Monday, September 30, 2013

Undoing Disasters: The Injury Rehab

This past Friday was the official beginning of my injury rehab. It's both a relief and agony to finally know exactly what was wrong after three years of gradually-increasing-but-never-bad-enough-to-stop-training pain. It's a relief because I can start to fix it. It's agony because I have to fix it (and therefore take more time off).

After the phone call the day I left for London, I was sure that the pain was coming from two different sources - the findings on my left hip MRI: (1) a labral tear and (2) a hamstring tear. This would most definitely explain why I was getting pain in so many places and at times would hurt all the way down to my ankle. But I found out last week that I was likely wrong. I was wrong about which "tear" was actually causing my pain. My Orthopod, Dr. Patterson and I discussed this in my first visit after returning from London.

It went something like this...
Dr. P: You are seriously messed up.
Me: Tell me something I DON'T know.
Dr. P: (explains how MRI images were taken and then shows me the longitudinal slice images from the outside of my hip inward). The good news is there is no problem with the ball joint, the bone.... (points out the labral tear) and here's the labral tear - it's in the front
Me: But I have no pain in the front...
Dr. P: (continues the slide show)
Me: EEEK! What's that?

I knew there was something seriously wrong with it as soon as I saw what turned out to be my hamstring tendon - the tendon that connects your hamstring to the sit-bone.

The diagnosis was severe tendinosis (I've never heard of that either) and partial-thickness tear of the tendon. It was a chronic condition likely the result of never rehab-ing the first hamstring tendon injury (and who knows how long ago that was?). It had gotten so bad that it would probably not heal on its own. In olden times, surgery would have been my option. But these days, there's a new therapy available: a PRP (Platelet-rich plasma) injection to force the healing components of blood into damaged (connective) tissue. Google it if you're interested in ways doctors are using PRP - it's a pretty promising therapy.

Here's how it works. My own blood would be extracted, then spun in centrifuge to obtain mostly platelets, then injected into my tendon. Because it's my own blood, my body will recognize it, and because it's platelets, it has a high concentration of growth factors. It should start rebuilding my tendon tissue as soon as it gets in there. The post-procedure protocol would have me in physical therapy and back to training in about 4-6 weeks.

There are several issues I can now report on - because I had this done three days ago.

First. IT HURTS!!! Like white hot pain for an instant and then imagine the worst pain that you had from the injury and triple it. The doctor who performed the procedure also confirmed via ultrasound that: "yeah, your tendon is seriously messed up" just as he stuck the needle full of fluid right into it. In his defense, he SAID it would hurt.

His next question was: "does it hurt like the injury did?"

"You bet your sweet bippy it does!"

He said: "good, that's what we want." It was the exact pain I'd been experiencing while running -- except I wasn't doing anything to induce it.

Second. It gets worse before it gets better. By that night, although the initial white-hotness had gone away, I couldn't walk or stand without pain, and I felt like I was sitting on a rock for many hours to come - through the next day, in fact - before things settled down and I wasn't hobbling around. This is supposed to happen.

Third. You must grin and bear it because YOU CAN'T DO ANYTHING FOR THE PAIN. No ice. No NSAIDs. Oh, yeah, Tylenol is ok (like Tylenol works - come on!) Why? Becasue the inflammation is necessary for the healing process. I always prided myself on my ability to tolerate pain, so now it was time to walk the walk.

Three days later, the aching pain has subsided, and I only get pain if I sit on my sit-bone. I've happily become a couch potato in hope that healing is underway. Heck, what I was doing wasn't working. I'm ready to try anything that might mean a pain-free run in my future. It's been way too long.

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