Recovery update and gratitudes
Many friends have assisted me in this hopefully temporary state of partial mobility. Darlene, Lindsey , Megan and Magali have all very kindly given me rides to work and home again. Numerous people, friends and students, have emailed or phoned with concern, support and offers of assistance. Several dear people have called or emailed to make me laugh in the midst of my deep despair. Carmella the cat has insisted that play is a big priority. Heidi, my wonderful PT, and Yoshiro, my incredible acupuncture guy, have assisted with skill and generosity. My gratitude to all of the above is deep, huge, and continuous!
My foot still hurts a lot with any extended walking, but less than in previous days. Today, I was able to walk to my local coffee shop, slowly and carefully. Then, I took a bus (I would have normally walked this distance with ease) to the Gryotonic studio. Although I was annoyed not to be able to walk there without pain, I was deeply thrilled to explore non-weight bearing activity, once I was there, and to move vigorously and consciously. I could think with my whole self, and experience rhythm and challenge in activity without compromising my foot.
Later, when I went for a walk in the lovely Summer day with my cane for help, I noticed that if I attended in a whole fashion to my length and width (requesting quiet, refusing to narrow or shorten, asking for width and length, refusing to check on results), my foot hurt far less, or at the least, I reacted to foot pain with minimal overall contraction.
At least I can walk a little bit. My slow and careful pace, and the required attention to whole self use, gives me an opportunity to notice the world at a reduced pace. Birds and foliage and clouds all register with more significance when I am forced to move with care and a very slow pace. It seems like I already learned this lesson earlier in my recovery, but I guess there must be more to learn.
Time Line: Injury and recovery and set backs to date
Let’s see the time line thus far for perspective on my very strained patience:
February 18 2009: fractured patella in a sidewalk fall
February 19 2009: emergency surgery to repair patella. Bone was stabilized for healing with two pins and figure 8 hardware. I was sent home with a full leg splint immobilizing leg into full extension.
March 4 2009: leg splint removed and replaced with a full leg Bledsoe brace; leg in full extension (no knee flexion whatsoever)
March 5 2009: returned to teaching private lessons and directing teacher training course with fully extended leg brace; cane required for any walking.
April 1 2009: 30 degrees flexion allowed in Bledsoe brace
April 15 2009: 60 degrees flexion allowed in Bledsoe brace; began PT
April 30 2009: Bledsoe brace removed; cane relinquished, careful walking resumes
May 8 2009: resumed Gyrotonic exercise with careful and expert guidance
August 12 2009: released from surgeon’s care
May 25 2010: hardware surgically removed from knee, resulting in far less pain and much increased mobility.
June 1 2010: resumed teaching post surgery, as well as walking to work and other destinations with great ease and joy
June 23 2010: excruciating foot pain begins to limit walking
July 2 2010: foot pain results in back spasms that make even simple mobility impossible
July 7 2010: metatarsalgia (extreme inflammation and pain in ball of the foot) diagnosed, likely due to increased mobility post hardware removal surgery. Cane required for even limited walking, even at home.
So, here I am a year and nearly 5 months after the original injury. Obviously, as evidenced by the above time line, recovery is not in any way linear in progression. This current set back is depressing and dismaying beyond tolerance. I had been hoping to resume my morning runs by Autumn; now, I am desperate just for walking capability.
Having endured so many levels of pain, and the deeper psychic pain of immobility (movement having been both my joy and my coping strategy), my patience and tolerance for discomfort is utterly spent.
Thankfully, I can teach, an activity I treasure and deeply enjoy. Now, if I can just (please!!) walk to work and home again, I will be gratefully overjoyed! Enough already! How much can a constitutionally active person endure?
Pain reduced with expert help
Thankfully, foot and back spasm were addressed and relieved to some degree via expert assistance from skilled professionals. Yoshiro, acupuncturist extraordinaire, helped reduce inflammation in my foot and spasm in my back. His work is mysterious, as in I can’t explain it, but very effective. I left his office with less of a limp and increased ease overall.
My excellent PT, Heidi, used various subtle hands-on manipulations to re-establish structural integrity and reduce the muscular guarding that had become quite fixed. In Alexander terms, my startle pattern had reached glacial proportions.
Heidi also guided me to allow the “wrong” thing while standing, sitting and walking, so that a new response to the ground could be allowed. By “wrong” thing, I mean it felt collapsed to me, but since I have been using the instrument of myself to stiffen away from my foot with great vigor, I have pretty skewed notions of what “right” or “wrong” might be. Faulty sensory perception, a basic notion of the Alexander Technique (“You can’t know a thing by an instrument that’s wrong” F.M. Alexander), becomes a more complex issue once high degrees of pain are involved. We naturally react to stop or avoid pain, and our habitual patterns, combined with heightened reactions to pain, can cost us our overall elastic balance and support. Even with all my years of studying and teaching the Alexander Technique, I need assistance in sorting out my choices in response once pain has become overwhelming. Intervention in areas of skill far beyond mine (Alexander Teachers teach, they don’t directly affect any condition) are needed when structural integration has been impacted dramatically.
So, as a result of Yoshiro and Heidi’s work, I can now think of other subjects besides pain avoidance. Although I am choosing my activities with care, I can sit, stand, and even walk with far less discomfort than yesterday.
I will return to teaching tomorrow, with the intention of best elastic self in that activity. My hope is to further improve in the dynamic quiet that hands-on Alexander teaching requires.
New diagnosis: metatarsalgia
After some days of very extreme foot pain, as well as severe and paralyzing back spasms (due to asymmetrical weight bearing and many compensations), it would be understating the case to say I have been hugely challenged in the use of myself. Good use has been close to impossible. I can’t stand, sit, walk or even lie down without nauseating pain in my back. The foot only hurts if I attempt to walk faster than a shuffle. I am not an inspiring example of grace or coordination currently!
Thus, I returned to my medical doctor today. She used a tuning fork to determine that no stress fracture exists, as the fork’s vibration would have made me scream if a fracture was indeed the issue. Instead, she diagnosed an inflammation of the metatarsal due to increased weight bearing demands after hardware removal from my knee, and my increased mobility after hardware removal.
Of course, this is a discouraging, depressing and disturbing set back, but I have some hopes of improving. I now have a little foot pad to assist my foot. The back spasm will hopefully quiet with some rest, ice and very conscious use.
You would think that after a year and 5 months of recovery that I would be accustomed to pain, but that’s not how it goes. I had enjoyed about a month of pain free mobility, and had delighted in that experience. The return of pain, and all the mobility and life limitations that pain brings, is incredibly dispiriting. Who’s in charge here anyway? Can I make an appeal for some relief? What more can I learn or relinquish? I just want to be able to live and move without pain, please.
Meanwhile, there are barn swallows swooping for bugs outside my window, and an eagle just flew past, pursued by a gang of crows. A local stellar jay is protesting a cat’s presence with vigor. I am reduced to observing, not acting, and active stillness is my only remaining option.
The challenge of further stillness
Diagnosis of stress fracture in my left foot was confirmed by both my doctor and my PT this past week. Stress fractures (hairline cracks in the bone) rarely show on x-rays, but my symptoms of localized pain, discoloration and slight swelling are consistent with a stress fracture diagnosis. Clearly, my foot was not elastically prepared for increased activity post knee hardware removal. My joyous enthusiasm for mobility backfired.
The primary treatment for stress fracture is rest, as well as minimization of pain causing activity (in my case, walking for more than a few blocks, as well as walking at more than a snail’s pace). I was so very happy to be able to walk with ease and speed after hardware removal surgery, and now I am reduced once again to dreary restriction.
I am very grateful that my knee has no pain whatsoever, and that I can teach Alexander lessons with ease. To say I am frustrated by rest requirements puts it very mildly. I am constitutionally restless, and despite nearly a year and a half of enforced limitation in mobility, I haven’t learned to like being physically stilled. I have defined my very being in life by an exploration of movement, and I wrestle mightily with being unable to walk, let alone being unable to run, dance, skip, or catch the next bus with ease and speed. Patience in healing and tolerance for immobility have been tested and worn to smithereens.
Quieting internal chatter, thinking with the whole self in stillness, and remaining dynamic without impeding healing is my current challenge. There are new skills to be learned, more identity with a constructed self to be relinquished, and more active stillness to be embraced. A sort of dynamic surrender is key now. I don’t like this experience one bit, but also trust, in my quieter moments, that larger learning is occurring, and I am hopeful that I can embody these hard lessons to assist my students in their mobility challenges, and the necessity of stillness as an internal skill.
The Alexander Technique offers a choice in response to stimulus. Although I struggle, my choice in response is to learn, find a new quiet, to go from undoing to doing without doing too much. Being happy with this necessity is not the question; learning is my only option. Fighting current conditions of self will get me nowhere. The battle becomes internal to a more extensive degree: quiet, refuse to narrow or shorten, request an overall elastic self, in an ongoing spiral of active stillness.
Stress fracture/cane use
After a long conversation with a consulting nurse, and some internet investigation, it seems a strong possibility that my enthusiasm for movement post hardware removal surgery has resulted in stress fracture(s) in the long mid-foot bones of my toes. This supposition will be confirmed, or another diagnosis offered, when I see my doctor this coming week.
I have been icing, elevating, resting and using a cane when I walk. Pain is reduced by all of above. I had learned how to direct well with a cane when I had a full length leg brace, and now can apply that learning again: don’t lean on the cane, but think of it as an extension from my hand to the ground, so that the cane becomes a source of gravity. Then, I can spring upward from the ground from that contact. Allow a whole self rhythm so that the cane swings forward as my injured foot swings forward, naturally and without interference. Look up and out rather than only downward. Enjoy the view, relish the slow pace, mourn lost mobility, but know the loss is temporary.
To say I am weary of recovery project is to wildly understate the case. But, what can I do? Life has happened, and all I can do is learn.
The right way to go easy
“The right way to go easy
Is to forget the right way
And forget that the going is easy”
Chuang Tzu
New pain and immobility
Since hardware removal surgery a month ago, I have been blissfully enjoying pain-free mobility and thus daily walking for both transport and fun, as well as overall relief from having my attention narrowed by discomfort.
Pain in my left foot inexplicably began a few days ago and has become intensely limiting in the activity of walking. Suddenly, and without any obvious trauma (the broken toe is healed), walking is a near impossibility. Thankfully, I can teach without pain, which is curious to me. No amount of inhibition and direction improves discomfort in walking.
I suspect a reorganization in supportive systems is taking place, at a great cost in comfort. After months with my leg in full extension, followed by many more months with systematically invasive hardware, my nerves, muscles, tendons and ligaments may be rebelling and stopping me from further use.
This is hugely discouraging and depressing. I had come so far, and now I am partially immobilized again! My endurance for pain in movement is diminished to a thread, and my stamina for directing and inhibiting in walking is all gone.
I will have to not walk until some assistance from my PT or other professionals is available to help me sort out the organization of myself beyond my skills.
Sigh!
Skipping, dancing and joy!
Yesterday, I skipped around my office just because I could and for the joy of being able to skip. Then, once I was home, I put on music and danced like a crazy person. I can skip and dance without pain! Running will hopefully follow sometime soon, with the proviso that I can use myself well and not challenge the knee beyond current strength.
Hurray!! After 16 months of pain and mobility limitation, hope of full function informs me with great gratitude and happiness!
Further report: metal free knee
For a year and 4 months, I have been living with varying levels of continuous discomfort due to patella fracture. The hardware that was surgically installed post-injury was initially necessary to stabilize the patella for healing. Once I established (recently) that the hardware was no longer needed for bone healing, I had it surgically removed.
The results of hardware removal seem nearly miraculous to me. I can now sleep, walk swiftly, ascend and descend stairs, sit for more than 10 minutes, and pursue all daily activities without pain or fear of pain. Although I still habitually guard or limp in some circumstances, I can quickly recognize my response as unnecessary and relinquish the compensation.
Today, I returned to Gyrotonic exercise with a happy curiosity as to what I could do with ease or effort. I was overjoyed and ecstatically thrilled to find that I could do my routine without any knee pain at all! Former restrictions due to pain no longer applied. Now, I can pursue both overall movement exploration and specific injury related strengthening without the limitation of pain and inflammation due to hardware interference.
Many lessons are apparent from this recent experience. We can use ourselves as well as possible with any condition of self, but structural interference (surgically inserted hardware, for instance) limits use and function in huge ways. Pain as a continuing signal restricts an overall elastic strengthening, as well as disrupting a whole person response. Pain becomes primary, and choice in response becomes dictated by pain. Alexander thinking can assist, to a point, in responding with the whole self in a manner of use, but can’t diminish pain, only a choice in response to pain. Removing structural interference that causes pain allows a vastly new world of response.
I did pretty well with living and teaching while in medium to high levels of pain in the past 16 months. I was able to keep a big picture, find ways to use myself as well as possible, and even explore strengthening with good use. It was a deep and large challenge, on far more levels than the physical. My entire sense of self has been questioned in this experience. I am not any longer who I was previous to injury, nor do I expect to be ever again. Now, however, with pain as a past measure, I can actively un-prepare, not fix, allow new coordination, and begin to explore life without the pain that has informed me for so very long.