Thursday, June 24, 2010

How I Fixed my Severe Ankle Pain (or Maybe it just Went Away.)

So evening before last I became aware that my ankle was hurting. A lot. I’d just come home from doing a massage. So far as I knew I hadn’t done a thing to it, though I had set my table unusually low, and hence been doing a fair amount of my work kneeling. Dropping to a kneeling position puts the ankle rapidly into extreme flexion; it wouldn’t be that surprising if I’d hurt myself, either by over-flexing the ankle or by the eccentric contraction of the calf muscles.

But the pain surprised me, because it was superficial and localized. Right on the point of the lateral malleolus, what civilians might call “the bump on the outside of the ankle.” As if I’d whacked it on something. Maybe I had whacked it on something, but you’d think I’d remember whacking it that hard. Man, it hurt.

So it was like trigger point pain in that it appeared rather mysteriously, without what Paul Ingraham (of so accurately calls “an Oh Shit moment” – a moment when you know you’ve been injured. But it was unlike trigger point pain in being very localized, and tender to the slightest touch.

Okay, well, this is my area of expertise, right? Physician, heal thyself. So I did the obvious sweep, carefully stripping the peroneals (along the outside of the lower leg.) Wow. That might be a trigger point, in the peroneus tertius. Reproduced the referred pain. Or did it? Well, maybe not. Hard to tell. Do I even have a peroneus tertius? Some people don’t. Maybe that’s the peroneus brevis. All this time studying anatomy, and mine in particular, and I’m not even sure which muscles I have.

Well, look it up. Oh! Yeah. I should definitely check the soleus (deep calf muscle, under the bulgy ones).

Whoa! Hurts like hell. Work on that sucker, for sure.

Okay. Does that feel better?

Well, I don’t know. It might. Is this really trigger point pain at all? Maybe I actually tore something in the ankle. Sometimes you get too clever, in this business. Sometimes the pain is exactly what it seems like, exactly where you feel it. Or maybe I really did whack it. No sign of bruising, though.

So sleep on it. Next day – yesterday – the pain was still impressive – in fact now it felt very like a sprain, and I felt it throughout the joint; I had a pronounced limp — and the point of the ankle just as tender. I worked the points several times.

Today the pain almost gone. I rode my bike to work quite happily. Almost certain not to have been ligament pain, then – they don’t get better that quick. And surely if I’d whacked it, I’d have seen a bruise? So I think I fixed it. With that trigger point on the peroneus tertius, unless it’s the peroneus brevis. Or the soleus one. I can still get a ghost of the pain if I flex my ankle all the way.

My point here is how very vague and provisional all your conclusions are, as you’re working on pain. If I had a different personality type, I might be trumpeting to the world how magnificently I just treated my ankle. And I’d rail against physical therapists, who would have told me to stretch (disastrous!) and train up (even worse!) the peroneal and soleus muscles, and physicians, who would have told me maybe I have bursitis or tendonitis or arthritis, and given me drugs to poison my liver.

But, being who I am, I’m acutely aware of the fact that I just don’t know. Maybe stretching and exercising it would have been just the thing – maybe they would have fixed it a day earlier. Maybe there was never a muscular problem at all: maybe I bruised my ankle and it just never showed up on the skin. Maybe I irritated a ligament but it got better quick, and ibuprofen would have spared me even yesterday’s pain. Nobody will ever know. Did my trigger point work fix my ankle? Was Napoleon poisoned on Elba? Did human beings wipe out the Neanderthals? I don’t know. Neither do you.

I do know that since learning that most of this sort of pain is muscular, and heals up really quickly if you know what to do, I’m much less intimidated by it. Pain drops on me out of the blue, as it does on anyone my age, but I meet it aggressively, with a bristling arsenal of methods and ideas. I have confidence I can make it go away. I have heat, I have contract-release methods, I have trigger point, I have visualizations, I have deep breathing, I have mobilizations, I have stretches, I have meditation, I have drugs. By God, something I throw at this pain is going to faze it.

And I have by now a history of recovering from chronic disabling pain, and helping other people recover from it. The back pain I had in my thirties, the debilitating knee pain Martha used to have – these things can go away, completely, as if they had never been. The model I used to have of the human body, as a machine made of delicate irreplaceable parts that wear out, one by one, has been replaced by that of an organic system that is so tough and vigorously alive that it even reproduces kinks and snags like trigger points, infinite loops (to drop into programming jargon) that sometimes you have to break forcibly to keep them from running forever.

The less you know, the scarier pain is. I used live in a very murky world of fear. What if my pain was a damaged nerve? Would that mean I would never get better? What if a disk slipped in my back and severed my spinal cord? What if this or that joint was just wearing out, cartilage disintegrating, connective tissue separating, never ever to heal? Seriously, I used to think all those outlandish things virtually any time I had back or neck or joint pain. It didn’t even have to be severe pain.

Sure, all these things are theoretically possible. They’re just all quite unusual, whereas trigger point pain is dead common. It was as if every time I had a cough I imagined I had tuberculosis. It is a possible explanation, no denying it; but it’s more likely to be a cold.

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