Monday, September 19, 2011

Finish line in sight.

The dissertation one, not the marathon one.  Which is, again, the reason for my blogging absence.

Let me catch you up on the running.  The last you heard from me, I was having numb and painful felt a lot like compartment syndrome.  Dr. W thought it was a slipped disc.  I kept seeing Penny for traction treatments, but I just kept getting worse.  Finally, an MRI was ordered.

My back is FINE.  Now, that's a good thing (one thing I do not need is chronic back issues)...except, what was with all the pain?  When I would start running, I'd be fine.  Within a mile...pressure, pain, and, finally, numbness would build in my calves (especially on the right one and especially on the outside).  You can see why it felt like CS.  The one thing that differentiated it, though, was that it got better as the run went on.  If you've ever had CS (and my sympathies to you if you have--it's brutal)...things get worse and worse the more you run.  You might have a quarter mile of pain free running, but the rest will be horrendous.  So I knew this wasn't CS.  Also because I've had the surgery and had my legs re-tested and they're good.

So what was it?  Dr. W didn't know, but thought it sounded like nerve damage.  So he ordered an EMG--which is a test that assesses nerve conduction (speed and force).  So I had a bunch of needles stuck into my legs, and it was determined that I do have bilateral sciatic nerve injuries.  So Dr. W had hypothesized that my bulging discs were pinching the sciatic nerve, thus causing my symptoms.  Turns out I do have sciatica, but not from my back.

From what, then?  The piriformis, my neurologist explained.  A tiny little muscle deep in your butt, attached to the back of your pelvis.  It's a hip stabilizer, and happens to be anatomically very close to the sciatic nerve.  When the piriformis gets tight or overworked, it can pinch off the sciatic nerve.  This leads to decreased conduction in that when my muscles are trying to run, the nerve impulses are delayed in getting to them.  So nothing works right, and it hurts.

He explained that injections to the piriformis muscle are generally helpful with this condition--cortisone injections.  Reduce the inflammation of the piriformis, unstrangle the sciatic nerve.  Fine, sign me up. wasn't that simple.  There are different ways of doing these injections.  Blindly or...well, not blindly.  Like I said, these things are DEEP.  Without going into too many details, let's just say that my cousin-by-marriage Tatiana came through for me and helped me get set up with an interventional radiologist who does piriformis injections under CT guidance.  That is, he puts you under a CT during the injections, injects you with dye so he can see the piriformis, and thus ensures that he goes deep enough but does not further injure the sciatic nerve with the needle.

His name is Dr. Staser.  He looks 18, but he's a really good piriformis injector.  He used spinal needles to do it (about six inches long), and "bathed" my piriformis muscles in cortisone.  He told me it had about a 60% chance of working and that I wouldn't know for 4-5 days.

The next morning, though, my run was a bit better.  Sunday morning?  It was a LOT better.  For 22 miles. Just a little tingling in my right foot.  None of the gripping pain.  So I'm counting the injections a success, and looking forward to them continuing to work over the next couple of weeks.

So I am officially in taper and I am, officially, injured.  But I think that taper with the injections will get me to race day on fresh legs.  If not?  Nothing I can change.  Still three weeks until race day...a lot of healing can take place.

So where did this injury come from?  Well...I'm pretty sure it came from my hip.  My hip injury has been really nagging, but not too painful.  So I've kept running on it.  It has stressed my piriformis into taking over its job, and so there you go.  True piriformis syndrome is rather rare....and so of course I got it.

The next time I blog, the dissertation will have been handed in.

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