Wednesday, 16 October 2013

Finding a Balance

My consultant's appointment eight weeks post-op revealed how stiff my toe is still, despite my efforts with my foot physio exercises.  As I posted before, I wasn't sure whether I was doing the right thing, and the consultant agreed that I should have some time with a physiotherapist on an urgent basis. After nearly two weeks and several phone calls to chase up my referral, and then chase up the lack of appointment letter, I had my first session last week and my second session yesterday.  It was good, but hard work and painful at times. Before physio, I had no pain when I was just sitting doing nothing.  I was in so much pain by the time I got home after the first session that I took some painkillers, sat on the sofa with a drink and woke up a couple of hours later covered in cats.  There's a very fine balance between doing enough exercise for osteoarthritis and too much, and it's impossible to know where the line is on any given day. The following morning, I felt as though I'd been hit by a truck.  My knees ached, and the scar along my toe had gone from being a healthy, pearly flesh colour to being a dark pinky-purple slash, with a lumpy, shiny pink zig-zag running up it where the internal stitches are and a suffusion of darker greyish purple under the skin on either side.

It turns out that the exercises I have been doing are all good, but don't work the toe and foot hard enough. Also, it might still be early days, and it could be that the lump of bone which looked as though it was limiting the movement wasn't the only limiting factor.

The massage needs to include pulling the toe out to increase the joint space, and gently working it up and down. It feels good when the physio does it and I can't quite reproduce that for myself, probably because it's my foot, so I hold it at a different angle. I was already massaging the tendons involved in moving the big toe, but I should work a bit more where I can feel the stretch and tension when I try to move my toe.  Trying to bend and straighten, lift and lower the toe against resistance is really hard and painful, but it's only for a few repeats.  And I should hold a stretch against something solid (for which I use the end of the bath - the hot water makes it so much easier!).  This seems to be effective in a very small, slow way. I'm still trying to get back the small degree of flexibility I had before the operation, so every millimetre counts!

The real trick with all of this is to find exercises and work to a level which does not cause or increase symptoms of, in my case, pain, stiffness and inflammation, and it is particularly difficult when other joints are also a problem. I also notice that in physio, we only work the 'problem' side, but exercises should be done on both sides to keep the body balanced.

I was given a resistance band to do some leg exercises.  One end is anchored around the leg of a table, the other end has a loop in which I put my 'bad foot' ankle. Standing with my feet together so that the band is taut, I then do sets of 10 repetitions moving the leg out and back in a cross shape forwards, out to the side, across to the other side and backwards.  The resistance strengthens the working side, but also pulls on the supporting side which has to work to balance and to counteract the resistance pull of the working side. It's quite a stiff band, and the table starts to move across the tiled floor.  It is an easy exercise, but I found it really tough on my bad knees and almost immediately, my right knee went into flare. My left knee is better than it was after the flare which started in June, but still not great, so now neither knee supports my weight properly.  It's times like this when I start to become sleepless, partly through pain, and partly through worry that my dancing days will soon be over. But I'm not going to give up without a fight, so if three reps every third day is all I can manage to start with, that's what I'll do. 

The second physiotherapy appointment allowed me to have some fun (and muscles going for the burn) with wobble boards and a rebounder/trampoline (just bouncing a little stretches the toe joints), since I don't have those bits of kit at home. After that, both my knees were truly in flare.  

As physio is not supposed to cause or worsen symptoms, it was decided to switch to hydrotherapy. I had my first appointment yesterday.  The lovely warm pool was very much more gentle on the knees and I had a pinging sensation in my toe (in a good way) when I was doing a gentle jog up and down in the water. Even though I felt good afterwards, by the time I had done a small shop around the supermarket, my knees were agony and I was wiped out for the rest of the day. Just pass me the painkillers. Next week I have a hydrotherapy appointment first thing, then a drive and a somatic movement workshop.  I might be being a bit too ambitious, but I really need to be able to stand, walk and dance again.

The other exercises mainly involve balance challenges, which, I've discovered, are an important component of rehabilitation following lower limb injury or surgery.  They make the feet work harder, but also involve working the whole leg and the core muscles quite intensively. I'm finding them very difficult because of the pain and weakness in my knees. My balance has deteriorated noticeably over recent years. I've decided that I need to do more, and add more balance challenge exercises into my classes. This made me look back on my notes about balance and do some more reading, which will be the subject of another post at some point.

I have a kind of love-hate relationship with these exercises, in that they are useful and effective, but I find them difficult and don't really enjoy them.  In theory, the starting point is 5 minutes, building to 15 minutes, but like the 10 reps starting point, I would start lower.  If you want to do these too, set up a space where you won't hurt yourself or damage anything else if you fall over, although the idea is that you don't let yourself fall - have a chair or stand near a kitchen worktop which you can use for support. Or heap cushions and pillows around you so that if you do crash land, at least it's soft!

Standing on one leg
It sounds simple, doesn't it?  Part of the trick is to start the balance by checking/correcting your posture, then transferring your weight to your supporting leg.  To start with, lift your working foot only a little way from the floor, and lift your arms to the side to help your balance.

As you get better, you can make this more of a challenge by:
  • Closing your eyes.
  • Lifting and lowering your arms.
  • Passing a small ball around your body.
  • Lifting one leg and passing the ball under your thigh.
  • Bending and straightening the supporting knee.
  • Moving the working leg to the front, side, back (away from the centre line of the body).
  • Standing on a cushion or something spongy.
  • Rising onto the toes of the working foot.
Any exercise done on one leg involves some degree of balance challenge, but sometimes it's good to play with being deliberately off-balance, extending and moving legs and arms around while tightening the core muscles and trying to find counter-balances.  It doesn't matter if it looks ungainly, you are working hard!  I used to do this in contemporary class and was reminded of it in a workshop by Galit Mersand at Fantasia last December.

I don't think I've ever truly appreciated ballet barre exercises until now.  The barre is just there as a light assistance to balance.  The exercises work the legs and feet intensively. I use the kitchen worktop as a barre, and do just a few demi pliés and battements various, an odd stretch and feeble rise here and there. Just a few, until my knees start complaining that they would be so much more comfortable were I to lie down. I can currently cope with about five minutes.  Still, it's better than nothing and good to start low and build gradually, however depressing it may be that I feel so utterly and pathetically puny. This month is going to be physically tough!

No comments: