I owe you an update! This Thursday, May 26th, I will be four months (17 weeks) post op. And many of you are wondering how my recovery is going. Am I glad that I had the surgery? Am I pain free? Am I at least in less pain than I was before?
In short: yes, no and yes.
As you might know, last week I started posting a series of interviews with my physical therapist, Katrina. (Parts two and three are coming soon. I promise.) But I also unexpectedly got to interview the owner of my PT clinic, Jody Hendryx, a seasoned therapist who now practices mostly in Sedona, Arizona. I will be posting my interview with her here as well, but today I want to touch on one thing she said that caused a pretty big shift in my understanding of my recovery.
At one point in our conversation Jody stood up and said, “This is what happens when you have an injury or a chronic physical challenge.” All of a sudden she jutted her right hip a little bit up and back. It was a very subtle shift, but I could definitely tell a difference in the way she was standing. And she looked a little stiff, maybe like someone who had a mild crick in her neck after a bad night’s sleep. She was still smiling and to most people she would’ve looked the same. But what she had done was shift the position of her body to alleviate discomfort.
“When I am unconsciously changing my posture so that I can function with a minimal amount of pain,” she said, “over time it becomes my new normal.”
In other words (and this is my hypothesis, not necessarily hers) my brain learns how to maintain equilibrium from that position, and it then becomes my default setting. My central nervous system may be saying to my body: “Don’t bend or reach from here. Use these muscles to do the job of those over there that are hurting. Avoid pain at all costs.” And all of this “self-talk” flies under the radar of my conscious movement.
So fast forward to a series of other events that have happened in my life (over time): I fractured my ankle by rolling it. I had a Morton’s neuroma removed due to excruciating foot pain. I was rear-ended by another driver (FOUR TIMES!) I went through a series of incredibly difficult circumstances that tripped my fight or flight response over and over and over again. I was beset by joint pain due to autoimmune issues. I could go on and on, but here’s my point: each and every one of these things required some sort of physical adaptation on my part so that I could keep functioning. If I could clip a microphone on the lapel of my subconscious, I imagine it would sound something like this:
“Ooof, pain! Shift your right hip up and back a few degrees. Wait! Adjust your knee to avoid foot pain. Wait! Don’t bend your ankle quite so much. Wait! Rotate your shoulders to avoid neck pain.”
My amazing body is subconsciously making huge modifications to try and accomplish two things:
- Avoid pain
- Keep me moving
What a heroic thing to do! I am grateful that my body automatically seeks new ways to maneuver around the pain. But there’s a downside to that. Can you see how I might eventually be a structural mess simply because there’s compensation over compensation over compensation going on? At some point it seems almost impossible to unravel.
But here’s the good news: I have come to believe that it is possible. In short, you can teach an old dog new tricks. Or said another way, our bodies will be adaptive until the day we die. We are adaptive beings. So we can always adapt again to a more functional and sound structure. And here’s more good news: I have come to believe that we don’t have to figure everything out in advance, as in, put our injuries and compensations in sequential order, and then un-do them in a systematic way. In the words of Theodore Roosevelt:
Do what you can, with what you have, where you are.
Here’s my perspective on my own situation.
I believe that my SI joint fusion gave me a foundation upon which I could finally build again. A stable pelvis is absolutely crucial to sound posture and good body mechanics. I could’ve done all kinds of physical therapy, chiropractic, acupuncture, massage and strength training, and they might’ve helped some. (Oh wait. I did do all of those things, and some of them did help.) But they never resulted in lasting functional change, because my body had no choice but to keep compensating for the ligaments that were damaged beyond repair. If the right side of my pelvis was unfastened, so to speak, everything else had to take up the slack. All of the soft tissue that was still functional had to adapt, and making it work overtime put a strain on my entire frame.
Now, not everyone has a major underlying structural problem, but many of us do. And trying to unravel our compensatory patterns without fixing the major underlying problem is ultimately futile, in my humble opinion.
And here’s the flip side of that: expecting untold years of compensatory patterns to vanish instantly after surgery is not only wildly unrealistic, it’s a HUGE setup for disappointment. You cannot take what goes on in the autonomic nervous system out of the recovery equation. In other words, there’s a very real part of us that is flying on autopilot. Recovery, for me, is about changing those coordinates and easing myself onto a different course. And that takes t-i-m-e.
Here’s how that has looked for me:
- I started going to physical therapy, where I am learning more about myofascial release. My amazing therapists are working on the actual tissue and teaching me how to do the same for myself. (All physical therapy does not have the same approach. Here’s a post that explains some of the differences that I have found.)
- I started researching fascia myself (here’s a blog post I wrote about it) which has given me a much broader understanding of what’s at stake in my own healing process.
- That research has led me to other resources that are rounding out the picture for me (imagine little light bulbs popping on.) One such resource is a podcast by Brooke Thomas, entitled, “Liberated Body.” I listen to these while walking, and though I’m not taking every single word, opinion or concept I hear as the truth, forever and ever amen, I have found some phenomenal information in most episodes. Most recently I listened to a segment where Thomas is interviewing Dr. Eyal Lederman, in an episode entitled “The End of The Structural Model” (which I highly recommend by the way.) In one particular discussion, Lederman said,
Here’s how it works. If you brush against somebody, something will change in their body. There’s no argument about that. So if you stroke somebody’s skin or you massage it, you will get a change. And no matter even how hard you press, you will always have some kind of a change. The question is, what is the magnitude of change, first of all, (i.e. is it going to be some amazing change that’s completely going to change everything), and — this is very, very important — how long is the change going to be there before homeostasis resets it to its original default level?”
This underscores the point I made earlier about how recovery, for me, is about establishing a new default. Now that I have a level pelvis, I’ve got the foundation that will hopefully enable me to effect some lasting change.
I’ll close by letting you in on an interesting way this has been playing out in my own life. Though I had tremendous pain in my butt (direct SI joint pain) my biggest complaint pre-surgery was low back pain. I believe that my floppy SI joint (right side) was torqueing my low back and as such I was always susceptible to low back spasms if I moved one inch in the wrong direction. As such, for many years I have walked and stood with a forward tilt (probably a result of extremely tight psoas and iliacus muscles that have been trying to stabilize my pelvis.) Walking with a forward tilt changes your center of gravity. A person with a normally functioning skeleton will in all likelihood be propelled forward (i.e. walking) with significant power coming from the pelvis and legs. Since my pelvis was dizzy, moving from that place was instantly painful for me. So my whole posture and gait changed to protect that.
When I was out walking the other day, I started trying to match my strides on both sides (I had always taken a shorter step on my right side to minimize pain.) I also started trying to lead more with my hips to see how it would play out. And here’s what happened: I was able to take equal strides on both sides without pain. And though it felt to me like I was walking in an exaggerated way (with my hips jutted way out in front of me) to anyone else I looked normal. It just felt abnormal to me because I’d been doing it the other way for so long. As I kept walking in my new posture and gait, my hips started swaying from side to side, and there was no low back or SI pain—thanks to my surgery! I felt the power of moving from my lower posterior chain, and it was a wonderfully strange feeling. I thought, ” So this is what it feels like when unencumbered people walk!” I slowed down and started really thinking about heel to toe walking, and about engaging my calves and hamstrings. In many ways I felt like an overgrown toddler, learning how to walk for the first time. For more than half of my life I’ve been moving from an alternate center of gravity, and it felt oh so good to be drawing the power from my pelvis again. I simply had to override the autopilot, which took some concerted mental effort.
To my post-surgery friends: welcome to overgrown toddler-land. It’s going to take some time for you to find a new default and adapt back to your optimal physiological stance. We’ve got to resist the temptation to keep taking our temperature every five seconds (Did the surgery work? What does that little pain mean? Am I reverting back to the hell I was living in before?) I have written myself a prescription for a chill-pill and I will write one for you too. Medicine instructions: take as needed for anxiety and fear.
To my friends who haven’t had surgery, or had a less than desirable outcome: you are a member of an adaptive species. Your body is going to try and fix itself until you take your last breath. There is hope; just keep searching.