On Friday I went to another massage session. We had a go at my left shoulder and my back. The shoulder was still too sore, as were my glutes. The hip flexors were tight - which I'd been told already - so it was good to get into them. Still, I move like a 90 year old when I try to get up or roll over on the massage table, so feel pretty depressed.

After this, I go and see the physio with the slightly bad breath. He is helpful if rather cold, and sets my mind clear on a number of things.

He encourages me to keep strengthening my left rotator cuff with the Theraband exercises to fix my left shoulder. These are going well. Since I am on holiday, I have been able to do these religiously twice a day. I am even doing them with my weaker (!) right arm to try to prevent any injury to that.

Finally, I get a reasonable sounding diagnosis for my hip clicking. The physio puts his finger on it and ask me to do the same. He says it's the ITB tendon flicking over some bone, which it does when it's inflamed or too tight. Hooray - always good to have a believable diagnosis.

He explains my long-standing knee pain with a pretty detailed plastic knee model. There is no current surgical solution which actually works. The patella is being pulled to the outside of my knee when I use my knees causing the pain, so I need to encourgae it to stay centred. To do this, basically I need to strengthen my VMOs - the muscles in the inside of my leg just above the knees - and stretch the ITB - the strong and long band of connective tissue that runs from my hip down the outside of my thigh. He gives me 2 stretches for my ITB - the usual glute stretches I have been given before, and one where I lean sideways on my forearm against a wall, with my free leg crossed over the leg I am stretching for stability. He also ask me to strengthen the VMO by standing on one leg and slowly dipping down on the leg until the point before it starts to hurt. He said it was pointless doing the exercise fast and that I had to feel the tightness in the VMO on the way down and the way up. I had to keep my upper body upright and not lean forward, and keep my hands on my hips. This was also supposed to be good for my gluteus muscles.

I feel refocussed after this and therefore see the way forward as follows:

(1) Keep doing the Theraband shoulder exercises 2-3 times a day to strengthen the shoulder. Ongoing massage should help the other muscles to relax as the rotator cuff strengthens, but I have been told that shoulders generally take a long time to reset themselves.

(2) Stretch the ITB by (a) rolling over the blue foam rollers you get in the gym, (b) doing the glute stretch, (c) doing the stretch where you lean against the wall. I had stopped doing (b) because it just seemed to aggravate my right SIJ, so I may have to see how it goes and rely on the other two for a while.

(3) Continue to strengthen my glutes and VMOs at the gym and at home.

Here is the chicken and egg as I see it:

(1) Fusion successful. (BTW, Dr. G said he thought the fusion looked successful too.)

(2) Sharp pain in right SIJ because of misalignment, or just general historical poor muscle strength in lower back.

(3) The pain causes bunching up of lower back muscles, although to a lesser degree than before the operation.

(4) The pain and the muscle tension causes me to walk differently, causing greater tension in the VMOs and hip flexors.

(5) This interferes with the correct operation of my knees, aggravating my knee pain.

(6) The knee pain means that I tend to place undue stress on my lower back when bending and crouching so the cycle perpetuates, viciously. It's touch to break it, but with this exercise regime and - more effectively - the PNS implant, I think I stand a good chance of getting my body back.