I have been keeping a pain journal over the last week or so at the suggestion of my new physical therapist. Our goal, of course, is to try and determine what actions aggravate my pain symptoms.
So far it has not been incredibly helpful. My pain levels have always seemed to spike and subside without any real 'event' to pinpoint. The journal is mostly confirming this, although it is beginning to help us hypothesize some scenarios regarding my level of activity.
In short, I generally report better pain levels on days after being active. That is not to say hiking and running around like I used to (oh that would be wonderful again some day, but clearly not yet) but just days where I'm not sat at my desk for most of the day, the way I am M-F when at work. When I'm really busy, like last week, I can get so engrossed in what I'm doing that I can easily sit down one minute and, four hours later, look up to find I haven't moved, eaten, or drunk anything. When I do go to stand up again, my brain begins to clue-into the pain I have been ignoring, presumably because I'm always in some sort of pain and have become accustomed to putting it to one side most of the time, at least mentally, and when my brain is otherwise engaged. I also feel a slight clunk in my sacrum area (probably actually my S.I. joint, but I'm still learning to pinpoint exactly where that is) as if everything is trying to realign as I stand.
The mornings after these kinds of sitting days, I notice that I have more nerve pain (I have begun to differentiate now between nerve and muscle pain) in odd places, like down my leg into my knee, sometimes in my calf and ankle, up into my groin and psoas and often on the opposite side to my primary injury. It's not pain all at once, everywhere, but it's like someone is randomly poking you with a needle from the inside out, at different spots at different times, whether sitting and resting or standing and moving around.
This is not to say that I am pain free on days when I am active, or the day after. I definitely experience some of that same stabbing pain, only less, and some soreness in my muscles of my leg and lower back - more like a soreness, as I said, though, or a dull-ache - not the stabbing neuromuscular pain of other days.
So, my PT is hypothesizing that my SI joint issue is aggravated by compression and sagnation, meaning that sitting compresses my SI joint, putting pressure on it, and that my inflammation is made worse by periods of inactivity, where fluid has time to settle and build.
This would be good news if this was the case because the alternative would be that my joint is made worse my compression, load-bearing, and motion - meaning, sitting and laying down more would be the prescription. As someone who likes to be active and who, mentally, feels like this kind of prescription is a death sentence (almost literally), I am hoping against all hope that the first one is true.
My PT told me the story of a woman who was told by her surgeon that she needed back surgery but that, after the surgery, she would not be able to sit for some time because she would be pulling ont he muscles he cut through and would be hindering her healing. She was, understandably, pretty freaked out by this because the idea of completely eliminating sitting from her life for a while, was pretty daunting. So, she did something really smart: instead of waiting until after the surgery to figure this out, she decided to practice for a month before the surgery, by only laying, walking or standing for three weeks. You've probably already guessed what happened to her - after 3 weeks, she was cured. She had no back pain whatsoever and didn't need the surgery! Wow!
So, for the next week, my mission is to all-but completely avoid sitting. I'm going to stand at my pub table to work on my computer (as I am now) and if I need to rest I'll lay down or I'll walk around a bit to avoid stiffening up.
Meanwhile I'll keep up my walking now the weather is better, as a control, and see how my pain journal looks this time next week.
Of course, if this doesn't work, I'm going to have to try a week of not walking. However, based upon the fact that my symptoms have not got any better on this decreased activity plan that my PT has me on (and, in regards to the nerve pain, sometimes worse!) I'm going to guess (hope?) that it's the sitting thing that is my nemesis.
I'm also going to tape-up my hips while I'm standing and walking, again as my PT suggested. She did this to me last week and I had an instant feeling of relief and decompression in my lower back and sacrum area. (Further proof this is an SI joint issue, she says.)
My inflammation is not down yet but I'm hoping that we can get beyond that this week with this new plan because I've been doing my exercises 2-3 times a day, icing 3 times a day, changing the way I bend down and pick things up, and generally being very cognizant of my back, and yet nothing feels remotely better yet. I need some progress in order to feel like I'm on the right track and even the PT said that I should have started to feel some kind of incremental improvement by now. So, something is still wrong and unaddressed. I hope this is it.
Wish me luck and, if you're on FB and want to send me a nudge every once in a while to be sure I haven't forgotten myself and started sitting down again, go ahead!
On a completely unrelated note....
This weekend I FINALLY met a goal I have had for the last 2 years - I did a one day photography workshop with Penny Silvia, the photographer who has been taking pics of me, Joss, and Daisy since I was pregnant.
Although it was a crash course for amateurs in how to utilize your camera's settings and I definitely cannot claim pro status yet, I already found the information I learned incredibly helpful yesterday when the family went to Tahoe. I think I got some really cute pics of Daisy in the snow, that I am really proud of. Here is one I LOVE here, and you can see more in my photo set on Flickr, if you'd like to provide some feedback! :o)