In a previous post entitled "Physio Lite" I outlined my plans for the winter of 2009-10. Due to hospital restructuring, the outpatient physiotherapy program at my hospital was terminated and those patients, like myself, were advised to find continuing physiotherapy in private community clinics. I chose the only clinic near my workplace accessible without without having book additional transportation
My reason for finding a clinic was two-fold. I wished to receive additional therapy to strengthen my core muscles in order to have better control and posture when standing upright. Secondly, as my home did not provide enough linear space in order to practice walking, I hoped to find a longer continuous space in which to walk while the winter snows prevented me from walking outside.
True to my expectations, the private physiotherapy clinic was not geared to treating patients with brain injuries, spinal cord injuries strokes or other major neurological tramas, but rather specialized in treating sports jocks and people with community acquired strains and sprains. That said, I found them to be quite professional and dedicated. The atmosphere and staff were welcoming and although the therapy sessions were a half hour each, I was never rushed and allowed to walk and use exercise equipment as long as I wished - usually dictated by by my scheduled ride home.
*(photo is of my physiotherapy clinic's gym. Gives some idea of the distance walked)
The half hour physiotherapy included a variety of stretches including hamstring, Achilles, and piriformis. I also recived further instructions on exercises I could do at home. Early in the new year of 2010, once a week massage therapy was added to the twice a week physiotherapy regime. Cost was paid for out of pocket but later reimbursed by my private insurance plan.
So what was accomplished in this half year of private physiotherapy?
- on the first day of therapy my physiotherapist performed a piriformis muscle stretch and the spasm that it generated almost threw her across the room. The spasms quickly subsided during subsequent visits & stretches however, after a winter of receiving the stretches, the increase in range and reduction of spasms has not translated into reduced sciatic pain. It continues as unpredictable and intense as ever. The links provided shows a technique in performing the stretch that differs from how I received mine. I lay prone on a table/bench while the physiotherapist braced with her hand around my hip while pulling my leg outwards like the handle on a slot machine.
- the range of my hamstrings is now about what would be considered normal, or pre-injury. The Achilles stretches were discontinued early on as the diminutive physio's physical effort was insufficient to be effective. (ie. I'm a big guy and she was a rather small young lady.) My own weight & repeated standing, whenever able during the day, was no doubt more effective than any force she could apply. Regardless, no matter how much I stretch the Achilles, I find that they tend to rebound to a tight state very quickly. The stretch doesn't last, perhaps due to the 'tone' I spoke of a few posts earlier. Early in January, I received another set of BoTox injections to the gastrocs and soleus muscles in hopes of reducing the tightness which prevents me from getting my heels down and not tilting backwards when standing. Although my physio thought she felt a slight amount of increased range right after injection, the amount she detected was minimal, nor did she feel the effects lasted very long. I felt very little change internally though after the effectiveness of the Botox wears off after about 3-4 months (due to the regrowth of the peripheral muscles targeted), I once again may have noticed a slight deterioration of my gait. (ie. walking was not as fluid and smooth). I now have to decide whether its worthwhile in getting future injections.
- laser therapy was applied to my hip and sciatic nerve area in hopes of lessening the pain however, in the end, I feel it had no effect, even temporary.
- Walking - core strength has improved which allows me to walk in an upright position and not lean heavily on the walker. In fact I can lift the walker off the ground while standing however I'm still unable shift weight to one leg while lifting the other foot, as in stepping, without the support of the walker. I don't have the measurements of the gym, however I graduated from walking the full length and back some 6 times when I first arrived to 25 to 30 times when I concluded last week. My stopping was due more to my time running out as my scheduled ride neared, than to fatigue. From full paralysis in 2006 to walking with a walker in 2010, I have yet to stumble and fall to the ground - a record I hope to keep.
- I used an apparatus where I could lift weights with my legs or switch the configuration to pull the weight downward with the hamstrings. This improved the muscle mass and strength in the hamstring muscles and quads. In the end I was doing about 50 repetitions of 100 pounds each session - twice a week.
- Massage therapy was started in January. Although advised by my BoTox physiatrist that it would be of little use and that I should save my money, I thought it was worth a shot anyways. During my post-injury recovery, my calf muscles have become rock-hard probably due to the tone - the very tightness which the BoTox had little effect on. More recently, I've noticed that my legs get very cold to the touch, especially at night (I don't feel cold, but the legs are noticeably cold to the touch). This again is probably due to the 'tone' - the brain telling muscles to clench which now constricts blood vessels and blood flow to the limbs (legs) affected. It appears that the doctor was correct as the legs remain very hard and tight even after my massage therapy coverage was exhausted. The massage was not restricted to my legs but also applied to stretching out and treating the lower back and piriformis muscles in an attempt to reduce the sciatic nerve pain. In the end I find myself undecided on the effectiveness. Some days post-massage I feel I have some relief, then again other days the pain that follows is as intense and as frequent as ever.
The future? As I entitled this post, 'Spring & Summer Regime', it is now up to me to prepare a schedule and find a suitable location to practice walking and build on the endurance I gained at the physiotherapy clinic. With better weather, I can venture outside along sidewalks, in local parks or in shopping malls when crowds have dissipated. Structured physiotherapy provided the incentive to attend bi-weekly. Now it is up to me to find the discipline to continue walking on a daily basis. Wish me luck!