The History of my Hips

I have had hip issues ever since I can remember, but it was always on and off and never much more than an annoyance. When I was a kid, whenever I walked, my hips used to make loud popping sounds, but it never hurt. It creeped my mom out a little, but I guess we all figured if it didn't hurt, it didn't matter. And in my family, sometimes even if it hurt, it didn't matter, as long as it wasn't going to kill you. :) It turns out that this popping has a name, called 'snapping hip syndrome,' which I learned about five years ago when one of my students wrote a paper about it for an anatomy class. I should probably mention here that I teach biology at a university, and I taught anatomy for several years before I got tired of spending my weekend dissecting cadavers, so I do know a little bit about anatomy.

Anyway, the most common cause of snapping hips is when something called the iliotibial band passes over a protuberance on the femur (commonly known as the thighbone) called the greater trochanter. The iliotibial band is a fibrous band that runs between the gluteus maximus (commonly known as the butt muscle) and tensor fasciae latae (which doesn't have a common name, but I used to teach it to my students as the 'angry coffee muscle' and that seemed to help them remember it), and inserts into the top portion of the tibia (commonly known as the shinbone). So it essentially runs from your butt all the way down the lateral (outside) portion of your thigh. Other tendons may also cause snapping hips, and this type of snapping may eventually cause problems, but it may not.

Another cause of snapping hips can be damage to a structure called the labrum, which lines the socket of the hip. The labrum is like a rubber seal on your hip joint, helping the head of the femur remain secure within the acetabulum, the major depression within your hip bone. In essence, it adds stability to your hip. The type of snapping due to a torn labrum is often associated with pain because cartilage can get stuck in the hip joint.

For a more detailed explanation and diagrams, see: http://orthoinfo.aaos.org/topic.cfm?topic=A00363

I outgrew my childhood snapping hips at some point, although I can't remember exactly when. However, I did have a lot of pain in my hip flexors in high school, and now that I know what I know, perhaps this was actually pain coming from inside the hip joint manifesting itself as muscle pain. On the other hand, as a competitive gymnast for many years, I'm sure it's also possible I just injured my muscles, because there was a fair amount of muscle injury that happened, too. But never mind that, this is just about my hip. :)

I did not give much further thought to my hips until 1999, when I was 24. After many years of gymnastics, I switched to diving (the type where you do flips in the air) in college, and after a brief dabble in elite-level diving and intense training, I finally gave it up (actually due to back pain, but never mind that, this is just about my hip :)). I decided to try running to keep in shape, even though I hate running any distance over 50 meters. (Seriously, I think I'm 100% fast twitch muscle, plus I have exercise-induced asthma.) When I started running, I got massive hip pain, to the extent that I could literally barely walk the next day. This was a change from my previous hip problems, which felt more tendonitis-y rather than extreme acute pain (though admittedly I have had tendonitis in my heel that was extreme acute pain). Oddly enough, the pain, although extreme, was very short-lived (about 24-48 hours), and after a few days I was literally totally fine, as if nothing had ever happened at all. I think the first time it happened, I was sort like WTF? I actually thought it might just be psychological - I hated running so much that I created the pain to give me a reason to stop. However, after the second or third time it happened, I finally called an orthopedist.

Of course, it took me a month to get an appointment, and by then I was fine. The orthopedist acted annoyed that I was wasting his time when I was actually not in pain, as if it were my choice to wait for a month before getting an appointment. He then proceeded to slap the X-rays of my hips up on his light box and tell me that what he did know was that I had extremely shallow hip sockets, and that it was likely I was going to need a double hip replacement by the age of 30. Ummmm, okay. At the age of 24, 30 seemed like some really old, far off age, so I don't think I took it that hard; at least, not nearly as hard as I would now, if someone told me I was going to need a double hip replacement by the time I was 45. Nevertheless, I didn't feel as if shallow hip sockets were an adequate explanation for my then current plight, and after one month of waiting, plus several more hours of waiting in the waiting room, I felt that I needed a better explanation. After I got him to hear me out, he said that based on my description, his best guess was that I had a torn labrum. This could potentially cause debilitating pain at times but be fine at others. However, I never got a sure diagnosis; to do this, he wanted to inject dye into my hip. (Uh, no thanks.) The other option he offered was that the next time I actually had the pain, I should come in and have anesthetic injected into my hip joint, and if that took away the pain, it could confirm that the problem was coming from inside my hip joint. Between the double hip replacement spiel and the dye in the hip and general 'you are wasting my time' vibes I got, I decided to take matters into my own hands and just stop running. Not running served me and my hip well for the next 14 years. Also, because it was 1999 and the Internet wasn't nearly what it is now (I only had Internet access at work), and because I was not yet a biology geek (that came later), I didn't give it much thought for a long time.

I know that I had issues on and off over the next decade, but they never lasted long, and I always returned to complete normalcy after any episodes, much like when I was 24. In fact, the only reason I know I had issues at all is because I remember mentioning to someone at some point that I thought I had a torn labrum in my hip. The person remarked that if I had surgery to fix it that I should be sure to go to Stanford to have it done. (We lived in California at the time.)

So fast forward 14 years from my first real hip crisis. Sometime mid-semester in 2013, my hip started to pop when I walked. Unfortunately, when the popping returned this time, it was accompanied by pain. At first it wasn't a lot, but enough to be annoying. I didn't think much of it at first and figured it would eventually go away, as it had in the past. When it didn't, I started to get slightly more aggressive about dealing with it (which for me means taking Ibuprofen and icing it). After a month of my slightly aggressive regimen, not only was my hip not getting any better, it was actually getting worse and worse and worse.

By January of 2014, I was in serious pain. The following is what I wrote in my journal mid-January of 20l4*:

I can seriously not walk without extreme pain! It's like the pain I used to have back in my 20s, only I am now in my third week or so of extreme pain and there is no sign it is going to get better. I. am. miserable. I have not gone to a doctor because I guess deep down I know what it is and I can't deal with that right now. I just read a very depressing journal article** on labral tears, which sort of confirmed my worst fears and reaffirmed some things I sort of already knew about labral tears after gathering info on and off for 15 years. One is that surgery is often not successful. I just remember someone in California telling me that if I did have surgery, I should go to Stanford to have it done because apparently it is tricky and the outcome really depends on your surgeon. So clearly I had some issue with my hip in CA, though I really don't remember, I just remember the comment about Stanford, but at the time I wasn't considering surgery, so it was like, eh, whatever. Unfortunately, I feel right now that something has to be done, and it's not even like it can necessarily wait. It's /that/ extreme right now. I guess I sort of envisioned doing something like physical therapy and then considering surgery later, but the review article I read said that PT is often not helpful, which does make sense considering PT mostly strengthens/stretches muscles, and the problem isn't muscular. As the orthopedist I saw in my 20s explained, the pain can manifest itself as groin pain (which actually explains a lot of what I've felt over the years), but there is nothing wrong with the muscles themselves (or if there is, it's just a side effect from the actual problem). So while PT might help alleviate SOME of the symptoms, basically... it won't help. Ugh, depressing.

So I tried to find information about surgery, thinking how bad could it be? Like, people have total knee reconstruction now and still make the Olympic team 10 months later, so how big a deal could hip arthroscopy be? I was thinking, hmmmm, maybe I can hold out until spring break and have it then, but from everything I've read, in the best case scenario, you can't walk for at least three weeks, and it's usually more like 6-8 weeks before you're totally ambulatory again. WTF? I mean, it makes sense, because the hip joint is a major joint, and unlike other joints you can't immobilize it and still walk, and the major movement that needs to be avoided after surgery is hip flexion. Nevertheless, I guess I was just... hoping.

So basically I am miserable. So far, Ibuprofen, icing, and stretching on my own are doing nothing, and it's possible PT won't help, either. I can't consider surgery right now; honestly, there is no way I could do my job on crutches.*** Even if I could consider surgery, surgery might not even help! And while the thought of trying to tackle a semester while recovering from surgery is daunting, the thought of spending the whole summer recovering from surgery is REEEEAAAALLLLY depressing. At the same time, I have to do something. That's the reality that is sinking in that's making me freak out. The other really depressing thought is that I'll become so crippled I won't be able to walk anyway (seriously I'm almost there). At the rate I'm going, it is quite possible I'll end up on crutches not because I'm recovering from surgery, but just because I can't walk. WTF, people? I'm 39 years old! I'm way too young for this.

* I'm sharing direct entries from my journals because I think these best capture what I was feeling at the time. However, the things I wrote here are not necessarily accurate or rational.

** As an academic, I always feel the need to back up what I write with a citation, but in the interest of full disclosure, I will say that I do not know what journal article it is that I read that led me to write this hysterical journal entry.

*** As someone pointed out to me, obviously I COULD do my job on crutches; it's not as if I am a roofer or a cleaning lady or ski instructor or some other job that really does require 100% able bodiness, but teaching at a university level is tougher than some might guess. My students hate me enough already; the last thing I need is an additional handicap.

A few other random things about me to conclude this introduction:

1. As a kid, I was extremely flexible. My natural flexibility led my mom to put me into gymnastics classes at the age of 2. I was flexible all over, but most notably in my hips. I am not sure if that contributes to my current hip problems, it is just a fact worth noting. I was considered very flexible even for a gymnast, who tend to be way more flexible than your average Jane. My coach used to make us do something called 'over-splits' every day at the end of practice; this involved doing the splits, only with one leg on a stack of mats at least a foot high. Then my coach came around and pushed us all down until we begged him to stop. We all called it 'The Rack,' and it pretty much made everyone cry except me. (Don't get me wrong, it definitely hurt me, but not to the point of tears.)

2. I think I have a pretty high pain tolerance. I mean, I guess there is no objective way to measure pain, and as a scientist, I prefer objective measures. I have none of those to offer. It is just that my life experiences have led me to believe this is the case. For instance, one time I was experiencing mildly annoying pain in my foot that lasted long enough for me to eventually go see a doctor about it. It turns out that I somehow managed to break my foot, although I don't know how. (The insurance company had a hard time accepting this, too, so eventually I told them I just slipped on some ice, and that seemed to make things better.) I do not mean to be gloat-y or anything, it's just to say that if I'm feeling pain to the point where I do something about it, that pain is pretty bad.

3. While I can tolerate physical pain pretty well, I am a total wimp when it comes stress. If I'm in pain, I feel like it must be something at least semi-serious (which causes me to freak out). On the other hand, if I tell you I am stressed or freaking out, just ignore me. I'm always stressed and freaking out; it's my default state. It's something I am working on, but it is a slow process. 

4. I do not like going to the doctor. Actually, to be more specific, I don't usually mind the trip to the doctor itself, it's just that for whatever reason I have a really hard time making appointments. I put it off and put it off and put it off. The same goes for dentists. I haven't been to a dentist in about 15 years, and before that trip to the dentist I hadn't been since I was a kid. I've spent most of my adult life without a PCP. I'm lucky enough now to have a great PA who understands me, but unfortunately she is moving.