Monday, February 08, 2010

From counter-productive to counter-intuitive

As you know, I have a new physical therapist - Marcia. I've been seeing her for about a week now and it's been a difficult 7 days. Not because of the therapy or the pain (no change there yet) but because of the prescription. Essentially, she is undoing everything I was doing to self-treat for the last 4.5 years; every piece of advice and diagnosis I've received from countless doctors, surgeons, physical therapists, chiropractors, and osteopaths.

It's proving to be not only a physical adjustment but a mental one as well.

In the last few visits, I've had the opportunity to quiz Marcia more about my diagnosis and prescription for recovery; to try and understand it from different angles. I'm not sure I'm 100% in-tune with it yet but, oversimplified, this is what has begun to sink in.

The pain(s) in my hip, buttocks, and leg that everyone has been treating as muscular are, in fact, neuropathy - nerve pain. This is wild to me. Just WILD. Not a single medical practitioner until this point has even mentioned nerve pain. Not one. The continued diagnosis of tight this muscle and irritated that ligament has been such a constant in the last four years that I can't even begin to get my head around the fact that the pain I'm feeling in many instances (obviously not all) is not muscular.

I believe and understand what Marcia is saying intellectually but there is still some part of me that won't grasp it, refuses to grasp it. It's like saying that the last four years, or at the very least the most recent two (since my surgery) have been a lie, a mistake, a serial misdiagnosis. I want to believe and trust that she is right - because she sure sounds like she knows what she's talking about - but to do that I have to have faith in the fact that she, this one person, has looked at the same person, the same symptoms, and come up with a completely different diagnosis. That's hard to grasp.

Of course, once you accept that your problem is not muscular but neurological, then you have to accept that the solution, your treatment strategy, and everything you've been doing up until this point, has been 100% wrong. And, in some cases, even counter-productive. Again, this is tough to accept; it's a big paradigm shift.

The nerve pain is not only made worse by excessive stretching (my previous self-treatment MO) but, my increased or hyper flexibility from the stretching, is preventing my muscles from protecting the irritated nerves and, therefore, continued stretching only serves to make the muscles spasm more, in order to try and protect the nerves. Basically, everything is freaking out, one thing trying to protect the other and actually making things worse. My pattern of stretching, doing yoga, and massaging only served to make my joint more unstable (hello pops and clicks) and my muscles more freaked out (hello IT band syndrome, psoas pain.)

So, yoga, at least for now, is out. (There's another big adjustment.) Anything that involves twisting or stretching my lower back or side-bending, is bad. No touching the toes, no picking things up below waist-height without bending my knees, no sitting straight up out of bed, no turning around in my car seat to grab Daisy's binky. In fact, Marcia taped my back after today's appointment, to help me understand all of the movements I make in a day that can potentially inflame my back. I have 3 layers of thick tape - one vertically to prevent forward flexion, one diagonally, to prevent twisting, and one horizontally to prevent side flexion - and feel as though I have a mini corset on.

For a good hour, the lack of mobility made me feel like I was a zombie. I got used to it as the day progressed, however, and have identified my sitting on the floor, legs crossed, as being the primary culprit, pulling and tugging on the tape. Otherwise, I have found that I do a pretty good job of avoiding any of the offending movements, probably because I have subconsciously been modifying my movements for some time and, also, I admit, because I knew the tape was there. Of course, when you have an active ten month old, avoiding sitting on the floor isn't always the easiest goal to meet.

In addition to the taping, Marcia has got me doing some core strengthening exercises and icing at least three times a day. In fact, I think that ice and rest is going to be a frequent prescription for my aches and pains in the long term. Learning what makes my symptoms flare up and avoiding that whenever possible is the primary objective - but that's in a perfect world; for the real world, RICE is going to be my new best friend.

As I said at the beginning of this post, I have not felt a significant difference in pain or discomfort yet. My pain and irritation usually fluctuates (sometimes wildly) from day-to-day, week-to-week, and so it's hard to determine what, if any benefits, I am getting from the new course of treatment. One thing I am very cognizant of, however, is that my previous pattern has been in place for four years and so it's going to take more than a week to undo the habits and damage done.

Right now I just have to have a bit of blind faith that Marcia is significantly smarter than about 10 other people who were equally, if not more, medically qualified on paper. So far, I have to say that it's hard to stay the course and not jump back into old habits, especially when any benefits from the new plan will be small, incremental, and long term. There is nothing to tell me I'm on the right track yet and for this impatient, results-oriented A-type personality, that's the toughest adjustment of all.


Urban Koda said...

Reminded me of the old quote about insanity... Doing the same thing over and over again and expecting different results.

I've had a couple of friends with different injuries spend significant time with doctors who've failed to fix problems, only to have a PT identify the real cause of the problem and fix it... I'm hoping I can count you amongst those friends in the coming months!

e said...

I think that doctors can be exceptionally obtuse. It occurs to me, after reading this post (gee, thanks Elena!) that often people with chronic pain need to see a pain specialist rather than a specialist who deals with whatever injury they're dealing with. It's quite possible that the doctors you've seen don't have much real knowledge of pain. And anyway, ALL pain is neurological, so what she's saying makes sense from that perspective.

But mostly, like Mike says, if the same thing over and over gets you no result, then it can't be the thing that if continued gets you that result. I think it's a great thing to be on a new path. As you say, it might take a little while, but more of the same really isn't going to help, it sounds like.

I think this sounds awesome. I'm really interested in your further progress.

Related Posts with Thumbnails