So I am not the only one in the world that feels like this! - April/May 2012

The first thing I clicked on after I typed  in “Hip Impingement” to google was Louisa Weeks Browning’s blog:  http://myfaihippain.blogspot.co.uk/

I  still have it saved as a bookmark. I quickly found her list of symptoms:

Basically they were the same as mine:

1) Deep pain in the bum
2)Leg pain, side, front and back, all the way to my knee but never beyond
3) Sacroilliac Joint pain
4)Groin Pain - mine was a stabbing one, like a hot knife, on and off.
5) Hip pain, mine was around the side of my hip, like in a C shape
6)Muscle Spasms in my lower back and legs. Louisa described the areas of her spasms being the QL, multifidus, TFL and illiiotibial band. I googled these terms.
7)Pain that comes and goes, worse on activity. everything I did involved pain, bending and twisting when doing the housework, caring for the horses, decorating and gardening in particular.
8) Kept me wake at night. Far to many nights I have lay awake just starting at the ceiling with intense stabbing pains in my back and hip.
9) sitting in one position very painful. Doing anything that involved sitting for a long time like the cinema or theatre were a no go. Long car journeys were horrendous, I usually dosed up on codydramol before hand if I wasn't driving!
10) Louisa said that her pain limited her to 30mins walking a day, At that time I actually felt that after pushing through the morning stiffness and getting active walking the dogs at work eased my pain. For a long time I felt like walking was the only thing keeping me going, and the only exercise I could do really.
11) Hip clicking on flexion. Oh yes, it could be a party trick. I know the exact point as which my hip will clunk (mine is a clunk rather than a click, deep inside my hip)

 

I Just couldn’t believe it. There was a list of ALL my symptoms, right in front of me, but written by someone else! I mentally put a tick next to them.  I didn't fully tick number 6 until I had googled the words QL, multidifidus, TFL and illiotibial band. Then I ticked it properly.

Incase you to are wondering:

QL = Quadratus lumborum muscle in the lower Back:

 

 

 

 

 

 

 

 

 

 

TFL: tensor fasciae latae muscle.

Illiotibial band the tendon  along the outside of your thigh joining your hip to the top of your knee. Basically the area where if I pressed, I could make myself feel sick.

Heres a good pic showing the TFL & IT band

I was rather shocked. There were people out there with the same symptoms as me? But I thought I was some sort of freak, no one else I talked to in "real life" to seemed to have my weird symptoms and no one who has tried to treat me had ever mentioned this FAI thing until Donna. Why didn’t the MSK or Pain Clinic doctor's mention this?!

I continued googling and reading A LOT is was quite an eye opener to realise I wasn’t the only one in the world that felt like this, that’s honestly how I was beginning to feel!

To start with it was over whelming to read people's descriptions of their FAI and treatment. Lots of big words (so lots more googling at a tangent!) and lots of scary pictures to. I found my way to the FAI face book pages:

https://www.facebook.com/groups/FAIhip/

https://www.facebook.com/groups/hipfai/

https://www.facebook.com/groups/255957281107466/

 

 I joined them all and became a bit addicted to reading them. Again, this was a little overwhelming as well as now I was not only reading of people experiences but seeing pictures of post op scars, their xrays and MRI’s. It was amazing. I was also reading a lot of the problems people were having post op. It seemed treatment for this FAI was not an easy fix with many people having lots of surgeries, and lots of different surgeries too. It was a mine field to wade through, and a very steep learning curve. I also found that many people also took many years to get to a diagnosis of FAI, so I wasn’t alone there.

I came to the conclusion that most FAI can be treated via key hole arthroscopy surgery, which meant a few weeks on crutches. I had never been on crutches in my life and the thought of that freaked me out. When I told my husband about it, he said “but what about work? You can’t work if you are on crutches” He was right. I worked for myself and if I couldn’t work, I would have no money. I would loose my hard earned clients as well. Maybe I couldn’t get this treated after all? Or perhaps there was another way. Maybe some sort of specialist physiotherapy could delay the need for surgery?

Anyway. I was getting way ahead of myself. I needed to get a diagnosis first.

April 2012 No More Crunching and Cracking and Femor-acey-what?

Donna was lovely. She did my exam, very thorough, took all my history that I could explain (with a sigh from me first!) watched me walking, stretching in all directions, pulled my legs about in all directions. One movement in particular that she did on my left leg was to flex my leg up and rotate it  OW!!! Pain shooting though my groin straight to my SIJ!

Well she thought she could do some work on my lower back. “No realignments – you’ve had far to much aggressive cracking and crunching about. What you need is just some gentle manipulation and massage to try and free it all up and try to get you exercising and strengthening your back and your leg. You are weak as a kitten” 

Ok sounds like a good plan, especially the not doing any more manipulations. Phew.  But she also said she wanted me to get my GP to refer me for an MRI on my left hip as she said I was testing positive for something called Femoral Acetabulum Impingement, FAI. She explained the CAM and PINCER versions if FAI. She also said that surgery might be requires to fix it. For some reason, this did not freak me out.

FAI, Cam, pincer, all new words to me. I hadn’t got a clue what she was on about but the thought there might actually be something wrong with me for real, that it wasn't all my head felt good!!! Maybe I can get it fixed. Maybe I can not have a bad back?! I got straight on to google when I got home. And so began  the last 18 months of my journey.

2010 to 2012. Chiropractors, the gym and massages.

In late 2010 I had had enough  of my back pain again and decided to go and see a chiropractor. He was nice. He Listened to me. He was surprised that no one had had any success at treating my pain. He said he would “fix me” great I thought, there is hope, lets stick with this guy for a while! The first few sessions were great. He said I had a twisted pelvis and that me SIJoints  were “out” so he used to do a re alignment of my SIJ’s which I hated but thought it was doing me good. This was the realignment he used to do: http://www.youtube.com/watch?v=NhwECwj3LDI  to watch this now makes me feel sick.

He also used acupuncture, which I got a fair amount of short term relief from. But it became apparent he was not going to be able to fix me as I just kept having flair ups and spasms. He referred me to Pilates instructor but she was snooty and made feel fat and unfit. We eventually went to just 3 month chiropractic checks, they were abosultly pointless and I was a wreck in between times. I think I realised he knew he couldn’t fix me but he never said. I just stopped going

I think it was about November 2011 we joined a nice gym. I was trying to swim and use the gym but the best way to describe it was that I just felt exercise intolerant. I tried swimming but breast stroke just hurt my back and I cant  do front crawl. I tried running on the treadmill and cycling but it all hurt my back. My back and shoulders were so tight and I was so miserable that winter. I decided to go and see Tanith, the deep tissue masseuse at the beauty salon there. It wasn’t cheap but I really enjoyed the massage in a calm and tranquil environment. She was really good. But I know that the severe tightness of my shoulders and lower back freaked her out. She kept at it though and it felt good. But I knew it wasn’t fixing anything.

Tanith and I  used to talk about my bad back. About what made it hurt, what treatment I had had and what I could do about it. I can remember one session she started massaging my upper leg, on the side (what I now know to be the TFL/IT band) It was SO painfull I was almost sick. “ I bet you didn’t realise you were so tight there” she said. No I did not! She mentioned to me a client of hers had been to a really good physio “Blue something” she said.

Over the next few months I continued with the massage. But my back pain was just getting worse. My legs hurt all the way to my knees, all the way round. If I pressed lightly on the outside of my thighs I could make myself feel sick. I was depressed. The doctor now had me back on the amitryptaline and also co-dydromol and tramadol when the pain was really bad. she didn't  think the pain clinic could do any more for me and I didn't want to go. I needed to do something new. Perhaps a sports massage was what I needed, to relax my legs? I got googling and found a Sports Physiotherapist called Donna, at Bluesky . Perhaps it is that one Tanith was talking about?  So I went to see her in April 2012.

2009 to 2011 and looking forward to my 40's whilst still being in my 20's

In April 2009 we moved to North Somerset for Pauls new job and rented a house with a paddock for the horses. Pauls parents moved with us, the plan being that we would rent for a couple of year to suss out the area and then by a property together. That didn’t happen. Pauls Dad had bowel cancer and he died in 2010. I think he and his Mom found it hard to let go of that house and we ended up staying there until 2013.  

I continued to have chronic back pain. Caring for the horses was becoming difficult never mind riding. I realised I could no longer be a vet nurse and I took on a Franchise Pet Care business working for myself. During the early days  my back went into a major spasm whilst I was at work on my own. I went to the nearest Minor Injuries Unit I was so scared of the pain. All they did was advise that I go and see my GP straight away. I didn’t really feel I was safe to drive. I was like a cripple. I drove in intense pain and tears all the way to our GP and parked in the disabled space outside the GP practice. I was in a mess. She prescribed diazepam and rest. I went home and went to bed for 3 days with my pills.

I can’t actually rember the  pain that forced me to go a see the GP again in 2010, complaining of pain in my right hip. But it is in records.  I got sent for an xray. Here it is:

My Hips, 2010.

 The GP said the results were unremarkable. So I carried on a little while longer before going back again to ask to be referred to the pain clinic again for my back.  Pain clinic decided that I should try the facet joint injections again. I never felt really comfortable with this as I remembered how much they hurt before for no relief. But some how Dr Chaun talked me into it, saying perhaps they weren’t done properly the first time, that  they might work this 2^nd time. It was awful.  Sooo painful and no sedation. And yep. You guessed it no relief in my symptoms whatsoever. At the follow up appointment, I honestly felt that Dr Chauan thought I was lying when I said they gave me no relief. He put me on Amitryptaline for nerve pain and to help me sleep. I was to take 40mg at night. It was terrible. It gave me such a dry mouth in the mornings and I felt groggy all day. Although it did help me sleep. I went back and said I could not hack the Amitryptaline. He said I was running out of options now. That there was no surgery to help me as my disc degeneration was “Not that bad” .  I was beginning to think maybe all this was in my head. Maybe the next step should be  a psychiatrist?! He referred me to the TENS nurse.

I did get some relief with the TENS machine, only when I wore it though. I used to set the timer and go sleep with it on. I got an NHS loan one for a while and got on well with it. I would have kept it on all the time if I could! But I had to give it back after 3 months and I didn’t get round to buying one of my own. I bumbled along again for a few more months, just getting on with it. I was resigned to the fact I had chronic back pain and there was nothing anyone could do for it. I was like millions of other people, a statistic. An adult with lower back pain. I might as well try and get on with it. My riding instructor at the time also had a bad back. He was in his late 30’s.  His spinal specialist told him that there was nothing they could do for him either, but that in your 4^th decade of life, lower back pain can often get easier as the discs become more static. Oh well that was something to look forward to. Only another 12 years or so and my back pain might ease!

2003 to 2009. 6 Years of lower back pain.

I really am not sure when I when to the osteopath first. It must have been around 2003/2004 . But I do know it was due to the pain in SIJ’s and a generally stiff lower back. I can remember her saying my pelvis was twisted. I had some manipulations and massage sessions from her but it didn’t really make a difference and I ended up stopping going.

Over the next 6 years I just tried to get on with my bad back. After all, my GP told me 50% of the adult population have lower back pain at some point in their lives. I must be now be in that percentage.  I would go several months not doing anything about it and occasionally I would go the GP to complain about it. I can remember having two sessions of useless NHS Physiotherapy. I went to another osteopath.  She obviously did not make much of an impression on me as I cant even remember where or when it was! In 2006 I think it was, I eventually got a  referral to the local Musculoskeletal Clinic in Malvern. I saw a doctor there who actually listened to me and agreed my pain was not acceptable. He showed me some exercises that actually helped me feel a bit better.  I had an x-ray and an MRI scan. I cant remember the exact details. But basically the sum up was that there was some degeneration of my lumbar discs but that the bulges seemed to be on the opposite side to where I was complaining of pain.

I should mention here that over the years my pain has switched sides so many times, I cannot keep track of it. Sometimes its was left SIJ, sometimes Right SIJ, sometimes both at the same time. So they were a bit confused by my case even back then. The doctor at the MSK clinic referred me to the pain clinic.

The pain clinic decided  that steroid injections into my lumbar facet joints  and one of my SI joints - I cant remember which one - would be a good place to start. The Injections were scary, I had to lie on my front on a table and they used an xray machine to guide the needles. I was sedated and had to be topped up during the procedure as it was so unbearably  painful that it made me cry. It was like a hot knife being forced into my joints. 5 times.  I got no relief from this procedure at all. I still had SIJ pain. The pain clinic doctor was rather surprised.  I felt like perhaps he did not believe me. I left pain clinic with the instructions to do Pilates, take diclofenfac, and try a TENS machine.

I had begun work as a trainee vet nurse in 2004. I struggled with my back there. Vet nursing involves a lot of heavy lifting  of sedated animals, holding on to struggling strong dogs,  a lot of walking about and a lot of standing still in one position whilst monitoring anaesthetics or assisting with procedures. I found my back was starting to  lock up and spasm. Particularly  when standing still for long periods. I had one terrible flair up there one day. I can remember being bent double across a consult table, crying in pain as my  back had gone into spasm. My friend Mari came and drove me to A&E and I was given diazepam and off work for 2 weeks.

I moved to a new vet practice in 2007. I can remember trying my best to hide my bad back during interview and trial period. In the two and a half years I was there I had a terrible time with my back. It hurt so much every day, aching, burning, occasionally grabbing me with severe pinching pains in my lower back. I was very miserable there. I would often drive to work in tears. I began to start taking a tablet called Citalopram due to anxiety. I was beginning to realise vet nursing might not be for me.

I think it was in 2007 that I went to a 3 day training clinic with my horse. My back was horrendous. It felt like it was in permanent spasm. I can remember lying on my bed there, sobbing. With heat packs stuck to my back, a cumbersome back support that I had off ebay to try and get me through the clinic and loads of over the counter pain killers. I was miserable. But I pushed through with the horse riding, I don’t really know why. Probably because I didn’t want to give in to the pain. I can remember one lesson having pain in my right SIJ, my horse bucked and the pain SWITCHED to the left SIJ! What the hell?! I thought I was going mad. This can’t be right.

Trying To Rember When I Didn't Have a Bad Back

One thing I often find  myself trying to do is think back to time when I did not have back pain. It is quite difficult and for some reason I find I think of it terms if what boyfriend I had at the time! I don’t know why, I just do. I guess that is perhaps how I have sectioned my adult life.

In September 2000 I went to agricultural College in Cornwall to start a HND in Horse Studies. Part of the course involved being on a duty Rota for caring for the college horses. I can remember not having a bad back when I started doing that. It was hard work, we would be assigned 2 or 3 horses each for the week and we would be responsible for all their care, alongside our classroom studies and general student life.  Then all that went  a bit a wrong when I fell of a horse.  The horse belonged to the stables head girl and I remember finding out after that she had been feeding  him horse race horse cubes because she thought it would be funny to see someone trying to control him if he went wild. The horse was called Star. He really was a sweet pony and it wasn't his fault.  I can’t really remember what happened but I can remember hitting the deck in the middle of the indoor school , left side down.

For a long time I blamed my bad back on that accident. That was where I used begin the story when ever I was asked. I didn’t break anything, didn’t go the doctors. I probably should have but when you are 19 you think you are invincible. I can remember having a very stiff neck for a week or two afterwards, and struggled to do my horse duties. I can remember one day in particular I was had been assigned to the Riding for the Disabled Association block. The 4 horses in there were all lovely and easy to care for . It was out of the way a bit and it  was possible to hide for a while in there. I can remember  sitting at the back of one the ponies stables crying because my neck and back and were so stiff.

At that time, I was with David. I split up with him in 2001. I can’t really remember a bad back being much of issue between that fall  from Star and when David & I  split up in 2001. In 2002 I got together with Paul, and moved to a different agricultural  college to begin my Degree in Equine Science. I think it was then that I first started to notice my back. I had a friend called Ellie and she had a really bad back. She used to really struggle with sitting on the bench/desks in the lecture theatre. Her lower back used to lock up and she would find it difficult to stand. I sometimes wonder about Ellie, where she is on her back pain journey now.

Anyway, I noticed I also began to have a bad back, almost as if it was coming down in sympathy for Ellies. But it was never as bad as hers. It was worst when sitting for long periods, my lower back would go quite numb and cold/tingly.  It came and went. It wasn’t chronic. I can remember going to the GP  about it and pointing out my pain as being “in the dips either side of my spine” What I now know to the Sacroiliac joints. I didn’t get  much out of the GP, just about doing stretches, Pilates, take paracetomol and ibuprofen.  And so that's what I did. I just got on with it for a year or two. Deciding that I must be one of the people that has a bad back.

Paul and I moved to our rented cottage on a  farm  half way between his work and my college in 2002, with  my then yearling Gyspy Cob. And we bought a pony as a companion for him. We got married in 2004. Whilst there I completed my degree. I also realised my dream of becoming an Equine Vet nurse might be unfeasible with a bad back. I started looking for a trainee small animal vet nurse job, which were few and far between.  So whilst waiting, I worked at a chemists as a dispenser. I can’t remember having much of a bad back, though at the same time I was undergoing investigations and treatment for endometriosis.  So I was having a lot of pelvic pain, I think my back pain and endometrioses all got a bit mixed up during that time. I had  an operation for the Endo in 2005 and resolved that issue.

So I think in answer to my question "When did I not have back pain?" the reply is 2000. When I was 18. I am now 32.

Why I sigh.

 I am sat in the passenger side of my works van as my husband drives back along the M5, England. Its 8pm on the 28^th January 2014. We’re just into that “dark bit” where the carriageways are about to spilt levels. I am clutching a pair of crutches in my left hand. I start to think about what has brought be me here, to that exact point in time, doing be doing what is I was I am doing.

 I notice now that whenever anybody, especially professional like physios or consultants’ ask me to explain my back pain history, the first thing I do is sigh. I am not sure why I sigh. Whether it is because it just seems like such a lot to explain, or I think it is just to complicated to make any sense, or I think they aren’t really interested.

 

Actually I think I sigh because I am so dam tired of the journey I have been on for the last 8 or 9 years. So I thought last night as we were driving home from my first hydrotherapy sessions 8 weeks after an open surgical dislocation and debridement on my right hip, I might perhaps try and write it down. I seem to have a lot of time lately. Maybe it will help me get my head a bit straighter after this roller coaster ride. Or perhaps someone might stumble across  it and  find it helpful. Anyway. I am going to give it a go.