Sunday, 21 February 2010

Work As Therapy

In the previous post I spoke of how the muscle tension or tightness referred to as 'tone' cannot be reversed or even reduced to any great degree by exercise or stretching out. Regardless, I have notice some increased flexibility and range of motion after having returned to work.

In exercising you are usually given a motion which you repeat in say three sets of ten. Lift your leg up and down 10 times, rest, then repeat, etc. The motion is usually unidirectional (up and down - in-line and for a duration of usually minutes).

Having returned to work and an 8 hour workday, I find myself having to move through a wide range of motions continuously. Reaching for items I need, twisting at the torso, swiveling, stretching, grasping, bending - to the left, to the right, up and down. The continuous motions required are so much more than one can get during an hour in physio or at home, held captive by your TV.

Some increased motion range and flexibility has been noted. In addition I've had the occasional sensation I refer to as 'micro-tears' in my back which I believe are the adhesions breaking up or releasing. As discussed in a previous post I believe these adhesions are bonds formed between the various layers of tissue during the time of non-use or restricted use. Tissue layers normally slide smoothly across one another when stretching however, when paralyzed and movement does not occur for any length of time, the tissue components begin to bond to the adjacent layers. If and when motion returns the feeling might be analogous to two surfaces sliding against each other without any lubricant or grease to make the movement glide smoothly. With muscles I feel this sticky, ratcheting sensation where the muscle feels as if it alternately and rapidly slides, sticks, slides and sticks again. When walking I can feel sheaths of muscles move within the leg. In the back I have some of the same sensation but sometimes when extending some motion I have a momentary twinge - where I feel a minute tear as one of the adhesions releases.

In summation, I feel that the increased exertion and range of motion required in my workplace has translated into greater range of motion in my own movements. Tone will always be present in the muscles affected and will always oppose any attempt for the muscles to return to a normal 'pre-injury' state.

Again, these observations are not scientific, and explainations may not be totally accurate, but they are impressions that I have based on my own experience.

Saturday, 20 February 2010



No, not that knob on your guitar or stereo system. Not even the reference to "toned" athletes or body builders. No, I'm referring to 'Paralytic Tone'.

Shortly after coming out of my post surgical 'fog', I noticed a tremendous discomfort bordering on pain whenever I coughed. It felt as if my chest was wrapped with elastic bands. Could my muscles have deteriorated and shortened in such a short time post injury? A half year later, after I began to regain voluntary movement, I noted that the tightness remained. I thought that those muscles that had not been used over the last six months would now stretch out with my increasing movement. I had mentioned this tightness to various health care professionals/physiotherapists in hopes of obtaining specific exercises to counter this unpleasant tension. No exercises or explanations were offered however I noticed the word 'tone' used when talking of my condition. Internet searches offered little more.

My simplistic understanding, which I gathered over time was that when the spinal cord is damaged, the injury causes the brain to send signals (whether different or increased) to the muscle groups involved and tells them to contract or clench more that in the uninjured state. As a result, the muscles are continuously 'turned on' to a greater degree and the resulting tension is referred to as 'Tone' or 'Paralytic Tone'. (My apologies to any Neurophysiologists out there as a proper explanation was never clear or forthcoming from my health care providers.) The result is this continuous tightness in the muscle groups controlled from the injured area of the spinal cord. As my injury level was at T-5, the damage was high enough up to cause my thoracic (chest) muscles to continuously clench. The result is this sensation of having my rib-cage wrapped in rubber. The sensation is outside of the ribs so breathing is unimpeded. The tightness is most noticeable on rising in the morning and although it can be somewhat loosened with stretching, it never approaches feeling normal and re-tightens quickly if I relax for any period of time. The tightness is most noticeable when twisting at the torso, reaching and when those rib cage muscles are stretched to their limit with a very deep inhalation.

In my situation, this tone presents itself the most around my chest and in my calves (gastrocs & soleus muscles) although I suspect it applies to every muscle group below my injury level. The calf muscles are so tight they pull on the achillie's tendon making it difficult for me to keep my heels on the ground. When standing, if not stretched out beforehand, the raised heels have me tipping backwards. This is what the Botox was suppose to address but again, my current physiotherapist feels that the toxin had done very little to block the nerves activating these muscles and have them relax to where my heels come down and my stance is more normal. Even with the Botox, my calves are as hard as petrified wood- repeated stretches and increaced walking have not loosened them and I]ve had too few massage sessions to see if this therapy might loosen them to any degree. As mentioned in an earlier post, my physiatrist (Doctor) claims that studies have never shown massage therapy to have positive effect on 'tone' tension.

It is my belief that this very 'tone' muscle tension is responsible for my sciatic nerve pain. Even after extensive physiotherapy and exercising it seems when I purposely tighten or clench my muscles, my left lower back seems to tighten more vigorously than the right. This asymmetrical response is probably due to the initial injury not being entirely symmetrical and with greater 'tone' on the lower left back muscles, the increased tension pulls my left hip out of alignment. It seems that however much I exercise and stretch out those muscles, the permanent 'tone' always pulls them back out of place to aggravate the sciatic nerve.

So, this constant tightness is a direct result of the injury and resists any attempt to be stretched out. Any give that occurs through exercise or stretching quickly retracts when resting. The drug Baclofen is taken to minimize this tightness and has some effect. While I'm not at the maximum dosage, I take enough drugs and don't wish increase this concentration and add to the chemical soup already in my system.

I now recognize that the condition is permanent and that both the sciatic nerve pain and the neurogenic pain are to be endured daily for the remainder of my life.

Saturday, 6 February 2010

Dumb Ass

Well, I really am a dumb ass. Been thinking about having my van converted so I have more freedom, not having to rely on public disability transportation. Just occurred to me that if I had applied before returning to work I could have cried poverty, declared that I was a poor cripple, and applied for assistance in the costly makeover or new purchase. (dropped floor, ramp/lift, hand controls, etc.) - but nnnnooooooo, lets fight this disability and get back to work. Now that I'm no longer on disability pay and once again employed full time, I'm certain that I'll be turned down for any assistance that might make the price renovation a little easier to deal with. Duhhh!

Friday, 5 February 2010

Wheelchair Etiquette

Wheelchair Etiquette

Waiting for my public 'disability transport' to arrive, I have ample time to observe people's behaviour in and around the hospital where I work. One thing that I've observed and absolutely drives me crazy is the lack of courtesy some people exhibit. At this point I won't even get into people ignoring wheelchairs sharing their world, letting doors slam on me, walking on the wrong side of the hallway (convention has it that you walk on the same side you drive), refusing to give right of way to a wheelchair which is harder to maneuver, people shooting out of doors without watching for others, able body people refusing eye contact - staring above and over you and your chair, ignoring requests of "excuse me", and on and on...

This rant is about one issue. Several times now I've witnessed an able bodied person wheeling a family member out to a waiting car using a hospital wheelchair. After tenderly putting their loved one in the automobile, they turn and push (or worse yet, kick) the manual chair in the general direction of the hospital entrance - then drive off.

Trouble is, its snowing outside and that chair will be frozen and wet with snow when the next person is looking for a chair to assist their friend or family member.

People, if God has graced you with good health, use those legs that I wish I could to roll the chair back into the hospital entrance and dock it where it is kept so that others might enjoy a clean & dry chair without searching for it!!!

Odds & Ends

1- Had a third series of Botox injections two weeks ago and hoped that this would aid the tightness in the calf muscles to allow better movement/range from the ankle.

Now, when I had the first two series of Botox injections, the physiotherapists were concentrating on getting me up and walking - with the hope that Botox would improve my stride. They didn't check for range of motion pre and post injection to see if there was greater range and flexibility. Internally I did not notice any change in sensation nor any increase in range from my perspective. As the effects of Botox were to last about 3-4 months, before blocked nerves regenerated and formed new pathways, the only feedback I had regarding the effects of Botox therapy was what I thought was a shortening of my stride as the next injection date approached. My Physio and I thought that this was probably due to new connections circumventing the Botox blockage and therefore the Botox was effective.

Now that I am upright and able to walk for periods of time, my new physio was concentrating on various manipulations to my limbs such as stretching out the quads and hamstrings as well as the piriformis muscle (but more on that one later). As she was directly observing and working on the range of motion of my lower limbs, she was interested in seeing exactly how much more range the Botox therapy provided after a series of injections to the Soleus and Gastroc muscles (basically the two calve muscles joining to the achilles.

As it turned out, she said that there was an increace in flexibility and range a day after I received the injections, however now after only a week has passed, she no longer detects that change even with the increased therapy. Could the Botox really be that ineffective for me? If so, I really have to reconsider whether to take any more shots in the future.

2- As mentioned, I'm back to the Gabapentin from the Lyrica as in the end I felt the Lyrica had no greater effect that the Gabapentin, had fewer side effects (for me blurred vision and probable weight gain) and was less expensive which would please my private supplemental health insurance carriers.

3- Also as mentioned, I'm walking more at the physiotherapy clinic though still somewhat unsteady. Have to improve on the core muscle stability as the muscles, particularly the lower back, tire quickly. Trying to regain that link - feedback from the feet on the floor, telling the brain what's happening and subsequent messages from the brain telling the muscles how to perform to correct, compensate and maintain balance while upright. Since standing for the very first time, post injury, I still have not fallen to the floor once.

4- Tone- not the tone that athletes & body builders speak of when they say an athlete is really "toned", but rather refers to the increased tightness, post spinal cord injury, where the communication between the damaged cord and the brain, tells the brain to clench or tighten. Baclofen is supposedly prescribed to lessen this signal and reduce the tightness experienced.

In my case, I believe, (I believe, because meaningful feedback from therapists and doctors is sadly lacking) - In my case, I believe that because the injury is not quite symmetrical, one part of my spinal cord received more or different damage that another. As a result there is greater 'tone' on my left back muscles than the right resulting in a greater pull or tension on the left. It is also my belief that this results in my left side pulling more on the muscles attached to the hip and this asymmetrical pull results in my sciatic nerve pain. A tremendously painful affliction which is bothersome even when not sitting. On my stomach the nerve throbs with pain with every pulse and heartbeat. A truly maddening situation. On the few good days it is noticeable but tolerable. On bad days it is excruciatingly painful, drawing one's attention to it ever minute or so. Something I've endured for three years and no health care professional has offered any advice other than to "learn to live with it". Yeah, right!

This new physiotherapist has at least attempted to stretch out the piriformis muscle with a manipulation akin to grabbing my leg by the ankle and while bracing with one hand on my hip, pulling the leg out sideways. When she first attempted this on my weaker (painful) side, the resulting spasms were so great the I thought the recoil was going to kick her in the teeth. However, within days the spasms lessened to where now she can pull through just about a full normal range with only a slight shudder on a very few stretches, I do believe this has helped the pain. Although a bit tender the day after the therapy, I get a couple of good days afterwards. For how long, I'm not sure as I'm back in physio receiving that stretch and subsequent post physio tenderness the day after. Not sure how long the relief might last however as the tone is always there, the hip will most likely be pulled out of alignment once more.

5- Low Level Laser Light Therapy. Not sure if this is revolutionary or just plain Voodoo science but I've had a few sessions with laser therapy in an attempt to help my sciatic nerve pain. Can't quite see how it would help in my situation. I understand the premise is that the laser light somehow alters the cellular biochemistry at the site it is applied thereby increasing healing. (very oversimplified). But I just can't see how shining light on my butt will cure a pain that is much more deep seated (no pun intended). Therapy consists of placing these light emitting panels under my shorts, positioned against the skin at the afflicted site. The laser is turned on for six minutes after which a different panel is inserted (different intensity?, frequency???) for another six minutes. There is no sensation associated with the therapy (ie. no heat, pulse, pain etc.) After about 4-5 sessions now, I notice no difference, however I notice very little change from any of the therapies except possibly the stretching of the piriformis muscle. Nerve still hurts but doesn't spasm as much. Laser therapy was included as part of the physiotherapy session.

6- My physiotherapist suggested I try massage therapy once again to loosen up the legs and perhaps increase circulation. I passed the issue by my physiatrist (Doctor), specializing in spinal cord injuries however he stated that there are no studies suggesting that massage therapy aids this tightness. The 'tone' will always be there - it cannot be shut off but only controlled with doses of Baclofen. It was my impression that he believed that the tone would simply undo, or fight any improvement the massage therapy might offer, negating any gains almost immediately. As my private insurance does cover limited sessions of massage therapy, I though I'd give it a try because;
  • my doctors have been wrong in the past, numerous times
  • each person responds differently to therapy
  • the cost is covered and the therapy can't hurt
  • it may aid circulation if not the tightness from 'tone'
Having had my first massage therapy session with the new masseuse, my impression is that she knows her profession and that it offers temporary relief if not longer lasting. With only one session I have yet to make judgment on the effectiveness of this added treatment. My hopes are that it too will help my agonizing sciatic nerve pain.

Phyisotherapy twice a week after work for an hour to hour & half and Massage therapy once a week for a half hour. 12 hour days! Pain at times is unbearable and not much to look forward to can really mess with the mind.