I understood myself only after…

A few days ago, I went for a walk around this beautiful historical estate that’s practically next to where I live now.

I’ve been making some big changes in my life recently, and some of them have been pretty difficult.  This park feels like home to me, so I went there to clear my head.


I walked around for a little while, and then stopped to lie down on the grass.  It was so peaceful, in the warm sun.  I just wanted to take in the moment.

And then I looked up, and saw this view:


Suddenly, it hit me.

I thought back to the days in high school, before I got compartment syndrome, when I would have been here running.

Rushing, rushing, hurrying, going as fast as I could.  A high-intensity day. Three miles, in as little time as I could.

Or maybe it would have been an endurance day, and I’d be purposely holding myself back for the first few miles, so that I could stretch my run out to six or seven.

I loved running.  I loved pushing myself, the freedom.

But you know what I wouldn’t have been doing?  Looking around me.

Looking up, specifically.

You can’t really look up when you’re running, at least not when you’re outside.  You have to look at the ground almost constantly, to make sure an awkwardly-placed tree root doesn’t leave you on crutches for the next two months.


I loved running.  Everything about it– the thrill of pushing myself, the endorphin rush, the adventure of being outside.

But it was always a blur.   Even when I ran through my favorite places– and I knew some beautiful trails– I was never able to stop and enjoy it.   In my head, it was keep going, keep going.  You have to burn calories.  You’re going to get fat.


I could never pause, never rest.  Even on Sundays, when my coaches made all of us promise not to run… I tried to go for walks, but I just wanted to be running.

I’d be in the middle of the most beautiful nature scenes, and all I’d be able to think about was how hungry I was.  And how fat I was going to get from not running that day, from the meager calories I’d decided to allow myself.


Things are so different now.

I can’t do the same things with my body that I used to, but I can look up.

I can go to a beautiful place, without having to spend almost the entire time staring at the ground.  I can stop if I want to; I can pause.

Don’t get me wrong; I will always love running, and exercise in general.  I love a good endorphin buzz even more than I love coffee in the morning.


But I exercise now because I want to; not because I’m afraid of what will happen if I take a day off.

It’s such a crazy feeling, and I don’t know if anyone who hasn’t been through it themselves can know what I mean.

I know what it’s like to have the ability to pause, because at one point I lost it.


(Check her out, she’s an amazing writer!




An update on my sacroiliac joint saga


For some reason, my post on my issues with the sacroiliac joint has been getting a ton of views recently.

I’m not sure what happened– whether Google decided to rank my blog more prominently in its search results, or if more people are aware of the sacroiliac joint in general, and looking to find answers.  (Hopefully both!).

But a lot has changed for me since I wrote that post, and to be honest I cringe a little bit when I see someone’s read it.  I wrote it from a place of doubt, when I was feeling really lost and wasn’t even sure I had identified the correct problem.

I’ve learned a lot since then.  I no longer doubt myself, or doubt that I have issues with this joint.  In fact, I’m starting to realize that sacroiliac joint dysfunction is actually way more common than it had seemed.  It also seems to be a pretty common experience for people with this issue to have trouble finding treatment, and to feel misunderstood.

With all that in mind, I wanted to provide a little bit of the perspective I have now, because luckily, I am no longer coming from that place of doubt.

First, a little background info:

I developed my sacroiliac joint problems in the fall of 2011.  I would be walking along, until all of a sudden one of my legs would get “stuck.”  I wouldn’t be able to lift that leg more than an inch or two off the ground.

The first time it happened, I went and saw a chiropractor who explained that it was caused by my sacroiliac joint getting “jammed.”  He adjusted that joint, and like magic the problem was gone: I could lift my leg and walk normally again.

But the same thing happened again and again.  I would go to the chiropractor, and feel better, but inevitably my leg would get “stuck” again the next day.  And nothing I could do would fix the problem, or allow me to lift that leg more than a few inches off the ground.  So back to the chiropractor I would hobble again.

It was confusing, and infuriating.  I’d never heard of anything like this happening to anyone before.  No one I talked to about it had ever heard of anything like it before, either.

And me, with my long history of chronic pain and unexplained physical symptoms that often just turned out to be my nervous system freaking out and being overprotective… it was hard not to wonder if this was just more of the same.

After all, this situation had a lot of parallels to problems I’d had in the past.  The times I was convinced I had injured part of my body, only to finally realize months later the pain was caused by my nervous system freaking out over nothing.  Was my SI joint really becoming stuck?  Or was my nervous system just “amplifying” the pain, and making a small problem feel worse than it was?

It didn’t help that none of the physical therapists I saw really seemed to know what I was talking about.  I would tell them about my leg getting stuck, and they would give me blank stares. “I didn’t learn about that in school,” they would say.  “The sacroiliac joint doesn’t really move.”

Doctors were not really much help either.  I saw two physiatrists and one orthopedist.  The physiatrists didn’t tell me that I didn’t have a problem– they just said it was out of the scope of their practice.

The orthopedist talked about doing some cortisone injections, but he didn’t seem to have any idea what I was talking about when I talked about my hip “locking.”  I passed on the injections, since it didn’t seem to make sense to receive a treatment from someone who didn’t seem to understand the problem.

So I just kept going to the chiropractor and getting adjustments, but ultimately, these adjustments were no more than a temporary fix.

A big part of the problem was that none of the chiropractors I saw seemed to be very interested in actually talking to me about what the problem was.  They all seemed to think that the long-term treatment was someone else’s problem– that I could just walk into any physical therapy clinic, do whatever exercises they gave me, and everything would work out.

There was nothing I could say, it seemed, that would make them understand.  How was I supposed to get a physical therapist to give me exercises for the sacroiliac joint, when none of the PT’s I saw even thought that could be my problem?


A lesson I’ve been forced to learn, over and over again, in different contexts, is this:

Don’t stop.  Keep looking.  Things aren’t always what they seem.

This has happened to me at so many different points in my life, where I felt stuck, miserable, and afraid my life would never get better.

It happened in high school, when I was caught in a vicious cycle of depression and an eating disorder.  It happened in my early 20’s, when I lived with unexplained pain throughout my entire body for five years.  And it was the same, with this problem:

Don’t stop.  Keep going.  You never know when things could change.  The answer could be just around the corner.


Every few months, I’d scour the Internet for anything I could find on the “sacroiliac joint.”  In 2011, there really were very few results (at least, very few that I could understand).  I think the first time I looked, the results were so pathetic and sparse that it was another six months before I looked again.

But as time went on, I started to find more and more resources.

Part of it, I think, is that maybe people are starting to become more of the sacroiliac joint.  And as awareness builds, more of that knowledge is finding its way onto the Internet.

Another part of it is that over time, my searching became more effective.  After all, at the same time all this was going on, I was also taking my prerequisites for physical therapy school, and beginning to understand more and more of those anatomical terms that had once been gibberish to me.

Two years into my problem, I stumbled across the website for a physical therapy practice near me.  One of the physical therapists actually listed the sacroiliac joint as one of her interests, so of course I made an appointment immediately.

That was the point at which things began to change for me.  Finally, I found someone who was willing to talk to me about what the problem was, and was able to think flexibly enough to give me exercises that would help me, but not make me worse.

She also taught me a way to use a foam roller to give my SI joints a self-adjustment.  It obviously wasn’t quite as good as going to a chiropractor, but it gave me the freedom to “unlock” my legs by myself, which obviously changed everything for me.  I no longer had to count down the minutes between chiropractor visits; no longer had to live in fear of my hips locking up on a Friday night and having to wait all weekend for an adjustment to free them up again.

This is getting long, so it will be continued in Part 2!


“Real Stories Take Time”

My friends’ raspberry patch, where I was housesitting last month.

“Most of the stories we are told now are written by novelists and screenwriters, acted out by actors and actresses, stories that have beginnings and endings, stories that are not real.

The stories we can tell each other have no beginning and ending.  They are a front row seat to the real experience.  Even though they may have happened in a different time or place they have a familiar feel.  In some way they are about us, too.

Real stories take time.  We stopped telling stories when we started to lose that sort of time, pausing time, reflecting time, wondering time.  Life rushes us along, and few people are strong enough to stop on their own.

Most often, something unforeseen stops us and it is only then we have the time to take a seat at life’s kitchen table.  To know our own story and tell it.  To listen to other people’s stories.  To remember the real world is made of just such stories.”


This quote is from the most amazing book– Kitchen Table Wisdom by Rachel Noemi Remen.  I randomly happened to pick it up off the bookshelf at some friends’ house, where I was housesitting last month.

Honestly, this book basically changed the entire month of August for me.

The quote I picked out above is part of the Introduction, and lays out the basic premise of the book: that stories can lead to healing.  Real stories– the ones with twists and turns.   The stories we maybe gave up on, in our own lives, only to revisit them years later and realize we managed to learn and grow from the experience, even if it wasn’t apparent at the time.

Not the stories we are accustomed to hearing– the stories that follow a perfect literary arc.  You know, the chart we all learned about in English class.

This whole idea really resonated resonated with me in terms of the difficulties I’ve faced in my own writing.  It’s hard to put yourself out there– to write from a place of vulnerability, when you’re afraid it’s going to look like a place of negativity.

It’s hard to do that, to write about your own story in a way that feels constructive, when you don’t actually have all the answers yet.

But you know what?  I never have trouble telling my own story when I’m just talking to my friends.  My close friends– the ones I would tell even my most embarrassing secrets to.  I consider them my sisters (a few brothers, too).

When I am with my friends– at Rachel Noemi Remen’s metaphorical kitchen table– I don’t feel the pressure to form my experiences into a discernable arc.  I am able to find meaning in telling my story (and hopefully my friends find meaning in hearing it!) even if I haven’t gotten to the end yet.  Even if there is no answer, and I’m not sure there ever will be.

Dr. Remen is right– in our culture, there is this pressure to talk about ourselves in a way that’s unfailingly positive.  To present our story in a neat package, with all the loose ends resolved.  To apologize for being negative.  To only talk about our problems in the past tense, once we’ve already found the answer.

As I’ve mentioned in a previous post, that’s a pressure I’ve felt on this blog.  Not, of course, from any one person.  (In fact, I have been shocked at how generous people have been with their support!).

The pressure comes from myself, from the general cultural expectation we have that people will be positive, that to talk about our problems is a sign of weakness.

My friend M. is from Costa Rica, and says it’s different there.  That people are much more free and open in talking about their problems.  That when people do talk about their problems, others don’t see it as a sign of weakness.  Everyone has problems– it’s just part of life.

So I’m going to try to incorporate Dr. Remen’s perspective, and M.’s, as I write this blog.

“Until we stop our ourselves, or more often, have been stopped, we hope to put certain of life’s events “behind us” and get on with our living.  After we stop, we see that certain of life’s issues will be with us for as long as we live.  We will pass through them again and again, each time with a new story, each time with a greater understanding, until they become indistinguishable from our blessings and our wisdom.  It’s the way life teaches us how to live.”


Telling the whole story


“Nobody tells this to people who are beginners, I wish someone told me. All of us who do creative work, we get into it because we have good taste. But there is this gap. For the first couple years you make stuff, it’s just not that good. It’s trying to be good, it has potential, but it’s not. But your taste, the thing that got you into the game, is still killer. And your taste is why your work disappoints you. A lot of people never get past this phase, they quit. Most people I know who do interesting, creative work went through years of this. We know our work doesn’t have this special thing that we want it to have. We all go through this. And if you are just starting out or you are still in this phase, you gotta know its normal and the most important thing you can do is do a lot of work. Put yourself on a deadline so that every week you will finish one story. It is only by going through a volume of work that you will close that gap, and your work will be as good as your ambitions. And I took longer to figure out how to do this than anyone I’ve ever met. It’s gonna take awhile. It’s normal to take awhile. You’ve just gotta fight your way through.” Ira Glass (thanks to Jo Malby for introducing me to this quote!).

My blog, as you can probably guess, means a lot to me.

I’ve had some really meaningful moments on here.  Times when someone has thanked me, so profoundly, for something I’ve written that’s helped them, and I feel like they really get what I’m trying to do here.  Or, in different way, the times when a person or an organization with a lot of followers has shared a link to my blog, and I end up getting hundreds of views and multiple re-shares in one day.  This, of course, doesn’t happen very often. But when it does, it’s an absolutely breathtaking feeling to know my words resonated with so many people.

But in a weird way, all these experiences have sort of made it harder to come on here and write from a place of vulnerability.  To admit that I don’t have it all figured out.  After all, I want to inspire people, not bum them out.  It’s supposed to be “Sunlight in Winter,” not “The Clouds of Winter.”  And the posts that people have really tended to gravitate to, for the most part, tend to be the posts where I talk about everything that I’ve learned.

But my roommate said something really helpful the other day.  In her careful, melodic Peruvian accent, she said, “You know what? I think you should just not give a fuck.  When I read a piece of good writing, I don’t care whether someone thinks they have all the answers, or whether or not they are writing as a professional.  What I am impressed by is their truth– that they had the courage to put something so real, so raw down paper.  When someone tells you about the truth of their experience, it makes you feel that you are not alone.”

And she’s right.  When I think about the different pieces of writing that have resonated with me over the years, it’s not necessarily the straightfoward, informative, “This is what I know now” pieces that have stuck with me.  It’s the writer’s voice that makes the difference.

After all, telling your story is not about skipping ahead to the end, to the answers you found.  It is about how you got through.

So I want to tell you about all of it.  About how, in high school, I starved myself, convinced that if I didn’t I would become fat.  And then I ran myself into the ground– all to later realize it was based on an illusion, and that I wasn’t being healthy at all.

And then, at 17, the leg injury I got from running too much.  For years, I blamed myself, and even after the surgery was afraid to move at all, feeling like I couldn’t trust myself not to break my own body all over again.

And then, at 20, how my nervous system changed.  It was a physiological process, not a psychological one, but I didn’t know that at the time.

And then, a few lost years of thinking I was crazy– of everyone else thinking I was crazy too.  Of my nervous system spinning out of control, and telling me that everything was hurt; everything was damaged…

Until finally, I discovered the work of Neil Pearson (and, by extension, Lorimer Moseley and David Butler)…

And how it changed everything about how I think about myself.  Not just my pain, and my physical body, but myself as a person.  How I realized I didn’t have a psychological problem, and that everyone who told me I did wasn’t seeing clearly.

And now, five years later, I’ve developed a perspective that I am honestly quite proud of.  I’m not afraid of my body anymore.  Not afraid of myself anymore.

I can now hear in my own voice, at times, the same rationality that I used to cling to in the voices of my doctors and physical therapists.  Thanks to all the classes I’ve taken, and the reading I’ve done, and all the questions I’ve sometimes had to push various medical professionals to answer, I’ve actually managed to piece together a larger picture.  One in which I’m not constantly afraid, or thinking something’s wrong with me.

Now I can think objectively.  I can think scientifically.

But I’m not out of the woods yet.

It’s the story of my life that just I find the answers to one problem, another problem develops.   I’ve written before about my issues with the sacroiliac joint, and they have turned to be almost as mysterious and vexing as my chronic pain problem.

But I’m going to write about them.  I’m going to write about all of it.

It’s not just about finding the answers.  It’s about how you get there.

To Be Professional, or Authentic?

So, you may have noticed that I haven’t written very much recently.

Since I started my blog, my policy was generally only to write if things were going well– or at least, to only highlight the positive.

The Internet is tricky. We’re all still figuring out– and as we figure it out, it’s constantly changing.

I’m honestly torn about what exactly I want this blog to be. Do I want it to be professional– kind of like my calling card, to start building connections in the field I hope to go into?

Or do I simply want to be what I’ve always “wanted to be” ever since I read the Little House on the Prairie series as a child– a writer?

I’m torn.

Do I want to create a “reputation” as someone knowledgeable about the body– a future healthcare professional? Or do I want to tell my story, in the hopes it will help someone else out there know she isn’t alone?

It’s awkward. Actually, it’s beyond awkward.

I’ve worked in the helping professions– mental health, specifically. And there, rule #1 is never to talk about yourself– at least, never to offer up anything you wouldn’t mind having attacked later on.

And I’ve seen it– how a person can turn on you, take something you only said in an attempt to be helpful, and try to turn it into something else, twisting your words into something ugly and unrecognizable. Even sinister.

Working in mental health changed me, that’s for sure.

But even without that experience, I think we are all coming to the realization that the Internet is a place that never forgets, where mistakes are never forgiven. In this day and age of screen-shots and screen-caps and whatever else, saying something on the Internet basically means you are saying it forever.

I mean, really. Can I pour my heart out here, admitting my mistakes and defeats… and also expect people to take me seriously as their physical therapist someday?

Honestly, I don’t know.

But I have always wanted to be a writer. To put my stories into the perfect words, to hold them up to the light and examine them, to extract all the meaning from them that I can, and then to share them– that’s always been something I’ve longed to do.

So I guess I’m going to keep trying. To step out on a limb, a little bit. To test the waters.

To see what will happen if I worry less about being “professional” on here (which, frankly, has resulted in me not writing very much at all) and see what happens if I instead focus on being authentic.

Wish me luck!


Nervous System Basics, Part 2: Excitatory vs Inhibitory


One of the things that’s helped me as a chronic pain sufferer is to learn all I can about the nervous system, as well as the research that is being done to someday develop more chronic pain treatments.

It’s not so much that I needed to understand every word, so much as the fact that the very act of reading these articles for myself provided me with a sense of vindication at a time when it seemed like everybody else was telling me the it was all in my head.

When I first started reading these articles, I would find that it was some of the same few key words every time which would prevent me from being able to understand an entire article.

Now, a few years and several science classes later. I know enough to at least begin to understand some of these concepts I wondered about for so long.  And it’s a great feeling.

So this series of posts is intended as a means of clearing up some of those very basic key words and concepts for other people, in case there’s anyone else out there in the same boat as me.

My hope is that this series inspires you to read more, research more, and begin to take matters into your own hands.

(To start at Part One of this series, click here).


Part Two

Nervous system cells, whether they are in the brain, the spinal cord, or the peripheral nerves, communicate with each other via a group of chemical messengers called neurotransmitters.  One nerve cell releases a neurotransmitter in order to create some kind of effect on the next nerve cell in line.

There are two major types of effects a neurotransmitter can have on a nerve cell: excitatory and inhibitory.

Excitatory refers to any stimulus that either causes a nerve cell to fire, or simply makes it more likely to fire (aka more likely to send a signal).

Inhibitory refers to any stimulus that makes a nerve cell less likely to fire (aka less likely to send a signal).

You will often find the words excitatory and inhibitory in scientific articles, whether those articles are discussing how pain works or how pain medication works.

For example, excitatory can refer to something that would encourage the nervous system to send more pain signals, more frequently. One nerve cell can have an excitatory effect on another, making that second cell want to fire.

On the other hand, some nerve cells communicate with other nerve cells and tell them not to fire. This is what is referred to as an inhibitory effect.

Many pain medications work in this way, by inhibiting the activity of nerve cells that transmit messages about pain.


But the body also has its own built-in inhibitory system when it comes to the nervous system sending pain signals.

Scientists are still discovering how many of these pathways work, and they are incredibly complex. I read about some of them for my neuroscience class last summer, and was blown away by how intricate they are; how many different neurotransmitters and hormones are involved; how many different types of nerve cells and receptors on those cells.

But the gist of the matter is that some nerves can have an inhibitory effect on the activity of other nerves, slowing the overall transmission of pain signals.

This is one way in which the body regulates your experience of pain. Sometimes your body decides it’s important for you to feel pain– like when you are home alone and get a papercut. You look down, see you’re bleeding, and realize you need to be more careful with the papers you’re handling.

Yet sometimes, the body decides it’s more important for your survival to block out those pain signals– for example, if you’re a soldier in battle who has been badly wounded, but still needs to get out of the zone of fire. In those crisis situations, people can feel no pain at all, because of the nervous system’s own inhibitory mechanisms.

Of course, these systems do not always work perfectly. Research suggests that in people with fibromyalgia/chronic pain, the inhibitory pathways might not be working properly, which is why they seem to experience more pain in response to non-harmful stimuli than do other people.

It’s not only that the nerves sending messages about pain are working overtime (which they definitely can!). But the other piece of the puzzle is that the nerve cells responsible for reducing some of those pain signals are underactive.

I’ll be discussing this more in Part 3. Stay tuned!

The beautiful photo at the top was available through a Creative Commons license thanks to Charis Tsevis/Harrison & Star

Medication picture courtesy of Steve Smith


Nervous System Basics


As I’ve said time and time again, I really feel that people living with chronic pain/fibromyalgia can benefit immensely from learning about how the body works. Even the feeling that you are just beginning to understand the complex processes making up your experience of pain can help give you a sense of control over things.

And reading about the new research that is being done on pain, even if you don’t completely understand every word, can sometimes give you a reason to remain hopeful at times when you’re feeling stuck.

With that in mind, I’m going to back way up and publish a post I’ve been meaning to write for a very long time.  Here I’ll outline a few key terms and concepts about how the nervous system works. Hopefully it will be helpful to anyone who is interested in learning more about pain.

So let’s get started.

The nervous system can be divided into two main branches.

Photo courtesy of the Anatomy & Physiology, Connexions Web site., Jun 19, 2013.
Photo courtesy of the Anatomy & Physiology, Connexions Web site., Jun 19, 2013.

The central nervous system consists of the brain and spinal cord, and is shown in pink in the diagram above.

The peripheral nervous system consists of all the nerves in the body, and is shown in yellow.

The brain is the command center for your body, and it is where your experience of pain is processed. It is where you think consciously, but it also controls many unconscious functions, such as breathing, your sense of balance, and the ability to orient your body in space.

The spinal cord is the relay system for messages between the brain and the peripheral nerves. (It can also play a role in affecting how strong your ultimate experience of pain is, but we’ll talk more about that later).

The peripheral nerves have two main jobs:

Sensory: Sensory nerves send signals to the central nervous system about what you are feeling physically. When you stub your toe or get a papercut, it’s sensory nerves that send that signal up your spinal cord to your brain.

Motor: This is (to me) a kind of funny scientific word. It really just means “movement.” The motor nerves of the peripheral nervous system are what tell your muscles to move, as well as tell your organs to perform specific functions.


When people talk about how pain works, they are generally talking about the relationship between the sensory nerves, the spinal cord, and the brain. The sensory nerves send signals up to the brain about any damage that may have occurred, and the brain decides how to interpret those signals.

But Pain is a Two-Way Street

Historically, people considered this pain pathway to be a very consistent, cut-and-dry system that always worked the same way every time. If a person was in a lot of pain, they had to have a lot of physical damage/injury. If they weren’t in very much pain, they must not have a very serious physical problem.

However, scientific advances in the past few decades have shown that pain is actually much more complicated than that. It turns out that the severity of a person’s pain does not always reflect accurately the amount of physical injury they have experienced.

You can have soldiers in battle who do not even realize they’ve been shot– their peripheral nerves are sending very strong messages of “damage” up to their brains, but their brains tune those signals out because they need to focus on survival.

Conversely, you can have people with chronic pain, who– due to a number of potential factors—can experience excruciating pain in response to a very minor injury, or in fact no injury at all.

Central Sensitization

At the risk of boring my long-time readers, let me define one of my most favorite terms again.  Central sensitization is the process responsible for this last phenomenon, where people can develop an increased sensitivity to pain.

The term refers to a series of changes that can take place in the central nervous system (the brain and the spinal cord) which can ultimately make a person much more sensitive to pain.  In some cases, central sensitization can become a self-perpetuating phenomenon, in which a person continues to feel pain long after their initial injury has healed.

Central sensitization is such a fascinating topic.  There is still much research to be done on it, but so far it is believed to play a role in such seemingly-diverse conditions as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, temporomandibular disorder, and many others.

One Last Thing

When I first started trying to understand the amazing, interesting new research that’s being done in pain, I kept hitting this one term that mystified me.  The dorsal horn.  What the heck is a dorsal horn?  I was so confused by this for a long time, and it really held me back from understanding a lot of articles.

Turns out, the term dorsal horn refers to an area in the back of the spinal cord.  The back of the spinal cord is where the sensory nerves meet with the spinal cord, so their messages can continue on up to the brain.  It’s pretty simple actually– the sensory nerves connect with the back of the spinal cord, and motor nerves connect in the front.  So when people talk about the dorsal horn, they are  talking about where sensory information is entering the spinal cord and then being relayed on up to the brain.

For more info

If you want a really great overview of the divisions of the nervous system, I highly recommend this video.


I really hope you’ve enjoyed this post!  As you can see, it’s written in a very different tone, and for a very different target audience, than my previous post.  I’m still in the process of figuring out what type of post works best on this blog.  I really want to be able to write about advanced scientific concepts for every day people, and I’ll probably be trying to figure out the best way to do that for a while. Your thoughts/comments/suggestions are always welcome, so please let me know if you have any! Thanks!

Top photo courtesy of Geralt at

Treating Chronic Pain as a Two-Way Street

The nervous system has a system of checks and balances that ultimately determine how strong a pain signal is experienced by the individual. Different parts of the spinal cord and brain can play a role in either magnifying or weakening the pain signals traveling through them.

How a pain signal is amplified or dampened depends on a lot of factors (the person’s chemical makeup; genetics; personal history with accident and injury; emotions; context; whether or something else is happening at the moment that’s more important– aka why soldiers in battle can be shot and feel no pain).

One theory posits that chronic pain patients no longer have the same signal-weakening mechanisms that healthy individuals have. This is why they feel things, much more strongly, that might not really register to another person.

This is why, in many cases, I feel as though it’s misleading to talk about chronic pain as though it’s “in” the nervous system; that it’s something the nervous system is just coming up with on its own.

Instead, I think a lot of what chronic pain sufferers feel is pain signals which would be present in anyone– it’s just that in chronic pain sufferers, the pain signals are magnified, while other people might never register them consciously.

Now, this is not definitely not true all of the time.  Research has proven that physical injury/pathology is not necessary for pain.  After all, someone suffering from phantom limb pain where his leg used to be does not still have a leg to have a physical problem in!  But I do think it is possible that it’s the case, in chronic pain patients, more often than some authors realize.

So why don’t we try to stop those pain signals, which helping to perpetuate the chronic pain cycle, from starting in the first place?

Think about what it took to trigger the process of central sensitization in the first place. It’s usually caused by some kind of traumatic physical event. I think it’s a little idealistic to assume that people are always going to bounce back into mint condition three to six months after an injury/illness/surgery and not have any structural reasons at all for pain.

Yes, a tight muscle here or there might not be “painful” enough to consciously register to patients in the general population. But when we’re talking about central sensitization, the criteria for what is “significant” enough to become painful is pretty low.

And if the point is to get the person’s nervous system to calm down, wouldn’t it make sense to try to calm down the thing that’s happening at the very start of the whole signaling cascade? Why not approach the problem by dealing with both the end and the beginning of the cycle?

Now, I get why some treating professionals have downplayed the idea of approaching treatment from this angle. When you’re trying to convince a person that a muscle spasm or a trigger point isn’t “dangerous,” you don’t want to turn around and make it sound like you’re worried about it. If you alarm the person, you’re going to cause his or her nervous system to leap back into action, cranking his or her level of pain back up.

But what if it was possible to educate the patient on pain, and what is and isn’t dangerous, and explain that a muscle spasm isn’t really dangerous at all… while still acknowledging that he or she might be in less pain without the muscle spasm starting the cycle off in the first place?


I’ve got a lot more thoughts on this subject, but I want to hear your thoughts.  Did you ever feel like you had a doctor, physical therapist or other medical professional who had great advice to give you about living with chronic pain, but didn’t seem to have much interest in looking for any potential physical reasons for your pain? I’m curious… let me know!

Everything in moderation, even the best things

This is a really well-written post on an important subject from The Sports Physio.

It is by a physiotherapist, intended for other physiotherapists, but it was also really meaningful to me as a patient. (For my readers in the US, physiotherapist means the same thing as physical therapist).

The author, Adam Meakins, talks about how many physiotherapists are now jumping on the “bandwagon” of viewing chronic pain as a function of a sensitized nervous system.

This is obviously a really important concept to be aware of.

My entire life changed for the better when I finally met a physical therapist who could explain to me that the pain I’d been feeling for so long, which all the other medical professionals were telling me was psychological, was actually due to changes in nervous system function.

But it is possible to take this idea too far—to be so excited about the fact that now you have a straightforward explanation for some patients’ complicated, ongoing pain that is also new and exciting—perhaps, in some cases, even “trendy”—that you overlook other things that could be going on.

Basically, before physical therapists knew anything about the phenomenon of central sensitization, they figured that all pain must be caused by a biomechanical or structural problem in the body. For example: the patient has flat feet and needs orthotics. The patient has a slight difference in leg length. The patient sprained his or her ankle and has scar tissue left over that must be massaged away.

However, as anyone who is educated on the complexities of chronic pain can tell you, there hasn’t always been sufficient evidence to back up these ideas. As Meakins explains,

“… thousands of therapists (are) realising that the traditional postural, structural biomechanical model just doesn’t seem hold up to scrutiny or to the evidence base anymore, and that pain isn’t just due to these factors.”

In the case of chronic pain patients, pain is often being perpetuated by a process within the nervous system, rather than a physical, structural problem. And you, as the treating professional, can achieve miraculous results by educating this person on how their nervous system is playing a role in maintaining their level of pain.

This is why many PT’s now speak somewhat disparagingly about the older, traditional “structural, biomechanical” model.

But when you are too quick to write off the idea that a patient might also have structural issues contributing to their level of pain, you might miss other factors that could be contributing to their pain.

This also happened to me. The PT that first taught me about pain and the nervous system—who, again, changed my entire life for the better—did take these ideas a little too far.

As much as he helped me figure out the mysterious pain that had been plaguing me, in one part of my body or another, for years, he also second-guessed my orthopedist and told me I didn’t have chondromalacia patella in my right knee. And this had overarching, years-long consequences for me, as I ended up injuring that knee to the point where the chondromalacia patella was excruciating and I could barely walk.

Along similar lines, Meakins tells the story of a patient who was diagnosed with Complex Regional Pain Syndrome, after breaking a leg. Her pain stretched on for months and months, and she was told “she would need extensive cognitive rehabilitation and medication for her pain.”

She later sought a second opinion, and it turned out she had physical damage (an osteochondral defect, specifically) that hadn’t healed.

I’ve also noticed a tendency for non-medical professionals to also jump on this bandwagon, without appreciating the other factors that can cause pain.

For example, I have certain members of my family who tend to assume whatever happens with my physical issues is somehow my fault. If I can’t do something, I haven’t tried hard enough. If I do something that makes the pain worse, I’m trying too hard.

Once these family members learned a little bit about how pain can be caused by changes in the nervous system, they started getting angry at me for “giving in.” For not “fighting” the pain hard enough (even though that is exactly what you’re NOT supposed to do when dealing with a problem of this sort. You’re actually supposed to be gentle with your nervous system to allow it to calm down).

And the articles they’ve read by medical professionals dismissing the biomechanical model have only given them ammunition to tell me I don’t have a real problem.

I think this is why I’ve been so reluctant to really talk about the specifics of my sacroiliac joint issue on this blog. I know that some of the pain, of course, is likely being magnified by my nervous system. And I’ve done so much reading on the workings of chronic pain, and the failures of the traditional structural mechanical model, that it’s made me a little bit hesitant to say hey, I think I really have a structural problem here.

But the truth is: I really do think it’s a structural problem. The irony is that it doesn’t actually hurt that much, not in the joint itself. What hurts is all the other areas that have to compensate when I’m limping. When I really stop and think about it, my problem doesn’t even feel like pain, in the truest sense of the word. It actually does feel like a structural problem.

So I’m going to stop apologizing for this problem, and stop doubting its veracity. None of the medical professionals I’ve seen at this point (which includes three physiatrists, seven physical therapists, and four chiropractors) have actually told me I don’t have a problem.

I think we all need to take a step back and realize that while the recent advances in pain science truly have the potential to change patients’ lives for the better, everything– and I do mean everything– is best in moderation.

“Build Me Up from the Bones”

Ever since I heard this song title a few months ago, I haven’t been able to get it out of my head.

Build me up from the bones.

That’s basically exactly what I’ve been doing.

Obviously, it’s intended as a metaphor, and I’m sure the song as a whole deserves its own analysis.  But for me, the title itself is  perfect.

The more knowledge I’ve acquired about the human body, the more I realize that most of the problems I have now are due to lack of muscle strength.

The compartment syndrome when I was 17—that was something else. That was overtraining (too much running, followed by standing up for too many eight-hour shifts at Starbucks) combined with flat feet and no orthotics, combined with eating disorder and lack of nutrition.

But everything since then—that’s all been the indirect result of muscular atrophy.

I first learned about atrophy when my friend fell in second grade gym class and broke her arm. I remember the gym teacher telling us then (after the ambulance had taken my friend away) that when she got her cast off in a few months, her arm would look small and shrunken compared to the other arm.

The teacher explained that when you don’t use a muscle at all for a very long time, your body lets it get weak because it doesn’t think you really need it. And that it can happen quickly– really quickly. That it would take my friend a lot longer to do these exercises to build her arm back up than it had taken for her muscles to get weak with the cast on.

That concept—atrophy—scared me so much when I first learned about it then.

But when it actually happened to me, it was gradual. I didn’t really notice the rest of my body getting weak, because it was overshadowed by so many other problems (namely the compartment syndrome itself, and the problem of needing to locate a chair everywhere I went).

If I could go back in time, I would have joined a pool. Actually, I would have belonged to a pool for the entire time I was running cross-country and track, and done a few workouts a week in there. That’s something a lot of professional athletes do—you can get just as good a cardiovascular workout, and a good strength training workout, depending on what you do, and the risk of injury is just so much smaller.

(In retrospect, I’m not sure how much my coaches would have gone along with that. They were kind of old school—the team was supposed to work out as a unit, every day, and exceptions were for people with injuries, not people trying to prevent them.   But again, if I was to go back in time, knowing what I know now—well, things are just so different now. Let’s just say I wouldn’t have taken no for an answer, but I’m also so much better at advocating for myself now that it probably wouldn’t have come to that).

Regardless, maybe if I’d been working out in a pool all along, I might have managed to keep all the muscles in my body I wasn’t really thinking about– back, shoulders, trunk/core– strong, despite the fact that I couldn’t really use my legs.

I didn’t actually feel the atrophy as it happened. I felt like I was choosing not to use my body to do certain things because of pain, not because of weakness.

But when I threw my back out, a month after my leg surgery—that probably wouldn’t have happened if I hadn’t come so weak.

And that, in turn, is when my nervous system really went crazy—which of course, started off its whole chain of problems, which of course my regular readers already know about.

But I’m coming full circle now.

I’ve addressed the pain—or, more specifically, learned how to address it. (This process of learning to manage chronic pain—it’s not something you do once and are done with. It’s about learning how to think. The knowledge that the more you feel you have control over what’s happening in your body, and that you truly understand what could be causing the pain—that’s an equilibrium that you must continually strive towards and re-create).

And now I see the underlying problem– that I am weak. Less now, of course, now that I’ve been working out in the pool for so long. But nowhere near as strong as your ordinary, average person who might not work out regularly, but has never had an extended period of time where they had to stop using their body.


When I first started to voice my idea of becoming a physical therapist, there were actually quite a number of people who discouraged me.

“But it’s such a physically demanding career,” they would say. “Can you do that?”

And yes, I’ll be honest—sometimes that question makes me a bit nervous too.

But there’s no reason I can’t get strong again. I am lucky not to have anything wrong with me that is permanent. I just need knowledge.

When I took Kinesiology last summer, that was the point at which everything started to click for me. I learned about the motions each joint of the body can perform, and how the different muscles work together to produce that movement.

I started to understand why some of the exercises I’d been doing hadn’t helped that much, and I actually began to see holes in some of the exercise programs past physical therapists had given me.

I realized how specific muscles can be.  Especially relevant to my case were the muscles of the back and shoulders. You can be doing two almost identical motions with your arm, but a ten degree difference in the angle your arm is at can completely change which muscles are working.

I’d never known things were that specific. I’d always progressed through my back exercises based on my level of pain, doing the easiest, least painful exercises first, figuring I’d work up to doing the tougher ones after a few weeks.   What I know now is that those easy exercises were never going to prepare me for the harder ones, because they simply weren’t working the same muscle groups (despite how similar they all seemed).

It’s frustrating– I’d always told my physical therapists what I was doing, and none of them ever warned me the plan might not work.


Part of the problem, I believe, is the physical therapy model (at least, in the United States) where the therapist can only focus on one specific diagnosis or part of the body at a time. This means that your physical therapist has to send you back to your primary care doctor, to get a new prescription and a new insurance authorization, just to be able to answer a question about a different part of the body than what they were treating.

Now, all the PT’s I’ve seen haven’t been like that. But there were enough, over the years, that I’m sure it cost me a lot of potential progress.

All of my various diagnoses had the same underlying problem—I was weak and extremely out of shape. Treating each problem one by one wasn’t going to stop the next problem from developing.

I have a great physical therapist now, who is able to think abstractly, and answer all of my questions about strengthening various parts of my body. And that is the kind of physical therapist I would like to be for other people.

The type who understands that strength is important—overall strength. And that you aren’t really helping the patient if you help them strengthen one part of your body, but leave the rest totally weak.


So now I’m strengthening everything.

The problem is not, primarily, my sacroiliac joint (although that’s obviously what causes me the most grief right now).

The problem is that my muscles are not strong enough to hold my sacroiliac joint securely into its proper alignment.

I’ve had to completely change how I think about my physical problems. When I work out in the pool, I’m not just focusing on fixing my SI joint, or my knees.

I’m troubleshooting.

I’m strengthening everything. Every major muscle group, and every major joint motion. (At least, as best as I can).

I’ve finally broken through the mysterious veil of pain that clouded everything I did, and made me afraid, and made all my physical therapists think I needed psychotherapy.

And now I’m back. I’m building myself up from the bones.  I will get there, to the level of strength I should have had all along.


Examined Life: Judith Butler & Sunaura Taylor

This is an amazing excerpt from the film “Examined Life” in which Sunaura Taylor, artist and disability rights activist, and Judith Butler, critical theorist, go for a walk and talk about disability, gender, and the politics of inclusion vs. exclusion.

Their conversation is so interesting that I really don’t need to write anything else, but I can’t watch this and not jot down some of my favorite quotes and ideas…

On Visibility:

In the beginning of the segment, Taylor explains:

“I moved to San Francisco largely because it’s… the most accessible place in the world. …The physical access—the public transportation is accessible; there are curb cuts most places… buildings are accessible… this leads to a social acceptability. That because there’s physical access, there are simply more disabled people out and about in the world and so people have learned how to interact with them and are used to them…. Physical access leads to social access; an acceptance.”

Taylor described how, when she had previously lived in New York City, she would sometimes go into a coffee shop and carry cup to her table in her mouth, but it wasn’t always worth it because of the unwanted attention it attracted.

On the Expectations of Others

This brought Taylor and Butler to the question: Why do people get so upset with someone who doesn’t use a body part in the way that we assume it’s attended?

Butler notes the parallel here to gender studies, which asks: why do people get so upset when someone’s body doesn’t fit our ideas of what a man is, or what a woman is?

What Kind of World Do We Live in?

Taylor explains that she considers it a form of political protest for her to go into a coffee shop and ask for the help she needs. Ultimately, this form of protest poses the question: Do we or do we not live in a world where we help each other?

Butler explains:

“My sense is that what’s at stake here is rethinking the human as a site of interdependency.

I think that when you walk into that coffee shop, you’re basically posing the question ‘Do we or do we not live in a world in which we assist each other? Do we or do we not help each other with basic needs?

And are basic needs there to be decided on as a social issue and not just as my personal individual issue, or your personal individual issue…?”.


I related to this clip on so many levels. Although much of my blog is about my experience with pain, there have been many periods of my life when I also had to deal with a level of disability, albeit in a much more temporary and transient sense. This only gives me a temporary glimpse into what someone with a life-long disability goes through, but I could definitely identify with some of the perceptions and emotions Taylor and Butler shared.


My saga with the sacroiliac joint

wikipedia SI joint

Update (Sept. 2015): I have come a long way in the year and a half since this post was written.  If you are looking for answers about the sacroiliac joint, please be sure to read my more recent post as well!


So, let me start out by saying that I feel totally crazy writing some of this.

Most of what I write about has a good deal of scientific research to back it up. I take this very seriously, because the internet can be a such cesspool of conspiracy theory and misinformation.  The last thing I would ever want to do is be the kind of blogger who adds to that.

But I don’t really have many scientific facts to back up this post with. And it’s not for lack of trying.

Since this ordeal has started, I’ve seen one orthopedist, five physical therapists, and two physiatrists (the word is confusing, but their specialty is Physical Medicine & Rehabilitation, not Psychiatry).

I’ve also spent a long time trying to find information about the sacroiliac joint online. Google searches turn up next to nothing. And searching the publicly accessible scientific databases such as the National Institutes of Health only turns up articles about people who seem to have different problems than me.

So I’m just going to write this based on my own experience.


This post picks up after where I left off in “How a physical therapist helped me through my lowest point, Part 8.”  In that post, I talked about how I was developing chondromalacia patella in my right knee, and that it was made worse by the fact that my physical therapist told me the pain wasn’t significant and that I could try to ignore it.

After a few months, things had gone from bad to worse and I was limping almost all of the time.

And, after weeks of limping, came the first time one of my sacroiliac joints locked up.

I was walking along, just minding my own business, when I felt this strange sinking feeling in the back of my left hip. The sinking didn’t hurt, but it was followed immediately by a “catching.” And the catching did hurt.

And once whatever it was that was caught had caught, I could barely lift my leg. Like, I could barely get it off the ground high enough to put it down in front of me. Going up stairs normally, even small ones, was out of the question, because I literally could not get my left leg high enough to place it on the next step, let alone put any weight on it once it was up there.

I had been seeing a chiropractor for a while at that point, because all the exercises I’d been doing in PT had made my lower back to start to hurt.

I went in that day, and he told me right away that it was my sacroiliac joint. I’d only heard of this joint in passing before—just one more word on the diagram in my anatomy and physiology class. It hadn’t even seemed like an important enough joint for us to talk about it at all in class.

It didn’t take him much time at all to click away with his activator and get the joint to fall back into place. I was able to walk out of the office normally, although it was a day or two before I was brave enough to try using that leg normally on stairs.


A few weeks later, the same thing happened on the right side. I was getting ready for a quick chiropractor visit before I had to drive to class that night when I experienced the same sinking and catching feeling. I felt as though I had a stilt under one leg, although which leg felt like it had the stilt under it kept changing.

I rushed off to the chiropractor, only to have the secretary tell me he was running late. I realized I didn’t have time to wait for him and still make it to class in time, so I burst into tears in the waiting room. It was pretty embarrassing.

Luckily, he came out from the treatment room he’d been in and saw me in tears, so he fit me in.


This was the beginning of the absolutely crazy pattern I’ve been caught in for the past few years.

I feel crazy, because I’ve fallen into the exact kind of trap that so many people with chronic health problems fall into, and it usually isn’t productive.

I’ve come to count on one type of health professional to help me—and it’s not one that is generally well-respected by mainstream medicine. And I’m not getting the same explanation from him that I’ve gotten from all the others.

But in this case, the thing is… I didn’t really get an explanation at all from any of the others.

And I don’t feel like I was asking them anything super outlandish. Again, this is a joint you’ll find on a basic diagram of the skeletal system. Like, anatomy 101.

I wasn’t asking them to give me their opinion on specific acupuncture points, or the merits of reflexology. This joint is something they’re supposed to be able to help people with.

But it seems like most of the literature and treatments that I found in my attempts to find scientific information with have to do with a sacroiliac joint that is painful. Or inflamed. Or “unstable,” which is the term that means the ligaments that are supposed to hold it in place are too stretched out to do their job.

I couldn’t find anything about what to when the sacroiliac joint becomes stuck.

The ilium, which is the very back of the hip bone, is supposed to line up perfectly evenly with the sacrum, which is the base of your spine. In my case, assuming my chiropractor is correct, my ilium is getting stuck too far back, behind the sacrum.

All of the papers I read, after describing problems that I didn’t sound like mine, concluded with the phrase “further research is needed.”  It was clear that the authors didn’t feel like their results were definitive enough to make a clear pronouncement about the sacroiliac joint, one way or another.


I’ve spent so much time living with this problem, I can feel it the second my SI joint starts to lock up.

Once in a while it will turn out to be a false alarm– I’ll move in a way that sets off the old familiar pain, and I’ll freak out, but an hour, I’m still able to walk normally.

But all too often, it’s not a false alarm– I feel the catching sensation, and then no matter what I do, I’ll be limping for days, until I finally give up and go back to the chiropractor.


So this is the trap I’m in. I still go to a chiropractor several times a month.  Once my hip has become caught in that peculiar way, a chiropractic adjustment is the only thing I’ve found that can make it become unstuck.

Meanwhile, I’m reading all these other blogs by people I really respect, who’ve turned out to be right about a lot of other things, who all say that chiropractors are at best misguided, and at worst, con artists.

I’m still waiting to find out that I’ve been completely wrong about the whole thing. That maybe my chiropractor was wrong, and that I didn’t feel exactly what I’ve been feeling.

That maybe the “sticking” feeling isn’t always coming from the joint itself.  That maybe my muscles are just tight, and something about the chiropractic adjustment is loosening them.

That’s why, from time to time, I check in with other medical professionals. But surprisingly, none of the people I saw told me to stay away from chiropractors. Both of the physiatrists I saw actually expressed admiration for someone who had enough expertise to be able to manipulate a joint that was, to them, still quite mysterious.


The only helpful article I’ve found about the sacroiliac joint, EVER, is this one by Roger Cole.

He explains that in many people, the sacroiliac joint becomes fused as they age. This is particularly true for men, starting around age 30. By 50, almost all men’s sacroiliac joints have become fused.

This means that the two bones, the sacrum and the ilium, fuse and become one bone.  The joint no longer moves at all.

But in women, particularly younger women, as well as people who’ve retained a lot of flexibility through yoga (which, he points out, might not actually be a good thing) this joint tends to remain unfused.

This is one reason why the medical profession might not have a good handle on this joint. Up until recently, it was pretty much only men studying anatomy, contributing to medical textbooks, and practicing medicine. And by the time they’ve actually become successful doctors and surgeons, these men’s own sacroiliac joints have completely fused.

And even for women like me, it seems like most of us need to have some kind of precipitating event to have issues with this joint.   My web research tells me, at least anecdotally, that it seems to most commonly affect women during and after pregnancy.

I don’t think any of my readers will be too surprised that a problem that disproportionately affects women might not have received enough attention from the medical establishment.


So basically, my plan now is just get stronger.

It’s actually my main chiropractor, Dr. K., who first convinced me to join a pool and stop working out land.

For months, after I had first come to him with a locked up sacroiliac joint, he started telling me that getting stronger would be the only way I’d get better, and stop this problem from happening.

I had all kinds of reasons why I didn’t want to join a pool, but in retrospect, this problem would not have gone on for nearly as long if I’d just stopped the land exercise and joined a pool the minute my knees started hurting.

So for those who are inclined to think of chiropractors as con artists, Dr. K. really got on my case about joining a pool.  He made it clear to me that his adjustments would only help in the short-term, but in the long run I was going to have to get stronger.  And that the only way he saw me doing that was in water.

Over time, he got progressively more emphatic:

“Just go online and see what gyms around here have pools.”

“Just make one phone call about joining.”

“Just go in person and check out one pool.”

Finally I did, and I’m still kicking myself (or I would be, if my joints could move) for not doing it sooner.


Since I’ve been working out in water for about a year and a half now, I am a million times better.  I haven’t completely stopped my SI joints from “sticking,” but now that I am stronger, they don’t “stick” quite as badly.  It also just doesn’t bother me quite as much when they do, because I have more strength in other areas of my body to compensate with.

So I am not out of the woods yet, but at least I feel like I am learning.

As I’ve promised in previous posts, I plan to be writing more about the specifics of my exercise program, as well as the exercise science concepts that I think are really useful for anyone with chronic pain and biomechanical dysfunction.

Stay tuned!


Sunlight in the Kitchen


Here’s something you probably didn’t know about me:

As much trouble as I’ve had with chronic pain over the past ten years, I’ve had almost just as much trouble with digestive issues.

I haven’t written about those issues yet for a few reasons.  For one thing, they’re embarrassing.  Really embarrassing.  I’d much rather talk about running injuries and muscle pain.

For another, I wasn’t sure how many different topics it would make sense to talk about on one blog.

But digestive issues, such as irritable bowel syndrome, are actually pretty closely related to fibromyalgia.   From the time I’ve spend interacting with other bloggers, it seems like most people with fibro have some digestive issues.

I happen to know a little something about all of that.


In the past ten years, I have been through six gastroenterologists, four nutritionists, and four pelvic-floor physical therapists.

I didn’t find any answers at all until I met my fifth gastroenterologist in 2011.  Even then, what really made the difference is that I had started doing a lot of my own research about what I thought might be causing my issues, and this doctor was open-minded enough to humor me.

At that point, I finally started to figure things out.  None of my issues turned out to be terribly rare, or even hard to diagnose.

It was simply that I had fallen through the cracks– that I was a young, relatively healthy-looking woman, and that the first four doctors I saw found it easier to write my problems off as being caused by stress, rather than ordering some pretty basic testing.

The fact that I had fibromyalgia made it even more likely that these doctors would write me off, because pretty much every medical person knows that these issues are so closely connected.

But just because there are connections between fibromyalgia and irritable bowel syndrome does not mean that treating one will automatically treat the other.  And just because a patient has fibromyalgia does not mean there cannot be other causes and contributing factors to her IBS.

So I have decided to start sharing my experience with digestive issues with others.  To raise awareness about the basic things that most gastroenterologists and other health professionals already know, yet don’t always bother to investigate with their patients.  Once you know about these potential issues, and the tests that can be done to diagnose them, you can begin to take charge of your own health.

I have decided to write about these issues on a second blog, simply because I don’t want to completely overwhelm the people who are already following this one.  I plan to post a lot of recipes/cooking inspirations on the new blog, which I know might not interest every single follower here (and that’s totally ok!).

I hope you will check out my new blog, Sunlight in the Kitchen.

**Strawberries photo courtesy of Sharon Mollerus**


The benefits of swimming in cold water


Today, Ruby shocked me by taking her first swim of 2014.  It was awesome.

As you may remember from my previous post about her, Ruby is my family’s 14-year-old Lab mix (she’ll be fifteen in July!).  She is a spunky, spirited dog, but due to some benign tumors in her left hip, as well as arthritis, she is in pain almost constantly.

We’ve done the best we can to keep her pain in check with medication and reassurance, but you can still very easily see how much pain she in.  She limps, often keeping her back legs together and doing a “bunny-hop” to get up the front steps.  She is usually in too much pain to come upstairs at night, so every night I sit and talk to her until she falls asleep at the bottom of the stairs.

But today– well, Ruby simply had an amazing day fetching sticks and walking around the fields at our favorite spot.

Fetching sticks out of the water… Ruby’s all-time favorite pastime.

Of course, it helps that the weather is finally warmer (trust me, we New Englanders were starting to collectively lose our minds after this completely absurd winter!).  But what I really think made the difference for her today is the benefits that come from swimming in cold water.


Swimming in the cold isn’t really fun, at least for humans.  Part of the reason I took so long to start working out in a pool after first hurting my knee a few years ago is that when I first tried it, I couldn’t get over how cold it was.  Here I was, trying to warm my muscles up enough for them to loosen up, and I couldn’t stop shivering.  My teeth were chattering audibly.  What the heck.

But when I finally started doing it regularly, I was amazed to find it made an incredible difference in my pain.  Here are the reasons why:


#1: Reducing blood flow

When you immerse yourself in cold water, it causes the blood vessels in your extremities, particularly those which are the closest to the surface, to constrict.  This is because your body is trying to send as little blood as possible to the periphery of your body, and keep more blood in the center of your body, to help keep your core temperature warm.

From an evolutionary perspective, this is because if we’re trapped out in the freezing cold, or we fall into a freezing lake, it’s essential that we keep our internal organs working.  If it comes down to it, we can survive without a few fingers or toes.  We absolutely cannot survive without a liver.

Of course, when you’re simply swimming in a chilly swimming pool, you’re not anywhere near the point of developing frostbite.  But the minute your body senses that cold stimulus, it starts that process of constricting your blood vessels, which in turn limits the flow of blood to the periphery of your body.

This means that if you have a particular part of your body that’s inflamed– for example, let’s say it’s your ankle–  you can temporarily stop the cycle of inflammation by reducing the flow of blood to that area.   Your blood is what brings the ingredients for more inflammation to your ankle.  If you reduce the flow of blood, you aren’t allowing those ingredients to come and produce more swelling.  The cycle is temporarily stopped.

#2: Cold slows the rate at which your nerves send pain signals

Anyone who’s ever been outside in the winter without gloves knows this: when part of your body gets cold enough, it will start to go numb.

The pool can be a much more subtle version of this.  I know that after I’ve been in the water for about ten minutes, I’ve totally forgotten about the aches and pains that were a “6” out of “10” all day.

This is because, when your nerves are cold, they simply can’t fire as fast.  This gives your brain a little break from receiving all of the constant input it was receiving, which in turn can have a calming effect. By the time you’ve gotten out of the water, your brain is perceiving your pain differently, and it’s sending fewer messages to the nerves in the rest of your body asking for more “information” about the pain.  Needless to say, this is good.

#3: Cold causes your body to release endorphins

Over the past few years, I have heard of many studies that show our bodies release endorphins in response to cold.  (Endorphins are chemicals produced by our bodies that help relieve pain and improve mood).

I actually have a few friends who swear by taking ice cold showers to improve their mood and help them “wake up.”  Of course, I’m not asking you to go swim in ice water– I think you can get the same effects with mildly chilly water.

This phenomenon is something that is not yet completely understood, so I wanted to be sure to provide links to a few credible studies, rather than simply asking you to take my word for it.  Here is one study that looks at cold as a possible treatment for depression; here is another that examines it as a possible treatment for chronic-fatigue syndrome.  (Don’t worry, I definitely didn’t understand all of the mumbo-jumbo either!).


I have personally found that chilly water makes a much bigger difference in my level of pain than the heated therapy pool I used to work out in.  The therapy pool was relaxing, but I still felt all of the exact same pain that I had been feeling on land.  When I switched to swimming in a regular pool (which is still heated, just not hot) I was shocked to notice that, after about ten minutes, those pains were almost completely gone.

There are many other benefits that come from working out in water.  They are equally fascinating to me, so of course I will be covering them in future posts.  But for now, I will leave you with this:


A few minutes after she got out of the water today, Ruby sped up and started to prance.  Completely out of the blue, she was trotting, quicker than I’d seen her move in months.  I could just tell what she was thinking:

“I can move!  Wow!  I can move as fast as I want!  I can’t believe I’m not tired!”

It was true– we hadn’t gone for a walk that long in months, let alone a walk and a swim.  It was clear as day, the expression on her face.

For a moment there, we both got to see just what her body was capable of, if only we provided it with the right conditions.

river 1


What’s going on with me right now


It’s been a few years now since I first began to understand my pain problem– three, to be specific.

Since then, I feel like I’ve made a lot of progress in terms of how I view pain and my nervous system, and how much trust I have in my body.  Finally, I was able to break the cycle I’d been caught in for years, where where I’d go from doctor to doctor, begging them to explain why I was in so much pain.

Unfortunately, at the same time that I’ve gone through these mental and emotional transformations, I’ve also had some very real physical issues to deal with.

I mentioned at the end of “How a physical therapist helped me through my lowest point, Part 8” that I was developing chondromalacia patella in my right knee, and that it was made worse by the fact that my physical therapist told me the pain wasn’t significant and that I could try to ignore it.

I was 26 when this happened… I’m 29 now.

What happened in the intervening years is so incredibly frustrating to look back upon. I thought my problems were ending when I finally solved my pain problem, but thanks to the chondromalacia patella, things were actually going to get a lot worse before they got better.


The only way to look back on the past three years without feeling completely powerless is to focus on what I could have done differently, knowing what I know now. Now I know:

If only I’d started physical therapy for the chondromalcia patella sooner, it never would have gotten as bad…

If only I’d known that the cortisone injection wouldn’t be worth it; that all the extra fluid in my leg would put me on crutches for a week…

If only I’d known how quickly I would become weak from inactivity, I would have refused to hold still…

If only I’d known that working out in a pool would be the only option for me, I would have joined a pool right away and not wasted any time trying to work out on land…


Basically, I started physical therapy for my knees too late. I went to physical therapy and did everything my new PT told me, but all of her exercises weren’t enough to counteract the downward spiral I’d ended up on.

As I would learn, there are two ways to weaken a muscle. One is to not use it at all. The other is to completely overuse it so that it doesn’t have a chance to rest.

I was, unfortunately, doing both of those things. It was excruciatingly painful to put any weight onto my right knee, so I moved very, very little—causing all those muscles I wasn’t using to weaken.

Then, when I did move, I was completely overusing the muscles I could use—aka putting all of my weight onto my left leg and completely overworking the muscles of my left hip.

I was doing everything my physical therapist told me, but I just ended up with even more pain in the front of my left hip, and then my right hip, and then the chondromalacia patella started up in my left knee. Then I ended up with pain in my low back.

And then, about six months after I’d really started limping because of my knee, I developed some issues with the sacroiliac joint (where the pelvis meets the spine, in the low back).

wikipedia SI joint

The sacroiliac joint turned into its own saga, which I will have write about in future posts, because there are basically no helpful articles about it online.


Things only started to get better for me when I started to work out in a pool, and even then, getting stronger was no easy feat.

I finally feel like I’ve started to figure everything out now; three years later.

It meant I had to let go of a lot of things I’d learned about exercise in the past, and really study some basic concepts in order to help myself.

I had to really learn a lot in order to help myself. It was hard to get help from anyone else, because, as anyone who’s been a patient knows, physical therapists (at least in this country) can only focus on one diagnosis and part of the body at a time.

I didn’t need physical therapy for my knees anymore. Or my hips. I needed to strengthen everything.

I didn’t have just one or two weak links anymore… I literally did not have the baseline amount of muscle that would allow me to walk from one end of the house to another and hold all of my joints in place without pain.  (Both the chondromalacia patella and sacroiliac joint issues were ultimately caused by lack of muscle strength).

So I had to start from scratch. From less than nothing, because I had to find a way to move despite the fact that many of the movements we take for granted were impossible for me.



Ever since the first time I wrote a description for the “About” section of my blog, I’ve said I planned to write about exercise and fitness. I haven’t quite gotten around to that yet, but now you, my readers, know why I will.

I don’t really plan to write about fitness from a bodybuilding or super-overachiever standpoint. That stuff is interesting, but it’s just so far removed from my daily reality right now that I don’t really have much use for it.

What’s important is the basics. Knowing that if you strengthen a muscle without ever stretching it, you will shorten its resting length. That there is a difference between strength and endurance, and if you only train for one, you will never develop the other. Knowing about this little thing called the Golgi tendon reflex, which will allow you to relax just about any muscle you want just by putting pressure on it (the concept behind foam rolling).

These are things that people with chronic pain can benefit from knowing. When I look back, I can actually see how a lot of my issues with pain—confused nervous system or not—were also related to the fact that I was simply so out of shape from the injuries and periods of inactivity I’d had when I was younger. I mean, yes, I had a heightened pain sensitivity, but at the same time, anyone who was as weak as I was was bound to be in pain. There’s just no way that wouldn’t happen.

I hope the things I’m going to write about will be helpful for you all. I’m going to talk about how my perspective on changed, and how I was able to use what I’d learned from Neil Pearson’s techniques to cope with what I was feeling, while at the same time knowing I had some physical issues that I couldn’t immediately change.

So much has changed in my life, even though all the while to the outside observer, it looks like I’ve been holding still. But that is just so, so far from the truth (sometimes I need to remind myself of that!).


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