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Saturday, August 2, 2014

bodywork updates, upcoming docs, and some hip investigation

So last week, I had both my first Rolfing treatment and my first manual treatment with Dr. Chikly. Here's a recap of those...

The Rolfing wasn't totally what I expected, though not in a bad way. The goal of this form of structural integration is to open, balance, and align your body by working primarily with the fascia, or connective tissue. It has a reputation of being pretty painful, and that's because when it was first developed by Ida Rolf in the 1970s, it was characterized by the depth at which the practitioner was able to get into the body and manipulate the fascial system. So, deeper = harder = more pain. These days, we obviously know more about how fascia is richly innervated with nerves. As a result, deeper/harder/more painful can easily become counterproductive, as the body responds by tensing up and consequently not allowing the practitioner to reach deeper tissue layers. The practice of Rolfing has actually evolved to be a much gentler method, but its reputation has sort of stuck. (Not that I would have cared either way...hell, I'd probably let someone take a hammer to my body if they said they could pound out the pain.)

Based on his evaluation, I wouldn't say that Dr. Maitland had any fresh thoughts (as in, new opinions we haven't heard) but he felt confident it was worth trying a few sessions. He worked on different parts of my body, though mostly shoulders and above, and used a percussor instrument (which is basically a hand-held high level vibration tool that rapidly pulses straight down versus a traditional circular motion) to help break up myofascial adhesions. I think he was expecting me to feel some changes during the session. I didn't, and that was sort of a bummer but also not super surprising. We decided that regardless of how I felt over the next few days, we'd get at least one more session on the books.

A few days after that was my appointment with Dr. Chikly. Craig reminded me before we went to be prepared for some out-of-the-box thinking. Example: Dr. Chikly had asked me to bring the supplements I'm taking right now (currently just Vit. D, fish oil, and my raw food multi) and Craig said he might hold them up to my body to test their energy fields. And he was right...that was one of the first things he did. I like to think I'm pretty open minded, even though it sure can frustrating at times to connect the dots. But, I can't exactly afford to be close minded right now either.

The manual work that Dr. Chikly performed on me was also gentle, and felt similar to the treatments I've been having with the two other cranial osteopaths (though I'm sure he was using some different techniques). His feedback wasn't extensive, but did say that felt torsion through my spinal cord, which aligns with all of the dural tension speculation we've been receiving over the past few months. Similar to Dr. Maitland, I didn't feel any changes in pain during the session but we decided to set up at least one more visit, this coming Monday.

Since both of those treatments, my pain has remained the same, which as you can imagine, is frustrating.

As always though, Craig and I have set in motion a few next/simultaneous steps.

1. This coming Tuesday, we see Dr. Dodick, my neurologist at Mayo. I mentioned this in a previous post, but the purpose of this visit is to discuss a referral to his friend/colleague and director of the headache and migraine program at UCLA, who is pioneering a procedure directed at C1. We've only communicated with Dr. Dodick via email about this, so all we know is that it's an x-ray guided C1 block that's similar to a C2 block but targets a different nerve root that has never been approached before because they didn't believe it caused pain until now. We're looking forward to getting in there to chat more and likely plan another trip out to LA soon.

2. In early September, I am scheduled to go back to AZ Pain Specialists to see Dr. McJunkin and talk more about Stem Cell Therapy for treatment of chronic pain. I'll talk more about this as the appointment gets closer or you can watch a quick video of Dr. McJunkin talking about it here.

3. This is going to seem a bit random, but lately my left hip has really been bothering me. I had arthroscopic surgery on both hips in 2010 to repair labral tears from soccer/running and for the most part, they haven't given me problems since. My left one has always felt a bit "pinchy", but as far as my commitment to fully rehab it goes, my headache has sort of taken precedence. It's annoying, but compared to my head, I can't even call the sensation in my hip "pain".

As I've mentioned before, though, I've always had this intuitive feeling of my left hip issues being connected to my left trap (chronically tight) and left side of my neck (both of which I am CERTAIN are part of my head issue). And I've had therapists work on my hip over the last couple of years, agreeing that a relationship between the two were quite possible...we've just never seemed to crack the code or gain any traction (on one or other).

In the past month or so, my hip has been feeling worse, and there have been really bad headache days that I've noticed correlate with even worse hip days. Craig and I decided it would be a good idea to restart some PT at EXOS to focus on my hips. Our thought being that best case scenario, we affect my head or gain some insight into whatever the relationship is between the two and worse case, my hip feels better and we've created an optimized healing environment for my head.

So a few times per week for the past several weeks, I've been working with Tony (PT) and Eric (massage therapist). Although all of hip muscles have benefited from the work we've been doing, I'd been having a hard time "getting at" the place where I feel the most discomfort. Kind of in the front...but underneath...a little in the back...but deep. We eventually figured out that the likely culprit is my psoas muscle. Bear with me...there is a reason I'm explaining all of this!

The psoas, also known as a primary hip flexor and ‘’13th Organ,’’ originates at the transverse processes of last thoracic and 5 lumbar vertebrae (T12-L5), bisects through deep inside of the gut and attaches at the inner femur (thigh bone). This is a very unique muscle that both flexes and laterally rotates the hip, and is one of the major muscles responsible for walking.
The lower portion of the psoas intertwines with the fibers of the iliacus, and together they form a muscle group known as iliopsoas.

The psoas also affects the structure of our upper body. It originates at T12 which is a major attachment site for the trapezius muscle. Through this junction the psoas can send forces into the upper body and directly affects the level of shoulder flexion (reaching your arm above your head).

Did you see that?!?!?

It originates at the attachment site for the trapezius!

Like I said, I have always felt 500% confident that the chronic tension in my left trap is connected to my headache. I haven't known how, and still don't, but just understanding this anatomy feels like I'm finally putting two puzzle pieces together.

Since figuring this out, I've naturally been reading and researching it like a f-ing maniac and have learned that although chronic hip flexion (sitting, etc.) is the most common cause of psoas dysfunction, it can also of course become restricted from physical injuries, car accidents, falls, etc.

I'm assuming if you're still reading, you're at least somewhat interested in what I'm writing so I'll include this excerpt that I found online...

The EMG study was done on a 50 year-old actress who, after a neck injury that occurred 30 years ago, suffered with dizziness, vertigo and tension headaches. Manipulation of the atlanto-occipital and atlantoaxial joints gave her only short-term relief. Possibly in this case, if the blocked sacroiliac joint was the cause of the hypotonic gluteus maximus, then manipulation of the sacroiliac joint would have eliminated the hyperactivity of the cervical musculature and would have been more effective than just manipulation of the upper cervicals.
It appears that the underlying cause of headache is this case was really related to a hypotonic gluteus maximus, which can have other causes besides a sacroiliac blockage. An internally rotated hip will inhibit the gluteus maximus, as will a chronically shortened psoas muscle. The gluteus maximus will be inhibited by its antagonist, the short psoas. Attempting to strengthen the weak gluteus maximus without normalizing the tightened psoas would prove fruitless.

In ordinary walking there should be minimal activity of the upper trapezius and levator scapulae but if these muscles are hyperactive, there will be over stress to the cervical spine. Janda has stated that with over activation of the shoulder and neck muscles, due to decreased activation of the gluteus maximus during hip extension, results in abnormal anterior tilt and rotation of the lower cervical segments, mostly at C6 and partly at C5 and C7.6 With each step there is excessive rotation and tilting occurring in the cervical spine.

With a patient lying prone with feet off the edge of a table, it is possible to see the hyperactivity of the shoulder neck muscles as the patient extends the hip.

This discussion emphasizes the fact that an abnormal pattern of movement in one areas (lumbar spine, hip and pelvis) was related to over activity of muscle activity in a distant area (cervical spine). The cause could have been articular (sacroiliac blockage) or muscular (shortened psoas). Obviously, we must look at the total subluxation complex with each patient.

Bottom line: I still don't know for sure what's going on, but I know that I have a cervicogenic headache (originating from cervical spine), my psoas doesn't feel good, and that psoas dysfunction can impact the cervical spine. Craig just ordered me a book called Front to Back “The Hidden Culprit”: This new approach to iliopsoas enables you to successfully treat your back pain, neck pain and headaches, which I'm really looking forward to reading.

Tony and I just started working on my psoas last week in PT (with deep tissue, dry needling, and some different exercises) so I'm feeling good about having a new focus with that too.

As always, hoping to have more positive news to report soon!

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