Health Matters: One patient's adventures with sciatica; Part One
It's astonishing really — how previously reliable parts of your body begin to malfunction after the age of 50. While in your head you still see yourself as a vibrant and resilient 20 year old, in reality a life of bad posture, too many hot fudge sundaes, inconsistent exercise and other bad habits can suddenly rise up and bite you in the ... how can I say this politely? ... posterior region.
A recent diagnosis of sciatica has landed me in the Brattleboro Memorial Hospital Rehab Services Department in hopes of mitigating the shooting pains I've been experiencing through my buttocks and down my right leg. I've been ignoring it, overmedicating myself with too much Advil, and generally being in complete denial about the whole situation, because I have a fantasy that it will just go away, coupled with a nagging fear that any remedy will involve going under the knife — a prospect that has me less than thrilled. My primary care physician suggested an initial course of physical therapy, and I appreciate that she's taking a conservative approach, rather than immediately recommending steroid injections or spinal surgery.
When I arrive at the Rehab Department I am struck by the natural light flooding in the large windows, the gleaming hardware of weight machines and parallel bars, the rows of tidily organized balance balls and hand weights. Every other PT gym I have ever been in has been a dark, cramped, and gloomy space, usually tucked into a windowless basement corner, so this is a pleasant surprise! My therapist, Kim (who, I learn through a bit of website stalking), not only has a B.S. in Human Movement and Exercise Science, but a Doctorate in Physical Therapy as well. I am impressed!
My sessions happen in a private exam room, which is a relief, as I don't really relish the thought an entire room of other patients watching me moan and groan my way through a series of relatively simple exercises. Kim leads me through a series of movements to assess my strength and range of motion, and as we go through them it quickly becomes apparent that my ability to perform simple tasks has become almost comically limited — tie my shoes? Surely you are joking!
Using a model of the human spine, Kim demonstrates what she suspects is causing my pain and how we can work on fixing it. She tells me that my symptoms are consistent with a bulging disc between two of the vertebrae in my lower back, which when compressed by forward movement, pinches the sciatic nerve that runs across the buttocks and down the back of the leg, resulting in, quite literally, a pain in the butt. Seeing the model and how the discs and nerves interact with movement makes it quite clear to me that all of the stretching I had doing previously — thinking that I was easing muscle tightness — has actually been aggravating the nerve further. So now I know what NOT to do! Kim sets me up with a series of simple exercises to do at home, shows me how to use things like rolled up towels and small pillows to achieve better positioning for my spine, and we schedule a series of appointments to cover the next few weeks.
Kim has been trained in the McKenzie Method, a therapy developed in New Zealand that focuses on extension of the spine to "centralize" the patient's pain by moving it away from the extremities to the back. Back pain is usually better tolerated than leg pain or arm pain, and the theory of the approach is that centralizing the pain allows the source of the pain to be treated rather than the symptoms.
A few days after my first appointment, I return and confess to Kim that while I had experienced some relief following that session, the next day I was in the worst pain ever, and had been cursing her very existence. Of course I know it's not her fault, but she's an easy target! She takes it with a sense of humor and explains that disc problems tend not to have a steady and even healing trajectory — I believe "variable" was the term she used. It can appear that things are improving, when suddenly, with no apparent triggering event; you can find yourself experiencing symptoms you thought you had overcome. Knowing that this is a typical part of the healing process is actually quite reassuring.
As my sessions continue, Kim sets me up with increasingly intense exercises, focused on extending my spine, and strengthening my core muscles. Since most of them involve lying on the floor, and I work in an office setting where I frequently wear dresses and heels, she helps me figure out modifications that I can do either standing or sitting at my desk. She gives me very clear written instructions, with illustrations, so in case my memory needs refreshing (see my previous comments about life after age 50!), I've got back-up.
A few weeks in to this routine, I can report the following: While you might think of physical therapy as one of the more "low-level" or "less-aggressive" interventions, it is extremely hard work! I sweat. A lot; I have a new appreciation of the term "non-linear healing trajectory." Truer words have never been spoken; and "Just Do It" might be an over-used corporate marketing slogan, but it is a useful mantra for those days when you think "Oh what would it hurt if I skipped my exercises today?"
I am seeing progress and improvement, but I still have a long road ahead. I'll report back soon and let you know how it's going!
At Brattleboro Memorial Hospital Rehabilitation Services you'll find a staff of physical, occupational and speech therapists ready to offer their expertise to help you get your life back on track. The spacious, fully equipped outpatient facility offers the largest rehab facility and the largest rehab staff in the area. You'll get one on one care, attention during your treatments and as a hospital based clinic we can provide comprehensive care for all of your rehab needs in one convenient location. Call 802-257-8255 or visit bmhvt.org for more information.
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