Still no better, still no answers.

It has been over eight weeks since this initial injury.  I have run a sum total of 5 times, and never over 2 and a half miles.  I've been getting ART massage.  I've been going to physical therapy three times a week.  I do my strength homework every day, at least twice a day.

And I don't seem to be getting any better.  In fact, it seems to be getting worse.  In the beginning, I couldn't sit for long periods of time without radiating pain down my right leg, and this eventually spread to my left leg. Then standing began to cause pain.  Last night I couldn't sleep because my right side hurt so much.

The spinal MRI was "not remarkable."  There wasn't anything revealing a source of pain.

When I first visited my chiropractor, she mentioned possibilities including impingement, a labral tear, stress fractures, and strained muscles.  I didn't think much of what she said, but after six weeks of treatment and the same symptoms, I spent quite a bit of time researching them.  Here's what I have come up with.

-Strained muscles?  Possibly but eight weeks would provide significant healing time.  They aren't healed.  At all.

-Pelvic stress fracture?  Possibly.  But again, there would be SOME healing that would have taken place in the past eight weeks, and I actually feel pain now in the very first few minutes of running as opposed to after a mile or two.  Pelvic stress fractures take a long time to heal, but they don't require surgery.

- Impingement.  My chiropractor performed manual tests for this at my first visit and it was a possibility.  I had to do a lot of research on this one, and it seems to match my symptoms pretty closely. Here they are (and I have all of these), stolen from an Irish website:

• FAI often presents as hip and groin pain with restricted range of hip movements.
• Symptom onset can be acute, following injury, or insidious after prolonged exertion. It is generally not disabling, except in sporting activity. 
• ‘Payback pain’ after participating in sporting activity is common
• Pain is primarily felt deep in the groin at the front of the hip, more rarely it can be on the side of the hip or the buttock.
• Movements can be restricted particularly high flexing and trying to cross the legs.
• Pain is often provoked by these manoeuvres, by exercise, or by attempted return to sport and relieved by rest and inactivity.
• FAI may occasionally present as groin pain after prolonged sitting. There is no rest or night pain.

- Labral Tear.  Initially my visit with the chiropractor presented this as a possibility but subsequent manual tests have been negative.  This really is the worst case scenario.  The symptoms are basically the same as FAI except for an addition:

• Groin pain
• Clicking and snapping sensations in the hip
• Limited motion of the hip joint

My hip clicks and snaps, and pops.  Only on the right side.  Right at the hip joint.  The first doctor I saw on March 7 diagnosed me as having "snapping hip syndrome", which is a symptom of an underlying problem. Possibly this.

I never thought I'd be wishing for a stress fracture or muscle tear.... but bones and muscles heal.  Joints don't.  They get worse.  You ignore FAI or labral tears (or quite possibly, both) and you can end up with a hip replacement down the road.

Recovery time for just the FAI procedure without a labral tear?  Optimistically looking at a couple weeks on crutches, then slowly returning to swimming, biking and finally running by 3-4 months post op.  If it is the worst case scenario (well, the worst case I'll even allow myself to imagine at this point) -- FAI and a significant labral tear -- it could be 6-8 months before I can return to "normal" activities.  If I'm one of the lucky 95% of patients who can return to "normal."

The good news is that although the FAI or FAI with labral tear surgical procedure is relatively new, the DC area has some very skilled doctors with this specialized training.  I've spent hours researching them, reading their online reviews, and asking around the PT, Chiropractic, and triathlete community.  

So what's next?  On Monday I have an MRI with IV-contrast.  This will hopefully get to the root of the pain.   At this point, I want it to show SOMETHING.  For the past 8 weeks I've had no idea what is wrong with me.  Whatever it is, let's just figure it out and get on with it.   If I need surgery, let's just do it.  Let's get the bed rest part over with, start the aqua therapy, get back on the bike, and be running by late fall.

I was reading forums of other triathletes who have been through the surgery, and one of them mentioned the handicapped hang tag for your car.

Wow.  From a 3:31 marathon, to a few months in the handicapped car space.  

And how does a mother of two little people with a job that demands playing classroom instruments, folk dancing, and sitting on the floor with kindergartners find the "right" time for hip surgery?

Maybe the MRI will show something completely different.  Maybe it will be something that they didn't see, but has a much easier fix.

Realistically, though, I know where my symptoms are pointing.

I have an appointment scheduled with one of those top hip surgeons a week from Monday.  My MRI results will be back in a few days.  Until then, my mind is swimming.