Piriformis Syndrome

WARNING ... Boring medical stuff about Piriformis Syndrome.

I always suspected I had Piriformis Syndrome but held off confirming it until I was on Medicare. I'm now on Medicare and I'm no longer paying $1,200 a month for shitty health insurance with a $7,000 deductible that forced me to think twice about seeing doctors. 

Before dealing with the Piriformis I got my back repaired as to not confuse the symptoms of the Piriformis issue with the back issue The back surgery was done a back in February.

An ultrasound confirmed that my Piriformis is inflamed and there is also a layer of scar tissue on the Piriformis from my hip replacements in 2013. The stiff scar tissue is most likely binding up my Piriformis and not allowing it to smoothly move thus the inflammation. Along with always having some degree of discomfort and sometimes pain (if I twist my leg wrong) it also causes occasional foot numbness as the ultrasound showed the Sciatic nerve to be "entangled" in the mess that is my scarred Piriformis. 

When I ride my scared Piriformis requires that I stretch every 10 to 15 miles during a ride as the Piriformis tightens up with use. I usually feel no pain from the Piriformis while riding but I do feel the onset of numb feet (my form of recumbent foot). The function of the Piriformis is the lateral rotation of the hip joint and other stability functions. Being clipped into pedals helps to stabilize the hip joint while riding. However once off the trike I generally feel some discomfort. Pain on occasion.

I'm moving forward with having the situation reviewed by a doctor to two. The expected game plan is for targeted physical therapy to soften the scar tissue and ease the fascia between muscles to get the area moving smoothly again to hopefully ease the problems associated with the Piriformis. The worse case option would be surgery, if even possible. 

Such a little muscle but it can cause so much pain.

Nerve Damage Post Hip Replacement

If you're considering a hip replacement please read.

Back in 2013 both my hips were replaced and left me with some problems. To begin with the right hip has suffered calcification of the soft tissue (heterotopic ossification). It hasn't gotten any worse after the first year and I've learned to mitigate the stiffness it causes through exercise, cycling and an occasional deep tissue message. 

The other problem caused by the replacement is the atrophy of the medial head of the Gastrocnemius of my calf muscles. It took a long time to recognize the problem. I've concluded that there is nothing I can do on my own to build up the muscle. I can't get that part of the Gastrocnemius to fire up. It seems that the nerves were damaged to that part of muscle. It might been caused by the torture table that was used to rotate the hips open as part of the anterior hip replacement procedure. Severe twisting of the lower leg to open the hip joint is my guess as to what caused the damage. 

For now I've become used to the situation and it has no pronounced effect on cycling as long as long as I'm clipped in to the pedals. The Gastrocnemius attaches to the back base of the Femur. Along with the less powerful Soleus muscle which attaches to the top and back of the Fibular the Gastrocnemius and Soleus comprise the primary muscles of the calf. So I still have enough strength to stabilize the lower leg and ankle. However walking is a little funky. 

I would think twice about doing the Anterior hip replacement again if I had more hips to replace.

It's All In The Seat

I took the 700 on ride down the coast today to make sure it was the hard shell seat on my new ICE that was a pain in my hip and not something more ominous. Good news, bad news. Good news, my hip is no worse or better then it was before. The mesh seat on my 700 is oh so comfortable. I've never really appreciated the comfort of my 700. The bad news, the cool carbon fiber seat on my new ICE Sprint 26 FS has to go. I tried to customize the seat with the diamond pads that come with the seat but they didn't solve the problem. After about 5 miles the muscles in my right hip protest.

Now I'll have to check out the ICE mesh seat. I wasn't comfortable with it when I initially tested it some time ago. If that still holds true then I'll have to consider selling my brand new ICE.  I'm also thinking that the 25 degree seat angle of the 700 takes some of the pressure off my hip muscles. The max seat angle on the ICE Sprint 26 is 37 degrees.

Here's a couple pics of my ride today on the 700

Looking out over Morro Bay.

Morro Bay and Morro Rock

ICE Carbon Seat Hard on the Hip

So far the rides on my new ICE Sprint 26 FS have been short. The carbon fiber seat is hard on my right titanium hip. After about 5 miles my right hip starts to succumb to the hard shell seat. It seems like the hardness of the seat and the upswing at the bottom edge of the seat plays havoc on my piriformus muscle. My left titanium hip is fine but the right side has been compromised by calcification of the tissue (Heterotopic Ossification) around the hip joint. On the positive side it only bothers me when I'm pedaling. Oh well.

The mesh seat on my Catrike 700 is very comfortable and causes me no grief. So my next step is to take a closer at the ICE mesh seat. Although when I took my first (very short) test ride on a ICE mesh seat awhile back I felt like I was going to slip off the seat. I'll check out the ICE mesh seat again before making any hard decisions. 

Dang, the comfort of the Catrike seat has spoiled me. I hope I can find that same comfort with an ICE mesh seat. 

Diagnosis - Heterotopic Ossification

It's taking a little longer then planned to get back to pushing pedals. The anti-inflamitories have eased matters up a bit and taking it easy has almost gotten me back to normal...at least my version of normal.

Final diagnosis...heterotopic ossification in the soft tissue of my right hip. Sorted details for heterotopic ossification here.

The x-ray shows my right hip and the offending bits of calcium buildup just above the femur most likely due to inadequate irrigation of the area following hip replacement surgery. Thanks Dr. Yun for the souvenir.

Physical Therapy for New Hips

"Just walk" is the only physical therapy I need after hip replacement. At least that's what the doctor said. DON"T BELIEVE IT!!! I did and now I'm going through intense physical therapy many months later after my hip replacements in September and December of last year.

At first recovery seemed to be going fast and on a positive track. Over the the last few months I started getting tingling and numbness in my feet and eventually up my calf. My legs and hips started feeling stiff and sore. Then the pain of sciatica started down my butt and legs. I'm  able to comfortably ride but walking and standing around became uncomfortable and painful.

I went to a neurologist last month and he sent me to a physical therapist. Finally after four weeks (with many more weeks to come) of poking, and pushing and pulling I'm starting to feel normal again. The sciatica is a fraction of what it use to me and the tingling and numbness is substantially reduced. No amount of stretching and exercise on my own could get me where I am today.

Piriformis syndrome is the cause of all the sciatica, tingling and numbness. Some recumbent riders suffer from this syndrome because of the over development of the muscles in our rear ends. For me it was exacerbated because of the big hit my hips and legs took from hip replacement.

The overall stiffness in my hips and legs is primarily due to the trauma my  fascia  underwent from hip replacement. For lack of better words it's as if my muscles are not sliding around very well and are stuck together.

Mike Burns at Custom Physical Therapy has taken me long way towards recovery. Three sessions a week and plenty of stretching before and after rides as well as in between is the key to getting my life back.

Hip replacement is a major surgery and takes it toll on the entire body. To maintain a healthy and active life after hip replacement surgery physical therapy is essential. Don't learn the hard way like I did.

Titanium Hips Post Op

I went to the doctor today for a post op visit. Everything is good. It's been six months since my right hip replacement and three since the left one was replaced. Now I need to spend the next few months working out the stiffness (and soreness especially after a ride) caused by scar tissue. I'm told that scar tissue is a good thing. Muscle and tendon are soft and stretch while scar tissue is tough and holds things in place well.

The soreness (nothing that a little Ibuprofen can't help)  after a ride is diminishing. As long as I avoid steep climbs on my 700 (not geared for steep climbs) I can end a ride with minimal soreness. Soon I'll start taking the Expedition out more with it's 16 gear inch low end and ride some of the hills around home

 Photos from today's visit to the doctors office. 

Finally...A Ride With Betzi

Other then a few laps around a school parking lot back in February the last time I took ma doggie Betzi on a ride was September 19th of 2013. I had my first hip replaced September 31, 2013 and the second hip replaced December 23, 2013. Finally it was time to test the new hips with Betzi in tow. I hooked up the Doggyride trailer to my Catrike Expedition and hit the road with a slow 8 mile (503 feet of gain) ride. I was not anxious to tow 100 plus pounds of dog and trailer with my new hips but all went well. I'll be doing more rides with the ole girl.

Ready to go!!

Woof

Watch out folks the circus is back in town

Just like the "old days" taking a break at Oak Canyon Community Park

Ready to head home

The Miles Are Coming Back...Slowly

A lot of short but sweet rides so far this year. The new hips feel good with short minimal elevation gain rides. All but one of the rides this year are on the 700. The short ride I took with Betzi convinced me that I shouldn't push to hard. I'm going to keep riding the 700 another month or two before hooking Betzi's trailer up to the Expedition. The short rides (one in particular, a 12.2 mile with a 577 feet of gain) allow me to ride a little faster, a little harder and with a respectable  miles per hour average with minimum stress on the hips. 

The Catrike 700 is a pure joy to ride. It's fast and light (for a trike) and still brings on the endorphin rush even though I've had to back off during hip recovery. I take the steeper hill climbs slow and easy and say a friendly "how do you do" as riders pass me only to give a wave as I pass some of them on the flats or scream past them on a nice downhill. It's all in good fun and with many of the riders I come in contact with I have chance to have a fun but short conversation. 

Recovery Hike

Last Sunday I pushed a little hard on my titanium hips. I road 20 miles on my 700, gained 1,200 feet and averaged 13.7 mph. Not a lot by normal standards but for me right now it translated into stiff and sore hips for a couple days. Now that I'm pretty much back to normal (normal for me) and I decided that a hike with my girls would be a good way to continue my recovery from last Sunday's ride. 

We hiked past the remains of the old Morrison ranch which is now part of the National Park Service at Cheeseboro Canyon.

Carrie and Leili 

Leili

Strength is Coming Back

My ride today was 20.1 miles, 1,230 foot gain, top speed 45.8 mph and an average speed of 14.4 mph. It's not much but for me it's my longest ride since I started the double hip replacement process back in late September 2013. It's been eleven weeks since the replacement of my last hip and my strength is coming back faster then expected. I still take it easy on the climbs, grinding up hills puts the most stress on my new titanium hips. I'm back to getting cheap thrills passing DF's on the flats and flying past them on the downhill runs. At 60 years old I'll get my thrills anyway I can.

Ibuprofen time!!

My Catrike 700 has made my hip recovery process easy.
I love this thing.

By the end of this month I'll be comfortable putting an extra load
on my hips and I'll start taking Betzi on rides with my Expedition.

10 Weeks

It's been 10 weeks from today (12 weeks being the magic number when I can start riding stupid) since my final hip replacement. To celebrate I upped the mileage a bit and added a few extra hills. I did 16 miles and 1,004 feet of gain. Average speed was 13.2mph. 

During the first 10 months of last year my average gain per mile was 87 feet. Today's ride was 62 feet of gain per mile. I'm getting there.

I still get stiff and a bit sore but no real pain like I would get before my hips went titanium. Back in the day I would not be able to ride two days in row. My hips would hurt to much. That's not a problem anymore as long as I keep within my limits.

I'm working my way back with at least three rides a week. Ride on!!

Crossing over Hwy 101 in Thousand Oaks

Riding Again With My Trik'n Buddy

First ride with Betzi since I had my hips replaced. During hip recovery I've been riding the 700, it's light and oh so fun. Towing Betzi is a big step up in weight. It's been exactly 8 weeks since getting my new left hip and 4 and 1/2 months for the right. It's time to get my triking buddy back on the road so I took her out for a short ride today. So good to have the ole girl join me on a ride!!

Ma Doggie

My rig...Catrike Expedition and Doggyride trailer.

Happy dog working off a few lbs she gained over the last few months.

Happy dog...happy triker...that's all folks.

Week by Week

Once again I transported the 700 down
my hill to take another ride on the flats.

Everyday it's either ride my 700, take a hike or go to the gym. Sometimes I go to the gym after a ride or hike but regardless I still have a long way to go to get my strength back. I've been told to expect up to a year for my hips to feel normal again. Although with every ride I feel noticeably stronger

I'm taking life week by week. Recovery from hip replacement is a long grind. If you measure progress on a daily basis you'll drive yourself crazy and those around you as well. The worst was over after about a month and now it's just a slow but steady trek to total recovery. I know my limits and I know when to slow down a bit, my body tells me so. My doctor tells me I should probably back off a little on my activity level for the first twelve weeks after surgery. His comment is based on  the average patient that is older, over weight and less fit. As long as my hips aren't becoming red or inflamed then I'll can carry on. At least I'll avoid any hill climbing until the twelve weeks are past me.

I've got my exercise routine kicked into gear and I'm enjoying my short rides. My longest ride on the 700 is 12 miles at about 15mph average speed and 500 feet of gain. I'll keep the rides at that level for the next few weeks until I get past the twelve week threshold that the doctor set out for me.

The biggest challenge is keeping my brain focused on where I'm headed and not where I am or where I've been. Getting out of bed in the morning  is a "here we go again" moment, time to get the hips moving. After moving around a bit and sitting with a cup of tea in the garden my head generally gets back into the game of recovery and getting physical. My first option is to hop onto the 700 and take a ride. I also need to walk to get a full range of motion and taking a hike into the back country is easy on the mind. So I mix things up a bit and I always make sure I get to the gym every other day. Visualizing what I want to accomplish and what I want to be doing by the end of the year motivates me to work past the soreness of my new titanium hips and go for a  ride, a hike and to tolerate the odors of a well used gym facility.

Doing Laps

My left hip was replaced exactly four weeks from today. Time for my first ride on the road...well I should say on the pavement. I took advantage of the holiday to take some laps in the school parking lot. I went around and around for 3.2 miles. I've lost a lot of strength in my legs. On the positive side, both hips are now replaced and I only get stronger from here. I've been told to expect eight to twelve months for total recovery. This new year will be dedicated to settling in the new hips and building up my strength. Oh the sweet pain of recovery. Ride on!!

MLK Day and the school parking lot is all mine.

Feels good to be moving on my 700.

Carrie waits for me to do a few more laps around the lot and then give me a ride back home. It's to soon to attempt the grind up our hill.

Almost Ready for the Road

I plan on getting out of the garage and back onto the road by the end of next week. It's been 19 days since my left hip replacement surgery and nearly four months since having my right hip replaced. I don't have any more hips to replace so it only gets better from here.

Riding the 700 in the garage is sooo much fun. The 700 is hooked up to a CycloOps and sits on top of a few bricks (high tech stuff). Raising the 700 off the ground makes it easier to get into the seat.

This is as far as I can rotate the crank...today. Everyday a little more. Moving the crank back and forth along with a few choice words not worthy of repeating here makes for a good stretch of the new hip. And yes...it hurts so good.

Supervising Leaf Cleanup

Won't be back on my trike for another couple of weeks but I can still supervise a little gardening.

Titanium Hips

Both hips are now titanium!! As my daughter Leili says...hip...hip...hooray!
It only gets better from here.




Day 2. Relaxing in the hospital bed reading Adventure Cycling Magazine. Thinking of future cycling plans.

Get It Done

The hardest part of recovering from the replacement of my right hip is waiting for my other hip to be replaced. I just want to get it done so I can put the whole double hip replacement process behind me and kick recovery into high gear. Right now I'm in purgatory trying my best to stay active and get strong knowing that on December 23rd I get to go through the whole hip replacement process again on the left hip. But then it will be DONE and then I can put all my effort into getting strong. This in between surgeries is taking it's mental toll.

Game plan....hang tight until December 23rd, let Dr Yun have is way with me and from there on all the pain of recovery will be headed in a positive direction.  "Good pain". When the last hip is replaced the ice packs and the stiffness and pain after each ride will be acceptable. I'm giving myself six months from December 23rd to feel strong and to once again stroke my (soon to be) sixty year old ego passing the properly contoured Lance wannabes on my Catrike 700. I can feel their youthful energy now as I pass them on my tricycle and they tuck down a little lower and shift gears. It's petty but I still get a kick out of it. I also look forward to towing my ole girl Betzi around town on my Expedition.

Oh the triken life is right around the corner. I must master the art of patience and good things will unfold.

I'm done venting, time to stop complaining and ride on!

Easy Rides For Now

Yep...I'm riding but not pushing hard. Just taking easy rides on the flats. It's been two months since my right hip replacement. I'm still working on getting strong and working past the aches and pains that linger. It's hard to get motivated to push hard since I'll be having my left hip replaced on December 23rd. It's three days after my 60th birthday and right before Christmas. Happy birthday, Marry Christmas, Happy Holidays and whatever else. 

After December 23rd the hips will be done and then it'll be time to kick recovery into gear. For now I'm just enjoying the ride and trying to keep myself in reasonable shape.

Ahhh... the 700. It's light, fast and easy on the hips.