Physical Therapy – the next step in healing

I had my first physical therapy appointment this week.  I got a phone call the day before my appointment that Danielle would not be available due to an illness – but they could move me to the afternoon to meet with Brenda.  I asked if my follow ups would stay as scheduled with Danielle, and was assured that they would.  Knowing this, I accepted the change and planned to meet with her the next day.

She assessed my movement and range of motion, checked my reflexes and strength, and asked about what I have been doing so far and how I am feeling at this point.  While I have been doing quite a bit of stretching, she wants me to focus more on some micro movements.  Building stability and supporting the fusion as it heals.  I was given a sheet of stretches and exercises that take about 20 minutes to do each day.

I start laying on the edge of my bed and letting the outer leg dangle down – stretching the front quadriceps and hip flexor.  Hold for 30 seconds, bring it up and rest, then repeat.  Then switch sides.  Next, on my back knees bent, feet flat – lift and tighten my pelvic floor, belly button to spine, keeping my knees together, slowly rock knees side to side – holding stability and gently stretching hips – but not rotating the spine and it’s a steady motion – for a count of 20.  Next comes a hamstring stretch with a strap – knee bent slightly, foot flexed, pushing up through the heal, and keeping the pelvic floor and belly button engaged – 30 seconds, switch sides, twice each side.  Next is knees bent, feet flat, pillow between the knees.  Inhale and on the exhale, squeeze the pillow, lift the pelvic floor, and belly button to spine.  10 repetitions keeping steady with my breath.  Keeping with this same them, of lifting pelvic floor, belly button to spine, I then do slow and deliberate marching – micro movements of lifting my heel no more than 2 inches – focus on engaging those muscles in my pelvis and lower transverse abdominals.  Count of 20, and then we continue on the marching theme with lifting foot, straighten leg, lower and lift (small micro movements of less than 6 inches total) and back to knee bent, foot on the floor, then the other side. Up, straight, lower, lift, bend, down…count of 20 total.  When I’m done with all those, I roll to my side, feet stacked, knees stacked, hips stacked…and it’s clamshells – 20 working up to 30 each side.

When I’m done with the series of exercises, then I stand up between the bed and the wall and bend at the hips…hands on the wall to stretch the long muscles in my back – it’s kind of a modified downward facing dog – to stretch the long muscles in my mid and upper back.  I hold it for 30 seconds, and then switch to bring my hips forward and a slight backbend, allowing my hip flexors to stretch for about 20 seconds, then another set of stretch for 30, and flex back for 20.

So far this is feeling good, without too much difficulty.  I had to set my mind to just doing it first thing in the morning.  So I get up, let the dog out, start the coffee, and then into the spare room to lay on the bed in there and do the stretching and exercises.  Then let the dogs in, feed them, and off to the shower to start my day.  My intention is to then be able to continue to walk throughout the day and especially at lunch, and at least 3 days a week, spend 20-30 minutes doing a gentle yoga routine.

For the next 6 weeks I’ll be seeing Danielle for more physical therapy appointments on Tuesdays and Thursdays – so we’ll see how the routine changes, but it is my hope that getting up and doing the physical therapy first thing will be a routine I can keep long term – and that hopefully Danielle will help me to incorporate more yoga into the therapy routine.  I also wouldn’t mind using the morning to do a little ride on the exercise bike too – before I’m really awake and full of excuses as to why it won’t fit in today’s schedule.  I’m working to establish healthy habits and I know it will take a bit of time to establish the habit – but that’s where a little help from God will be useful!

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Counting Recovery

It is not quite 2 months since my surgery.  If you count days of the month, then tomorrow is 2 months.  If you count weeks, today is the end of the 9th week of spinal fusion recovery.  If you count weeks another way, Monday marks the start of the week 9-10 of recovery.  It’s kind of like vertebrae and disks – if the day is the vertebrae – and the disks are weeks – there is a week before and a week after.  I think at this point, I’m ready to just start counting MONTHS.

So I’m at 2 Months post op.  As I sit here today recounting my recovery, and reflecting on my progress – I feel “pretty good”.  I’ve made tons of progress of course, like I talked last week – no more walker, cane, back brace.  My discomfort is manageable.  I recognize that I have physical limits on what I can do, and my body does a good job of telling me when I’m pushing those limits.  But if I don’t do a bit of pushing, I won’t make progress, and I understand that too.

What am I doing?  Well, since you asked…I’m using a fitness tracker app to track my steps and other activities throughout the day.  It varies by day, but I generally get some combination that adds up to 6500 or so steps.  I don’t know the algorithm or logarithm that tells it that 15 minutes of stretching equals 1321 steps, but I look at it from an “overall activity level” .  For the record…that’s up from 250 steps a day the first week after surgery! Ha!!!  Anyway, I got on my exercise bike yesterday for 10 minutes, I did a 20ish minute yoga video and about 5 minutes of additional back stretches, and ended the day with a grand total of 6618 calculated steps for the day.  I try and use my lunch hour at work to go for a quick 10-15 walk, and then a gentle yoga video and some stretches.  The rest of what I do is just my moving around at work and home.  I’m trying to get into a routine of getting on my exercise bike more – since that is easier on my feet than tons of walking.  But mornings…ugh.  Trying to find the discipline to get up a little bit earlier every couple of days and pedal while the coffee brews…that’s my goal.  I enjoy my yoga during lunch time as well.

Last year while considering my fitness level, and my back pain level, I was researching yoga – but honestly, as a Christian, I was feeling a little bothered by the “Eastern Philosophy of Yoga” – the chanting and ooooohhhhhmmmmm – the stereotype I assigned in my head to what I thought about yoga.  And then I stumbled on a website that was Christian yoga practice.  Lots of information, some time in prayer, and a few websites later, I had reset my internal bias, and was ready to spend some focused time on a yoga mat WITH GOD.  And so for the last many months, I have been combining bible study, prayer, and yoga to my lunch time routine.  My favorite website and “teacher” is at www.carolinewilliamsyoga.com .  I’ve even exchanged emails with this beautiful woman, and she is by far my favorite Christian yoga video instructors.  A few of her guided meditations got me through a couple of rough nights early in my recovery, too.  Having that spiritual, faith-filled connection was vital when I needed to get through a pain flare.  Anyway, there is actually quite a community of Christian yogis out there.  If you too have been reluctant to think about yoga – I encourage you to do your own research, but I would hope that just watching one of Caroline’s many videos and listening to her bible study and prayer in EVERY PRACTICE, will convince you that just maybe, yoga might be a good fit for you too.

Alright, so next week I have my first appointment with my physical therapist.  She incidentally is also a yoga instructor, just FYI.  When I worked with her before for an issue with my upper back/shoulder she had me doing some yoga stretches then as well.  I hope that while working with her, I can get some tips about what modifications I can make to some poses, as I regain some strength, stability, and flexibility in recovering from this surgery.  I’m sure she’ll have me doing more than just yoga, but I’m hopeful we can work towards a sustainable long term plan to help me keep my back as strong and comfortable as possible.

Balancing – 7 weeks post op

It’s been 7 full weeks since surgery to fuse my spine from L4 to S1.  My incision is well healed – not that people see it, heck I don’t even see it unless I turn just right and look in a mirror over my shoulder.  I run my fingers along it as I wash in the shower, and it’s smooth and doesn’t hurt to touch it.  I can rub lotion over it after my shower with no complaints either.  Gentle pressure around the surgical site is fine, the muscles seem to be fine underneath and I don’t feel anything “weird”.  When I had my toe fused a few years ago, the hardware is just under the skin – so I can visually see the plate and a couple of the screws in my foot – and obviously I can feel them under the skin.  Not the same with my back.  I’ve got a layer of skin, (fat), and muscle that covers my spine and therefore the screws and rods that are holding my spine into place.  Plus, there is bone kind of packed all around it like modeling clay that will ultimately add even more strength and stability.  If you read on the internet, you will hear that the first 3 months after fusion are critical for allowing the fusion to “set”, but you are not completely fused for more like a year, year and a half.  So, while 7 weeks sounds impressive…I’ve got a LONG road of healing ahead of me.

But really, I’ve come a LONG way already!  The first week, I could barely walk.  I used a walker most of the time and relied on a back brace any time I had to get up.  I couldn’t get out of the recliner without help, and it was a monumental effort to get onto the toilet, and back off of it.  One week post op I needed the walker to get up and back down from sitting – in the recliner or on the toilet – but I could walk without it (it was pretty handy for carrying stuff from the kitchen to the chair though!) I still used the back brace constantly when I was up.  I started walking up and down my driveway, with a cane, and I managed to actually cook a few meals.  Two weeks post op I was starting to feel more normal and steady on my feet – but my surgeon wanted me to wean off the use of the cane, and the back brace.  So I worked on that, and I started to drive a little bit too.  I also started to actually sleep in bed for a few hours each night.  It was hard to re-position during the night, but it was nice to be completely horizontal for a few hours.  Three weeks was acclimating to walking more and preparing to go back to work, finding clothes that I could wear, and getting as much rest as possible.  Four weeks post op I was back to work where the biggest challenge was making the drive in and home each day.  I worked short days, but they still felt long!  I also was allowed to begin doing stretches for my back and start to strengthen some of the muscles.    Five weeks post op, was still short work days, but I was feeling more and more comfortable and while I knew it would be a long and challenging day to teach my seminar that Friday – I felt like I was ready.  It zapped my energy, but I was glad to be teaching and feeling good enough to BE teaching.  I was also learning to recognize the necessity of resting – not just sitting at my desk with an ice pack, but truly resting.  Six weeks post op, I pushed through a long drive and teaching again, but had some girl time and rest with one of my favorite friends and her daughter, took time out for a massage, and an afternoon for more girl time with another favorite friend.  I also got the clearance from my surgeon to “do more” – return to things I’d been doing “pre surgery” like yoga and riding my exercise bike.

So it’s nearing the end of 7 weeks post op, and I’m sitting here feeling a little sorry for myself.  In my well established pattern of being a chronic over-achiever, I pushed my limits this week.  I had lots to get done, and not a lot of time to accomplish it.  So while I did sit in my chair in my office with ice on my back, and I did go for walks at lunch time, and I did do my stretches and a few gentle yoga poses, I didn’t actually do much resting.  And my brain was running a million miles an hour, so I didn’t sleep great either.  Add in laundry, housecleaning, dishes, and staying late to teach – and my body rebelled.  Remember last week when I said I am listening to my back and I can tell when I need to move, or get ice, or rest….well, I haven’t been great about that this week.  I’ve been hearing my back protesting – but I’ve not taken steps to calm it down.  Well, not until it screams at me…like it did yesterday.

So this week I’m working on finding the balance.  Using my voice to say no.  Giving myself grace for what I just can’t realistically do right now.  Leaving a little early from work, and using that extra time at home to actually rest – not do the dishes or the laundry – but rest.  I need to finish my book.  I need to write a few overdue thank you notes.  I need to rest – so that I can heal. If you saw me in the grocery store, or walking on campus you probably wouldn’t know that I had back surgery almost 8 weeks ago.  But I did.  I’ve got bones that are needing to heal.  I’ve got ticked off nerves that need to heal.  I’ve got muscles that need to relax so that the nerves will heal.  I’ve got muscles that need to rest before they will get stronger.  I can’t rush this process for my own convenience – and I really do need to listen to the subtle cues my back gives me.  What do I need most?  Rest.

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