Peggy Berg - Ceramic total hip - Dancer/Iyengar Yoga Teacher
Surgery date: 2-6-14
Surgeon: Dr. Steven Myers
Hospital: Penrose Main
I've been dancing and teaching professionally since my teens. I earned a B.A. degree in dance at Bennington College and worked toward a Dance Therapy degree at Naropa University. I also attended the University of Wisconsin. I've taught in various places internationally, including at the Centre Internationale de la Danse in Paris and in Arles, France, and I've taught master classes in China. I choreographed and performed in NY for several years before moving to St. Louis, MO, where I taught at Washington University. I moved to Colorado Springs in 1980 to teach at Colorado College where I remained until 2011, finishing as a full professor. I am now a professor emerita of dance at Colorado College.
My journey toward a hip replacement began in September 2012. I was at a yoga therapeutics workshop and had tried to stand in tadasana (feet together, legs straight) for a relatively long time during an observation exercise. Since I have a leg length discrepancy of almost a half inch, I am fairly certain that, as I stood there, my left femur was in the process of shredding the labrum. Afterward, I found that my left hip was painful.
The pain was mostly centered in my left groin and inner thigh. I found that I could not flex the hip fully without pain, and even "simple" poses like child's pose were impossible. Over time, this pain grew worse, and additional symptoms began to worry me. These included pain while getting in and out of cars, lowering my left leg from an extension. I was fairly certain that the labrum was torn and this was confirmed by my orthopedist. But when he saw my x-rays, he was surprised by the level of arthritic changes and said I needed a new hip.
I had been a dancer and a professor of dance for over 40 years when this occurred. When I retired from the college where I taught I began teaching Iyengar yoga locally. Iyengar yoga had been the one physical activity I'd been able to manage for over ten years without pain. Even though my "injury" occurred during an Iyengar based workshop, I am fairly confident that my years of dance coupled with some scoliosis and my leg length discrepancy was responsible for the arthritic changes the orthopedist saw. The yoga was probably more protective than destructive -giving me many more years of function--even though the straw that broke the camel's back may have been a yoga workshop.
I was slow to accept my orthopedist's diagnosis and tried various therapies, including strengthening the abductors and adductors, and even trying a Synvisc injection which, although approved for knees by the FDA, is currently not approved for hips. I did get a very short period of relief with this injection-for about one week I felt great.
Gradually, I was forced to accept that my hip was not going to measurably improve with exercise or other modalities. Walking my dogs became painful. Putting on pants became painful. I believe the loss of the labrum added to the instability so that the arthritis was getting worse all the while. I realized that waiting longer would only mean losing more function and strength that would be needed for my recuperation and determined to go ahead with surgery.
The kind of implant my surgeon wanted to use was a titanium post with a ceramic ball placed into a highly cross-linked polyethelene liner. I consulted many different people about this kind of implant, including orthopedists who have themselves had THR. At first, I was very distrustful about the ceramic implant-I could not find any research showing that this material was better than the materials that had been used for many decades prior to the disastrous metal on metal recently recalled and disapproved by the FDA. And I heard scary stories about ceramic implants crumbling like sand (making revisions really hard!) or squeaking with every step! It took me a long time to find enough information to accept that this is, for the moment, the highest standard of care. One hopes this is true. A hip registry, like the ones found in Great Britain and Australia would be enormously helpful so that patients could track what improvements are being made both in surgical techniques and in the materials used. I am participating in a study run by a group in Massachusetts that may provide this kind of information. And this sort of blog will also help others as they contemplate what to do.
The first week out of surgery was up and down-I had a reaction to the drugs and found that I became quickly nauseated and dizzy when I stood up and tried to walk. This was true only for the first two days, though, and I made quick progress once I could stand up without passing out. I have been using painkillers (Tylenol and Tylenol 3 or tramadol). The oxycodone was necessary at first, but I've quickly stopped using them since they tend to make me feel very groggy. I don't actually think they really kill pain, either. I could feel the pain when I was taking them but they made it so I didn't care that I was in pain. Strange drug!
Meanwhile, as of today, I am two weeks out of surgery. I can walk easily without a cane. Stairs are no problem-up or down. I have very little pain, although there is some dull ache down the side of my leg past my knee. My limitations are mostly defined by the surgeon who asks that I not outwardly rotate the leg, cross the leg over my midline, or extend backward beyond about 30 degrees. I've been doing a limited yoga practice for the past 6 days, and have begun doing shoulder stand and headstands for the past two days. Earlier today I was able to push up from kneeling on the surgical leg. I'm impressed by how quickly this healing is taking place!
I managed to teach my first class post surgery on Sunday--17 days post-surgery. I was amazed at what I can do. (so were the students...)
Manitou Bindu Studios in Manitou Springs, Colorado
(I asked Peggy for her thoughts about yoga and hip deterioration. Here is her reply -NR)
I've given a lot of thought to your question about yoga contributing to the deterioration--it's possible, and I know many people who have had hip problems who haven't been dancers. I'd be happy to talk it over with you and I have tried to understand how someone might be damaging the joint without realizing it. Mostly though, I believe my yoga practice gave me at least a decade more without surgery--I was really in a lot of pain before I began yoga, in my back, shoulders, hips, knees, etc. I have really done some damage! What has been amazing is that the Iyengar approach has "cured" so many of my issues. It has taken an enormous amount of awareness and caution, but I continue to be amazed as my body "evolves" along with my practice.
In my opinion, the people who seem most at risk for hip damage in yoga are extremely flexible people who either lack the strength to support their own flexibility or who tend to "drop" or "hang" into their joints when doing certain poses. One sees this most in bent knee standing poses. You can observe the torso's weight dropping into the flexed hip rather than strongly lifting out of the hip as the practitioner bends or holds the pose. It is somewhat less of a problem in some seated forward bends, but I'd urge caution about those poses as well (e.g. upavista konasana) if the flexible person is not observing good control in the legs and low back while moving the chest onto the floor. People with less flexibility seem to be less at risk--a curious irony, since yoga tends to attract flexible people who get lots of ego reinforcement for their ability to move into extreme poses.
25 February 2014