Femoral head necrosis

Medical Q&A [Moderated]
1

Hello docs,

First of all I’m a long time follower and a huge fan of the info you put out here => keep up the excellent job !

Now for the bad news (I guess ?)
I was finishing powerbuilding I around november/december last year when I started to feel some pain at my left hip and specially around the left lower glute. (my 1@8 were around 180kg on the DL and 140kg on the squat at that time btw, I’m around 76-77kg)
I did the usual steps to manage it (i’ve been through a patellar tendinopathy in early 2019 thanks to your excellent info) lowering RPE, lowering the weights, introducing tempo etc.

The pain would get a little better and then worse again until march this year when I started to have a really tough time even to walk. I had a bad limp and all and it was impossible to train my legs for some time (I wasn’t really doing anything heavy for more than 3 months concerning squats/deads/etc).

This period was when the gyms closed here anyways and we were locked down (I live in France) so i finally saw a sports doc here that told me to keep mainly doing some rehab work with what i could find at home (glute bridges,nordics, tempo single leg RDL with water jugs, this stuff) and I kept working out and doing some kind of rehab for the hip for 3 full more months.

Good news was the pain got better and better and I was able to go back to the gym when they reopened and keep progressing little by little with it. I dont have any more pain to walk or any kind of limp but I felt that there was something still kinda weird with my left hip, my range of motion was way worse, I can’t squat to depht (so I was doing pin tempo squats) and pulling from the floor stills fells weird. And I still had some pain when doing in some tasks that required lots of hip flexion (like bending over to tie the shoes). At the moment I’m doing hypertrophy I and just focusing on my bench and my upper body, training what I can for the lower body without much pain.

Anyway I saw the doctor again and he also though that the reduced range of motion was worth checking out.
Some hip x rays and MRI after came the news => I have a necrosis of the femoral head of my left leg.
So sports doc refered me to ortophedic surgeon.

Well, I have an appointement with an orthopedic surgeon (hip specialist) in some weeks to see what we can do about it. I’m guessing I will need surgery one way or another.
My main question is just => should I keep training with the modifications as usual (limit range of motion, train what I can without pain, etc.) or given the nature of this stuff is maybe better to avoid putting weigth on the affected leg for some time ? (I find that conterproductive given that I’m pretty sure exercise is what made me walk again without pain on the first place).
I will ofc ask more info to the ortopedic surgeon in a couple of weeks, just curious about your take on it while i wait for the consult.

Anyway, just hopping I would Brett Favre out of this in some way of another (lol)
Sorry for the rambling and keep up the good work !

Cheers !

2

Hi there,

Sorry to hear about this issue.

How old are you? Do you have any other medical problems?

Do you take any medications?

Have you ever had traumatic injury to the affected area?

Do you happen to have the actual MRI result available?

3

Hello

thanks for the quick reply.

I’m 34 (turning 35 later this year), no other medical problems, no medication and no traumatic injury.

MRI also shows a beggining of necrosis on the other leg as well (no pain and no symptons as of yet).

I can send you on private the MRI by e-mail, just tell me where to => not really confortable sharing publicly if you don’t mind.

4

I see. Based on your description I certainly agree with orthopedic consultation (and potentially medical evaluation for other predisposing conditions).

I don’t really have a strong basis of evidence to make recommendations about how you should train in the meantime. You should be able to train upper body movements normally, but unfortunately I am not comfortable making recommendations regarding the lower body lifts here. Hopefully you can get that consult done soon.

5

Hello,

So I had my appointement wih the ortho surgeon and just wanted to share in case someone else goes throught that.
Basically he told me that my necrosis is already past the first stages and the femoral head has already collapsed on the left side (it’s not fully round anymore and you can see it in x-ray). But no OA as of yet on the hip joint.

What the ortho told me is that I’ll maybe need hip replacement in the future but for now my pain presentation, my symptoms and my age don’t justify it (he did tell me that 80% of orthos would say I should get surgery now btw). It’s also a good sign that I don’t limp anymore and that the pain got better.

At the end the only thing to do for now is to keep following it (another appointement in 3-4 months with new x-rays) and see how the symptoms evolve. He said I could keep going to the gym and just basically follow what my body tells me I can push without much pain. I forgot to say before that I’m a smoker and he advised me to quit as well (which I was already planning to do and now will see to it)

If it gets better (or just not worse) it’s possible that I won’t need Hip replacement for quit some time. It’s also possible that the pain gets much worse and I’ll end up having to do it later in some months or years => impossible to tell as of now anyways according to him.

He also said that since I don’t have any pain/symptoms on the right side there’s no point of doing anything even if MRI show some necrosis (cases like mine are usual bilateral he told me).

I think I’ll get in touch with your rehab team for a consult to see how to work arond this issue pain-wise.

Thanks for your time !

Cheers