surgery. the hard tissue can press against a nerve, or may act as a distruption or interference point within the fascial system. scars can cause tugging of tissues and organs within the body, causing pain and nerve irritation.
lj smith, a football player for the philadelphia eagles, underwent sports hernia surgery in summer of 2007. a few months later, despite physical therapy efforts, he was still in pain and had to undergo more surgery to clear out painful scar tissue that was a result of the injury and its microtears.
so some of you who are still experiencing post op pain can feel somewhat confident that there is a bunch of scar tissue in there. who knows whether or not it is the cause of pain. my surgeon told me that my nerve irritation is due to scar tissue. that is why i began structural integration treatments and then neural therapy treatments to follow. both modalities tend to scarring.
structural integration: http://theiasi.org/index.php
neural therapy: http://www.neuraltherapy.com/