Episode #41: Femoroacetabular Impingement, A Labral Tear, & A Hip Fracture: Coach Rori’s Story of 5 Nationals, 4 Arnolds, & 2 World Championships Without Surgery
Injuries can happen to anyone. Even to the people who are supposed to help you prevent training injuries and rehabilitate from powerlifting injuries back to the powerlifting platform. And PRS Clinical Coach Dr. Rori Alter, PT is no different.
What we know about injuries, how to treat them, and long term prognosis has changed over the years. Since the onset of Dr. Rori’s hip injury over a decade ago, prevalence, diagnostic measures, and treatment options and outcomes have wildly changed for femoroacetabular impingement syndrome and hip labral tears.
Dr. Rori has helped countless barbell athletes rehabilitate from hip injuries and surgeries related to FAI and barbell training and it is the injury category she is most passionate about helping people overcome. Because she has gone through it herself!
In this episode of the PRS Podcast Dr. Rori shares her story about the onset of her hip symptoms leading to many bumps in the road on her powerlifting journey. She shares:
What lead her to realize something was wrong with her hips
How and why she was initially diagnosed with FAI and if her symptoms at the time were actually related to FAI or training
Why she decided against surgery
How her hip dysfunction increased her risk for low back pain from barbell training
How she fractured her hip
What lifts are most affected by her hip condition
How she was able to continue to train and win podium spots at Nationals, The Arnold, and the World Championships despite what many people would consider career enders
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Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:00:49] Welcome back to the Progressive Rehab & Strength podcast. I'm your host, Dr. Alyssa Haveson, and I'm here with my co-host, Dr. Rori Alter. And today we are going to be talking about Rori's history with her hip injuries, hip symptoms, how she's managed to navigate them while continuing to train and compete at a very high level over many years. And the history of when they began before she even started barbell training. So, Rori. Why don't we start with you telling us about why are we talking about your hips?
Dr. Rori Alter, PT, PRSCC, SSC: [00:01:23] Well, we're talking about my hips because it is hip month here at Progressive Rehab & Strength. But yeah, I mean, I think that the most important thing that I want to get across, well, one of the most important things that I want to get across with this episode is that. It happens to everyone. And just because we know what we're doing about injury prevention, injury risk reduction, and we are the people who help people who are injured, rehabilitate and write their programs so that they stay safe, stay healthy, and can continue to train where our bodies are. We're all human. We're not robots, you know. So even the best of the best. Not that I'm saying I'm the best of the best, but the people who are supposed to be the people who help us not get hurt or recover from injury get hurt themselves because it's not injury prevention. It's injury risk reduction. You know, I always say that we can look both ways before we cross the street. We can, you know, make sure that no one's coming. We can be at the crosswalk. We can wait for the walk sign, but we still never know what's coming around the corner, you know. So I wanted to kind of share my story because I think it's important for people to recognize that it really does happen to everyone.
Dr. Rori Alter, PT, PRSCC, SSC: [00:02:41] And it's usually the people who have had long journeys and stories related to what they do that helps them relate to their clients and get them like we really understand. Like even Alyssa You've had numerous injuries. Actually, before we turn on this podcast, you know, you had a training blooper and if you guys if you're watching on YouTube and you see Alyssa moving around a lot, it's, you know, she tweaked her back. So, you know, we're all human. We're not robots and life happens. And, you know, our bodies, you know, we talk a lot about what we see on imaging and how those things exist, not from the training itself, but those things exist in our body. And there's things that we do or don't do in training that can cause our things that are lying dormant and asymptomatic to start to present themselves. So, you know, I just wanted to share this because I've never stopped training. I've had, you know, maybe a week here or there that I have to not train more. So I've stopped training, not ever stopped training, but I've had more interruption to training from having a kid than from any injury. And, you know, we can talk about what training looks like through injury and all that kind of stuff, but trying to always look at the bright side, always continue to train no matter what.
Dr. Rori Alter, PT, PRSCC, SSC: [00:04:08] So I guess where did it start? My symptoms in my hip. So the official diagnosis upon imaging, you know, and this isn't even a diagnosis because it's just what I have in my hips, which is called femoroacetabular impingement syndrome. Why can't I even say it today? Femoroacetabular impingement. And I have the pincer type, so I have bony overgrowth on the acetabulum in both my hips. My acetabulum are considered retroverted. So there's nothing. It's not abnormal. It's just my normal. I have retroverted hips, but I do have this bony overgrowth that I wasn't born with. It developed as I got older and then as the result of the numerous incidences that I've had in my hips, I ended up with an MRI and we found that I also have a labrum tear in the hip that they married. Now I have symptoms periodically in my other hip that could indicate that there's probably a labrum tear in that hip as well. But we don't need to know if I have it because I'm not having surgery on it. So but both my hips have been X-rayed. They've diagnosed or identified that I have FAI and I have a labrum tear in my left hip. So those are just.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:05:32] When did you have So I'm just wondering in your journey from PT school and barbell training, when did you have imaging or first have imaging and find this out? And what was your reaction to it when you found that out.
Dr. Rori Alter, PT, PRSCC, SSC: [00:05:49] So well, my first symptoms that something was weird in my hips was actually before I even started barbell training. And, you know, I only share this not so anyone can make inferences or think anything of my life, but my first symptom in my hip was present when I was in the bedroom and I was having difficulty with traditional positions with my hips and it would cause me pain. My hips would lock, they would catch, and I was like, What the heck is going on? But I didn't have any other symptoms. So, you know, you kind of work around that. It's something that not a lot of people talk about, but it's a real.
Dr. Rori Alter, PT, PRSCC, SSC: [00:06:30] It's a real thing, You know, this is something. Yeah. I mean, when we talk and this kind of is why I want to share it just to, to like let you guys know as clinicians when we are working with you like we've been through it and our clients will not tell us anything about the bedroom and their symptoms, you know, or the bathroom or showering. And we have to ask these questions because we know that injuries don't just affect you when you're walking or when you're in the gym or when you're sitting at your desk. They affect every aspect of your life. And, you know, a lot of people with back pain don't talk about like, well, I can't be intimate with my husband or my wife because of my back. But like, that's one of their biggest concerns. But they'll never share it, you know? So I just I'm sharing that being intimate was like the first sign that I had something wrong with my hips because we know that that happens. And you should share that kind of information with your clinician. So that was the first sign I was probably like 21 or 22. And I'm currently I'll be 36 in May. So this has been ongoing since I was pretty young and for a long time. So that was the first sign.
Dr. Rori Alter, PT, PRSCC, SSC: [00:07:46] I didn't really do anything about it. I wasn't barbell training at the time. My symptoms started to get worse, though, in PT school when we were sitting a lot and I could never sit still because my hips were just always aching and irritated and I was always changing position or lying on my belly and my back would start to hurt But of course I never did anything. I was like, oh, I'm just like, you know, in school and sitting a lot, you know, my hips hurt because I'm sitting all the time and there's not really like, I don't have a sit stand desk in school. So then when I graduated PT school and started doing a novice linear progression with barbell training, more seriously, I think I had probably gone through my first competition. Honestly, the timeline is like blurred at this point because I'm getting old. But you know, I had I was doing a novice linear progression, but I was also teaching. I was doing a lot of HIIT training, kind of like metcon classes, a lot of jumping. You know, burpees, mountain climbers, plyometrics, like all that kind of stuff. And I was teaching group fitness HIIT training like 3 or 4 times per week. And, you know, I'm like the gung ho kind of person I'd like do the classes, you know, I don't like.
Dr. Rori Alter, PT, PRSCC, SSC: [00:09:15] There's no days off for Rori at that point anyway, which was part of the issue, you know, like I was doing this novice linear progression. I had no idea what rating of perceived exertion was. I did, you know, I was squatting, benching, deadlifting, an overhead, pressing, squatting every session and they were hard, hard squat sets really hard. I was probably resting like five to to seven minutes between sets and I hadn't not finished my linear progression at that point. So I was on like five sets of three for squats and I actually I'd have to look through my videos, but I've seen videos of because I remember what outfit I was wearing. I remember like what shoes I remember, you know, everything about it. I could probably find that video, but. It just couldn't walk. Like I could not stand up. I couldn't, like take a full step. So the first and it was bilateral. I really had severe hip flexor inflammation. And it was so bad that John, who was my boyfriend at the time, was like, You got to go to the doctor. And so I went to I went to this hip specialist that we sent a lot of people to. I still see him for my hip injuries, like I would recommend him to anyone. And he, you know, did the kind of general orthopedic screening tests on the table.