# FAI Femoro Acetabular Impingement



## jezhkrider (Mar 22, 2006)

Hi,
I have just been diagnosed with FAI, which causes pain in the hip joint. It came on about 16 months ago, I thought it was tight muscles and ignored it. Having spent 3 months off the bike with a neck injury and the problem still be present and getting worse i guessed it was not muscle realted, its not. Basically the ball and socket are mis matched and cause rubbing of the cartilage, and ultimately arthiritis, none of this nice. Surgical intevention would appear to be the only sollution.

The Surgeon said that this is a common issue with cyclists, any of you guys had, or heard of this and any related treatments?

Thanks,
Jez


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## robdamanii (Sep 27, 2005)

Consulted a sports doc yet? It only came on a year and a half ago, but the degenerative process is likely pretty advanced to begin to cause symptoms. 

I'll probably be crucified for this, but consider a good chiropractor with experience in extremities and sports treatment. Perhaps a few adjustments of that hip will at least alleviate your pain and allow you to function without surgery. Nutritional supplementation might be worth considering as well. Worth a try anyway...at that point, I'd do pretty much anything to avoid going under the knife for a hip surgery.


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## robdamanii (Sep 27, 2005)

Yet another double post. What's up with the server today?


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## jezhkrider (Mar 22, 2006)

Hi Rob,

Yes i have seen two sports Orthopedic Surgeons, both of whom confirm the diagnosis. I have had great sucess in the pasy with Chiro and Physio but fail to understand how either will change the shape and form of the bones that are causing the Impingment.

i agree that surgery should be avoided at all costs, however it looks like the options are from what i can see are:
- become a slob and do no activity to cause the impingment.
- carry on with the help of drugs, phsio and pretent its not an issue because i can't feel it and deal with the arthiritis when it eventulally come
- have an op hope all goes well and be back on the bike in 4-12 weeks.

There only seems like one option available to me?

Jez


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## pro-gravity (Oct 27, 2004)

Hey Jez,

I am quite familiar with Femoro Acetabular Impingement (FAI). About 2 years ago I was diagnosed and this past august I had open dislocation to correct the impingement. So far my recovery is going well. I could probably even return to riding, but want to take it easy before I get my other hip operated on (in May). Unforturnately, this bone deformity will not get better on its own. In order to delay (or hopefully prevent) hip resurfacing in the future, intervention must be taken as soon as possible. I highly recommend consulting a surgeon, who specializes in FAI. FAI can also be treated arthroscopically (less invasive and lower complication rate). A great messageboard for this topic is http://health.groups.yahoo.com/group/Femoroacetabular_Impingement/

also a list of qualified surgeons
http://hipuniverse.homestead.com/files/PAOSurg.htm

best of luck,
-Patrick


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## jezhkrider (Mar 22, 2006)

Patrick,

Many thanks for your post. You have confirmed my understanding, even though my Physio wants me to see what they can do, i just can't understand how moving muscles will re shape the bones?

I am seeing a hip specialist here at home but intend to use what he has to tell me to line an appointment up with "The man" in the UK who is a real specialist in this field. I have been advised by another surgeon to seek treatment outside of HK for this problem.

Can Cam, and Pincer forms be treated by Arthroscopy do you know? Obviously its a case by case scenario.

Thanks again, good luck with your recovery and future op.

Jeremy


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## pro-gravity (Oct 27, 2004)

Jez,

I know CAM can be treated arthroscopically, not sure about Pincer. 

-Patrick


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## slowtrain (Feb 17, 2007)

Same thing has happened to me, plus what looks like a success story (so far). a year ago, out of no where, serious IT-band, hip flexor and quad pain during/after cycling, with increasingly sharper pinching in my groin. PT didn't help and the MRIs confirmed FAI (cam-type) and labral tears on both hips.

8 days ago I had the arthroscopic version of the femoral neck debridement (grinding down the bone) and the labral tear repaired at the UMichigan hospital. I can tell immediately that the impingement is relieved and i'm very optimistic., especially in that they found no damage to the cartilage of the hip proper... i'm having hip 2 done in 4 weeks, and the expectation is that i'll be back on the singletrack by July.

i'll feedback more as i recover.

good links i found:
http://www.hipfai.com/
http://uuhsc.utah.edu/ortho/patiented/hip/hiptrtmt_faisdd.htm


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## jezhkrider (Mar 22, 2006)

Hows the leg feeling Slowtrain?

I saw the specialist here in Hong Kong who has confirmed i have mixed form FAI, with both Cam and Pincer forms. I have been told they can trat the CAM and Pincer using Arthroscopy. They can pull the labrum back and debride the Acetabular and do the same on the Femoral head.

Strangely, and against Dr instructions :nono: i went in for a race at the weekend, and beat my target time :thumbsup: . After no pain either. I have been doing some Pilates too this week which has really helped a lot. awaiting reply from the Surgeon i have selected in the UK to give me a date for the procedure.

Thanks,
Jez


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## slowtrain (Feb 17, 2007)

I am 2+ weeks post-op, and am so glad i did the surgery. I am on crutches (4 weeks of 50% weight bearing so the bone they whittled heals), and my leg aches, but i can tell it's corrected. I saw the scope pics of the ravaged labrum and the repair, plus saw the money shot where with my leg pushed up to my chest: no femur hitting the labrum!

I have already scheduled hip #2 for late March. My advice is that if they can do it scoped, go for it. every day and pedal stroke you wait is more tearing of the labrum and eventually, destruction of the cartilage in the ball and socket.


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## jezhkrider (Mar 22, 2006)

Slowtrain,

Hope the recovery contiues to go well.

I know have a date and conformation that all can be done by Arthroscopy.
I am having to wait a bit ( quite typical in the UK ) till the end of May. i could have been on the table 2 weeks ago here, but would prefer "the Man" in the UK to conduct the procedure. I guess if he is busy doing hips he's going to be good, and as the old saying goes, "the best things in life come to those who wait" 

Hope all goes well for the next op in a few weeks, hope to hear that this one has produced the same positive results.

Cheers,
Jez


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## snook36 (Mar 26, 2007)

*I need a good surgeon*

Slow train, can you please tell me the name of your surgeon? I've just been diagnosed with FAI and no one does the surgery here in florida. I will fly anywhere to get it done if the surgeon is good. I am hoping to have the arthroscopy. Did your doc say you can go back to unrestricted activity after the rehab? I like to bike but running is my passion and I hope that I will be able to continue after all this.


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## jezhkrider (Mar 22, 2006)

Hi this is the link : http://health.groups.yahoo.com/group/Femoroacetabular_Impingement

there is a Dr in Colorado called Dr. Phillipon his name comes up again and again in this forum. Good luck


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## slowtrain (Feb 17, 2007)

*excellent surgeon*

i am fortunate enough to be treated at the Uof Michigan, surgeon Karl Schultz. fantastic. i just had hip number 2 done last Friday and I am already at work (though the leg/hip is sore!).

50% weight-bearing day 1 (it's out-patient via the scope) for 4 weeks, 2 weeks on a cane and after the 6 weeks i can start crashing in the woods again. should be better than new! hip #1 was 6 weeks ago and i can tell it's aok!

good luck


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## jezhkrider (Mar 22, 2006)

Good to hear of the success of your treatment. I have my treatment next week now its come forward. will report back.

wish you a speedy recovery and fun crashing in them woods when the time comes!


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## snook36 (Mar 26, 2007)

*good luck slowtrain*

Slowtrain, thanks for the reply. That is most encouraging and I wish you the best of luck with the recovery. I am compiling a list of surgeons through out the country that have experience. Hopefully I can find one that takes my insurance (Blue cross PPO by the way). I live in florida, so this is going to be a pain in the ass, but I'm going to do what I have to do. Slowtrain, did you have a CAM impingement or was it combined with Pincher?


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## jezhkrider (Mar 22, 2006)

Slowtrain Snook, how are you fairing? Just back from the UK where i had my op. Great surgeon, he did a Labral repair and removed a cam impingment from my right leg. I was up walking 45 mins after coming round, flew 12 hrs to HK 8 days after and feel so much better already. Due to the method of repair i am partial weight bearing for 4 weeks on crutches but have been told i can hit the static bike after 4 weeks, great news! what these people can do through the 'scope is amazing.:thumbsup: 

pls post how you are post op and in search of your surgeon.

Jez


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## jezhkrider (Mar 22, 2006)

Snook, have you located your surgeon?

Slowtrain how are you?

I am now 8 weeks post op, walking with no problem but find bending over the bars on the static bike a problem, sticking with cross training.


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## slowtrain (Feb 17, 2007)

life is good for me. I'm 10 weeks post-op on hip 2, 16 weeks on hip 1. feeling great and starting to ride harder. i know what you mean about getting down low on the road bike; still a bit uncomfortable, but i'm letting pain be my guide.

I am out of shape, and my pelvis/lower back/ legs all hurt, but i believe the skeletal issue is fixed and now it's just being old and fat and slow i'm battling! good lulck.


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## fauxpas (Jan 26, 2007)

*Fai*

Very interesting thread on the FAI! I too have been diagnosed with FAI in my right hip. I'm 49 y/o and I've had the pain off and on for about 2 1/2 years.The pain is certainly exacerbated by long periods of mountain biking. Being an operating room nurse (yes, a male nurse!) specializing in orthopaedic procedures, I've replaced literally hundreds of knees, hips and shoulders, and needless to say, total joint replacements are SERIOUS surgeries. I've chosen to have an arthroscopic debridement and repair soon because, as mentioned earlier, delaying the repair can lead to advanced arthritis and ultimately, the need for a total hip replacement! The results of total hip replacements on patients under 55 years old has been less than encouraging. In fact, the need to have a REVISION of that hip within 10 years is around 30%, that's too high for me!
So, it sucks that we were born with funky hip joints, but I think if we recognize the problem (there are still a lot of orthopaedic docs out there that aren't aware of FAI!), alleviate the impingement, then we should be able to continue biking for many years to come, with our original "funky" hips!:thumbsup:


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## pro-gravity (Oct 27, 2004)

*FAI Surgery Update*

Great Post. I am glad you are getting the necessary surgery to hopefully prevent the need for a hip replacement (or resurfacing) in the future. I feel as though FAI is more common than most people realize. Unfortunately people don't receive a proper diagnosis until there is too much damage in the hip to salvage.

Currently I am about 1 year (left hip) and 1.5 years (right hip) post-op from open (full dislocation) FAI surgery. This past month I have finally got back into mountain biking after a 2 year hiatus. Everything is back to normal. Best of luck with your surgery.

-Patrick


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## fauxpas (Jan 26, 2007)

*Fai*

Thanks, Pro-Gravity, for the vote of encouragement on my upcoming surgery. I believe I'll do well and hope to be riding as strong as ever before too long! Like you, I also have FAI in both hips, but for now, only the right side is symptomatic; time will tell.
It's encouraging to hear you are doing so well after your open debridements bilaterally, and it's good to hear your activity level is back to normal!
You're so right about people with FAI being diagnosed too late. My guess would be that a large portion of the hips being replaced today, could have been delayed, or possibly, prevented all together! 
So, my advice to fellow athletes, who do activities requiring repetitive motion, and suffer from medial hip pain: if your doctor tells you your x-rays are normal, be sure he or she is educated on FAI and knows how to rule it out! If they're not "hip" to FAI (sorry, I couldn't pass on the pun!), get another opinion!


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## pro-gravity (Oct 27, 2004)

I was only symptomatic in my left hip upon surgery. However, x-rays and a cat-scan indicated both of my hips were affected. Oddly enough my "good hip" had an even larger bump (impingement) than my "bad hip". I figured since I was eventually going to resume athletic activities it was best to resolve FAI in both hips before symptoms/damage arose in my "good hip". A MRI with contrast should give you a good indication if there is any labral damage in your non-symptomatic hip that should be addressed. Take care.

-Patrick


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## fauxpas (Jan 26, 2007)

The MRI does show a tear in the symptomatic hip, haven't done the "good" hip yet. I'm going to have the symptomatic hip injected with a little steroid/marcaine mixture next week. I'm hoping that will provide me with some restful nights, at least for a little while! Ride it like you stole it!


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## bidda (Jun 28, 2008)

*Fai*

New to this forum, but have read many posts on this subject. Have 52 yr old hips, 1 with FAI and want to know if there are riders out there >50 who've had surgery to reshape the femur to get rid of the impingement. I've read that most candidates are younger but I want to postpone replacement until that is the last option. I'm concerned about the limitations w/replacement vs reshaping surgery. Any info will help my decision making process.
Thanks, bidda.


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## sorehip (Jul 16, 2008)

*FAI Diagnosis- post op recovery time*

anyone gone through the surgery yet? I spent 3 months working with a physio to avoid surgery with no improvement- only decline in that time period.

I just want to know what the post op timeline is like for activities. I was a porfessional cyclist until this season when the muscle tightness, fatigue and pain in my hip flexor, inner leg, and outside of hip kept me from training or being strong enough with that leg.

will I be able to swim right away? trainer? walk? hike?
any information would be appreciated.


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## jezhkrider (Mar 22, 2006)

Hi, sorry to hear of your situation.

Yes, i have had the Arthroscopic procedure, had the bone debrided and the labrum re stuck back to the pelvic joint.

I would question what a physio can do to remedy a physical/ structural problem, yes you can try and ensure the femoral head sits right, but if the bone is rubbing the labrun because its deformed ( cam ) or the joint is overreaching and causing an impingement ( Pincer ) then its needs surgical intervention IMOP.

I had my procedure done on Apr 4/ 07, I was swimming 4-5 weeks after ( no frog kick ) and was playing tennis ( lightly ) in June. No limp after about June and I was back on the bike again in Aug from memory. I managed the steps on the great wall of china with crutches in May, its after the op that the Pysio comes into play.

Good luck if you go with the procedure, pick your surgeon carefully.

Jez


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## Sinecure (Aug 26, 2008)

sorehip said:


> I just want to know what the post op timeline is like for activities. I was a porfessional cyclist until this season when the muscle tightness, fatigue and pain in my hip flexor, inner leg, and outside of hip kept me from training or being strong enough with that leg.
> 
> will I be able to swim right away? trainer? walk? hike?
> any information would be appreciated.[/COLOR]


I'm in a similar boat. Trying to decide between doing surgery now vs. after ski season (I care more about skiing than mtg - I know that's sacrilegious here). I have a bone spur on my left femoral head which is what's causing the pain for me. If I were to schedule surgery today, it would probably happen sometime in September. Will I be strong enough to ski by December? Will I have to wait longer? Hmmm.


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## CrashCanipe (Jan 12, 2004)

I'm bringing this thread back up. I had FAI arthroscopic surgery on Dec 31st on my right hip. I was off crutches in 10 days and am in the middle of PT. I'm shocked by how good the recovery has gone and I'm back riding the stationary bike. 

Like many of the others that posted I had both cam and pincer impingement, labral tear and arthritis. My problems started after a crash in 2000 training for the Leadville 100. During the race I started suffering in the first few miles and struggled through the race. The next day I couldn't walk and have been the whole PT, Chiro, route. I had two cortisone injections that got me through the last two years of biking. Finally got it properly diagnosed a couple of months ago. Like many of you, i have the same problem in my left hip as well but don't have the labral issues and arthritis yet. I will probably put that off another few years.

I expect (hope) recovery continues to go well and I'm back on the bike on the trail in 3 months. I had never heard of FAI until i was diagnosed. I had the same pain as others - lower back, groin, IT band and knee. The change already is tremendous. I highly recommend the arthroscopic procedure but strongly recommend researching for the right doctor. I'm fortunate in that I live close to NYC and could go to the Hospital for Special Surgery that is world renowned. 

Good luck to those of you recovering. I would love to hear an update on your progress and any challenges.

Barry


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## Green Giant (Dec 19, 2003)

*Argh... I'm in the same boat and a bit nervous*

So for the past 10 months now, lower back pain, outside of the hip pain (IT band), diagnosed with a disc and bursitis etc.

Finally, pushed for a MRI which found a labral tear.

Diagnosed with FAI and they want to do surgery with a scope at U of Michigan.

However, I guess I'm a bit skeptical/scared.

First, I'm pretty positive that this started when I almost crashed my road bike and got my left leg caught to the side and then quickly behind me. This would explain the tear.

I had no problems on the right side until 8 months after the original problem which I attribute to compensating.

If both femurs look the same and both acetabulums do also, then really the only thing different is the tear, and the only side with real problems is the left.

I'm really tempted just to have the labrum tear fixed and see if everything else clears up.

The first surgeon almost seemed to come in with a preconcieved notion that the FAI was the only way to go, wants to shave down the femur, clean up the labrum and possibly shave down the socket. He also suggested an IT band lengthening and Bursecomy at the same time.

My MRI (both) clearly stated no bursitis seen? So, I felt this guy might have just been way overaggressive.

Am I wrong to feel like both sides should have the same problem if it is the FAI, after all the bone structure is the same, but my tear is on the left only and I think I know when it happened?

It's been extremely frustrating, lots of money spent and time both on and off the bike lost.

I have a second opinion lined up this week.

Furthermore, the FAI board on Yahoo really doesn't seem all that positive, lots of post-op problems, many without getting better etc...


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## pro-gravity (Oct 27, 2004)

*Fai*

You are correct that FAI is most likely present in both hips. The impingement can be seen by specific x-rays (Frog-leg or internal rotation). I also know exactly when my labrum teared, it was on a run. The pain wasn't even in my hip, it radiated to a part unique to the male anatomy. So the first doctor I saw was a urologist.

Since both of my hips had FAI I opted for surgery on each, even though only my left hip was symptomatic. I figured with my active lifestyle the other hip was going to have trouble down the road, so I might as well do some preventative maintenance and sure enough there was some labral damage in the joint when the doctor opened me up.

Your first doctor does seem aggressive, especially with the IT band, which will probably resolve itself once the FAI is addressed. And you do make a valid claim about Yahoo. But realize a lot of people tend to post negative comments looking for answers as opposed to the success stories, who have the peace of mind and time to partake in other activities. The success stories that I have noticed tend to occur with the more athletic patients, who have enough muscle mass and physical therapy knowledge to minimize the rehabilitation process.


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## CrashCanipe (Jan 12, 2004)

Green Giant,
My situation is similar to pro-gravity. If you are getting scoped for the labral tear, they should fix the bone as well. You are right in that you could be asymptomatic in the one hip and the other one could have been injured in a crash. That is exactly what happened to me. Both hips have the deformity which is normally in white, athletic males (according to my doctor) and occurs during growth spurts. I had mild lower back issues for years but nothing I attributed to my hips. It wasn't until a hard crash that I tore the labrum in my right hip. That is the only one I've fixed for now although like pro-gravity, it may be a good idea to fix the other one before too long.

When the doctor went into my right hip for the 90 minute procedure, it took 4 hours. The damage is not always apparent on MRIs and xrays. I saw cool pictures of how shredded my labrum was and there already was a ton of arthritis. But like I said in an earlier email, it is already much better. Of course while I'm limping around on my right hip, my left hip is starting to have issues.

There is a racer who has a blog of his experience that is still active with postings (you'll see one from me) at the following website:
http://505live.com/?p=187

Hope that helps. My own inclination is to get the arthroscopic procedure but I would be skeptical of the other IT bank/bursectomy "repairs".

Best thing is that insurance is coming around to covering everything. I have Aetna and my total out of pocket was only like $400. I heard that just a year ago, FAI was not a covered procedure so check it out before committing.


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## Green Giant (Dec 19, 2003)

CrashCanipe said:


> Green Giant,
> My situation is similar to pro-gravity. If you are getting scoped for the labral tear, they should fix the bone as well.
> 
> --- I'm considering getting the labrum fixed and seeing how it goes, and if it happens again getting the bone done. It just seems to me that the injury caused the tear, not the impingement
> ...


The insight is good though, this just really feels like a procedure that I want to research in a big way before going forward with any bone shaving.


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## sbstumpy (Jul 2, 2006)

Crap. I was just diagnosed with this.

I had the best season ever last year. ~4500miles, mostly road, with two centuries and two doubles. No pain anywhere except my low back, which is typical for me.

Over the fall I took it easy and then started base training with some running, yoga, swimming, and kept my cycling miles pretty low. My weight was down and I was in the best shape of my life.

Then the hip pain started in December and continued to build into January. Dull pain only after riding. Started to keep me awake at night. I took two full weeks off, but stupidly continued doing yoga/stretching through the whole incident.

Went in to the ortho (well respected sports med guy) and the X-rays show pretty clear FAI. He said he couldn't rule out a mixture of iliopsoas tendonitis/bursitis, but the physical exam also supported FAI.

Not sure whether to write this season off and do surgery or take a steroid injection and try to gut it out until fall.

Depressed. Maybe I'll just sell my kit.:madman:


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## slowtrain (Feb 17, 2007)

*beats being a couch potato*

It's been a few years since i had both hips scoped at the UofMichigan to repair my FAI (repair torn labrums and reshape the femoral neck so the damage wouldn't recur). I had my two hips done 6-8wks apart, which was a mistake, in that i was demanding too much from the first leg while recovering from the second. impatience is evil, as i then pushed right out of PT too quickly and had some minor issues for the eyar following.

now i am all good. the surgeries were the best choice (if the door is rubbing on the frame, eventually the hinge breaks). Committed and patient PT is crucial. it's just a few months (3-5), and better than living with the pain/causing more damage-arthritis.

I recall my first diagnosis: i was told if i was a couch potato, i'd never have become symptomatic. i choose life!


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## Zukfanatic (Apr 17, 2009)

Sorry to bring this thread back to life. I have started riding a lot more lately and have had some recurring pain as described above. I stopped riding for a few weeks and it has not gone away completely. Kind of wraps from my groin around my hip and down the back of my leg stopping at the lower hamstring before it gets to the knee. Not a horriffic pain, just bad achyness/soreness/tightness in that region. There is one spot on my inner/front thigh near the groin that is particularly tender though. I know you guys are not doctors, but do you think that it could be this FAI stuff or something less serious? I am only 29 and am not doubled over in pain, but it does pretty much hurt all the time except for when I have slept/rested for a while or have not walked up/down stairs for a while. All started when I had to do a takedown/restrain on someone who was disturbed and went down onto my right side. Then I did 12.5 miles offroad on the new bike over 2 days, and I think I might have made it worse...:madman:


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## TXmk (Mar 6, 2009)

I'm no doctor, but you may want to take some additional time off, rest and anti-inflammatories and then start back slowly.

I've been riding with a nagging hip pain for the past year. Thought it was ITB, finally went to see a PT for it - he figured out the issue immediately. After X-rays, an MRI arthrogram, and a trip to the hip specialist orthopedic surgeon, I'm scheduled to get my hip scoped in 2 weeks.

So, don't ignore and ride through those nagging pains, they may be worse than you think.

I'll post back after surgery. Hopefully back on the bike before end of summer.


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## sbstumpy (Jul 2, 2006)

Could be, but your symptoms don't sound specific for or against.

From what I've read, the pain can radiate various places, but one thing that consistently makes the pain worse is flexion of the hip past 90 degrees (like when you sit in a chair and bend forward). Part of the treatment for FAI is behavior modification to avoid repeated over flexion (raising your chair at work, adjusting your bike minimize the head of the femur bashing into the pelvis, no deep hip stretching like some yoga poses).

One exam test they did in the clinic was to lay me on my back and push my knee toward my chest past 90 degrees and then rotate the hip by pulling my foot away from midline. As they rotated the hip and pushed it toward my chest it recreated the pain.

But the diagnosis was a combination of consistent history, the exam and the Xrays that showed the bony prominence.

I suggest you go in and see an ortho who specializes in sports medicine (not just surgery). My pain got (at least temporarily) better with a steroid injection and this helped confirm that it was the joint and not a muscle/tendonitis. So far the steroids are allowing me to have something of a season on the bike.

Once I had the diagnosis, he referred me to a specialist who does the arthroscopic FAI surgery and I'll consider it in the fall if I can't ride strong throughout the season. Right now, 2 months after the steroids and with behavior mods, I still have mild nagging pain during rides but it hasn't slowed me down. I may even have another steroid 5-6 months after the first. I'd rather have surgery in the fall/winter.


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## TXmk (Mar 6, 2009)

I'm 2 weeks post-surgery for FAI in my right hip. Surgery went well, and the hip feels good - no real pain issues now, although I'm not using the hip much. I'm on crutches for 2 more weeks before I can start PT, or walking. I'm really encouraged by the lack of pain so far.

What's somewhat concerning is that my left hip/groin is now bugging me due to all of the time on crutches, using only my left leg. 

Does anyone know the statistics related to having this in both hips? If this occurs in 1 hip, are you much more likely to get it in the other? Hopefully, this is just muscle pain, time will tell.


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## ilovemtnbiking (Oct 26, 2009)

*no pain from FAI*

I just got diagnosed with FAI. I have no and have had no pain in my hips. I went into get stitches removed from my hip (mtb crash) and they took x rays just to be safe when they noticed I have FAI. The doctor said there is a chance it could never be an issue but said he needed to give me the low down in order to CYA in the case down the road I have issues. After doing research, I'm a bit freaked out. I also read that using pain as a guide can be misleading. Anybody out there like me diagnosed with FAI but still are riding without pain and confident they are not shredding their insides while riding?


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## tanchris (Aug 12, 2010)

Anybody else post-op?


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## TXmk (Mar 6, 2009)

I'm 3 months post op on my right hip now. The right hip feels quite good. It's better than the left hip. I do still get some soreness/achiness on the right hip if I go big on the bike. But, it doesn't seem to last long.

The left hip has been hurting since about 3 days post op on the right hip. It started with groin pains. I had an mri arthrogram on it this week - looks like another labral tear, with mild arthritis, and a cyst. Here we go again. I'm planning to have surgery on the left side before the end of the year.

For those considering the surgery, the worst parts of the recovery for me were:
- CPM machine for 2 weeks. Really difficult to fit in 8 hours a day for this.
- crutches for 4 weeks

I'm still having hand pain from the crutches. 4 weeks on crutches is a really long time.


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## breilly (Apr 30, 2008)

I just had surgery this past Friday (3 days ago) to correct FAI in my left hip. I had a tear in the labrum cleaned up and some of the femur shaved down to correct a CAM impingement. I feel much better than i thought I would. The day after I was on the trainer for 20 min to get my range of motion back. (docs orders) I will be having my post op appt on Wed to get the stitches out and will be starting PT this Friday. I will try and keep up with posting about my recovery. 

I was back and forth for a while on whether or not to have the surgery but it got to the point where I couldn't run for more than 20 min without having pain. It was getting worse and worse, and I am glad I decided to go through with it. I am pretty optimistic about the recovery and would like others to share their recovery stories if possible. I am hoping that I can start working on my base after a month or so. I can begin swimming again after 3 weeks, so that is another way I can get some cardio in.

My background - I am a CAT1 mtb and also do xterra's. Hip started hurting 2 years ago mainly when playing hockey. Progressively got worse to the point where I couldn't skate anymore and running was almost unbearable. Biking however did not bother me at all, but I enjoy cross training to much to be limited to only the bike.


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## breilly (Apr 30, 2008)

One Week Post Op -

Feeling much better than anticipated. Starting PT today, up to 30 min daily on the trainer with no resistance. Also down to one crutch and honestly I don't even need it. I am just trying to do what the doc says. When I went in for my post op appt on Wed - the doc was amazed with my range of motion and what little pain I have.


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## fauxpas (Jan 26, 2007)

*Fai*

Hello again fellow FAI sufferers! It's been nearly 4 years since I first posted to this thread complaining of hip pain, and diagnosed with FAI. After many sleepless nights, painful hikes/rides and 3 intra-articular hip injections, I finally had my right hip arthroscopy on Wednesday (12-14-2011)!
Though it's only been 3 days, I feel GREAT! Actually I've had very minimal discomfort since day one. I needed to have a labral repair done with the cam/pincer osteoplasty, so I am only 50% weight bearing on the operative side for the next 2 weeks. After that I'll be back to spinning!
As I mentioned 4 years ago, I've been an operating room nurse for 18 years, specializing in orthopaedics and spine surgery. The doc I chose to do my surgery (Dr. John Knight- San Francisco East Bay area) started doing these hip arthroscopies about 5 years ago, and I was part of the team that assisted on his very first case. So, for the past 5 years, I've been silently watching and waiting while Dr. Knight perfected his skills. When my mountain biking become more painful than enjoyable, I decided I had waited long enough!
My advice to those with hip pain: get X-rays and see an ortho doc who is familiar with FAI. If FAI is confirmed on X-ray, try to have the arthoscopy done at your earliest convenience. Delaying the procedure will only prolong the pain, take some of the fun (mountain biking is still fun even when you're in pain!) out of riding, and possibly (probably?) lead to a labral tear which will delay your recovery!
Five years ago FAI was a term unknown to many orthopaedic docs, now it is one of the fastest growing procedures performed. In the right hands, it can add many, many years to your passions!


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## breilly (Apr 30, 2008)

10 days post op - no crutches. Feel great. No pain meds, and barely walking with a limp. Had my first day of PT on Friday and I was doing things that "normal" people don't do until 3-4 weeks post op. My PT thinks that I could be totally unrestricted by mid Feb. I am not getting my hopes up, but that is great news considering going into the surgery I was told at LEAST 3-4 months. I am only doing what they tell me and not rushing anything, but I am up to 40 minutes on the trainer at the lowest resistance with absolutely no paid. I am still using flats and will continue until I get cleared to add so resistance.


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## breilly (Apr 30, 2008)

3 weeks post op - started swimming wed. Sat was so nice out I couldn't take it anymore. Just did my first outdoor road ride for a hour. Nice and easy and felt great.

If anyone is questioning whether or not to do this surgery - I would say go for it. My only issue is now my fixed hip feels better than my "good hip."


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## bill345bikes (Jan 8, 2012)

*fai*

After 40 years of cycling on a regular basis I have had to give it up. I developed hip pain (groin area) on the right about 15 years ago. A work up by a well respected orthopedic surgeon found no problems. Being a physician myself, I decided to "heal thyself." I stretched frequently and continued cycling but with some pain all the time that eventually got much worse. At age 61 the pain would no longer allow me to cycle or do much of anything without constant pain. I was diagnosed with fai-a diagnosis virtually unknown when I began having pain 15 years ago. By this time my joint was pretty much shot and I had to have a hip replacement. I felt I had a good result and started riding again a few months later but developed increasing groin pain. Turns out I developed heterotopic bone in my hip flexor (iliopsoas) tendon). Had surgery to remove a 3 inch piece of bone that grew in my iliopsoas muscle and tendon. Felt better after this second surgery and tried to return to riding but pain on my operated side got worse and then developed similar fai symptoms on the unoperated side. Decided to stop riding since the pain wasn't worth it and I didn't want to accelerate the damage on my good side. Eventually will probably require hip replacement on the other side as well. There is some controversy regarding surgery to fix fai. Many doctors believe the bony abnormality will just grow back. Lots to consider for you riders who continue to ride in spite of pain or return to riding after fai surgery. Good Luck!!


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## Ashley Fleming (Jul 13, 2012)

*FAI information*

Hello! I stumbled upon this forum about FAI and I wanted to comment and share my new blog post. I recently underwent surgery for CAM impingement, torn labrum and torn cartilage in my left hip. Before surgery I was a competitive triathlete and ran half and full marathons.

I am 7 weeks post-op and doing well so far. I still have some hip flexor pain, but I no longer have the hip pain I used to have. I am cleared to swim and bike for about 20 minutes and can do the elliptical and stair master along with some strength training. I had my post op appt. yesterday and the physician said I can jog in 3 weeks.

Anyway, I wanted to share my blog post because I interviewed my surgeon (Dr. Peter Maiers at Methodist Sports Medicine) and his physician's assistant. They answered some general questions about FAI that might help those of you who are wondering if you have FAI and if you do, what the next steps or options are. I was misdiagnosed for almost two years so I am trying to spread the word about FAI.

I tried to submit my post with the link to my blog post, but am unable to link to my website unless I post to this forum 10 plus times. The website is called Fitness Is Delicious and you can google it to find the name. The url is fitnessisdelicous dot com.

Best of luck everyone with their recovery and decisions moving forward!
Ashley


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## Dan Zulu (Jul 5, 2008)

*Surprised to find so many fellow FAI ninjas!*

Apparently my years of mandatory running ignorant of my FAI chewed on my labrum a bit. Fortunately I was diagnosed correctly on my first civilian orthopedist visit. Lots of previous posters in this thread deliberate on postponing the fix, but I saw one doctor respond with his cautionary tale of the risks of manning up. My doctor apparently agrees, and told me that if I did not fix my impingement now I might need bilateral hip replacements by the time I was 45. I had the right hip done this past April and will have the next hip done later this year. If any of you suspect FAI you'd be wise to go get checked out. I'm glad that I did.


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## nzumbi (Jun 22, 2004)

slowtrain said:


> plus saw the money shot where with my leg pushed up to my chest: no femur hitting the labrum!


Sorry to bring up old stuff, but that makes me a little giddy right there. I have Xrays in hand that clearly show CAM. No official diagnosis yet.

Anyone have anything bad to say about surgery? Any reasons not to do it?

Looking fwd to being able to get knee to chest, inward rotate, and actually stretch my right glut.

-K29r


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## Dan Zulu (Jul 5, 2008)

*No diagnosis?*

I just have to play devil's advocate and ask how you know the X rays clearly show CAM impingement if no diagnosis has been made yet? Maybe there is still a chance you don't have this problem.

As far as surgery my recovery is taking a while, but that's different for each patient. And recovery is better than letting the impingement continue to chew my hips ever worse.


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## nzumbi (Jun 22, 2004)

I have my X-rays. If I were to post a pic, you'd see it too. Bump out on the right femur head is clear as day. Fits with my lack on inward rotation. My doc is due to get back to me on Monday. 

What I don't have is any chewing going on, as far as I know. I can run, and I can ride, without any significant issue. I have little inward rotation though, and I can't get the right leg to my chest without it flaring out. End result is that I have nearly no way to effectively stretch my right glut. I suspect that things are extremely tight on that side, and my back is sore...a lot. Probably a lot of compensation going on.


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## Dan Zulu (Jul 5, 2008)

If you get the surgery to correct the impingement and gain ROM you might want to read the operation report. Mine told the story about the labral tears that were shaved or anchored, which weren't mentioned during my post-op visit. I'm definitely not symptom free but my doctpr did give me the approval to mountain bike again until my next hip gets done.


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## Dan Zulu (Jul 5, 2008)

I'm curious how everyone else's recovery from hip arthroscopy has progressed. I had my second hip done and now I'm looking forward to getting back on the trails in 2013 as much as possible. Does anyone have any recovery stories to share?


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## noflyzone_allstars (Nov 25, 2005)

Greetings Dan, A-Rod, and fellow sufferers. 

I am now 3.5 months postop on my left hip and 5 weeks postop on my right. 42 y.o. male, cam+pincer impingement, both labrums reattached and "some" arthritis found on both sides. My hips had been bugging me for about 2 years and I got the diagnosis at about the time hard, deep flexion riding became intolerable. I was (am?) a racer - XC, CX and road. Obviously can't speak to the long term outcome but at this point I am definitely glad I made the decision.

That said, this surgery, and especially the recovery, is no joke. I've had a knee scope and this is not even comparable. Left side, my hip flexor was essentially paralyzed for the first month and very painful. Right side flexor has been OK but I had some insanely painful adductor spasms the first week and now my lower back is super tight. I still don't have enough range on either side to stretch glut med or piriformis muscles which really need it. 

Worst, especially with 2 back-to-back surgeries, is just the mental grind of months of dealing with the discomfort, the daily time-consuming exercises and not knowing what level I'll be able to return to. My whole life and identity for 25 years was as a cyclist then, suddenly, it isn't. The last 6 months of my life have not been fun and I have several more months to go.

Best is that I know I will be able to ride again, maybe even stronger than before. Spinning on the bike is actually THE most comfortable thing for me - better than lying in bed, sitting in a jacuzzi or getting a massage. I was on the trainer 9 days after each surgery, on the road at 3.5 weeks and even jumped in a cyclocross race 10 weeks after the first op.


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## robinmbers (Dec 14, 2012)

yeah,I know CAM can be treated arthroscopically, not sure about Pincer.


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## Dan Zulu (Jul 5, 2008)

No Fly Zone, thanks, that's the kind of experience I was looking for. Based on my last post-op discussion it sounds like any regular running would be a very bad idea but cycling is ideal. I'm kind of debating the choice of whether I try to maintain some running proficiency to pass my military fitness tests, which will aggravate my existing cartilage damage, or not even try to run and let the Reserves either give me the timed walk or kick me out. I never ran for enjoyment, so as long as I can continue cycling for fitness and fun I'll be happy. My left side is 4 weeks post op and I have two more weeks of crutches. Right now my right side is 8 months post op and still quite sore so I'm hoping that more cycling (when I'm done with crutches) will reduce the soreness.


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## bike4mee (Jan 1, 2013)

Great forum! I have been riding for 30+ yrs and in the last 6 months have developed the dreaded "groin pain" It's worse after long uphill rides and sitting in a desk chair. My ortho suspects FAI looking at xrays. There is the bump on the femur. I'll get a MRI soon. My question is what about a partial hip replacement? I'm 57 yrs old but not ready to stop intense riding and hiking. I have a friend who did the replacement and was riding 10 days later. Anybody have a partial instead of the scope?


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## Dan Zulu (Jul 5, 2008)

*Partial replacement*

I haven't had any parts replaced but my orthopedist portrayed the hip scope as a method of keeping my natural parts as long as possible. I can always explore parts replacement later on if these two hip scopes don't prove successful.

My left hip, which was done 7 weeks ago and had much more damage than the right, is responding very well, but my right hip which was done 9 months ago still gives me a lot of trouble. Even if the doctor needs to do more work on my hips later on I'm still happy with the decision to try the hip scopes first.


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## L&A (May 29, 2007)

Hi all I am a 47 yr old female, former triathlete, runner, road cyclist, with my passion being endurance mtbing. Misdiagnosed 9 yrs ago with "sacroilliac dysfunction" and told to just live with the pain. Went on to race and try to be as functional as possible untill last winter could not stand the pain anymore. Had mri of back and pelvis when the torn labrum in left hip was found. Diagnosed with FAI in both hips with the left repaired in Nov.2012 and will have a labral reconstruction on the right as the labrum is to shredded to anchor back onto the acetabulum in June as I want to get as much recovery on my left hip as possible. At 3 mos post op I am back on the mtb doing short 15 to18 mile rides with elevation gain at 1500 to1800. Hip can only handle 2rides a week at this point along with pt exercises, short hikes, and pilates. Even though the surgeryand recovery is very hard and slow, up to a year before you are "as good as it gets", it sure is better than a THR! Most definitely recommend surgery as with the boney abnormalities, cam or pincher, there is no amount of pt of chiro treatment that is going to get rid of the impingement and magically rrepair the damaged labrum.


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## bike4mee (Jan 1, 2013)

my recent MRI is showing a little damage w/ the labrum. My bike friendly ortho doc suggests. Cortisone shot (if you get 6 months + then stay with that) >>> next a scope to clean up the tears >>>> next a resurfacing replacement. For younger people the resurfacing isn't a great option. The question is always how long do we prolong the eventual replacement of the pain producing parts? If you wait too long then you destroy too much and have to do the total hip replacement. Dont live with pain! the artificial parts will make you pain free and still ride at a top level.


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## mm9 (Apr 22, 2008)

I'm trying to decide whether or not to do the surgery. Was just diagnosed. It's been suggested that I modify my activities and do some physical therapy for a while first.

Here's my story - I'm 52. I was just diagnosed with Cam Impingement in my right hip and some damage to the articular cartilage. The radiologist called it a minor cortical irregularity involving the lateral aspect of the acetablular rim associated with thinning of the articular cartilage consitent with a grade IV Chonromalacia. No evidence of labral tear or detachment. No evidence of tendinosis, bursitus, muscle strain or hematoma. 

I can see the cam lesion on the xray and I can see some damage to the cartilage on the MRI. But, the marcaine they injected into the joint didn't make it feel better - same time the contrast agent was put in for MRI. Also, my internal rotation doesn't seem to be near as bad as the external rotation of my hip.

I play or practice soccer 2 - 3 times a week and have spent hours and hours over the last 8 years kicking a ball at a wall for practice. In addition, I ride mtb, dirtbikes, occasionally do some snow skiing and water skiing. My hip started hurting playing soccer - felt like hip flexor pulls a few times. Noticed it started happening after a hard hip collision in a game, where my hip hurt. But, later times occurred while sprinting or kicking. I also pulled the hamstring several times on my right leg over the last 8 years.

About to do a round of physical therapy. Doesn't hurt too bad when not playing soccer. Mainly hurts when standing for a while. Sometimes hurts when getting out of bed.

Are there any long term recovery stories on here? 3-5 years or more? Just curious how the hip is doing now?


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## bike4mee (Jan 1, 2013)

Hi
Try a cortisone shot first. I have the same thing as you and the shot is working. How long determines wether you need surgery or not. They can do a scope on that


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## WiTrailRunner (Mar 1, 2011)

Anymore updates or success stories from those of you who had surgery? 

I'm set to have surgery in March for a labral tear and possible FAI. I used to be an avid runner, but took up cycling in the past few years because it didn't hurt as much as running did.


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## Dan Zulu (Jul 5, 2008)

Well I can't provide a complete success story, but I can share an update. I've had both sides scoped, one side was too bad to repair so the surgeon shaved out the torn tissue and smoothed out the damaged cartilage. The other side, the right, was repaired with two dissolving OsteoRaptor anchors to hold the labrum back in place. This is the side still causing me problems 18 months after surgery. It hurts to sit for long periods of time, and on days like today gives me sharp pain that feels like the joint is cramping up. 
MRIs don't provide a lot of information when scanning a hip joint that has already been surgically modified, so the surgeon said surgery is really the only way to determine what is happening inside the joint. The diagnostic injections gave me relief for a few hours, which the surgeon said is enough of a positive finding to justify surgery. Unfortunately I now have other doctors debating whether my aorta has a lethal disease, or whether it is perfectly normal, so until they resolve that debate I am disqualified from further hip surgery. 

I suspect a lot of people who have had successful FAI surgery don't post on these threads because it isn't foremost on their mind anymore.


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## AlliKat (Apr 28, 2006)

WiTrailRunner said:


> Anymore updates or success stories from those of you who had surgery?
> 
> I'm set to have surgery in March for a labral tear and possible FAI. I used to be an avid runner, but took up cycling in the past few years because it didn't hurt as much as running did.


I had surgery 11/23/2012 and consider myself a great success. Surgeon Darby Webb in Boise. I had both pincer and cam lesions with a 2cm tear in my labrum. Both bone spurs were ground away. Three anchors were placed to reattach my labrum. While under traction they could see significant synovial condromytosis (cartage forming in my hip joint) which was removed.

I was off crutches 12/31/2012 and already working on the trainer. First outside ride in February. First road race in late March (Hammer at the Slammer 2013, race 3. Sprint Finish - YouTube) 3rd place for under 40 men 9-5 ultra marathon in June (95 miles, 12K vertial in 8 hours)

I wrecked in August in an XC race and broke my left side femoral neck and spent another 6 weeks on crutches. My repaired right hip got a bit achy on my longest days 2-3 weeks after injury while at burning man.

PM me if you have specific questions. This repair was a huge improvement for me.


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## AlliKat (Apr 28, 2006)

I had both treated by scope


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## WiTrailRunner (Mar 1, 2011)

Thanks so much for all that info, AlliKat! Do you feel like you're limited in any way post surgery? I just fear being worse off than I am right now, because I'm not that bad right now. I can run a little, bike a lot, but I always have that mild aching pain in my groin if I am walking or running.

I bike commute to work spring - fall, and it's a 32 mile round trip with some hills. I know I will have to give that up this spring, but I would love to be able to do it a couple of times a week starting in the summer sometime. How quickly did you build your miles back up on the bike?


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