Tuesday, July 16, 2013

Me vs. The Psoas

Last night I had PT for the first time since last Wednesday when I really angered the psoas by doing the rotating lunges. I went into the appointment thinking that A) I was GOING to increase my weights on that leg raise (for the first time in about 5 weeks), and B) I was going to conquer the lunges. Why I thought I would conquer the lunges is beyond me…I can’t even understand how my brain operates and it’s in my own head.

Well…I accomplished A and went up one pound in every leg lift exercise. I was really happy about that. It was hard to do the exercises, but not painful…which was a bonus. Then I did my physio ball hamstring curls and then moved on to my core exercises. I DID add in the marching planks on the Bosu ball like I said I might do in my last post. I did 4 sets of 10, so I was psyched about that. They weren’t even painful, really...my leg is still just a bit weak and this exercise showcases that. That’s okay though…I expected that.

Tom and I then talked about upping the ante a bit. He wanted me to start really focusing on that psoas (and the area in the front of the hip with all the tendons and ligaments and crap in general) and the hip flexors. We decided to add in another new exercise. We added in standing leg circles with the Ab Dolly. Now, that’s like gibberish to you people so I’m going to do my best to explain. Here’s my best description:
I stand with my right foot (this is my RPAO-ed side) flat on the ground, and I put my left foot on this contraption called the Ab Dolly. Here’s a picture of the Ab Dolly, and then a picture of the dolly in use so you can see its wheels and how it rolls.

Put my foot of my good leg in the center.

It's on rotating wheels so you can move it in any direction.

So, with my RPAO-ed leg on the floor and my good leg on the dolly, I use my good leg to move the dolly forward in front of me as far as I’m able, and then I swing it out to the side and behind me in a circle, and then I pull it straight forward into its starting position. This creates a big circle. While you’re doing this you’re obviously bending your right knee a little and you’re in the ever-popular “athletic position.” That wasn’t so bad, I did a couple of those and I thought I would be okay. It wasn’t easy, but it wasn’t really hard or painful. It was a good workout. Then Tom wanted me to focus on just one direction with the dolly. So, I would go straight out forward out with the dolly and pull it straight back in. Then to the side. Then…then I started going backward. And THAT’S when the problems began. I did it once…and it felt a little if-y. I told myself that if this psoas is ever going to get better, I’m going to have to challenge it. So I did. I did a couple more, going back as far as I was able. By the fourth or fifth one it was downright painful to come back up. I decided to do just a couple more, so pushed the dolly as far back and as I could…and as I brought it back in…pop crackle pop. The psoas had had enough and it let me know right then and there. OWWW. That hurt like a son-of-a-gun. I got off the dolly immediately…but the damage was done. I could hardly move my leg and I certainly couldn’t walk. I limped over to a chair and sat for a while hoping it would calm down. When I got up a few minutes later it felt a little better…but still really, really sore. I was talking to Tom about the pain and what triggered it this time, and what triggered similar pain last time. As I was showing him the lunge movement that hurt my leg, I felt my psoas pull and pop again. This time it really meant business. I had to just call it a night and I very gingerly limped to my car and drove home. 

At first I was really discouraged. It was the worst I’ve felt since my time right after surgery. It hurt so badly and I just kept thinking that I was just going to have to deal with this and it wasn’t going to get better. I sat in what was my PAO recovery recliner of choice, and iced the crap out of my hip. I sat there and thought a lot about everything I've been through and I realized that it’s probably going to get worse before it gets better. If my psoas is really as much of a problem as it’s turning out to be…maybe I’m just going to have to keep beating it into submission until it starts to loosen up and cut that crap out. Maybe it’s just a battle of wills. Do I feel like I can keep pushing it until it finally loosens up and repairs itself? It is really painful, but I can deal with it if it’s what I have to do to make it better. 

While reflecting on these thoughts last night, I also tried to think about what I was actually FEELING happening in the joint while these things were happening. It felt like “stuff” (muscles? Ligaments? Tendons? I dunno…I’m not a doctor) was moving around in there. I’m not sure if it was moving over any screws and that’s what the tension was that I felt and then felt releasing. I’m not sure if everything in there is just super tight and it’s going to take some pulling to loosen up and that’s what I felt. Pulling and tearing? I don’t know. But as I laid in my comfy bed last night, I poked and prodded at both my surgical ilium and my normal ilium. I will tell you there is DEFINITELY a palpable difference between the two. My normal side is smooth and thin and my surgical side is thick and clunky and awkward. And then, on the surgical side, I can also feel my screws...at least two of them. So…who knows what’s going on in there? I haven’t had an x-ray in a long time…so I’m not sure what kind of bone growth I have going on. I know Dr. S said that I am definitely growing excess bone. Maybe that’s wreaking havoc on whatever “stuff” is in there? Who knows!

I laid in bed for a long time, wide awake with pain. I tried lying every which way until I could finally find some comfort on my left side with a pillow between my legs. This was my position pre-PAO. This was the only way I could find relief at the end before PAO when my hip was REALLY crummy. Lying in that position last night made me sad…but it also motivated me to do whatever it is I need to do to fix this silly thing. I feel like this has gone on long enough…I’m declaring war. It’s Me vs. The Psoas!

We’ll talk soon,
Thanks for listening,
P.s. After constant icing and taking it very easy, I do feel better today. It is still very sore, but it’s not keeping me from walking. Thank goodness. I think I will be doing a better job of heating and icing for PT sessions from now on.

Thursday, July 11, 2013

Oh, I'm psoas sore.

So, I thought it would be a neat thing to post about all things Physical Therapy today. I’ve been spending so much time going to it that I figured it might be nice to keep track of what I’ve been doing. It might be helpful for my hip ladies to see what I’m doing at PT and give them ideas of new exercises to do.

First I thought I’d start with some astounding facts and figures.

Last night marked the 41st time since RPAO that I have attended a physical therapy session. 41 times! Every physical therapy session bills out at $320 a pop. This is NOT what I pay, I am covered significantly by my medical plan…however I think it’s amazing what these numbers come to for health care in general. So, if every session is $320, and I’ve been to 41 sessions…that means that my little hippy has needed $13,120 in physical therapy! Holy guacamole! That brings the grand total for my bionic hip to nearly $70,000 to date. And that’s not even counting surgeon office visits, all of the medical imaging it took to get to this point (many many x-rays, MRI’s, CT Scans, etc), the equipment, the corticosteroid injection, or prescriptions, etc. That is one EXPENSIVE hip. YIKES. No wonder Dr. S is insisting I be so careful with it!
I guess I should explain what the heck it is that I do there when I go…seeing as it’s costing an arm and (HAHA) a leg!

My suite of exercises that I do at each session has evolved significantly since surgery. Now, I’m doing more advanced exercises, but it’s mixed in with some pretty rudimentary things. In some ways, my leg is far along in the healing process…and in others it’s not. There are some exercises that I can complete that are pretty challenging…even for a normal, healthy person. And then, there are things that I really struggle with that seem like they should be so easy. Going to physical therapy is like being in a glass box of emotion (to quote Anchorman…I’m sorry if no one gets the reference). There are times where I’m so happy and proud of myself…like last night when I completed 3 sets of 10 pike planks. Pike planks are by far one of my hardest exercises and to get that many was a personal success. However, there are also times where I’m really bummed out and discouraged…like when I still can’t increase my weights on something as simple as a side leg lift. Those are so difficult, and so painful…and they just don’t seem to be getting much easier.
Anyway, I’ll list all of the exercises with reps and include photos so you can get a visual on what I’m talking about. They are as follows:

I start with leg lifts. I do them four ways, 3 sets of 15 each:
I'm never this happy when I do these, FYI!
Side leg lifts with 6 lbs. These are pretty hard for me still. They hurt and it’s hard to keep correct form. My hip and muscles, etc. pop and crinkle while I do these. I haven’t gone up in weight in a while on these because I can’t seem to get my act together. This is one of the ones that discouraging.

Leg lifts backward while I’m on my stomach with 7.5 lbs:
This looks awkward and uncomfortable...because it is!

Inside leg lifts with 6 lbs:

Straight leg raises with 4 pounds. These are the hardest and most frustrating thing that I do at PT, by far. They hurt, and I feel crinkling, clicking and popping in my psoas and in the ligaments and tendons in the front of the joint. When I do these, some of my muscles rub over the top of my ilium which has excess bone growth from the bone cuts…so I feel it moving and pulling. My iliopsoas is still so weak…and I’m really worried it may never come back. I hate to think like this. Dr. S says it’s probably going to take until March 2014 until I can get this back to normal. Another example of how SLOW this recovery is.

Then I do my physioball and bosu ball exercises.
Hamstring curls on the physio ball. 3 sets of 15.

Planks on the physio ball. 2-3, hold for 1 minute each.

Pike Planks on the physio ball. 3 sets of 10

I hate these and love these all at the same time!

Marching planks (on bosu ball). 3 sets of 10. I currently do these without the bosu, but had progressed enough post-RPAO to do these on a bosu ball for a couple weeks before my second surgery in March. Since then, I haven’t been able to do these yet…but I’m thinking about adding them within the next couple weeks (depending on what Tom says).

I do this and then lift one foot at a time off the ground.

The three above, I do one of those each session, sometimes two. I don't do them all at one session.

Side planks on the bosu ball. 2-3 each side, hold for 1 minute each.

Then I do my moving exercises.
Side Steps with resistance. I go about 15 steps one way, then go the opposite way 15 steps, that’s one rep. I do 6 reps.

Sumo lunges. Same rep description as the Side Steps. 6 reps


Weighted, walking, rotational lunges. I just added these back in. Last night was the first time I’ve done lunges since February. These hurt pretty bad for the first few reps, but I did 8 reps with a 2-3 lb medicine ball. By the end I was okay, but these exercises showcased my weakness and instability for sure. These specifically bothered my psoas. The turning in both directions really stretched and pulled at it.

Lastly, I do step-downs. 3 sets of 15. These are difficult for me as well…but these are getting easier as the time passes.

I rotate the step downs and marching planks (on or off bosu) in and out of the regiment depending on what else I’ve done and how I’m feeling.

So, when you’ve been going to PT once or twice a week for 30-ish weeks, you sometimes have days where you’re just plain tired of it. I was driving to PT last night and I just kept telling myself “I am SO SICK of this!” It’s time consuming, and exhausting, and quite frankly when it’s dragged on for this long it’s freakin’ inconvenient. I was frustrated and I just wanted it to be over. When I have these nights, I tend to react in a rather negative manner by doing WAY MORE than I should. Like, magically, if I do 4-5 sets of leg lifts instead of just 3 it’s going to cross some kind of invisible threshold and be instantly better. I just don’t have the patience anymore and my answer for it is to over-exert myself sometimes. I need to just chillax…but it’s HARD to do that when you’ve been working at something for this long.
I worked really hard last night and it was probably one of my most difficult sessions. At the end the hip and especially the psoas was pretty painful, and my bum was painful too (too much info?). It was this deep, aching and spasm feeling…every time I’d move a little bit this way or a little bit that way and WHAMMY (second Anchorman reference…yessa). I pointed out the trouble area to Tom (my physical therapist) and learned a brand-y new word: Piriformis. 

It’s my piriformis that’s now behaving badly, as well as the psoas. I stretched out quite a bit last night trying to avoid any long term aggravation from this new little trouble maker…but left there feeling a bit uneasy.
I limped my way home and around the house the rest of the night, sort of because of the pain and sort of because of the stiffness. When I woke up this morning I was (and still am) very stiff, it’s almost comical. EVERYTHING is sore and stiff. What’s worse is, that little pesky piriformis is not feeling any better…and either is the psoas. The piriformis isn’t so bad because it doesn’t hurt me that much. It’s constantly just a little achy. Only every once in a while do I move wrong and make it spasm badly. However…the psoas…yowzer does that bother me today. I can’t take a full step, and if I do I cringe from the pain. It’s like a stabbing, pulling pain. I have been trying to stretch it out when I’m standing…but gosh…it’s really sore today. I don’t know if I’m helping or hurting it by stretching it out.
Well…to close I’ll just say this. This hip preservation recovery is still emotionally as well as physically challenging. Besides all of the physical challenges like those listed above, I spend most days reading through messages from other hip ladies talking about their dancing and their running and all the normal exercising they’ve had the opportunity to return to. It’s hard for me to see these things. While I’ll more than likely be able to dance here and there, I’ve been told many times over by Dr. S that I will surely never run again. I haven’t run in years because of the pain, but when I first started on this hip preservation journey I thought I might be able to get back into it. It’s hard to give up something that you love. The worst is the loss of volleyball, though. The feelings of sadness have been worse lately, as I see lots of posts from my friends about all the volleyball they are playing. I really miss it. I think it’s also harder now because I’m so much more capable than I was before. I’m moving around almost completely normally. It’s hard to think of what could have been had I not had the deformity. When I think about volleyball, it’s one of the few times I really feel like I have a disability. It’s not a great feeling.
Anyways, enough with the pity party. I’ll keep you posted on anything new.
Sorry for the long post,
We’ll chat soon,

Wednesday, July 10, 2013

The "Comeback" Shoes

Well, I learned a valuable lesson yesterday.
Monday I had a great day. Hip felt fantastic. Had a really awesome PT session, worked really hard and felt GREAT. I increased my weight on all my exercises, did sumo lunges, resistance side-steps, hamstring curls and planks on the physioball and bosu ball respectively, everything felt so good. I really was marveled because I felt normal walking out of there. Not a stitch of pain or discomfort. I felt so empowered!
So…Tuesday morning I woke up and was a little stiff but nothing crazy or unexpected. I got dressed and ready and as I was getting ready to leave the house I had to make the ever-important decision: what shoes do I wear?
Well, I felt GREAT, right? I felt confident and comfortable and normal! So I picked up my new shoes, the ones I bought right before my surgery, the ones I dubbed my “comeback” shoes. My brown leather heels with the cute little buckle on the toe. I picked them up and I said to them “After a long winter of being nestled snug in your box: I am ready for you!”

Comeback shoes! The heel looks so innocent, doesn't it?

Went to work, all excited in my new shoes…even boasted to a few people: “These are my comeback shoes!”

And then…it happened. BAM! I made one wrong move and a sharp stinging pain in my hip went allllllll the way down to my toes. I stopped immediately, sat down, and took off my “comeback” shoes. Of course a million things went through my mind…many of them variations of how stupid I was for wearing them in the first place. Many others were fears that I re-tore the labrum, or something to that effect.
I sat for a few minutes…pondering my next move and how I would go about the rest of my day. Cocky Danielle decided it was “comeback” shoe day and never thought of a contingency plan if said shoes ended up being the wrong choice. I had no other shoes to wear except these terrible, no good heels…and suddenly they didn’t look nearly as cute as they did in the morning. So…I sat there in my desk chair…rubbing my hip that I still can’t feel because of the numbness that lingers since October. I had no choice but to continue my day in these devil shoes. 
So…I got up and took a few steps, and much to my dismay I had pain while walking. It wasn’t terrible pain…but the pain was reminiscent of a time pre-surgery…and this really gave me a blow to the ego. I was so bumming the rest of the day, I was deflated. And I was petrified I’d done something horrible. 
I walked awkwardly and extremely carefully in the devil shoes for the rest of the day, taking them off any chance I could. When I got home, I immediately threw the stupid shoes in my closet and retreated back to my ever comfortable Crocs. The hip wasn’t hurting when I walked anymore…but there was still a stinging pain deep inside that ached. It felt that way for the rest of the night…and for the first time in a long time, my hip hurt when I was in bed last night. I had to put a pillow between my legs to try and stop the stinging and aching.
I was really concerned at that point. It wasn’t terrible pain…but it was consistent and I hadn’t felt it in ages. I was so disappointed.
Thankfully, I woke this morning with no pain at all. I am relieved. I certainly learned a valuable lesson yesterday: I DEFINITELY am not ready for heels. Maybe someday down the road I’ll get there. But, for right now, I’m happy in my comfortable flats.

Monday, July 1, 2013

10,000 Steps

Well, I had a fantastic achievement for myself and my little hippy this weekend. I will preface this by saying that every day I wear a neat gadget called a Fitbit. It tracks the steps I take throughout the day, how many sets of stairs I climb, approximately how many calories I burn while going about my daily business, etc. Well, yesterday was my first day since before the surgery volunteering at the zoo. When I’m there for my shift, I do a lot of walking. This shift, because it was my first shift in a long time and many things have changed, I had to do a particularly large amount of walking (even for a “normal” person). We had new animals I needed to see, new exhibits opened, animals that had swapped areas, all sorts of new things. So, I walked around the whole zoo, in its entirety, TWICE. This included hills and steep areas, uneven ground, etc. It is something that I don’t think I’ve ever been able to do before…and I did it without missing a beat. 

What’s even more exciting is that my Fitbit told me that I walked over 10,000 steps yesterday, and I climbed 26 floors! That’s incredible! That’s the daily recommended value for a healthy lifestyle and I finally achieved it! I’ve never done that before! Granted, I’ve only had the thing since March and I’ve been gimpy the whole time, but still! That’s so exciting.

The most important thing about all of this? I have ZERO hip pain today, and I didn’t have any yesterday either. During the day, while doing all of that walking, I had some fatigue when I pushed myself…but no pain! None at all. Zip, zilch, NADA. And today? I feel GREAT! 

These past couple weeks it has really been apparent how effective the surgery was. I am so amazed, and grateful, and thankful that I have had such a successful journey so far. It makes it so abundantly clear how much pain I WAS in before the surgery…and how I was really just “dealing with it.” It’s one of those things that I think you can’t truly appreciate until you come out the other side. And now that I am 8 months post-op, and doing better than I ever have in my life: I am one happy hip chick.