My I-fuse Recovery: It's Complicated
I am now two months post op sacroiliac joint fusion/fixation via Ifuse implants on left and via screw fixation on right. Since Ifuse is relatively new, I wanted to provide some feedback to people who may be considering using ifuse implants. I know it would have been helpful for me, but there wasn't alot of information out there on recovery expectations. So, I hope this helps...
Well, one of the ideas for this blog was to be informative during my recovery. Unfortunately I really wasn't able to sit long enough to type at length at a computer, so that didn't really work out until now! Let me start by saying that I am quite amazed with the results before I talk about the recovery that is a little hard. Also, let me qualify my recovery with the fact that I was extremely unstable for eight years.. holding myself up on the right side since I did not have a hold on the left side (ligaments were not holding my pelvis in place). I didn't realize how weak I had become on my "bad" side, which made my recovery harder. So, many people will not be as bad going into surgery. In talking with other SI patients that had surgery, I found that their condition pre op was an indicator of their recovery. My condition pre op was that I could not stand really for any amount of time without pain. I could not go to store or walk a block.. I had eliminated all activity. I required a wheelchair in the airport to Georgia. I tell you that so you can compare to yourself. I talked to two other Ifuse patients whose recovery did not seem quite as hard as mine, but they did voice the same type pains. I will try to outline it by weeks. It seemed every week, there was some type of concern that may have been scary, but it always resolved within a week or so.
First Days after surgery - Pain was well controlled. I could definately tell a huge difference in the pain of ifuse versus the screws immediately after surgery. I really hardly noticed anything done on my good side with the screws after a few days. Week one I really don't remember much.. just very sedentary. I was able to take a shower when I got home, using a shower chair (a must). They also ask you to be partial non weightbearing for six weeks on the ifuse side, so I used a walker at first. It was painful to walk, so I was glad I had the walker instead of crutches.
A huge praise during the first week.. along with my back pain and mobility problems I also had intense lower abdominal pain. It would get better with corrections and taping, but if I took the tape off it would go to this enormous 10 pain: pressure like, burning pain in the lower ab/pelvic floor..it was the worst pain I have ever had.. it is a pain that instills panic. In the pre op holding area it was terrible.. after surgery it came back a little as I traveled home and then went away for good. I had talked to one other patient who described the same thing. Incredible!!!
Week Two - I got very concerned because the pain around the implants became very strong for a few days... like a burning pain. It felt like inflammation, trying to settle in..etc. Still very sedentary. I went off the anti-inflammatory after five days, so I wondered if that was why the pain was worse in the second week. Since you are trying to fuse bone over the implants, it was suggested not to take anti-inflammatories as it might interfere with the process. I am still not clear if this is true for ifuse (I know it is for traditional fusion), but we wanted to be sure.
Also, I kept feeling an intense pulling pain in the groin/inner thigh area, especially when sitting or partially sitting. This was very bothersome, but I also had it before surgery. Vicki told me to keep doing the corrections for the front bone, as that could be unstable. The pelvic ring includes three joints: the two in the back that we fixated and the one in the front. Even though we fixated the two in the back, the front one can still be unstable. They say it usually tightens up in four to six months. This pulling sensation got better in week three for me, but I still to this day have to correct it at least once a day.
Week Three - The pain around implants was not nearly as severe. I was able to move and walk around the house more, not alot, but I could tell the pain was better so that was encouraging. It is still too uncomfortable to sit for longer than a few minutes. I really only sat to eat and just for a few minutes at a time.
Week Four - Each week I feel the pain around implants getting better, but it still really hurts to stand much and I am incredibly weak. I started PT and it was really hard.. very painful to do that much activity. I started to get worried. My PT said he wished he had a tickmark for every time I said "I am afraid...". I found a great PT, very encouraging and very smart. SI patients are so broken and fragile... you really need an encouraging professtional to help you when you get home.. start looking now. I am very thankful for mine.
I started to realize that my new position felt very foreign. I had been out of alignment for so long, and I drug my left leg since there was no hold on that side. Now I was lined up over this leg that didn't know what to do!! This is the part that may not be as bad for some, since my leg had atrophied due to eight years of not bearing full weight. My muscles are in total confusion and they are so weak. I started to wonder if I liked this new position (now I do!) It was a little frightening.
Week Five - I moved onto crutches after the first few weeks, but still not full weight bearing. I start to feel anxious that I don't think I will be able to walk unassisted at six weeks. I try a few times and it elicited alot of lumbar pain. My back muscles were extremely tight and just not ready. We set a goal to go to one crutch at six weeks. We worked several times just on how to transition weight over to the left side. My PT says I am going to have to teach you to walk again. I was glad he said it out loud, because that is what I sure was thinking. Again, thankful for a great PT.
Week Six - For about two days, I had alarming pinching feelings in both sides of the groin area. I think it was that front bone trying to stabilize as I was walking around more. I transitioned to one crutch relatively smoothly. However, I am still unable to sit for long periods and very concerned that I am still having to use the crutch. We decide to stick with that until I feel more comfortable though.
Week Seven was the Magic Number for me as far as overall pain. I finally am able to sit comfortably for longer periods..as long as I am able to get myself in a comfortable position. I feel very relieved. BUT, as I started sitting more, the pirformis and glute muscles really started acting up... the piriformis is known to be a problem post op.. and mine happened later, since it took a while for me to sit. With some good stretches, it did ease.. but it was pretty bad. It seems the back muscles are loosening up and...
Week Eight: I take my first unassisted steps! Praise the Lord! They are not pretty but they are steps. As I began to walk more, the piriformis and glutes get pretty angry. I have to say that is my biggest source of pain now. We have found some good stretches that help that. I have a huge network of SI friends and we all exchange tips.. priceless. I love them...another God send.
Now I am two months post op.. and I finally can see that I will be able to enjoy life again. The way I would describe the feeling is that I now have a HOLD on my left side. Before there was no hold and my leg would fall backwards, then my back would start killing me and feeling like it was twisting forward. I would fight with the other side to hold myself up.. I felt twisted...I was twisted. Now I am untwisted, aligned correctly, and I can push through my leg.. wow, an awesome feeling. I feel how weak it is.. it is shaky no doubt. We have started some squats and the muscles are sore.. what a great feeling.. they are working! Now, I have to rebuild all the strength that was lost and correct all of the muscles dysfunctions that happened. I love how Vicki explains the muscle inhibitions in laymen terms that occur with sacroiliac joint dysfunction. The brain tells the body "Hey, we have a weightbearing joint out of alignment, muscles tighten up"...so the piriformis becomes very spastic trying to hold the joint in place. Then the brain tells the muscles that allow movement, the abs and glutes, "Nobody move, she might fall over." So, they become very weak. Now we have to undo all of that, and build strength back on my left side that I was not fully using. This can not be fixed until you achieve stabilization. I have a firm foundation now and I can do it..
I have just started walking and exploring how it feels to be stable. Today, I am walking very freely around the house and it feels great and solid. I still feel very fragile and not by any means pain free. My back pain is minimal at rest..it still gets aggravated with more activity, but it is not as severe and long lasting. I still have to limit sitting and standing due to the piriformis pain, but I can now see a finish line.. it is pain with a purpose, as Melany would say!! They say that a full recovery is a range of six to twelve months.. and maybe longer for some severe cases, such as mine. I know where I came from, and I could not be more ecstatic about where I am now.. thanks be to God who worked through Vicki Sims,PT, Dr. Weiss, and my current PT, Jeremy Pittman, to allow me to walk normally again, and reclaim my life from the devasting,disabling, and misunderstood effects of sacroiliac joint dysfunction.