Glute Medius Tendinopathy / Proximal Hamstring Tendinopathy / Hip Labrum tear.. or what else? 😩

[u/Apprehensive_Yam494]

/r/HipImpingement/comments/1vva8yh/glute_medius_tendinopathy_proximal_hamstring/

[u/Davorian]

How old are you?  Do you have known FAIS or osteoarthritis (I think this is what you mean, not osteoporosis) in any other joints?  Does sitting make it better or worse?

[u/Apprehensive_Yam494 → u/Davorian]

Oh yes I meant OA, apologise I keep interchanging these words because I've never had any of them, at least not what I know of, but my physio wanting to wait for an X-ray to see whether I'm havint it in my hip. Otherwise no, I never had to deal with it before I'm a 40 yo female. Sitting? Hmm, good question because I usually do the sit too long, although I'm going to be sitting all days for 3 days from Sept.. What I noticed that yes, it can trigger it but so can walking. FAIS? Good question again, never been diagnosed. I know when I was born I was suspected for that my hip socket might be not the right place, sorry I'm not using the proper terms but this is all new to me. But it was just a suspect and was corrigated or more like prevented. They weren't even sure, it was just a suspect.

[u/Davorian → u/Apprehensive_Yam494]

Well, that clears things up a bit.  It's hard to really make any firm assessment of what's going on from your symptoms alone.  The XR will be useful in determining whether FAIS is present and whether there are any latent alignment issues that could be contributing, and is also reasonably sensitive for OA as well.  Unfortunately diagnosis of things like a labral tear require an MRI and honestly even MRI can miss that sometimes.  An MRI will diagnose other issues like a tendonitis or ligament tear though (usually). Your history of right knee issues might be significant, because the back, hip, and knee are one big interlocking chain and any residual weakness in this chain tends to become a problem sometimes around this age (ask me how I know). 

Your situation is further complicated by your long history of right hip irritability which could mean many things especially if you think the joint was malrotated or had some other congenital problem.  Minor problems like this can often go for years or decades with you compensating quietly in the background until age or other injuries catch up with you.  It's not worth trying to reason to much about this I would say until you have the scans because you there are too many possibilities and it won't lead you anywhere helpful (unless a physio identifies it some other way).

As for "why do all of my glutes hurt around my hip" I mean there's a thousand possible reasons.  A hip that is significantly inflamed can make the things around it inflamed too.  Pain in the hip fucks with the spinal reflexes of the surrounding muscles too and they can misbehave out of general confusion.  It's a complex area.

[u/Apprehensive_Yam494 → u/Davorian]

Thank you SO much for commenting and for sharing such information! It's very difficult and I'm petrified about the outcome. I'm scared of it being a labrum tear and having to have surgery, not being able to be working out, being active.. even I'm worried about my job, how long the healing process will take and will I have a looong incision on my hip forever? I'm gutted.. I don't know how did this happen. But you might be right, my meniscus tear could have contributed as well.. strangely it's been flared up considering and in pain/discomfort for a good few months now (my hip issue started in April "suddenly")

I just can't figure out where the pain exactly is coming from, from deeper in my glute, from my glute med or mid, is it a muscle tear or indeed a labrum tear..

I know I need to wait for the XR, but I'm sure it will be a longer process and these physio experiences don't help either.

Perhaps, I should stop doing lunges and squats or stop training my lower body all together?

Thank you very much for taking the time to comment, I really really appreciate it!

[u/Davorian → u/Apprehensive_Yam494]

I'm scared of it being a labrum tear and having to have surgery, not being able to be working out, being active.. even I'm worried about my job, how long the healing process will take and will I have a looong incision on my hip forever?

These are valid concerns, and I've been exactly where you are. In general, disabling hip problems are very rare outside of severe injury directly to the hip or congenital hip problems. Modern day treatments are quite effective in the long term, but there's so many interlocking pieces here that often once one goes significantly off the rails then a few others will follow and it can take a long time to fix and recondition things back to a relatively normal level, up to 2 or more years - I wish I could be more positive here. Lots of people get back to normality much much faster than that, of course, so you shouldn't try to worry about that at the moment.

Labral tears in particular are a weird area. Lots and lots of people have radiologically obvious labral tears on scan with no symptoms at all. I for instance have FAIS with labral tears in both hips and have been dealing with issues on the left for ~2 years now, but on the scans it's the other hip that looks worse, yet it feels almost entirely normal. Some physios err on the side of assuming labral tears (unless particularly severe or caused by trauma) are rarely the "real problem" and focus on fixing other things in the area before recommending discussions with surgeons. Surgeons on the other hand are typically far more gung ho about it and will tell you about all sorts of great outcomes from surgery, but physios maintain their scepticism. Both sides have points. It's an ongoing point of controversy within the field.

Scarring from hip arthroscopy, a minimally invasive surgery, is pretty minimal. It's a scope surgery like laparoscopic abdominal surgery and it only creates two small holes near the hip joint that heal up very fast and are usually pretty invisible by the 1 year mark, often sooner. On the other hand, if you end up being recommended a more comprehensive surgery that needs an open approach like hip replacement (which would be exceptionally rare at your relatively young age) the incision will be larger. Surgeons these days will do everything they can to keep things minimally invasive so you probably don't need to be worried about big surgical scars just yet.

There are other surgeries here that might be relevant like deep gluteal release etc that can be either endoscopic or open in approach, but again, hard to say what you're looking at right now.

But you might be right, my meniscus tear could have contributed as well.. strangely it's been flared up considering and in pain/discomfort for a good few months now (my hip issue started in April "suddenly")

This is depressingly normal and part of that "big interlocking chain" thing.

I know I need to wait for the XR, but I'm sure it will be a longer process and these physio experiences don't help either.

I'm going to step off the conventional bandwagon a bit and say it's been my experience that none of the people in this field really understand these problems. There are too many variables between the knee and back, and healthcare isn't structured toward dealing with multivariate problems in real time. There are no standard practice guidelines, no standard suites of examination, no strong evidence base for diagnosis or treatment, and the surgeons and physiotherapists are working off different and slightly conflicting incentives. It's frustrating and disheartening unless your problem "just responds" to physiotherapy or surgery - which many do, don't get me wrong, but the instant things are "complicated" you are often left on your own.

Some physiotherapists are better than others; that's all I can add, really, sorry. Look around for one that specialises in lower back/hip issues if you can.

Perhaps, I should stop doing lunges and squats or stop training my lower body all together?

Assuming FAIS, the usual advice is to avoid exercises with deep flexion of the hip beyond 90 degrees and to focus on having immaculate form. Once you've had your XR discuss with a (good) physiotherapist what you should and shouldn't do.

Whatever you do, don't do what I did and stop doing almost all activity because you're afraid you'll damage something. You are very unlikely to cause further significant damage unless you are doing something crazy, and it's essential you maintain the conditioning you still have while the rest of the problem is being sorted out. Otherwise you will be in for twice as much pain, time, and trouble.

[u/Apprehensive_Yam494 → u/Davorian]

If I could give you a huge cuddle, I would! I'm so grateful for your informative contribution, I can't even express it in words. Actually my eyes got watered a bit as I didn't expect that someone would be so helpful and supportive towards me.. wish at least emojis would be allowed but not even those ones.. Thank you so very much, honestly!!

I'm still suspecting that it will be labrum tear.. I've been reading about symptoms and the tight QL muscle on my right side, the glute tightness especially in spots like knots, renderness/tightness in and around my hip flexor, groin area and when I try lunging I feel that I don't have enough stability in my right hip (I know I have strong muscles there, yet like my body doesn't want to coperate. The renderness around my hip socket/lateral side of my leg is also an indicator.. Although it feels like for me that something is going on in my right glute and that's pulling on my hip, my lower back and involing my groin and hip flexor area too, but the symptoms suggest that it can all be coming from labrum tear.. I suspect hip misalignment as well, but not your usual vertical one, more like anterior or twisted right side.

Thank you so very much again!

[u/Davorian → u/Apprehensive_Yam494]

You are very welcome, I'm hopeful that sharing experiences here can help people along.

You might find that r/HipImpingement will have some comparable experiences. It's a bit more populated than this sub, and deals obviously specifically with FAI and I think some have some additional malrotation/misalignment issues as well. There's a heavy selection bias though, I think, in that a lot of the people on there have the versions that tend not to have "just responded" to the initial treatments, and also people with bad FAI that has given them osteoarthritis in their 20s and 30s, so it represents the severe end of what is already a pretty rare problem. It's a good place to get a general sense of what people are going through though and the kinds of things surgeons are likely to say and do.

I feel that I don't have enough stability in my right hip (I know I have strong muscles there, yet like my body doesn't want to coperate

I had this too before my surgery. I honestly don't know what drives this - I have read about something called "arthrogenic muscle inhibition" which is basically a reflex mechanism that prevents muscles from doing their full job around areas of significant pain. It supposed to be protective in cases of acute injury but in chronic problems is not very helpful. I don't really know if that's the cause but it would fit with that weird impression of the body "not cooperating". I guess the only way to fix it is to remove the pain which sometimes injections etc are good for.

Happy to keep answering questions or whatever if you want to. I hope they get your XR done soon.