Tag: physical therapy

I’m just sittin’ here doin’ time

After a couple of weeks, even introverts get a bit stir crazy. I am out of new books. Each day I browse the bookshelves looking for something to re-read. It’s really the perfect time to revisit a tome from long ago like Richard Adams’s Shardik or John McPhee’s Coming into the Country.

Yesterday I got back on the bike but it wasn’t as warm as last week and my effort was halfhearted. A friend drove down from DC and he and my wife walked the 1 1/4 mile circuit at Fort Hunt Park maintaining proper distance as they went, while I rode laps. They did three. I did ten or eleven. It wasn’t at all crowded and people, with one annoying exception, were keeping their distance. The exception was a chatty woman in a group. She had zero situational awareness. We all did our best to give her a wide berth.

I am still doing a couple of sessions of stenosis physical therapy each day. I put on my headphones and play some meditative woo woo music so that I focus on what I am doing and take it slow. Each session lasts between ten and fourteen minutes depending on how closely I am paying attention. And I do 20 to 30 minutes of meditation while lying on the couch. Occasionally, this morphs into a nap. My mind doesn’t much mind.

I am also a fan of crossword puzzles. I do the Washington Post, The Atlantic, the New York Times mini, the New Yorker, and the New York magazine puzzles regularly. I only pay for the Post so access is limited. The Times also has something called the Spelling Bee that I find amusing.

I mowed the lawn for the first time the other day. The grass isn’t doing much these days but the weeds and wild onion grass were going gangbusters. I bagged the clippings which didn’t do my back much good.

I am also listening to music online. There’s so much good content. My fave are the daily “broadcasts” of Neil Finn and his sons Liam and Elroy live from their homes in Los Angeles. (For the uninitiated, Neil Finn’s most well known song is Don’t Dream It’s Over but he’s written scores or maybe even hundreds of others.) These mini-concerts happen every night at around 6 p.m. east coast time on Fangradio on an app called Mixlr. Unfortunately, this has become so popular that the connection gets overwhelmed. This leads to buffering and loss of connection sometimes. Luckily, the Finns archive the performances daily at the link above.

Mr. Fangradio

One thing I like most about these online versions of the songs is that they are stripped down if not quite unplugged. In many cases I prefer these to the recorded versions. Liam and Neil did an album last year that I really didn’t much like called Lightsleeper. When performed on Fangradio, however, the songs take on new life and I really enjoy them.

Not to beat a dead horse, a few years ago Neil recorded an album live online over the course of four weeks. It’s called Out of Silence and can be found on You Tube.

Another place for performances is NPR’s Tiny Desk concerts. Many radio stations, often NPR affiliated, have similar content. And there’s the You Tube time sink. You can blow entire days wandering around there.

Well, it’s time to hit the floor for more fun with back exercises. Stay safe, you all. Eat your vegetables. Go easy on the TP. Call your mama. Make good choices.

Darth Stenosis, an MRI Report, and a Clarification

Bad Genes

“My father has it. I have it. My sister has it.”

Yesterday I was talked with my sister who is 2 1/2 years younger than me. She said she’s having back pain. She does not read my blog. I asked her to describe it.

Pain in the outside of her lower left leg. Pain when walking that is reduced when she leans forward or leans against something like a grocery cart. Pain that kicks in after about 50 yards. She can’t trust her left leg; it feels like it’s going to give out.

Gregor Mendel, phone home.

MRI Report

My MRI report confirms that my spine is FUBAR. Most of the pathology doesn’t seem to be causing me pain. I have moderate disc bulging and thinning here and there. And there is some stenosis in various places in my mid to upper spine. Mostly this seems to be the cause of mild discomfort as well as numbness in my feet and hands from time to time. My lower back gets achy when I stand or walk for long periods but muscle spasms are rare.

Near my 4th and 5th lumbar vertebrae, however, the report said:

There is severe left foraminal stenosis with indentation of exiting left L4 nerve root. The right foramen is moderately to severely stenotic with indentation of exiting right L4 nerve root.

This is consistent with my recent left leg problems. My guess is that’s where the epidural will go.

The same MRI center had a record of my 2014 scan. The report noted that a disc extrusion (i.e., bulge) found back then no longer exists. This is one reason why back patients are told to give it time. Many of these abnormalities resolve on their own, as did my 2014 problem.

A Clarification

In yesterday’s post, I described a conversation with my friend Julie who is a Rolfer. I may have given the impression that she is reckless or aggressive in her methods. If I did, I apologize to her and want to clarify.

Recapping: a Thai massage therapist skipped past my thighs when I indicated that the therapist had hit a sensitive nerve. What Julie meant when she said she’d “dig right in” to nerve pain was that ignoring the problem as the massage therapist did is unhelpful. The objective of massage is to grant short term relief and reduce tension. Oversimplifying, the objective of Rolfing (and for that matter Feldenkrais) is to reduce pain and stress in the long term by improving how body parts interact. Rolfing focuses on connective tissue called fascia that wraps around muscles and nerves. The end result should be pain and stress reduction on an on-going basis.

For now, I am focused on getting the offending nerve to calm down. Once I get the pain under control, I can consider how to deal with the situation longer term. My guess is that I’ll be doing some combination of yoga, PT, massage, Feldenkrais, and Rolfing.

 

 

A Day of Frustration

Today was a day of promise and frustration.

Last night I set my alarm to get up for Friday Coffee Club. I woke up at 3 am went downstairs and noticed that it was 2 am. Somehow my alarm clock had been changed. Rather than wake up Mrs. Rootchopper, I just put it in my head to wake up on time. And I did.

I slept well. My back was very relaxed from the Feldenkrais class.

The ride to Friday Coffee Club was easy. I had taken yesterday off from riding and I had a tailwind. There was a sizable crowd at Swings. I met a Twitter follower and re-met someone who is currently living in New York City. The latter reads this blog and is considering a cross country tour this summer. To him I say: DO IT!

The group at my table traded medical war stories. One person had had back surgery that worked except for the fact that part of one foot is numb. Another person had a DVT and a pulmonary embolism. Still another told is of how his Achilles tendon ruptured when he dismounted his bike last summer. None of these three people is over 45 years old. We’d all be wolf dinner if we’d lived a few hundred years ago.

Today was apparently Wear-Strange-Things-on-Your-Helmet Day.

Standing at Swings was not agreeable to my left leg so I ended

up sitting for most of the get together. I rode home 15 miles without a problem. This stenosis thing is just bizarre. I can ride all day but can’t stand for ten minutes. For the next couple of hours, I had no leg pain.

Mrs. Rootchopper and I decided to run a few errands. First, we went to the bank to get a document notarized. Next we went to the phone store for new cases for our cell phones. Next up was the post office to mail our notarized document. Our final errand was to the Apple store at a mall to get a new battery for my phone. I walked maybe 100 yards to the store from the parking garage and stood around for a few minutes. My leg pain came back so strongly that I had to sit.

The battery was only charging to 65% of capacity. While Apple replaced it we went to the food court. By the time I got there, on a scale of 1 to 10, my leg pain was a 9.5 .

After an hour of sitting, we went to pick up the phone. Again I had to sit while the phone was brought out from the back of the store.

On the way home, the pain went away. I started charging the battery. I checked the software. The maximum capacity of the battery was 65%. Did they forget to replace it? I’ll see how the phone performs before going back to the store.

In the morning I made an appointment with the Feldenkrais instructor for an hour-long session next week. I am hoping that some good will come of it. I am not at all hopeful that Monday’s PT appointment will be worth the bother but I am going through with it.

After today’s pain party, I have decided to reschedule my orthopedist appointment to next week (from the week after).

No mas.

Marking time

Today was an up and down day. I rode to PT where I went over various yoga exercises. My therapist pointed out the ones that would aggravate my stenosis symptoms. She and the trainer gave me a new core exercise to do involving stretchy bands. Unfortunately, the exercise strained my shoulders which have compromised rotator cuffs and, since the exercise is done while standing, my stenosis pain came on while I was doing it.

So I used Feldenkrais techniques to gently get rid of the pain while lying down. It took more than five minutes before I could move on to my PT routine which now involves stretches and core exercises from a prone or supine position.

I got through it all without pain.

Afterwards I got on my CrossCheck and rode the Arlington Loop, a 16-mile circuit, including some roller coaster hills, around Arlington County. By the time I reached home I had ridden 36 miles. I could have gone farther but I’m trying to be careful.

I spent most of the rest of the day sitting or lying on the couch reading.

 

 

Happy camper on a bike

For the last six days I’ve been taking a declining dose of the steroid prednisone to calm the irritated nerves in my back and legs. Prednisone pills taste gross but they are very powerful. My pain became tolerable after a day. Although I didn’t notice, they improved my mood and, my wife and daughter report, even made me chatty. As I said, it’s powerful.

Until I took prednisone, I couldn’t tell where in my lower back my nerve problems were coming from. Now I can feel tension above my left butt cheek. Hello, you little bugger. I’m coming after you.

The best part of this pill party is that I am riding my bike like it was the summer of 2018. I have nearly zero discomfort, I am accelerating like a boss, and can cruise 20 percent faster with practically no effort. In five days, I’ve ridden 159 miles. Each day I stop long before I get tired. I could easily have ridden 50 miles today but decided to err on the side of caution and quit after 36. The Mule abides.

My leg ache comes and goes and the hot spot outside my left hip is still there, but otherwise my body is so much happier. I go up hills without a care. My back, arms, and shoulder feel relaxed as I pedal.

All of this makes me wonder if my hip and knee problems have been a side effect of stenosis, rather than in addition to stenosis. If I’ve been in low level pain for months, it’s no wonder my riding has suffered. Not the mileage, but the enjoyment. Riding across Kansas this year was work; riding across North Dakota and eastern Montana last year was play.

While I have the pain at bay, I have been blending yoga with my physical therapy. Up until now I had been doing PT in a very regimented fashion. This many repeats. Hold for this many seconds, etc. The idea was to build strength in particular muscles, mostly in support of my hip and knee.

Now I am letting my body dictate what to do. I am flowing from one position to the next, concentrating on keeping my motions fluid.  The regimented aspect has been one of the reasons I hate yoga classes. (And don’t get me started on yoga teachers who physically move you into the “proper” position. Must not kill!)

Instead I’ll hold a position for as many seconds as seems helpful then go right into another one without stopping. If a posture causes something to ache, I stop and move on to another posture.

A typical sequence might be (PT exercises in italics):

  • Step over a horizontal pole for 25 repetitions (A warm up that helps me getting on and off the bike.)
  • Stretch hamstrings
  • Stretch quads
  • Stretch iliotibial bands
  • Runner’s calf muscle stretches
  • Shoulder scrunches
  • Add standing yoga positions
    • Rishi’s posture
    • Chest expansions
    • Deep breathing
    • Toe touches
    • Side bends
    • Trunk rotations at the waist
    • Neck rotations
    • Squats
    • Dancers posture
  • Lay on the floor and do
    • Open book shoulder exercises 
    • Pull knees to chest, first one leg, then the other, then both
    • Ankle over knee and pull legs toward torso
    • Sway back and forth with bent knees at the hip
    • Hurdlers stretches
    • Groin stretches
    • Neck pushes
    • Toe touches
    • Back bridges
    • Side planks with torso on ground
    • Side planks with legs on ground
    • Bird dog
    • Cat/cow pose
    • Planks
    • Cobra pose
    • Locust pose
    • Twist torso while lunging
    • Lunges
    • Child’s pose
    • Shoulder stand
    • Plough
  • Sit ups (or crunches)
  • Set of super six exercises on a foam roller

That’s over 30 different exercises. And I left a few out. I have all of  them written down but I tend to do whatever seems to make sense in the moment. If I’m doing a pose while lying on my back, I might pop into a shoulder stand, for example. Then I’ll gradually fall into a plough (legs extended over head while on my back) and roll out of the plough and do a back bridge.

I’m trying my best to be gentle and not strain. Some of the positions are a little beyond my ability right now but I’ll get there.

Hopefully, I can get this routine established quickly. I have only three more days of prednisone pills, and then the effects will wear off.  And they can wear off rather suddenly if my prior experience with oral steroids is an indication. Taking them for long periods of time results in side effects like osteoporosis, cataracts, and growing a second head. (Okay, I made that last one up.)

Cheers.

 

 

 

 

Left leg saga continued

On Sunday, I rode the Hains Point 100, the final event ride of the year (for me anyway) in DC. The ride is 30 laps of a 3.3-mile circuit in East Potomac Park, down to Hains Point and back. It’s about as flat a course as you can find. Serious riders form fast-moving pelotons. We mere mortals ride a few laps, socialize, munch goodies, and hang out at the raffle. (I won a gift certificate to a taco place a mile from my physical therapist. The burrito gods are on my side.)

I had no intention of riding anything close to 100 miles. It was pretty cold, in the 30s for much of the time I would be riding. The Mule and I took it easy, rolling along, mostly at 12 miles per hour, but, occasionally cranking it up to 20. My legs were holding up just fine. Until about 28 miles into the ride, that is. The ache in my left leg, formerly only present when I was walking, appeared. I managed to ride another 9 1/2 miles with plenty of rest stops but I was really not a happy camper.

Fortunately, I made an appointment with my orthopedist on Monday. I felt fine when I woke up. Oh, great. What will I tell the doctor? I decided to do some stocking shopping before my appointment. I lasted 50 feet before my leg started aching again.

I limped a few blocks to and from a store and my left calf, groin, outer thigh, and butt cheek were having a contest to see which one could make me drop a salvo of F-bombs. (The calf won.)

At the doctor’s office, I explained my woes to the doctor. He nodded and smiled. When I told him about hurting after 50 feet of walking his eyebrows went up. Forttunately, this was obviously a no-brainer to him. 

He examined my legs and back. He was impressed. “Push. Pull. Resist. You’re strong,” he remarked. Funny, what 30,000 miles in three years can do.

Then he checked my back for flexibility. I acquitted myself well for an 85-year-old. I did however manage to touch the floor from a standing position without bending my legs. I took about 15 second for my back to relax though. “I’ll only be a minute.”

The diagnosis was stenosis.The passages through the vertebrae in my lower back are narrowing as I age. The nerves emanating from my lower spinal cord are being compressed. Lucky me, I’m old. The good news is that I haven’t incurred appreciable muscle weakness in my legs. (And you thought I was nuts to ride so much, didn’t you?)

The treatment plan is pretty simple. I am on a nine-day declining does of prednisone, a steroid that will almost certainly calm the nerves down. (I was on a seven-day course prior to my back surgery. It worked well. It wore off just as I was being wheeled into pre-op.)

The doctor gave instructions to my physical therapy team to change my PT regime. He agreed that the gentle yoga exercises I have been doing would be helpful.

When I arrived home, I looked up PT-for-stenosis videos. As it turns out, most of the exercises are already part of the yoga/PT routine I discontinued last year.

The plan is to follow this exercise regime for a few weeks, unless the pain doesn’t abate in which case we amputate.

Just kidding. If I don’t recover, we’ll discuss surgical remedies. Time will tell.

Ironically, my PT team has being trying to improve my posture, thinking this would help with my general mechanics, I suppose. Well, it turns out that stenosis patients find that a forward lean helps to attenuate symptoms. When I ran back in my 20s and 30s, I had a pronounced forward lean. When I sit, I naturally lean forward. Riding a bike puts my in a forward lean as well. 

So I asked the doctor, can I ride my bike.

Yes.

Considering the fact that two years ago I was in a hospital bed on anticoagulants and trying to breathe with one functioning lung, I’ll take this year’s medical conundrum any day.

Merry Christmas, y’all.

 

 

The saga continues….

Today I cancelled Monday’s PT appointment. Yesterday I did a two-hour recumbent ride in the basement. My wonky left leg felt fine throughout. When I walked away from the bike, the ache in my leg returned.

I did a very abbreviated PT session, took two Tylenols, and chilled.

Today, my leg felt fine for a few hours after waking. Then, as I was telling Mrs. Rootchopper that my leg felt pretty good, the ache returned.

I went for a 30-mile ride to test out the repairs done on Little Nellie. The shifting works fine in the front. I still get some chain misbehavior in the rear but that’s the norm for this bike. I wonder if there isn’t some kind of flex in the frame caused by the folding mechanism.

In any case, my leg felt absolutely fine for the entire ride. The left knee hurt a little going up hills or grinding big gears. There’s a small painful spot on the outside of my hip, as well. I don’t know if the leg could handle a mountain out west but for present purposes it’s okay. I stopped to shop at a store and within a few minutes my leg was aching again. I think weight bearing is triggering the pain.

When I got home, instead of PT, I did a short version of my old yoga routine. There are over 30 poses involved. I spent about a minute on each. By the end, my leg was very achy.

It has been suggested by several people (my physical therapist and my brother, a retired nurse, who has similar back problems) that this ache is referred pain from a pinched nerve in my lower spine. My lower back doesn’t hurt any more than usual. It’s always stiff thanks to the family genome. I’ve had sciatica in the past as well as a herniated disk. My current symptoms don’t follow the classic knife pain from butt to calf of sciatica, nor do they follow the aching thigh numbness of my slipped disc. Still, some sort of nerve compression in my lower back is a pretty good candidate for the cause.

So I looked up yoga videos for lower back pain. The three that I found all include positions in my routine. Most include extending the leg away from the body, either while doing a standing yoga position or a kneeling one. (Some of them involve reaching back and pulling the foot back toward the body.  Ain’t gonna happen.) The level of difficulty of these is easy to moderate, for me anyway. If I had full blown sciatica, they’d be impossible.

Another candidate for the pain in my calf is repercussions from my blood clot episode of two years ago. It turns out that some people who have had a blood clot called a deep vein thrombosis (DVT) in their leg have residual pain that can show up much later and last a life time. The pain is caused by the body reacting to the DVT by redirecting blood flow around the DVT. After the DVT is gone, the blood flow gets discombobulated and pain and swelling results. (When I had the DVT,  I had no pain or swelling. It was a sneaky little bastard.) Depending on how my visit to the orthopedist goes on Monday, I may make a follow up appointment with my hematologist.

Digression: one way to tell that you are old is by the number of medical specialists you see. My specialty list includes ophthalmology, neurology, hematology, pulmonology, endocrinology, orthopaedics, and physical therapy. If this goes on much longer, I’m going to need a psychiatrist. As long as my list does not involve a mortician, I’ll consider myself ahead of the game.

A third possibility is acute Christmas cookie intoxification. ACCI is a bitch. The only known cure is January.

I happen to have a vibrating massage gizmo that I acquired during one of my many episodes of back pain many years ago. It’s basically been useless until now but it turns out to be surprisingly effective in calming my calf muscle down. This device can target the muscle tightness much better than a foam roller, massage stick, or a lacrosse ball.

So for the next several days it’s biking, yoga, massage gizmo, Netflix, and pills.

Flossing amid the winter gloom

So the weatherman cooperated with my new regime. Yesterday I didn’t ride at all. Not riding makes my brain restless so I started the day with 20 minutes of meditation. I haven’t done sitting meditation in a long time, because long slow rides make it superfluous. (Most meditation teachers would disagree but I doubt they’ve ridden a bike across Kansas. Then again, I did run into a Tibetan monk in a cowboy hat walking down the road in Missouri this summer so what do I know.)

Cold drizzle made outdoor riding unappealing, so I rode Big Nellie in the basement for the first time since last winter. Two hours on a bike indoors may sound boring but I multitasked with a Bill Bryson book, Neither Here Nor There. It’s his account of travelling solo through Europe.

After that I did a PT session. After reviewing several YouTube videos on nerve flossing, I decided to stop beating my left leg up with the foam roller. I did four or five flossing sessions (they only take a minute). So far, I am seeing no noticeable change. If this doesn’t work, I’m going back to my yoga-based routine from 2017 – 2018. In many ways it is quite similar to the PT I’ve been doing but costs nothing. I tried some balance moves today. The Flying Wallendas will not be calling me anytime soon. I also did a shoulder stand that I cut short to avoid taking out the router on the table next to me.

After that I watched Room on Netflix. A gloomy movie for a gloomy day. Lots of really good acting though.

Tomorrow, I hope to pick Little Nellie up from the bike shop. Then I’ll go to the WABA Holiday Party. I’ll be the guy with the pronounced limp on the left and the beer on the right.

 

A change of plans

My recovery from knee and hip pain has hit a setback. For the last several days, I have been experiencing aching on the side of my leg from my hip to my mid calf. After 10 weeks of physical therapy I was hoping to see some progress by now but I am getting worse.

I was going to throw in the towel on physical therapy, but, after reading Brittany’s post today, I decided to change things up.

When I explained this new pain issue, my therapist examined me and concluded that I probably have a sciatic nerve impingement. I need to stop tightening the muscles around the nerve and free it up instead. So we decided to drop certain exercises that were intended to strengthen my outer left hip and left butt cheek. Instead I’ll be doing nerve flossing. This involves gently moving my left leg out and back from a sitting position. I’ve done this before for other nerve problems. I don’t recall if it worked but at least I won’t be making pain worse. Also, based on another video I found, using a lacrosse ball or a foam roller to knead the muscles in my left leg is probably not helping so I drop that for now.

Another thing my therapist wants me to do is back off my bike riding. Eek! We talked about taking a couple days off each week a few appointments ago. Now she wants me to ride every other day.

Today, the weatherman cooperated. It was gross outside. I went to the gym and did some upper body weight lifting for the first time in a while. When I got home my leg was still killing me so I went to bed, laid on my back, and did a body scan meditation. Of course, as is often the case, I fell asleep. I woke up without any pain.

Hey wait a minute.

Take the Rootchopper hibernation cure! Send me $500 and I’ll show you how in ten easy-to-follow steps. Sign up for my new hibernation retreat. Only $2,000 for a fabulous weekend in the mountains. Ear plugs and eye masks provided.

Zzzzz.

 

 

What a difference a week makes

About this time last week I was ready to throw in the towel on physical therapy. My knee and hip were regressing and I was getting frustrated.

Then I raise my saddle a couple of millimeters on Little Nellie. It seemed to help. Surprisingly the new position didn’t bother my back either.

When Little Nellie’s front shifting went to hell, I switched to the Cross Check. Again, I raised my saddle a couple of millimeters. The first ride didn’t cause me pain but I felt like I was getting no power transfer to the pedals. My physical therapist suggested I leave the seat up and see if my body adapts to it.

That night, Monday of this week, I went to a concert in DC. I stood on concrete for over four hours. If you have a messed up leg and a back back, standing on concrete for hours is not a great idea. My legs were incredibly tight for the last hour of the concert. And my lower back was aching.

It took about an hour to get home by car. When I got out of the car my left hip and knee were screaming at me. They felt like they did before the cortisone shot and the PT. I thought I had screwed the pooch.

I took two ibuprofen PMs (with a sedative) and went to sleep. About six hours later I woke up with my left knee screaming at me. In a few minutes the sedative put me back to sleep.

I slept until 9:30. It’s the latest I’ve slept in months. I woke up groggy only to learn that I had overslept my 7:30 doctor appointment. I’ve never missed a doctor appointment. (He fit me in anyway.)

Then I went for a bike ride on the Cross Check.

I was expecting to feel like a cripple. Instead, I rode like I had a tailwind. Other than some brief soreness on the outside of my left hip, my legs felt great. My back did too. I rode 32 miles and could have gone on for another 10 without any difficulty.

Today, I rode the Cross Check again. That little bit of soreness outside my left hip came and went within 10 minutes. I rode hard into a headwind without discomfort. My route took me from the Mount Vernon Trail along the Potomac River up the Custis Trail, a roller coaster of short, sometimes steep hills. No problem. I didn’t notice any discomfort beneath my left knee cap or near my left hip.

The ride home was a blast because I had a tailwind and it was gently downhill back to the river. I flew in a big gear. 35 1/2 miles with plenty of pop left in my legs.

I haven’t felt this strong on a bike since last year when I came home from riding to Portland.

So much for throwing in the towel.