Spine Journey: Rehab Pilates & Nerve Block

Hi again! I hope you are doing well. As I promised, I will keep you guys updated during the healing process of right sacroiliac (“SI”) joint arthritis that I suffer. Continuing my story in previous post, I would like to rekindle that I have already conducted two SI joint injection in the past 1.5 months. It wasn’t effective enough to cure the joint inflammation. The symptoms were still there. It was getting worse with the movement that stress on SI joint, such as prolonged sitting or walking, rolling over in the bed, waking up from a seated position, and carrying quite heavy loads.

After the second injection, Dr. Luthfi advised me to do exercises and physical therapy, most of which are isometric exercises. The objective is to restore the range of motion in this joint, strengthen the imbalance muscle and pain management. I did swimming every four times a week and rehab pilates every twice a week. That’s sound ambitious, isn’t it? Lol 🙂 I’ve done the trial and error by did only swimming in a week and only rehab pilates in the next week. I think, swimming didn’t really provide immediate pain relief, but rehab pilates did. Maybe swimming has to be done repetitively to result in muscle strength. It is also good for post scoliosis surgery. Actually, you can also find a private instructor in a gym to guide you through core muscle strengthening program. I haven’t done that because swimming and pilates already filled my schedule in a week.

Rehab Pilates

I must admit that it was difficult to find a pilates teacher who fully understand how to treat client with limitations like me, because I have rods from T2 to L4 and SI joint arthritis. Luckily, my former pilates teacher from Pilates @ Kemang, Dini, referred me to Paula Blaker at Vitruvian Physiotherapy & Integrated Movement Centre located in Pondok Indah, Jakarta. She also worked as a medical rehabilitation and has experienced with cases like me.

In my first meeting with Paula, she examined my posture and movement using SI Joint Form Closure, SI Joint Force Closure and another assessments. She understands that I didn’t like to be touched in SI area, so she treated it gently. Her judgement was close to Dr. Luthfi’s. Something happens in my right SI, the sacrum is tilting to the right, muscle imbalances, and my piriformis was very tight that it may irritate the sciatic nerve. She also said that the exercise goal for lower back pain is to make the pain closer to the source, to reinforce efficient movements and to educate me to use the right muscle.

Paula also took attention of my daily activities that cause the inflammation worse. For example, she taught me how to get on my back / stomach and get up because I expected pain everytime I did that. She even inspected my car seat and adjusted the position of it because my SI got worse everytime I drove. Take a jot of this, when you have T2 to L4 rods, please don’t make your seat higher in knee and lower in hip because it will make the SI work too hard.

So, in scoliosis, some part of the muscle is weak and the other work too hard to compensate. After the scoliosis surgery, the muscle adjust itself to find a new balance. Some people’s work well, but mine don’t. It is a total chaos especially in my right leg.

We focus to train the abdominal and glutes (three of them: minimus, medius, maximus) to alleviate pain in SI. Other than that, we stretch the hip flexors because mine is very weak. I do a lot of bending and twisting from the hip because it is the only mobility that I have.

The studio provide real good equipments. The most helpful is the vibration device that capable to alleviate stiffness and pain. I throw myself on that device every time I have chronic pain in SI to leg. Besides, I also use the Redcord for suspension exercise. It involves a lot of ropes to challenge my strength and alignment.

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Paula always influences me to think positive in facing the ailment, because we are what we think. Our body will listen what our mind says and move in that direction. I am not allowed to describe my ailments in any negative words. For example, I should say “I feel something in my sacroiliac today, but nothing in upper thigh to the knee” instead of “I feel pain in my sacroiliac”. It really shifted my perspective. She teaches me gratitude by saying “It is fine when you feel pain, just remember that you ever felt pain free the other day. Cherish the moment. Be hopeful.”

After four sessions of rehab pilates, the pain from upper thigh to the knee has gone eleven sessions of rehab pilates, I felt significant difference, in a good way. Undeniably, I still feel something in my SI joint, but hey the SI is the toughest part. Nothing has made me feel better, even the steroid and opioid. I’ve done pilates for five years and it’s still the exercise that I always count on. Best exercise.

You have to be patient in muscle strengthening. Progress is slow, results don’t come fast. For your information, it is cost IDR 1.3 mio for a single visit and IDR 10 mio for 10 visit with my teacher.

Nerve Block

Given now is a year that I bear the SI joint pain, Dr. Luthfi said that it is rare one suffers this kind of ailment for so long even after treatments and physical therapy. By the way, lower back pain source is tricky to be analyzed. It’s like the heavy traffic in a crossroad, it can be from anywhere. He considered another steroid injection with improved dose to confirm the source of pain, once again. Afterwards, he proposed to place the titanium rods on my SI to stabilize it. He said that the hospital is currently importing a new equipment that is estimated will arrive in January 2018 to perform the fusion.

Maybe it sounds simple, but for me, another titanium implanted on my body is too much. I have already a lot on my whole spine for my whole life. I don’t want another one. I was worried about future pregnancy. Although in his opinion, most likely the certain effect is just necessity to undergo sectio caesarea. Still, there are risks. I also don’t want taking opioid (narcotic pain reliever) every day become my reality. I have lived dependent to it for months and fed up with it.

So, we decided to conduct the nerve block using radio frequency (“RF”) to suppress the pain. I really hoped it works, because it was my last chance.

Dr. Luthfi referred me to Dr. Sugeng, an anaesthesiologist who would perform the procedure at Rumah Sakit Mitra Kemayoran. Dr. Luthfi called to explain my case that day. The procedure was held in operating theatre. Beforehand, Dr. Sugeng explained that this procedure is beneficial both to confirm the pain source and suppress the pain. If it is true that SI is the source, patient will feel total relief for 3 months – 2 years. After this period, the nerve will regenerate and the pain may return. In this case, the joint is stable so it won’t trigger the pain to reappeared. If the pain returns in less than 3 months, it means that the joint is not stable and have to be fused.

We discuss the cause of my SI joint arthritis. It is quite strange because the disfunction is more common to elder patients (osteoarthritis), pregnant women and people who experienced trauma. For those people, the joint must be stable and inflammation could be treated with steroids. I’m not all the latter. Another possibility is lumbar fusion that cause weight shifting, which means the SI work too hard to coordinate transfer of weight from upper body to lower body. In this case, the joint is not stable. I did the lumbar fusion (scoliosis surgery) before, so this thing haunted my mind.

The RF procedure means interrupting nerves that carry pain signals in the SI joint. First, I was laid on my stomach, given intravenous sedation and injected with local anaesthesia. The next step was Dr. Sugeng used x-ray guidance to direct six RF needles alongside the branch nerves. A small amount of electrical current is carefully passed through the needle to assure it is next to the target nerve and a safe distance from other nerves. The targeted nerves will then be numbed to minimize pain while the lesion is being created. The RF waves are introduced to heat the tip of the needle and a heat lesion is created on the nerve to disrupt the nerve’s ability to send pain signals.

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The procedure takes two hours. Was it painful? Yes, it was one hell of a ride. I was given ice in my SI and 120 mg of etoricoxib to reduce swelling. It wasn’t enough so I took another 30 mg of oxycodone. I was treated under one day care, so I returned home in the same day.

The nerve block worked like wonder on me. I didn’t feel any single pain for two days. It was my first time during 11 years of struggle. I was pain free and amazingly happy I could shed a tear. Until the third day, the SI pain started to reappear in my gluteus, radiated to the groin and leg. I was worried so I immediately contacted Dr. Sugeng to meet him. In our meeting, he said that he saw major improvement on me for approximately 50% because my body movement was more efficient. However, the pain still lingered. He should observe for two weeks post procedure to determine whether the joint is stable or not.

That was quite a long story, phew. I hope these informations are useful for you, my friends, who share the same story as me. I will update you guys again after the two weeks observation. Talk to you later. Please stay happy and healthy! 🙂

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