Three months post op - ifuse implants on left / screw fixation on right
sijd = sacroiliac joint dysfunction
Wow, I am three months post op and walking around quite well now. What is gone?... the debilitating back pain, the pulling sensation down my inner leg, the feeling as if my pelvis is twisting underneath me, the abdominal pain...all of that is gone. I am so excited to be at this stage, and now I can truly say I believe the surgery is a success. We did find my problem, we just took a really long detour getting there. More on that later. What I am dealing with now is the severe muscle dysfunctions that occur along with sijd, especially long term sufferers. The main source of my pain and mobility problems now are coming from the piriformis muscle.
While many of my pain symptoms have dissipated, I am really struggling with pain and constant spasm coming from the piriformis muscle. This is very common after SI surgery. The piriformis is the strongest muscle in the body - attaching from the sacrum to the hip, generally speaking. Piriformis syndrome is very common as a coexisting condition with sijd. Because the piriformis muscle is a stabilizing muscle, it becomes facilitated, and works overtime trying to stabilize the joint that has become subluxed, thus becomes very angry! The symptoms can include spasming in the buttock and sciatic like pain down the leg, due to its proximity to the sciatic nerve. I was talking to an SI friend, and we agreed the feeling is akin to the top of your leg being choked. The Georgia team does testing on this pre op (EMG via FAIR testing) to determine if the piriformis needs to be released surgically. While mine showed some strong pain signals, the markers did not show it needed to be released. This means that the hope is it will calm down with therapy and possible steroid injections - I even hear some talk of Botox injections.
Mine began to get aggravated at around the six week mark as I started sitting and standing more. It would wax and wane, but now has become chronic. So, we have a protocol now to follow for the piriformis syndrome, and I will likely begin a series of injections and therapy specifically for the piriformis. The feeling is an angry pull in the back of my hip, and really limits the length of time I can stand and sit. I had these symptoms before surgery too, so I don't like the reminder. However, now I can see what was SI and what was piriformis. The degree of aggravation, the tightening down of the muscle, is worse than before which has me concerned. For now, I have stopped the strengthening exercises until this can calm down.
However, the piriformis will likely stay somewhat aggravated until I can continue strengthening the other muscles that became inhibited during my dysfunction. So, I am hoping the injections will buy some time to strengthen. I am past the severe and debilitating back pain, but this setback with the piriformis muscle has me bummed. I was feeling close to the point of being able to take off with strengthening. We are now working on trying to retrain muscles that are not working properly, and it is a daunting task! Vicki teaches the Janda theory of lower cross syndrome that occurs with sijd: piriformis and hip flexors become tight and facilitated, while the abs and glutes sometimes stop firing, and become inhibited. This creates a very dysfunctional walking pattern and will take alot of time to retrain the muscles to work, and try to calm the spastic angry ones.
How do I feel now? What is my pain like?
I am no longer in severe constant back pain. I can walk with a more fluid, natural gait, without dragging my leg. I can fully weightbear on my left side without feeling like I will just fall onto the floor...it is truly a remarkable feeling that often brings me to tears. I no longer feel like my body is trying to "level" myself out. This in itself can cause the upper body to spasm..which, yes I dealt with also as do many sijd'ers.
My pain now is pretty bad in the piriformis muscle as it is clamping down on the sciatic nerve in its angry state. This is greatly limiting my ability to sit and stand. Even though I can weightbear on the left side, it feels extremely weak and some of the muscles are not firing properly. So, as the day goes, my leg starts tiring, and I start feeling the dysfunctional muscle patterns happen again. At that time, I need to remember, stop, drop and ice! These painful muscle patterns that occur are a huge reason that early diagnosis is so important. The "no pain no gain" theory does not apply here..the more you walk around, exercise, pushing through the pain, the more damage you are doing. I did that for almost a decade as I floundered through the medical system as an enigma. The lower half of my body just feels like one big muscle spasm..my legs are so tight that I feel like I am lifting cement. I have found a great massage therapist and we are working on that a little at a time, but I feel like I need more..this area needs tweeking. Overcoming sijd is not a quick process; it is like an onion - peeling off the layers one at a time.
So for now, as my husband is doing P90X in our living room trying to "confuse" his muscles so he will strengthen and lose weight...I will continue to work on "unconfusing" my dysfunctional muscle patterns. First on the list, get this piriformis to be quiet!!!