Monday, June 10, 2013

Tiny Rays of Hope?

This picture is here because REASONS. If you have a problem with it, then we cannot be friends.
Today I was supposed to get x-rays & see my sports medicine (read: running problem) doctor & find out whether he thought I had a stress fracture or not. I arrived a half hour before my appointment as instructed for said x-rays, only to be told that apparently the insurance company doesn't think my PT has "standing" to order x-rays (RUDE), and they would prefer that I see my running doctor first & find out if he thinks x-rays are really necessary. (Sidenote: Don't x-rays cost, like, 7¢ each these days? Because I totally would've just given them a quarter or whatever.)

So. I go in to see my doctor, very nearly trembling on account of he might ask me to do the things that give me the horrific, nauseating, eye-bleeding pain (bearing weight on my right leg with my knee bent, going up or down a step on my right leg, etc.) in order to show how bad it was. We talked for a few minutes about everything that had happened since I'd seen him in March, & then he got me up on the table for some examining.

At first he did a lot of the same things my PTs had done--passively moving my hip through extreme ranges of motion, tensing & flexing it & different ways, & "loading" it (ie, applying force) in different directions, none of which caused me any pain.

"This is VERY good," he assured me.

Then he had me do some things standing up--first just standing straight with my weight equally balanced on both legs, then standing on my right leg with my knee locked (which I can do with no pain), then squatting two-legged as far down as I could with my weight equally on both legs, which I could do basically all the way to the floor with no pain.

"Okay, how about a single-leg squat."

"AIN'T GO' HAPPEN."

"Give us a little hop?"

"NOPE."

I tried holding on to the side of the table, standing on my right leg, & very, very gingerly putting just the tiniest bit of weight on it to make the point, which is that it makes me feel like my leg is about to snap completely off right before I throw up. He had me walk normally up & down the hallway without the crutch, then walk sideways both directions, which, again, I could do as long as I locked my right knee & otherwise it is pain city.

"You really are moving quite well," he assured me.

Finally he had me lock my knees, stand on my toes, then on my heels, then stand on my toes & crash hard down onto my heels, none of which was the least bit painful.

"I don't see any evidence that this is a stress fracture," he said finally. "We loaded the joint pretty seriously in every direction & had you put it pretty well through its paces. If you had a stress fracture in your hip, I don't think you would've been able to do half the things I had you do." The standing on the toes with knees locked, then landing hard on the heels is particularly telling, he said, because if it were the bones in the femur / pelvis, locking the knees would not protect them from the force of that impact.

Me: "Soooooooo okay what's wrong with me then???"

If I understand & summarize him correctly, what he thinks is that the right side of my body was already massively fubar'd, which caused a TFL / sartorius / adductor strain that I didn't let completely heal before I ran a marathon on it, which greatly traumatized that entire complex of muscles & tendons (and maybe tore some things as well). In an effort to protect themselves while the tissue tries to heal, they have tightened up even further (which leads to the spasm-ing, the REALLY bad pain I feel, when I trip or try to go up/down stairs/etc.) Essentially, I have given my right hip/glute/adductor area PTSD.

Me: "But is there ANY chance it could be a stress fracture? Like a really bizarre, freakish one?"

Dr: "Yes, there is a nonzero possibility in the same way there is a nonzero possibility that dragons will quantum tunnel into this room. But no, I do not see anything that supports that diagnosis. Like, nothing."

Me: "But what if it is?"

Dr: "Then we are not messing around with x-rays & I will order an MRI right now if you want. But I don't see any reason to do that."

Me: "So what do we do now?"

Dr: "You take it easy for three weeks, try to CAREFULLY wean yourself off of the crutch, & avoid things that hurt. Whatever doesn't hurt is fine. If it's still this bad in three weeks then we MRI it. But honestly, I think it's just really, really angry with you right now & doesn't trust you not to hurt it again, hence the tightening / spasm-ing."

Which, in the immediate aftermath, had kind of a funny effect. Although I'm a little gun-shy from all the times I've tripped or stumbled or stepped wrong, I stopped using the crutch as soon as I left UCSF & just tried to walk really slowly & carefully. And, funnily enough, I think it did start to relax a little, & some of the little warning pains that I've gotten used to feeling when I step a certain way did disappear.

This makes me wonder if indeed there might be a little bit of a psychosomatic element to this. I wonder if the worst of the pain causes a feedback loop where my body is afraid of the pain => the muscles tense up & spasm when I step wrong => my body becomes even MORE gun-shy => muscles tense up to protect themselves => etc etc. So I'm working on trying to consciously undo as much of that as possible, if indeed it is the case.

Functionally, what you do in response to the worst case (stress fracture) & the best case (white-hot hip/glute ├╝ber hate) is really the same. But the tiny ray of hope I'm taking from this visit is that perhaps it will only be another two weeks or so until I'm able to run again, rather than the six-to-eight range I'd probably get for a stress fracture. So I'm trying to focus on that.

And...I'm also doing my best not to weep too much over SFM 2nd Half, which I've been looking forward to for months. :-/

11 comments:

  1. Good news, but man, I am still concerned. That much pain just doesn't sound like muscle spasms. Or I'm just overly dramatic. Just take it easy and see about the three weeks - rest can't hurt!

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    1. Since the "treatment" is the same (and I can't run anyway), I'm willing to go with it for now, but I'm definitely retaining a healthy skepticism based on the number of people I've heard from with stress fractures that were misdiagnosed as soft tissue stuff. Hopefully he's right, but it was good to know that if it doesn't get better, or gets better & comes back, he's willing to order an MRI to be sure.

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  2. I am super glad to hear that you don't have a stress fracture. That is really good news! I hope that after a couple of weeks with some rest you will be able to start transitioning back into some easy running. What can you do in the meantime? Ride your bike? Aqua jog?

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    1. He said anything that doesn't hurt, which cardio-wise right now is probably limited to swimming. So I might have to search out a pool. Otherwise I'm just trying to keep up the core work so I'll still have it once I can run again.

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  3. Happy healing, Angela! Bummer about SF 2nd Half - but hopefully you'll be back in the saddle in no time.

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    1. Thanks! Hope I'll still catch you after the race! :D

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  4. As someone who had something which presented as a soft tissue injury but it ended up being a bone thing I have a slightly different perspective on this. My pain levels were never anywhere near what you describe so that worries me a little. I will say, you are absolutely right that the treatment for both is the same at this point so you aren't really wasting anything by waiting another three weeks to see what happens. Quite frankly, the whole stress fracture thing is just "don't do anything that hurts" which in a way means you never even really need to get it imaged if you play it smart. If I had followed that rule I probably would have been better 4 months ago. Be smart and take it easy and I really hope it works itself out soon. I saw what your friend on FB said about Bikram -- if it is soft tissue, it will probably do wonders for you. I had a really tight hip flexor muscle that caused pain for months. I saw a chiro 3x a week for 1.5 months with little improvement. I went to Bikram and within three session was 100% pain free. There is a fair bit of standing on one leg though (mainly with locked knees), so I am not sure if that is something you want to try just yet.

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    1. Thanks for all the helpful info!

      I'm definitely retaining some healthy skepticism about things. Since I definitely can't run on it now, I'm happy to go along with the "not a stress fracture" theory for now, but it was really good to know that he's open to doing an MRI if it doesn't get better, or if it seems to get better & then running causes the same kind of pain again.

      Clearly I really am going to have to look into this Bikram thing -- you're now the third person who's recommended it for the soft tissue stuff.

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  5. Gutted about 2nd half for you. The pain does sound crazily like when I broke my leg (although in a different place, obviously). Let's see what happens in a few weeks, hopefully it'll all be over by then. Maybe Roadbunner is right and you should try some Bikram even though the thought makes me feel ill on your behalf.

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    1. Lol...It could be interesting. But I'm willing to try it if it'll get me better faster!

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  6. Interesting. I've gradually learned that most doctor appointments don't seem to be as bad or as good as you think they are going to go - they usually are in the middle. Hopefully it is not a stress fracture and he is correct. His explanation about the muscle tightening up and causing even more pain actually kind of makes sense. So maybe he is accurate.

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