At the moment I'm working on being able to kneel down again. I can get part of the way, just can't sit on my heels. I think the knee joints are up for it, but the other bits and pieces in my legs are too tight.
Before PsA some of my joints were probably a little too mobile e.g. I could easily pull my thumb sideways to touch my wrist. One doctor told me that this meant I was 'officially' double-jointed which is not unusual. The thumb / wrist tendons stiffened immediately when PsA hit me. That doesn't matter as the range of movement is still adequate, but it was just such a sudden change from how I used to be.
Over time I've realised that other tendons .... or muscles ... or both, have tightened up too and some of those do affect me on a day to day basis.
I know PsA causes enthesitis. But that hurts, right? Most of my stiff tendons do not hurt. Does PsA also just plain stiffen these soft tissues?
Yes enthesis can be a huge part of psa. For some people they have more of an issue with this than joint pain. I have it in my shoulders knees and feet and gets really bad at times. I haven't found any magic remedies for it yet. Just heat an painkillers.
I reckon I get enthesitis too e.g. in Achilles tendon area. It's just that some muscles or tendons are tight, too tight all the time, like a permanent change. They don't hurt as such unless I try to do things such as kneel or crouch down for example. I'm going to continue trying to loosen up the key ones.
Irishchick said:
Yes enthesis can be a huge part of psa. For some people they have more of an issue with this than joint pain. I have it in my shoulders knees and feet and gets really bad at times. I haven't found any magic remedies for it yet. Just heat an painkillers.
My understanding is that tendons and muscles shorten/tighten when they are not being regularly stretched. I suspect what you're experiencing is the consequences of a lack of use in these movement ranges. Wonder if a physio consult might be worth its weight in gold?
I think you're right. I do a lot of exercise and very proud of myself I am too - yuk! But there are some movements I do not attempt, I've been a bit fatalistic about them. I'd have thought Tai Chi would have addressed some of the tightness but actually that's getting a wee bit harder rather than easier.
I think I'm going to have to take a long hard look at what I can and can't do and then see about a physio referral. But this does feel like cherry on the cake time, kind of a luxury even to be thinking like this! I should have got around to it sooner though.
Jules G said:
My understanding is that tendons and muscles shorten/tighten when they are not being regularly stretched. I suspect what you're experiencing is the consequences of a lack of use in these movement ranges. Wonder if a physio consult might be worth its weight in gold?
Thanks for that. Pride demands that I give my own home-baked physio a shot first ..... so does the wallet probably. But yes, I almost certainly will self-refer in a month or two. Funny how we get used to things isn't it?
Jules G said:
If you're happy to pay you can self-refer for private physio ... cuts out the loooooonnnnnnggggg wait!
I never really asked for an explanation from my rheumy, I just told him how stiff my knuckles, wrists, elbows, toes and shoulders were. He told me it was tendonitis. But, I wonder if it was a combination of tendonitis and enthesis. The funny thing is, I never had much pain or stiffness in my heels! I would have to say that of all my PsA symptoms that stiffness has been relieved the most since I'm on Enbrel. It used to feel like my joints locked up if they weren't in constant motion. And, although the stiffness itself isn't much more than discomfort, the "locked up" feeling was painful, if just for a few seconds. I always thought it was more muscle pain than joint or bone pain, but someone told me it probably just felt like my muscles hurt but the pain was radiating from my joints or tendons. So far, after almost 19 months on Enbrel, I'm still not experiencing that "locking up" in all those various joints like I used to. I am having some pain in my feet and back when I spend too much time sitting or when I get up in the morning. My back has been one big pain in the a## every morning lately, but after I apply ice packs for 15 minutes I'm good to go.
Sybil, do you feel that you hurt more after exercise--like the next day or two? Sometimes I wonder if I'm overdoing it when I workout because I have sore muscles for a couple days afterwards.
I sometimes hurt the day after a lot of walking but sometimes not and sometimes hurt after too much sitting around and occasionally for no apparent reason on and so forth! I think some degree of pain or at least stiffness and soreness comes with the disease & of course what matters is how badly it affects us as individuals. It's got to be trial and error with working out I should think.
But my stiff muscles or whatever they are aren't painful and they don't vary. I think Jules is right and that some have contracted 'cos they're rarely stretched. So I'm going to keep trying to kneel down, lowering my backside as far as possible till it's comfortable to do that. It's nice to have such a small and hopefully achievable goal!
Grandma J said:
I never really asked for an explanation from my rheumy, I just told him how stiff my knuckles, wrists, elbows, toes and shoulders were. He told me it was tendonitis. But, I wonder if it was a combination of tendonitis and enthesis. The funny thing is, I never had much pain or stiffness in my heels! I would have to say that of all my PsA symptoms that stiffness has been relieved the most since I'm on Enbrel. It used to feel like my joints locked up if they weren't in constant motion. And, although the stiffness itself isn't much more than discomfort, the "locked up" feeling was painful, if just for a few seconds. I always thought it was more muscle pain than joint or bone pain, but someone told me it probably just felt like my muscles hurt but the pain was radiating from my joints or tendons. So far, after almost 19 months on Enbrel, I'm still not experiencing that "locking up" in all those various joints like I used to. I am having some pain in my feet and back when I spend too much time sitting or when I get up in the morning. My back has been one big pain in the a## every morning lately, but after I apply ice packs for 15 minutes I'm good to go.
Sybil, do you feel that you hurt more after exercise--like the next day or two? Sometimes I wonder if I'm overdoing it when I workout because I have sore muscles for a couple days afterwards.
I get the foot cramping pretty badly at night as well. I also have visably tight tendons in my feet as well. I use muscle relaxers on rare occasions for my rib probs when I get back spasms but I truly hate devoting an entire day to these Debbie-downers. I was wondering if muscle relaxers actually relax tendons as well? I tried to find out on line but didn’t have any luck. Does anyone know?
I have a lot of tenosynovitis, my last US confirmed it. My calf muscles used to be rock hard, they would never relax, it wasn’t until I took hydroxyclorequine for 7 months, they started to relax, it was shocking when it first started relaxing…
Seems that tense muscles / tendons aren't uncommon then. I know that when I've had a steroid injection in my backside (which I hear isn't done that often in the US, given that way it can have an all-over effect) I suddenly feel all limber and pleasantly 'different'. But that's always been when joint swelling and stiffness has been uppermost in my mind rather than just the tightness. I'd be interested to know whether one of those shots would make a difference to my ability to do some forms of movement now but I doubt I could get one just to satisfy my curiosity.
Glad to hear your problem has resolved Jon, the 'shock' aspect does sound like how I feel after a steroid shot, like being a whole new person! Rachael, sounds to me as if there might be different things going on with the different areas you mention. I'm thinking maybe physio or stretching you could do yourself might just help loosen up your feet .... but I can't at this moment imagine what you could do to ease up the rib area other than use muscle relaxers. Incidentally, what are muscle relaxers?
Thr tendons are attached to the muscles, if the muscle is like a coiled spring, then it will be putting tension on the tendon, if the muscle is relaxed it will decrease the tension.
Rachael said:
I get the foot cramping pretty badly at night as well. I also have visably tight tendons in my feet as well. I use muscle relaxers on rare occasions for my rib probs when I get back spasms but I truly hate devoting an entire day to these Debbie-downers. I was wondering if muscle relaxers actually relax tendons as well? I tried to find out on line but didn’t have any luck. Does anyone know?
Ugh. Foot cramping and leg cramping. I had so much of that nonsense before I was diagnosed. Not much of a problem since starting treatment, though. I do have one achilles tendon and calf muscle which is very noticeably different than the other. When I do my stretching exercises, one is so much tighter than the other, and no amount of stretching seems to be able to loosen it up. Believe me, I’ve tried. Nothing works. Why?
Well, when I was at the PsA clinic, I asked Dr.C what was with that. He got a quizical look on his face and said something vague about its being because of inflammation and scarring and … no real answer. There, now isn’t that an anticlimax? And you thought I was going to give you some nugget of wisdom from one of the world’s foremost PsA experts.
Before I was diagnosed, I struggled with exercise, supplements, diets … anything that might ease the pain and stiffness. The doc, after all, didn’t think there was much wrong with me that couldn’t be cured with diet and exercise. So it was my fault that I was like this, and it was my job to figure it out. Magnesium supplements did provide some help with the terrible night cramps in my legs and feet. As far as meds went I didn’t have much to choose from, only what I could get over-the-counter. By far the most effective for me was a muscle relaxer, which is available here in Canada on the drugstore shelf under the brand Robaxacet or Robaxasal. Both contain methocarbamol, which is a very common drug used for back pain. It is similar, I think, to prescription Flexeril (cyclobenzaprine) My doctor clearly found that plain weird, but I’ve since read that inflamed tendons can cause muscles to cramp up. That’s what we are talking about, right?
Since going on the biologics, I have had no muscle cramping or spasms, but my right calf and achilles tendon are still way too tight.
So basically PsA affects tendons and muscles which I guess we knew already. But clearly there's a whole lot more going on than inflammation of the entheses, which is interesting.
The cramps are just barking aren't they? And all rheumys seem equally hum ho about them.
Also ..... I posted a link in 'Complementary Therapies' to a radio programme about exercise and health which doesn't seem to have inspired anyone lol! However if anyone does fancy a listen, it is really interesting about how often apparent joint pain is actually muscle pain. It focuses on people with OA or just muscles weakened by lack of use .... but it is easily applied to us I think. I think I've been focusing on strengthening muscles and haven't done enough gentle stretching though.
Seenie said:
Ugh. Foot cramping and leg cramping. I had so much of that nonsense before I was diagnosed. Not much of a problem since starting treatment, though. I do have one achilles tendon and calf muscle which is very noticeably different than the other. When I do my stretching exercises, one is so much tighter than the other, and no amount of stretching seems to be able to loosen it up. Believe me, I've tried. Nothing works. Why? Well, when I was at the PsA clinic, I asked Dr.C what was with that. He got a quizical look on his face and said something vague about its being because of inflammation and scarring and ... no real answer. There, now isn't that an anticlimax? And you thought I was going to give you some nugget of wisdom from one of the world's foremost PsA experts. Before I was diagnosed, I struggled with exercise, supplements, diets ... anything that might ease the pain and stiffness. The doc, after all, didn't think there was much wrong with me that couldn't be cured with diet and exercise. So it was my fault that I was like this, and it was my job to figure it out. Magnesium supplements did provide some help with the terrible night cramps in my legs and feet. As far as meds went I didn't have much to choose from, only what I could get over-the-counter. By far the most effective for me was a muscle relaxer, which is available on the drugstore shelf under the brand Robaxacet or Robaxasal. Both contain methocarbamol, which is a very common drug used for back pain. It is similar, I think, to prescription Flexeril (cyclobenzaprine) My doctor clearly found that plain weird, but I've since read that inflamed tendons can cause muscles to cramp up. That's what we are talking about, right? Since going on the biologics, I have had no muscle cramping or spasms, but my right calf and achilles tendon are still way too tight.
Ok so of I understand it correctly there is nothing but stretching to relax tendons. Muscle spasms are a side effect of the tendons being tight and those are treatable. I have used fexeril in the past which really knocks me out and leaves me almost druelling on the couch, lol. I have used methocarbomal as well but it did not work as well and still left me unable to fully function as well. I am back to flexeril which I can now use a pill cutter to take smaller doses because biting in half leaves your tongue half numb (big muscle stupid on my part) which is only funny to my kids. So new challenge to the medical industry we want tendon relaxers! Thanks the info was really informative!
Ya, we’re just piecing nuggets of experience and understanding and “I’ve reads” together here. Maybe we’ve got it all wrong. If so, I hope that someone with a more authoritative voice will speak up.