Pain After THR?.... It could be trigger points

Hi all,

I am about 10 months post op from LTHR. Like many of you, I have had bouts where I struggled through pain that did not seem totally normal. Everything from tendinitis, to bursitis, to failed osteointegration went through my mind (and my surgeons). While I steadily progresses, and pain got better over time, I continued to have flare ups of pain after overdoing it (which can be extremely easy to do if you suffered from limited RoM for many years prior to a THR (atrophy and tightness of muscles can lead to strains and tears). Anyway, what I found really odd was that my pain seemed go move all over the place, and was often felt in places far removed from my hip (knee, shin)... but also in the groin, the outside (lateral) of the thigh, and low back. I just couldn't figure it out. I eventually found a very experienced and highly respected sports physiotherapist. He spent time explaining the concept of referred pain and trigger points (I have known about trigger points and pain referral for a while, but did not realize just how far pain can refer).. He pressed hard on a number muscles, and I was shocked at how it triggered pain in other areas (for example, he pressed on my TFL, and it referred pain well below the knee). He recommended a massage ball, and it seemed to really help.

Recently I found a fantastic book on Amazon called "The trigger point therapy workbook". I was a little sceptical, but the reviews were very high. So I figured since it's only $25... so why not. Long story short, the book is awesome. It has a ton of information on trigger points and there pain referral pattern. Anyway, what I learned is that I have trigger points all over my left leg... in my glutes, in my quads, in my adductors and abductors. Basically every muscle around the hip. I do not know if they were cause by the trauma from the surgery, from over doing it during my recovery, or existed prior to the surgery from the limited RoM. But one thing that is for sure, once I started treating the trigger points (via IMS and self massage), my pain quickly started to abate.

I still have a long way to go in my recovery. At 10 months out there is still considerable weakness in muscles that were not used for over 4 years (primarily external rotators). And I still get pain flare ups when I over do it... though that happens much less as I gain strength, and I am able to treat the quickly. I have not yet returned to sports that require sprinting or jumping (baseball, volleyball, hockey, etc.), mostly because I will not be cleared by my surgeon until the 1 year mark... but also because I know I kneed to continue to strengthen the muscles around my hip. But discovering most of my pain is being caused by trigger points, and being able to treat that pain has really help my recovery and overall confidence in my new hip.

So, if you are several months post op and are still in a lot of pain, you might want to consider the possibility that some of your your pain is muscle pain from trigger points. You don't need to see a physiotherapist or buy a book (like I did) to learn about trigger points and how to treat them... there is lots of information on the good old interweb ;P ... though I will say I like having the information right at hand in the boom and not having to hunt for it.

Anyway, I just thought I would share my experience and some information I have learned. I hope some of you find it helpful in your recovery.

P.S. I am on the younger side (just past 40)... so, as my surgeon pointed out early on in my recovery, being younger does not mean recovering quicker. And it may mean that you will develop more trigger points due to increased muscle mass. Just something to consider if you are on the younger side and frustrated by your recovery not going faster.

Cheers!

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