A Motivated Patient’s Guide to Maximize Recovery from a Hip Arthroscopy Surgery
August 29th, 2024 for my second surgery. July 11th was my first surgery and there are some lessons learned.
Introduction
This article will be my personal recovery blueprint for a hip arthroscopy that I plan to get done on August 29th, 2024. The intent is straightforward: I am writing this with the intent of recovering well myself and passing on my (very hard) lessons learned about surgery and self-care. It’s written pragmatically and with a logistical lean. This document includes all the things I have the power as a patient to maximize my recovery from this surgery.
It is intended for those who are interested in maximizing their body’s ability to recover and are willing to do some extra work to make it happen. It is appropriate for the motivated weirdos such as myself who have gotten to the point of doing it all because its important. This article is one part prescriptive and one part experimental. So, there are two parts: (1) the Recovery Plan and (2) Documenting the Process. The former focuses on the blueprint. The latter will track the effectiveness of my current plan - such as it is.
All that said, I am currently a middle-class 29-year-old who is comparatively fit with access to quality insurance, a safe living situation, and a stable job. So take what I write for what you will, please disprove what I have wrong, and use it as a starting point, not a foolproof guide. Most of my actions have sources and defensible underlying principles. For most actions I take not provided to me directly from one of my medical providers, I’ll cite.
Also, this is not medical advice as I’m not a physician (yet). It’s what I’m doing for myself. And so if you find it also useful, great. If not, no skin off my hips (heyo!). That said, I have three goals with this article. One, provide a detailed strategy to follow for myself and anyone who wishes to build upon it. Two, present a framework for maximizing their recovery using the combination of general principles and some specialized concepts from physical therapy. Three, document my recovery and see if this makes any difference in my recovery. I do not have a peer-reviewed methodology that I am following. It’s my best guess for myself and my own health. So read on at your own risk. It’s not going to be scary, but it is going to be long.
Part 1: The Recovery Plan
Build the medical team
The medical team that any person can build is dependent on their personal resources and insurance situation. I am a middle-class person who works at a University with Blue Cross Blue Shield Insurance and comprehensive medical access. Strategically, I find it helpful to start at what my resources are and then work my way backward. In July of this year, I had my first hip arthroscopy with Dr. Coleman. So I’ve also maxed out my insurance co-pay (ie. not have to pay for future services from June 1st, 2024 to June 1st, 2025) and thus have abundant access to the resources that I need medically assuming they are in the network.
So I aim to build the most robust team that my insurance allows. For this surgery, my team will be:
Hip Arthroscopy Surgeon, Struan Coleman: a world-class surgeon based out of New York who will be doing the surgery.
Nutrition and supplementation, Scott Luper, NP: a trusted internal physician who will help me apply optimal nutrition.
Sleep Specialist: Various studies show that patients suffering from FAI have lower sleep quality and quantity (source 1 and source 2). I can personally confirm this. But can seeing a sleep specialist help with this post surgery? One study suggests that patients have showed an increase in recovery for Total Knee Arthoplasty with clinical intervention focusing on sleep improvement, though this was a randomized control study involving zolpidem (link). So it’s worth a shot.
Physical Therapists, Amanda Atwood and Taylor Miller: These providers will help me both recover the specific joint and integrate the ‘gain’ mindset for me to strengthen the things I can work on while I am out of a normal training routine.
Massage therapist (TBD): this provider will help me calm my nervous system, work on tight tissues, and generally make me feel better as I recover.
The general principles of recovery
This is my second surgery and the plan has primary tasks to complete and secondary tasks to complete. Per my initial conversation with Dr. Jesse Lewis (DPT, OCS, CSCS) the things to do really well are sleep, nutrition, and stress reduction. So I am putting extra effort into those components This will be an exhaustive list of everything. that I will have, purchase, and use throughout the recovery process from this surgery. The general categories are food, supplements, medicine, rehabilitative tools, and software apps that I will use to maximize my recovery.
A two-pronged approach for recovery and weaknesses
The general protocol for physical therapy is outlined in this document. The protocol highlights that I will work two to three times per week with a physical therapist. I intend to take this plan and combine it with the “injury as an opportunity” model proposed in High-Performance Training for Sports (p. 373, online). This model proposes that injury requires specific rehabilitation / is unfortunate but can also can be used as an opportunity to work on other aspects of a person’s profile.
Borrowing from them, athletes can, “improve these aspects:
· Injury-risk profile (bullet-proofing)
· Physical capabilities (eg., aerobic power, upper-body strength)
· Movement efficiency, qualities and literacy
· Psychological and emotional resilience
· Out-of-sport capabilities (eg., studies, charity work)"
The elements of these categories are discussed in detail in other chapters of this book (p. 372 online edition).”
So, the physical therapy will have two focal points - working on the surgical tissues / related structures and picking additional aspects to focus on, ideally from the list above. My goals are related to long-term performance in CrossFit, dance, and most importantly, getting out of pain. In general, any good, “rehabilitation programme is invariably broken down into staged phases of escalating demand. The programme might typically be composed of acute, low-load, moderate-load, high-load and return-to-sport sections. Ideally, there would also be some thought given to ongoing risk reduction training once the athlete has returned to sport." (p. 372, online).
Part one will be designed by Dr. Coleman and executed upon / modified by my physical therapists. Part one is divided into four phases spanning 16 weeks. Each phase outlines specific goals, precautions, and recommended treatments, with progression contingent on meeting certain criteria and physician approval.
Phase 1 (Weeks 1-4): Focuses on pain management, protecting the surgical site, and normalizing gait with an assistive device. Treatment includes patient education and a home exercise program.
Phase 2 (Weeks 5-10): Aim to eliminate pain during daily activities, improve core control and pelvic stability, and achieve normal gait without an assistive device. Precautions emphasize avoiding premature strain on the healing hip.
Phase 3 (Weeks 11-13): Targets independent exercise, optimized range of motion, and improved strength and balance. Core control is assessed using the Sahrmann abdominal strength scale.
Phase 4 (Weeks 14-16): The final phase focuses on minimizing post-exercise soreness while continuing to advance strength, balance, and plyometric training. The patient is expected to maintain an independent home exercise and gym program.
Part two will be designed between the physical therapist and myself in a two-way conversation (also a separate article) that outlines things to do, in detail, and when. The question to answer is - what opportunities does this recovery process present to me as a CrossFit athlete? I am a relatively detrained athlete with aspirations to get to a competitive level again.
Regardless of the physical therapy parts (1 and 2), the underlying principles of healing from surgery are the same: get as much excellent sleep, eat well, maintain low levels of stress, and listen to my surgeon.
Next, let’s discuss…
Nutrition
To heal faster and keep existing muscle mass, eat lots of fruits and veggies (at least 800 grams of different kinds), eat enough protein (about 1 gram per pound of body weight), drink plenty of water (more than 2-3 liters), and use a protein shake as a back-up protein source. In surgical recovery, materials to rebuild take priority over high energy and performance goals. So micronutrients and protein intake are top priorities - which isn’t to say that carbohydrates and fats should be ignored. They shouldn’t. Rather, just not a focal point of analysis. In this case, quality meat and vegetables are the priority and so we want to aim for local. In my case, I will go with US Wellness Meats for organ meats and then Mike’s Meats in Eagle River for the remainder. The basic meals will be outlined below.
Next, let’s talk about supplements. I will take the following:
Momentus Protein Powder (1 lbs): the imperfect backup on the off chance that I cannot eat enough protein.
Momentus Collagen Powder: to increase the collagen intake for surgical repair needed.
Momentus Sleep Pills: the aim is to increase the sleep density and hopefully quantity following surgery.
1000 mg Vitamin C : take 2 - 3 times a day to help connective tissue glue together.
Vitamin A → 25000 IUs for the first week (max 1 month)
Vitamin E → 400 IUs a day.
Zinc → 30mg
Curcumin that needs to be absorbed → 2 caps 2x a day. If pain is too high, 3 caps 3x per day.
All the supplements beyond the momentous products were recommended to me by my physicians. Now, the next component is to build this together into a daily plan. So let’s give it a go and divide it up into three parts.
Morning (25 minutes of work):
Wim Hof Breathing Upon Waking: Perform 2 minutes of max vent breathing with max exhale hold (3-5 sets) to decongest.
Sleep Review (Whoop): Check Whoop data to assess sleep quality and aim for 8-9 hours of sleep (9 PM to 7 AM). Prioritize sleep for optimal healing.
Hydration: Drink at least 16 oz of water and aim for a total of 2-3 liters throughout the day.
Element: add the electrolight mix right early in the morning (1 packet, lmnt premixed in with fruit and kombucha)
Game Ready System: use it as directed by the provider. Recommended by Dr. Coleman.
Breakfast: Consume a meal rich in fruits and vegetables (aim for 800g total daily intake) and protein (1 gram per pound of body weight). Consider a protein shake as a backup option.
Kombucha, sparkling water & fruit mix
Chia seeds
5-eggs (30 grams of protein)
Collagen shot (15 grams of protein)
Multivitamin
Gluten-free toast w/ Organ meats
Daytime (1.5 hours of est. work):
Walking: Perform walking sessions as prescribed by your doctor or physical therapist. Prioritize movement throughout the day.
Physical Therapy: execute whatever your physical therapist tells you to do.
Lunch: Consume a meal rich in fruits and vegetables (aim for 800g total daily intake) and protein. Consider bone broth (self cooked, better) with organ meats for additional nutrients.
Huckleberry’s Superpho
Bone broth 12-16 oz
Beef 8-10 oz (60 grams of protein)
Other protein: whatever seems fun.
Veggies (8 oz at least). Pack the bowl.
Coffee, decaf with milk (organic)
Evening (45 minutes of work, 1-2 hours of play):
Dinner @ 6:30 PM: Consume a meal rich in fruits and vegetables (aim for 800g total daily intake) and protein.
Call your loved ones: don’t be monastic monk about your time recovering. Spend time with people who fill your cup, be part of a community, and still enjoy the people who are important to you.
Mobilize non-surgical tissues after about 5 days. Use the hyperice massage gun for when you’re too sore.
Pre-Sleep:
Wind Down: Dim lights and avoid screens at least one hour before bed. Alarm @ 9 PM.
Take a sleep pack from Momentus.
Bedtime: The bedtime alarm goes off at 9:00 PM. Be in bed by 9:30 PM. Listen to NSDR if you like or listen to an audiobook of something.
More details could be explored (which crutches to get, insurance, etc), but this is better explained in this book. With the above, we should have a complete physical therapy plan that helps me recover from the surgery, a training plan that maximizes the opportunity that this surgery presents, a nutrition plan, and a basic daily routine that gives my body the chance to heal. That said, this plan is rather unrealistic. And most of it could be dropped off as long as nutrition, sleep, and physical therapy are nailed.
Ok, good. Now, the big question with all of this prep is - will these efforts make the recovery process better in any way? What principles are right and helpful? On those questions, I’m not sure. So I’ll document my experience and see how I get on.
Part 2: Documenting the process
How this recovery plan will be documented and communicated
It is tricky to recover from a surgery, keep track of the data, and document it thoroughly. As the patient my primary job is to recover well, make sure the data is tracked, and keep an honest record of how I am feeling throughout the process. This must be low-stress, as unfiltered as possible, and honest.
So over the next 13 weeks, I’ll aim to capture two components:
A documentary was created to the best of my ability to try to capture the emotional experience of this surgery and recovery
The data and a post-reflection analysis of how well I did during my recovery. This will have both functional analysis and analysis of process-oriented goals. This is to sanity check and to help others learn from the mistakes I’ll inevitably make.
I will write about the documentary in a separate document - because, well - it’s a different thing for a different audience. But for now, let’s talk about the analysis.
The Analysis
The goal of this one is to answer that simple question - did it work? How do we know? There are two things that we should be thinking about here: the things I can track and have control of and the things that my providers can track and have control of. Let’s start with the former. As I execute the general principles of recovery outlined above, here is how I’ll track how well I do:
Sleep quality and quantity: The goal will be to get at least 8 hours of sleep per night (averaged over 90 nights). This will likely be challenging but it should be relatively trackable with a Whoop Band.
Step counts: this is a hip surgery and will have multiple stages of recovery to it. However, over time, I would expect my step count to come back to the 10,000-per-day baseline of healthy living. The goal, starting week 4, will be to get 10000 steps or more on average every week through week 12.
Heart Rate Variability Trends: this will track my nervous system health as a result of the surgery. This currently is causing symptoms that lead to low-grade pain. My current hypothesis is that this is keeping me in a relatively unbalanced state of sympathetic overload (HRV averages around 76 as of 8/9.2024). I will expect this to improve as time progresses. So the goal is to finish this surgery with a consistently trending upward HRV or, ideally, a higher baseline HRV.
Physical Therapy Compliance: The plan will be whether I do it or I don’t do it. I will likely measure it via a system I set up or via an app through my provider. Simplicity is better here as every piece of data to punch in will add stress (and forgetfulness). So I will it as a custom journal entry for my whoop band. The question will be “Did you do the prescribed physical therapy today?” Presumably, that frequency will be four times per week with non-pt training days. I am estimating 6 days a week of work after week 2. So I will aim to track it this way. There will be part 1 of physical therapy and part 2 of physical therapy (call it opportunity therapy). The goal is 90% compliance on both parts.
There are more but if we measure sleep, stress, daily movement, and physical therapy that should be enough to give us a shot at measuring how well I perform and what outcomes we are looking at. Generally what I will do is track how well I am recovering relative to the estimates within the surgical recovery plan. The goal, generally, is to make a full recovery - not to recover faster than Dr. Coleman suggests. Going too fast and being too ambitious can hinder my recovery. Which is bad. So instead, I intend to do as much as possible and not a lick more.
Conclusion
That’s about it for now. Make a plan. Work with my providers to make the plan the best it can be. Execute the plan to the best of my ability and earnestly track how I do along the way. Make a series of videos on the emotional component of this (which this article is a little devoid of). See how it goes. Thank you for taking the time to read through this article. If you have surgery, I hope some of it was useful for you.
And whew, we made it! I know this article was long but, honestly, this recovery is too. So time invested should equal recovery earned. With that, let me leave you with a song that’s become important to me. Enjoy.
