It’s been nearly a year since I’ve updated this blog. Yes, I’ve been super busy, have traveled a lot, worked a lot and have continued my journey toward health and healing. I’ve thought about writing a post here and there but the bottom line is that I felt like I needed some time to get clarity on what I have to say. I don’t have any black/white stories for you, accounts of finding THE thing that took all my pain away. If you’ve read this blog at all you know that I have comorbidities, which is to say that my pain is coming from a variety of sources. But as it relates to my SI Joint, it’s time for an update. So here we go.
Next month will be two years since I had surgery to stabilize my right sacroiliac joint. I had the Rialto procedure with Dr. Beck on January 28, 2016. You can scroll back through all my posts here to get the blow by blow of the time leading up to and just after my surgery. But here’s the question most people are asking me:
“Are you glad you did it?”
Yes. Yes, I am glad I did it. I could go into long explanations here but here’s the bottom line: I believe that I am one of the small number of people who truly needed this surgery. I had torn pelvic ligaments that went undiagnosed for more than 30 years (again, you can click on the hyperlink or use the categories on the right of this page to access the posts where I explain how they got torn and how I finally learned they were torn.) Anyway, before surgery one of the greatest sources of my pain was my low back. I had major lumbar spasms and problems. And I’m happy to say that this surgery took away 90% of my lumbar back pain. Yes, I can still say that even after two years. This is huge.
I am still not pain free, which is really important to consider if you’re looking for a one-stop solution. In my opinion, there isn’t one. As I sit here typing this I am having major shoulder neck pain, and my body aches all over. I have autoimmune issues, which contribute to my ongoing chronic pain. But here’s probably the most important thing I have to say (and you’ll have to forgive the idioms and metaphors):
Rome wasn’t built in a day.
You can’t whip a U-turn with the Queen Mary.
This fairytale idea that one surgery is magically going to fix everything that ails us must go. Let me explain.
For 30+ years, my body adapted and changed and learned a host of really bad habits. It had to, to survive. Example: instead of using my right quad, glute, foot to engage the leg and propel myself forward, I was dragging it. It wasn’t powering my gait much at all. Why? Because before my surgery, this is how my body compensated so that I wouldn’t have excruciating pain in my low back when I walked. Somehow it said, “AVOID THIS PATTERN.” This wasn’t a decision I made consciously, as in, let-me-map-this-out-and-find-a-way-to-avoid-pain. It was completely unconscious. So naturally, when I gave my glute, quad, and foot permission to be lazy, other parts of my body had to take up the slack. Other muscles had to pitch in and do jobs they weren’t designed to do (helloooo adductors and hamstrings.) In addition to this, my upper body wasn’t moving much when I walked. This, too, was probably an unconscious coping strategy for the torn ligaments and resulting lumbar pain. I suppose my brain said, “It hurts when you twist. Don’t twist.” These are just two very brief examples of how my posture, gait and movement became completely scrambled due to living with this injury for three decades. One surgery isn’t going to reset all of that. It takes work. A LOT of hard work. And I’m still in the throes of it.
If you haven’t read it, I highly recommend the book, “Crooked,” by Cathryn Jakobson Ramin. Let me first say that I don’t agree with every single thing she says in this book. (For example, I have been helped by chiropractic. And I don’t think all doctors are driven by money – though some clearly are.) But the basic gist of her message is that for most of us, the answer is to address the functional movement and weakness problems. And I agree with that. I have been through the labyrinth of western medicine’s “solutions” to back pain, and I can echo her lamentation: for me, most of it has been a very difficult, frustrating, expensive, damaging, and dead-end endeavor. The way we approach back pain in the west is lacking at best and harmful/destructive at its worst. That said, I do think I was one of the few that really needed the surgery. But after doing three post-surgical stints of physical therapy (with three different therapists) I believe that my ongoing hip problems and a lot of my chronic muscle tightness all over my body stem from bad functional movement and weak muscles. In short, I think it may take years for me to sort all this out, and here’s the take-home: it will take a LOT of hard work. Most of us are holding out for a passive healing, and I think that’s a mistake. Now, that said, I do know that many of you are NOT in a state to hit the ground running with physical therapy and training. So please know that I’m not saying, “Just get off your ass and work.” Listen: I wasn’t in a place to do that before my surgery. Most rehabilitation efforts would’ve failed because MY major underlying problem remained unaddressed.
And here’s the really shitty thing about all this: each of us has his or her underlying problem(s). Some require surgery, some don’t. Some are chronic illnesses that we have to learn to live with and adapt to. But in the end I think we can all find something foundational that will help us to build and get better. It may take YEARS to discover what your “thing” is, but please don’t give up hope. You will find it.
As for me, the surgery was key. Now, the hard work of reprogramming my body is key. Aside from those major revelations, there are a few things I’ve learned this year that have helped me incrementally:
- I’ve learned that avoiding dairy protein and nuts helps cut down my systemic inflammation dramatically. (Again, these are MY sensitivities. Not meant to be a blanket warning against them for others.)
- I’ve learned that I have a few gene mutations that make me more likely to suffer from chronic pain (I did 23 and Me.) I am currently trying to learn more about how to reprogram my brain, which is ultimately where all the pain signals come from. I think this is a huge, unexplored area for most of us who live with chronic pain. And I think it has the potential to make a big difference in our daily lives. I’ve just barely started to scratch the surface on this.
- I’ve come to believe that my feet are a major problem in terms of the kinetic chain that dictates proper functional movement. I have horrible feet – ULTRA high arches and a triple-A heel, hammer toes, super high instep. I had an avulsion fracture in 2005 on my right ankle and never had any physical therapy or remedial intervention. I still have lots of scar tissue and my right foot is much more rigid than my left. I have almost no dorsiflexion on my right side. I’m currently working on this and think it is definitely a player in my overall rehab efforts.
I recently hired a personal trainer who is way knowledgeable about functional movement. Instead of having me on the ground doing planks and running and lifting dumbbells, he is helping me retrain my brain. You know how when you walk, your shoulders usually move from side to side and you swing your arms (even if it’s micro-movements?) Yeah, I had no idea how to do that. I couldn’t figure out which arm went forward when one foot went forward. I stood there while he was explaining it totally confused (for the record, when your right foot is forward, your right arm goes back. I was trying to bring that arm forward. That’s how scrambled up I’ve been.) He has me doing Mr. Miyagi movements, along with some very light strengthening exercises—think three-pound weights. Right now, bulking up my muscles isn’t the ticket for me. We are doing some taxing work on activating my glutes (and yes, it burns) but for the most part I am relearning how to move. How to stand. (It’s been foreign to me to plant my feet, rotate my legs from that stance and use the lower half of my body to plant my weight and stand from the bottom up. I’m telling you, this is toddler stuff.) It was my physical therapists and my trainer who observed my weaknesses and bad patterns. I believe they are the ones who have the most potential to help us once we’ve addressed any underlying problems that’ve gone undetected.
All that to say, I am still in pain, but not in my low back (okay maybe an ache here and there, but nothing like it was.) I am still chipping away at my physical issues but I have learned a helluva lot. Will I ever be pain free? Maybe. Maybe not. The key for me is to keep searching. Keep trying. Keep being willing to do the work. Don’t give up. Your trajectory will likely look a lot different than mine. But don’t get caught up in the notion that there’s a medical prince somewhere who will put you on his horse and ride with you into the sunset. He doesn’t exist. Your best bet for getting better is right in front of you. In the mirror. You. You can do this.
**I am currently pondering whether to keep this blog going for another year. I really wanted to archive it as a source of information for people who are where I was three years ago. But I wonder if it’s served its purpose. If you have thoughts on this, please speak up.**