reply to Mark
Thanks for your kind reply Mark. I'll try to answer your questions although it's hard to describe postural issues with words!
But first re. your question about pain meds and depression. I reluctantly went back onto antidepressants, having been off them for about 2 years and I'd say that both my depression and my pain decreased shortly after. It's hard to say which influenced which, if at all.
The drug I was prescribed is a newish med called Duloxetine (the trade name in the UK is Cymbalta) and it is used for pain from diabetic neuropathy as well as for depression, which is why my psychiatrist gave it to me although my pain does not appear to be neuropathic! The improvement in pain wasn't dramatic but the improvement in depression certainly was.
I am now taking a cocktail of 1 tramadol, 1 solpadeine max (both analgesics) and 1 clonazapam (muscle relaxant) twice a day. Before Christmas I was taking 6 tramadol, 3 solapdeine and 3 clonazapam. So way to go still. I am still on the anti-depressants and have no intention of coming of any time soon. For people in the USA there may be a cost issue. Cymbalta is an expensive drug (approx £1 a day here) but we have the NHS, which, with all it's faults, still means I only pay £7 for 2 months supply.
Re the postural issues... as I said it's hard to explain but I'll try. I'm quite tall and as a child was self-conscious about my height so always had a tendency to slump and round my shoulders. (Over the years I saw at least a dozen osteopaths, chiropracters, physios, Alexander, Pilates and yoga teachers and none of them picked up that my posture could be a cause of the remaining pain.) My tendency was to slump back, sticking my chest out or to over-correct this position by stcking my butt out and pulling my shoulders back, both position over curving the lower back and putting pressure on it.
The other issue is that I had been to Pilates and Keiser Training and back strengthening excercise over the 'pain years' and no one told me I was making a serious basic mistake. When I was told to pull in my stomach, I was pulling in the upper abdominal muscles instead of the lower abdominal muscles. This meant my upper abs were very strong and tight and consequently so were my lower back muscles. The large muscles in the lower back were so strong (and hard and tight) and were doing the work that the smaller muscles all along the spine should be doing. These paraspinal muscles were not doing their job at all. Also my gluteal muscles had slightly atrophied and when I walked I tended to twist my pelvis - I couldn't separate my pelvis from my legs. I imagine there were/are other subtle problems too, that only a trained phsyiotherapist would understand.
So very, very gradually, through a series of graded excercise, I've learned to let go of the upper abdominals (not easy) and consequently to let go of the big lower back muscles too. The 'correct' muscles have slowly begun to wake up and kick in, my gluteal muscles have began to work and I can lie on my back and lift my legs without moving my pelvis or hips, just using the pelvic floor mucles, gluteal muscles and lower abdominal muscles. I've also learned to stand with my hips directly below my shoulders and not several inches in front of them.
I still have a long way to go - these things just cannot happen quickly, especially after a lifetime of bad habits. You have to reach the stage when you no longer have to think about how you are standing or walking; when it feels natural, and this takes time. But this programme has given me renewed hope that I can reduce my pain still further. it seems a great shame to me that surgeons rarely think outside of their surgical box. They often regard phsyiotherapists as inferior beings whn in my experience they are often absolutely vital to recovery.
I'd be happy to answer any questions but would prefer if people email me directly as I don't check in here that regularly.
Good luck to all pre and post ADRers
Vicky
Al
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