Sunday, March 1, 2015

More on Prolotherapy and PRP Injections for the SI Joint



I went to see a doctor about my si joint and getting prolotherapy to see if it can help stabilize everything around my hips and low back. I went to a doctor who specializes in this at the same clinic where I had my hip arthroscopic surgery in 2011. She is a physicist who specializes in prolotherapy and other regenerative techniques. I was waiting for an appointment at the end of the month, but got a call to come in this week. The only problem was that it was an early morning appointment and I had to get up at 5:00 (on my vacation week) to make it through traffic and get their on time.

She went through my history and did an evaluation. What I liked is that she doesn't just focus on one body part. It all works together. On the other hand, that means she can't pinpoint the actual problem for me. She says the si joint and hip joint all work together. She said she would have like to have seen me 10 years ago and that she would have done injection in my hip back then.

She explained that using prolotherapy on my si joint would be a good idea, but with the bit of arthritis found in my hip, it may mean that later, she might need to suggest PRP therapy in my hip joint. I read enough and I am ready to give it a try. The part I don't like is that insurance does not cover prolotherapy and I will have to pay for each visit (around $350) and she suggests that patients commit to coming in once a month for five to six months. She said we would know by the third visit if it is working. I would also have to not ride my ElliptiGO (at least at the intensity that I do) after the injections for a few days or longer. Then after she has worked on my si joint, the hip issue comes into play. I am quite sure PRP therapy is a lot more expensive and I am not sure I could go there, unless I was 100% sure for a positive outcome.

Meanwhile, everything around my left lower back, si joint, and left hip are somewhat troubling every day. I feel OK, but can't do the things I would like to do on a daily basis as everything keeps going out of balance and pinching or pulling all over the place. I started using my Serola Sacroiliac Belt and that gives me more freedom and stability, but I sure would like my body to do the work without resorting to a belt.

Anyway this gives me a bit of hope, even if not for running, just to get rid of the constant imbalances origination in my hips and si joint. She also wants me to work with an osteopath to get myself realigned before the injections. She knew a ostepathic physiatrist up in New Hampshire and gave me her information. It turns out that she has some office hours at one office just 3 miles up the road so I have an appointment next week. This is good as I was searching for a local osteopath last month, but gave up after the first office I called wanted to make it very difficult to even set up an appointment. I decided to skip it at that point. With my current insurance, I am at the point where I don't have to pay for office visit or even copays anymore, so I should take advantage of seeing specialists that may help.

On a related note, I went to visit a podiatrist again at the office where I had my orthotics made back in 2011. The world renowned podiatrist that used to work there is now retired, I had to pay out of pocket to see him a few years ago, but now my new insurance pays for the visit. Let's just say this new guy does the minimal  that I ask of him and shows no interest in me as a patient at all (something I notice a lot in the health care field). I visited him a month ago for the first time and he did what I asked: looked at my left foot and adjusted the cuboid bone and also the poplitius. That foot has felt fine since then, but the right foot felt out of whack. I asked him about that and he checked and adjusted something with the ankle, looked at my left foot and readjusted the cuboid and then he was basically done and out of the room before I could ask about anything I could do to help myself with stretches or something. I glad I didn't have to pay out of my own pocket for less than 5 minutes of his time. I mentioned that I was hoping to get some prolotherapy done and he said he had never heard of it. I find that interesting as a few people I know let me know that had it used on their ankle and feet with great results. I am often amazed at how little doctors know or are even curious about new or different therapies than what they were taught. I would think they would read up on everything they can about how to better service their patients (I read everything I can about teaching to improve how I teach). I guess I call that going through the motions and it is quite obvious that this is what this guy is doing.

Here is an article on Prolotherapy and PRP written 5 years ago concerning research at Harvard by the doctor I will be treated by and Dr. Hauser, who is the most visible prolotherapist in the country. Prolotherapy and Platelet Rich Plasma Research at Harvard: Interview with Joanne Borg-Stein, MD

This article is old, but this was interesting about PRP therapy (use you own blood plasma rather than a sugar solution) and labral tears: RH:

One condition you mention there was hip or labral issues. Do you find that is a condition that responds to regenerative injection therapy?
JBS: I don’t know yet. The hip girdle is complicated. Often times labral tears are incidental radiographic finding and not the proximate cause of pain. I think we need to be diligent and careful in our physical examination and assessment of the hip girdle: anteriorly, laterally and posteriorly. I don’t think there is any data yet, and certainly no radiographic data and pre- and post- studies, looking at what happens to the torn labrum if one gets regenerative injections.
Here is a Wall Street Journal acticle (again it is 5 years old):  A Pinch of Sugar for Pain concerning prolotherapy. Here Dr Borg-Stein is again quoted on the effectiveness of prolotherapy (I believe I am one of those carefully selected patients as I don't think she would waste my time otherwise). I do have back pain, but that is related to the si joint and the second doctor talks about how this responds well to prolotherapy.

The strongest evidence in the scientific literature is for chronic tendon problems such as tennis elbow, says Joanne Borg-Stein, medical director of the Spaulding Wellesley Rehabilitation Center in Wellesley Mass. Some studies suggest it can work for thumb and finger arthritis, she adds. The evidence for back pain is conflicting, but Dr. Borg-Stein says she finds it effective in carefully selected patients. 
One type of back pain, caused by looseness of the ligaments around the sacroiliac joint—near the hip—responds very well to prolotherapy, says Michael Osborne, assistant professor of physical medicine and rehabilitation at the Mayo Clinic in Jacksonville, Fla.
Here is a video of prolotherapy performed on the low back by Dr. Hauser. It is not for the squeamish or for those who dislike needles and but cracks:



Wednesday, February 18, 2015

Awesome 4 Week Postural Realignment Therapy Program: Online Videos and Instructions

These videos make up a 4 week/ 4 video postural realignment program that is found on Breaking Muscle and contributed by Maryann Berry. Maryann is someone who has fully recovered from the chronic hip pain in her twenties which put her in a wheelchair. She uses an exercise technique called Posture Alignment Therapy, These exercises remind me sometimes of Egoscue. I started this program on week one, but stopped doing it because my si joint was real sore. I got a Serola Sacroiliac Belt last week and it is feeling better, so I am ready to start the program again. There is a video for each week of the program and you can find more directions for each week's exercises here. I have been following the videos each week as Maryann makes them available online and it looks like a well-thought out program.








Wednesday, February 11, 2015

Meb Keflezighi relives the 2004 Athens Olympic Marathon video






Here is a new video where Meb recounts the Olympic Marathon in which he won the silver medal in Athens. While watching this video, I noticed for the first time the number that Vanderlei de Lima was wearing when he was attacked by psycho man as he was leading the race. Let me now reemphasize something that I found out, just like Venderlei did: 1234 is not a lucky number.



Monday, February 2, 2015

New Pathways back to Running: si joint dysfunction and Prolotherapy?

I have given up on running. I have never been able to figure out what is going on with my hip post labral tear surgery. Last year I only ran a total of 88 miles (most of those during snowshoe races). I did not run an actual running race for the first time since I started running in 1973 and decided it was not worth it to do more snowshoe racing this year knowing that after each race, I would spend a few days with my hip area all beat up and uncomfortable. I have read everything, tried everything, and have found nothing really helps that hip area: strengthening, mobilizing, or rolling things out, PT, doctor, and injections have not been helpful either. I say my hip is sore, but it really is not the hip socket, but everything connected to the hips within and without.

I have even been feeling uncomfortable riding my ElliptiGO. I am getting my rides in indoors this winter, but my hips always feel rotated or off level. Before Thanksgiving I was really off and sore in the sacrum area. I again researched ways to fix a stuck si joint. I worked on some self mobilazations,I found that were way beyond my flexibility, but low and behold a heard a pop and then everything calmed down for me.

I started getting more discomfort in the si joint after a few weeks and kept trying to work through it. I decided to research more and it hit me quite clearly that what I have been fighting is an si joint problem. The more I read, the more it made sense and everything I read about the symptoms matched me totally. There are methods that can pop a stuck si joint back into positions,, but the problem that people have is that the ligaments connected to the si joint get stretched and don't stretch back, thus chiropractic adjustments can make things worse.

One method that claims to fix this is something called Prolotherapy. I certainly have read about this before and found comments I made (TDF) on running message boards about this from back before my hip surgery. I had ignored it, because it considered experimental and insurance does not cover it. Basically, they inject a sugar type solution into the ligaments and that is supposed to stimulate recovery. It seems to work well with the si joint and tightens up the ligaments and making the joint strong again.

I am in the process of trying to get an appointment with a doctor for this and then I will have to see if it is for me and if it is even something I can afford.

Update: I have an appointment at the end of March with a doctor that specializes in this at the same clinic that I had my hip arthroscopic surgery. Surprised that the doctors, physiatrists, and PT people that I saw there didn't mention this, but maybe they were just focusing in on the hip.

Here is how it makes sense to me. I always had an awkward running stride, but I made it through high school and college running with no problems except my knock knees and  weird stride (due to femoral anteversion). Then two years post college, I got into triathlons. Six months and after only two races, I completed my first Ironman distance triathlon. There was no such thing as bike fit back then and I had problems with my left weird leg getting comfortable right from the start and jamming up my hip-lower back. That winter, my back was already sore, so someone recommended I see an osteopath. He did manipulations on my si joint and I would feel good for a day or two and then it would hurt, so I started lying down an pressing on that si joint myself until it clicked and I felt better. By the end of my my fifth season doing triathlons I could barely stand comfortably and was clicking my back 10-30 times per day. I had my first PT to try to figure it out in 1988 right before my wedding because I didn't think I could stand comfortably through the ceremony. I was told to never run again.

I now know that was the si joint and if the ligaments remained stretched, then I have been fighting that unstable joint for over 30 years (and yes, that is what it always feels like even if I am riding my ElliptiGO). I think once I run and put all the weight on that one joint, my body tries to compensate and that is why everything falls apart when I run. It literally feels like it needs to be stitched back together.

This video even shows how an si joint dysfunction is a cause of a hip labral tear (particularly someone with a long standing dysfunction). Well if I have run for over 30 years with this (I have never been comfortable since 1983- but have controlled it better at times) then that may be a real good reason why I developed a labral tear.



Another video explains the symptoms of si joint dysfunction. Instead of saying, "You can have pain.." she could have said, "Jim has pain..." as it describes my last 30+ years quite accurately.



I will be curious about the Prolotherapy or anything else I learn along the way. So far, the best appointment I can get is in July! If anyone reads this and has comments or has had good or bad results from prolotherapy, I would be interested in hearing them.

Thursday, January 29, 2015

Excellent slow motion video of Haile Gebreselassie running barefoot and with shoes

This video was just posted by James Dunne from Kinetic Revolution and it shows the great Haile Gebreselassie running in slow motion. I particularly was fascinated with the barefoot video and watching what his foot and toes do as they reach for and touch the ground.




Sunday, January 11, 2015

ElliptiGO Get On The Map Rewards

The ElliptiGO is tons of fun and a great workout and the ElliptiGO company is top-notch in every way. Last year they had a Get On The Map points competition where you could earn points for completing various activities and qualifying rides. At the end of October, they added up your earned points and you could choose rewards. I had enough to either get an engraved pewter chalice or an ElliptiGO jacket and shirt. I went with the practical over the very cool and a couple weeks ago got my awards. Now when I wear my ElliptiGO gear, I won't' get as many questions shouted out at me like, "What do you call that thing you are riding?" How many companies do you know that treat their customers so well with challenges, community, and even awards?

Here is recent ElliptiGO convert Brian Baker with me in front of Nobska Lighthouse in Falmouth, MA. as we were riding the Cape Cod Marathon (and Falmouth Road Race) routes on our ElliptiGOs. I hope to do more rides with Brian and his brother Jeff as they both have recently purchased ElliptiGOs to deal with running injuries (and time off from running) or as a supplement to running training in order to stay healthier and get more training in without getting injured.



Friday, December 19, 2014

Ron Hill's Amazing 50 Year Running Streak

Ron Hill winning the 1970 Boston Marathon
Former Boston Marathon champion (1970) and the second man to break 2:10 in the marathon, Ron Hill, is about to master another long distance and long running achievement. On December 21, 2015 he will have completed his 50th year of his running streak of running at least one mile per day. Here is an article by Jason Henderson at Athletics Weekly that explains Why Ron Hill is Running Royalty.



Boston Marathon victory
I didn't start running until 1973, however I knew a tiny bit about Ron Hill already. I knew he was one of the favorites at the 1972 Munich Olympics in the marathon and I knew about his string fishnet singlet that he wore at races like his Boston Marathon victory. I must have been aware of photos of him and the "science" behind his choice of clothing. Once I started running, I wanted to look like a runner, so I went to the local Bradlees store and found a fishnet jersey, probably in the underwear section, and bought it. It was my first ever running related purchase (even before getting "real" running shoes) and my inspiration was Ron Hill. Fifty years is an incredible running streak.

I continued wearing my "Ron Hill" inspired jersey for a few
years, including during my first Falmouth Road Race in 1975.