Post Surgery - Day 92 (13 weeks)

Pain Rating:

My Physical Therapist found time to write the following referral note, prior to my visit with the Surgeon's assistant tomorrow:-

Pt. has been seen for a total of 17 physical therapy visits since initial
evaluation on 2/7/2008.

Subjective Findings
Pt.
reports some improvement post surgically. He states that his overall
alignment has improved and general functional mobility has increased, however
intermittent spasms and hip pain continues.
No lower extremity
radicular symptoms are reported. No sleep disturbances are reported.
No medications being taken.
Chief complaint relates to morning
stiffness and transitional pain from sit to stand.

Objective Findings
Inspection: Standing
posture reveals moderate left lateral shift. Lumbar lordosis is
normal.

AROM L/S: Flexion: Minimal loss with complaints of
bilateral hip pain L>R upon initiation of movement.

Extension: Minimal loss with no complaints of pain.

Reflexes: +1 bilateral lower extremities.

Sensation:
Unremarkable throughout bilateral lower extremities.

Strength: No
myotomal weakness noted.

Palpation: Moderate
tenderness noted over posterior iliac crest L>R. No tenderness over
surgical site.

Stability:
Unremarkable.

Assessment
Pt.
has made fair progress with therapy. He has been extremely compliant with
his program and I am pleased with the progress made throughout the L/S
region. I am not pleased with the continued hip and gluteal region pain
noted upon initiation of position changes. Soft tissue mobilization and
exercises have been able to reduce the symptoms, however some symptoms
persist.
Although insurance benefits have expired I recommend
continued therapy 1x/week for advanced stabilization program and soft tissue
mobilization.

Plan
Pt. to return to M.D.
for follow up visit on 4/25/2008.

Post Surgery - Day 91 (13 weeks)

Pain Rating:

Progress continues to be slow and indifferent. On some days I don't feel too bad , on others it's a struggle to get out of bed.

In general, the bulk of the pain is in and around the hip area - predominately on the left hip. Based on my Physical Therapists judgement, it appears to be muscular. The sensation is hard to describe, but it feels achy and tight. When I experience the discomfort and try to bend forward from the hips, the tension or pressure or whatever it is, inhibits my mobility to do so.

An average day is as follows:-
1) Wake up in the morning, after a good night's sleep, and feel discomfort in the left hip
2) The first hour or two after waking up are the most difficult. It's hard to stand up-right and bend forward
3) Around lunchtime, the mobility starts getting a little better and I can quite easily seat in comfort for an hour or two
4) Either walk twice a day, swim once and walk once or gentle bike and walk once: Note: After my 25min walk, it's always difficult to bend forward for an initial period , however the walk itself is pain-free.
5) Do my 15minute set of stretching exercises
6) Go to bed

Having said all that, I'm not helping the cause by over-exerting myself at times (especially on the weekend with my two boys). Also, the last few trips to the Physical Therapist have been very beneficial. He's essentially doing some deep tissue treatment on the muscles around the hip that loosens everything up almost immediately, before the symptoms return the next morning.

The general concensus still seems to be that the back is re-adjusting to the new posture and trying to stretch muscles that have tightened incorrectly for over a year and a half.

While it's fustrating to see a lack of progress, my general posture is still much better than before surgery and while I still have adjust to bend forward, the deviation is much less than before surgery.

I have another Physical Therapy appointment tomorrow (still twice a week), although there are some issues with my insurance continuing to allow me treatment.

Additionally, I have a meeting with the surgeon's assistant on Friday and another set of X-Rays - more to follow.