Wednesday, February 03, 2010

Going backwards

... to go forwards.

That's the highly abbreviated version of the plan my new physical therapist prescribed for me today.

I'll start with the fact that I cried.

Yes. Me. Tears. WTH?

From the moment that Marcia, my new PT, started talking, I began to get a lump in my throat. I think that it was a combination of stored-up anticipation and last-ditch hope being released, as I began to realize that this chick was no ordinary PT. My new doc was right - she is the bombdiggedybomb of physical therapists and, given that she will be PT #5 for my hip, I should know the difference.

Then, when I started to talk (and she actually listened!), to explain my five years of pain and failed treatments, the way my life has been impacted both physically and emotionally, the sense of hopelessness that I will ever find relief, and the simple things that I wanted to achieve by being there, the tears began to flow.

Just from looking at the diagram of my body on the intake form, where I'd scratched angry Zs and diagonal lines to show pain, ache, and burning in various places, she was able to hypothesize 90% of what I was going through and why, before I'd even given her the verbal ins-an-and outs. I knew this because, in a stroke of luck, she was training an intern from Sac State that day and, through her explaining her thought process and strategy for quizzing me, I was able to learn not only what she knew, but also what that knowledge was telling her. Her experience was skipping her ahead, joining the dots almost quicker than I could place them.

She would be examining me and asking me questions and saying things to the intern like, "Typically in patients experiencing xyz, the abc nerve is also inflamed and patients will also describe discomfort doing 123 or 456,"meanwhile I would be nodding profusely, as she named seemingly disconnected symptoms that I hadn't yet described.

Then, she grabbed a life-size skeleton of the pelvis and lower back and began to explain to me, not in lamens terms, but in real medical language that assumed I was an intelligent and engaaged adult, how my SI (sacro-illiac) joint, pelvis, pubic bone, and lumbar spine worked together, where the nerves came in and out, what differnt kinds of nerves produced different kinds of pain and why, how they played off one another, how inflammation played a role and how my surgery had resulted in some problems and my pregnancy in others. It was a comprehensive explanation that I will spare you the specifics of because, although I got the general gist of it, I couldn't even begin to remember 90% of the terminology. However, the fact that it all made sense to her, that everything came together in an explainable story, made me want to jump up and kiss her. I was close, let me tell you.

I also liked the fact that she stopped me a couple of times as I went to bend down and pick something up, or get on the treatment table in a certain way, or try to turn over from front to back. She stopped me and showed me how my movements could be affecting my pain and inflammation right now.

The end-result of all of this is the following:

  1. Nerves around my hip, specifically in my SI joint, were/are inflamed after my surgery and never really got the opportunity to calm-down. They're now causing irritation and inflammation in other nerves - in other words, the inflammation has been spreading. This is the cause of a lot of my referred pain and muscle pulls. So, strategy #1 is immediate and short-term: to reduce the inflammation through ice, anti-inflammatories and avoiding activities that irritate those nerves. This includes repetitive motion of my hip particularly with impact (walking), anything that involves bearing weight on that leg singularly (yoga, lunges), and stretching my leg across the plane of motion that replicates the pain (yoga and many of the stretches that previous PTs gave me). I am now icing my lower back three times a day with ice directly on the skin which, she believes, provides a deeper kind of numbing and cooling for those deep nerves that are pissed off in my lower back and hip.
  2. My hip and groin on the right side is hyper flexible in one specific plane of motion and impinged in the opposing plane of motion. The hyper flexation is causing instability in the joint overall (popping and snapping and clunking). So, strategy #2 in the short term is to stabilize the muscles all around that joint properly, ensuring a more natural range-of-motion and pattern of movement that will, in turn, begin to alleviate some of the core nerve irritation/inflammation and prevent further injury. I already have some exercises to start me on that journey.
  3. Long term, her goal for me after the short-term goals are achieved, is to get me to a place where my physical check-book is balanced. She explained to me that it wasn't that I would never be able to do many of the activities I did before I was injured and that now irritate the injury, but that I would just need to balance those negative activities with the positive ones. So, maybe I can ski again one day but maybe I can only ski one day at a time vs. two in a row and instead, on the second day, have a day of rest and self-treatment. I liked the way she explained this. It made sense to me. Just don't go into the "physical red". I can do that.

So, I'm off on the new plan... stepping back on some of my regular physical activities for a while with the goal of forging forward with renewed knowledge and awareness of my body and what makes it tick (or, specifically for me, click). I already did the icing at lunch time and about to do it again after I publish this post.

Wish me luck...


e said...

This is outstanding. Can't wait for further updates!

Urban Koda said...

I'm with e! That whole post was just oozing optimism and anticipation. Way cool!!

cjmonkey said...

I am happy, relieved, and hopeful for you! I'll be cheering you on!

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