Chronic pain.

Tara Stiles doing 'pigeon pose'.
Still from her youtube video.

I have been going a little bit crazy lately with this leg of mine. Despite what genuinely seemed like real progress over the winter months and into the early spring, I have lately felt as though there has been a reversal of progress in healing. I can ride my bike. I can go to the gym and work out. But I also have pain in my leg, from hip to foot, regularly and relentlessly. It strikes most fiercely when I spend a long design day at the computer. I get an awful 'full' feeling in my calf (like the skin can't contain the stuff inside), and a binding in my knee, and sometimes, the scariest tingling feeling in my foot. When I lie down at night, I feel a weird hum (best word I can think of to describe) in my right foot, and fierce aching in my whole leg. This all despite best efforts to stretch my legs and hip flexors (yoga's pigeon pose) is superb for this, and (as discussed in previous posts) lots of work in hip/core/glute/quad strengthening/stablizing (deadlifts, squats, split squats and lunges, among others).

And yet, the physical part is only part of the problem.

I have also been hamstrung (useful term, that) in the realm of medicine. I was scheduled, July 27, for a deep tissue ultrasound, as mentioned, and then possibly a cortisone shot, depending on the results of the ultrasound. I was assured by my sports medicine doctor that "[the cortisone shot] would put out the fire" and that I would be thereby relieved of pain. Excited, I was. And yet, when I arrived at Humber River Hospital, on July 27, prepared and energized to find some answers to this ongoing and vexing problem, I found I had been mis-scheduled – nearly blithely trotted into the xray department for a contrast/xray guided cortisone shot (sans ultrasound), when I asked the question, "what about this part on the requisition which reads 'ultrasound assessment, cortisone if necessary' "? This, plainly written, even though by a doctor. The response from the tech, bless her, was chagrin, and a "the charge nurse books these, it does seem wrong, I'll have to check it out"...but still, obvious screw-up. So, I waited, and then had an ultrasound done (but not done by Dr. Mascia, as expected), and no cortisone shot. A week of waiting for results ensued, no word from the sports medicine doctor, and my call last Wednesday (August 8) to their offices yielded a startlingly unsympathetic (I don't even know what to call her) person who, when I asked to speak to the doctor, said, "I'll see if he has time."

Exciting times, today, then - when, to my surprise, a voicemail from their offices today said the doctor doesn't want to speak to me, he wants to see me, on Monday (!) (a somewhat amazing difference, in terms of scheduling, from the 3 months I waited to see him last time). Either the ultrasound has shown something, and there's a course of treatment on the horizon, or, the ultrasound has shown nothing, and the next step is an MRI. One way or the other, I just hope there's some kind of answer pending.

Chronic pain is confounding. In a way, you get so used to it that you sort of dismiss it as a natural state of your life. But it's not a natural state. It really shouldn't be that when you lie down to go to sleep at night that your first thought is either a) "did I take an ibuprofen so I can sleep?" or b) "holy crap, my leg hurts - and what's that weird hum in my foot". The other confounding part of chronic pain is that one does get tired of being a one-note song, always complaining about the same thing. I sometimes feel helpless in the grip of this stupid leg of mine, which feels, often, almost disconnected from me - 'you are not my leg, you vexing thing you' - we are ever at odds, it seems.

This has been a long post. But it's been a while. In my renewed attack on solving the mystery, I have an appointment with my GP on Friday, the sports med guy on Monday (surprise!), and a physiotherapist on Tuesday.  I will have some things to report - even if no thing (per se) in the days to come.

Iliopsoas bursitis. Or, the thing that happens to my leg.

Image is from hipflexor.org, which also contains lots of useful information
  about hip stretches, strengthening and prevention of hip flexor injuries.

After another visit to Collingwood Sports Medicine, I finally have a more certain diagnosis of what the heck is going on with my leg: iliopsoas bursitis. This was well explained by Dr. John Bowman - essentially, the iliopsoas muscle group is the strongest of the hip flexors, it's vital for standing, sitting, walking, running, and in my case, pretty darned important for cycling, too - particularly in mountain biking where there is a lot of standing in the pedals and maneuvering around the saddle. Generally, iliopsoas injuries are caused by overuse/overtraining - which would be accurate for me, as, when this injury occurred, I was trail running, mountain biking, weight training and doing a lot of plyometrics - some weeks adding up to nine workouts/week. 

So what happens, as a rule, with me, is that I'll do one of the sports I love, sometimes have pain in the hip during, and then often or always in my hip, glute, outer quads, knee, and sometimes all the way down to my ankle the next day. So, I'll take that day off, see if I'm pain-free the next day, if I am, go for a ride/run/workout/whatever, and then repeat the cycle. The pain part of the whole deal is the result of the bursa becoming aggravated and inflamed and then sending its consequences down my leg. 

Since I've started my new workout regime, which, as mentioned, involves much in the way of hip strength/stabilization exercises - and stretching - the time from aggravation (pain onset) to resolution (pain mostly to completely gone) has shortened considerably. Where before it could take a few days for my leg to stop hurting, now it's usually on the order of 24 hours. This, obviously, is progress. 

Next steps for my hip? Well, first an ultrasound, to have a look at the bursa. I await an appointment at the Humber River Hospital, with Dr. Anthony Mascia - here is an interesting article about him and the treatment of a patient's chronic pain. Next, possibly a cortisone shot, depending on the extent of inflammation. And following that, I am told, disciplined adherence to exercises to keep my hips and core strong and resilient. 

It is pretty amazing, to have a name to put to this remarkably annoying chronic pain of mine. Also, nice to have an enemy to put forces decisively against. Rawr.