CAM and Labral Tear?
“”For the first time, I have an injury that just didn’t get better. What’s worse, it was mine and not a patient’s. Actually, I don’t know what is worse, as I feel personal upset when a patient doesn’t make significant improvement , i feel it is my fault / issue, which is ythe opposite of my bvelief which is we are all responsible for ourselves. However, that is what keeps me grounded in my passion, trying to get people better.”Philip Aarons Jan 2023
For Philip, last January 2022 after a week running in the Cotswolds life was good. Yet sometime in March he started developing hamstring pain for no reason. It was the side of the hip and back of the leg. At first, it was thought it was a hamstring injury or just “getting old”. A month of two past and it was still constant pain, made worse every time he tried to run even 3 km. Treatment to the local soft tissue, strength work at the gym and anti inflammatory did little but palliate. However, we looked at what made it worse in more detail, he started to be aware what aggravated it and noticed uphill, run or walk, or even uneven ground increased that ache. This wasn’t making sense as the hamstrings were powerful at the gym and all test were negative. It wasn’t following a normal pattern
Back to Philip,
“To cut a long story short (too late I know) by November 2022 I had given up my favourite game, squash after playing since I was 16 (I am now 52) and not running over 5 km. I tried a 8km with a friend “G” and suffered two weeks of constant ache. Enough was enough and I referred myself for MRI. It showed to my surprise a CAM deformity in both hips and a labral tear of the right.
Now , we know that labral hip tears and CAM deformity cause groin pain and impingement syndrome. It must do, because it says so all over the internet, but more importantly in the orthopaedic journals as well. The problem is , I had none of that. Its interesting. This means the classic description we read in books or (on the net) is certainly not the whole truth. https://orthoinfo.aaos.org/en/diseases–conditions/femoroacetabular-impingement/ for example. This I knew , but it was an experience when it happens to your own body.
A CAM deformity of the hip is likely to be from impact injury in adolescents (i.e when hip was forming), I certainly played a lot of sport from 16 onwards and the usual school activities. However, I never had any injuries to really talk about. I have lectured on why running and impact is actually good for the cartilage (see my other blogs on the Osteo house web site). Running lessens the chance of arthritis, but here I am with a classic deformity increasing my chance of hip surgery.
Now a labral tear, is a tear in the small ring of cartilage that rings the hip joint. It is a “lip” around the hip socket. The symptoms are similar to a CAM deformity for many people but not for me. A tear is usually due to wear and tear, direct trauma or repetitive twist and pivot exercise (tennis, squash , dance etc). I don’t remember any nasty injury but that can form over time. I do remember however extreme pain in my hamstrings mile 12 of a marathon and finishing it nonetheless by hobbling to an excruciating 4 hours 40 minute finish. Maybe that was point zero?
The ”orthopods” will tell you that CAM and tears often if they cause pain, will need to have an arthroscopy for either or both of the above and lets be fair that could be my future. But as an osteopath and supposed expert in the field the last thing I wanted was a few weeks off work, surgery and a direct insult to my core belief and proven treatment plans. Trust the body and it will get better.
So avoiding the big “No’s” of what aggravates it and being sensible will avoid early osteoarthritis I hope. Treatment will be with balance of the feet and pelvis in relationship to the 3rd lumbar vertebra (the centre stone of the spine). The shoulder girdle will be more integrated into running allowing the impact of forces to be taken by the arms as much as the feet. I must thank Luca here, as he refreshed my eyes on impact of fascia and “carry” of load through the shoulders and arms.
Here are my top tips if you have a tear or CAM deformity
- Don’t give up, you will exercise again, find what is right for you and ignore what a lot of internet says.
- Work with an expert like one of the practitioners at The Osteo House. Also our PT (personal trainer)
- Get an MRI if you have consistent pain in the outside of hip, groin or hamstring area. (we can arrange one for you (£300) ish as of Jan 2023. I have referred a few patients now with unquiet glut pain for MRI which has also shown tears.
- Start Rehab, this involves a set of exercises from cross figure hip to shoulder changes to light glut builds.
- GET YOUR SPINE IN LINE, this was the game changer. Until I worked with one of my osteopaths who was trained in body adjustment specifically, the progress was slow to non existent. Yes sports massage and exercise was good, but nothing changed it like the progress of a few treatments. Focus on Central gravity lines.
- Do think about not crossing legs as much. Lying on the poorly side to sleep etc.
- Be Patient, it will take months.
- Nutrition may be a factor. You need amino acids and low sugar.
- Consider using nsaid as and when. (Check your stomach can handle them and it doesn’t interfere with any meds you are on)
- Use hydrotherapy at home. Hot packs and cold packs.