Daniel Alexander is a multi-sport recreational athlete from the UK who has participated in sports including cycling, running, tennis, football, and basketball.
He is currently midway through a recovery journey that involved surgery and on-going rehabilitation for bilateral hip injuries.
In this piece, he recounts the relationship with sport and activity that he's had from a young age, and the impact of persistent pain and injuries which led to his recovery journey today. He also shares his lessons from this experience and advice for others in the process.
To tell my recovery story and the nature of my injury, I need to take you back to my childhood and formative years playing sports because as I found out recently, it all started there.
As a kid growing up in the late 70s and early 80s, I had a fascination with sport. I couldn’t say where that stems from because nobody in my immediate family is what you would call “sporty”. I would watch any sport that was on television and still do. Back then sport on TV was limited to the odd midweek match, one-off events, or World of Sport and Grandstand on a Saturday afternoon (not the 24/7 sports fest we’re used to these days). As a result, I wanted to play every type of sport available and copy those athletes who entertained me for hours.
I feel fortunate that I have a natural athletic ability and at a young age could translate my enthusiasm for watching sports into a certain degree of competence when participating. Football was always a staple on television and so I played for multiple local teams during childhood and adolescence. When the Wimbledon Championships were on, I’d be out playing tennis. If there was a test match on TV, I’d be playing cricket. When the NBA became popular in the UK, I was playing basketball. Throw in some rugby, hockey, cross-country running etc. and you get the picture of my relationship with sport. I was never disciplined or focused enough to become a professional and I’m fine with that. Besides, anyone who participates at amateur level will agree that it is no less challenging or competitive. If I have variety and can train and compete at a good level, I’m happy.
Now you know my history, let’s steer this toward the topic in hand. The one element of sport I enjoy most and perhaps I’m most suited toward is endurance. I’m drawn to activities that require a long, sustained effort in which the biggest challenge is typically against yourself, the distance, and the clock. In my adult years, I became a cyclist taking part in events around the country. I was completely absorbed and trained throughout the week with long rides and races at the weekend. However, during and after each ride I would experience pain in my left groin and stiffness in the hip. At the time I thought nothing of it; if you participate in sport, you experience a certain level of discomfort and pain so why would this be any different? I was training hard and riding 100+ miles in a day so something was going to hurt, right? I also thought it might be an uneven pedal stroke and spent hours examining and correcting my pedal effectiveness score on a Wattbike. It may also have been my bike setup, so I had a bike fit to rule that out. I went to physiotherapy and was told it was a glute issue and that by strengthening that area the problem should resolve itself. I did all these things and nothing worked; the pain was still there. I felt frustrated that I couldn’t get an answer to the problem which I knew deep down was more than just overtraining or muscular.
With other things going on in my life at the time, and the continual pain, I decided to stop cycling and switch to tennis and badminton. Being back on the court again since childhood I was so absorbed in retraining my body toward racquet sports that I wasn’t aware of any problems in the hip, and it was a full year of playing before the pain started creeping back. However, this time it was much worse due to the lateral movements, loading on a single leg and short bursts of acceleration required on the court. My left hip felt like it was being torn apart and my right was deteriorating. I took weeks off from playing and went back to physio which alleviated the symptoms, but as soon as I returned, they came right back. I decided to try running again which had the same effect; a few months without problems as my body adjusted to long-distance runs and then pain. I was eventually referred to a podiatrist for a biomechanical assessment and it was here that I got a tentative diagnosis. The podiatrist noted my poor hip rotation, which was reminiscent of a problem he’d experienced personally, that of Femoroacetabular Impingement (FAI). The podiatrist told me there was a surgery that can correct the problem, a local surgeon who specialises in FAI, and I’d be able to continue enjoying sport again. The emotion I felt at the time of hearing that was one of relief, finally a medical condition and a solution. After years of being told it was muscle weakness and I just needed more physiotherapy, I felt vindicated in my belief that something more sinister was going on in my hip.
A quick anatomy lesson for those unfamiliar with FAI. The condition is a result of abnormal contact between the ball and socket of the hip causing groin pain (yep, got that), stiffness and reduced range of movement (that too), and often develops during adolescence and is exacerbated by sporting activities (the hattrick!). And a quick caveat: some people have FAI with little or no symptoms and physiotherapy can be very effective in managing the condition. Back to the story…
To not delay things further, I paid for an X-ray and MRI and booked a consultation with the FAI surgeon recommended to me by the podiatrist. The consultation was far from as straightforward as I expected. Yes, I had FAI and the bony growth that had developed on the femur could be shaved down, but I also had a severely damaged labrum (the ring of cartilage around the hip socket) which had calcified. The scans also showed the problem is in both hips, so I’d need two surgeries. And the final kicker, the part I wasn’t prepared for, was that I also have osteoarthritis. Our conversation turned from whether to perform the FAI surgery (a hip arthroscopy) or a total hip replacement (THR). The surgeon was convinced hip arthroscopy would buy me perhaps 5-10 years before needing a replacement. He also recommended I go back to cycling again after surgery as tennis and running would reduce the timescale before needing a replacement.
When met with any new challenge or topic I’m unfamiliar with I do endless research to learn more and act. I looked up other people’s experiences of FAI and how well they recovered from surgery. I investigated whether I could continue playing all the sports I enjoy with a completely new hip (the answer is generally yes but with caveats). I also sought the opinion of two more orthopaedic surgeons who both said the left hip is too far gone to do anything but have a THR. What all three surgeons had in common was their surprise that I went from cycling back to tennis and running. Typically people with hip problems do it the other way around!
For a few weeks, my dilemma was about which choice to make. I reconciled quite early on that the hips would be replaced at some point and plenty of people far younger than me go through THR. I would be able to participate in sport in some capacity with replacements and so I wasn’t going to dwell on that fate. However, my gut feeling was that if I can preserve my hip for a few more years that was worth a shot. I got in touch with the first surgeon and said let’s try.
It was a big weight off my mind making that choice. For all my sporting life I’ve always had a goal to train toward, typically an event or tournament, but I was in so much pain that in the last few years I couldn’t realistically enter many events at all. My last running event was the Great South in 2021 which I ran while experiencing a lot of pain (not big or clever). I’d hung up my tennis and badminton racquets earlier the same year. My life had become one long monotonous rehab session with no end in sight. That period was probably my lowest point mentally, but now there was something specific to aim for - the first surgery.
The wait for surgery was long (NHS) but I threw myself into “prehab” and worked on strength and conditioning at the gym with a personal trainer and racked up plenty of long indoor bike sessions. The goal was to go into surgery as fit and strong as possible to come out the other side and recover faster. I was up for the challenge because it felt like I was training toward an event, but one with an unspecified date. When the surgery date was eventually set (Feb 2023) I had ten more weeks to wait so I ramped up the training. By the time I lay down on the operating table, I felt prepared both physically and mentally.
As of now (April 2023) I’m in rehab. The surgery took longer than is typical for FAI as in the surgeon’s words “the hip was a mess” and he needed to clear out a lot of arthritic material. The calcified section of the labrum couldn’t be saved and was removed completely with the remainder anchored back onto the hip socket. I’ve been reassured that although the labrum helps with stability, losing a section shouldn’t cause any issues. The femur was reshaped (an osteoplasty) to help improve the range of motion. I’m on the waiting list for the same procedure for the other side which could be anything up to 6-8 months, so a steroid injection was administered into the right hip to alleviate symptoms while rehabilitating the left. It’s now a case of wait and see how the left hip reacts. There are no guarantees the surgery will work, and I probably won’t know for certain until I can try running properly again which may not be until after the right hip operation and subsequent recovery. That’s probably going to be a good year from now and I’ll use my time just as I did before surgery to get as fit and strong as possible through cross-training. One of the positives for this journey is that I’ve rediscovered swimming, something I loved during childhood. I foresee a triathlon event in my future!
My preferred outcome has always been a return to participating in a variety of sports at the intensity and frequency I was able to before. What I am learning is that I need to manage these expectations. While I believe much of what I want to achieve can happen, I also need to understand there will be adjustments and perhaps limitations. In a way, that is happening anyway due to my age - I’m not the athlete I was! This “injury” will play its part in how I approach sport in the future. However, I will always strive to be a multi-sport athlete even when the day comes to replace both hips with prosthetic implants.
What have I learned during my recovery journey?
From a sporting perspective, it’s been the hardest challenge I’ve faced. No endurance event has come close to the dedication and effort required to come back from a long-term injury. I’ve seen friends and people on social media competing in events and receiving their well-deserved medals at the end with big smiles on their faces. Quite rightly their dedication and effort are rewarded with both a piece of shiny hardware but more importantly the feeling from knowing you can achieve great things. There is no medal at the end of rehab (although there should be!). However, there is the greater reward that your mind and body can overcome adversity and return to your chosen sport(s).
I feel fortunate that I could physically and mentally prepare for my surgery and subsequent recovery because my issue was slow and attritional. Many athletes are blind-sided by acute injuries and thrown into a sudden change in circumstances with no way of knowing what to expect. Hats off to you if you’re going through that experience as that to me seems so much tougher to deal with.
If you are in a similar position to mine, figure out all the options to help maintain fitness and strength without aggravating your existing condition. Cross-training was a key component for me. If you have the means, find a professional who has experience with injury rehab and can help prepare your body well in advance of surgery - it does help with recovery.
Finally, as per above and if your injury results in surgery to a lower limb that restricts flexion and rotation, I highly recommend cutting your toenails back before your surgery because it took me at least six weeks before I had anywhere near enough mobility to trim them again and I hate anyone touching my feet!
Good luck with your recovery!
Thank you Dan for sharing this great piece on your journey with rehabilitation, and thank you for all the great support you've shown others in the Brace Community! We wish you the best of luck in the next stage of your journey!
If you're recovering from an injury and would like to access a supportive community during the process, alongside your exercise tracking and management, you can download the free Brace app from our home page to take control of the recovery journey in an empowering and connected way!