Open gluteus medius and minimus repair pain 15 months post op

@jaysaki Welcome to Connect. I'd like to share with you what I have learned from my physical therapist who is also certified as an Expert level Myofascial specialist in the John Barnes methods doing a treatment called "myofascial release".

All surgery creates scar tissue. Injuries create scar tissue. We all have patterns of body tightness in our fascia which is the stretchy connective tissue that holds us together in-between the other specialized cells like muscle fibers. Cutting fascia causes scar tissue in it and binds it up preventing normal movement. Stretching too aggressively can also tear fascia creating more scar tissue. The tightness causes pain. The secret to releasing it is with slow stretching and it may take some weeks of sessions to work through the layers and get the body moving better.

I first learned of myofascial work in rehabbing from thoracic outlet syndrome. I've also had spine surgery and ankle surgery and this has helped me a lot. I've used this to loosen surgical scar tissue.

Here is our discussion about MFR. The first pages have lots of information and links.
Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

My suggestion is look at the provider search at http://mfrtherapists.com/ and ask your doctor for physical therapy with one of these specialists. Having pain is enough to justify physical therapy and you do not need a specific diagnosis that something is wrong. I think that is the wall you are hitting with your surgeon because they believe nothing is wrong and that they did a good job. They do not want to fail at anything. Some know about MFR and some do not. You can even see your primary care provider for a script if your surgeon will not support this.

Have you heard of MFR before?

Thanks for this information. We worked very carefully in the specialized physical therapy practice I work with throughout the early recovery of my surgery. I am actually back in physical therapy by the recommendation of my surgeon because he refuses to believe something is wrong. The therapists at the practice have all consulted on my case and recommended I get a second opinion and are shocked at the course this has taken since this surgeon comes highly recommended. I was a rare case from the beginning and they never read my chart before I come in. I have to continually course correct them when they try to standardize my case with the average. I appreciate the information and will consider this after my next follow up and my consult with 2nd MD.

@jaysaki Thanks for your update. You may find information on this site useful because it is very technical information focused on neurology and physical rehab. I don't know if this applies in your situation or not, but this article does cover pelvis related issues that can happen. I'm glad you are getting a second opinion. I was a rare case too when I needed spine surgery, and 5 surgeons missed the problem and wouldn't help. I had a good experience with surgeon #6, had surgery and it fixed the issues. Good luck in your quest.

"How to identify and treat lumbar plexus compression syndrome (LPCS)"
Posted on March 30, 2017 by Kjetil Larsen
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/

This is interesting. There are multiple "subsystems" involved here and because medicine has become "super-specialized" it has become challenging to find the "right fit" when it comes to medical care.

I also concur with the recommendation regarding fascia, injury, and surgery. Movement is among the best means of treatment. I think you have to continue to be persistent, do your homework, use the medical literature as well as other sources as a guide and formulate a strategy and case in order to get your issues addressed.
What you may have going on may not be uncommon.

Thank you. Before surgery, I lived a very active lifestyle (CrossFit, hiking, biking etc.) and remained diligent throughout the recovery to work what wasn't injured from the week after surgery. That's what makes this so discouraging and why my therapists are so perplexed. I was an extremely compliant patient and the outcome just doesn't line up. I also had a few events early into recovery (fell on stairs with crutches and slipped in the shower ) that were pretty much dismissed. I'm in the same or more pain than I was pre operatively and have communicated regularly with the surgeon and staff from day 1. I have been told it's bursitis and tendonitis even though the bursa was removed during the procedure and I have not returned to repetitive motion due to exacerbation of pain. It's beyond frustrating and my only goal is to get back some consistent movement and quality of life. This has been a traumatic experience to say the least. Thanks for your insight.

I will say my surgeon was not quick to suggest surgery. I have had needling (which did something), therapy, recently a bursa injection. The injection "freed" up something but caused another. I have a couple of diagnosed issues (similar and more of what you had). I would say that there is always something more to learn about the human body. Fascia and adhesions play a role. Brain to muscle "connections" play a role. I practice yoga, mindfulness with movement (somatic conditioning). I do have calcification build up on my hamstring tendon that makes sitting sometimes excruciating. The article that was provided is pretty long and I would recommend reading it. (Keep a medical dictionary handy.) I have found that doing something else for awhile can help. I recently had to work on my posture to address the issue and it helps.
Keep working the problem and let your providers know.

We did conservative measures for 18 months prior to the repair and steroids many times via mouth and injection with no more than a week relief. I ended up having a large underlayment tear that was unseen on imaging. I have been focusing on mobility work for over a year and will read the article for sure. Thanks again

My wife has been going through a very similar situation. She had a gluteus maximus repair, with pain continuing, then a hip replacement, with pain continuing. A doctor finally discovered a torn muscle that had been overlooked for so long that it was atrophied beyond the point of repair, so she was told that the debilitating pain would be something that would have to be managed the rest of her life.

Most recently she saw a physiatrist, who referred her to a nerve ablation specialist. Last week, after a trial injection of anesthesia to the nerve at the hip joint, she had a nerve ablation. She had very welcome relief the day after ablation, but the longer term effect won't kick in for 2 or 3 weeks. She has gone through a bunch of cortisone injections over the past several years, too, with no benefit.

The surgeon who did the muscle repair missed the second tear. The same surgeon missed the damage below my ankle when he did repair to my ankle, now requiring a fusion. Frustrating.

It's great that you are taking initiative in getting the appropriate treatment. Doctors can be dismissive, unfortunately. If one won't pay attention, you can try getting the tests and treatment from a different doctor. A physiatrist is a good resource, as they tend to look at the bigger picture than the other doctors who can get focused on what they think they know.

Jim

I think it helps to know the physician's background. The level of expertise is very important. I would prefer to say doing your own self evaluations will help.

I have been exercising heavily for years until recently (full-time job) and symptoms are worse. Oddly, this past weekend, I rode over 100 miles and I had little pain after. It is slowly coming back... Most doctors might be shocked that a patient could do that much mileage and think there isn't a problem. Some of us are not typical. And that should be recognized. Good wishes.

Thanks for sharing your experience. It's frustrating. The surgeon came highly recommended from multiple sources and is known as the only surgeon in the state that has expertise in glute med repairs. I 100% agree with you that doctors have difficulty with very active patients that can still retain strength & endurance despite an injury. In my experience, that has been the disconnect and why my pain is being dismissed. I don't represent as the standard 53 yr old with a glute tear. My next option is to travel a few hours away for a 2nd opinion as there are a handful of surgeons out of state that do glute surgeries. Fingers crossed I am heard at my next appointment and can at least get some post operative imaging and move forward with life. Thanks for listening.