Thursday, April 10, 2008

Why I Still Don't Think My Psoas Needs to Be Released

I have been experiencing pain in my psoas with some snapping, and no, it is (still) not pride that keeps me from running back to my OS to have it released. My feelings still hold true in my case, and in many cases regarding releasing tendons.

Many of you have asked me why I was so adamant about not having my psoas released. No, I am not a psychotic bitch who wanted to make my OS absolutely crazy, or an arrogant PT who thinks she knows everything. Firstly, I knew with all my heart that it was not the root of my problem, so releasing it would not have abolished my pain, and I was 100% correct in that, as was found on arthroscopic examination. Another point, for me, is that I have a hypermobile SI joint, which periodically gives me problems. All of my surrounding muscles are extremely tight, hamstrings, TFL, ITB, Piriformis....My feelings are that my muscles tighten to protect my SI and maintain in correct alignment.

My right hip is the one giving me the psoas issues.This is the "revision hip". This hip now has a tremendous amount of ROM, compared to pre-op, and compared to the contralateral side, since a lot of bone was taken down. Don't misunderstand, I love the way it feels now, but, my body has never functioned in this range before, it "thinks" that I now have an unstable hip, which in comparison to pre-op, I do. My ROM values are normal and not indicative of a hypermobile hip, yet I do not have the neuromuscular control yet to feel stable there. Initially, my adductors were tightening and going into spasm to stabilize. Once I strengthened them well (with a few knee blips along the way), they fared quite well.

Then my ITB went haywire, and still does occasionally, but I had been doing a lot of abductor strengthening as well. Psoas is now playing into this and making sure to get its share of the limelight. I am hoping that my new found love of Pilates will help with the neuromuscular control I need in the right hip, to help the entire joint stabilize and function well.

Lets just say, I did not have this realization, and decided that now would be a good time to have my psoas released, since it is acting up, I would most likely end up even more unstable hip and would probably begin to have problems with my ITB or maybe the adductors again. This would lead me down a vicious path of multiple releases. Even if the releases are not surgical, but rather manual (PT type) releases, things don't always work out so well, as I experienced at another course I took. It is imperative to retrain the muscles properly to avoid this and to re-educate the joint. Neuromuscular re-education needs to be a huge part of rehab, not just bridges, straight leg raises and clam shells.

I know I am having issues because I have not been the most compliant patient with my PT, especially after the MCL incident in December. But, I am pretty fed up with hip issues, so maybe I need to stop writing and get my butt into Pilates gear!!!

Disclaimer: This is in no way meant to be printed and brought to your OS to negotiate a tendon release (tenotomy), every case is different and every body is different. This post (and the entire blog) represent only my opinions, are not medically or scientifically backed, but rather, me venting and sharing personal ideas and experiences.
I will get off of my soap box now.

16 comments:

Anonymous said...

Hmm.. I won't print it for Dr. Kelly... I'll just send him links to various posts...

Ha Ha

Anonymous said...

Susie,

What sorts of things can one do to accomplish the neuromuscular reeducation?

I'm currently scheduled for a partial psoas release (surgery 3 on the right) and possibly psoas bursectomy for lingering searing hellish pain (injection into hip joint yesterday didn't do much so a funky labrum area may or may not be debrided, I'm pushing for debridement just in case because I don't want a FOURTH surgery). My pelvic doctor as well as my PT, who I trust and respect, also dislike the partial release idea, but I've been in PT for a year and had 2 surgeries and am still a disaster. I'm kind of desperate at this point...also, I'm assured by my surgeon that I won't have any permanent weakness from the partial release, and the temporary shouldn't last too long post-surgery. He also says the worst post-surgical pain happened with my FAI bone-shaving surgeries, and this one won't be as bad. BUT, I'm still on the fence...

If anyone has had the psoas partially released, please post and share your experience!

Anonymous said...

i am scheduled to have mine partially released in mid may...this is on the hip that is having a revision. prior this hip had a labral tear only debrided and now i am going to have the retear fixed and the fai addressed along with the psoas.
soccermom

Susie said...

Laura, did you have the psoas injected? If so, did it help? did the joint injection help at all? Are you still in PT? If so, have your PT manually release (not just stretch) your psoas, which is SO important post-op, followed immediately by some resisted PNF patterns, once it is released, exercise it so it learns to function at that length....just a thought. My "deal" with Dr Kelly was that if needed, he would do a psoas bursectomy and NOT release the psoas, kind of a good compromise, he ended up not doing that either once he was inside since the whole area was fine. Lots of luck!

Susie said...

Amy- I think Dr Kelly would appreciate my opinion, especially me not wanting to seem like a psychotic bitch!! Although it may be too late to change his mind!!! hahaha

Anonymous said...

So, I SHOULD print this and hand it to him at my 3:50 PM appointment so he can harass you at your 6:10 appointment. Maybe we should bet cupcakes on what he will say... You would be the psychotic one that hangs out with the crazy one and together devise plans to drive Dr. Kelly nuts!!

Amy

Susie said...

It would make for an interesting discussion!

Anonymous said...

i wish i understood this whole psoas/IT thing. i have that horrible clunk and it is doing it now way more frequently than ever before. that thing pops everytime i sit, lay down, and sometimes when i walk. it gets my whole thigh aching. any good reading you can suggest? what's the diff between psoas and IT band? hate to sound stupid, but like i said, if your kids are ever sick...call me!!! :)
soccermom

Anonymous said...

I have no idea about this clicking,popping, clunking in the hip joint....I sure hope doctors know....Are they sure it is the Psoas? what if its the labral tear coming in contact with the FAI. Also, some have pain with it and some dont...What does that indicate?? Not tight enough- LOL
Why would it get tight in the first place... I hear a psoas release comes with a long recovery and no muscle strength in the leg. Does anyone know how a Psoas release might affect the spine, since it starts at T12 ??

Susie said...

Soccermom,
The psoas is on the front of te hip, the ITB runs down the side and attatched distal to the knee. Sometimes, you can stick your hand in your pocket, reach forward and feel the psoas click. Mine also clicks when I sit down sometimes.
Onto a peeds question- how terrible of a mother am I if I can't get it together enough to give my kid amoxicillin b.i.d. for 10 days, we are on day 11 with ALOT left!!

Anonymous said...

uhhh, what was he being treated for? if it is ears, you should probably do a "recheck" after he is done with them for a few days. also, sometimes they send out more than what was needed--has to do with reconstituting it and "kid spillage" issues. you will probably be ok, but you just added to the world of resistent bugs :)

my IT must also hurt, i always thought that was bursitis from all the funny walking i am doing. i definately have the wonderful snapping psoas phenomena..it is getting worse and more painful. but then again...i am just fed up!
soccermom

Anonymous said...

Soccermom,

Are you referring to a full psoas release? My understanding is there is a difference between a full psoas release and a partial psoas tendon release. My understanding was that with a partial release, which I think is what most hip arthroscopy surgeons do on those of us with psoas problems in conjunction with our FAI/labral/etc. problems, did NOT cause a lot of weakness at all. Also, my surgeon said recovery from the partial psoas release is EASIER than recovery from the bone-shaving FAI work..what is true!?!?

Anonymous said...

laura: have never had the psoas done before, but have had the fai surgery...recovery was fine. i am going to have a zplasty on the psoas with the fai this time...zplasty is just a lengthening. i am not certain how much weakness will remain after the zplasty...susie probably knows...she is WAY smarter than me with this stuff!!!
soccermom

Susie said...

I dont know quantitatively how weak you will be, I know I was weak in the hip flexors each time post-op with NO psoas release. But I think I had a slow initial recovery compared to most.
BTW-How bad is it if I give amox 1x/day.....better than none I hope!!! Isn't the newest "ides" not to treat ear infections with abx????

Anonymous said...

well....you aren't really treating it. some say watch and wait with ears, some treat--i've done both. certainly you are not the first to undertreat with amox for ears...trust me it has been done before!!! :) if the infection comes back...you will have to go to either high dose amox or another drug as it may become resistent to the lower amount of amox. you can call your pediatrician in the am and see what their office says to do...i would probably do the f/u visit to recheck those ears in a couple weeks. just to make sure it is all cleared up and there is no leftover fluid back there. especially if this isn't his first or second ear infection. i think you said he is about 2....so a lot of speech development going on.
definately f/u if the fever returns, pain returns, ear drainage, acting sick, or you think something is going on (how is that for a disclaimer?) next time ask for once daily dosing....there are drugs like that for ear infections now (like i said, you are not the first parent to miss some doses).
soccermom

Susie said...

The way the psoas effects the spine seems to eb controversial, if you are interested, check out this article- http://www.medscape.com/viewarticle/542466_5