training with hip problems... how do you do it?

[twistkick kid]

Greetings all,

it's been a while since I've posted here, but I come to you all with questions and seeking some advice.

Martial Arts Background first.

I've been a martial artist in various styles since I was 7. I'm going to be 25 in November of this year. I trained very heavily from the time I was 7 until I was 18 in Tae Kwon Do. After I turned 18, I went away to college, and my training load lightened from 5 to 6 days a week in the dojang to 2 or 3 days a week practising on my own or with some classmates who also studied TKD. I got involved in Aikido at a local dojo for 3 semesters or so, then had to knuckle down on my studies because I was taking 300 and 400 level classes as a sophomore. After I finished college in June 2014, I took about 9 months off from formal training entirely because of various health issues (some of them requiring surgery to straighten out). In March 2015, I tried to go back to my old TKD dojang, but I felt alienated and like the programme had changed waaaaayyyy too much from what I liked, so I searched out other places to train. 2 months later, I found a USSD (Shaolin Kempo) dojo within a short walk from my house. Fast forward to today (15 months after starting with USSD) and I'm loving what I'm learning, just got my green belt, and am in their Instructor's Academy Programme.

Health Background.

I was always hypermobile in many of my joints as a kid. I could entertain myself by finding odd positions for my fingers or grossing out my friends/parents/teachers with bending my thumbs in to touch my inner forearms. I got the nickname Gumby because I could kick over my own head without stretching (and still can when my hip is not making me miserable). I was diagnosed with Ehlers-Danlos Syndrome hypermobility type in 2012, and again by a different set of physicians at the end of 2015. I've always had incredibly flexible legs (especially at the hips) and my right hip always made horrible popping noises, but I never thought anything of it. Unfortunately, I've had recurrent bursitis (at the greater trochanteric bursa) since 2012 and partial dislocations of the right hip starting in 2013. I had a minor training accident in December of 2015, and that led to discovering that I have a torn labrum in my right hip, snapping hip syndrome, and to top that all off, I was also diagnosed with congenital hip dysplasia by x-rays and CT scans two months ago. I will need surgery to construct a hip socket that will not dislocate.

My questions are these:

1) how do you find motivation to train when you are in pain and it feels like the slightest wrong move will pop the joint out of place?

2) how do you cope with training partners who nag at you to do things the un-modified way when you have a modifier that makes doing a technique less painful?

3) how do you handle being teased or picked on for being young and in pain all the time?

4) how do you know when to ask if there's an acceptable modifier for a technique?

5) how do you know when is a good time to sit and watch class instead of participate?

6) I'm to start using crutches for mobility assistance when the pain gets really horrible- is there a way to still train while on crutches?

Any and all assistance, ideas, coping mechanisms, thoughts, and commiserations are welcome

-twistkick kid

[sensei8]

Speak first with your doctor!! Then, speak with your Sensei about what your doctor said, without providing private things, if you can. Your health before anything else, or you won't be able to do anything else...at all!!

Forgive me my short answer, but I'm no doctor, and I believe that you need to consult with your doctor, and you both can come up with a plan for your long term health.

I know you're hurting, and for that reason alone, the sooner you visit with your doctor, the sooner you'll have medical answers to your questions, and not the uneducated answer that I'd try to give you. SEE YOUR DOCTOR...FIRST...then visit with your Sensei.

Don't execute anything that causes you discomfort and/or pain!! The pain is there to inform you that something's wrong, and don't try to ignore it for any reasons. If fellow class mates are pressing you to do things you don't want to do because of the pain, I'd bow out for the moment.

Hang in there!!

[twistkick kid]

I have an appointment with the surgeon who will be fixing my hip tomorrow at 1.30 pm. Unfortunately this office has been less than cooperative when it comes to communication and responding to messages, phone calls, and emails. So they will be getting an earful from me.

I plan on discussing all my options with this doctor tomorrow, and explaining that martial arts is how I make a living.

I have started to do more behind the scenes work rather than being on the floor teaching and training. I'm in the office placing calls, scheduling, doing the stuff to keep our dojo running.

Sensei8- any answer you can give, even if it appears short is food for me to think about and grow from. I appreciate the input.

[sensei8]

Good news that you're tending this now, instead of later; you're in my thoughts. Yes, it's frustrating when not even a doctor's office practices good customer service, because of all the places that it's paramount, it's at the doctors office. Don't rush me through the examination as though you're rushing cattle!!

I've been chronic with my right arm, elbow to fingertips, and with my right leg, knee to toes. Oftentimes, the pains more than I care to endure, but I push through. Yet, what's lessen the pain is when I stay on track with stretching everyday, twice a day, as well as doing yoga, twice a day. Also, going to the gym as often as I can helps me.

What doesn't help me is when I don't get out of my recliner for any length of time. That gives my body time to take 3 steps backwards, instead of forwards.

1) how do you find motivation to train when you are in pain and it feels like the slightest wrong move will pop the joint out of place?

My motivation comes from my students, first and foremost. Then there's Shugyo!! Basically, it means "suck it up"!! I push through the pain to teach, do yoga, go to the gym, stretch, swim because the alternative is to just sit, and sitting down for any lengthened time, only makes it more difficult to move whenever I do.

I don't do anything that's against my doctor's advice!!

2) how do you cope with training partners who nag at you to do things the un-modified way when you have a modifier that makes doing a technique less painful?

I tell them, in a very sweet and nice way, to SHUT UP!! Everyone that knows me and/or trains with me knows about my chronic situations, and they are quite affable towards me. Whenever I train with someone who's not aware of my chronic situations, I bring them up to speed before we walk onto the floor.

3) how do you handle being teased or picked on for being young and in pain all the time?

I'm no longer young, however, rank does come with its privileges...I'll explain it twice, if need be, but there will be no third!! If your training partners exhibit an unwillingness to be mindful of your health situations, then refuse to train with that training partner(s).

4) how do you know when to ask if there's an acceptable modifier for a technique?

When I'M HURTING AND IN PAIN ALL OF THE TIME...that's when I know when to ask. However, I'll show the proof to the proper individual in a discreet manner.

5) how do you know when is a good time to sit and watch class instead of participate?

When I'M HURTING AND IN PAIN, and nothing I put into practice seems to help. I won't push myself so hard that I'm going to cause myself more harm than good. Sometimes, Shugyo, can take a back seat to common sense, with I'm guilty of.

6) I'm to start using crutches for mobility assistance when the pain gets really horrible- is there a way to still train while on crutches?

If there's a way, I'm not aware of it. Besides, a crutch in the dojo can be dangerous to the other students. Also, insurance companies wouldn't like that at all....not even close. That would be a fast way to have the dojo's insurance cancelled...QUICKLY!!

Please let us know how the doctor visit goes tomorrow!!

[Nidan Melbourne]

Discuss with your Physician to get some assistance to find a way to help you with your health issues. From my Point of View you'll need to be doing some strength training, but also to rest until your Bursitis gets to a level that is safe and comfortable for you to train.

1) how do you find motivation to train when you are in pain and it feels like the slightest wrong move will pop the joint out of place?

I train with Knee Pain (courtesy of No Meniscus + Prepatellar Bursitis), I normally adjust what i'm doing to manage the pain. But since I have bursitis, I have limited my Physical Activity to allow for recovery.

2) how do you cope with training partners who nag at you to do things the un-modified way when you have a modifier that makes doing a technique less painful?

I'd suggest speak to your Sensei, because obviously they aren't listening to you. IMHO in my eyes they are disrespecting you by disregarding your pain.

Since I have knee issues, i still try and complete the non-modified technique although i sometimes modify when I feel like it is appropriate. That is usually where I can move and feel + see how to do things. But majority of my partners understand that every once in a while I'll change techniques to suit me. If it is with a partner where it involves throws i'll try my best to do the right thing but many throws i change (even a little) but works for me and is still safe for my partner.

3) how do you handle being teased or picked on for being young and in pain all the time?

My fiancee unfortunately has so many physical issues (Juvenile Arthritis, Major Bone Injuries [smashed Patellar is one], asthma and several other problems). She is in constant pain and manages the bullying by standing up for herself, but also she has learnt how to manage that pain.

4) how do you know when to ask if there's an acceptable modifier for a technique?

I think when your instructor is discussing the technique, you can ask if there are any variants to that technique. Many people will find out that same information and can use that variant as well.

5) how do you know when is a good time to sit and watch class instead of participate?

This varies from Person to Person, but if you feel like your body is not doing well that day then i'd say sit back and relax whilst watching. Even by watching; you'll be learning through observation and passively.

6) I'm to start using crutches for mobility assistance when the pain gets really horrible- is there a way to still train while on crutches?

Honestly I'm no expert on training students with crutches or wheelchairs, but i do believe this as i mentioned before is to ensure you feel how to move and how to figure to shift yourself on it.

[twistkick kid]

Thanks for the input Nidan Melbourne.

Ironically, my bursitis has been relatively well controlled since starting Shaolin Kempo, and most of the current round of aches and pains in my hip have been from the torn up cartilage and the partial dislocations.

I've found a few modifiers for defensive maneuvers, like DMs 3, 4, 10, 11, 14, 15, 17, 19 and Kempos A, 1, 10, 15, 16. I unknowingly did an accepted modification to the scissors kick in #3 Kata and a work-around or two in #3 Pinan. some of them I picked up from watching other students with physical issues in the dojo, and others I discovered because I specifically asked Sensei and Hanshi Turner

Hopefully I get more answers as to things I can and can't do from my ortho doc today. It's just frustrating as hell to sit and watch, or be the loner off in the back working on forms and DMs and Kempos in the air when everyone else is doing sparring or rolling around with grappling stuff.

[Nidan Melbourne]

Thanks for the input Nidan Melbourne.

Ironically, my bursitis has been relatively well controlled since starting Shaolin Kempo, and most of the current round of aches and pains in my hip have been from the torn up cartilage and the partial dislocations.

I've found a few modifiers for defensive maneuvers, like DMs 3, 4, 10, 11, 14, 15, 17, 19 and Kempos A, 1, 10, 15, 16. I unknowingly did an accepted modification to the scissors kick in #3 Kata and a work-around or two in #3 Pinan. some of them I picked up from watching other students with physical issues in the dojo, and others I discovered because I specifically asked Sensei and Hanshi Turner

Hopefully I get more answers as to things I can and can't do from my ortho doc today. It's just frustrating as hell to sit and watch, or be the loner off in the back working on forms and DMs and Kempos in the air when everyone else is doing sparring or rolling around with grappling stuff.

Unfortunately i am not a Kempo practitioner so i don't know what you mean by the bolded above.

[twistkick kid]

Ahh, here's a quick run down of those things.

Dm's are set system wide and there are 108 of them. They're the equivalent of one-steps. Also called combinations.

Kempos are defenses against a punch that are more free form than Kempos. The ones taught at my dojo may not be taught at the dojo down the street.

A scissors kick is where you spring off the ground and execute simultaneous back kick and front kick (right foot front kick, left foot back kick)

There's some good explanations of Kempo as an art and the different combinations at https://www.kempoinfo.com and tge katas are there if you are interested

[JR 137]

As has been mentioned, make sure you're following your doc's advice. Make sure he/she understands what you're doing and you're doing it for a living rather than some weekend beer league softball player.

Contrary to common sense, orthopedic surgeons really ARE NOT the best at modification, prescription of exercise regimen, etc. Orthos know what's wrong and how to go in and fix it. They know parameters such as 15 degrees of flexion and extension the first two weeks, adding 5 degrees weekly afterwards, etc. Seek out a physical therapist or occupational therapist for specifics, as you'll be seeing them for post-op rehab.

As far as communication with physicians, that's on their assistants, be it a secretary, PA, nurse, etc. Surgeons are a mess, and they know it. Their assistants tell them where they are, where they're going, and what they're going to do tomorrow. In all fairness to them, their schedules are hectic and they've got far more important things to keep their brain occupied. Assistants are there for a reason. Bring up your communication issue to the doc, as he has an idea of what's going on.

Sorry, I've been around quite a few orthopedists. Most have been great people. Make sure he/she answers all questions you have. They get the mentality that you know what's going on and don't get too thorough in explanations.

But remember, the modifications stuff is best coming from a therapist. That's what they do. Surgeons operate.

As far as people saying this and that, so what? As long as your teacher knows what's going on (and you know), everything will take care of itself.

While you're on crutches/wheelchair? Anything seated (upper body). You can still do basic blocks, punches, etc. Maybe get someone to hold focus mitts. I know, not glamorous, but better than nothing.

Edit: I somehow didn't say orthopedists aren't the best at modification of activity. Edited stuff in caps.

Edited August 10, 2016 by JR 137

[Nidan Melbourne]

As has been mentioned, make sure you're following your doc's advice. Make sure he/she understands what you're doing and you're doing it for a living rather than some weekend beer league softball player.

Contrary to common sense, orthopedic surgeons really the best at modification, prescription of exercise regimen, etc. Orthos know what's wrong and how to go in and fix it. They know parameters such as 15 degrees of flexion and extension the first two weeks, adding 5 degrees weekly afterwards, etc. Seek out a physical therapist or occupational therapist for specifics, as you'll be seeing them for post-op rehab.

As far as communication with physicians, that's on their assistants, be it a secretary, PA, nurse, etc. Surgeons are a mess, and they know it. Their assistants tell them where they are, where they're going, and what they're going to do tomorrow. In all fairness to them, their schedules are hectic and they've got far more important things to keep their brain occupied. Assistants are there for a reason. Bring up your communication issue to the doc, as he has an idea of what's going on.

Sorry, I've been around quite a few orthopedists. Most have been great people. Make sure he/she answers all questions you have. They get the mentality that you know what's going on and don't get too thorough in explanations.

But remember, the modifications stuff is best coming from a therapist. That's what they do. Surgeons operate.

As far as people saying this and that, so what? As long as your teacher knows what's going on (and you know), everything will take care of itself.

While you're on crutches/wheelchair? Anything seated (upper body). You can still do basic blocks, punches, etc. Maybe get someone to hold focus mitts. I know, not glamorous, but better than nothing.

Unfortunately I disagree with you on the bolded above, because as much as they can say what you can do in terms of when returning to exercise due to trauma but they shouldn't be prescribing as it is outside of their Scope of Practice and Training. Unless they have been trained and qualified specifically to do so, but many good Doctors will study and get quals to ensure that they are covered and have a scope of practice to such Training.

Although they do have a responsibility and a duty of care to their clients (People feel less stigmatised when called this) to inform them if there is anything that they should be limiting. In particular Exercise or Certain Movements or Behaviours. Example; My Surgeon informed me that I now have to take 3-4 weeks off training due to Subcutaneous Prepatellar Bursitis and be careful of any form of exercise and excessive loading of my knee.

I know over in NZ many surgeons are fantastic and have done further study (and received additional quals) to do it. Although not as much here in Australia where they seem to prescribe everything left right and centre even if they're not really trained in it.

Exercise Physiologists IMHO are the best course of action because they are specifically trained to deal with this type of problem, along with a wide variety of problems. As they can Prescribe Exercise (60-70% of their studies have been about exercise prescription), whilst taking recommendations on limitations from Doctors or other Medical Professionals.

Occupational Therapists are great for Daily Management of any conditions that you have and ensure that they don't impact you on a daily basis.

My apologies if I caused any disrespect JR or anyone, this is my point of view and i am studying to be in this field. Due to many colleagues of mine (including teachers at University) and I have found many Orthopedic Surgeons have done what you've said [Prescribing Exercise] and failed to prescribe appropriate exercise (along with Sets, Reps, Rest, Tempo and Load) and disregarded exercise specific guidelines we follow with clients.