Anteverted

For my skating friends who talk about "open" and "closed" hips - this diagram gives a nice visual for the anatomy behind the terminology. (My hippie friends already know about angles of version.) I have severe anteversion (see "B" in the diagram). Those of you who are "open hipped" are more like "C" in the diagram. Dance and skating are both much easier for "A" and particularly "C" people. Many coaches who have normal or open hips don't understand how challenging it is for closed-hip people to do even simple things like Mohawks, although twizzles, hydroblades and loops may be easier.

There is a limit to how much external hip rotation you can get if your anatomy is similar to "B" - but there are ways to maximize what you have. "Turnout" includes external hip rotation as well as rotation from the knee and ankle/foot. Once you reach the end of your external hip rotation, no amount of stretching is going to change the alignment of your bones.

Pre-PAO, I was able to get a lot of hip rotation because my hips weren't in their sockets, so they turned more easily. However, this caused bad things to happen, including lack of stability, arthritis, and labral tears. My body learned to turn out below the knee to get things to happen, but my on-ice movement and alignment never looked correct to me when I watched myself on video or saw myself in photos. It all makes sense now.

HO Status Report

I spent two weeks vacationing in Spain, and walked everywhere - up to 10 miles daily, over cobbled streets - and my hips held up just fine. But there is a lot of residual weakness all over the place.  At my 3-month visit to Dr. Santore he signed me up for physical therapy. More on that later.

I've skated twice, and it's the typical cautious return that happens every time I'm injured or cut upon. After dinking around a couple of times I decided to wait until everything is stronger. My PT, Ashley, worked with me after I sprained my ankle and already knows a lot about my body alignment issues.

I'm convinced that even during my PAO rehabs, I cheated on a lot of my exercises, and therefore everything that was weak then never got strong and I just learned how to compensate differently.  While this means the body is a wondrous machine, it really doesn't help me skate better.  This time I vow to do the exercises right, even if it means I can't walk the next day.

And that's about where I am -- in a lot of pain. I'm working the hip flexors, the glutes, the quads, the glutes, the hamstrings, the glutes, the adductors, the abductors, and of course, the glutes. Ashley showed me the CORRECT way to do clam shells which proves once and for all that I never did them right in the past.

GLUTES GLUTES GLUTES! It's all about the glutes.  I'm a skater, for Pete's sake, and I've never had strong butt muscles. So of course my body is all wonky and misaligned and crying out for help.

I guess at age 52 it's time to fix this once and for all.

HO Update

I've had one reader (yes you LS, how ya doing?) ask me to do a followup and I've ignored that request until now as life has just been SO. DARN. BUSY.  But I have a small break and thought it would be good for my hippies and skatepeeps to know what's going on.

It seems I can never do anything in moderation and Dr. Santore described the amount of bone he removed from my left leg as "massive." He seemed astounded that there was even more than what showed up on the x-rays and I was grateful that he removed that too.  So, he basically detached the rectus femoris muscle at the tendon insertion point (for the second time, as this was done during my PAO) and then, I believe the medical term is "chopped and hacked" until all of the bone was outta there.  That bone was blocking my internal rotation as well as flexion (ability to bend at the hip).  He then removed the other bone that was growing on the outside part of my lower pelvis that was blocking external rotation - which we didn't even know about until he was in there and saw it.

I had noticed that the outside of my hip looked "bulgy" after my PAO but never realized that bulge was caused by HO.  So I am more than thrilled that it's out.  I can sit in a V for the first time; I can reach forward and touch my toes.  I can put on shoes that buckle on the outside.  I can put on socks like a normal person.

I had a lot of nerve pain during the first month or so, which has mostly resolved.  I do have a large numb patch on my upper and mid thigh (even more than after my PAO).  Dr. Santore couldn't see the nerves because of all the scar tissue and bone and so he's pretty sure the chopping and hacking impacted the nerves.  Now that the sharp pain has resolved, the numbness doesn't bother me and may eventually resolve as well.

I also had a pretty severe reaction to the adhesives used on me.  We're not sure which one it was yet, but not only did the skin around my incision blister, I broke out in hives all over my body and that took 3 weeks to resolve. The culprit may be Tegaderm or the glue used on the incision. We will do some patch tests to figure this out.

I took one Tylenol 3 the day after my operation and a couple of Tylenol the next day. Other than that I haven't taken any medications except the strong NSAID I take daily to keep the bone from growing back.  I have to take that for 2 months.

There is a lot of residual weakness in the hip flexors. I'm not yet allowed to work on strengthening because Dr. Santore wants everything to heal.  As previously stated, he did a lot of chopping and hacking.  I still have to use my hands to lift my leg into the car, for example.  But this is no different than after my PAOs and I think with some work that strength will come back, at least partially.  I won't try to skate until more healing has occurred - I'm thinking in April.  Meanwhile I have been walking and stretching and I can do 3 miles walking in my neighborhood on hard pavement with no pain.

Dr. Santore is a god by the way - in the same god-like way that Dr. Mayo is a god. They are my heros.  And Dr. Santore is one of the nicest people around.  I just can't say enough good things about him.  I've been so lucky to have such great medical care for such a difficult and rare condition.

That's my update -- I go back to see Dr. Santore in early March, so watch this space for more updates.