Overzealous and anxious at the same time?

[David Brown]

Over the last two months I have been working with a patient post labral repair and osteotomy to correct a FAI. The patient is a competitive distance runner, like me, and we share many of the same mutual friends. Knowing he was going into the surgery, and knowing I was going to be his therapist after the surgery, I tried to help manage his expectations going into it over a cup of coffee one day. He is also a PTA so I knew he had a rudimentary understanding of what to expect with this kind of surgery. I explained tissue healing timelines and typical weight bearing precautions that his surgeon might prescribe for him but reminded him that the specifics will be explained to him by the surgeon. Despite this conversation, when I evaluated him a week later (4 days after his surgery), he was perplexed that he was still feeling pain and cavitations in his hip when he was rolling around in bed or moving his hip in any kind of way. He was under the impression that he would have more or less walked out of the operating room a new man and be completely fixed and healed. The frequency and severity of cavitations were the same as they were prior to the surgery. Having experienced this, he went online and found statistics off of different websites showing the likelihood of failure of these types of surgeries and immediately thought this was him. Picking up on these signs, I began educating him on the typical trajectory of healing and progression back to PLOF. Much of this I had already covered with him over that coffee, but I went over it again in greater levels of detail. The patient was understanding, but still feeling worried and uneasy. With that, for his first follow up appointment, he presented to the clinic without his crutches! This is despite his surgery being 1.5 weeks ago, and his protocol calling for a minimum of 4 weeks with bilateral crutches and 50% body weight. I was flabbergasted when I saw this to say the least. As a friend, it was difficult for me to devise a way to approach this as I want to stay on good terms with him but I also wanted to convey my frustration and importance that he continue to use the crutches. His reasoning is that he was feeling much better, but upon further questioning, he was still experiencing the same level of cavitations that he was experiencing at IE that drove him to research the incidence of labral repair failures and become anxious and scared that he was among that 50%. I tried, but could not convince him to use his crutches and immediately reached out to his surgeon whom my patient was going to see for a follow up the next day. Despite his abolishment of AD use, I kept my treatment in line with established protocols and tissue healing timelines. Fast forwarding to current, the patient is now 8 weeks post-op and has been progressing relatively well but is still experiencing cavitations to the point where he cannot perform any transverse plane exercises in weight bearing. I have continued to perform good and indicated manual treatment and the patient is 100% compliant to his HEP including self hip mobs. Despite his continued fears of failure of his surgery, he is already talking about returning to running and he is only 8 weeks out. This has been a difficult situation for me as I have to keep refocusing on his expectations almost every visit, even though he expresses his fear of the surgery failing multiple times a week. It has been a challenge to explain to the patient that regardless of how advanced he feels with his healing and post-surgical protocol, if he begins running, the chances of something truly pathological occurring to his hip is very high. I am continuing to treat this patient and hope I can corral him and hold him back for the sake of his hip.

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