Tuesday, May 31, 2011

This Is Not The Time To Quit

Yes, just keep telling myself that, I said to myself. What's a little pain? Look at what Thor had to endure. No----wait---- maybe I'm thinking about his silly voice. Hmm. Oh, well, I did once have a Thor some, but I digress (when don't I?) What? Who, me? Oh. OK, I've just been told to get this post back on track or go home for the day (which doesn't sound like such a bad choice, actually.) But, whatever.

The doggies are a bit better, improving veeeeerrrrryyyyyy sllllooooowwwwwwllllllyyyy. And I'm doing the whole nine yards - soaks, analgesics, creams, massage, Acme safes from a great height. I've even forced myself to watch golf on TV - not quite as numbing as watching paint dry, but close. Really close. And really trying to keep the pain meds at an extreme minimum - don't like they way they make me suddenly enjoy watching Oprah reruns (shudder).

On other fronts, I recently made the acquaintance of a new clubbie - three months old, now. Dos piedes clubbo (bilateral, if you must know!) Cute (redundant when speaking of babies, unless you are George Castanza, I suppose.) The Mommy was freaked when she first got the news (is it just me, or do sonograms make you long for the Dark Ages when you had to wait for the actual arrival? It is? Oh.) But I reassured her to not worry, her kid would grow up to be the president of something anyway, which given how badly we treat presidents these days may not be much reassurance. I also told her to buy shares in some guy named Maddoff way back when, but thankfully, she didn't listen.

I was glad to see she'd chosen a Ponsetti approach - I just love those things at Christmas time, don't you? And the kid really looks good in a pot, besides. Seriously, he's cute. Really! I did want to grab him and run for the border, but then I remembered that word that should strike terror in the hearts of all do-gooders - diapers. So, sorry to say, the kid will just have to make do with what he's got - loving parents, well-trained Doc Martins, and a martini when he turns twenty.

On me. Yep - I put it in writing.


Wednesday, May 25, 2011

What a Heel! Part Deaux

Well, in my efforts to get this heel spur issue resolved, I went in for another prolotherapy session. Painfuuuulllll! (say it in a very high, squeaky voice, then pass out, for full effect.) But the fun was just beginning. It turns out that inducing inflammation (which is part of the prolo process, by the way), can on occasion have a cascade effect - inflammation squared, you might say. So imagine my delight upon waking up Sunday (the session was Saturday morning) to discover my foot was swollen about like that really bad boil you had last spring. You know the one - you just knew if it didn't subside soon, it was going to go volcanic all on its ownsome, because the skin simply had no more room to stretch? Yeah - call it Pop-a-palooza. So there I was, completely unable to even flex my ankle without screeching pain, like a 16 penny nail being driven into my heel with a pile driver. Every motion. Every single bloody motion. Oh, joy.

So, crutches, cold packs, hot soaks (both of which produced their own special pains,) elevate, massage (oh, no you can't!!!) drugs (what kind of weak soup do they make these things from?) When I take a med for pain, by gummy, I want to feel NOTTHING!!!! What's a guy gotta do to get some relief around this dump???!!@!

So, the doctor, (nice guy, by the way, sends me jokes by email,) says, take aspirin, elevate that sucker, cold and hot soaks, and (you will just LOVE this one ) time. Time, he says!! That's easy for him to say! He doesn't have to try and walk on pitchforks, does he?

Two days off work. Back today, but with a rigid cast shoe (I'm telling everyone else it was a skiing accident, but for some reason, they just laugh at me - must know me too well. Note to self - Have to change that.) Crutches, too. Makin' my arm pits ache. Giving me a 10-scale back ache. Giving me grief. Yeah, I know, it will settle down, and be better in the long term. Well, I have my own term for that weak-assed explanation:

Phooey.

Thursday, May 19, 2011

Limpy Gimp - At Least I'm Not a Governator

Let's face it - muscles will get you further than a limp in this world. They will make you more money, get you more attention, even (apparently) get you more sex. So, workout, Dude! But there is apparently a downside - these days, nearly everyone will think you cheated. Steroids, philandering, pay-for-play, whatever spin you want to give it, its still cheating. At least I came by my limp honestly (not like I had any choice, mind you.)

But, I hear you say, those of us who are not rich and famous cannot possibly know the troubles they've seen, oh, the hard-pressed rich folk! Yeeeaaah -no. I don't think so. There are many examples of wealthy and powerful people who don't resort to cheating, but the press finds no value in such boring fare. They only salivate to the freaks and crazies - makes better money for them, you see. But gimps? Sure, they gave Roosevelt a pass, maybe because of that cigar, who knows. And Stephen Hawking (my hero, I'll admit,) well, he only gets press because he's too freakin' smart, and that high, squeaky machine voice doesn't hurt his screen presence, either. (Besides, he may be our only hope against the black hole headed this way. Oh, sorry, you missed that story? Well, too late for that now. Have a nice day, won't you?)

Being a crip does have it's upsides: I ain't never getting drafted, not even for the NBA. And the only famous person I have to model my own desire for fame on is Dudley Moore, and honestly? I cannot drink that much. My bladder would probably fail before I got fully loaded, so what's the point? Then there are all those other examples of fame and fortune who simply by fate were "Born This Way." No, not her, though I tend to think she's still in the closet about her gimp-dom. No, I'm talking about what's his name, and who-she. Right there on the tip of my tongue. Oh, well, more part-timerz, I guess. It will come to me when neither of us expect it.

Anyway, the point is, I'd rather emulate my shoemaker, who has spent his entire life using his time and talent to help other people live a little better life. Much as I'd like the money, I'd much rather, at the end of my life, be able to say I did good. You can't take the money with you, but you can leave a better legacy through honest effort than by basing your life on getting yours, and screw everyone else.

Wednesday, May 11, 2011

Uncle Gimpy's Story Time

Limping, as I've touched on before, is nature's way of accounting for pain, pathomechanics, and trauma, affecting the body in an asymmetrical manner. Again, the body has two primary goals in the face of any of these causes: to maintain as level a visual horizon line as possible, and to keep the inner ear balanced. All else is secondary to these two central requirements. This is mainly because it is easier to limp than to alter one's inner equilibrium or the alignment of the eyes with the horizon. Thus, the body works to compensate by other mechanisms: bending the knee, abducting the foot, lifting the heel on one side early in the gait cycle, externally rotating the leg. Each of these actions in turn produce effects further up the body: hip raise on one side, shoulder drop on the other; slow changes to the sacral level toward imbalance, that eventually results in scoliotic and lordotic changes; even going as far in some individuals as causing a primary head tilt. I have even met individuals whose multi-level compensation has led to an observable change in the levels of the eye orbits, this last being found only, in my experience, in individuals with pronounced ligamentous laxity.

The most interesting aspect of limping is how it varies from person to person. Some of us manage to compensate without limping, especially if the compensation has occurred throughout one's life. But when the trauma is new, the body has not had time yet to compensate, so it is left only with the option of limping, unless a lift, or the appropriate orthotic device is introduced, reducing or eliminating the need to compensate, and thereby stopping a limp from developing. This series of observations, over many years, has led me to an understanding of compensatory function and the secondary purpose of limping.

The primary purpose, in my view, is to offset changes to one's biomechanics in gait, that result first in pain, and soon after by challenging the inner ear and the visual horizon. Limping is thus initially an accommodation to a rude new reality. But as time goes on without any intervention, either mechanically or surgically, limping begins a chain of actions referred to as compensatory. That is, they permit the body to rearrange itself to account for the pathomechanical changes not otherwise addressed. So, an early heel-off limp might slowly be absorbed by the development of a change in the sacral-pelvic angle, which in turn may eventually lead to a shoulder drop on the opposite side. And each type of limp, combined with the ligamentous tonality in that particular person, will eventually reshape and realign the biomechanics presented originally into a new format, so to speak. Thus, we can see limps where the leg externally rotates (usually an effort to "shorten" a long limb - effectively reducing the length of the "lever arm" of the forefoot during the propulsive phase of gait); limps where the knee bends (long side) or hyperextends (short side, and usually accompanied by other levels of compensation); limps where the pelvic girdle rotates more than normal (where there may be some muscular weakness, often to the short side.) And of course, limps caused by acute trauma that dramatically or subtly alter the nerve, muscle, and tendo-ligamentous structures and functions.

The downside of non-intervention is obvious - the longer the limping is allowed to continue, the deeper and more problematic the resultant compensatory changes become. And time, along with severity of the pathomechanics, are factors in how to (eventually) intervene, and at what speed such intervention might reduce or eliminate the compensations. Someone who is twelve years of age when their trauma initiates the compensatory chain of events will allow for rapid response once intervention is initiated, whereas someone in their fifty's whose trauma has been interfering with their bodies for years may well take several years of graduated intervention before real counter-compensation can take shape.

We are complex creatures, physically (I am unqualified to speak to our other complexities, except to admit to their existence.) And the fact our bodies are capable of changing structurally in response to trauma, whether abrupt, or of a congenital nature, is for me an amazing challenge, and will continue to be something I study, because there is nothing I like better than solving mysteries. And believe me, humans are nothing if not full of mysteries.

Tuesday, May 3, 2011

Home on the Range of Motion-Redux, or, Tilt-a-whirl is My Middle Name

I've spoken about the concept of range of motion before, mostly to highlight how us clubbies don't have much to play with. The thing about feet is, they are (usually) a rather remarkable adaptation by the organism known as Prince, er, humans. They are extraordinarily adaptive to changing conditions, both on the ground, and, like most amphibious critters, in the water, as well. But that adaptability is highly dependent on an adequate range of motion. When that range is restricted, well, lest just say it leads to a life of mischief. No?

OK, how's this? When you can't adjust to changes in ground contour sufficiently, your body has two choices - compensate, or fall down. Most of us, with the possible exception of skateboarders, would opt for number one - compensate. But compensation, while not that problematic in the short term, can be very problematic over time. For example, you walk down the same sidewalk every day, when going to work, with your right side pointing toward the street, and when returning in the evening, with your left facing the street. Now, nearly all sidewalks have some degree of "cant," that is, they tilt toward the street, for the obvious purpose - to shed water more effectively. But this means walking on that sidewalk off-centers your body, with one side acting longer than the other.

Now, a truly adaptive foot can accommodate this imbalance with little strain, but feet with poor, or limited range of motion are forced to use joints other than those of the feet to achieve any degree of compensatory function, meaning the ankle, knee, hip, back, and shoulder/cervical spine complexes. Depending on the duration of this forced compensation, meaning both number of such encounters, and the amount of time each such encounter takes, the compensation can create both acute (short term), and chronic (long-term) changes to the entire body. And this can be further complicated by the quality of the ligamentous tonality. That is, people with a loose ligament tonality will generally compensate to a higher degree than people with tighter tonality. But looser tonality usually permits more levels of compensation to occur at a quicker rate than will happen with tighter tonality, while having a lower likelihood of pathological impact, and tighter tonality's compensations have a higher likelihood of producing a greater pathological impact. Not the best tradeoff, but there it is.

In some respects, this may explain why some clubbies have fewer long-term issues, especially if they have a loose ligamentous tone. It might also explain why some clubbies get other gait and postural issues as they age - tight ligamentous tonality will more likely cause up-chain pathomechanics (above the feet.) If you are wondering about your own ligamentous tone, there is a simple test to at least ball-park it for you: Take your right (or left) thumb with the opposite hand, and bend the thumb down toward your forearm.  If you can get it close to, or even touch the thumb to the forearm, you have a loose tone, whereas if you can't get it much past 90 degrees, you run tight. (The phrase, "double-jointed" usually refers to someone with very loose tone.)

In my experience, I've found that people with tight tone need to be evaluated for any possible discrepancy in the functional and/or anatomical length of their legs relative to each other. Because they cannot usually compensate as readily, they will benefit the most from both orthotic and lift therapy, to help offset the trauma of poor compensation. And as for post-club feet specifically, even where there is loose tonality, there may be little benefit over tight tone. Especially where there have been many surgeries, as the more surgeries, the higher degree of scar tissue potential that further tightens the structures of the foot. This is usually a good candidate foot for rocker sole therapy.

Now, obviously, these are generalizations, but in my experience, they show themselves in these manners more often than not. I simply point out that, having a better understanding of your own ligamentous tone can help explain your won particular development over time. And while it wasn't me that originally said, "hey, its all downhill from here," it probably applies. Most clubbies I know find they have a harder time walking off paved surfaces, or on canted paved surfaces, and especially, on sand. Meaning Cabo is probably better appreciated from the cabana bar.