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.

First ride of the year. Also, first ride in 3 years without pain.

On Sunday, I went for a bike ride. And it was awesome. It was very short - perhaps 30 minutes. It was mostly gravel trail, with a bit of single-track and some nice rooty climbing, so it was super easy. But it was perfect. Perfect because my leg didn't hurt within five minutes (which is its usual habit) and even perfect-er because it didn't hurt after 30 minutes, or the next day either.  It truly was the first ride I have had in three years that didn't hurt in any way. Which, on Sunday, was nearly tear-inducing - but ended up being beer-inducing, which is to say, I celebrated  in the sunshine with a cold bottle of, well, beer. 

And, even better, on Monday morning, I had a great workout, which involved split squats and glute bridges and hamstring curls and other exercises which would have ordinarily caused serious leg complaints following a ride (or run) - but didn't - which was cause for more celebration. This time without beer (workday, after all).

I am hopeful. 

I am, actually, more than hopeful. I am energized. I am totally thrilled to have found a way back into biking - which I really must credit to the workouts designed by Steve Neal. His insistence on perfect form and on developing genuine core and hip stability seem to have made all the difference. 

And so today I am going for (oh me oh my) another bike ride. Similar to Sunday's ride (in fact, probably identical). My toes are crossed that it will be another pain-free ride.

This one's for my dad.

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I was thinking a lot about my dad yesterday. This is because yesterday was the three year anniversary of his death. He died at age 64, from cancer, at Southlake Hospital in Newmarket. This year was the first year I was able to think about that time without being overcome with abstracted grief.  The kind of sadness and grief that made me, on the first year anniversary of his death, reverse my wee VW – at reasonable speed – into the back of a sturdy (and enormous) pickup truck. I was certain that I had checked and double-checked to make sure there was nothing behind me, but I was, more or less, blinded by sadness. One smashed taillight (mine) and dented rear-hatch (also mine) later, I realized it was probably not safe for me to be driving on that day. (There was no damage to the pickup truck that I could see. He or she never responded to my apologetic note, either, so I assumed my assessment was accurate.)

My dad was so proud of me, and he told me often. He was proud of me for getting my university degree, for finding a career that gave me both creative and monetary satisfaction, and for my general independence. But he was also so proud of me for being athletic. I was born quite premature, and the doctors (so my dad told me) said that even if I survived brain-intact, I would never be able to achieve physically.  Something about my lungs and their less-than-optimal functioning.  So he was always so thrilled to hear about how much I loved running and cycling, and would make a point of telling me that that I was never supposed to be good at either of those things.

I miss you Dad. Just so you know, I am working hard to get back on my bike. I’m keeping busy with working out, just to make sure these lungs of mine stay in shape for the moment my leg is ready to bike again.

Deadlifts, resistance bands and BOSU balls.

Because reading about workouts is boring, but mountain
biking is always fun. Plus, it IS the point of this blog.

Okay, so the Functional Movement Screen showed me to be ‘hypermobile’ and ‘lacking in strength’ – to which I said ‘bah!’ – as I may be particularly bendy but I would never say that I am not strong. Anyway. After a bit of back and forth in which I challenged the above assessment, I warily signed up for a session with Steve Neal, along with my good buddy Jodi.

And I know it’s super boring to read about other people’s workouts, so I won’t get into too much detail about the ins and outs of this one. There were (yep) deadlifts, resistance bands and BOSU balls, and a nifty ankle strength exercise and some neat kettle bell stuff and overall about 25% new-to-me stuff which was great. The rest of the workout was stuff I’ve done before, which was also pretty great – primarily because Steve is a real stickler for proper form and, it seems, for drilling the idea into your head that just because you’re doing, say, a deadlift  - doesn’t mean you’re only using your legs for proper form, you’re also using your core AND your cardiovascular system. This applied to (honest to god) every exercise we did. We paid a lot of attention to breathing. Which sounds sorta dopey, but I really was made to feel very conscious of taking a deep breath at the start of the exercise, and releasing it as I progressed through, particularly in the deadlift, where apparently it’s going to come in real handy when the weights get heavier and heavier. Woot.

The good news is, apparently I don’t lack strength after all. Or at least it didn’t seem so to me. I’ll have to ask Steve when I see him again on Thursday. And woohoo, in the even more good news department, so far, my leg doesn’t hurt any more than it usually does (which is always a teensy tiny little bit). Which is, you know, nice.

I love exercise. My leg – not so much.

Spin class - this time, it didn't hurt.
Next time, who knows?

Yup. That’s the totally ickily bummer thing about having such a bad old leg. It hurts - sometimes during exercise. Almost always after. Which, well, sucks.

I use exercise like a stress-relieving drug. I know now, after years and years, that exercise is the one thing certain to put me into a better frame of mind, no matter the circumstance. When my dad was sick and dying of cancer in palliative care, I am quite certain that exercise kept me from spiraling into despair. When I went through major life change after that, exercise kept me sane. Even now, when things are calm and settled – life still has its crappy moments, and exercise is still the thing I like to use to feel better. 

So when it just so happens that most forms of exercise that involve LEGS (sigh) tend to aggravate my right hip/thigh/knee – sometimes to the point of limping pain after, it can be a crazy upsetting, not to mention a real crap shoot trying to figure out what to do to get a workout fix.

This is all perfectly frustrating, too, as I’ve now gotten into a pattern, wherein I will get back into the gym (for example) for a good four weeks of strength training and lung/heart conditioning, with just twinges of pain. And then whoosh, all of a sudden, my leg will freak out, and then I limp around for a week, which seems to negate the four weeks previous, whereupon, at the end of the limping week, my leg seems okay, and then I tentatively get back into some sort of pattern, only to have it disrupted again. Profoundly annoying.

Anyway. I called Collingwood Sports Medicine to find out next steps, now that they have received the results of my x-ray, and I have an appointment booked for the end of February, prior to the as-yet-unscheduled MRI.

And next week, I will be doing something called a Functional Movement Screen with Steve Neal at his Crossfit Gym here in Orangeville. Steve did an awesome bike fit for me years ago, which resulted in instant and remarkable climbing improvement (it also improved just about every other darn thing I did on my bike). He’s also a great mountain bike coach, so I am really looking forward to hearing his impressions of how this leg of mine is working/not working.

What the dog did. 120 lbs of canine enthusiasm.

To give you an idea of how big Jake is, compared
to me: Yup. We're just about the same size.

Meet Jake, the world’s best dog. Well. He's the best dog in the world most of the time, anyway.

So, we’ve talked about how I hurt my leg originally. Then came the two subsequent injuries, about a year and then six months after that – both thanks to Jake.

Jake has a thing for squirrels. And we, every day, put three paw stamps on the daily walk sheet of his life. These walks generally take place in the park that is directly behind our house. About 100 metres from the back gate of our yard, there is a nice stand of rather mature maple trees. Squirrels love these trees. And, every day, the moment Jake’s nose goes beyond the back gate, he is in super-dog-squirrel-hunter mode. I know this, so he doesn’t get to have room on his flexi-lead until I too have scanned the landscape for squirrels. But there was this one day (there’s always that one day) when I wasn’t paying attention so much, and Jake shot out of the gate in pursuit of a squirrel, right to the end of the 16 feet his leash would allow, which was, naturally, about 200 feet short of where the squirrel was (sigh). He yanked me off my feet, quite thoroughly, and of course I went over on my RIGHT ankle. More sighing.

So that hurt a bunch, and ended up being a minor sprain. Which added to the whole right leg problem, now extending down into my ankle.

The next incident was much the same, except Jake spied not a squirrel, but rather a most unusual dog – a German Shepherd Corgi cross (honestly, the oddest looking dog I have ever seen) – I am pretty sure Jake didn’t actually perceive it as a dog, which led to his great excitement to get closer and check it out. The problem this time was much the same as the squirrel incident, except I managed to start running with Jake, but just couldn’t quite get the big guy under control, and tripped. On the same right ankle. Sprain. Again.

The whole point of the ‘what the dog did’ story is that my right leg has really suffered its fair share of injury over these three years. I’m sure these two incidents have helped create this everlasting inability to keep it stable. The good news is, my ankle doesn’t hurt anymore – but that took a really long time.

And Jake is getting a lot more mellow about squirrels, and we haven’t seen that odd-lookin’ dog. Just don’t lets talk about groundhogs, and we’ll just pretend that I have Jake under control all the time.

Woof.

The hip x-ray. Super procrastinator strikes!

Hip x-ray from Wheeless' Textbook of Orthopaedics

Hmm. Okay, so when I went see Dr. John Bowman, a sports medicine doctor at Collingwood Sports Medicine back in October of 2011, he twisted my leg every which way to examine it and try and figure out where the stupid thing (not his words, obviously) was injured. All of this pushing and pulling led to pained groans from me, and looks of contemplation from him, and then eventually concluded with the acknowledgement that ‘there’s definitely something wrong with your hip’. Which wasn’t so, well, boneheaded (you know, from a doctor) as it seemed – basically, it seemed to me, he was saying ‘it’s not your knee, it’s not the leg muscles, and it’s not the IT band, per se, it’s your hip’. Sooooo he said the only way to really figure out what was going on was to get an MRI done. And before he could get the MRI ordered, he’d have to take a look at an x-ray.

Which I stupidly didn’t do. Yes. I put it off and it put it off and put it off.

You see, I would have gotten the x-ray done, but I had to get home first and get some work done (see about me: self-employed), and then I had to get more work done over the next few days, which led to the next few weeks and then for a while it seemed like my leg wasn’t bothered any more (which had way more to do with me not doing very much with it than it not being injured any more) and then all of a sudden it was more than a year later and I still hadn’t gotten the stupid x-ray done and I was having just as much trouble as ever with it. SIGH.

So ahem. I got in touch with the sports medicine office, and they re-sent the requisition for the x-ray. A week before Christmas. Which meant I didn’t actually get the x-ray done until January 3. But I did get it done. One year and two months after it was originally requisitioned.

Now, it’s waiting time – waiting for an MRI appointment. But, I’m like, a professional at waiting now. So no worries.