Whac-A-Mole Physical Therapy, Meet Ankylosing Spondylitis

by Michael Scepaniak on August 3, 2014 in diet & exercise

Bluebells - Mugdock Wood - Scotland

On January 1st of this year, I weighed a pleasing 178 lbs. About 45 days later, I had involuntarily lost almost 20 of them. And so began a progressively deteriorating 7 months for me.

I thought I had wrapped-up 2013 pretty well. I finished it hitting 6 month milestones of doing a Stronglifts work-out and eating a Paleo diet. I had a few aches and pains that I was looking forward to nursing, but nothing too significant. A sore right shoulder, general hip soreness, and a couple of groin pulls. Oh, and an odd sore spot localized to the front bony point of my left hip.

My girlfriend and I spent a week in the Dominican Republic in early January. Just lots of rest and relaxation. Unfortunately, we came back with stomach viruses. Mine lingered for a while, pretty much right up until we left for a trip to Florida at the end of that same January.

So, I ended up spending January completely away from the gym. Unfortunately, all of that “nursing” wasn’t doing me any good. The pains in my right shoulder, hips, and groin actually intensified. Lacking other options, I decided to continue my resting and stay away from the gym through the first couple weeks of February.

Nothing really improved, though. And that’s when I realized that my weight had dropped to 160 lbs (from 178 lbs). Wow. That took me by surprise, so I stubbornly returned to the gym and tried to work through the pain. But, there was only about 3 movements total I could do somewhat pain-free. After 3 frustrating and very limited work-outs, I finally conceded defeat and, on February 25th, went to see my doctor.

Physical Therapy and Me

My doctor recommended that I give physical therapy a try. Three days later, my long stint of (mostly twice a week) physical therapy sessions began. Because I was coming in for a number of issues, my physical therapist and I had to prioritize my treatment. My right shoulder came first. (At that point, raising my right arm up toward parallel wasn’t doable for me.) My hip soreness came second. My physical therapist quickly determined that I had a lot of stiffness and little flexibility in my lower spine, which she surmised was causing my hip soreness.

While I had been suffering from roaming back pain for many years, the degree of stiffness that I now came to realize I had surprised me. I had always thought of myself as pretty (physically) flexible. But she made me realize all of the ways in which I had come to unknowingly circumvent use of my lower back (e.g., lifting with my legs, bending at the hips, etc.). It was enlightening, in a depressing sort of way.

After a couple of weeks, my general hip soreness had alleviated (but the rear of my hip joints at my glutes still hurt). After a third week, my right shoulder started coming around. At the fourth week, I started doing exercises to address my groin pain – mostly lots of indirect balance exercises. It was around this point that the aggregate burden of all these issues got to me. Physical therapy appointments twice a week, plus physical therapy exercises in the mornings, in the evenings, and at the gym, plus stretching constantly throughout the day – it was mentally exhausting me. I felt like all of my time was spent doing physical therapy. But, I kept on.

Mole #1

Then, the first “mole” popped-up. The front of my left thigh started to hurt – a lot. Lifting it to parallel was very difficult – and painful. Apparently, that localized tenderness on the front bony point of my left hip was a warning sign of things to come. So, we started treatment on it – along with my right shoulder. Ha ha – that’s when shit got real. I remember the first time my physical therapist started digging her hands into the front of my left thigh. Pain, pain, pain.

Regardless, we stayed on that course of treatment for a couple weeks. And, as a result, my right shoulder and the front of my left thigh improved. However, my groin wasn’t progressing. So, we decided to cool it for a week. The goal was to get my groin to “stay quiet” for the week – with no spasms or tweaks. In general, it worked. So, we started including my groin in the treatments (with less focus on my steadily improving right shoulder).

Mole #2

Then, the second “mole” slowly started to pop-up. My feet had been getting sorer and sorer over the course of the preceding few weeks. It got bad enough that I had to stop using my standing desk at work. I went to see my doctor again, who diagnosed me with plantar fasciitis. I discussed it with my physical therapist and I started incorporating some foot stretches into my day. Ugh. More physical therapy.

At this point, I was 2 months into physical therapy. I had varying degrees of pain in my right shoulder, hips, groin, front of left thigh, and feet. And I was getting burned-out working through it all. Between that and a trip to Savannah and Charleston in early May, I only had a couple physical therapy sessions in my third month. And it was just before that second appointment that I hit a low point.

Mole #3

My third “mole” popped-up in the rear of my left thigh. And, as frustrating as could be, it was caused by my biking to the gym. Just like the localized tenderness on the front bony point of my left hip was a warning sign of the pain that was to surface in the front of my left thigh, the localized pain in the rear of my hip joints at my glutes was a warning sign of this pain in my rear thigh. I was so frustrated.

Fortunately, one physical therapy session brought it under control. (That was good – because the pain was a “hard to sleep, hard to walk” sort of pain.) Unfortunately, I had to stop biking to the gym. There was only so many problems we could treat at one time. Pushing the envelope wasn’t going to happen.

Three months into physical therapy, I was a mess. I had added the rear of my left thigh to my long list of broken body parts, I was down 21 lbs from the start of the year, I couldn’t use my standing desk or my bike, I couldn’t lift at the gym, I was spending all of my “free” time doing physical therapy exercises, and I had stopped seeing my physical therapist on a regular basis.

However, I managed to re-group and re-started regular physical therapy sessions in June. And things started to look up a bit. My right shoulder managed to improve to the point that I could slowly ease back into lifting at the gym. My groin started to show some progress – gaining strength. And we started to actively treat my feet.

My Poor Feets

Unfortunately, with all of the progress I was making in other places, my feet just progressively got worse. The plantar fasciitis pain, which had been… not insignificant in my left foot and mild in my right, became flat-out significant in both feet. The top of my right foot hurt a lot, too. And one Sunday morning I woke up to find the second toe on my left foot swollen up like a sausage.

Walking was becoming an ordeal. Co-workers took to stopping me in the hallway – asking me if I was OK. I started rolling and icing my feet at night. The tennis ball rolling was like nightly self-inflicted torture. (The video I’ve linked to does not paint an accurate picture of the willpower required!) It hurt so bad. But, I did it. I mean, I had to.

My balance was getting worse and worse. I no longer even tried to put on my socks and shoes while standing anymore. I couldn’t balance on one foot, especially the right foot.

I was spending more and more time on the weekends laying down, resting my feet. Just sitting wasn’t relief enough. I actually had to lay down. It got to the point where I actually began looking forward to the start of each work-week – because I could spend 8 or so hours just sitting on my ass in front of the computer. For that, I was very thankful.

At that point, I think I came to understand how old people felt. My top speed was “shuffle”. I was always moving slowly so as not to inadvertently hurt myself. Well, that – and everything below my knees was constantly sore.

The simple act of going through my morning routine had become a feat of endurance. One to two hours on my feet – brushing, shaving, showering, dressing, grooming. And it was taking progressively longer for me to get through it all.

Mole #4

Toward the end of my fourth month of physical therapy, my fourth “mole” popped up. Slowly, insidiously, my left shoulder started to hurt. As my right shoulder improved, my left shoulder worsened. For weeks and weeks, I ignored it. I refused to acknowledge it. I didn’t mention it to anyone. But, at some point, the scales tipped, and I had to admit it – to both myself and my physical therapist.

My physical therapist was mystified. The only activities I had been doing with my left shoulder were physical therapy exercises meant to treat and strengthen my right shoulder. There wasn’t any reason either of us could see why it would start hurting. After all, the course of action she was going to recommend to improve my left shoulder was pretty much the exercises I was already doing with it. It just didn’t make sense.

But, what could we do? Treatment continued. I remember one session where I got treatment on both my left shoulder and feet, I ended up getting 26 dry needles put in me. At that point, I started feeling like an experiment as much as I did a patient.

Something Systemic

For my physical therapist, the pain in my left shoulder became the proverbial straw. With her encouragement, I returned to my doctor to request a blood screen. Either I was just going through a run of very bad luck or something more systematic was having its way with me. My doctor had me tested for every reasonable inflammatory marker he could think of.

While I waited for the results of the blood test, my girlfriend started pushing me to try other options. She bought me a pair of flip flops designed for people with plantar fasciitis. She also insisted on buying me some Penetrex and convinced me to buy a pair of Orthaheel orthotic insoles for my shoes. My physical therapist also encouraged me to start rolling my calves at night in addition to rolling my feet. And so the war on my foot pain escalated.

My blood test results eventually came back. They didn’t show a whole lot, except that my rheumatoid factor was out of range by 1, and my general inflammation markers were very much out of range. My doctor recommended that I go see a rheumatologist. Admittedly, the only thing I did immediately was look up what a rheumatologist does. 😛

Mole #5

During my intervening procrastination, my fifth “mole” popped-up. I developed some significant pain in my left knee. Silently, I freaked-out. I really, really didn’t want to develop knee issues, especially on top of everything else. Fortunately, my physical therapist didn’t think the pain was coming from my knee joint, per se. Rather, it was probably just a slightly different manifestation of the pain I had been working through in the front of my left thigh.

Whew. I felt better. Still, though, it hurt. I took to going up and down the stairs one step at a time.

Search for a Rheumatologist

The knee pain got me to move on the rheumatologist angle. I called up the group my doctor had recommended and got an appointment – for September 3rd. That was a month and a half out. My well-meaning girlfriend encouraged me to look for other options, so I asked around and got some other recommendations. I managed to snag an appointment with someone else – this time only one month out. Still not satisfied, my girlfriend found and scheduled me an appointment with a rheumatologist – 3 days out. 🙂

I was skeptical, but who was I to judge? Besides, nobody wanted to see me wait a month for a possible answer to my issues. While physical therapy had definitely gotten me past some of my broken body parts, new issues kept appearing without any sign of stopping. And while my efforts to address my plantar fasciitis looked to be working, I wasn’t walking any better, the swelling in my left toes was spreading, and my feet still hurt all the time.

I met with the rheumatologist and he put me through my/his paces. He suspected I had something and ordered more blood tests, plus x-rays of my pelvis. I quickly took care of both and, after 5 months of physical therapy, finally understood the source of all of my “moles”. The rheumatologist diagnosed me with Ankylosing Spondylitis.

Diagnosis – Ankylosing Spondylitis

Ankylosing Spondylitis is a form of arthritis that primarily affects the spine, but other joints are susceptible, as well. One of the blood tests was for the genetic marker HLA-B27, which it turns out I have. It is a tell-tale sign of Ankylosing Spondylitis. The x-rays were to evaluate my sacroiliac joints, which typically expose the progression of the disease. The good news is that my Ankylosing Spondylitis is mild, as my sacroiliac joints look good. And so, my rheumatologist introduced me to my new best friendCelebrex.

My rheumatologist gave me 6 doses of Celebrex out of hand, plus a prescription for 2 months’ worth. I took my first pill and, I swear that my feet started feeling better within 2 or 3 hours. From that point forward, everything has gotten better. After the past 4 or 5 days of taking Celebrex, the soreness and swelling in my feet have gone down noticeably. My walking has improved markedly. I no longer dread standing up from my chair, walking into work, or going through my morning routine. Rolling over in bed at night is no longer the painful ordeal it’s been for months. All of my other body parts that had broken, which physical therapy had helped fix to one degree or another, got even better.

I’ve never been one to look to a pill for answers, but I am so happy that Celebrex exists. I don’t expect to just stop my physical therapy, but I can now use it to strengthen what had broken instead of playing whac-a-mole with my body. And that’s important. While my Ankylosing Spondylitis is mild, the disease is still progressive in nature. As I get older, it will tend to intensify. But physical activity, aerobic health, and overall muscle strength will help to fend it off. Which is exactly what I intend to do.

Credit Where Credit Is Due

My physical therapist through all of this has been Lisa Kanning at Evolution Sports. Week in, week out, she worked with me to figure out a plan of attack. (Not an easy task, given my simultaneous and compounding issues.) She remained flexible with regards to treatments and exhibited her expertise again and again and again. I highly recommend her. Just don’t take my 4pm appointments!

My rheumatologist is Dr. Rida Frayha. (I’d put a link here, but he’s old-school. No site or anything.) I’ve only had two appointments with him, but I have no concerns about his abilities. Neither he, his office, or his office’s location are flashy or overtly impressive, but he broadcasts a silent message – “I know what I’m doing”.

My primary care physician is Dr. Gregory Small. He did exactly what I needed him to do. He forwarded me to those specialists that he felt were most capable of properly addressing that which he could not address himself.

In Conclusion

I went months hoping for a reason why I kept getting random muscle pains and injuries all over my body. For the most part, each injury responded well to physical therapy, but new ones just kept on coming. Even after five months, I don’t think any of them went away completely. If someone reads this and, as a result, is able to cut to the chase more quickly than I did, I’ll be very happy.

Knowing that I have something – something that is the root cause of all of my physical issues – has been a relief. I can only hope that the physical and emotional roller coaster that I’ve been on for most of this year is over. Regardless, I can’t thank my wonderful Deborah enough for helping me through it all. Without her, my low points would have been pits out of which I may have never been able to climb. Thank you, Deborah. 🙂

Mike
Want to be notified when new articles are posted?
Enter your email address:

{ 0 comments… add one now }

Leave a Comment

{ 1 trackback }

Previous post:

Next post:

Member of The Internet Defense League