Andrea: Athletic pubalgia Post-Surgery Weeks 3-6

See related posts: Surgery and Weeks 0-2

The rehab rollercoaster continues...

I feel like I am on a never-ending cycle: pain ("I'm never going to get better") - some relief / not too bad ("I'm getting better!") - aggravated / pain ("this is never going to end")... repeat X a million times.

The good news here is that the pain doesn't get quite as bad each subsequent cycle, the bad news is that I can't seem to truly improve in my overall progress level...and I am a mental basket case. 

Summary of Weeks 3-6 post-op:

The beginning of this block of time was not great. Quite frequently I had sharp pains in my left abdomen and pubic bone. The left SI joint felt out of place and I was constantly trying to pop it back into place. On the right abdomen, the seroma still had a ton of fluid and hurt a lot like the pain prior to surgery. I had small, tight bands of tissue on the right side that became more pronounced/painful with activity.

The steri-strips came off right at 3 weeks. It probably wasn't until a week later that I noticed that the end of the left incision had not completely closed. It would occasionally have a white discharge or bleed with redness around the area. I waited a few more days and then Dr. Meyers put me on an course of antibiotics to make sure this reaction didn't become a full blown infection. 

I started doing some mild stretching and massaging of the incisions and muscles. This progressed to more aggressive by the end of six weeks. I have been going to PT Danny 2-3x a week and that time is almost entirely devoted to soft tissue work on the adductors and incisions (...and talking me down from the ledge). We added many new exercises to my therapy as well.

By the end of week 6, the right seroma had decreased in size so there was only a little fluid left, although it still swelled during exercise. The left "reaction" went away and I finished off the antibiotics.

My typical day:

Morning - heat, massage, and stretch
Afternoon - walk, bike ride, and/or weights
Evening - PT exercises, heat, and ice

New exercises since last post (still doing most of the others from weeks 0-2):

-Bent knee fall outs
-Single leg raises
-Modified planks -> planks
-Ball squats -> Modified squats -> squats
-Modified lunges -> lunges
-One leg bridges
-Adductor squeezes (Note: it was difficult to do adductor exercises on the left side because it would increase pain at the pubic bone significantly, so I had to do some modifications and only do them when it didn't increase pain.)
-Stretching of hip flexors, abdominals, and adductors

I tried running a couple times in the last 4 weeks just to see what it feels like, but I can tell that my body isn't ready for that yet. The elliptical causes too much irritation, so I'm sticking with mostly walking and biking for now. And playing with my favorite puppy!

Thank you Amiee for letting me borrow Roo for happiness :)

Andrea: Athletic Pubalgia Surgery Post-Op Rehab Weeks 0-2

I am now two weeks out from surgery. I spent the first six days in Philadelphia, working with a physical therapist (Nicole) at Vincera Rehab and checking in with Dr. Meyers. My dad was nice enough to take a few days off from work and keep me company, as I would have gone crazy from boredom without him.

I traveled back to Salt Lake City after six days, and the traveling day was hard on me. Over eight hours of sitting in an airplane is not easy after abdominal surgery! I had increased swelling and pain the following day, but it returned to previous levels after another day.

Throughout the second week, my pain level remained about the same, if not slightly increased. I have been consistent with my physical therapy exercises and walking prescribed by Nicole. I started seeing PT Danny at Canyon Sports Therapy in Salt Lake City, and he has been great so far - he even contacted Nicole to discuss my surgery and the appropriate rehab program for me.

At 11 days post-op I noticed an accumulation of fluid in the lower right abdominal area. Dr. Meyers told me it was called a seroma and was related to the extensiveness of the tissue dissection on that side. Jake and I call it my "pooch" - let's just say it does not make my stomach look attractive!

Other things to note: I went back to work after 7 days but limited my time there to only a few hours and worked from home the rest of the second week post-op. I also lost 3 lbs since surgery (good-bye muscle) and needed 10 hours of sleep at night plus a 2 hour nap during the day!

Here are the PT exercises that I have been doing -

250m walking
4x25m side steps
4x25m backward walking
2x10 bird dog – arms only, lead with thumb - then progress to both arms and legs
3x10 posture shoulder exercise (arms at right angle and rotate out) with 3s hold
3x10 clams with 5s hold
1x30 transverse abdominis isometric contraction with 5s hold
2x10 bent knee adductor squeeze with 5s hold
2x10 bent knee abduction against resistance with 5s hold
3x10 bridges with 5s hold - then progress with both a band around knees and ball b/w knees
1x5 extended leg lift and resisted adduction with 3s hold
1x30 back flexion and extension
3x10 side leg lift at 120 degrees (targeting glute medius) with 3s hold
250m walking
2x25m side steps
2x25m backward walking
Heat and ice several times a day
Massage starting at 10 days.

Icing after a round of morning PT exercises

I feel like I've gotten better and worse at the same time. The exercises are becoming easier for me, but I'm also having more pain than I anticipated after how well the first week went. I'm also an emotional rollercoaster - super optimistic one minute and then convinced that I'm never going to be pain-free the next. Jake really enjoys dealing with the mood swings on a daily basis! :)

Andrea: Athletic Pubalgia Surgery #2

She's back - this is Andrea's first post on Wasatch and Beyond in 2014! 

Dr. William C. Meyers

Last week I went to see Dr. William C. Meyers of Vincera Institute, the expert in the field of core muscle injuries (aka sports hernia, athletic pubalgia, etc). This has been a long time coming as it has been 16 months since I had an unsuccessful surgery with Dr. Brown in May of 2013. I tried many, many types of rehabilitation over the past year to recover from the chronic pain that intensified after the first procedure, but finally came to the realization that there was nothing more that I could do.



What I really liked about the Vincera Institute is that it comes as a whole package - the imaging, doctor's office, surgery center, and rehabilitation are all in the same place and are focused on the same patient. Unfortunately, the monetary cost is quite hefty due to the "experimental" distinction of this surgery by most insurance companies. One thing I have learned in the past two years is that my health and well-being are worth a LOT!

After MRI imaging, Dr. Meyers discussed my injury with me and did a thorough evaluation. He then brought in the radiologist to discuss my pain and ensure that all pain areas were examined on the MRI. He confirmed the critical areas that need repair by having 5 diagnostic/steroid injections done in my hip and groin. Based on all of these findings, Dr. Meyers recommended that surgery was my best option and scheduled it for the following day.

This is a very complicated area!!

Here is a summary of the surgery:

1) Left adductor compartment release
2) Left surgical reattachment of the rectus abdominis muscle to the pubis
2) Both sides psoas tendon release
3) Right adductor longus reattachment
4) Right re-repair and release of abdominal tissue

I have three incisions from the procedure. As he re-repaired the right side, there was a lot of excess blood/fluid so Dr. Meyers put me on a drain to wear for 4 days (gross). Because of the extensive nature of my surgery, he also recommended that I stay in Philadelphia for a week so that I could see him a few more times and also start rehabilitation immediately.

I honestly can't believe how different the recovery has been already from this surgery. I took pain medication as instructed but have really not felt much worse than before surgery. Definitely nothing compared to the pain from the first surgery (which makes me believe that something went very wrong there). I was able to walk a mile without difficulty the day after surgery and able to sit/stand/lay down mostly on my own. I  had a bit of nausea/sickness but food and drink helped - apparently you burn a lot of calories after surgery!

I will be posting updates on my recovery and rehabilitation. I am optimistic that this is the beginning of the end of this injury. There is still a small part of me that is afraid that this surgery won't work just like the last one, but I know that a positive attitude is critical to recovery. I will do everything I can to be pain-free again.

In good spirits :)