(no subject)

[tylik]

So I've been slowly doing better. Saw my osteopath again on Tuesday. Went into the lab yesterday. After a bit under two hours in the lab I was in pretty bad shape. (Meanwhile, my PI is asking helpful questions like "isn't there some way of paralyzing these muscles?"* and "so have you looked into getting a set up so you can use your computer while lying down?"**

So I went home and lay down for a bit. And then I unhappily peeled myself up and went to my PT appointment, by bus and train after a lot of "bus and train is more environmentally friendly" "but bus and train takes longer and is less comfortable" "but if it gets bad I probably shouldn't be driving anyway..." On the way I thought a lot about what the heck could be going on with my back, and why I hadn't had anything quite like this happen before... or whether I just had better physical therapists in Seattle. (Not that it didn't take me some time to find them.) And I thought a lot about scapular support, and core and spine stability, and how I could knit these ideas together... because darn it, when I got my spine to stabilize the first time it wasn't from doing a bunch of sets of low weight exercises, it was from teaching my muscles of spinal support to activate differently, and then making a point of reminding myself to do it several hundred times a day***.

I was really generally not a happy camper. After all, last week I had a PT appointment on Wednesday, and ended up being sent first to PM&R and then the ER. (And while I am firmly convinced that I didn't belong in the ER... well, darn it, I was beyond coming up with better answers. That really sucked.) So here I was, feeling like crap, and heading back to another PT appointment. Yeah, I think I'll think about core stability exercises and whether careful triggering of the subscapulars can calm some of the grief in my upper thoracic...

So I get there, about ten minutes early... only to find out that my physical therapist - who has meanwhile been talking about my poor disintegrating back with my physiatrist and the senior PT I was supposed to be seeing but who had to go out of town - had put me down as coming an hour earlier in her schedule. (After some discussion we confirmed this as her mistake, but not much help there.) And anyway, she doesn't want to touch my neck, and really she just want to hand me off to the senior PT. I am left stunned "You mean I just spent an hour getting up here when I'd rather be in bed and now I need to turn around and go back?" We talked a bit about options - traction has worked well for me in the past, could we try that? But basically she's afraid to touch me. And thinks maybe I should take a break from martial arts. And so I lock myself in the bathroom briefly to cry (I was really, really in a lot of pain) and then go home.

This, by the way, encapsulates a lot of why I tend to get twitchy around new health care professionals. I don't really like asking for help - a bunch of things with the whole provider - patient relationship kind of mess with my sense of autonomy, and I tend to get more twitchy about that when I'm not feeling well. I am also weary unto death of trying to explain my long and weird medical history to new people. Not to mention the martial arts. (Look - I have seen scores of medical professionals about my spine problems, only a small number of which have helped me at all. The martial arts on the other hand have pretty much always helped with the pain and I think have saved my life at least in terms of the parts that make it worth living. This is a hell of an improvement over never being able to live an active life again. I am willing to discuss changes... but I want people to at least understand what I do and what it involves first.) We're talking thirteen years of history just of the spine injury stuff. Meanwhile, I'm a pretty highly non-standard patient.

These things aren't the faults of the health care providers. Okay, some are gits, but most aren't. But it does mean that it takes a long time to establish useful working relationships... and a lot of people really don't know what to do with me. I mean, it's kind of nice that my orthopedist's response, when had an appointment to check on my ankle, was to have me do tricks for the three residents she had in tow. (Why yes, on my recently sprained ankle I have better balance than most uninjured people have. Martial arts, FTW!) It's a little problematic when my PT can't actually do a lot of the core stability exercises she'd like me to do - not really a problem, they all have different levels, and not everyone is expected to be able to work at the most difficult levels. It's more problematic when she touches my neck and goes "OMG, you're so hypermobile I don't think anything is holding your spine together!" and completely freaks****.

I tend to forget the both Kendall and Alexa, who had both worked with me for quite a while, were unusually flexible and able to deal with some of my oddities. For instance, I'm really good at muscle isolations. I'm sure the martial arts doesn't hurt, but it happens I practiced muscle isolations since I was a wee young thing - it seemed like a good idea at the time. I don't pretend to explain me as a kid. I also had a regular meditative practice by the time I was five or six. Anyhow, Alexa and Kendall were used to saying, "okay, I want you to activate just your mid traps" and I could either just do it, or they'd give me some feedback "no, you're turning on the lower ones too, just the mid ones" and everything would be set. And if we talked through what needed to happen, and general postural changes, and I understood it well, by the next week the pattern would be re-set.

And then there's the third thing that I run into dealing with health care providers. Often then can't help, or worse, aren't available when they said they'd be or are otherwise difficult to deal with. Again, these things happen. But... ugh. If I must break from time to time, I want to be able to fix me. I can kind of deal with consulting with others. I don't really like to have to rely on someone else to fix me. (I'm expanding the number of things I can deal with myself all the time, but there are still a lot of exceptions. Including the days I'm exhausted and all I can say is "I hurt. Here. Don't know why. Fix it?" But it's more annoying when I know exactly what the problem is, could fix it myself on someone else, know it would take five minutes... and know I'll have to wait several days.

Anyhow, while I was pretty depressed about the day and about how much pain I was in, I also thought a lot about how to integrate some of the scapular support into some of the spinal support work I'd done on the way home. (Well, and played with the activation of some of the muscle groups, and how I might work on a better general pattern of support. I'd played with this idea earlier, but hadn't quite gotten all the pieces together.) And weirdly, by the time I got home I was feeling a little bit better - a lot of the irritation in the upper thoracic calmed down. So I worked on it some more. And lo, some of the upper cervicals released. I still felt like I'd been beaten, but oh, so much better.

Worked with it some more (the trick is building up a really good pattern, so you can remind yourself to activated the whole darn thing in a fraction of a second) went to bed. Woke up without a blinding headache. Stretched. Sparred (had to stop 28 minutes into half an hour - I can live with that). Trained. Best training in a long time. The springy center thing came together. Great happiness. (Still hurt a lot, but that will pass.)

Better, I have a theory. Last summer and fall, when I was feeling so good, I noticed I was getting more and more movement in my thoracic spine. And it was great. (I was pretty sure I was working through some of the accumulated scar tissue in the muscles around my spine. There was kind of a lot of it.) There were probably overwork and postural things involved when things started to go awry... but I'm thinking that I could have continued to work the thoracic spine loose. (Which would make sense with some of the exercises I was doing.) The PT I've been seeing out here mentioned that my lower thoracic spine was way too straight. We talked about this, and it seemed to be coming from over-activation of the multifidi. (She didn't know that they could be trained to activate at that level. I, on the other hand, had never thought about over activation there...) She mentioned that I really needed to work on the scapular support - which has been brought up before, though not so much in the context of spine support. Anyhow, I'm thinking that increased mobility in my thoracic spine pushed things to the point where the lack of scapular support was critical. I compensated for this in the lower thoracic by over-activation of the multifidi, but the upper thoracic kind of went to hell. Which it tends to - seems to have a lot of the worse of the ligament damage there. (And in the SI joint, but that's easier to deal with.)

Meanwhile, I'm realizing how much I just expect hypermobility of my scapula... *sniff* In most other mammals scapula move freely (seriously - the scapula can rotate full forwards towards a target). Doan wanna lock them down. (Well, yes I do. But I regret the necessity.)

So, mostly really good news. Though... why does it have to suck so much before I figure these things out?

And the theory might be crap. But I'm kind of thinking I have it mostly right.


* Yes, botox is used therapeutically. However there are problems with its use, the muscles that are most iritated are kind of important and need to work, and if the irritation is not simply mechanical, this would just mean that while they were acquiring heavy layers of fascia I would not be able to work them and to keep them moving, flexible, and not all gummed up and stuck together by layers of fascia.

** And I have. To use it for extended periods of time I need to find a monitor stand that will hold my monitor horizontally above my head. The rest is trivial. (I have a set up now that I can use for shorter stretches.)

*** I'm not joking. I was supposed to be aiming for six hundred times a day. I didn't actually count, but I'm guessing I was in the ballpark. This from the first PT I ever really trusted.

**** It's always a fun question with my spine - how much is my natural tendency towards hypermobility, how much is the injuries? Do I have a connective tissue disorder? When I was a kid they thought I might have muscular dystrophy... (Clearly not!) But the hypermobility does run in the family.