An Update on my Sacroiliac Joint Saga, Part 2

Update, Jan. 2018:  Hi everyone– I’ve learned a ton since I wrote this post.  Be sure to check out my other site, My Sacroiliac Joint Saga

And now, the original post:

In Part 1 of this series, I explained how the learning the “muscle energy technique” from my physical therapist Paula marked a turning point for me in my SI joint journey.

Above, I’m including a Youtube video of a physical therapist demonstrating this technique.  (I actually use a few different variations on the moves she does, but the principles behind it are exactly the same).

By using this approach regularly, I’ve not only been able to keep my SI joints better aligned, I’ve also developed more of an understanding of how the pain and sensations I feel correspond to the anatomical reality of what’s actually happening down there.

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For me, this whole process has had to be very intellectual.  The movement patterns of the sacroiliac joints are some of the most complex in the body.  It wasn’t a matter of simply doing my exercises and getting stronger, because this joint is like a puzzle.

The SI joint reminds me of those old metal “tavern puzzles” they made in the Colonial days (http://www.tavernpuzzle.com/).  I don’t know if most of you would have ever seen one—I grew up in a town with a lot of Revolutionary War history, so I feel like I grew up playing with these things.

They are impossible to figure out by just looking—they’re too complex.  Instead you have to just start moving the different parts around, hoping the solution somehow becomes clear as you go along.  Half of the time, you move a piece and realize it actually just made things worse.

That’s been my experience with the SI joint.  It’s been so unpredictable, the things that will cause my SI’s to “slip” and lock. Walking on a flat, well-maintained trail at my favorite conservation land?  No big deal.  Going to a party and sitting on someone’s dilapidated old couch?  I sink in instantly, and my hips are locked again.

It doesn’t help that everyone’s SI joints are different.  Obviously we all have the same bones down there, but the shape of these bones and the way they fit together can vary widely from person to person.

For this reason, things that can work well for one person might not work at all for another.  I’ve tried techniques and exercises that other people have sworn by, and found they made me worse.

Only by learning, and developing a sense for exactly which types of motions and textures are going to create instability in my pelvis, have I been able to make sense of my own SI joints at all.

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What about mind over matter? a lot of people have asked me.  Why can’t you just push through it, even if it hurts?

What I wish they could see is that it has been mind over matter, just not in the way they think.

There’s no pushing through an SI joint that has locked.  Anyone who’s experienced this will know what I mean.  It makes about as much sense as trying to use brute strength to unlock one of those tavern puzzles.

But you can use your mind to learn about the anatomy of the joint, and solve the puzzle that way.  Technically it’s still mind over matter, but in this variation it’s about being open, receptive, and mindful, rather than trying to harness sheer force of will.

To be continued in Part 3!

 

The benefits of swimming in cold water

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Today, Ruby shocked me by taking her first swim of 2014.  It was awesome.

As you may remember from my previous post about her, Ruby is my family’s 14-year-old Lab mix (she’ll be fifteen in July!).  She is a spunky, spirited dog, but due to some benign tumors in her left hip, as well as arthritis, she is in pain almost constantly.

We’ve done the best we can to keep her pain in check with medication and reassurance, but you can still very easily see how much pain she in.  She limps, often keeping her back legs together and doing a “bunny-hop” to get up the front steps.  She is usually in too much pain to come upstairs at night, so every night I sit and talk to her until she falls asleep at the bottom of the stairs.

But today– well, Ruby simply had an amazing day fetching sticks and walking around the fields at our favorite spot.

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Fetching sticks out of the river… Ruby’s all-time favorite pasttime.

Of course, it helps that the weather is finally warmer (trust me, we New Englanders were starting to collectively lose our minds after this completely absurd winter!).  But what I really think made the difference for her today is the benefits that come from swimming in cold water.

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Swimming in the cold isn’t really fun, at least for humans.  Part of the reason I took so long to start working out in a pool after first hurting my knee a few years ago is that when I first tried it, I couldn’t get over how cold it was.  Here I was, trying to warm my muscles up enough for them to loosen up, and I couldn’t stop shivering.  My teeth were chattering audibly.  What the heck.

But when I finally started doing it regularly, I was amazed to find it made an incredible difference in my pain.  Here are the reasons why:

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#1: Reducing blood flow

When you immerse yourself in cold water, it causes the blood vessels in your extremities, particularly those which are the closest to the surface, to constrict.  This is because your body is trying to send as little blood as possible to the periphery of your body, and keep more blood in the center of your body, to help keep your core temperature warm.

From an evolutionary perspective, this is because if we’re trapped out in the freezing cold, or we fall into a freezing lake, it’s essential that we keep our internal organs working.  If it comes down to it, we can survive without a few fingers or toes.  We absolutely cannot survive without a liver.

Of course, when you’re simply swimming in a chilly swimming pool, you’re not anywhere near the point of developing frostbite.  But the minute your body senses that cold stimulus, it starts that process of constricting your blood vessels, which in turn limits the flow of blood to the periphery of your body.

This means that if you have a particular part of your body that’s inflamed– for example, let’s say it’s your ankle–  you can temporarily stop the cycle of inflammation by reducing the flow of blood to that area.   Your blood is what brings the ingredients for more inflammation to your ankle.  If you reduce the flow of blood, you aren’t allowing those ingredients to come and produce more swelling.  The cycle is temporarily stopped.

#2: Cold slows the rate at which your nerves send pain signals

Anyone who’s ever been outside in the winter without gloves knows this: when part of your body gets cold enough, it will start to go numb.

The pool can be a much more subtle version of this.  I know that after I’ve been in the water for about ten minutes, I’ve totally forgotten about the aches and pains that were a “6” out of “10” all day.

This is because, when your nerves are cold, they simply can’t fire as fast.  This gives your brain a little break from receiving all of the constant input it was receiving, which in turn can have a calming effect. By the time you’ve gotten out of the water, your brain is perceiving your pain differently, and it’s sending fewer messages to the nerves in the rest of your body asking for more “information” about the pain.  Needless to say, this is good.

#3: Cold causes your body to release endorphins

Over the past few years, I have heard of many studies that show our bodies release endorphins in response to cold.  (Endorphins are chemicals produced by our bodies that help relieve pain and improve mood).

I actually have a few friends who swear by taking ice cold showers to improve their mood and help them “wake up.”  Of course, I’m not asking you to go swim in ice water– I think you can get the same effects with mildly chilly water.

This phenomenon is something that is not yet completely understood, so I wanted to be sure to provide links to a few credible studies, rather than simply asking you to take my word for it.  Here is one study that looks at cold as a possible treatment for depression; here is another that examines it as a possible treatment for chronic-fatigue syndrome.  (Don’t worry, I definitely didn’t understand all of the mumbo-jumbo either!).

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I have personally found that chilly water makes a much bigger difference in my level of pain than the heated therapy pool I used to work out in.  The therapy pool was relaxing, but I still felt all of the exact same pain that I had been feeling on land.  When I switched to swimming in a regular pool (which is still heated, just not hot) I was shocked to notice that, after about ten minutes, those pains were almost completely gone.

There are many other benefits that come from working out in water.  They are equally fascinating to me, so of course I will be covering them in future posts.  But for now, I will leave you with this:

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A few minutes after she got out of the water today, Ruby sped up and started to prance.  Completely out of the blue, she was trotting, quicker than I’d seen her move in months.  I could just tell what she was thinking:

“I can move!  Wow!  I can move as fast as I want!  I can’t believe I’m not tired!”

It was true– we hadn’t gone for a walk that long in months, let alone a walk and a swim.  It was clear as day, the expression on her face.

For a moment there, we both got to see just what her body was capable of, if only we provided it with the right conditions.

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Breaking up muscle knots, without completely breaking your budget

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Sometimes, there’s nothing like a good massage.  Exercise and stretching are incredibly important, but sometimes you really just need someone to dismantle the knots that have taken over your muscles, and give your body a “reset.”

Unfortunately, if you’re dealing with a chronic condition, the cost of things like massage, acupuncture, and other bodywork can add up quickly.   How you can you pay for these things without completely ruining your budget?

Here are some of the best strategies I’ve learned over the years for using your money as effectively as possible to get the help you need.

*Before booking anywhere, look the place up on Yelp to see if other people had a good experience there.  This is especially true if you’re following my next tip:

*Check websites like Groupon and Living Social.  Many massage therapists post deals on these sites to try to bring in new clients.  I’ve saved a lot of money and met some interesting, helpful people this way.   I’ve also seen people start to post deals for other types of therapies, such as acupuncture and chiropractic.

*Check the massage therapist’s or business’s own website.  A lot of places offer a discount to first-time customers, or a monthly special.  (Many also offer a discount for people who book multiple appointments, but leave that until after you’ve had at least one massage there).

*Check to see if your insurance company will help you pay for massage.   Some companies, at least in the US, will pay for about 15% of the cost of your massage, if you go to someone that’s in-network.

*Ask if there is a sliding scale.  Sometimes people in the helping professions offer a “sliding scale” to those with financial difficulty.  It isn’t something they always advertise, however, since they (quite understandably) don’t want to be taken advantage of.

This is sometimes an awkward conversation, but if it’s the difference between you getting help or not, it can be worth asking.

*Try to find a massage school near you that runs a student clinic.

Massage students have to perform a certain number of hours of massage before they can be licensed.  Most massage schools operate a student clinic where members of the public can come and get a discounted massage performed by a student.

This probably won’t be a spa-like experience.  You might end up sharing a room that has multiple massage tables in it with other people.   But it is a way to get a low-priced massage, without having to book too far in advance.  (Thanks to Jezzybel for this suggestion!).

*See if you can find a physical therapist who specializes in massage. 

Unfortunately, not all physical therapists consider massage to be an important part of treatment.   Some PT’s haven’t had very much training in it.  Others are discouraged from performing massage on patients by the companies they work for because insurance companies do not reimburse as much for massage.  But once in a while, you’ll find a PT who considers massage to be an important part of treatment, and whose place of employment allows him or her to perform it.

I am currently seeing a physical therapist who specializes in massage, and it’s incredibly helpful, convenient, and cost-effective, as my insurance company pays for most of it.  But it took me forever to find her.

Unfortunately, there is no obvious way to find a physical therapist like this.  I would suggest looking for someone who mentions manual therapy or soft tissue release among their techniques.

*Check out Community-Oriented Businesses

I’ve come across a few really awesome places over the years which follow a slightly different model than the traditional spa or health center.

Many of them have had the word “community” in their name, and they place an emphasis on being affordable and accessible to everyone.   These types of places generally offer a sliding scale upfront—everyone pays what they can.

I make it a policy not to post the names of businesses I currently frequent.  (Maybe I’m being paranoid, but the internet freaks me out).

I am, however, comfortable posting the names of businesses in places I no longer live, so here is a place I went for acupuncture when I was in college.  You can check this out as an example of a community-oriented business, and see how it’s a little bit different from other places.

http://amherstcommunityacupuncture.com/welcome.html

Many businesses that follow the community model offer other services, such as massage, counseling, and nutrition therapy.

*Self-Help Techniques for Muscles

Of course, there are plenty of things you can do for yourself to help ease muscle pain and prolong the length of time you are comfortable between appointments (for example: ice packs, heating pads, and self massage with a tennis ball and other tools).  However, there is so much to say about this that it will have to wait for another post!

Thank you to Foundry Park Inn for the use of the above photo!

How a physical therapist helped me through my lowest point, Part 6

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**If you are new to my blog and would like to start at the beginning of this series, click here.**  

Part 6: Re-adjusting my concept of what is “dangerous.”

When I was running long-distance in high school, I’d really pushed my limits.  Pain didn’t scare me as much as my irrational fear of gaining weight and not training hard enough.  I had rarely let pain stop me, and on more than one occasion, I had paid a price for that refusal.

As a freshman, I had partially torn my hip flexor off of my hip bone during a cross-country race.  I’d had some pain in the few days before the race, but one mile in, endorphins had taken over, and I felt no pain.  Then, as I sprinted down the finish line, my right leg completely gave out beneath me, and I’d had to hop across the finish line on one leg.  After that, I was on crutches for months.

Then, while training for track during my junior year, I’d developed compartment syndrome.  I’d had pain and a feeling of “deadness” in my calves for weeks, and I continued to push it.  Running was the only thing that chased the dark clouds of depression away, and I was excited about the fact that, once track started, I was going to be in amazing shape.  Instead, by the end of the season, I was barely able to walk.

After these injuries, I’d sworn I was never going to let anything like this happen again.  How could I have been stupid enough to ignore all the warning signs?  My body had tried to tell me again and again that it was a bad idea, and I hadn’t listened.  So I promised myself I’d never ignore it again.

But now, in physical therapy, Tim helped me to realize that maybe I’d gone too far in the opposite direction.  There was a big difference, he said, between pain in someone who’s running 40 miles a week, and pain in someone who is basically sedentary.

My nervous system was functioning differently now, as a result of the physical traumas I had endured.  It was as though my body was looking at pain through a magnifying glass.  A little muscle spasm that I might have been able to ignore in the past was now debilitating.

I might have the same amount of pain now, just walking down the sidewalk, as I’d had running at seventeen.  But, Tim explained, I wasn’t subjecting my body to anywhere near the same amount of forces.  I might have the same amount of pain as I’d once had running, but it didn’t represent the same amount of “danger” to my body.

From running, I had learned that the way to respond to something that was agonizing was to stop and rest.  If something hurt that much, it must be on the verge of rupturing, of tearing… tendons were about to come unattached.  Right?

Wrong.  I was doing what anyone in my situation would do—taking the information my nervous system gave me at face value.  But Tim helped me to see that, because my body had adjusted its “criteria” for causing me to feel pain, I needed to change my own “criteria” for evaluating that pain.

Things just weren’t as dangerous, Tim promised me, in someone with my level of physical activity (or lack thereof) as they were in a long-distance runner.  I might be feeling a muscle spasm that hurt just as much as a pulled muscle when I was running, but– given the fact that my nervous system was revving everything up, and that I was not subjecting my body to anywhere near the same amount of forces– it was nowhere near as dangerous.

Tim urged me to stop thinking of pain as a sign that something was ripping or falling apart.  Those types of injuries were definitely possible when I was running a 5K race, or pounding down a track at 5:30 mile pace.  But they were simply not possible in a generally-healthy twenty-five year old who went for a walk a few days a week.

It seems obvious now, but of course, pain is specifically designed not to let us ignore it.  There’s no way to tell, based on sensation alone, whether or not a painful sensation is safe to ignore.  Pain doesn’t come with labels saying “this is inflammation in your joint” and “this is an overworked muscle.”  It all just feels dangerous.

What I love about Neil Pearson’s approach is that it in no part blames the person with pain for what has happened to him or her.  Instead, he suggests that the person in pain ask him or herself, “Is this really dangerous?”

Pain is designed to draw our attention to something, to make us change our course of action.  But that doesn’t always mean that we have to stop using that part of our body completely.  Sometimes, our nervous system just wants us to focus on something; to give it the attention it deserves; to make an educated guess about what is needed.

Maybe it means we decide to only walk for five minutes, instead of ten.  Maybe it means we promise ourselves that we’ll schedule that doctor’s appointment as soon as we get home.  Maybe it means we promise our aching neck that we’ll get a massage soon.  All of these things can actually have an effect on reducing pain.

When you stop and focus on what your body needs, it stops trying so hard to get your attention.  I’m not saying that this is a miracle cure and you’ll never feel pain again.  But you might find that the pain becomes manageable.

When your body sends you pain signals, it wants you to answer the question, “Is this dangerous?”  Your body doesn’t have all the answers; something that’s painful might not always be harmful.  It just means your nervous system thinks it might be, and wants you to find out for sure.

This is why something as simple as scheduling an appointment with a doctor you trust might actually reduce your pain.  Your body wanted you to answer a question, and you took a proactive step towards getting that answer.

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Of course, I probably wouldn’t have made as much progress if I had tried to use this approach on my own.  It really helped to have someone else there with a lot of expertise who could help me make an educated guess about what was really going on in my body.  I was completely terrified by the concept of trusting my body, and it really helped to be able to ask Tim what he thought the pain meant.

I trusted him because, well, he took the time to earn my trust.  He didn’t have me in the gym trying to do exercises on my very first day.  Our first four visits were all spent talking about the information in the Neil Pearson lectures, and about my past experiences with injury and exercise.

I’d had many other physical therapists in the past who’d expected me to just get up and do all sorts of exercises right away.   Based on my diagnosis, they said, I “ought” to be able to do all sorts of things.  And when I would refuse, saying I was scared, it would turn into a conflict.  I’d either end up doing the exercises, which would of course increase my pain because I was scared, or I’d get a lecture about how I had to listen to this person if I really wanted to get better.

Tim didn’t ask me to do any exercises until the fifth visit; only after he’d spent the previous four reassuring me that there were, in fact, a lot of exercises I could do safely, and that my body was capable of handling much more than I thought.

He started out by having me walk on the treadmill.  The first day, I only did five minutes.  The next visit, I did ten.  Of course, I was apprehensive, but the important thing was that I didn’t feel like I was being forced to do something.  I knew it wouldn’t turn into some kind of huge conflict or battle of wills if I needed to stop.

From there I gradually progressed to other exercises.  I had been terrified to use the elliptical trainer, although up until the pain became debilitating it had been my favorite machine.

One day Tim convinced me to get on for just three minutes.  Just to see how it felt.  “Is this dangerous?” he asked.  “No.  No way this is dangerous for you, in just three minutes.”

Three minutes ended up feeling so great that I ended up doing ten.

To be continued in Part 7!

**Track meet picture courtesy of oscarandtara on Flickr.**

New York Times: The Heart Perils of Pain Relievers

An interesting look at the risks that come from taking anti-inflammatory medications.

http://well.blogs.nytimes.com/2013/06/17/the-heart-perils-of-pain-relievers/?_r=0

The article quotes one doctor as saying, “If these drugs are making your life a lot better, that may be worth the risks.  But a lot of people will tell you, ‘I can’t tell if they’re doing anything, I just take them every day anyway.'”

I think a lot of people with chronic pain are told by their doctors to take these medications.  They are considered by most doctors to be a lot safer than some of the alternatives, which carry a risk of dependency and have a potential for abuse.

But NSAIDS have never really done much for me.  They help if I’ve  strained a muscle in a very acute manner, or when I’ve had a specific injury such as an ankle sprain.  But for ongoing, chronic pain where the original injury happened a long time ago, NSAIDS don’t seem to do much.

Don’t take NSAIDS just because your doctor recommended them.  Make sure they are actually producing a reduction in pain before subjecting yourself to the risks.