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.

Back to biking: so far, so good.

Mono Cliffs PP - beautiful views, fun trails.

So it's begun. I have been able to ride my bike many times, since my last post, without too much pain. Truth: there are some times when my knee gets a bit sore, and I feel that weird tightening up my leg into my hip, but not so much that I feel the need to stop riding.

What has made the difference this year? Certainly the effort made at strengthening my hip flexors and leg muscles (particularly the good ole glutes). The work done with Steve Neal, I think, was vital - and if it wasn't for the need to purchase a new furnace ($: sigh), I would definitely still be doing (ahem, could afford) those awesomely fun workouts. But, interestingly, it's not as though I've had setbacks since stopping those workouts just about a month ago now. I make sure to not ride too long (so far, not over an hour). I make sure to moderate, if I can, my effort while I'm riding - which can be tough, when having trail fun. And I've been keeping up with weight training twice a week - doing deadlifts and squats and lunges and glute bridges and so on - and thereby staying strong for time spent in the saddle.

In more good news, I've also begun to run again. Short runs (nothing over 5K), and at an easy pace. Sticking to trail helps a lot, and again, not enough credit can be given to the strength work done since February.

Still haven't had the ultrasound/cortisone treatment that was prescribed when I went to Collingwood Sports Medicine - I did follow up with a phone call, thinking I had missed something, but they reiterated that they would call me when the appointment had been set up. Hm.

Next steps (pardon the pun): picking a goal for late summer, both for riding and for running. And maybe, the Stomp the Quarry run (I think the 5K) on July 28 as an interim effort. We'll see!

Patience.

I was an impromptu fitness model once.
This is my leg before it started misbehaving.

It's tough to be patient. Even when it's been  proven that impatience is detrimental to healing, and, in truth, detrimental to just about anything in life, it's still not an easily natural human trait to be genuinely patient. 

Certainly I learned the hardest of ways that I had to be patient, with this stupid leg problem of mine, what with all the times I would get it so far toward better, and then screw up all that progress by doing something boneheaded like a long trail ride with competitive friends. It is a bit ridiculous, despite all that, that even now, while I know slow and careful is the best way to go toward healing, I still get astonishingly jealous of someone who says 'I was out for 3 hours yesterday on trail with my buddy so-and-so'. You know, considering that a long trail ride would just set me RIGHT BACK where I was before I started all this good healing work?

On the healing note - my leg continues to respond positively to strength training. I have yet to hear when the ultrasound with Dr. Mascia will occur. This is on the list of things to do. Along with (ha) being patient. A funny thing to put on a list of 'to-dos'.

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.