Tuesday, February 26, 2013

Trying a new approach within PT

So my PT is now trying something different so that my right hip will clear the test for impingement.  The goal (obviously) is that I walk in to the clinic, lie down on the table, he applies the test, and boom I pass.  Once that happens we can then go on and take it to the next level; we could then do exercises standing up.  At first my body appeared to be doing X, but since I'm doing the exercises (they tend to make me pain free, so that's a great incentive) and I'm not really responding, he thinks Y might be going on.  Forgive my use of X and Y, Mike tried to explain it but it was just a bunch of acronyms.  But what he thinks is going on is I have a tight Obturator exernus which is pulling on my hip and is causing me to fail the impingement test. It's a strange stretch, you place some rolled up towel (the fulcrum) between your legs, then you have some one push on the knee part of your femur (the lever).  It's like your femur is a see-saw on top of the towel, and by pushing down on one side your applying force upward on the other. That force is what stretches the obturator.  I've never heard of this muscle, and I've never heard Bobby comment on my having a tight obturator, so I asked Mike about manually releasing it.  He responded with, "There is a way to do that, but it would require me sticking my finger up your rectum, and if you want that done you're going to have to find another physical therapist."  ...I fine with just the stretch.

So we've named a new culprit, and hopefully a week of doing this stretch and exercises will help me move on to the next stage of my therapy.

Sunday, February 17, 2013

Progress report with PT

Well the past week or so has been frustrating for both me and my PT Mike.  The groin pain seems to have gone away, but there is still that little bit of pain in the hip that is lingering.  I am having a hard time pin-pointing it.  The pain is so subtle, so vague. Also, it comes and goes.  There are periods during the day where I’m pain free, and then there are periods where it feels like there’s a tiny, tiny fire in my hip.  Then there are other times where it’s just a dull throb.  So you see, it’s very confusing and so I’m not sure which muscle is causing the pain.  …I say muscle because after Mike did some Graston work on my hip and lo and behold I wasn’t in any pain.  That, in one respect, is a huge relief.  For a while I was concerned that my pain was joint as well as muscular.

After getting my muscles to release Mike had me briskly walk on a treadmill, and some pain, and I mean the slightest, started to creep back in.  Full hip extension seems to be the movement that aggravates it, but that’s about as definite as I can get.  Mike doesn’t want me to progress to any new exercises until I am completely pain free.  I completely agree, but I worry that I’ll never get there.

There have been so few times where I’ve been pain free, like right after the wedding.  I look back and I think about how I was an idiot. A complete idiot.  Here I was, pain free, and when I went back to doing squats I did a horrible, horrible approach. I went too heavy too quickly, and when I started to be in pain I just ignored it because I thought there was nothing I could do.  Now I realize that although I got stronger than I ever have before, I was undoing all of the previous year’s work on fixing my hip.  The hip pain is different, my psoas isn’t as near as tight as it used to be, in fact it’s practically normal. It’s something else, it now seems to be the pectineus and maybe the rectus femorus.  Although, it might have always been those muscles as well, and I just couldn’t tell because the psoas was grabbing all the attention (greedy bastard).  Also, I would still be dealing with an overactive right groin/ underactive left groin if I wasn’t seeing a physical therapist.  I just have to be patient. I am so close to being pain free right now, I just need to keep doing what I’m doing and hope that everything works out. It can just be hard, after working with so many doctors/therapists, to believe that there is actually a way to become pain free.

Time to focus on the progress

1)      I am now using my abs more than ever throughout the day.  I never knew that I was in anterior pelvic tilt all the time, like just walking around the house. I’ve known for years that I tend to arch my back with overhead lifts, but now I see it everywhere.  Like when I’m doing dips, when things get tough I start to arch my back.  Now I don’t do that anymore.  Also, I would hyperextend my back when I would overhead press.  It never hurt my lower back, but now I’m much better at keeping a neutral spine when I overhead press. Actually, I’m better at keeping a neutral spine with every lift now. Probably because…
2)      I am now realizing what keeping a straight spine feels like. What I used to think was hunched forward/rounded back is actually a neutral spine.  So all of my life when I thought I was keeping a “straight” back, I was in hyperextension with Lordosis. I think part of this was back when I was young I was given the cue “Chest up” when doing things like seated row (As talked about in this article here).  “Chest up”, in turn meant letting the rib cage fly, which meant arching the back into hyperextension.  I am just a product of my environment with this one.
3)      My groin pain has been reduced dramatically.  I would have said completely, but it seems that my pectineus or another one is still tight all the time.  I’m not really sure how to turn it off other than constant foam rolling with a softball, but when I get on that sucker it burns like a hot poker until it releases.
4)      My left groin is really gaining in strength, I’m starting to be able to command it much better now.
5)      The same goes for my right glute. I did the elliptical for a warm up and walked away with sore left groin right glute. That means something is working right.
6)      I’ve been given clearance to practice bodyweight, ass to grass squats.  I’ve been doing them all the time, really trying to focus on keeping my abs tight. Who knows when I’ll start to do weight, but I imagine it will be months down the road. Sucks.

I am going to see a different PT on Tuesday, from the sound of it she is a bit more senior than Mike, and he wants a second opinion as to what to do with me. Should be interesting, and will try to keep everything on here up to date as it happens.

Wednesday, February 6, 2013

Making strides with Physical Therapy

So it’s been about two weeks since I’ve started physical therapy, and my groin pain has pretty much gone away. If I try to engage my adductors they let me know that they’re not 100% but while I stand here typing this out I’m not experiencing any of the pain that I once was.  I recently progressed to an extremely complex exercise that I’ll just call “glasses” (bit of an inside joke).  I won’t even try to describe what goes on in glasses, but it has effectively turned on my glutes and turned off my right adductors, thus the alleviation of groin pain.

Although the groin pain has subsided considerably, I still have some impingement going on, and until the physical therapist, Mike, is able to move my hip around without it catching on the acetabular socket we can’t progress to standing exercises (which is a big deal).  Surprisingly, I now have full ROM with my right (bothersome) hip, it is my left (pain-free) hip that is not responding to the stretches and exercises as nicely.

In doing a stretch for the left hip, Mike was super concerned that I would irritate my right hip. He kept asking if I felt any pinching. To which I kept telling him I wasn’t.  He responded with “well that’s a good thing, that means your pain is probably muscular, and not capsular.”  I was being honest when I said I didn’t feel any pinching, but when I replicate the stretch at home I’m now worried that I might be experiencing a pinching sensation. I might be psyching myself out here, but I keep worrying that maybe I’m not. Maybe some of the pain I’m feeling isn’t muscular, that it’s something that can only be corrected with surgery?  It’s fears like this that keep me up at night. I just have to keep telling myself to calm down, that we’ll cross that bridge when we get to it. For now, I just need to focus on my adductors.

The progress on the groin pain has been awesome. However, I am still experiencing some small, dull type of pain in my hip area.  Of the onion of pain that my hip has proved to be, I think I’ve peeled away pretty much every layer now except for one.  I mean, I think it’s one last, underlying issue.  The pain is strange, it seems like it moves around, different parts of the hip get this dull… ache, I guess? It’s very hard to pinpoint. I keep thinking it’s the pectineus, but it very well might not be. Who knows.

I hope that working with Mike we will get to the bottom of this, that we can figure out precisely what is going on. I sure hope so.  Mike, as a physical therapist, doesn't think that squatting ass-to-grass would be a good goal.  He thinks squatting to that depth is bad for one's knees.  ...He knows that I'm in disagreement on this, and he would be interested in why, so I'm sending him some links and other info.  Thankfully neither of us are getting defensive on this issue, he's a great guy and I recognize that I'm not the one with the degree.  Still, I really, really hope I make him a convert.

Spreading the paleo/primal word

I just learned today that a few years ago I got my office mate to quit grains and go primal. My office mate, in turn, converted a couple other people and they, in turn, have converted their friends as well.  The thing is, I didn’t even try to convert my office mate, I just talked about what I was eating for lunch and why I was doing it.  He went and read “good calories bad calories” and the rest is history.  I feel pretty awesome having such an influence on others, especially one for the positive.