Oops I did it again.. lower back pain

Honestly, I don't remember when I last hurt my back.  It was an awful feeling waking up last Saturday not being able to move. I met up with a friend later during the day who offered some muscle relaxant which I hesitatingly took and insisted that I see a doctor if the pain doesn't go away.

Well, the pain worsened and the first thing I did yesterday was to hobble to Intercare to get some kind of relief. Luckily, the rehab doctor Dra. Annie Dizon was there to attend to me. She ruled out sciatica, pinch nerve and said that the cause was muscle-related. She also mentioned that I had the same issue as early as 2007.   (Note: I now love medical records!) Specifically,  she diagnosed left lumbar strain and sacroiliac joint dysfunction:

Since the pain was unbearable, Dra. Dizon recommended that I undergo daily treatment consisting of Physical Therapy (i.e. hot packs, light massage, ultrasound with tense and stretch), myofasial therapy (deep tissue massage) and chiropractic treatment with Dr. Martin Camara. She said that the cause may be attributed to stress, improper bending or lifting and even poor posture.

I did a postural alignment test, actually a video of my spine was taken using the Kinesio Capture, an iPad app. As shown in the video below, the result indicated that my spine is off a few degrees in certain portions of my body. One of the doctors of Intercare pointed out that the misalignment may be causing the muscle strain and tension and thus, over time triggered the lower back pain. He added that good posture and chiropractic treatment may help relieve the tension in the low back area.

The axiom health is wealth is a popular cliché but after this week's bill plus next week's (unfortunately, Intercare is not covered by my insurance policy), it is best to take this dictum to heart. Prevention is the key to good health. After this week's experience, I made a list of resolutions that will prevent such hiccups  and let me go on doing the things I love to do.

All taped up

Here's my list of resolutions: (1) Because core muscles support the spine, focus on core stabilization and strengthening exercises; (2)  Always stretch especially the hamstrings and piriformis - i.e. after work out, sitting for a prolonged period of time, and before sleeping;  (3)  Book a massage at least once a week (preferably, myofasial release); (4) Lift objects properly by bending knees (hmm.. I have to check with Miggy though regarding  dead lifts); (5) And lastly, apply kinesio tape (left) to support the strained areas - back, legs, shoulder.

Since it's Buddha's birthday this week, let me end with a quote from him To keep the body in good health is a duty... otherwise we shall not be able to keep our mind strong and clear.

Are you OA?

Guilty! Yes, I am OA.  I was recently diagnosed with joint effusion which is really osteoarthritis or OA. The x-ray confirmed the diagnosis. The report says "impression: beginning degenerative changes."

Osteoarthritis is a degenerative joint disease which is one of the leading causes of disability amongst elderly men and women.

At the World Arthritis Day forum today though, I found out that this disease is not age specific. Women are more prone to OA and tend to start developing symptoms in their 30s and 40s and worsen as they age. 70% of all OA is knee-related.  The risk increases to 57% in those with a past knee injury.

I must confess that my threshold for pain is quite high. I have ignored the aches and pain that come with my running regimen - drills, intervals and distance. It was only last month in Victoria, BC (Canada) when the weather dropped to a chilly 10 degrees Centigrade that I paid attention to my knee. I guess the cold weather affected my knee joint. I was experiencing constant pain, stiffness swelling and limited range of motion.  I found it difficult to walk, bend and even, climb up and down the stairs.  So, when I arrived home, I immediately headed straight to the hospital to see an orthopedic.

At the clinic, the orthopedic doctor overhead me discussing my ailment to my running coach over the phone. He corrected me and said "you have joint E-ffusion and not I-ffusion. . water on the knee which is actually a symptom of osteoarthritis." He said the cause is repetitive stress or overuse of the knee. He prescribed the following medications: anti-inflmatory (arcoxia), topical cream (V-Gel) and to wrap my knee for 20-minutes with a warm towel twice a day. He also advised to avoid anything strenuous and to specifically stop running. If the swelling does not subside, he recommended to aspirate the knee to remove the excess fluid which he said is better than knee replacement.

Well, I don't like anything invasive so I went to see an alternative, holistic sports doctor, an acupuncturist (Dr. Kit Navaro) who recommended to limit leg exercises to  3x a week and to go back to 'basics'. This means, correct my form and strengthen the leg muscles - knee, calf and hamstrings. He stressed the need to rest in between; meaning, do absolutely nothing.  Tomorrow I am seeing a sports rehab doctor, Dr. Bate, who hopefully, will recommend physical therapy.

If all things fail, I found out at the forum that another option is viscosupplementation. This is a procedure that involves the injection of gel-like substance into the knee. The first step is similar to aspirate to remove the diseased joint fluid and then, introduce the gel-like substance. The substance will simulate the synovial fluid to protect the joint by absorbing shocks and lubricating the moving surfaces. The product available in Manila is called Synvisc-One, a USFDA approved  injection regimen that provides up to 6 months of knee pain relief.  Of course, the procedure requires a prescription from either a rheumatologist or orthopedic.

The upside of this treatment is fast relief lasting from 6 to 12 months. The downside is, it's another botox treatment where you need a shot every six months.

Pain in the butt

I have a pain in the butt... it's no joke, I'm literally experiencing discomfort in my left behind. The pain manifested on Dec 1, a month after the the New York marathon when my left knee gave way. I've seen two doctors and despite rehab, this pain won't just go away. (Note though that the traction relieved my cervical slipped disc which recurred and eased my lower back pain). So, call me a cyberchondria but I checked online and based on the symptoms and web description, i think i have piriformis syndrome..
Online MD says "Your piriformis muscle attaches from your hip to your sacrum (base of your back). Therefore, when your piriformis muscle is tight, it can pull on your sacrum, which then pulls on your lower back, placing additional strain on it. Your piriformis is a deep muscle in your buttock region." Hello, this is it.
Anyway, i finally went to see Magoo's highly recommended sports ortho - Dr Gar Eufemio, today. And guess what - - he said i do have piriformis syndrome.. A N D ... iliotibal band (ITB) syndrome (the tendon that runs along the side of the leg from the hip to a point just below the knee) triggered by patellofemoral stress syndrome (knee injury). Oh wow...the doc said "everything is connected" and prescribed meds and recommended to see his partner for rehab, Dr. Rafanan who wil release knots through mayofacsial therapy. Gosh, I should have gone straight to Dr Rafanan He was the one who helped me get over my heel spur problem last August i.e. recommended physical therapy and also put me on 3x elliptical training and water running so i won't loose my fitness level.
I just checked online MD and says that ITB is casued by: worn out shoes or shoes with inadequate cushioning, too much mileage or sudden increase in mileage. Looking back, I guess I had a brewing ITB problem because I only started increasing mileage from 15km, 21km to 42km after the heel spur eased or two months before the marathon. Well, the good news is, Dr Eufemio says that after mayo (he doesnt know how many releases though), I should be back on track soon. yoohoo!

Synovium inflammed

thank God that there's nothing seriously wrong with my knee. My sister drove me to Berkeley Ortho to see Dr. Strotz (tel #510 845-3856). He said that my ACL, ligaments, joints are all OK except that there's an inflammation in the synovium.
According to About.com, Synovium is the smooth lining of a joint. Synovium produces synovial fluid, a clear substance that lubricates and nourishes the cartilage and bones inside the joint capsule.
He recommended to REST (off my legs!) and to take 3x ibuprofen tabs per meal or 9 tabs for at least two weeks until the swelling subsides. He also said NOT to engage in any weight-bearing activity for that period. Swimming is okay as long as I don't kick.
Bottom line is, he said that my base training preparation was inadequate for the 26.2 mile distance (or 42-km). He said that minimum of at least 30-miles a week as base (at least 6 months to a year of running) prior to training. Honestly, I only trained after the triathlon in Bali (a week after June 29) plus laid off training for a month due to my heel spur injury. I must admit that I'm no spring chicken that can wing less than 16-weeks of training. I guess it was sheer will power that propeled me to cross that finish line last Sunday.
If I have to do this again, my sister who's a serious biker, said to do periodization and plan properly. And to add weight training to strengthen my quads which will help strengthen my knees. First thing, first.. Let's see how fast my knee heals.

Survived my first 21-km!

I was so surprised that I didn't vomit or crawl to the finish line on October 11, 2008 at the Adidas King of the Road race at the Fort in Taguig. For someone who just started marathon training in July, got injured for a month from over training, then resumed training mid-August - -I am very very happy, thrilled that I completed the 21-km distance (i.e. Fort-Buendia-South Super-Buendia-Heritage Park-Fort), finished in 2 hours 17 mins (note: arrived late and started running 4 mins after flag-off)... and didn't experience any pain that day! Note though that I felt the tightness in the thighs (lactic acid build-up) and some muscle twitches the next day and on the third day after 48-hours, feverish and deadweight. My therapist called it delayed onset of fatigue.
Anyway, a lot of things contributed to this 21-km milestone! First of course is the training. After the heel spur and plantar facitis fiasco that kept me off the track for a month, my coach (Mario Canjas - 0919 657-5124) resumed training slowly. He focused more on endurance and gradual building up the workouts in terms of time instead of mileage. He reduced the training from the previous 6x a week schedule to 5x a week with Sun-Wed as rest days. The weekly workout consisted of 2x speedwork, 2x fartlek and a long run on Saturdays where the length is increased each week by 30 mins. Plus 1x-2x Core training with Pilates instructor Cecile Sicangco. At the last 5km when I felt like I was about to hit the wall, I just tucked in my tummy and remembered her saying to use core muscles.
I still had to contend with my prevailing heel and foot injury and mind you, had additional injuries - like the shin splints on my left leg and patella femoral pain syndrome on my right knee. The plantar actually disappeared when I started wearing my specially moulded orthotics (from Ortho Frey 634-2705). The second factor is therapy. My weekly therapy sessions with Sante's acupuncturist Dr. Butch Ong was increased to 3x a week and also with intuitive nerve therapist Miguel del Prado. Note that Jo the healer left for Russia and found instead Miguel.
Third is nutrition and rest. I started taking Timelab's Endurance Fuel during training and Whey Protein after (both available at Health Express) and the chinese herbs presecribed by Dr. Ong. I also started taking a lot of carbs - pasta and bread. And most of all, sleep. I'm in bed at 10pm!!!
Lets see how I fare in New York on Nov 2!! Wish me luck.

Rehab madness

Pain is a way of our body reacting from physical stress and telling us to stop and rest. Well, last July 24, after a 5-km warm up, i had to tell my trainer Mario Canjas that my left heel really really hurts. He normally tells me not to baby the pain, mind over matter.. But its the same pain I had before I left for New York which was relieved by following Dr. Bengzon's advise to do RICE - Rest, Ice, Comrpess and Elevate.
This setback is a major disppaointment since I'm training for the New York Marathon (NYM) this November 2008 and I am already doing mileage build up of 30-40 km a week.
I rushed back to Dr. Bengzon. The xray (photo) indicated a heel spur (bone outgrowth) and plantar fascitis and recommended this time, to do rehab. I went to see Dr. Bonifacio Rafanan (Medical City, tel 706-3649) who prescribed daily rehab for two weeks (tens, laser, heat packs, ultrasound, stretches and 20-min eliptical).
This is the third week of not runnig. Dr. Rafanan yesterday confirmed what my dorn therapist (Jo, the healer at 0918-9110035 or contact AWHAI at 753-1468) said - my left leg is LONGER than my right which caused the heel spur, My left leg was trying to compensate the imbalance. Plus, my left hip is higher due to childhood scilosis. He added MORE rehab exercises to address the lower back, hip and strengthen knee, soleus muscles, achiles heel. Total rehab protocol is now two hours long. The good news is, he said I can do the NYM!!! Aside from 3x a week rehab, I can now run on treadmill and hit the oval next week for 30-minutes light jog.
I'm trying to accelerate healing ... Polo-Tri Ria V recommended miracle ortho/acupuncturist Dr. Butch Ong (tel 435-8014) of Sante Center in 7 Masaya St. in Quezon City who has cured several triathletes and also nerve healer Miguel del Prado (who's now in Spain with polo team).
All in all.. I'm doing 3x a week rehab in Medical City, 30-min treadmill everyday, dorn therapy with Jo the healer, pilates with Cecile Sicangco (to strengthen CORE), 2x a week weights with Jocel, lets see how many times with Dr. Ong who I'm seeing on Saturday... this is madness!