Hernias and labral tears in runners

2010 was a rough year for me, as I was dealt some very serious injuries: bilateral inguinal hernias, obturator hernia, and a labral tear in my right hip. Ok, that’s a mouthful! This was the first time since 2003 I’ve had to take time off from running. I’ve trained through other things (like my fractured rib in ’07, torn calf in ’08), so for something to completely knock me out…. was a very big deal! I knew when it wasn’t getting better with conservative treatments, ~PT/ART/Massage/Chiro./Acupuncture, that something was seriously wrong. I’ll try to break it down on what I experienced and how I cameback.

Labral Tear in right hip joint

Looking back, I’ve had a few “moments” over the years where I’ve felt a “pull” in my right hip (flexor area) or had some sort of accident. Sometimes it would be sore, and my massage therapist would work on it, and it would feel better. I’ve also fallen down many times on my hips, whether while playing basketball, slipping on ice, or slipping in races (I slipped and fell on my right hip in a race in ’07). So I believe my hip issues may have been precipitating over several years, and all it took was some point for everything to “snap”. I specifically remember feeling a “pull” in my hip in fall ’09 and then again in Feb. ’09, when I tore my calf in a race, began dragging my leg, and then felt a pull in my hip. I dragged my leg for 5 miles before dropping out.

Assuming I had just pulled a muscle, I treated it as so (~getting massage, chiro., and acupuncture). I jogged easy for a few weeks. While my calf healed quickly, my hip did not. I began getting sharp/pinching pain in my groin (~feeling of pressure), and it became increasingly more difficult to lift my leg (~hip flexion). I went back to the doctor, got a bone scan, and it showed bilateral stress reactions on my pubic bones. The doctor said to take it easy. I continued jogging easy, and the sharp pain subsided.

Within a few weeks, I tried getting back to training and racing. I didn’t race too bad, but I couldn’t accelerate at all or use my “gear shift” at the end of races. It became extremely frustrating because I could start a race Ok, but at some point my hip/leg would shut down, like I’d lose control of it. Sometimes I felt like I was dragging my leg– it required a lot of “work” just to lift my leg. I had deep, dull pain in my hip with every step, sometimes sharp pains to my groin/down adductor area, and my leg felt unstable– sometimes it would get weak and give out. Conor said it looked like I was “churning butter” with my leg– it would swing all over the place. If I tried running beyond ~marathon pace for an extended period, at some point my leg would give out and shut down. I could do ~1K or mile repeats Ok, but anything beyond that, beyond MP, or trying to accelerate…. my leg would shut down. My massage therapist said I had less muscle mass on my right leg vs. left (right leg being the hip with the problems).

In April, still assuming it was a muscle problem (~my iliopsoas), I was getting extensive ART and massage treatments. That would make it feel better and improve my hip extention/flexion, but the positive effects were short-lived. I still had difficulties “shifting gears” at the end of races, as my leg would shut down. It felt like I was fighting my leg.

By May at the Indy Mini Marathon, I was at my worst. I had pain around my entire hip and in my lower back as well. It felt like I ran the race with 1 leg! My right leg felt like a “stump”…. like it would jar the ground, and there was no shock absorption/spring in the leg/hip. The last 4 miles felt like I was dragging my leg and couldn’t use it. I somehow managed to run sub 6:00 pace (1:18+), which I guess wasn’t bad considering it felt like I was running with 1 leg.

I went back to the doctor again, and they did an MR arthrogram. This is where they inject dye into the hip joint to illuminate it, and then they do an MRI. It’s a very specific test for determining whether there’s a labral tear (the cartilage in the hip joint). I need to point out here: I have specifically requested the discs of all my imaging and the paperwork findings as well. Here were the significant findings with the MR arthrogram:

  • Suspected small labral tear/separation at the superior aspect of the acetabular labrum

Chronic avulsion injury at the symphysis pubis, consistent with the general category of athletic pubalgia.

 

 

 

Ugh, bummer!!! Labral tears are serious, since the cartilage has little to no ability to heal itself. How did this develop– acute injury or chronic (bony or muscle impingement)? Is it inflammed (since labral tears can be present but not necessarily symptomatic)? However, of greater note: what’s causing the chronic avulsion injury to the symphysis pubis? This radiologist did not see any features on the MR arthrogram to suggest a CAM or pincer-type bony impingement.

Where to go from here? The doctor advised me to stop running and rest for 2 weeks. Then, I began running again…. and my hip felt even worse! Felt like my leg was collapsing, inner groin pain/pinching/pressure, and like the femoral head was grinding/jarring in the hip joint. My doctor decided to give me a little bit of cortisone in the hip joint to see if it provided any relief– for diagnostic purposes. Because the cortisone shot was isolated to the hip joint, they could determine whether the labral tear is truly inflammed, or if the problem is outside the hip joint. Sure enough, I felt relief, just with walking. I waited 2 days before I started running again.

Wow, when I started running again! It was like all the mechanical problems and deep hip pain went away. My leg didn’t feel like it was going to collapse under me, and I couldn’t feel my hip jarring with each step. I ran for a month, and in the meantime…. visited a hip specialist in Indianapolis (Dr. Lintner). He recommended a hernia specialist in Indianapolis (Larry Stevens), and suggested I see the very best labral tear surgeon, Dr. Philippon in Vail, CO. At this time, I thought my only option was surgery for my labral tear. I knew this might be a lengthy road, so I was very aggressive and persistent, sending the Vail clinic all my paperwork, imaging, etc..

I should also add that I seeked out several opinions about my MR arthrogram. My local physician consulted with a radiologist in California (who apparently wrote the textbook used by radiologists). He thought the labral tear was significant enough to cause problems. However, he said the “chronic avulsion” injury is very common in female runners, likely because of the shape of our hips and the muscular stresses imposed on the area. I also sent the images to a relative who’s a Radiologist, and he consulted with another Orthopedic Radiologist. They weren’t concerned about the labral tear, noting they’ve seen worse in football and hockey players. However, my relative thought it looked like my hip is rotated/twisted forward/medially (see x-rays below).

The people in Vail requested an Anterior view and Cross table lateral view X-rays of my hip, to determine if I have a bony impingement. The images are below:

I was consulting with Dr. Philippon’s Physician Assistant. In his opinion he didn’t think my labral tear was bad, nor did I have a bony impingement. However, after consulting with Dr. Philippon, he said I do have a CAM impingement. I researched what a CAM impingement is, which is basically a mis-shapened femoral head that “rubs” the cartilage in the socket. Looking at other people’s x-ray images…. no way does my femoral head look like that!

Although I was approved as a surgical candidate with Dr. Philippon, with the wishy-washiness of opinions (which included Dr. Philippon’s expert opinion), I couldn’t take the risk of undergoing the highly invasive and traumatic $40,000+ surgery, having my “femoral head shaved”, and risking whether I’d ever be able to train and race the marathon at the same level again. As my local physician suggested, I should try a conservative approach of getting back to running and see if I could successfully comeback.

I was also reassured to try this approach by Strength and Conditioning guru, Michael Boyle, and one of my runner friends, who also had the cortisone shot for a labral tear 10 years ago, rested, and successfully cameback…. no problems 10 years later. As Michael stated, 97% of the population will develop a labral tear, and most won’t know it or be symptomatic. As long as there’s no pain and no bony impingement, you can successfully live with a labral tear. If you have a bony impingement, it’s a far more complicated situation on whether to get surgery or if you can live with it. Knowing my tear was small and no longer inflammed, I decided to try and comeback without surgery.

Hernias

Although my deep hip pain and mechanical issues from the labral tear had gone away following the cortisone shot, I still had persistent abdominal pain and a feeling of pressure/pinching in my groin. It was mostly a throbbing and sometimes sharp ache in my abdomen, a few inches below and to the right of my belly button. Sometimes I felt it on the left side too. This pain was especially bad after sitting, driving for long periods, and having the seat belt across my abdomen. Also, I had some pain on and above my pubic bones. The pain was especially bad when I would try to accelerate in races, as this area would tighten up/pull and I couldn’t “go”.

I should also mention I had a lot of GI issues for a few years, which I thought was a normal part of running. I would sometimes develop sidestitches that were so severe it was like someone twisting a knife around my lower abdomen. This happened to me when I ran my 2:38 PR at Twin Cities, where I had an excruciating sidestitch for 1/2 the race. Looking back now, I believe a lot of it was tied to what all was wrong down there.

I was referred to hernia and laproscopic specialist in Indianapolis, Larry Stevens. Larry felt my abdomen, had me cough, and do a crunch. He could feel a “pulse”, a weird palpable spot, right where I had the pain. He felt it on both sides. He said this indicated I had indirect inguinal hernias on both sides, which is a tear or weakness in the inguinal canal. The inguinal canal runs along the panty line of the hip. I did NOT have a big bulge, as most assume when they think of a hernia. Also, none of this was visible on the MR arthrogram, which was focused more deeply on my hip joint. He also said he’s been seeing more women runners with this condition for some reason. He was able to schedule me for laproscopic hernia surgery the following week (yeaaa!).

The laproscopic surgery entailed 3 small incisions, 1/2-1 inch long. I was put under general anesthesia. He used mesh and tacks to repair the hernias, kind of like patching up a tire. The tissue would grow over it. To his (and my) surprise– the hernias were far worse than expected! I had 5 hernias total– I had both indirect and direct hernias on both sides (4), along with a very rare obturator hernia in my groin. I had basically torn the entire inguinal canal! He had to put mesh and tacks over my whole abdomen.

He said I had enlarged inguinal canals, which is more common in men– this is how I’m developmentally built, so I had a pre-disposition to herniation. Also from researching it, obturator hernias are more common in thin women– since there’s less fat and more space around a thin woman’s pelvis, there’s greater possibility for herniation in the obturator canal. It’s likely this hernia was pinching the obturator nerve down my leg, hence why I’d lose control of my leg when I tried to accelerate.

Finally, that pain in my lower abdomen and groin was gone…. but I still had to recover from the trauma of surgery! I only took the 2 required anti-inflammatories for 5 days, knowing I’d heal faster without them. Bloating, constipation, and trying to get out of bed were the toughest things to deal with. After a week, I began walking…. and boy was that rough! I cried cause it hurt so bad, and I couldn’t even imagine running! I continued to walk every day, and then twice a day, for 5 weeks (probably 4-8 miles per day of walking).

Physical Therapy

I should first point out that we thought the problem all along was with my iliopsoas, adductors, and relating muscles around the hip/abdomen/back. I exhaustively received treatments with massage, ART, chiropractic care, and acupuncture. While all these things provided pain relief and helped improve my range of motion, the deep hip pain and abdominal pain persisted, which is when I began visiting doctors and getting imaging. I now know the muscles around my hips were being overused to stabilize my hip/abdomen/back because of the hernias/labral tear.

I did physical therapy pre- and post-hernia surgery with Brian Schuetter at St. Vincent’s Sports Medicine in Indianapolis. He’s a fellow runner and was ‘great’! I did PT for 4 months (2 months before surgery and 2 months after). I believe this helped A LOT.

I learned I had a lot of tightness in my upper right chest– I had fractured a rib back in ’07, so I had likely compensated for it, which meant a crazy right arm swing and significant rotation in my torso. With the oddities in my hips…. along with this “quirk” in my torso…. it’s easy to see how the “levee broke”. I had to work extensively on “opening up” the right side of my chest so my momentum was going forward rather than twisting.

I also had to work on my hip range of motion and mobility, both hip flexion and extension and also adduction and abduction. Hip extension continues to be a limitation for me, but I’ve learned to accept my anatomy for what it is. Especially, I had to work on stretching my hip adductors (inner groin) and strengthening my hip abductors (lateral hip). As female runners, we tend to overuse and develop overly strong adductors because of both the shape of our pelvis and also overpronation. You can see this in most females– the leg/knee collapsing medially during the running cycle. However, since we’re not moving laterally, we develop weak hip abductors, which further compounds the leg “collapsing” medially. My PT program involved several months of doing an exercise where I’d prop my leg on a chair, hang over, and lean for a few minutes into my inner thigh to stretch the adductors. Then, to strengthen my hip abductors I’d do “band walks”, which is lateral walking with a rubber resistance band around your ankles– this BURNS and is very difficult! I progressed to a stronger band.

I did a ton of different bridging and plank exercises, rotational and functional control exercises, spine and abdominal mobility, along with “rolling patterns” to work on gaining correct neuromuscular firing patterns. I had to learn how to disconnect my torso from my lower body so it’s just my legs lifting and going through the running cycle (rather than compensating by twisting my torso and overusing my hip flexors).

I had also lost a lot of strength and coordination in my right leg– I did lots of single-leg jump roping, lateral jumping exercises, and single leg balancing exercises. I’ve spent the past year and a half continuing to work on this, and I’ve come a long ways!

I was compliant-to-a-t with my physical therapy! I highly recommend working with a physical therapist– it was great being able to work on my weaknesses and see progress like I see with running. When I went for my follow-up post-surgery, they were highly impressed with everything I could do. My mobility and strength in my lower abdomen was excellent. I finally got the green light to start back running!

Starting with walking and progressing to running

A week following hernia surgery, I went for my first walk, ~30 min…. and it was painful and awkward! I cried…. a lot. I wondered how I would ever run again, considering how much walking hurt. I was emotionally wrecked after the first walk, so I waited a few days before I tried it again. Each walk got better! I kept walking 30 min-1 hour a day, and I progressed up to doing 2 walks a day (6-8 miles/day of walking). I figured if I walked twice a day, it would eventually make it easier getting back to running twice a day. I walked on bike paths and trails– rolling terrain.

I was cleared by the doctor after 5 weeks (late Aug.) to start back running. Him and the nurse were very impressed with everything I could do, compared to most patients– I credit the PT and walking. I started running 5 min. the first day…. and walking the rest of the time. It felt ‘amazing’ to run! I almost couldn’t believe I was running, given my emotional distress with walking a month before! I kept up my two-a-day walking routine. I did 10 min. of running the next day, then 15 min., 20 min., and so on. I was never exceptionally sore– I credit the walking (~being weight bearing) for easing my transition back to running. However, with my “new hips”, it felt like I had to relearn how to run. I definitely had some muscle/body quirks and saw a few health professionals to help me get over this hump.

I didn’t start tracking my training until after 3 weeks, when I felt I was training enough to start recording it. I kept up the twice a day walk-run routine until mid-October, when I was finally back to full running twice a day. I also got up over 100 mpw by mid-Oct. (yes, happened pretty quickly, and my body felt better running more too). In Oct., I started adding in strides and some light heart rate based progression runs– man, I was out of shape and slow! My first real workout (late Oct.) followed by my first race, were terrible (personal worst type terrible)!!! My husband Conor reassured me the next race would be much better…. and it was (2 min. faster for 10K!).

My friend Janet’s husband, Jay, contacted me in early Nov. about running Dallas White Rock in Dec.. I told him no way because I was out of shape. Well, after that second 10K and my first long run with progression pacing (2 weeks before Dallas), I took a leap a faith and signed up for Dallas!

A leap of faith in Dallas

I arrived in Dallas with this feeling I was meant to be there and that I might win my first marathon. Lo and behold, I get there and two African ladies signed up at the last minute! Oh boy, I was nervous! I was having dinner with the Robinsons the night before (elite coordinators), and Vanessa told me, “I think you can win!” She said it with conviction and a sparkle in her eye! She had total faith in me, and it made me believe it was going to happen.

The next day we toe the line, and I had this, “OMG” feeling… I’m about to run a marathon…. What am I doing here…. I can’t believe I was walking for fitness a only a few weeks ago! I hadn’t felt that nervous since my debut! We took off, and the pace was so slow and uncomfortable, and the two Africans were sitting on me. I wasn’t feeling great at all, and wondered when the Africans were going to take off. By 8 miles, I was pissed cause we were still running slow and the Africans were still sitting on me -20m back. Once the HMers turned off and I was alone, I took off and dropped the pace.

I finally started to feel good, and by 11 miles when we started to go around the lake, I could no longer see the Africans. I was completely alone and in the zone. I felt like I was out for a Sunday long run with progression pacing! I was feeling pretty good… until I hit the top of the second Dolly Parton hill around mile 21. I felt my legs collapse underneath me! I took a gel and within a mile I got my second wind. Those last few miles I told myself to run it like a 5K and took 1 mile at a time. I came across…. I’d won!!!!! 2:42, only 4 min. off my PR! It wasn’t until they put me on TV when I realized what I’d done (see video ).

Winning my first marathon…. esp. after what I went through…. was the highlight of my career (as I type this, I’m teary eyed!). It meant a lot to me. Little did I know it was the beginning of a ridiculously awesome next year!

Conclusion

I hope by sharing my story, it’s helpful to those who might be struggling with hernias and/or a labral tear. I also hope it provides inspiration that you can successfully comeback (esp. if you’re a high performing athlete). I also wanted to share my story to show that labral tear surgery isn’t always necessary…. a conservative and patient approach could save you from the highly traumatic (and costly!) surgery! Also, a labral tear may not be the main problem (as I found out with the hernias). Be persistent… Get lots of opinions… Keep all your records and imaging…and do your research!

I appreciate donations for my free advice! I write with my heart and desire to help others. Your contribution will help cover my running-related expenses as a full-time professional runner. Thank you!


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Comments

  1. With such proper care and attention the human body wonderfully healed and got back to it’s full on joy of running. Your such an inspiration!

  2. Hi there, I found your blog while googling “hernia vs labral tear”. I have had problems with chronic hip pain for about 1 1/2 years and have been diagnosed with everything from IT band syndrome to bursitis and did physical therapy for a while which seemed to make it worse. I’ve gotten to the point that even a little walking causes pain. It hurts on the side of my hip, my lower back and in the front of my hip up into my abdominals even to the ribs. I had an MRI about a month ago which showed what might be a labral tear, but when I went to a Hip specialist he seemed to feel it was more likely a hernia. He doesn’t specialize in that so couldn’t diagnose it himself, but he thought it was pretty likely I guess from what my symptoms were and moving my leg around himself… it really didn’t hurt much when moved it or pressed on spots… As a 2nd diagnostic move he gave me a cortisone shot in my hip socket to see if it helped. THis was yesterday and honestly I couldn’t tell. Today it hurts like hell. Not sure what that means exactly. I’m curious though, did you have hip and leg pain from the hernia or the tear? Right now I’m having worse problems in the front of my hip which makes me believe it is a hernia… so scared of having the wrong surgery though!!!!!! Also, can I ask how much you had to pay for your surgery? I have insurance but of course there’s still a copay :(

    • runcamille says:

      Hi Lia! Sorry to hear about your frustrating hip pain! My suggestion is to keep seeking out the right people and get several opinions. I had to get an MR arthrogram to diagnose the labral tear– they injected dye into my hip, so it was not a plain MRI. I consulted with at least 5 radiologists/hip specialists, who confirmed the labral tear. Also, I got relief from the cortisone shot– if you’re not getting relief, that means your problem/pain is outside the hip joint. It sounds like you need to see a hernia specialist.

      I had pain all over the front/side/back of hip/groin/back, and radiating down my inner leg. Most of my pain from the labral tear was concentrated on the anterior side of the hip in the middle, near the panty line. This was NOT palpable, since it was in the hip joint.

      My hernia pain was sharp/throbbing pain in my abdomen, where a seatbelt goes across the abdomen. This would hurt after sitting for long periods of time, like with driving. We could palpate the abdomen in a certain spot and feel pain/weird pulse. Hernias can develop anywhere in the abdomen/groin/pubic area.

      The labral tear surgery is something you don’t want to get until you’ve exhausted all the options and you know for certain…. you have it. It’s a very traumatic surgery. I heard it costs around $42,000+ (which I’m not sure what insurance covers). For my hernia surgery, I think it cost ~$12,000, and insurance covered the whole thing.

      Have you checked to see if there’s a problem in your spine? Or see an internist?

      Keep trying to seek the right people who can fully and correctly diagnose you. Don’t go through with a surgery until you know for certain what’s wrong and have exhausted all the non-surgical options. :) Camille

  3. Hi Camille,
    I think I’m experiencing the same exact problems as you were. My right side just seems much weaker than my left. My right leg does not seem like all the muscles contract when i squat or run. Also, might right torso is tight compared to my left side, which isn’t. From mid abdominal all the way to the shoulder is tight. I hope that my diagnosis will be just as precise as yours.

    I was curious, did you get any MRI to diagnose your hernias or just the tests Dr. Stevens ran was enough to determine if there were hernias?

    Thank you

    • runcamille says:

      Hi Galaxy! My hernias couldn’t be seen on the MRI. However, my MRI was deeply focused on my hip joint, so that may be why the hernias didn’t show up (which were in my abdominal region). Dr. Stevens diagnosed by feeling my abdomen– you could feel a weird “pulse” on both sides with coughing and doing a crunch. It wasn’t the typical big bulge that’s easy to diagnose.

      Best wishes figuring out your problem!

  4. Jessica Latino says:

    Hello. I came across your blog when searching online for info about labral tears. My problems started 2 years ago when training intensely for many long distance races. I went in to the doc with hip/groin pain. He did an MRI, which showed my hips were ‘normal’ but that I had torn my right hammy 80% off of the origin and my left 50%. After PT for the hammies, which felt tight but not unbearable, my hips still bothered me. Doc ordered an arthrogram, and bilateral labral tears showed up. I saw one (well-respected) surgeon who said I needed to do the surgery asap if I wanted to run ever again. Got a 2nd opinion who said not to jump into it. I didn’t, and the pain went away after a couple of months. Had PRP injections on my hammies, which responded decently. My running went to heck, as I have no power in my legs whatsoever, but at least I could run mostly pain-free. That is until the pain in my hip has returned about a month ago. I can function with everyday stuff pretty well, but running is just not happening. Have another arthrogram scheduled for this Friday. I haven’t even thought about the possibility of a hernia till reading your blog. I’m scared to death of surgery and coming out worse than I was before, but at the same time, running is very important to me, my passion! HELP!:) I feel like my whole body is rebelling against me, and it’s inspirational to read your story and find that maybe, just maybe, things will turn around again someday. I am 35, from Arvada, CO, and a 2:57 PR marathoner. Any suggestions would be awesome!

  5. Robert Semnic says:

    Hi Lia!
    I hope you are well now! I am MSK radiologist from Serbia and writing a book “MRI of the MSK system” (in serbian language). I would like to ask you for permission to use two images with labral tear from your posted blog. I would put the credits under images.
    kind regards

    Robert Semnic M.D., Ph.D.

  6. I’m also a distance runner and started having knee pain that progressed rapidly to adductor pain after a fall on some ice during a training run. Over the course of about 3 months as I continued to run, the pain started to localize to my groin. Long story short, I had 5 opinions, 3 MRI + arthograms (all ‘negative’ for labral tear)and 2 cortisone injections before I finally had surgery. My surgery only cost about $1000 out of pocket and was by far the best thing I ever did after living with constant and debilitating pain for well over a year. Thank you so much for sharing your story! I had a very difficult time finding information about my suspected injury while I was going through it.

  7. Hi Camille! I just want to say your blog is awesome! You provide the most resources of any running blog I’ve read, and your response to my question about residual pain after a stress fracture was so helpful and reassuring!

    I’ve just been diagnosed with what looks like mild FAI/hip impingement. I’m not sure if I have a labral tear, but if I do, it’s very minimal since I can still run, get up and walk easily with just discomfort. The most discomfort I have is from sitting all day at work and it goes away easily with getting up. I do have tightness/discomfort with running but it doesn’t stop me from slow, easy mileage.

    Of course, I consulted your blog again to see if you’ve had experience with a CAM hip impingement, and you have! My doctor tells me I can try to treat it conservatively, but will not do a cortisone injection. I get amazing relief from just one Advil (which I hate taking, but I wanted to see), so I think I might be a candidate for an injection. I am now increasing my strength work which I’ve been slacking on, and been told I can run slowly up to 30 miles a week through it.

    I’ve got Boston and Big Sur coming up this spring, with no time goals aside from finishing without injuring myself again. I’m scared though as I don’t know if this can be trained through (at a very low intensity), if anyone has successfully gotten rid of the discomfort of a hip impingement without surgery, and if I am hurting myself more by running.

    It sounds like you got rid of your discomfort with a conservative approach. Can you talk more about your approach? Did you run slowly/low mileage through it? How soon after did you run a race? I am so desperate for information from someone who has been there, the only thing I read online are unsuccessful surgery stories that are incredibly disheartening.

    Any advice is so helpful! Thank you again for putting this info out there! What an amazing resource for the running community!

  8. Hi Camille
    This is a brilliant blog re the cause of hip/groin pain due to a hernia and every medical practitioner should be made aware of your case so as not to send their patients on a frustrating goose chase of tests, specialists and/or unnecessary surgery . In a quest to understand the cause of my own pain/injury reading thousands of blogs re labral tears and hip pain – i was convinced i had labral tear – it appears to be the in-vogue/miracle ailment. The sales pitch seems to be that they dont heal on their own. However, the daunting thing was the overwhelming number of comments of frustration from the majority of those; either considering surgery or post-op disappointment at the lack of improvement after surgery. Fortunately for me the first thing the doc did, in addition to an x-ray, was to request an ultrasound to eliminate the possibility of a hernia (even though his physical examination did not detect one) Guess what? – yesterday they found a small inguinal hernia. Although i was not surprised it was unexpected as there was no physical bulging ( i had already found the best labral tear expert in the country anticipating surgery). Next step is to get the hernia sorted. Time will tell if the hip pain goes. But Camille aren’t you glad you did your own research and didn’t listen to the experts and get your “femoral head shaved”? FAI and CAM impingement seem like a real bona fide cash cow for these surgeons. I am curious to know how your hip is travelling these days?

    • runcamille says:

      Hi George– thanks for commenting! Yes, I could probably be a “case study” for physicians. Sounds like you had a similar experience! Being an elite marathoner, I HAD to be cautious/conservative, as hip joint surgery is very risky. I have another elite marathoner friend who went through with the labral tear surgery recently, so time will tell if she’s able to come back and not have problems longterm.

      I’ve had absolutely no problems with my hips since getting the hernia surgery! I’ve run 5-6 marathons/year the past 2 yrs and am aiming for at least 12 this year (my goal was to tie Doug Kurtis’s record of 12 sub 2:20 marathons, which for a woman is sub 2:45). I’ve actually had PF really bad since last August, which has almost been more frustrating than what I went through with the hips!

      Good luck with the hernia surgery! It was well worth it!

  9. Kevin Burke says:

    Camille,

    A friend sent me your blog yesterday and reading your report on labral tears and hernia was like looking at a chapter out of my own medical history. The progression is mostly the same, pain in the groin losing power and stride, then progression of bilateral abdominal pain. I was diagnosed with a “sports hernia” and surgery was done on my right lower side with a mesh put in place. However, at the time, I was also suffering from pain in my lower left side and also to this day pain over my both of inquinal areas. The herina surgery did not resolve the problems in my hips so I finally went to the an orthopedist a year later who ordered a MRI with contrast of both my hips. The radiologist interpreted the findings as small labral tear on the right side and possible tear on the left side. However, I live in an area without any surgeons with a great deal of experience in the area, and the Doctors sugguestion was the cortisone injection into the hip socket. It was almost immediate relief. I could not believe how much better my hip felt But still, it did not relieve my abdominal issues hernia issues. Both hips are flared up right now and am thinking about asking for cortisone injections in both hips to see if that resolves any issues. Even if temporarily, I think I would rather do that then the Labral surgery that may or may not work. Anyway, bottom line, after reading your blog I can’t help but wonder if there isn’t some correlation between the hip issues and the bodies compensation of putting the stress of that injury on the abdominal area! Would love to see what you think…or anyone else that reads your blog. Thanks,

    • George says:

      Kevin
      It appears to be a chicken and egg situation. Does a FAI/Cam/Labral issues cause the compensation and subsequent abdominal/hernia injury? OR do the abdominal/hernia injury cause the compensation and subsequent Hip, FAI/Cam/Labral issues? OR is there a third dimension such as a long standing scoliosis of the lower back and/or uneven leg length being the founding/primary issue for both injuries?
      Of course all injuries can cause a nerve dysfunction as the groin contains many sensitive nerve endings. Research indicates that the genital branch of the genitofemoral nerve is affected in the sports hernia, and the ilioinguinal and iliohypogastric nerves can also be involved, especially if osteitis pubis sets in. Another issue to consider is scar tissue from the healing tear of the sports hernia and if microtears continue to happen, there will be more scar tissue growth. This scar tissue may irritate nerves, especially if it grows around the nerve, causing nerve ending entrapment. Long-term irritation may work its way into the nerve ganglions up into the roots (found along spine). This basically means that the nervous system has reset its default settings and may be firing pain signals all the time, even after the injury has healed.

      • runcamille says:

        Totally agree! I have a developmental defect where my right hip is anteverted– twists in. I have to land with my right foot splayed out, so my right knee is aligned forward. This is only on my right hip! I subsequently run a little funny, like a misaligned car! My feet land differently. However, as long as I’m not in pain, all is good!

        There can definitely be longterm complications, even with hernias. Other than my obturator hernias, I think my hernias were a bit higher up, along the crease of the hip/inguinal canal. It sounds like ~sports hernia is more in the groin/pubic area, and that might lead to complications with scar tissue pinching nerves. I’m pretty certain my problem was the obturator hernia pinching the nerve down my leg.

    • runcamille says:

      Hi Kevin, sorry to hear about your frustrations! The doctor who treated my hernias, Larry Stevens, discovered during the surgery I had hernias on both sides, plus an obturator hernia. 5 total hernias! He COMPLETELY fixed everything in the surgery. Maybe you should go see him?? Maybe your surgeon didn’t catch everything, and if so, that’s a shame.

      You could go try the cortisone in the other hip. Also, I worked with a PT on muscle imbalances, so that was very helpful in straightening me out.

      I agree, it seems like a chicken and egg situation. I’ve had some pains to my groin area for years (like 10 years), which I think was the hernias. I fell and landed on my right hip in ’07 (maybe caused the labral tear?), felt the “pull” in my hip in ’09, and then everything spiraled out of control after that. There was definitely instability all over the place, which made me overuse certain muscles to stabilize my hips (like the illiopsoas).

  10. Kevin Burke says:

    Very helpful to have a sounding board. I think my friends I run with are getting tired of me talking about my issues. As a side note I forgot to mention, the sports hernia diagnosis came after visiting with the Dr…At the time I had a raging case of Athletica Pubalgia where every attachment to my pubic bone was on fire and I could barely sit up out of bed. I have to admit that did subside slowly over the next year and a half. Probably the single most helpful thing 6 months after the heria surgery was by chance finding a local Chiropractor that did Active release set up after a triathlon I completed. I told Dr Hochstein where I was having problems and he was like OK, roll over on you side. He was truely the first person I felt like was addressing the issue and putting a stretch on abdominal area. That probably helped calm down the symptoms more than anything…but alas not completely.

    As if dealing with those issues weren’t enough I developed a nagging pain in my upper left abdominal area that felt like an intestinal issue. It feels like cramping sensations so I went through the whole gastro intestinal testing that all came back negative. The gastroenterologist was at a loss so referred to a pain clinic. Their diagnosis is malfunctioning nerves…just as George points out…apparently, the thinking is that the nerves become so inflamed it triggers this sort of response. However, I think that as you point out Camille, I’m over using that illiopsoas and it’s creating this spasm response in my upper abdomen just below the rip cage. It hurts and the nerve treatments they have me doing really aren’t resolving this spasm. Hense the thought it all is triggered from my hip sockets in some fashion. Arrrggghhh.

    Camille, two things, what did you do to work on stabilizing you hips and resolving the psoas issue…and Congrats on the Lincoln Marathon win. That’s my hometown!

    • runcamille says:

      Hi Kevin, I mentioned some of what I did, but I did so many different exercises and it would be difficult to describe everything I did. I definitely recommend working with a PT who can develop a program that meets your needs! Like what you experienced, ART was very helpful… but it didn’t completely solve the problem.

      Thank you– loved Lincoln! Would love to go back and get the course record!

  11. Czechmate says:

    Kevin, I dealt with a nagging sports hernia & groin strain for about 5 years. After years of painful races and running, I finally stopped myself and came to a crossroads realizing that running in pain all the time is simply not right. I think back now and just shake my head on how I managed to string together PRs in complete pain. Couldn’t cough/sneeze, get out of bed, or rise from the floor without sharp pains down below. Once I stopped the insanity, I reflected and had a decision to make. Choices were: 1) Pay up for a surgery that is not full proof, 2) PT, 3) take up cycling, or 4) self testing. I chose number four simply because I’m a tight wad that doesn’t like surgeons or cyclists. Also found out that some docs believe hernia surgery is unnecessary and the reason it’s successful is it forces the patient to do the PT. I’m stubborn and wanted to fully exhaust all possiblities before getting help or buying a bike. I spent the next months doing a lot of reading and research in the area of hernias and PT based solutions. I spent a lot of time in the gym experimenting with exercises. After 6 months of research, weight training, pain, and sweat, I was running mostly pain free. I was hitting the gym three times per week and very slowly jogging when I could. I took another 3 months or so until I was running completely pain free. So overall, it was about 9 months until I was running pain free again. Now I do maintenance expercises of three specific movements about 1-2 times per week. Two of the exercises were never directly prescribed protocal, but I found essential in my recovery. I still get sore in the lower abs during the last few miles of my long runs, but it’s nowhere near as painful as it once was and I have no more groin issues. I know my comments are probably not helpful to you now, but just want restate what George Sheehan said “we are each an experiment of one”. Take time to reflect and experiment through exercise and strength building. At first, the exercises I did were very painful, but after three weeks the pain was already decreasing. Hang in there!

  12. Wow..my husband just found this blog and it is giving me hope that I can run again without surgery. I was training for the NYCM and had to drop out as I developed severe pain in my left hip and have not run since. I had a steroid injection and I feel great today, that was one week ago. I haven’t even thought of running since it hurt in August, 2013. I had this “clunking” sensation for a year now, but zero pain until now.

    I’m in Indy and we are good friends with Dr. Stevens. He’s done surgery on my husband several times including herinas. He is excellent!!

    I was just diagnosed with a labral tear through MRI-a. It is in my left hip. At ortho indy dr. Lintner said I needed to have a scope to cut it out, i.e. the torn part. I’m getting a second opinion from a Dr. Nho in Chicago and if I have to, several other opinions before I let someone do surgery on me. As far as they have diagnosed, I have no other issues.

    Have you still been running pain free?

  13. Camille, Thank you for this post, most importantly because it gives me comfort that I’m not making this problem up. Three years ago I lost control of my right leg at the end of a tempo run and it hasn’t worked ever since, and has gotten progressively less coordinated. What used to be an effortless gait is now like pushing a shopping cart that has one bum wheel. It takes constant effort and concentration to lift my right leg and I have to think about it with every step. I can’t run fast or I lose all coordination. Weirdly, I can get through my runs after my right leg starts to die by running with my hands on my hips, pushing down on my pelvis, and kind of zig-zagging to relieve the muscle tension on my right leg, My husband says I lean to one side when running, but that the hands on the hips help level out my shoulders. In my natural gait, I end up throwing my right shoulder instead of keeping the shoulder straight and moving the arm freely forward and back. For a couple of years, I was able to manage longer runs by switching to NB Trail Minimus (love!), which are light. However, because my gait problem caused my right foot to land wrong, I developed peroneal tendonitis during a treadmill session and the sports doc sent me back to heavy, squishy Nike Pegasus with arch support. Whether my uncoordinated gait was caused by a labreal tear is unknown, but I wouldn’t get surgery anyway. I tried to get an MRI-a two months ago but I had a vasovascular reaction (almost passed out) when the doc was rooting around my hip with a needle for 10 minutes trying to find the spot to inject the dye. The plain MRI showed nothing. I’ve been to many docs, chiros, PTs, etc. with nothing structural showing up as wrong. I know I should look at this as good news, but at least with a broken bone I would know how to treat it. I’m sticking with my latest PT for now, hoping that this theory of muscle imbalances and reactivating the glutes pans out. Much luck to you keeping healthy.

  14. I just underwent a labral repair in my right hip, and a FAI impingement that was corrected… prior to that I have a constant ache on the right side of my groin and the lower right abdomen… I’m 2 months post op and I’m starting to get the groin and abdomen ache again… I’m starting to think I might have a inguinal hernia myself.
    I did feel a pull in my lower abdomen one day working out at the gym (prior to be told my hip was the problem).
    Did you have any lower abdomen pain from your hip issue? Where did you feel the pull in your hip?

  15. Hi Camille,
    Great posting…I have similar problem except that its on my left hip….i run 6 to 7 miles now, and once, i increase my pace, i start having deep hip/abdominal pain…it seems like hip flexor pull and deep inside bottom left side of pubic bone….feel like i am dragging my left leg or my left leg is not supporting the run. After running, my leg becomes imbalance/wobble. I also have a clicking sound…I sometimes had to kind of open my left leg outside fast, in order to create that clicking sound, to feel a relief…..it feels like some muscle opens up…Went to PT for sometime, chiropractor for few sessions…did hip abductor exercise, did some squat and dead lift for strengthening…nothing seemed to improve the pain/pull around hip/lower abdominal area while running….(used to run marathons/iron man…now unable to run more than 7-8 miles)….Did MRI Arthogram….found labrum tear…did not go for surgery…had cartisone injection….felt better for few days….Pain again started after running…Also, feels discomfort in digestion area….lot of farting, loose stools etc….I believe, it might be Inguinal hernia for me too….(By the way, I am 5’2”, 112 lbs….lean, short and thin)……Have the discomfort while driving….one of the left leg muscle seems to hold up the leg and once, i realize it and relax, the leg just drops and tend to move outside (towards hid abductor side). The left feet doesn’t seem to stand fully and balanced on the floor…..also, sometimes, the pressure is more on the left heel….I would have to rotate my ankle both directions for some relief….

  16. yogarinamusic says:

    Camille,
    Thank you so much for sharing your detailed experience! I was a professional dancer in the ballet, contemporary, and jazz world, for 17 years, was doing gyrokinesis and pilates everyday, dual career as a musician, got out of music school, started dancing again, and as a cellist was in and out of major cities carrying my heavy instrument…like you I am quite thin (usually 100lbs or less), ran cross country and track for 2 years, wrestled for a year, and was doing gyrokinesis, pilates, or yoga everyday since 2003!

    I spent the past four months misdiagnosed by an initial ER visit, visited seven doctors, and finally one of my specialists whose been in practice for ~50 years was very sure I had at least one hernia. I haven’t been able to work for the past four months, had an ovarian cyst rupture on the left side leaving a small amount of fluid in my pelvis (which was swollen for a month-I could barely get out of bed), then thought I was ok, and boom: back pain returned, i felt like i had a pulled groin again (started in dec as i was shooting a video), severe fatigue and pain, indigestion, cramps, blood in places it shouldn’t be etc it was a bit scary especially being in my barely mid 20′s I was very weirded out and still am by all of this, but always keep a positive head on my shoulders!

    The specialist said I had a hemorrhagic cyst now on the right ovary, the left one was basically dissolved, sent me to a general surgeon. Surgeon sent me to have an ultrasound done, he is amazing and even had said to me to mark the spot so it doesn’t get missed! I went in, the tech explained and showed me what the initial hernia looked like…this was my 10th ultrasound in just under 2.5 months, so I was so happy to hear some concrete answers :)

    I ended up like you-the 2% of women that have inguinal bilateral hernias! I just had keyhole surgery two weeks ago and it is very slow. I can empathize completely about that first post week after surgery not having a core…I am 24 so this has been very strange to say the least. I knew something initially was wrong back in dec because yoga shouldn’t hurt and I had been doing it 5 days a week, and not seriously pushing past my limits—at least not compared to dance (constant hip rotation to “turn out” and flexors used 24/7 + leg extension stretches et al). I got off my pain meds a few days after surgery, and have been blessed with a great surgeon.

    If time permits I was wondering if you may be able to answer a few questions?

    Was going up steps difficult in the few weeks after surgery?

    Every body and being is different, so I am mindful of that, is there a specific type of PT you recommend trying out?

    Does the hip pain ever feel kind of stabbing or burning pre/post surgery/in the present?

    Thank you really does not say enough, I have been searching and searching to find other women who have gone through this and all of your experience has been so helpful!!

    Best wishes and stay well!

    • runcamille says:

      Hi! Sorry to hear about your longtime frustrations, but glad you finally figured it out! To answer your questions:

      Was going up steps difficult in the few weeks after surgery?

      We don’t have stairs in our house, and I wasn’t really going anywhere or doing anything, so I don’t remember! Walking was pretty painful the first few weeks– I walked on trails too, and walking in general was difficult. It got easier though over time.

      Every body and being is different, so I am mindful of that, is there a specific type of PT you recommend trying out?

      I did what my PT told me to do. We were pretty “gentle” right after the surgery when I couldn’t do much. Are you doing PT right now? I can’t imagine not doing PT! It was too extensive to write about here, but I highly recommend working with someone to figure out your strengths and weaknesses.

      Does the hip pain ever feel kind of stabbing or burning pre/post surgery/in the present?

      As mentioned in my blog, I definitely had pain before and after the surgery, but the pain directly on the spot(s) was essentially gone after surgery. I’ve had absolutely no problems in the present.

      Good luck and keep making progress!

  17. Nichole says:

    Dear Camille,
    I really appreciate your blog about your running experiences and injuries. Its so inspiring to hear about very real issues and your desire to better yourself in so many different facets.

    I took a fall and than ran injured during a very challenging half further causing more injuries.

    Short summary I got ART to fix and maintain my PF in my hurt heel from the fall but am now needing to work on my hips. Seem a Ortho Surgeon who says I have the same problem as yours (shape and laberal tear) in addition I pulled my hammy way up high sprinting too. I got suggested the same kind of surgeries and came to the conclusion I would like to go the route of physical therapy to fix my weak lower abdominal wall and hip instabilities on both sides. Do you have any Physical Therapist that you could recommend to help me? If you would like you can email me your suggestions.

    Thank you
    Nichole

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  1. [...] As Dr. Noakes points out, he advocates walking, before you begin running, to get the muscles AND bones aquainted to the impact/weight bearing. I previously talked about the benefits of walking before running in my post about stress fractures and also when I cameback from hernia surgery . [...]

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