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October 24, 2018

Joyriding Once More

By SharingMayoClinic

When chronic hip pain drove Brenda Brault to seek medical care, the long-distance runner and triathlete assumed her high-level athletic pursuits were over. Rather than limiting her abilities, however, surgery allowed Brenda's training to keep moving forward.

When chronic hip pain drove Brenda Brault to seek medical care, the long-distance runner and triathlete assumed her high-level athletic pursuits were over. Rather than limiting her abilities, however, surgery allowed Brenda's training to keep moving forward.


For more than 30 years, Brenda Brault lived with pain. Beginning in high school, when discomfort from a congenital hip malformation first began to bother her, the pain was never far away. But Brenda, who lives in La Crosse, Wisconsin, didn't let it stop her from ambitious athletic endeavors, including marathons, triathlons and biking competitions.

As the years passed, however, Brenda's pain increased to the point she no longer could ignore it. It sidelined her from competitions and prevented her from exercising. The pain also took a toll on her mental toughness.

In December 2017, Brenda reached out to Mayo Clinic orthopedic surgeon Bruce Levy, M.D., in Sports Medicine. After meeting with Dr. Levy and discussing her treatment options, surgery was recommended. Brenda underwent an outpatient hip arthroscopy that corrected her hip malformation without compromising her athletic pursuits.

In August, the 52-year-old completed the biking portion of the Chicago Triathlon, where she and her teammates took home trophies for second place overall. More remarkable was that Brenda beat her time on the bike from when she completed in the same event 14 years earlier.

"What's amazing about Brenda is she's a really high-level athlete. She's incredibly dedicated to rehab, and she followed the plan to a T," Dr. Levy says. "She worked extremely hard at her conditioning and muscle-building. And it was quite impressive that she was able to get back to the nationally competitive stage.”

With surgery behind her, Brenda couldn't be more excited to move forward with her life.

"It's disturbing to have the malformation that I have. I would have limited mobility for all my life, and Dr. Levy changed that course for me," Brenda says. "If I can convince just one person to not have to live in pain and to do it differently, it would be awesome"

Pain-filled past, promising solution

Brenda was a junior in high school when she first experienced pain related to her hip malformation, which included bony growths near the ball-shaped femur head. When Brenda bent her leg, the bony growths rubbed against the socket of her joint — a condition known as femoroacetabular impingement. Over time, the continued friction from the bony growths caused the cartilage ring lining the hip socket, or labrum, to tear.

"I had major hip pain during the day and couldn't sleep at night because of it," Brenda says. "I kept trying to exercise, but the impact was debilitating. I used to be a marathon runner, so to run a couple of miles and then have a week of recovery, it wasn't what I wanted for myself."

Despite the pain, Brenda put off making an appointment to have her condition evaluated. She was fearful the remedy would be a total hip replacement that would severely limit her activities.


"Each patient is unique, and it's important to take in the patient's goals and what's important to them. For Brenda, that meant getting back onto her bike again." 

Corey Kunzer, D.P.T.

But hip replacement was not the best option to treat Brenda's condition, Dr. Levy says. "When I saw Brenda, she had mild arthritis in the hip. That means that the cartilage on the socket of the ball and socket was starting to thin. But it wasn't bone on bone."

Dr. Levy recommended arthroscopy to Brenda. An outpatient procedure, arthroscopy involves making two small incisions into the anterior, or inner, side of a patient's hip. A camera is inserted through one incision and instruments through the other. During the procedure, Dr. Levy shaved off the bony growths on Brenda's femur head. He also used sutures and anchors to repair and secure the torn labrum.

Brenda says the procedure and the recovery couldn't have gone better. Not only was she pleased to learn she'd be back at home the day of her surgery, but within days of the procedure, the pain she’d knows for decades was much diminished.

Personalized therapy, remarkable results

About four weeks after surgery, Brenda began working with Corey Kunzer, D.P.T., a physical therapist in Mayo Clinic's Department of Physical Medicine and Rehabilitation, to rehabilitate her hip. Initial exercises focused on range of motion and slowly increasing the amount of weight Brenda could bear.

"Typically, we follow a protocol that the physical therapist develops with the orthopedic surgeon," Dr. Kunzer says. "The protocol gives us direction, progression and limitations, and it's important that we have it. But each patient is unique, and it's important to take in the patient's goals and what's important to them. For Brenda, that meant getting back onto her bike again."

To Brenda, having a therapist who fully appreciated her strong desire to quickly get back into her athletic pursuits was integral to a successful outcome.

"Corey knew I was an athlete, so his way of dealing with me was very good," Brenda says. "He told me, 'At this point, pain is not your friend,' and that if I was having pain to pull back because my tissues need to heal. I listened to that, and it was important."

Following the restrictions after surgery and listening to the body are among the most important components of a successful rehabilitation, Dr. Kunzer says.


"As surgeons, it's patients like this that motivate us to continue doing what we do. It warms our hearts when we can get people back to the activities that they enjoy."

Bruce Levy, M.D.

"I truly feel like I help the patients along the way, but the majority of their success with their outcome has to do with the surgeon and with the patient's ability to be involved in their exercises," Dr. Kunzer says. "Brenda was compliant, motivated and engaged in the process. Sometimes, because she was so motivated to get back, she needed instruction on not doing things too soon because she didn't want to irritate or inflame her tissues."

Brenda had progressed through several months of physical therapy when she received a call from her triathlete team that she was registered to participate in the Chicago event.

"They called me on the 26th of June and said, 'We signed you up, and you have two months to prepare because you'll be biking,'" Brenda says. "We competed and took second overall, which was still very good, given we are all in our 50s and have recovered from our own events in life."

Brenda says not long after the triathlon, she reached out to Dr. Levy to tell him about her team's place and her improved time. She also thanked him for helping her achieve her success.

"Brenda probably had had those bony growths for a long time, and it was probably hard for her to get into that deeply flexed position on a bike," Dr. Levy says. "Removing the bumps allowed her to get rid of that pain and get into a deeper position. That most likely allowed her to get a better time. As surgeons, it's patients like this that motivate us to continue doing what we do. It warms our hearts when we can get people back to the activities that they enjoy."


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Tags: Arthroscopy, Dr. Bruce Levy, Dr. Corey Kunzer, Mayo Clinic Sports Medicine, Orthopedic Surgery, Orthopedics, Physical Medicine and Rehabilitation

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