First off, I loved the doctor. People had warned me previously that I would see a PA the first time or two at this place, but I saw the surgeon, with a med student in tow. (I would have been fine with a PA, for the record.) The doc was awesome. I loved him. He had a great bedside manner. I should take lessons from him. He asked me some questions and did some maneuvering, trying to elicit pain, most of which was unsuccessful. (I knew I should have run that morning or the day before so I'd be nice and inflamed when I got there, so there'd be something to examine). The only thing we were able to reproduce was my ham-ass pain, and that's been there so long that I don't even really care or notice it anymore. After that he sent me down the hall for some x-rays. We both knew that would be a waste of time (x-rays don't show much of anything, in terms of soft tissue injuries), but hey, what the hell. I got some cool pictures out of it:
The one in the top left is my favorite. Yeah, I have a favorite xray. I mean seriously, is that not the nicest knee you've ever seen?? :P My least favorite one is the bottom right, because, well, it's my pelvis for pete's sake. If you're good at reading xrays (which I hope you're not), you can see that I'm literally full of shit (lots of brownies the night before!) and maybe also a tampon. Anybody have any idea what the two horizontal lines are on my thighs? The ones kind of underlining the word "weightbearing"? I have no idea. (Update: Jeff seems to think the lines are "butt cheeks". I'm not convinced.)
After that, I talked to the doc. He said the xray looked fine, as he expected it would, and that if I had time, he would like to look at an ultrasound too. I didn't have anything planned (other than sleep!) so of course I stayed for some ultrasounds. This is where it got a little weird.
I had to strip from the waist down, except for my socks. No underwear, no nothing. For an ultrasound! It was because they were looking at my ham-ass in addition to my knee, but still. Geez. So in a few minutes I'm laying on a table on my stomach with a sheet covering one leg (gee thanks), covered in a lube, with a lady rubbing me down with an ultrasound probe that looks not unlike some kind of sex toy. Kinky.
|Okay, I'm exaggerating. While this picture is in fact of an ultrasound probe, mine wasn't quite this bad.|
|It was probably more like this.|
Good thing I don't have a thigh gap. They might have seen my tampon string. Though they probably saw it on the pelvic xray anyway. TMI? You're welcome. While we're doing TMI shares, remember the brownies? Yeah, so I was a little gassy too. Wouldn't that have been extra awesome if I had farted during this already awkward moment? Thank god that didn't happen. Small wins.
Also the tech kept saying "isn't she fun to scan?" to each doc that took me for a spin. She said I had "great anatomy". I wish she meant that I had a nice ass, but alas, she clarified that she meant that everything was well delineated, easily visible, and in the right spot.
Random aside: have any of you ever seen "Miranda"? It's a british sitcom, it was on PBS a few times. I love it. I love Miranda Hart. (She also plays "Chummy" on "Call The Midwife" on PBS). Me laying on the table with my ass in the air trying not to fart on 4 hot doctors totally reminded me of any one of Miranda's many "awesome" moments. Here's an example:
Anyway, the ultrasound didn't show too much. Mild thickening of my IT band on both sides, slightly worse on the right, but nothing to write home about. Could be considered within normal limits. Thickening of the hamstring tendon on the right, but that didn't elicit pain to palpation where it connected. Their best guess about the ham-ass pain was that my sciatic nerve had become "tethered" to the hamstring tendon, and that the nerve moving around when I contracted my hamstring is what was causing the pain. I guess they saw the nerve moving a ton on the ultrasound when they asked me to bend my leg. He said it was just theoretical though, there's nothing official to say that that even happens. He had one other patient before with the same symptoms and similar imaging results, and that was his theory with him or her after some digging too. Whatevs. He thought maybe PT with a focus on deep ham-ass massage might free the nerve and alleviate the pain, so I got a referral for that. Hopefully I can keep my pants on for that. :P
The knee really didn't have any information at all, except that my pain seemed to be more medial than would be expected with ITBS, such that it could be the lateral edge of Hoffa's fat pad, although the pain was more lateral than would typically be experienced with Hoffa's syndrome aka fat pad impingement. He said a steroid injection into the fat pad is really simple to do, and offered to do that. I said sure. I asked if he could just 'roid me up all over the whole knee, like an acupuncturist with cortisone-tipped needles, but he declined. Apparently it all has to be very "scientific" and anatomically specific. Silly doctors. I was encouraged by the fact that the pain when he injected my knee felt very similar to the pain I have while running. It didn't hurt when he put the needle in, but when he pushed the plunger and the fluid went into my knee, it felt a lot like it does a couple miles into a run. That means it's the right spot, right?
I figure I'll just cover all my bases. I got the fat pad covered with the steroid injection, and I'm back on the horse with the IT band specific rehab program. I'm following this one:
The main focus is on hip abductor strength and endurance, secondary focus on stretching, and optional foam rolling:
"Hip abductor strength is by far the most scientifically supported treatment for ITBS, but most doctors, trainers, and physical therapists will recommend stretching, rolling/manipulation, or both in addition (and unfortunately, sometimes instead of) hip abductor strength training. The evidence for these treatments is much more limited and their utility is much-debated among the research community."
Here's another similar link, with better images of the exercises I'm doing:
The above link does recommend rolling your quads, hamstrings, glutes, and upper hip area 1-2x per day, so I guess I'll start that too.
"Using a foam roller to loosen up soft tissue around the IT band is a great idea, but actually rolling over the painful area should be avoided. Remember, IT band pain stems from irritating the highly sensitive area between the bony knob on the femur and the IT band, so you don’t want to further aggravate this spot!"So, my hips are completely sore right now. I'm up to 3 sets of 18 reps of all the exercises, and man do they burn. Here's what I'm doing:
- Side lying abduction
- Isometric wall presses (The inside leg is pushed into the wall for a 5-second hold. These look easy, but they are the hardest of all the exercises, after a few reps!)
- Hip hikes
- Glute bridges (the up position is held for 5 seconds each rep).
Plus the classic "teapot" ITB stretch, and the strap stretch, which I prefer. I'm doing these every day, plus 10-15 minutes of unrelated strengthening from my "Strong Stride" workout DVD which I'm rotating through.
At this point I rarely have pain walking or with normal activities or at work, except for some rare twinges, so that's great. I haven't tried to run since that one time June 2nd, which was 30 minutes of 4.5 min walks alternating with 30 sec runs, and was painful. I'm not going to try until after I get back from vacation. My goal at the Alaska half marathon is to not run a single step of it.
When I come back, I'm going to come back so freaking strong from all these strength exercises and swimming and stuff. Watch out PRs, ya'll are going DOWN. In a few months. Like, maybe in November. Or March 2014.
I'll end with some random self-photos I took this week. I have no idea why. Probably because my hair looks so funny sometimes that I can't help it.
|Extra awesome bed head one day this week. I'm not that skinny in real life. It's some kind of optical illusion.|
|Interview attire. Those are size 8 pants and jacket people! Of course, I couldn't really breathe. And they probably just ran big. But still.|