Hello everyone, Destinie here!
As some of you may be aware, I spent September at home recovering from a surgery to repair my left hip labrum. Given how common labral tears are, I thought it would be beneficial to share my story.
First, let's set the stage with some basic anatomy.
Where and What is the labrum?
Gear up for a tongue twister: it's a fibrocartilaginous structure—yeah, try saying that 10X fast! 😜 This essential structure lines the acetabulum, the official name for your hip socket. Its key role? Deepening the socket to make sure your femur's head fits snugly and stays put.
Picture of Hip Joint w/ Labrum Shown
More Detail on the Labrum’s Important Functions:
- Stabilization: It adds an extra layer of security, keeping the head of the femur in place.
- Load Distribution: The labrum helps distribute the pressure across the hip joint, minimizing wear and tear.
- Lubrication: It aids in maintaining synovial fluid, the natural lubricant for your hip joint.
- Shock Absorption: In activities like running or jumping, the labrum serves as a cushion to absorb some of the force.
Understanding these functions underscores why a labral tear can lead to pain, instability, and reduced mobility.
My Experience with Labral Tears (I’ve had two 🙃)
One question I frequently encounter is, "What does a labral tear feel like?" Understand that this answer is highly subjective. To respond, I need to rewind to 2005, the year of my first labral tear. You read that right—I've torn both labrums. Poop!
During my junior year of high school, I transitioned from swimming to rowing. Soon after, I picked up on a "clunking" sound in my right hip at the end of each stroke, accompanied by an achy feeling near my right groin. An orthopedist's visit and MRI confirmed a torn labrum. My treatment? Physical therapy and a send-off. This was back in 2005.
Maybe it was because I was only 16, or perhaps because some labral tears are asymptomatic, but my right hip pain vanished for a decade after the initial onset of symptoms. I went on to row for UCLA's D-I team on a full scholarship, graduated, started a corporate job, and then fell head over heels for marathon running and long-distance triathlons. My right hip became a distant memory until a left-foot stress fracture occurred.
Destinie in a "Pair" rowing shell
I was put into a "spaceboot" to help my left foot heal, and I believe that kicked off my right hip issues anew. If you've ever worn a spaceboot, you know it makes one leg longer than the other—New Balance sneaker and pencil skirt ensemble notwithstanding (yes, that was me). I think the boot threw my pelvis off and re-aggravated my right labrum to the point of symptomatic impingement. I'm well aware that my body had already endured its fair share of wear and tear between 2005 and 2015. Oh, to be young and to think you’re invincible! #guilty
When the right hip pain returned, it was merciless. You know that pain scale with smiley faces, where 1 is bliss and 10 is the red face of agony? My daily pain levels hovered between 7 and 8, from dawn till dusk. I used to sneak into the handicap stall at work just to lie down on the floor for some relief.
The sensation in my right hip was best described as a "fire or acid in my joint." No loss of mobility or strength—just sheer pain. Speaking with others who've had labral tears, symptoms differ. Some mention a dull ache in the groin, others talk of a "pinching" at the front of the hip. So, when a similar burning sensation appeared in my left hip in 2017, my internal response was simply, "fuck."
An MRI revealed another torn labrum in my left hip. Just like the right one, symptoms vanished—until they resurfaced in 2022. Who knows how long that left hip had been torn.
Why Me?
A question I've asked myself many times when it comes my hips!
Individual variability in susceptibility to labral tears often comes down to a combination of anatomical factors, mechanical stressors, and hormonal influences. Here's a quick breakdown tailored to my experience:
- Height and Leverage: At 6' tall, the biomechanical forces acting on my hip joint are different than they would be for someone shorter. Greater leverage can sometimes result in increased stress on the labrum.
- Gender-Specific Factors: Women are known to have a different pelvic anatomy compared to men, including a wider pelvis which can affect hip joint mechanics. Hormonal fluctuations can also affect tissue elasticity and integrity, making women potentially more susceptible to soft tissue injuries like labral tears.
- High-Impact Sports History: Engaging in high-impact and high-intensity sports like rowing, marathon running, cycling, and triathlons places considerable stress on the hip joint. These activities involve repetitive and sometimes forceful hip motion, making the labrum more vulnerable to tearing over time. As I've detailed, I was hard on my body from a young age.
Understanding these contributing factors not only clarifies why I was more prone to labral issues but also reinforces the importance of tailored preventive measures and specialized post-op care.
I Chose Surgery for the Second Time: A Complex Decision
Why It Wasn't an Easy Decision
- Varying Severity of Symptoms: While my left hip was acting up, it was nowhere near as debilitating as my right hip had been. Thanks to my Pilates regimen, I experienced fluctuating periods of good and bad weeks, a stark contrast to the relentless bad months I faced with my right hip.
- Inertia: For the self-employed among you, you'll understand that not working is hard to stomach. My commitment to my students is something I take seriously. Leaving my students for a month to heal felt like a greater challenge than finishing any marathon.
- The Dread of Recovery: My right hip's recovery was fraught with setbacks, causing spikes in anxiety and bouts of second-guessing. The memory of enduring that physical and psychological pain was far from appealing.
Why It Was an Easy(ish) Decision
- The Clock is Ticking: At 34, time is not on my side for optimal healing. The labrum is poorly vascularized—its blood flow diminishes with age. Opting for surgery sooner rather than later was likely to offer a smoother surgical and recovery process.
- Proven Track Record: My right hip has been a non-issue since its 2015 surgery. Working with the same skilled surgeon for my left hip boosted my confidence in the procedure and outcome.
- Educational Backbone: Since my first surgery, I've delved deep into the world of Pilates and movement science, earning my M.S. in Applied Kinesiology and Physiology in 2022. This expanded knowledge base reassured me that I could capably steer my recovery journey and mitigate any anxiety better than before.
- Inevitable Deterioration: Unlike some bodily tissues, a torn labrum in the hip does not possess regenerative capabilities. Its avascular nature means that once torn, the labrum is unlikely to repair itself. Moreover, neglecting the issue often leads to degenerative changes—accelerated cartilage wear, osteoarthritis, and chronic pain are potential downstream consequences. This unpalatable trajectory bolstered my decision to intervene surgically rather than opt for a "wait and see" approach.
So, with these factors weighed and measured, I chose surgery again—each reason serving as a stepping stone to a future of greater stability and lesser pain.
The Procedure Itself: A Detailed Breakdown
Destinie Pre-Op
I was put under anesthesia for this two-hour procedure. The surgeon started by making two small incisions in the front of my thigh. One was used for the arthroscope, a specialized camera that provides a clear view of the hip joint's interior. The other allowed for the insertion of surgical instruments tailored for labral repair.
The joint was distracted—temporarily pulled apart—to give the surgeon enough room to work. This enabled access to the labrum, where bioabsorbable anchors were inserted into the acetabulum. These anchors have medical-grade sutures attached to them, which were then woven through the labrum and secured, effectively reattaching the labrum to the acetabulum.
Inside Destinie's Hip. Internal sutures securing torn labrum shown.
Over time, the bio-absorbable anchors and sutures will dissolve and be naturally absorbed by the body. This leaves your own biological processes to finish the job, allowing the labrum to permanently reattach and heal itself.
After these steps were completed, the two incisions were sutured shut and I was moved to the recovery room.
Recovery:
Destinie First-Day Post-Op
I kicked off my recovery on crutches. For that entire first week, my husband was essentially my personal assistant, chef, and nurse combined. He did the cooking, the cleaning, and even assisted me with the basics like showering and getting dressed. I was prescribed hydrocodone, but I nixed that after just two days due to the headaches it gave me. Elevating my leg was crucial, as was maintaining some semblance of movement. My doctor recommended a trio of exercises for that first week—exercises that I've handily filmed for anyone else in the same boat. I also iced my hip intermittently throughout those initial seven days.
This video is for educational purposes only. Please defer to your doctor or physical therapists' instructions!
Week two marked a turning point. My doctor gave me the green light to slowly ditch the crutches. That first step sans crutches? Terrifying. Your brain pretty much screams, "Don't do it!" But once you've gotten the medical all-clear, it's a mental hurdle you have to conquer. I also initiated physical therapy in week two and dabbled in some gentle pre-Pilates work. By week five, I was back to private Pilates sessions using equipment, and I've been keeping that up consistently.
In my Pilates sessions, the focus has been on activating the muscles that surround my hip in three dimensions. We've leaned heavily into isometric exercises at the outset. Physical therapists often opt for these exercises initially because they allow for muscle activation without the joint moving through a range of motion. This minimizes stress on the healing tissues and avoids aggravating the surgical site. Isometric exercises essentially provide a controlled environment where specific muscles can be targeted and strengthened without risk.
Another critical aspect of my recovery has been connecting with my left foot. This isn't arbitrary; there's biomechanical reasoning behind it. Your foot acts as the base of a kinetic chain that extends upwards through your leg and into your hip. Any dysfunction at the foot level can propagate up this chain and potentially cause or exacerbate hip issues. Re-establishing a healthy foot-to-hip connection helps in aligning the entire leg and aids in balanced muscle activation, facilitating a more effective and safer recovery. Remember that stress fracture I mentioned earlier? You bet its showing up during my recovery, even after all this time.
Maintaining a robust core is not just an exercise mantra; it's crucial for effective recovery post-surgery. A strong core acts as a stabilizing force for the entire body. In the context of hip surgery, it provides much-needed support to the hip joint, mitigating excessive loads and forces that could otherwise impair the healing process. It's like your body's internal brace, supporting not just the hip but the spine and other key areas as well.
Finally, the importance of a skilled and trustworthy Pilates teacher during this delicate period of recovery can't be overstated. Healing is as much a mental endeavor as it is a physical one. Having a teacher who understands the anatomical intricacies of the hip joint, as well as the psychological aspects of recovery, adds an invaluable layer of support. It's not just about executing exercises correctly; it's about having a guide who can adjust your program in real-time, accounting for both your physical and emotional state. So, if you're on this journey, do yourself a favor: find a teacher who you can trust implicitly. I’m lucky to be surrounded by the best of the best in San Francisco.
Where I am now:
I'm two months post-op and cautiously optimistic about the strides I've made. Just one month after surgery, I was back teaching Pilates, equipped with ice and scheduled breaks to be on the safe side. The precautions are not to be underestimated; they made a real difference. Six weeks in, I attended a friend's all-day wedding. While I did feel some discomfort by the end of it, it was manageable, and I listened to my body, opting to go home instead of to the after-party. Recently, I even attended a two-hour concert and did some light dancing without significant issues. I went into the concert with some rules for myself and with the goal of leaving earlier than later. Today marked a milestone—I went for a 50-minute walk, the longest since my operation. I've also resumed Pilates mat classes this week. I'm continuing to work with a physical therapist and have once a week Private Pilates scheduled through November. While I can't say I'm back to my pre-surgery normal, it feels like I've crossed an important threshold in my recovery. The key has been a vigilant awareness of my body's signals and a willingness to accommodate its needs.
Written by: Destinie Slavich
