Monday, July 07, 2008

More on the mysterious sore spot

I had a Physical Therapy appointment today and dilvulged the diagnosis/prognosis (or lack thereof) from my surgeon about the sore spot on my thigh.

I have to say it was self-affirming to see the look of disgust and confusion on my PT's face. It's not just me.

Sensing my frustration with said sore-spot, he dug deep (quite literally in some cases) to learn more about its characteristics. Pressing, rubbing, and massaging various points on my hip, butt and thigh led him to doubt that the soreness is the result of any nerve damage - a relief, sort of. The soreness is entirely localized, meaning that it only hurts in the precise spot you put pressure on, at the time you put pressure on it. If it was a nerve, he said, certain movements would trigger the pain, as would pressure elsewhere on the nerve itself - none of which happens. It's more like a bruise - it hurts only when and where you put pressure on it. So, this leads him to believe that it is a soft-tissue issue (say that ten times fast).

He thinks that the months and weeks of massage for my IT band may have caused some soft tissue damage (which wouldn't be surprising given the voracity of the manual therapy I've had in the last 3 months) but I'm not confident in that part of the diagnosis. I've had this soreness/pain since the surgery itself and I can assure you, I wasn't massaging anything then - I could barely touch it.

One thing he did literally guffaw at was the surgeon's suggestion to give me a cortisone shot. As I thought, cortisone shots are not usually administered in soft tissue but instead into joints/sockets and since this is not a joint issue, he has no idea what the surgeon is thinking.

So none of this gives me any concrete answers. Ultimately, I think I just have to make an appointment with my PCP and see what she suggests at this point.

In the meantime, I'm continuing the heat-and-ice dance and avoiding pressure on the area as much as possible to see if we can chill my pore, sore flesh out.

2 comments:

Julianne said...

I must admit I have not been following your blog lately because of the improvements in my own hip condition. I began following it last February or March, when I googled acetabulum.

I was the one who sent you the Aetna link about their position on this kind of surgery.

I am very, very saddened to read about your outcome. I followed you so closely because I, too, was thinking about some sort of hip surgery.

It turns out that my problem was not with the acetabulum. A subsequent MRI with contrast did not lend itself to that interpretation. Still, my hip was just killing me. It took at least 30 seconds to go from a seated to a standing position, I had to wait until the pain in my thigh/groin subsided, and a leg could bear my weight. I went through three injections of an arthritis drug. That didn't help.

I got to the point where I was looking seriously into arthroscopic surgery. What kept me searching was my understanding that the hip had to be pulled out of its socket in order for the surgeon to gain any access to be able to see what is going on. That struck me as something it was going to take a while to get over -- and what really haunted me was the feeling that what if I undergo the surgery and I'm not any better?

You know, turning points are always a conglomeration of random events that you're finally able to draw lines among.

I was looking at a physical therapy site, which I had run across before. It didn't hit me until later, but the site made the point that in physical therapy, after an injury, the first thing they do is get the muscle stretched, and then they work on strengthening.

I had always blown off stretching because I, like you, had been a lifelong yoga acolyte. I always figured that I was stretched. But I decided, on my own, to stop any strengthening notion (although I had long before because of the pain and inflammation), and to concentrate exclusively on stretching. I knew how to stretch the muscle that was plaguing me When I stood up, and I could make up more exercises because I could feel when the stretch felt good.

It was miraculous. Within three or four days I could pop up out of a chair and go about my business. My hip was not healed, mind you, I've had this gnawing ache in my groin for the last 18 months -- but the worst part was over. What was driving me to get the surgery was now under control.

To add to that luck, just after I had made my discovery I had an appointment with a doctor of osteopathy. I went in there a skeptical woman. Finally, someone who listened to my entire rendition of the past 18 months, starting with an otherwise uneventful spill on a treadmill. She was very helpful in providing an explanation of what might be going on (the hip capsule itself got so tight that it causes the incipient arthritis that is their to flare up).

I say all of this to tell you to keep on with your stretching, but also to see an osteopath. They have a different way of framing the problem, and a different way of listening.

I read a lot about how doctors think (how everybody thinks, for that matter). Getting a lot of different viewpoints isn't a bad strategy. Your case, unfortunately, is an object lesson in how thin the veneer of the doctors knowledge really is and how good we are at explaining even when we don't know what the hell is going on.

TravelVixen said...

Julianne, thanks for your comment.

I actually did almost 3 years of therapy and stretching (limiting my strength training) before deciding to undergo surgery. My path to surgery was THROUGH two osteopaths, the last of which basically gave me this diagnosis: "I think the majority of your problem can be resolved through stretching of your IT band. Whatever else is going on in there might not be a big deal but if it is the only thing I can do is refer you to a surgeon and all they're going to do is recommend surgery."

To say I am peeved is an understatement. My hip problems today take over more of my life than they ever did pre-surgery.

I perform more than 1-2 hours of therapy on my leg and hip each day (excluding the odd weekend day) consisting of at least 45 minutes of stretching and 30 minutes of heat-and-ice therapy.

In addition, I go for a 30 minute theraputic massage every other week, and on the off-week go to a Physical Therapist (which I pay for out-of-pocket) who performs 60 minutes of manual and ultrasound therapy on my hip and leg to loosen it up.

Despite all this, my IT band is still irritated, my hip flexors are tight, my joint is stiff, my piriformis is tweaked, my psoas is unhappy, and I have an undiagnosed soft-tissue issue on my lower thigh.

So, I'm lost. I have tried Physical Therapy, stretching, strength training, surgery... none of them have provided relief.

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