ischial tuberosity – Cynsspace

Looking for My Pony

Shell-shocked. There is really no other word to describe my reaction after finally seeing the hip specialist in Hamilton. I waited for 3 months to get to the bottom of what was going on with my hamstring – a tear at the insertion of the ischial tuberosity. I waited another three months for a consultation with Dr. Bentley, whom I thought was going to prescribe platelet-rich plasma therapy to strengthen the tendon. I got more and more excited as the days to that appointment got closer; I felt like a 6 year old hoping to find her pony on Christmas morning. But I left his office feeling dejected. There was no pony waiting for me, not even a stuffed toy that could act as a substitute. Instead, I left with a piece of paper: a prescription for more physiotherapy.

During the examination, Dr. Bentley commented, “I don’t think you need an injection. It won’t help you. I think there is something else going on.” Like most runners who have been off longer than they want to be and are desperate for answers and healing, I tried to pry more details out of him. “Let’s finish the examination. Then we can talk.” But the words “won’t help you” kept my mind spinning. So I am that one in ten who PRP injections aren’t suitable for? I wasted all of this time waiting for nothing? Is there no hope of recovery? Will I ever run again?

During our debrief, Dr. Bentley explained that my pelvis is not aligned properly. I have an anterior pelvic tilt, meaning that my right hip sits forward; in doing so, the right hamstring is stretched and that, he believes, it the root of my problem. This also explains the occasional sciatica discomfort that I get, my tight hip flexors and, most visually obvious, the right leg swing when I run. The treatment, Dr. Bentley said, is pelvis realignment through physiotherapy, and he suggested 10 treatments would correct the problem. “Once a week?” I asked. “Oh no,” he said. “You need twice a week.” Between his words, I imagined hearing “Your pelvis is that messed up.”

“And what if this doesn’t help?” I asked. After all, I have gone through the rounds of chiropractic care, physiotherapy and worked with an osteopath, yet I am still considered injured. Dr. Bentley told me to book another appointment if I felt that the treatments don’t help.

It’s taken me almost a month to emotionally recover from his diagnosis and recommendations for treatment. I am angry that I had to wait so long to get to the root, or what seems to be the root, of the problem. I am frustrated that I have had to go to yet another physiotherapist, one who specializes in pelvic realignment, and explain the events of the past 9 months. And I am confused as to why he wouldn’t want to strengthen the tendon when it is going to remain a “less than 50% tear” for the rest of my life (since tendons don’t repair), especially with osteoporosis-arthritis showing in January’s MRI. But, as with all other wounds, time heals and we move on.

On Wednesday, I am starting my fourth week of treatments. Some days, I leave feeling optimistic and ready to start running again; other days, I leave feeling frustrated and wonder whether this will, in fact, let me return to running. There have been good days and bad, laughter and tears, and longing….a longing for good news, a wish for running health….and hope to find that pony with a pink ribbon around its neck.

When the Wind Changes Direction

Don’t you love that feeling when you are out for a run and, after fighting the wind for miles, you turn around and let the wind blow you back home? Other times, we aren’t quite so lucky and turn around to find that the wind that we thought we were running into was the tailwind, which means that running back is going to be that much harder.

Emotions can be like that too. Almost anyone who lives with a teen has experienced the noise which can follow them home from school, similar to the sounds of an explosion after a 747 has crash landed in your living room. As adults, we are better at controlling our emotions. We can run with the feeling of the wind being on our back for months or years on end until, without any warning, a plane crashes into our home and leaves us feeling broken.

Last night, I got my results from the MRI of my hip. This was requested months ago, at the end of October, and I finally had imaging done at the beginning for January. Since I had started running again, I thought about cancelling it, but my husband and son both said, “Why not? It’s only going to give you more information.” So I went ahead with it, hoping that I would find out exactly why it still hurts when I run.

I got what I wanted – and more. First, I learned something new; there is a tear in the labrum. The doctor says I don’t need to worry about that because it isn’t an area that is bothering me. Secondly, I got more information about my old friend, Izzy. While I thought that Izzy had moved out, she is lying low and creating havoc. There is inflammation between the gluteal insertion at the tuberosity, which is diagnosed as enthescopathy. This seems to be caused by osteo-arthritis, which is starting to show in the hip, and by overuse from running. And, even though I thought I was getting better, the tendon at the ischial tuberosity is still partially torn. It involves less than 50% of the tendon which, to me, sound like it is between 25-50%, or the results would read “less than 25%.” So, in a nutshell, my hip is a bit of a mess.

It isn’t the hip results, though, that are weighing on me. I also got some unexpected results. A round structure was found in an organ. I’m not ready to talk about it yet, other than to say a more detailed ultrasound is in the near future.

Dr. Elliott and I looked at a treatment plan for my hip. First, I am off running, and he thinks it will be another 3 to 6 months before I will be able to again. We decided to go ahead with Platelet-Rich Plasma Therapy to strengthen the hamstrings so he sent in a referral to the specialist at McMaster Hospital. Hopefully, I can get an appointment soon.

This was a lot of information to digest. In some ways, I am not surprised by the hip results. I feel better knowing why running has been hurting, why it doesn’t feel right, and why I have been so hesitant to push myself. It’s not because my muscles are waking up; it’s because there are some structural weaknesses. I’m glad that I followed through with the MRI as now I have a concrete plan to correct the aches and pains that we know about and, I hope, eliminate the other concern.

Last night was the first night that I crawled into bed before 10:00 in a long time. I needed a quiet spot, a place to rest, a place to think. Like the plane before it crashes, I felt myself start to shake while fighting to maintain control. And then I cried. By the time I got out of bed this morning, I was over it. For now, I will salvage what I can and do what I am able.

This is a new day, filled with questions and hope and I am reminded of the words “Focus on the things you can control, not on what you can’t.” Today, I will focus on me, my thoughts and my actions. I will focus on finding inner strength and moving forward – one day at a time.

Bridge Work

I think everyone knows that lunge workouts have become one of my training habits. We have a love-hate relationship. I started doing them in late August and, by the end of October, I could feel my quads getting stronger; another month later, the physical definition in them was more obvious. My lunge workout takes time (30-40 minutes) and effort, but it is good for me.

When Izzy was finally diagnosed with a tear, Dr. Sajko added bridge work to my regime. I initially wondered where the extra time to do them was going to come from, but I listened to his instructions. Sandy has earned my trust; if he wants me to do something, I do it. Besides, I like bridges. It is one of my favourite holds at yoga.

When Sandy saw that I could do the typical bridge pose, he challenged me. “This time, lift your core, then lift one leg so that it is parallel to the other.” I did, and Sandy stepped back. “Wow, you have a strong core.” Suddenly, I felt jacked.

After working through a set of those, we bumped it up again. “This time, start with your feet together, lift your leg like you did before (parallel to the other), then lift your body up.” Basically, I was lifting myself into a bridge position with one leg. They were harder but I could do them.

I was a bit relieved to hear I only had to do 3 sets: 10 of the typical bridge, 5 (each side) of the single-leg bridge, and 5 (each side) of the lifting single-leg bridge. Finding 15 minutes is easier: before school, before yoga, even before the dog realizes that I am on the floor and tries to lick my face.

It’s been three weeks since I have added bridge work and I can feel my glutes and hamstrings getting stronger. There is still more work to be done, but this is a good start, especially when I can sense that they are forcing Tammy and Izzy to pack their bags and head out for good.

I know that working with weights to build and maintain muscle mass is in my future. Until I am 100%, though, and physically ready to start, I am happy to keep up with my lunges, bridges and whatever other rehab exercises are thrown my way.

Introducing Izzy

After 6 weeks of waiting, I finally have an answer; it’s a tear and, yes, it is a real pain in the butt.

My official diagnosis is a partial tear of the tendon at the ischial tuberosity. In October, when that first came up as a possibility, I asked, “The what? Did you just make that name up?” It is real. There are three hamstring muscles and one leads to the ischial tuberosity, which is at the top of the femur but under the gluteus Maximus – basically, at the sitbone. When we sit, the glutes pull up and leave the sitbone to dig down. With the tear that I have, sitting kills. This week, I almost feel like I could start to run, but with sitting bring as painful as it is, I know I can’t run yet.

3mm deep – between the height of 2 dimes and 2 nickels

It is obvious that I tore my ischial tuberosity at the beginning of October. After 6 weeks of healing, it currently measures 6mm by 4mm by 3mm; I wish that I could tell how big it was when I first started.

The first thing I did when I got home was text my kinesiology student, who replied with “LOL. The old tuberosity, eh. I literally had my hands on one an hour ago.” After a few messages back and forth, I decided to name it – something with a harsh sound, but one that Tammy the Hamstring would like. I decided on “Izzy, the Ischial Tuberosity.” Can’t you imagine Tammy and Izzy hanging out together?

Messaging my son gave me another idea. I had to make a model of the tear so that I could understand it better. Suddenly, the pain I have had makes sense as I imagine a gap or a hole in my tendon that needs to be filled.

Dr. Elliott, my sports medical doctor, said that healing can take up to 6 months, but he doesn’t think it will take that long. “You’re in a lot better shape than most people at this point,” he said. “It will probably be another month.” I don’t need surgery, which is great. Dr. Elliott suggested a cortisone shot, but I want to stay away from that as cortisone can break down tissue. PRP (platelet rich plasma) therapy is another option, but it won’t speed up healing; it does, though, strengthen the tendon. While that still sounds appealing, it comes with a hefty price tag (up to $2000) and there isn’t enough evidence to prove its effectiveness. I will continue to research that, though, and sit on it (haha!) for a while. At this point, my answer is ‘no’.

Meanwhile, I will continue to do what I am as it is obviously helping. And now that I know exactly what the problem is, I can work with my chiropractor and coach to get me running again and, hopefully, ready to race in a few months.