Personal experience of FAI – what worked

Shortly after finishing my first 12 hour TT in 2016, I started getting pains in my right hip and lower right back, and also delayed muscle fatigue in the right glute.

I assumed it was related to cycling a lot that summer, but cutting back on training and racing didn’t diminish the problem, in fact, it got worse. I went to osteopaths and physiotherapists, they were all confident a bit of massage and physio would make leg stronger and get better. When it didn’t, after a few months my osteopath said he would ask for a second opinion as he felt he couldn’t do any more. (I appreciated his honesty). Another osteopath at the same clinic said it was probably all in your mind. So I tried to think away the pain and carry on, but it didn’t work out.

Then I tried the Egoscue method. Egoscue concentrates on improving your body posture, the logic is that if you out of position, you place strain on joints e.t.c. I was out of position with my head forward, one shoulder higher than the other and a bent back. I religiously did the egoscue exercises for a few months. My posture improved, but the hip issue was unsolved.

Then I heard it might be FAI, so I did an internet search and became convinced that was the end of cycling. However, not all the internet is useless. When I announced my retirement on my blog, a few readers said there were solutions to FAI. I was deeply grateful for those comments as it encouraged me to keep trying.

I went to GP and he suggested an X-ray. When I went for an X-ray there was a mixup and I had no appointment (I think I went to the wrong hospital) Anyway I was getting impatient so went to a private doctor who specialised in back pain. (at that point back pain at top of the pelvis was worse than hip.) The private doctor sent me for an MRI, which was reassuringly expensive. The doctor said the MRI scan revealed nothing was wrong; backs often cause pain and it may heal itself in a few years – perhaps suggesting it was all in the mind or something. Hearing there was nothing wrong was both encouraging and discouraging. Encouraging because it sounded good in theory, but in practice, I didn’t believe it.

Then someone suggested it might be arthritis. A quick internet search seemed to confirm this diagnosis so I went into Blackwells and bought a book on arthritis that suggested all arthritis can be cured by a change in diet to fruit and veg, no wheat, dairy e.t.c. The fear of arthritis sent me back to the GP. The GP thought arthritis unlikely but he sent me for an X-Ray. This time I made it to the right hospital and got an x-ray of my hip.

When the X-ray came back, the GP pointed to the hip and said look at the bone spur on the right femur, it is FAI. I got a referral to a private clinic in Oxford that deals with FAI (Oxford Nuffield). When I went to the private consultant, he looked at X-ray and said that is not FAI – it’s just a quite common bone spur and it won’t cause any of the problems I had. However, he did think something was wrong and suggested another MRI.

The second MRI the doctor was quite excited because he clearly saw FAI at top of the hip joint and a laberal tear in the muscle. He said untreated, it would probably develop into arthritis. The back pain he didn’t fully understand but thought it was all connected. By this time I had researched hip arthroscopy as a treatment for FAI. The internet gives mixed reviews – many say it is waste of time, other (including some blog readers say it helps). The consultant was 50/50 about operating but he passed me onto a colleague who specialises in FAI in young adults (mostly athletes as they are the most likely to notice it is problem). The doctor gave a reasonable chance of improvement but said it was up to me as there is no guarantee. A big factor that made him willing to operate is that I had spent two years of doing physio, being patient, resting, riding through e.t.c. I felt I had come to the end of that particular road. After two years of exercising, stretching, strengthening and yoga, you just don’t feel more of the same is going to change anything.

I had the operation. It went well. After a few weeks, I was tentatively back on my bike. After a few months, I felt some old pain in my lower back and I had to cut back. But, when I tried again in 2019, I mostly felt better.

I would say I am back to 90-98% fitness. I still get some lower back pain if I really push it. At the end of the hill climb season, it was getting a bit bad, so it was a good excuse to rest up over winter. This year I have steadily got back to fitness and I feel it is pretty good. About twice a week I am doing 40-60 miles at 22-23 mph and really enjoy it. Average weekly mileage is currently about 120 miles.

Conclusions

• I really missed cycling so I tried really hard to get better. The focus on getting better and trying different exercises were useful for filling in the gap from not being able to cycle.
• I tried many, many different things. Massage, osteopathy, rolfing, trigger point therapy. Generally things where someone does things to your leg, didn’t give me any benefit.
• I feel there is great value in physio, strengthening and certain yoga movements (which I continue today. I have created a daily routine of yoga and strengthening, which has helped general core strength and I think helped make surgery more successful.) However, in my case, this physio approach wasn’t enough to make full recovery. For example, I signed up to an FAI exercise programme. I think it was worth the money, but I disagree with their claim you only need exercise.
• Doctors and practitioners were a mixed bag. Everybody tends to view your ailment through their filter. A physio says you just need physio, the back specialist only thinks of your back and seemed to dismiss or miss the hip angle. And those who think it is all in the mind, will tell you it is all in the mind. The hip specialist at the Nuffied Prof S Glyn-Jones was very good. I had great confidence and he seemed to really know what was going on.
• I think I got lucky with my GP diagnosing FAI, even though the consultant swore he would not have diagnosed FAI from my x-ray!
• The hardest thing was getting a proper diagnosis and knowing where to go. It was one time, where I felt you had to not rely just on doctors, but actually get to know the issue yourself. You have to know which person to go to.
• Needless to say, there are conflicting opinions on the internet. I felt the most reliable source was the comments section of cyclinguphill.com – so there you go.
• Every case is different and I am only writing about my own long zig-zag path.
• Ultimately, the £7,000 for private operation was a really good choice. I think without it I may not have made full recovery.

Diagnosis from hip specialist

Notes from my operation

Right hip arthroscopy, labral repair, osteochondroplasty and stabilisation of carpet lesion with stem-cell rich bone marrow concentrate and Tisseel glue.

Evidence of large labral tear from the 3 to the 9 o’clock position. Bed prepared. 4 CynchLok knotless anchors impacted with excellent fixation of labrum. Small associated carpet lesion but there was good chondral labral stability, therefore, this was stabilised with bone marrow concentrate yielded from the rim of socket. Bone marrow processed using NTL Biologica method and mixed with Tisseel glue. The rest of the hip was pristine. The femoral head was in good condition. Good ligamentum teres condition, no loose bodies.

The peripheral compartment entered after a traction time of 21 mins. There was evidence of a large CAM lesion on the anterior/lateral of the femoral neck, this was removed using a 4.5 burr. The edges smoothed. The hip was placed in the impingement position with good excursion of the femoral head/neck junction beneath the rim of the socket.
Thorough irrigation. Good