Physical Therapy...blah

I am back in physical therapy. My SI issues have re-emerged and it makes standing and sitting (mostly sitting) uncomfortable. The good news is that I don't have shooting pain that causes problems sleeping like I did last time I struggled with this. The bad news is that it is still uncomfortable and does impede my ability to exercise somewhat.

I have insurance that covers most (80%) of the therapy. I like the physical therapists I go to, and am confident they will be able to "fix" me. I am grateful to be able to live in a place with advanced medical care, and to have a job that is not physical so that I can rehab this better and lie on the floor to work when I need to.

The other day I was walking through Walmart and there was a girl who was between the size I am now and the size I was when I started -- probably about the size I was the first time I had these back/SI issues a bit more than a year ago. She was bent over and stocking shelves. I know nothing about this girl, but if I had to guess her healthcare is either crappy or nonexistent, and she's probably not getting paid that much. I thought to myself, "What if that were me and I could not only not afford to go to PT, but I probably also could not afford to take time off work to get better? What if I worked a job that made my condition worse?" It was a reminder to be grateful for what I have, even when my back hurts and it feels like life is a challenge. Things can always be worse, and there is a lot to be grateful for.

Great News

Last night I slept through the night -- pain free -- for the first time in several weeks! Also, yesterday I went to the pool and did my water aerobics thing. I couldn't do everything because some of it made my foot go numb. I stopped when that happened, but it was great to be able to do something active. I am taking life easy this weekend, but I think I might be on my way to getting fixed! YAY!

PT Update

I've been home for a few days. First of all, can I tell you how excited I was/am to be home? The first night when I cooked my meal, I was in heaven. I had complete control over what I put in my food. I knew how much sodium was or wasn't in everything -- it was fabulous. I savored the food so much that night. OMG. Seriously, it was blissful. I was glad not to eat out. So glad. (but last night I ate out -- um, what?)

I was able to schedule an appointment with the physical therapist for the first day I was home. She confirmed that the problems in my SI had returned, but also thought that some of my symptoms are related to either a bulging or herniated disc due the pain I experienced on the side of my leg as she pushed around on my back.

She has decided that I need treatment 3/week at least for awhile -- I am glad it is summer so I can more easily accomodate this in my schedule. After my first treatment, she said my back was likely to be very angry with me. I decided to lay on my back and stomach all day to minimize pain and also the chance that my SI joint would pull out of alignment. Her main methods of treating me were ultrasound and electrical stimulation, as well as getting me back in place by poking, prodding and tugging me all over the place. She told me to use ice and rest; she encouraged me not to stretch and mess things up.

The following day, I had another appointment with her. The SI had gone out of place, but it felt nowhere near as bad as it had before. I told her how I had experienced a decent amount of tingling and numbness in my left foot when I was in certain positions -- sitting, laying on my back, etc -- and she seemed really concerned. She again used ultrasound and electrical stimulation, but we also added massage and stretching exercises to the mix. She told me that if I experienced pain or tingling/numbness, I should tell her and we would stop doing those exercises. We had to stop 2-3 of the exercises due to the tingling/numbness. I sensed that the tingling and numbness concerned her, but in googling around, I cannot figure out why.

After I left, the tingling and numbness sensations were both more common and more pronounced. I called the PT this morning to let her know (I do not have an appointment until Monday) and to ask if I should be concerned, but I have not heard back yet.

I have not taken Lortab today, and each of the previous two days I only took one. I am hoping to go completely without today.

The PT has indicated that swimming and water aerobics is probably ok. I am going to give it a go tonight, since not being able to work out has been driving me crazy, and causing me to lose muscle mass.

This morning I woke up discouraged and concerned because of the tingling issue. I decided, though, that I would adjust my attitude. I decided that today WOULD be a good day -- I couldn't control the issues surrounding my health and wellness, but I can control my attitude. And so far, I have and it is working :) This is a lesson I need to remember in the future.

SI Drama and another Life Lesson

After a really tough weekend, I decided there was no choice: I absolutely could not make it without going to see a PT. I used Google Maps’ search near me feature, and was so pleasantly surprised to learn that there were a good 20ish PTs and/or PT clinics in a half mile radius of my hotel. I looked around at their websites and sorted through the list to prioritize who I wanted to try to see first thing Monday morning.

I called many of the PTs’ offices Sunday afternoon to see when the offices opened. I was able to talk to a clinic that was willing to see me at 9:30, and also willing to offer me a discount if I paid by cash (my insurance is a regional insurance, and would not have a carrier network several states away – not to mention the hassles associated with getting a referral prior to seeing a PT, etc).

As I walked to the PT clinic (0.4 miles from my hotel, according to Google), I could feel myself leaving the swanky tourist area and getting closer to a sketchy neighborhood. I didn’t feel unsafe, but I did feel out of place and as though I were being stared at. When I arrived at the clinic, the building was nice and the inside was clean but I felt further out of place. There were folks outside smoking. There was a man wearing a crocheted doily to cover a huge wound on his neck (maybe one of those throat cancer things). There were several folks with thug-type baggy pants and huge gold chains with their names on them. And then there was me – white with not a single tattoo on my body – in my khaki pants and polo.

I had to sign a form that was literally 1.5 pages long about their narcotics policy – which prescriptions would and wouldn’t be issued, how often the prescriptions would be issued, how the drugs were and weren’t supposed to be taken, etc. There were signs everywhere about how lost prescriptions would not be replaced. As someone recently prescribed Lortab as though they were TicTacs, I found this so ironic. (I hate to take medicines unless there are no other alternatives – I prefer a natural and holistic approach whenever possible.)

I seriously contemplated leaving, as I questioned the type of care I would receive. I decided I would give it a go, though, largely because I was already there and because the other places I had called were unable to see me until much later in the afternoon.

I have to give the therapists and the office staff so much credit. Aside from the front desk people, all of the folks I dealt with – intake, billing, office manager, and PTs – were very very kind, empathetic, professional and, most impressive/important, good at their jobs.

I was seen by two PTs. They both worked with me at the same time. They verified that they thought the issues were SI related, and explained to me that my tight hamstrings were the source of the problem. They explained to me a way to stretch them that was more effective than what I had learned previously. Although I had been told by my previous PTs/PTAs (PTA = physical therapist’s assistant – generally equipped with an associates degree or some amount of lesser training than a “real” PT) to stretch the hamstrings, they either did not identify this as the source of the problem or did not communicate this effectively to me. I was grateful to be equipped with this new knowledge.

At the mostly-white people, non-indigent patient population clinic that I go to in Fayetteville, they are also reasonably professional. However, I almost always worked with a PTA who was helping two (sometimes even three) patients simultaneously. I have never received the amount of individualized, personal attention I received at the clinic I visited in Louisville. I recommend this clinic whole-heartedly. I definitely felt validated that my pain was legitimate, and treated like a person, not just one of a few patients that a PTA was dividing his/her time between. Also, I appreciated working with PTs rather than PTAs – and two of them, focused solely on helping me out!

The PT was able to align me reasonably quickly. His approach was more like a chiropractor, cracking me into place rather than the more gentle apply resistance approaches my previous PT/PTAs had used on me. He warned me that my SI joint was likely to pull back out of place since my hamstrings were so tight, and he was right: it was out by the evening despite stretching it and laying down most of the day to minimize activity. I have to say, though, the pain has been much less since visiting the clinic than it was before, and I honestly do not think I would have been able to make it through a travel day without loads of Lortab without his help. I have only taken one today, whereas I am certain I would have had to take 4-5 without the help of the PTs.

I feel I am being placed in lots of situations that make me think about who I am, how blessed I am, and how much I complain lately. I want to be positive, and see the good in things/people/situations even when they are not so rosy. I want to learn from life, and contribute positively to it. Realizing how snobby I am – even when I don’t intend to be – makes me realize that I have a ways to go. I am embarrassed that I almost left this wonderfully helpful clinic because I felt I was too good for it. I am grateful to the clinic for not only for fixing up my body and making it possible for me to go home without too much pain, but also for reminding me to be a lot less judgmental of others, and supportive of and grateful for people who work with the less fortunate.

Bored bored bored

I have been in this hotel room almost for the last 48 hours. I am so bored. I have been laying on my back and side -- anything to avoid my hip hurting. The good news is that by doing this, I have been able to limit the amount of Lortab I had to take. I am sort of terrified of taking the stuff because you can get addicted if you're not careful and -- as is probably no surprise to many of you who are fellow recovering food addicts -- I am pretty prone to excess and might end up addicted if I am not careful. Also, it had begun to have limited effectiveness, so I wasn't that jazzed about taking it anyway anymore (and was not about to start taking two or three of those guys at a time).

I ventured out for food twice, but other than that have been subsisting on the continental breakfast here (thank goodness I was upgraded to a club floor!!). My eating has been terrible, and I have really been unable to move much. I brought workout clothes and intended to do weights for my arms. I tried that once and realized that was totally a joke; I left in 10 minutes because it hurt so bad.

So, I sit here and do nothing. The TV channels here suck. I have books to read, but for some reason haven't been reading. I've just been wasting time online and sleeping (depression anyone?). I have decided to go to a PT tomorrow. I know my insurance won't cover it, but it will be worth it to get something out of this conference. I am especially bummed since I had to miss the final day of my workshop; I simply could not walk that morning.

Sacroiliac Joint

I have written -- although not as much as I feel like it -- about my sacroiliac (SI) joint problems. They have really put a cramp in my style. I wanted to link to several of the resources I have found helpful in dealing with my SI joint issues so that other SI joint sufferers can hopefully save a little time when trying to find ways to deal with this issue. If you are a person dealing with this issue then

1. I am really sorry to hear that; I hope you find relief soon.
2. Please let me know if you have any additional links or resources to add; I will happily integrate any commented stuff into this post.
3. Please know you are not alone. I absolutely know how much it sucks to deal with SI joint issues.

First of all the standard stuff -- I'm not a doctor (well not a medical one anyway), I'm not a physical therapist, I'm not an official anything having to do with SI joint issues. I am, however, a frustrated civilian tired of dealing with pain, and a relentless researcher. That having been said, you should probably consult a medical doctor for any official diagnosis or advice. Additionally, these exercises/recommendations are things that have worked for me. Your milage may vary.

So what is the SI joint? This is in your lower back/hip area, where your sacrum (the lower 5 vertabrae fused together) meet your ilium (the largest bone in your pelvis)

I have read that SI disorders are much more common in women than in men. Personally, I injured my SI joint on my first surf lesson, and I have subsequently reinjured it by attempting to run using the Couch to 5K program -- I think I have to accept that running and triathalons just aren't in my near future, sadly.

If your SI joint is misaligned, it can smash your sciatic nerve. It is incredibly painful, and the symptoms are often mistaken for sciatica. However, if the underlying issue really is the SI joint, then re-aligning the joint can cause almost instant relief.

I have found that chiropractors are, counterintuitively, not that helpful at this as it may initially sound. Yes, they can align everything and put it back into place -- but more often than not, the reason why the joint is out of place is because of muscle imbalances. For example, if your hamstrings are tighter or more stressed on one side of your body than the other, they will keep pulling the joint out of place. Until the underlying muscle imbalances are fixed or resolved, a realignment will only be temporary.

The SI joint issues often cause the hips to twist out of place. I think this site's analogy on how this works is good, but the bottom line is that these problems will often show themselves in the form of a functional leg length difference, where one leg appears longer than the other. To determine which leg is longer, it is best to have a friend help you. This video explains how to assess this.

If you don't have a friend handy, you can try the following: experiment by putting a magazine or magazines under your feet until you feel like your hips are even again. This becomes easier to tell with time, and as you get to know your own body (for example, my right leg usually appears longer than my left leg).

You can then align your hips using this method. I suggest rechecking your leg length after this alignment

.

Here is another trick I found on a cycling forum. This works for me sometimes, but more slowly and I find with less success than the methods described above.

• Lie on your back, knees bent, feet flat on the bed.
• Stick a pillow between your knees.
• BARELY, gently, imperceptibly squeeze the pillow for 10 seconds.
• Let off for 10 seconds
• Do until you are bored silly. (generally you become bored when the SI's have returned and your bod is no longer excited by the gradually shifting SI's) Maybe 10 or 20 or 30 times.

To correct the underlying muscle imbalances, stretching is key. Some of the key stretches the PT told me that I should do are

1. The piriformis stretch. This is key since many SI problems are caused by piriformis syndrome, where the muscle spasms out of control.
2. Single knee to chest stretch.
3. Spinal twist stretch. Note that if you're having a flare up, straightening the leg is probably a bad idea. This will make your already irritated sciatic nerve pain worse.
4. Hamstring stretch. Any will do, but this one is super important.

If I am in reasonably good shape or just starting to feel a hint that something bad is about to happen to my SI joint, I have found Jill Miller's Hip Helpers DVD to be invaluable. In fact, this video was absolutely helping me -- so much that I took it on my last business trip. I literally forgot to do it one day, and the next day I was doubled over in pain. The fact that this video made so much difference was amazing to me. I will make myself do this 1-2 times/week once I get back to normal (during flareups, though, avoid the stretching as it will exaccerbate problems with your already tender sciatic nerve).

I hope this helps SI sufferers, and that we are able to pull together a comprehensive list of resources so that they are easy to navigate for others. Please let me know if you have other favorite resources or suggestions I have missed.

Mess mess messity mess

Today I am a mess. My back/hip issues have been so so bad lately. Yesterday I had a trip for work that I could basically under no circumstances miss. The meeting I had to attend took place about 3-3.5 hrs away from home, and I was beyond apprehensive about the drive. Fortunately a colleague was willing to do the driving, allowing me to lay down in the back seat the majority of the time. The same colleague helped me to adjust my leg length, temporarily relieving some of the pain and allowing me to sit up for the 3 hr meeting and the lunch that followed. By the time we got back though, I was spent. I laid down flat on my back when I got home around 5 PM, and that felt great. So great, actually, that I fell asleep until 11 PM. I woke up, watched a little TV, took some more ibuprofen, and then tried to go to sleep again around 1. I woke up this morning at 6. For those keeping score, that's 13 hours of sleep in 24 hours (I had to be up at 3:40 to go on the trip).

Today was supposed to be the only day I am in the office, as I leave for another fracking trip tomorrow. I really wanted to go in and take care of a lot of stuff (I was only in the office one day last week as well because of travel), but unfortunately there was absolutely no way that could happen. The pain was simply excruciating and intolerable.

I called the doctor first thing this morning and was very fortunate to get her last appointment for the day, which was around noon. I needed to get a referral for physical therapy (which was helpful but really dragged out last time these SI joint issues presented themselves), and was hoping to get something that would help get me through my trip this week.

When the doctor came in, I immediately started crying. This really surprised me, but is a testament to both how badly this injury hurts, and how absolutely insanely frustrated I am. She gave me a cortisone shot, and controlled-substance-level prescriptions for both muscle relaxers (Flexerol) and pain relief (Lortab). She also told me, "If I could tell you the absolute worst thing to do, it would be to travel and to be forced to sit for long periods." As luck has it, of course, this is the day before I fly to Louisville for a three day 8:30-5 workshop that I was totally stoked to attend.

This morning, my stomach was really letting me know it was super hungry, probably because I went to bed (aka fell asleep on the floor) at 5 without eating dinner, and had only a banana when I woke up from 11-1. Although the physical signs of hunger were there, I didn't want to eat. I could not believe it. This behavior was totally uncharacteristic of me. I just didn't want to have to find a way to sit comfortably, and I could not think of a way to eat lying flat on my back. I ended up eating a bowl of oatmeal with a banana, blueberries, and milk -- but I didn't want to eat it.

For lunch, I was again hungry and I was a little more excited about eating, but not all that much. I ate two tacos.

When I went to pick up my prescriptions this afternoon, I started crying immediately upon entering the Walmart. I was just so so frustrated, and I wanted to binge. I wasn't hungry, but I wanted red velvet cake. I wanted ice cream. I wanted chips and dip. I wanted chocolate. I wanted basically everything.

I thought about that morning in the doctor's office. The technician guessed I weighed somewhere between 160-180 (down from last time when she guessed 180-200). These last 10-15 lbs I have lost have really made a difference in my appearance. Several people have told me they think I look great now, and a few have even suggested that I stop losing weight. I thought about this and weighed it against the prospect of a huge binge. I thought about the two donuts I ate the day before, and how they tasted great but made me feel tired, sluggish, and not myself. I thought about the new clothes I have bought, and how I am maybe 10-15 lbs away from being out of the plus sized section and able to shop in "regular" stores. I also thought about how I just feel better about myself now.

I decided I like my current life better than my old one -- even with this temporary injury -- and reminded myself that binges really lead to nothing good. I cried the entire way through Walmart (and felt like an idiot, but fortunately ran into no one I knew) -- partially out of pain and partially because my brain was screaming for junk food. I steeled myself, and I made it out of there only with my prescriptions, some cottage cheese, and some mandarin orange slices. These are admittedly a treat, but a calculated one.

I am sick of feeling bad, but I am proud of myself for remembering that food will not fix this problem. If anything, carrying more weight will mess up my SI joint even worse. I hope I feel better soon, but I am glad that the mental aspect of figuring out how to live a healthier lifestyle is something that -- at least for now -- I am still able to control.