Physical Therapy Catastrophe

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Near the end of June I blew out a disc doing a PT exercise. The irony! I’d exchanged a goodbye hug with my PT that very week.

I’d been doing PT mainly for my knees. One of the exercises I’d been assigned, the ‘forward T,’ had earlier aggravated my back.  The exercise involved bending forward on one leg into somewhat camel spin-like position. I talked to my sports medicine doctor about it and he added my back to the PT prescription. Things settled down and I was able to do the forward T exercise without pain.

Then my PT added a progression to the forward T exercise which involved bending forward and then twisting a bit up to one side, then the other. In retrospect, with pre-existing back problems I never should have done an exercise like that. But I’d been doing PT for months and I was strong, right?

Again the T’s began to aggravate my back. Meanwhile with the buyout of the PT practice I was not getting the consistent one-on-one attention I’d had before. Throughout June I had sciatica in my left hip and I woke up several times in the night with the calf in spasm. I didn’t think much about it. Then one Saturday I skated a long morning ice dance seminar and in the evening did my PT before bedtime.

That night I woke up with excruciating shin pain and my back, hip, and leg rippling with spasms. It was right up there with childbirth and kidney stones. I let my husband sleep through, but I was up and pawing through the medicine cupboard. I found some expired Celebrex and started taking it at full strength. That plus hot packs got me through the night. I spent the next week in bed or on the sofa reading novels (The Bone Clocks, anyone?) and waiting for the pain to go away.

Ten days later I went in for an unrelated doctor visit. My blood pressure, usually normal, was a shocking 130/110 on the first try and 145/102 on a re-do. They sent me to my primary doctor where my blood pressure was still high. She told me to stop taking the Celebrex, which can cause high blood pressure, and start Tramadol and gabapentin instead.

Much as I didn’t want to be on those meds I did need them. My blood pressure came down a bit but was still in the hypertensive range, probably from pain. I was waking up at night with the sciatica and muscle twitching that felt like it was shaking my torso. Most nights I would get up when the meds wore off, take more, and soak in a hot Epsom salt bath for about an hour until I could get back to sleep.

I went to Dr. A, my sports medicine doctor in mid-July. By then I was able to get by with Tylenol though still waking up at night. On his tests my balance was poor on both legs, I could hardly stand on one foot at all, and I couldn’t walk on my heels. When I’d try the left foot wouldn’t stay up but would slap down flat onto the ground.

The weakness was a sign of nerve compression at the spine. He said there would be no way I could compete in Vancouver at the end of August. I asked when I could expect to get my balance and strength back on the left. His non-comittal answer gave me a chill of anxiety. He sent me for an MRI.

When I returned for my follow-up he was training a medical student and showed us both all the structures on the MRI. I have quite a bit of facet joint arthritis and various disc bulges, but the glaring problem is a large L4/L5 disc extrusion. On the MRI we could see the L5 nerve root, which innervates the leg, traversing through the blob of extruded disc matter. It was easy to see why my leg was weak and in pain.

Dr. A offered me either an epidural steroid injection, followed by PT, or to go straight to PT. He said if I didn’t improve I could consider surgery. I couldn’t decide right away whether I wanted the injection and took a week to think about it. Since my pain was improving bit by bit I decided just to start PT. I couldn’t face going back to my old PT office after what had happened. Nor was I motivated to seek out a special PT who would likely be a long drive away. I picked a practice very near me that offers one-on-one care with a PT, with no assistants, and let them book me with someone.

I had my first visit last week and we started with easier stuff than I even did when I started PT last fall, but that’s where I’m at. This PT was also vague about when I could expect a return of my strength and balance, “Well, it’s hard to say about these neurological things.” I cried on my way out of the office and am unsure what will happen with my skating future. From what I’ve been able to read it’s very likely that strength will return on that left side but it’s not guaranteed. It depends on the type of injury the spinal nerve has received and whether it’s able to heal, and that’s not knowable except with time.

I’ve been on the ice a couple of times. The first time was scary. I felt like I couldn’t trust my left leg and only lasted a short while. More recently I tried again, with some improvement, and spent 45 minutes working cautiously on basics. With full effort I can do one or two back crossovers before my toe starts to scratch. I just can’t get the dorsiflexion to keep it off the ice.

In a way I’ve been through this before. My voice was injured by a neck surgery when I was younger and I was told that the nerve could be either temporarily or permanently injured and only time would tell. For three months I could only whisper. Imagine raising small boys without being able to be heard across the room, or standing behind a car that starts to back up without being able to yell. Or, on a better note, calling a sewing machine repair shop and being asked, by a clerk who thinks he’s speaking with a fragile old lady, “Would you like us to pick that machine up from your house, ma’am?”

After the three months my voice gradually strengthened. It still seemed weak to me, but on testing the vocal cord had full movement. They told me all was well, my voice was only weak with disuse and would soon be normal.

Now I hope for the same with the L5 spinal nerve. My left calf muscle has been reluctant to work and looked to me to be visibly wasting. Though my PT hasn’t assigned me any leg work yet, I’ve been doing things for it. I tap the left foot to music in the car. In the bath I flex the right foot and then make the left foot copy it.

More soon.