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Thursday, March 12, 2015

holy serratus

It's only been a week since my last post, and although I seem to have slipped back into my "normal" headache since the few days of sustained reduction a week ago, I do have some interesting rehab progress to report.

First though, a quick update to the ozone IV therapy from last Wednesday. I hadn't felt anything unusual except for maybe a little fatigue when I posted my most recent blog entry on Wednesday evening. But by about 9 pm that night, while lying on the couch (getting our nightly fix of House of Cards, obviously), I started feeling really dizzy. Dizziness and nausea are typically NOT symptoms I experience with my headache so I knew it was likely a reaction to the ozone treatment. The dizziness progressed pretty quickly over the next few minutes until I was throwing up an equally impressive and disgusting amount. There's nothing quite like a night with your head in a bucket to make you and love and appreciate the guy holding your hair back. Am I right?

So it really took me a few days to recover from that little episode...aside from feeling generally lousy, my headache had spiked back up to a high-normal range...where it's stayed for the past week-ish.

I had decided to stop seeing Dan Daliman for PT. Recognizing that I had made some significant progress with him over the last 6 weeks in strengthening my deep flexors while maintaining my c-spine alignment, I felt that we had hit a bit of a plateau and it was time to figure out the next step.

"Figuring out the next step" isn't a straightforward process, but the longer I've been in pain and seeking treatment, the better I've become at trusting my own intuition. When dealing with a chronic health condition of any kind, the ability to confidently weigh in your "gut feeling" with the advice and expertise of those around you isn't always easy, but so important. After all, there is not a single person in the world who knows and feels your body the way you do.

With that said, I've been growing increasingly frustrated by our inability to connect the dots between my headache and the chronic tension in my upper left back. As I've explained before, the "tightness" has felt so deep and SO connected to my pain above, yet has been completely unresponsive to all tried modalities by the best practitioners in their fields over the last several years...massage, dry needling, cold laser, ultrasound, acupuncture, cupping, various injections...the list goes on and on.

Of course, we don't for sure if this "tension" is manifesting as a response to my pain rather than the other way around, which is one reason that chronic pain is so tricky. I've talked about the pain-spasm-pain cycle before and the complexities of centralized pain but as a refresh, the longer you're in pain, the easier the brain's ability to properly process pain perception can change, becoming hypersensitized to pain input. It's a self-feeding mechanism...and a really shitty one at that. We're still trying to figure out the best way to tackle this possibility. So far, I have tried quite a few things that can be effective in treating more centrally-driven pain, from various medications (including the ketamine infusion) to other less invasive treatments like brainwave optimization, transcranial magnetic stimulation, eye Movement desensitization and reprocessing, etc.

But because I just refuse to give up chasing down this left upper back connection, we've decided to try a few new things. Earlier this week, I met with Tony, one of the PT's at EXOS who I've seen in the past. He pointed out how much less thoracic rotation I have on my left side and so decided I'd spend a few sessions trying to tackle that.

Yesterday, I also saw Jeff Beran, PT who I started back in the fall of 2013 (yikes!). After Craig and I caught him up to speed with findings from the past year since we last saw each other and he evaluated me, it become clear to him that my scapular mechanics are disrupting my cervical spine mechanics. This disruption was further evidenced by a few observations: my left shoulder is lifted about 1 inch higher than my right when lying supine, and my left pec minor is significantly tighter than my right.

Jeff hypothesized that the specific spot I feel on the left side is likely referred pain from the C5/C6 level, which is being affected by the scapular dysfunction.

It all makes a lot of sense to me, based not only on my understanding of the anatomy (see below how the levator scapulae connects the c-spine to the scapulae) but really more so what I FEEL is going on in my body.

It's turns out that I haven't been activating my serratus muscle (see below). Like is so often the case, it's not a matter of strengthening a muscle but actually re-learning how to fire it correctly. Proper activation of the serratus (see below in red) keeps the scapulae in better contact with the rib cage.

You can physically see my serratus "turning on" in this video.

And then, when we try to progress to lifting one arm (which we soon found out I wasn't ready for), you can then physically see my levator/traps taking over. I KNOW that the "tension" of those muscles is part of my headache and really feel like this discovery is an important breakthrough in cracking the code.

So the plan now is to do these serratus-activating exercises until they're boringly easy and then I'll go back to see Dr. Beran to keep progressing them. I've been activating my serratus all day long like a f-ing champ and the exciting news is that even in this short time I can already feel a significant difference in the tension through my upper back and into my neck. The hope now as I continue is that pain reduction will follow!

I'm also still on a once-weekly acupuncture schedule. In today's session, Sara tried a bit of new approach based on everything that's happened with my PT visits this week. Team effort at its finest.

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