Pain in the Butt

Anyone who knows me understands that movement is as important to me as breathing. Any kind of movement-dancing, hiking, walking, biking, weightlifting (now also important because of osteoporosis), Pilates, yoga. Moving helps me feel healthy. Movement helps me feel alive.

At this age and stage, it is as important as ever to keep moving.

For the last few months, I have been dealing with a pain in my butt. Yes, a real one. Go ahead, laugh, make jokes, because believe you me, I have been. I’ve gotten funny texts such as, “Let’s assess.” People giggle when I tell them I have a pian in my butt. Someone just today asked, “How do you hurt your piriformis?”

If I knew, I’d tell you!

The only thing I know for sure-I’m pretty sure I can trace it back to a Pilates class with a substitute over the summer. In that class, we didn’t really do anything out of the ordinary; yet I felt a twinge in my butt. That particular day three other people also felt some sort of pain-it’s not that the instructor did anything we haven’t done before-maybe it was the pace of the class, or the other things we were doing. I’ve been attending Pilates mat classes steadily for over two years. I’ve been weightlifting in group fitness classes, dancing, and practicing yoga. Walking and hiking with friends. Biking when I can.

I can tell when something is not right.

Something was not right. I knew it immediately.

I made an appointment with the physical therapist I had seen for ankle and shoulder issues, and he “released” the piriformis which provided immediate relief. He suggested other exercises which I followed.

Pain-free for about a month, I joined the walking club. The first week was fine and pain-free. The second week, I walked too fast with long strides and my piriformis contracted again. Once more the physical therapist released it. I began sitting on ice, at home, at the pool (that’s me at the pool, lying on ice! behind smiling friend), whenever I needed it. I could still do yoga, Pilates and even went dancing a few times. All with relatively little pain.

And then, in early October, I woke up on a Sunday and couldn’t sit, stand, move, bend. I knew then something was up. Or down. Or…not right.

Something that needed to be checked out.

The next day in a weightlifting class I ran into my friend Mary Ann, a retired physical therapist and she volunteered to “tape” my butt (giggling) with kinesiotape. We were doing a StoryCorps interview, so I headed to her house and yes, she taped my butt. Within hours I had immediate relief. The piriformis muscle comes out of the sacrum/the end of our spine, so taping my butt provided the ability to move without pain.

I also knew I needed to see a doctor because while Mary Ann could tape me, she said it’s not the cure.

Booking myself into the Sports Injury Clinic on a Tuesday, Dr. Sookochoff, the orthopedic doctor ordered an x-ray and then an MRI. He told me there were three scenarios from easy fix (relatively speaking) to complicated. “I choose the easy one!” I said.

He laughed. All options also included REST. “What does that exactly mean?” I asked.

“You can stretch, do yoga, no walking, running or jumping.” (I don’t run or jump anyway.) I asked, “Do you know what kind of yoga people do?” when I explained it, he said, “No don’t do that. Can you do gentle yoga?”

I asked how long this “rest” was mandated.

“For at least two weeks,” was my first answer.

He also said he wanted me to see Joan the “butt expert” physical therapist at the Washington University Physical Therapy STAR center.

Well, sign me up. More giggling.

Within a week, his office had called me back and said the MRI had shown a tiny, tiny tear in the hip tissue (labral) which in theory was causing the pain. He recommended a steroid injection which made me burst into tears. Dr. S. then told me many people have these tiny tears and most don’t even know they have them.

The injection was scheduled the following week, so I had plenty of time to obsess. I also began going to Surrender yoga classes. I needed to be out in the world and among my people. If I couldn’t do mat Pilates, dance, or weightlifting, I could go to gentle yoga classes.

My friend Sandy took me to the injection appointment where they were running an hour late. As if I wasn’t nervous enough!

Once back in the out-patient surgery center things went fast. I had the chance to talk to Dr. S. and ask all my questions-which I had also emailed. He told me he was glad for all the questions because as doctors they know what’s happening and forget patients don’t know! Again, he told me I would have to rest for 2 weeks and do NOTHING. After that I could go back to gentle yoga and see the physical therapist.

In the procedure room he showed me the MRI (looked like a map) and explained that it would feel like a bee sting when he numbed the front of my hip. The ultrasound technicians were so helpful as they held my hand and talked about Harry Potter world (big fan). The procedure was over quickly.

And I was on my way.

On my way to…. REST.

Well, okay, if I must rest, how could I be productive?

I decided to use the time to write and organize, network, and set up meetings.

My friend Sandye texted three days in and said, “The sunrise is spectacular (we love sunrises). Would you like me to take you to dinner tonight? I’ll pick you up at 5:15. No driving-you are supposed to REST!” We had a lovely evening, and it was good to get out. The company was as wonderful as the dinner (and the butter cake at Yia Yia’s).

The next week my friend Kate texted and asked if she could bring me goodies and her company. YES! We spent a lovely afternoon on my patio chatting.

I’d like to say two weeks went fairly fast-it did not! However, I organized, attended zoom meetings, edited a blog, talked to friends, brainstormed, and read.

And then…I was back to Surrender Yoga.

Though, I could barely bend down to organize my mat with the four or more blankets I needed, I figured out by sitting on a bolster, I could set myself up. I was IN the yoga room and that was the important part. The yoga instructors assured me to do “whatever I needed to do.”

Fortunately, Joan, the butt specialist is top-notch! As we began working together, she understood what movement meant to me. After the first session, I was ready to jump right back in. “I’ve only seen you once. We have work to do to strengthen your core, your back and yes, your butt.” When I told her how I found her, she replied, “I didn’t know the doctor thought I was a butt specialist. My husband will get a kick out of that!”

Joan has provided guidance and insight about my butt. One of her theories, is that my core needs to be strengthened and that it is very possible that during all these years of mat Pilates I wasn’t doing the exercises correctly. She is helping me to fix that. “In time, you will be back, however, we are going to do this one step at a time.”

About a month into working together, mid-December, she released me to try our movement yoga classes and that made a dramatic difference. I could do it. Pain-free.

It felt AMAZING to move again.

She also released me and encouraged me to walk ten minutes out and ten minutes back. To great success!!!

And then finally…finally…in the beginning weeks of December, with the help of the surrender yoga classes and life itself…I finally surrendered to this entire journey. Because this was a butt journey-a journey that has frustrated me, made me angry, brought me to tears, has me missing my friends in Pilates mat classes and miss dancing.

In late November and December, I found I could hike two miles without pain.

Also in December, after seeing Dr. S., ordered an MRI of my lower back to confirm that everything was okay in there. While working on this, a special Angel from Dr. S’s office, Lalita, helped me out by answering my questions on MyChart and returning my calls. I will be forever grateful that in the maze that is BJC/Washington University Medical Center (which by the way, I am so appreciative that we have this option in St. Louis!!!-but it is a maze of phone numbers and people!) that Lalita was and is someone who heard my concerns and my fears and was incredibly patient with me. She kept me updated on everything I needed to know and made this journey a little easier.

The MRI confirmed everything was where it was supposed to be and okay. One of Joan’s theories is that the pain is actually from my lower back and the butt pain is simply referring pain. (I’d like to refer it to go away.) She also thinks my anatomy/how I’m built might have something to do with how I use my back.

It is January and I am still working with Joan. And often I am feeling much better. The pain is still inconsistent and comes and goes sometimes without reason.

Besides being able to hike two miles, as well as practice moving yoga classes and weight lifting classes with NO squats (those definitely bring on the pain), thank you Mindy!!! for talking to me week after week to help me figure this out.

Joan has recently released me to try hot flow yoga and Pilates mat classes and I survived both-not on the same day. As I write this, she has also encouraged me to try a dance class. (Watch out Rockettes!)

Joan is a thinker and is determined to offer strategies so that I can continue to move and groove.

I continue to do the exercises and stretches Joan prescribes. She has said that the crunchiness in my hip is something to be aware of as it continues to scar over, too. “It’s been over three months!” I said in our last appointment. And she smiled.

While my butt and I are still on speaking terms, I am looking forward to putting this injury behind me. Giggle.

Expect good. Sparkle on. Defy gravity.

UPDATE: the pain came back with a vengeance in late January and early February. And while Joan was able to release the piriformis, we eventually reached out to Dr. S. He had mentioned in December that he could give an MRI-guided injection directly into the piriformis if the pain wouldn’t go away. We were at that point. And so, in late February, my sister drove me to the South County location where Dr. S. and I discussed the pro’s, the con’s and the way forward. He even asked if I had any more questions-he has gotten to know me well! It seemed as if the pain was still presenting after all these months, the injection would be helpful. Lalita greeted me that day as if we were old friends and was in the procedure room the entire time. We laughed and joked about weekend plans, going out for margaritas (in addition to the pain meds!) and Dr. S. did his work. He showed me the ultrasound afterwards and pointed out the needle and the piriformis muscle which was inflamed. Dr. S. explained that patients usually feel good for two weeks, somewhat uncomfortable for two weeks and then we are fine. That evening I was a little sore and very tired. Throughout the weekend I took it easy and while I could feel something deep inside my butt (I’m very Princess and the Pea which is annoying!), it did seem as if the pain was subsiding. The left butt yelled and Dr. S. said often that happens as we favor what is painful.

Leaving I hugged Lalita and shook hands (those steady, gifted hands) with Dr. S. He wished me well and I said, “I appreciate everything you have done! And I hope to not see you again!” He laughed.

Still….looking forward to putting this injury behind me….and I’m still giggling.