My Sports Hernia Experience Part 2 and the Road to Recovery

Once surgery was scheduled, it was huge relief to me knowing there was finally going to be an end to all the discomfort my body has been going through for the last six months.  This injury physically, mentally, and emotionally drained me and to the point that I decided to give up on any and all endurance activities. This I feel was what really caused many other issues to arise.    It is truly amazing to me how the human body can adapt to a weakened unstable core due to the sports hernia.  My back, hips, and other surrounding muscles had compensated for the injury and were now guarding the injury causing all sorts of referral issues.  Due to the lack of exercise, excessive scar tissue was able to develop and take over increasing my discomfort and decreasing range of motion in my hips and back.  I was mess and was feeling as though I would never be able to return to endurance running let alone many day to day activities.  It all hurt!  My surgery with Dr. Brian Busconi and Dr. Demetrius Litwin, both out of UMASS, was set for Monday, February 4, 2013.  The actual procedure required was called a Pelvic Floor Repair.  This type of surgery didn't involve mesh but rather an open procedure that involved a suture repair to reattach one of the several muscles that may have been torn. In my case a large tear in the abdominal rectus muscle.  On the friday before, a nurse had called with specific pre-surgery instructions which entailed what to wear, what not to wear, and not to eat anything after midnight.  The morning came quickly and I was super excited about the surgery until I remembered that I couldn't eat and drink fluids until after surgery.  I believe it was about 19 hours before I was able to eat.  My wife took the hour and half commute from Connecticut to Worcester Massachusetts to be with me and to get me home safely. As soon as we arrived and checked in, we were called in to prep for surgery.   Prep nurses, Orthopedic doctor, Surgeon, and Anesthesiologists all had their moment with me.  Dr. Busconi, my Orthopedic surgeon along with Dr. Demetrius Litwin, my general surgeon came in and explained the procedure.  Both doctor's bedside manner exuded confidence and reassurance and that went along way with me knowing that I was definitely in the right hands.  Once again the Anesthesiologist returned...It was GO time!  My wife headed for the waiting room after a brief good bye and I was given a quick cocktail of medicine and then rolled off to the OR.  Things started to get very floaty briefly after the cocktail. The next thing I remember is being in the OR and having numerous people talking to me and moving me onto a table then lights out!  I'm awake, foggy and slightly nauseous from the anesthesia and I have two nurses staring at me.  Shortly after, they rolled me back into the room I was pre op and greeted my wife.  Dr. Busconi stopped in and told me they found a much larger tear than they expected to my abdominal rectus muscle but there was no issues repairing it.  Busconi gave me my next post op appointment and went over important post surgery protocols.  I was eventually released from the hospital and on the road back to Connecticut. The Dr. Busconi's protocol for rehabilitation required nothing but rest for the first 4 to 6 weeks post op with weight bearing as tolerated.  After about 4 to 6 weeks his protocol states that a light abdominal core plan can be implemented.  After a few good weeks of core, about week 7-8 post op, more sport specific activities is advanced at tolerated.  A full return to sports is about 10-12 weeks with an open suture procedure.  To be honest, I never truly was in significant pain as it was more of a discomfort.  My expectations of the recovery process was far worse than what I experienced personally.  I did rest a lot but I was up and walking around since day 1 post op without much in the way of pain.  There was less discomfort with walking as there was with laying down on the couch.  By the end of week 2, I was really feeling as if things were healing up well.  So well in fact that I'm beginning to get that urge to run again.  That feeling that had been taken from me quite some time ago due to the pain and frustration of not being able to get properly diagnosed so quickly.  I'm not going lie, I have jogged like 5 feet and it felt so good.  However, i'm still dealing with excessive tightness to my abs, hips, and back due to the guarding issue so I have been working in massage sessions to help out.  I am currently 18 days post op and counting down the days until I get the green light to begin PT.

11/18/13

Many of you have been asking about the remainder of my recovery process so I will sum it up for all of you.  Recovery went very well after following Dr. Brian Busconi's strict protocol.  I was itching to get into physical therapy and felt absolutely ready by week 4 but no office would consider unless I had permission from the doctor....that did not happen!  So at 6 weeks I did start physical therapy and quickly realized that I had a better shot at recovery if I took my rehab in my own hands...so I did.  I returned to running at 14 weeks post op and built up very slowly.  1 mile at a time until their was no lingering discomfort post run.  After about a solid month of build up my body felt ready for a challenge.  I signed up for a 5K with intentions of giving myself a baseline to set the tone for an upcoming marathon training season.  I ran a lung searing bittersweet 19:22.  I was pleased that I just ran my first race in 6 months but upset with how much speed I had lost within that off time.  My personal best in the 5k was an 18:03.  I knew I had a lot of work to do to get back to a PR in the marathon.  The first week of June I began my marathon training for an early September race (Lehigh Valley Marathon in PA).  After a solid build up I incorporated more "effort sessions" such as your typical tempo runs, intervals, and repeats at the track.  My split times were very consistent with similar workouts prior to the injury...this proved that I was making significant progress.  This was going oh so great until week 9 when all of a sudden I began to hobble.  It felt like a lower leg issue tibial tendonitis or shin splint or whatever you want to call it.  It was not!!!  It all stemmed from a nerve root impingement from my L4-L5 and I spent two months rehabbing back into my running sneakers.  It was a slow slow injury to comeback from.  My back was always chronically tight, I had little motion through the back or mobility in my hips but now with this injury it was a disaster.  I felt like I was an old man getting out of bed every morning.  I decided to experiment with a gluten free lifestyle and after about a week...no joke, a week I felt great again.  I had less inflammation and more mobility and even a ton of energy that I thought my kids have permanently sucked out of me. After this injury I decided to buy a road bike because I was not going to lose my fitness once again so I biked and logged 100+ mile weeks for 2 months.   I just recently attempted my come once again and I am shooting for a December 1/2 marathon.

My Sports Hernia Experience

 I have never blogged before but after a complicated injury that has set me back from running marathons and dropping out of my target Boston Qualification race, to my long and frustrating road to recovery, I felt compelled to write about my experience.  More importantly to spread the word about the lack of information on doctors who specialize in groin injuries in hopes to help a fellow athlete that may be facing the same injury.  I am an avid runner and have completed several half and full marathons. In August while I was in mid marathon training for my third full marathon in 2012, I developed dull ache in my left lower abdomen/ groin area. When the symptoms first came on it was a gradual onset and there wasn't a notable day that it occurred.  It only bothered me with physical activity such as running.  The strange thing about it was that it would be uncomfortable for a mile or two and would then disappear allowing me to continue training for several weeks. However, it got to the point where that discomfort level increased significantly eventually causing me to reduce and alter my marathon training and eventually causing me to drop out of the ING Hartford marathon at mile 9 which would have been my 6th full marathon. I scheduled my first of many frustrating orthopedic appointments to confirm my suspicion. I just knew that I had a Sports Hernia though I hoped for the best. A sports hernia is usually classified as long standing groin discomfort or pain and is NOT actually a hernia but more of a tear in the groin where our adductors, rectus abdominals , and external obliques all join near the pubic area.  A Sports Hernia is often called Athletic Pubalgia or even Gilmore's groin.   It is unbelievable to me that so many doctors have little understanding of what a Sports Hernia really entails and that they have little informations as to who to send you to. Due to my rising frustration I took to the internet in hopes to find a groin expert.  I spent several days  research hoping I could find somebody local that could help me out.  One day I got lucky as to how I Google searched the topic and found a blog by an athlete by the name of Pat Dwyer blogging about his very similar experience with Athletic Pubalgia.  He in fact had the surgery for Athletic Pubalgia in Massachusetts out of UMASS. Great stuff! I googled the orthopedic doctor he used (Dr. Brian Busconi) and immediately came to the realization that this doctor and a local general surgeon had several publications related to athletic pubalgia. I made my appointment with Busconi. He was two hour commute but worth every mile. He conducted X-rays of the area and read my MRI and determined that I had slight cam impingement in my hip as well as Athletic Pubalgia and believed my hip issue was asymptomatic.  Dr. Brian Busconi attempted an injection into the groin and I was told to rest (once again). I rested and continued ongoing PT, stretching, ART, core strength but no relief just decreasing fitness and increasing frustration. I made the call back to Busconi who recommend me seeing the general surgeon. Dr. Demetrius Litwin, the same guy in the publications and exactly the fella I read about in the blogs. Very recently I met up with general surgeon Demetrius Litwin at UMASS Memorial Hospital. At first I was very uneasy about the whole deal because researching the internet and running forums, it appeared that there were two ways that doctors fix this type of injury.  These methods were either through an arthroscopic mesh overlay procedure and open surgery suture technique.  From my findings, many athletes were having bad outcomes with the arthroscopic procedure and later had to go under the knife again.  Based on my research , there were only three doctors that people talked about who operated via open surgery.  Dr. William Meyers located in Philidelphia (the guru in Sports Hernia surgeries), Dr. William Brown out of California, and Dr. Muschaweck in Germany.  After calling Dr. William Meyers office (where all NHL, NFL players go) I learned that he no longer deals with insurance companies.  My luck was beginning to run out. It all came down to my visit with Dr. Litwin and the technique he used for his procedures.    I'm happy to say that Dr. Litwin along with Dr. Busconi are the right men for the job. Before Dr. Meyers worked in Philadelphia he recruited Dr. Litwin to work side by side with him. He uses the same open procedure as Meyers and doesn't believe in using mesh for this type of injury. They consider it pelvic floor repair. I am finally scheduled for surgery on February 4th and it is truly exciting to finally see the light at the end of the tunnel and I cant wait to get back to the competitive addiction within sport I have grown to love.