More physio fun

[stephbg]

Today I went to physio Georgia to explore the significance of the knee-centred relief I experienced during my latest massage. i.e. if I could experience such relief would it be possible to replicate the effect without the subsequent crippling pain. The short answer appears to be "not really".

First up I wanted to find out if there was some sort of treatment like ultrasound (or indeed any machine that goes ping) that might help to loosen me up and/or relieve the pain. Answer: No. It probably would have helped with the last inflammatory reaction, but not the original baseline problem. Something to bear in mind for the future if I make myself particularly sore, but it's not a path to improvement per se.

Could surgery to loosen/lengthen/soften some connective tissue be an option? Answer: Possibly, but not recommended. Bearing in mind that surgeons and physiotherapists are natural enemies, she did say that the surgery was a last option and had a long and difficult recovery. It's true I'm built unhelpfully (the angle formed by hip, knee and ankle is much more acute than advisable, and my feet are weird (technical term)), but she'd naturally prefer we tried other things. I'll give those other things a good go and ask that question again later.

So, I got the answers I pretty much expected for those options, and we moved on to the usual physio biomechanical reprogramming stuff. I've been through all this before, but each time my body has been in a slightly different shape; I was after a 47th opinion. I knew I shouldn't/didn't need to but I kept apologising for not being able to bend, or for being ridiculously sensitive to pain. Fortunately Georgia understood and was sympathetic to the needs of a fibro patient, and was quite able to hold in her head two conflicting trains of thought regarding treatment for normal people ("I'd like to just get in there and loosen all that up.") and actually treating me. At one point she ever-so-gently rolled a round sponge over the side of my knee and merely raised her eyebrows in curious interest when I calmly informed her that it hurt like hell please stop immediately. Similar interest was exhibited when she stretched something in the knee department and I reported tightness in an unrelated bit of calf. Such are the ways of neuralgia, and my massage therapist N is familiar with the genre, if not all its wonderfully weird expressions. (Sometimes I feel phantom water trickling down the inside of my knee. Trust me, it's weird.)

I explained my history with orthotics and she said that her strategy was not from the bottom up (i.e. fix the feet and the rest will follow) but bottom er arse down – get the hips right first.

There are indeed some little exercises for me to try in small doses, and I'm writing this mainly to try and capture those. The goal is to strengthen the muscles that oppose the tight ligature along its entire length. We're talking finely tuned arse power and quads worth the name. I have no argument with that. The challenge (and this is exactly why I sought professional help) is to exercise those bits of me without breaking the other bits of me. Unfortunately I do not disassemble for maintenance purposes.

Sitting/standing. Feet aligned and equally turned out, and stick out that bum. No more dignified straight-backed curtseying into chairs for me.

Walking/standing. Like a duck*. Turnout is good, but try to turn both feet out at the same angle. Rotate knees and hips out. Don't forget to bend the knees. Rotating the hips is done by imagining the points of the hips migrating back and around. The end result is a somewhat clenched arse, but it's a completely different clench than would be achieved by simply following the instruction to clench one's arse. I do respond well to such imagery (my apologies if you're now thinking more about clenched arses than you had scheduled for this time, but you can think a bit less about clenched arses tomorrow to make up for it). All this seems to separate my feet a bit, whereas normally (pour moi) my feet are always ankle to ankle. I think this is correct but I may check back. Don't actually try to do anything different with the shoulders, but do relax them.

In other words, do NOT do as I was taught/yelled at as a child: "Feet together, back straight, shoulders back, head up, bottom tucked in."

Walking is a complicated business. I might have to pop into a robotics lab for some pointers.

Stretches/Exercises. In the pool I'm to do the steps I've been avoiding in shallow water, and do them in deep water instead with the portable step. If I'm adding new exercises to the program I should remove something else. (I've certainly never heard any physio say that before, but she takes my chronic fatigue as seriously as my fibro, which is much appreciated.) Reduce the number of walking laps, for example. She also solved a mystery about my written instructions for walking laps: what did "4 lengths across the pool" mean, exactly? Ah, she said, with a hint of embarrassment, it means different things, depending on the person, and whether the pool was crowded. She was happy that I'd interpreted it as the maximum of 8 lengths (4 laps) along the length of the pool and said I should cut out some of that. Not could, but should.

On land she suggested I try manipulating my kneecaps. As you do. And to otherwise keep doing all the little rubbing and stretching things I already do, because none of them are doing any harm as long as I listen to my own body and don't overdo it (a physio saying "don't overdo it" seems like a miracle to me).

To be honest I was actually a bit shocked at how much her gentle explorations hurt. I'm usually in my own little world of pain and don't often get surprised by it. Such tiny little things she did caused ridiculous amounts of pain. I apologised some more. I'm doing it right now, I can't help it.

I think that's about it. She seems happy enough for me to drop in occasionally as I have for this and for the hydrotherapy assessment, so there's no specific followup set although I'm encouraged to call if I have any questions. I do believe she trusts and respects me. I'm keeping her.

* Please do not smother me in oranges, thanks.