Dr. Derailleur

I need some suggestions for some right sided hip pain that I've dealt with since my final ride of the 2009 season.

On that Fall day I rode very hard to squeeze in a decent ride before taking my daughter to a college football game. That night I carried her for miles and lifted her up several times to see the action on the field. The next morning I had some low back pain, and right sided hip pain. I had never had hip pain to that point. After a few weeks of some relief with NSAIDs and rest, I went to my family doc. They ordered some blood tests to rule out inflammatory arthropathies and some xrays. The blood tests didn't show a thing, and the xrays showed minimal right hip osteoarthritis. The pain lingered through the winter until I made a change in my life.

On February 2nd, I started on a path to improving my health. I'm 6'3" and 242 pounds now--down from 278 pounds. I accomplished this mostly from calorie reduction, and the hip pain went away. As the bike season arrived this spring, I began riding again. I rode 200 miles this April, riding between 15 to 45 miles per session (a fairly normal April for me). As I've pushed myself faster than I have been before, the pain has returned (duh). It's a dull pain over the front of my hip joint. It's worse in the AM, and clears with activity and NSAIDs--classic hip OA. As a 34 year old who has previously ridden pain free centuries on my high racer recumbent, this concerns me.

I happen to be a family doctor who deals with patient who suffer with osteoarthritis on a daily basis. Right now I'm looking at solutions:

1. Rest. I'm taking a break from cycling to let things heal up a bit.

2. I'm continuing to lose weight. I'm getting close to my goal of 220.

3. Today I'm going to start some self-directed rehab by swimming instead of cycling. I'm going from low impact to ultra-low impact. I'm going to stay off the bike for two weeks, and in the down time swap out the dying rear wheel bearings.

4. On my last ride I thought long and hard about pedaling dynamics. I use platform pedals, and it occurred to me that I'm mostly putting compression on my hip joint--not dividing the work of the pedaling stroke more evenly between compression and tension. Today I will yet again try to find some size 14 wide cycling shoes.

5. I'm going to use Aleve (naprosyn) 220mg, 1 tab, twice daily for the next month.

6. I may do a trial of glucosamine and chondroitin. However, the small subsets of people who showed relief in previous studies had severe--not mild osteoarthritis. Some patients I've recommended it to have found some relief, then again, the placebo effect is powerful.

7. When I get back on the bike, I'm going to focus on high cadence rather than cruising along at 20mph. (My April average speed was 16.1mph). My goal is going to be close to zero hip pain on mornings after I ride.

8. I'm going to avoid an off season--I'm looking at using a trainer for my bike/or just riding an exercise cycle at the Y over the winter.

9. Focus on the weird joint dynamics stuff. Make sure that I don't rest on my right leg when standing (as I did over thousands of hours in the hospital in medical school and residency). Keeping my hip in a more neutral position (instead of sitting "Indian style" on the couch every evening. Also considering giving up on a life long love of manual transmissions. It really freaks me out that this pain is unilateral. I have no scoliosis, and my leg lengths are similar. I believe this is currently in my right hip mostly from leg dominance, and it will likely appear on the left side in coming years.

10. I'm also going to look long and hard at staying with the recumbent. I originally got 'bent due to hand numbness I experienced on my old steel mountain bike on rides over 50 miles. I'm just curious if the high racer pedaling angles are not the best choice for me. I may also look at changing my seat position. I may pull the trigger on a nice diamond frame road bike later this summer to mix things up.

11. If things do not improve, I may have my doc look into an MRI. I did take a hefty course of steroids (oral and IM) for some wicked poison ivy last summer, about two months before the onset of the pain. Avascular necrosis, while highly unlikely, is in the differential.

gotls1

Have you considered a chiropractor? I go to a DNFT chiropractor with my joint issues. The nice thing about DNFT is that it's really gentle and I usually only have to go see her 2-4 times before an issue is resolved. No violent backcracing movements and no extended treatment plan. If you're interested, you can go to www.nonforce.com to see if there's one in your area.

pennstater

I was having some unilateral hip pain towards the front of the joint last year. A friend who teaches spin classes suggested doing "fire hydrant stretches". Whether by coincidence, placebo or actually due to stetching it worked. No more hip pain. Easy enough to do. Might be worth a shot.

Dr. Derailleur

1 week update

Swam 3 times last week--1 mile per session. Worked on core strengthening as well. Weight is at 242, body fat down to 28%. Hip pain is improving. Taking Aleve. I'll swim again this week and plan on getting back on the bike next week for some short rides. Thanks for the advice. My partners are DOs and do manipulations. I may see if they can help me out. I'll try some fire hydrant stretches as well.

Dr. Derailleur

2 month update

I'm back on the bike after two months of self-directed rehab. I've ridden twice in the past week--10 miles and 20 miles. Feel pretty good. Weight down to 230.6 from 278.2 on February 2--just 10.6 pound from my goal. I need to focus on easy riding and not producing as much power as I can.