In which I am Stiff

22 April 2008 at 19:50 (Arthritis, Hypermobility, Pain)

It is morning after some afternoon yard work (a couple hours spent lopping back a shrub by 2/3, and then cutting down those branches for pickup), and I am waiting for arthritis medicine to kick in.

Then I realise that it has. Enough time has passed, and this is “better” (at least for the medicinally-mediated improvement). Which-all leaves me wincing, and wiping wet corners of my eyes on my shoulders. I am tearing up less from pain than frustration-with-pain. When I see my rheumatologist in a few weeks, I will have to explain that pain meds are not working so well, as even post-medicated I am in pain much of the time. I cope with it and “keep on truckin’ “, which is not to say that it doesn’t affect me. (I haven’t even been tracking my blood pressure, which I should be doing now that we actually have a mini-clinic on campus.)

Today I am not just creaky and feeling nauseous before breakfast and after breakfast + meds, but I am also stiff. It shows in the halting progress of my first foray down the stairs and the bumbling around the kitchen. (Thank you, hubby, for making the coffee! Again.) I fumble, and more than once drop things, and then in Slow Motion must bend over to retrieve them from the floor. Knees locked, legs straight, I reach down with my fingertips straining to touch the floor and pick up my sock.

Now, you would think that if I can reach the floor like that, then I am doing pretty well. There are arthritic people who have difficulty reaching past their knees. But all things being relative, I am indeed stiff. This is because I am normally hypermobile. On normal days (now Good Days), I can bend over, knees locked and legs straight, and put my palms flat on the floor. Oh yes, even when wearing 2-inch (5-centimeter) heels. I am really bendy, and had I been coördinated, would have made a good gymnast or dancer.

Later on in afternoon when I had loosened back up (still achey, just less stiff), I did a test to see what the morning stiffness means in terms of loss of mobility. Per this book on Musculoskeletal Assessment, “A tape measure is used to measure the distance between the tip of the great toe and the most distal point reached by both hands. Normal ROM is present if the patient can touch the toes. In the event the patient is able to reach beyond floor level, the test can be carried out with the patient standing on a step or platform to measure reach distance beyond the supporting surface.” So I grabbed a ruler and tried a step on some stairs, found it to have too little rise, and then went over to a small stage and did the procedure (barefoot), measuring just how far beyond the undersides of my big toes the ends of my middle fingers reached.

That was a change of 20.3 centimeter (8 inches).

When I bend over to pick something up, that involves hamstrings, hips, curve of spine, and shoulders. Flexibility is spread out over a series of joints, and loss of flexibility is thus cumulative, depending upon how all those joints are interacting. But even so, end result is still that 20.3 cm (8 in.) loss of what for me is normal range of motion (ROM).

Anyone who from one day to the next loses 20.3 cm (8 in.) of reach is losing a considerable amount of flexibility. It’s when we try to compare my personal (reduced) ROM to “normal” ROM that we run into a false comparison. “Normal ROM” dictates being able to touch one’s toes with fingertips. I have gone from my hypermobile reach to normal reach. If doctors or PTs only look at how I compare to the norming model, then they would consider that I am fine.

But I’m not fine — I’ve lost normal mobility. I cannot do what I normally do, how I normally do it, and furthermore, doing what I can involves pain. I don’t know if a PT would consider this amount of ROM loss to be “clinically significant”, and fact that I do regain my normal ROM over relatively short periods of time (within day or two), would likely remove the stiffness out of realm of rehabilitative significance (for PT).

You might simply wonder why I’m concerned with being able to pick stuff up from the floor with my knees locked; why not simply bend my knees? Well, I can, and I do sometimes. Doing so may not only result in some impressive cracking noises (no worries; it’s only air bubbles in joints), and even uses the large, strong leg muscles, but also requires me to use slightly different means to keep myself balanced, and involves different stresses on knees.

Truth be told, in such situations I find that squatting to reach the floor hurts more, and is harder to maintain my balance than simply bending over. I like to avoid situations that can result in falling, as I get enough bruises just from ordinary navigation.

In the end, I have to wonder if comparisons to normalcy need always be to standard-normal, as personal-normal may sometimes be better baseline for comparison. I am not living in standard-normal body, but my own. I am needing to do things that are significant for my life, howsoever that may be dissimilar to someone’s ideal of standard-normal life.