Tuesday, March 31, 2015

DNS and the big picture

Somehow it is March 31st. Where did March go? Why is April almost here? I do not understand. I shudder to think that my run analysis was so long ago. At the time, I was told that I would be good to run a trail half marathon the first weekend of December. Oh how the Universe likes to take all those plans, dump them down the drain, and then run away laughing like a toddler. I see you, Universe. I see you.

So, the race I was contemplating participating in the previous weekend. It was part of a series put on by EX2 Adventures, the Spring Backyard Burn. I have been wanting to run one of their races for a couple of years now but I have never been healthy enough to do so. I registered for the 5.6 mile option at Laurel Hill Park a few months ago, confident in both my PT and my progress in treatment. Don't get me wrong, I love my PT. She's amazing and she has thrown the kitchen sink at my body in hopes of getting this figured out. My body just continues to have other plans.

I spoke to my PT and the needle guy early in the week about how, if at all, I should participate in the race. I'm pretty sure I heard the laughter as soon as they opened my email. Their obvious answer was don't do it. The secondary, "you're a pig-headed runner who would try to race anyways" answer was to enjoy a brisk walk on a Sunday morning and stop if it hurts. Get my first DNF. For once in my life, I wanted to really think things over and make the decision that was best for me in the long term. If possible, I was even more hypersensitive to my body all week. On Saturday night I sat down and journaled about it, threw it up to the Universe, and went to sleep.

When I woke up race morning, I felt really peaceful. I knew I wasn't going to run, walk, skip, or crawl. To avoid any last minute change of heart, I threw on jeans and a long-sleeve t shirt so that I was not dressed in anything remotely appropriate for running. My job that morning was to support MS as he ran the course and spectate my broken heart out.  Although I knew it was the right call, I will be honest and say it was still hard to be there in a non-running capacity (plus, it was windy and bitter cold). I did my own thing at the gym later in the day and that was that.

Six months ago I would have run that race. No doubt, I would have and ended up in worse shape for it. The only difference I can see now is that I have bigger goals set for this year. More important races, running camps, and fitness challenges, all of which matter so much more to me. I want to be as healthy as I can be and if that means going batshit crazy resting the lower half of my body, so be it. I have an appointment tomorrow morning with what I hope is the last doctor I will have to see. I'll hold off on the details for now, but I hope to have this resolved once and for all. Even if it isn't what I want to hear, at this point I just want to know. I'm done with the doctors and therapies and the uncertainty. I'm going in with a list of questions and I plan to leave with answers and an action plan.

The pool at my gym is starting to feel too much like home these days and I would like that to stop as soon as possible. My running shoes miss me. My favorite trails miss me. No seriously, I can feel it. They do. I miss them too. Hopefully we'll be reunited soon.

Monday, March 16, 2015

That time I had needles in my leg on purpose

Happy Monday, friends! Okay maybe not happy, but...Monday. I wanted to pull this post together in a fairly prompt fashion so that it would be done while the experience was still fresh in my mind and so I could share this experience with anyone who might be considering dry needling as a form of treatment for injury.

Before I tell you what my appointment was like, I thought I'd provide you with a little background on dry needling. Honestly, I had never heard about it until it was suggested that I try it and I saw myself as someone who was fairly up to date on injury interventions and treatments for runners. First of all, do not confuse dry needling with acupuncture, as they are NOT the same. While acupuncture targets meridians in the body, dry needling targets myofascial (muscular) trigger points. The goal (in my case) is to treat spasm and tension related to muscle and ligament strains. This is a great explanation of what dry needling is and how it works.

The short short version is that a small solid filament needle is inserted into a specific area (for me, the insertion was guided by ultrasound) in order to create a twitch reflex. This reflex interrupts the pain cycle. Additionally, the insertion of the needle itself generates an immune system response and asks the body to respond to the increased inflammation. The end game is to increase range of motion, decrease pain, and promote healing. I'm (clearly) not a medical professional so I don't completely understand the science, nor can I articulate it as well as I would like. If I have muddled the explanation at all, forgive me. Onto the appointment itself!

I was treated by Dr. Tobacco, and he was awesome. I'd seen him a few weeks prior for the original ultrasound that identified what was going on. I could have had my first needling session right then and there but I wanted to have a day or two to think about it, do my research, and find out if my health insurance would cover it. Once I decided to move forward and had the thumbs up from the insurance company, I made the appointment. I honestly didn't know what to expect. The whole appointment took 30 minutes but most of that was getting ready beforehand and putting myself back together after.

We went back over what was originally seen on the ultrasound and he explained how things would work. Because of the location of my injury, we had to get pretty comfortable pretty quickly. Runners aren't a modest bunch to begin with, but whatever modesty I had left went out the door at this appointment. As I'd explained previously, the injury is located where the adductor meets sitz bone. Or, as I am calling it, my legbutt. This means 2 things. 1: I'm getting needles stuck into what is already a fairly sensitive area. 2: I'm baring almost all to a person I've met once before for 30 minutes and he'll be paying pretty close attention. Sigh. Remember what I said about modesty?
The face of a very unhappy camper
Because I was prone as shown above, I could not see the needles being put in. Once I was in an optimum spot for prodding, he used the ultrasound (and some hand-poking) to narrow down the spots for insertion (aka find the ouch and then add more ouch). The initial poke of the needle was fine, but location of certain needles and what they connected with shot the pain meter up more than once. I had 5 needles in overall, two or three that stayed in for several minutes as I could tolerate them easier than the others. When Dr. Tobacco and his tech stepped out for a minute, I did my best to snag a selfie of his handiwork. Yes, I got the picture. No, I will not post it here. Ow and ew.
My view while they worked
As I said, I was in and out in 30 minutes. No activity for the next 48 hours, although I could stretch a little later in evening if I felt up to it. On Sunday I could go for a slow 0.5 mile jog (yes, I used the word jog) to see how it felt. Based on the outcome of the jog, we would decide if another session would be helpful. I went back to work for the last couple of hours of the day, but it wasn't ideal. I could not get comfortable at my desk. I wasn't in pain, I was just really uncomfortable. Standing up was the best option but my workspace isn't set up for that (yet). I spent Friday night horizontal and therefore slightly less uncomfortable. All sorts of soul-soothing foods were applied (thanks, MS).  I took a sleep aid after struggling to fall asleep on my own (mental and physical stress, my friends).

Images Dr. T captured to show needle placement
I was achy on Saturday morning but things eased up the more I moved around. Nothing strenuous, just walking around the apartment (and maybe a stop at Trader Joes and Total Wine). Easier time falling asleep, less achy Sunday morning. At this point, I am a little shaky on determining what is actually pain, or whether I am anticipating pain. I felt good enough to try the 0.5 mile jog. I foamrolled first, walked for 5 minutes to make sure I felt warm, and then hit start on the watch. I focused on all the form cues I've been given over the past months, kept things as slow as possible while still making forward progress, and overanalyzed every second. After I hit the mark, I walked another 5 minutes, foamrolled again, and resumed my horizontal position. On a pain scale of 0-10, I'd say that jog was a 1. Progress.
I could waste emotional energy on the time it took to complete that 0.5 mile. But it was my first run in almost 8 weeks. And I was outside in the SUN. It was both a HUGE tease and a HUGE treat. I felt less achy this morning, but after 10+ hours of sitting in a car, at my desk, and in a plastic chair at a study group, I was uncomfortable again. Sitting = stretching the area. Sitting = pressure on an ouchy area. I've got the ball rolling at the office to see if temporary accommodations can be made in my workspace. Fingers crossed there! I am leaning towards a second round of needling, as I feel better after than I did before. I am planning to debrief with Dr. T and my physical therapist tomorrow, let them know how things have been going and see what a return to regular activity should look like.

I have a race this coming Sunday. Ha. You know I'm going to ask if I can go. Stay tuned to see how that shakes out. :) Thanks for hanging in there this long! Have you had dry needling or any other new-fangled treatment before? Would you consider trying it?

Wednesday, March 4, 2015

What you make of it

If I had a real post for every time I actually thought about posting an update, there would be one gazillion posts on this blog. Instead, I have an idea for a post and then I watch 4 hours of Big Bang Theory reruns instead. That’s normal, right?

I am long overdue to provide a physical therapy update, and the longer I wait to do so the worse things seem to get. Hopefully this breaks the cycle or gets rid of the bad juju or whatever is going on.  Anyways, in the span of less than two weeks, from January 25th - February 7th, I tripped twice. Once while running, once while walking, both times yanking on the same spot of my left leg. Like a good patient, I told my physical therapist at my next appointment, as it had caused some minor discomfort. She did some manual therapy in the area and said that it did seem to be “lit up” but taking a break from running and keeping up on the foam rolling/strengthening stuff should knock it out.

Oh if that were only true. Instead, I started having discomfort during activities that were previously pain-free (spinning and elliptical). Rude. Not to mention the discomfort continued over the course of the day. Super rude. Given these sudden developments, my physical therapist shuttled me across the parking lot to a sports medicine doctor who had the pleasure of getting real up close and personal with me. I had an ultrasound of my left hamstring/adductor/glute area (where all those things come together) this past Friday. While I had hoped for answers, I was holding out for something…not what it was. Three microtears in the adductor near the ischial tuberosity (where both the adductor and hamstring connect). With the added bonus of bursitis in the bursa in the area of the ischial tuberosity. Sigh.

Ultrasound image. I can't see sh*t on it.
Immediate actions? Stop all cardio for 2 weeks. I can try to swim but only if I use paddles and a pull buoy so that my legs are not involved.  Otherwise, I can do upper body work and gentle yoga. Consider a steroid shot to the bursa in hope it will calm the heck down (OW). Dry needling with guided ultrasound to the area of the tears (what is up with all the needles?). At the end of the appointment I told both the doctor and my physical therapist that I needed a day to process this and see what, if anything, would be covered by my insurance. I’m already paying out of pocket for the physical therapy and it is a struggle just to do that.  While I await word from my insurance company, I am asking around about people’s experiences and opinions on both treatments.

I am 99% sure I am not going to get a shot. I’ve heard too many bad things about it and the odds of it being helpful (beyond pain relief, which I don’t need) aren’t awesome. As far as dry needling goes, I’m getting 50/50 reviews. Some said it hurt and did nothing, others said it was fine and really helped. I still have a day or two to mull things over while I wait for the insurance company to get back to me. I have a new sets of home exercises to do and I had manual therapy at the clinic this morning. Hoping to get in the pool tonight. I know that these things are better than nothing, but not being able to work up a good sweat just sucks. I think about all that endurance I’ve built up just leaking out of me like a soft tire.

I thought I had convinced myself that I would have a 5 second pity party and then move on, appreciating what exercise I was still able to do. The areas I could gain strength in where I hadn’t focused before. But that has not been entirely successful. I miss the exhaustion and epic sweatiness that comes from a spin class or a long elliptical workout. I know that the lifting and the core work and the PT exercises are helping my body become stronger. But at the end of the day I am still that toddler who wants to do the one thing she was told she could not. Does anyone have any other ways to look at this turn of events? Lemonade from the lemons? Silver linings in the thundercloud? 

The 2 week cardio embargo is up shortly (because it took that long to post this), but I still need to lay low and see what the doctor says. I am sure it isn't "go back to everything you were doing before" because the human body doesn't work like that. I am just hoping to hear that things are improving. These surprise setbacks and trouble spots that weren't there before are making me crazy. Which means I'm making the people around me crazy. Thank God that MS loves me because living with an injured runner is not an easy task. Especially when that injured runner is me. 

Captain Crankypants, signing off.