When an Adaptation Leads to a New Injury
Last updated: December 2023
I recently shared an article about an unexpected, rather emergent surgery I had to repair a ruptured disc in my back. The injury, subsequent quest for surgery, and recovery shook my entire world.
Life after surgery
I didn't know until after I woke up from surgery that my life for the foreseeable future would be dramatically different.
Imagine this: after cradling an injury for months that progressively worsened, I only expected to feel relief after my operation. Instead, I had crippling pain, stiffness, and dramatic restrictions on movement.
For the first 8 weeks after surgery, I was not allowed to bend or twist at my waist - meaning that every single move I made consciously or subconsciously for my entire life had to be changed or completely omitted. Additionally, I couldn't lift anything heavier than 10 pounds, including my 3-year-old daughter — something neither of us had been prepared to adjust to.
How an adaptation led to injury
But I really want to share my experience with adaptation and how that led to another fairly significant injury for me.
Yes, I'm serious. Unbelievably frustrating and frankly unfair too.
About 2 weeks out from surgery, I reached a point where I stopped living in nightshirts and asking for help when getting dressed, and I took things into my own hands.
The only way to explain this next part is to walk you through it.
How did this happen?
When putting on my underwear and pants every day, sometimes several times a day, I would inadvertently shove my foot into the leg hole, tug on the pants until they left my toes uncovered, and then shove my toes (the phalange bones) into the ground quickly to balance myself out before toppling over. The ungentle and repetitive motion of shoving my toes, specifically on my left foot, into the ground caused some pain, but it wasn't enough to think deeply about right away.
In fact, after 8 weeks of spinal surgery limitations, beginning physical therapy, a work trip halfway across the country, and three very long days in "professional" shoes - I was feeling a little stressed by the mounting pain in my foot. The limp it began to cause meant it was time to ask for help.
It was worse than I thought
During a routine visit to my chiropractor the next week, I asked him about the pain. When I showed him it was hurting most where metatarsal bones connect to the tarsal bones along the Lisfranc joint complex, he immediately sent me for an X-ray. He assessed that I likely had a stress fracture, but I could be dealing with a Lisfranc injury - tearing of the involved tendons and/or ligaments.
I walked into the X-ray room and told the tech I thought I had a stress fracture on metatarsal number 3 or 4.
She went back, took one photo, and came back laughing. She said, "You have fractures on metatarsals 3, 4, and 5."
I'd been walking around on three broken bones, and I didn't even know.
As a person with RA, I thought about what that said in terms of my pain tolerance threshold, and then as an RA patient, I thought about what that meant for my recovery.
A constant battle
For the last 10 weeks, I've been walking in an Aircast boot. It's heavy and awkward; it's shifted my gait, caused rotation in my hips, a persistent pain in my hips, lower spine, and sacrum, a tightening of my glutes, and an overall discomfort I just can't shake.
For the last two weeks, I've been trying to transition into a solid-soled shoe at home. However, I'm still wearing the air cast when I leave my house, and it's a constant battle of which feels worse - not wearing it and giving the rest of my body relief but still feeling sizable pain in my foot, or wearing it, protecting my foot, and faring with the consequences?
Yesterday, I underwent my second foot MRI in 2 months and my third total MRI in the last 6 months. In my opinion, it never gets less anxiety-provoking with all the sounds and the tightness of space, but that's another post entirely.
One of the many frustrations of RA
As I wait for the results of this second MRI, I can't help but reflect on the frustration I've experienced, nursing an injury for months and months that never should've happened.
Yes, I'm steroid dependent due to another chronic medical condition, and yes, I have been diagnosed with osteopenia for years. But frankly, these bones break much easier than they should, and that causes me much fear going into the future as I'm only 36 years old.
Have you ever experienced a compensation injury that became a whole saga itself? I'd love to empathize with you.
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