Physical Therapy Day 1

Today marks a new kind of experience for me: physical therapy. I have increasingly become more comfortable with medical evaluations. This is something I have worked up to slowly, because certain phrases ("I'll refer you to a cardiologist," or "Unless you want to consider physical therapy") just signaled something far more serious than what I was experiencing. Cardiology is for people with heart problems, not people who can't find the right blood pressure med. And physical therapy is for people who have been injured. And maybe this is still getting used to the world of good health insurance, which I have, courtesy of my employer, who also mandates an annual "wellness visit" calculated to make me a hypochondriac. I'm learning to get over that, as well.

The Problem

The problem is joint pain. I can trace it back to at least 2017, maybe further back than that. I have gone to the doctor repeatedly for back pain, rib pain, hip pain, pain behind my knee, ankle pain... But the hip and the back pain are the most consistent over the years, and the hip pain in particular is the most limiting. I have learned some things over the course of Googling, since anything that's unexplained and non-life-threatening remains a medical mystery until you're referred to a specialist (i.e. - until it's that bad). One thing is that outer hip pain and inner hip pain are different. Inner hip pain is about joints. Outer hip pain is about ligaments. This is important, because outer hip pain can't be osteoarthritis. 

Another thing is that most adults can't bend over and put their palms flat on the floor. Huh. If you can, then something in your back/hip area is hyper-mobile, and when you stretch to the point that it's a little bit painful because it feels good, that's not good. Here is the web site that gave me a breakthrough or two; there's a lot of postpartum/pelvic floor/etc. information, and it's focused on women-specific anatomical issues (a great thing!), so a lot of it isn't what I was looking for, but there's a free course about hips. While I didn't really do the program, the pre-course 'evaluate your flexibility' segment gave me an 'aha!' moment, and I immediately tried to STOP over-extending when I exercise. This has helped some. 

Not long before I discovered this, I sent a message to my doctor in despair--everything hurts, all the time. I had had several days of just being sore, and not muscle soreness, even though it was from exercise. I had been trying since June to be more active, and participating in a 'Hinge Health' program to help my hip pain for several months before that. But in June, I proposed to my husband that we start getting up at 6:30 a.m. and taking walks. The primary objective was to get his A1C in a range that was acceptable to his doctor and avoid medication.

We started with the neighborhood, but the pavement is very uneven. We moved to a nearby 1/3 mile track to even things out. Still, the first two times I walked that mile, I was imagining myself with a walker. That is how bad the pain was. I already had good shoes, but some internet searching told me that more arch support would help. Not wanting to replace a pricey pair of tennies, I opted instead for fancy shmancy insoles from our local  upscale/earthy/orthopedic shoe store (you know the type). They helped immensely! After the walks, I would do my hip exercises from the app/program, but more and more, this seemed not to be a good idea. As the day wore on, I was just... sore. Hence the email to the doctor.

While I was waiting for the physical therapy appointment, I tried a couple of other things. I dialed back all other exercise, consciously trying not to extend my joints to their limits. I also bought a compression band to wear around my hips when we walk. And after our walks, when we're heading the few blocks home in the car, the seat warmers are wonderful. These things seemed to help. But as short-term solutions. (Actually, I need to ask the physical therapist if the band is still okay. The seat warmer is fine.)

The Appointment

The appointment went very well. Doctor visits often frustrate me because I want explanations. And instead I get something like, "Well, if that hurts, don't do that." (Exaggerating--mostly it's "maybe these exercises will help what we kind of think you might be talking about?" Which isn't better, really.) But the physical therapist actually knows what can cause pain. In my case, it looks like certain muscles are weak, and other muscles are doing more than their fair share of the work of movement, which is putting strain on ligaments. Also, I do seem to be hyper-mobile in some areas in my back. So I have been on the right track. The beauty is that she can pinpoint areas that need strengthening and tell me what exercises to do to strengthen those areas.

After chatting with me for a while, she evaluated my flexibility, having me bend forward and back, asking me where there might be pain. (Another issue I often have with normal doctor appointments is that by the time I get to the doctor, the specific pain is not there. This wasn't a problem at the PT appointment. They can evaluate without the pain being present.) I did some heel lifts, standing, raising up on my toes, one leg at a time. Then, she evaluated strength--having me trying to hold a position when she pressed down: knees lifted, leg extended, then a "clamshell" position, then "reverse" clamshell. The reverse clamshell turned into one of my first exercises. She evaluated my hip flexibility--which, she confirmed, is not a problem for me.

After the Visit

I came home and changed. (I wasn't sure what to wear, so I wore capri jeans and brought knit shorts--good call on the shorts!) Then... I stayed. I can work from home, so I did. Because I am sore. Not terribly so. But wait--I took Advil! So... yeah. Still, not terribly so. Heaviness in my joints. Tiredness. Better to be home where heat can be applied if needed. But hopeful.

A Theory

I have a sneaky suspicion that hormones might be compounding my hip (and rib) issues. I know that when I was (very briefly) pregnant last January, my hips were immediately affected. Lying on my side was already painful, and I dreaded the thought of 9 months of that. When the pregnancy ended and the hormones leveled out, that level of pain went away. I haven't mapped my hip pain to my menstrual cycle, but I wonder if there might be some correlation. I did read that joint pain was a little-discussed symptom of perimenopause, and while I'm missing some of the most obvious markers, there are some other suspicious symptoms that might be explained by hormones. Without hot flashes, though, no one listens. (To be fair, I used to wake up very uncomfortably warm in the middle of the night, but since taking Vitamin E for breast pain, that seems to have stopped...)

But anyway, that's where I am for today. In a good place, I think.

Cheers!

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