Favorites, Fitness, My Story, Sacroiliac Joint

Building Back My Muscle Strength

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.

When I developed compartment syndrome at the age of seventeen, it was due to over-training for the spring track season (combined with the fact that I had an eating disorder, and was also starving myself).

But everything since then—that’s all been the indirect result of muscle weakness.

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I first learned about the concept of muscular 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, following my leg injury, it was gradual. I didn’t really notice the rest of my body getting weak, because it was overshadowed by the pins and needles in my lower legs.

If I could go back in time, I would have worked out in a pool every day, so that I could I maintain all of the other muscles in my body I wasn’t really thinking about– back, shoulders, trunk/core– 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 the pain in my legs, 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.

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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 back 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.

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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.  My whole body was the problem, not just one part.  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.

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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, back to the level of strength I should have had all along.

 

Chronic Pain, Sacroiliac Joint

My saga with the sacroiliac joint

A note:

Hi everyone!  If you’ve found this post, you’re probably looking for information on SI joint issues.  This seems to be the post that Google brings the most traffic to, probably because it’s the first one I ever wrote on the subject.

However– although I’m proud of everything I’ve written, this particular post is not the best post to help you find answers!  I’ve come a long way since I wrote this, and have even started a separate site, My Sacroiliac Joint Saga, to share what I’ve learned.

I’m leaving this post up as a testament to the fear and confusion I felt when I had first developed my injury.  However, things are definitely not as bleak as they seemed, and help is available.  Please don’t let this post be the only thing from me that you read– I’ve learned so much since writing this!

And now, here is my original post from May 2014, which I’m leaving up for the purpose of telling my story ONLY:

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.

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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!

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Again, this is an old post (from 2014), and it is NOT my most informative post on the subject!  I’ve learned so much since then, and have so much more to say that you might find helpful!  Please be sure to check out My Sacroiliac Joint Saga for more. 

You can also check out my more recent posts on this blog.  

Chronic Pain, Pain Science

The benefits of swimming in cold water

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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.

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Fetching sticks out of the river… Ruby’s all-time favorite pasttime.

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.

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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:

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#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!).

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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:

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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.

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Chronic Pain, My Story, Sacroiliac Joint

What’s going on with me right now

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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.

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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…

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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.

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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.

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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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Photo Credits:

Chronic Pain

How a physical therapist helped me through my lowest point, Part 8

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This is the eighth post in an ongoing series.  If you would like to start from the beginning, click here.

The last post in this series was the hardest to write, and that’s why, of course, it took me so long.

I was just starting to get a handle on things by my sixth visit. I had gotten brave enough to use the elliptical trainer at home for short periods of time, and was starting to go on short 45-minute hikes. I was no longer afraid of every little ache and pain in my body, but I was holding my breath; afraid it was too good to be true, that one little thing would change and all the pain would come rushing back.

This is the point at which Tim told me my next visit would have to be my last. He said he had done his best asking for extra visits from the insurance company, but they had finally put their food down with this next one.

He reassured me that I already knew everything I needed to know, but promised that I could email him if I had any questions.

Despite all my fears, everything was fine for the next few months. I increased my time on the elliptical trainer, and started going for longer hikes. I knew that if something started to hurt, I would ask myself, “Is this really dangerous?” But I didn’t even seem to really need to– most of the pain was gone, and the pain that I did have didn’t seem to snowball out of control like it had in the past.

Except for my knee.

Knee pain was actually the original reason for my referral to physical therapy. Chondromalacia patella, or inflammation of the cartilage under the kneecap, was the diagnosis I’d gotten from my orthopedist.

But Tim had viewed the knee pain as part of my overall problem with a revved-up nervous system. He told me that chondromalacia patella was sort of a “catch-all” diagnosis, and sometimes doctors just gave that diagnosis when they didn’t know what else could be causing the problem.

So he hadn’t done anything specific to treat the knee. Once he’d seen the 20 X’s I’d marked down on the form that asked where I had pain, he’d switched immediately over to a chronic pain/nervous-system mindset, and had treated me with the protocol he’d learned for that.

I believed Tim of course, because he had helped me more than anyone else ever had. But the fact of the matter is that, even though he was right about the other 19 X’s on the paper, he was wrong about the knee.

I didn’t want to freak out and rush back to the orthopedist, of course. I had taken a leap of faith in trusting Tim when he told me the pain in my back and my ankle was safe to ignore, and I didn’t see why the knee should be any different. I didn’t want it to be different. I wanted everything to be fixed; I wanted to be cured. After years of wandering from specialist to specialist, I wanted my problems to have one answer.

Much of Neil Pearson’s teaching focuses on not beating yourself up mentally, on not forcing yourself to keep going through a pain that doesn’t melt away with the “Is this dangerous?” dialogue. This is, of course, precisely what I did.

I tried to rest my knee, but it didn’t seem like there was any amount of rest that could make it better. I tried ice, and I tried Advil, and I tried to just forget about it. I heard my parents’ voices in my head from all the years of unexplained pain and injuries before: You worry too much. You dwell on things. Why do you have to get so intense about exercise? Just relax.

But ignoring my knee didn’t make it better. In fact, it got worse and worse, rapidly, until even the act of lowering myself down onto a chair was painful. It was high time to admit I had another problem; one that changing my perception of pain couldn’t fix.

So I went to a second orthopedist. Sure enough, I had chondromalacia patella, and it was worse now because I hadn’t treated it. It was bad enough for the inflammation to actually show up on an X-ray, which, I learned, not everyone’s does. But luckily, it wasn’t so bad that I was likely to have permanent damage or need surgery. I just needed to go back to physical therapy, and actually treat it this time.

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For a while, I wasn’t sure whether to include this last part of the story. After all, I really believe so strongly in the potential of this approach to help people with chronic pain, and I hate to end this series on any kind of a negative note.

But it’s important to remember that nothing is a silver bullet; that just because one thing might fix 95% of our problems, it won’t necessarily fix that last 5%.

For this approach to truly help a patient, it has to be implemented in a setting that allows for the type of injuries that won’t go away just by fixing a revved-up nervous system.

The therapist should be looking for two kinds of pain: the pain caused by a revved-up nervous system when nothing is physically wrong, and the kind of pain caused by particular biomechanical issue that needs to be treated. In fact, it’s pretty likely that both will exist in any chronic pain patient, since chronic pain usually develops after a person has been through some sort of extreme injury or medical event.

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You might have noticed from my other posts that I harbor a lot of anger and resentment towards the medical professionals whose judgmental attitudes and lack of compassion cost me months, if not years, of normal life when I was younger.

But to be honest, I don’t really blame Tim. He was doing the best he could in an extremely limited setting. He was attempting to implement an approach that he didn’t have a ton of experience with, and that most pain management specialists in this country still even haven’t heard of. And he was going up to bat against both a billing department and an insurance company who didn’t have any idea what he was doing.

I mean yes, technically, he shouldn’t have told me to ignore the orders of my orthopedist. But I know from my own experience as a patient that physical therapists often fill in the gaps left by a physician who was rushing, or who didn’t really care.

And I also know from my own experience working at the mental health agency that everything is different when you’re actually on the job. It’s easy to have the right answers when you’re a student; when you have time to sit and think and put the pencil to the paper and write the right thing.

It’s a whole different story when you’re actually in the field; when patients and coworkers and bosses are all asking something different from you. When you have too much to do and not enough time to do it in; when you’re trying to help a patient as much as you can before her insurance company cuts her off.

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The reason I decided to include this part of the story is that this approach to physical therapy has the potential to help people even more than I was helped. I am so incredibly grateful for the help I received, and I don’t mean for this to be a negative thing.

Instead, I am excited. What would happen in a setting where the physical therapist had all the time in the world and didn’t have to rush? If he knew he wasn’t the only one who knew about this approach to pain management, and didn’t have to feel like he was going out on a limb or deceiving the insurance company by explaining pain concepts to a knee patient?

Of course, I don’t mean to make it sound like there aren’t already great physical therapists out there who are already doing all of these things. I know from all of the reading I do online that they’re out there; I just haven’t been their patient.

I’m just excited about all of the potential there is to build on what I learned in my experience, which–even with its limitations–changed my life.

***Photo Credit: Elliot Cable on Flickr***

Chronic Pain

How a physical therapist helped me through my lowest point, Part 7

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**If you are new to my blog and would like to start at the beginning of this series, click here.**  

From the elliptical trainer, we moved on to some very gentle weight lifting and core exercises.

For reasons neither Tim nor I understood, the hospital he worked at had recently made the decision to get rid of all of its weight-lifting machines.  (Who does that?).

So, he explained, we weren’t going to be able to do the full range of exercises he would have prescribed to me a few months earlier.

But he did have me lifting some very light free weights.  During some of these exercises, I would sit on an exercise ball while I lifted, to strengthen my core at the same time.

I also used the arm bike, which I absolutely loved.  It was so freeing to feel all of my back muscles working, in a way that would have been much too painful for me months earlier.

The main purpose of these exercises, however, wasn’t strength-building.  The real purpose was to give my nervous system the chance to experience using my muscles, in a way that didn’t increase pain.

***

Many of the researchers/writers I read regularly talk about the importance of making a patient feel safe, so his or her nervous system doesn’t feel like it needs to be on guard during an appointment.

Sometimes it is necessary to push through pain in physical therapy.  When my father was in physical therapy after having surgery on his knee, his PT stressed how important it was for him to regain as much flexibility as possible before scar tissue took over.  He would stretch my dad’s leg out as far as my dad could stand it, and use very painful techniques to break up the scar tissue that had already formed.

But when the number one goal of treatment is to calm a wound-up nervous system, it’s important not to cause even more pain during an appointment.  You want the patient to feel totally safe, and not pressure him or her into doing exercises that he or she has apprehensions about.  As long as the person is afraid, even a little bit, his or her nervous system is going to conclude that it needs to stay in protection mode, and it’s not going to relax.

I know I’ve said this in previous posts, but I’m going to stress it one more time: what was so important about my treatment with Tim was that he had taken the time to really talk to me about my exercises, and whether they were safe or not, before actually asking me to do them.

It was a transformative combination: having new information about how my nervous system worked, as well an environment where I felt safe to try new things at a pace I was comfortable with.

It really did work.  I started finding I was able to do a lot more when I was on my own between appointments.  I started going for little walks again, amazed that the same pain that had once built up so quickly was now a quiet murmur.

I started using the elliptical trainer at home.  First I started with ten minutes, as Tim had urged me not to overdo it.  But then I would add one minute on, then two minutes, and then one day I did eighteen.

I started driving to some of the nature trails that are near my house and just getting out of the car and walking, trying not to overthink it.  Instead of watching and waiting for the pain to start, I tried to keep my mind empty and light.  If pain signals entered my mind, then I would focus on them and ask myself “Is this dangerous?”  And I tried to be ok with the answer, whatever I decided the answer was that time.

I didn’t allow myself to push through something that really hurt, because Tim had made me promise not to.  But the amount of time I could walk before it started to hurt became longer and longer.  My walks went from no minutes to five minutes to ten minutes, to fifteen, until on the day of my last appointment I had just gone for a forty-five minute hike.

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To be concluded in Part 8!

Top photo courtesy of tinydr on Flickr.

Botton photo courtesy of Boston Photo Sphere.

Chronic Pain

How a physical therapist helped me through my lowest point, Part 6

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**If you are new to my blog and would like to start at the beginning of this series, click here.**  

Part 6: Re-adjusting my concept of what is “dangerous.”

When I was running long-distance in high school, I’d really pushed my limits.  Pain didn’t scare me as much as my irrational fear of gaining weight and not training hard enough.  I had rarely let pain stop me, and on more than one occasion, I had paid a price for that refusal.

As a freshman, I had partially torn my hip flexor off of my hip bone during a cross-country race.  I’d had some pain in the few days before the race, but one mile in, endorphins had taken over, and I felt no pain.  Then, as I sprinted down the finish line, my right leg completely gave out beneath me, and I’d had to hop across the finish line on one leg.  After that, I was on crutches for months.

Then, while training for track during my junior year, I’d developed compartment syndrome.  I’d had pain and a feeling of “deadness” in my calves for weeks, and I continued to push it.  Running was the only thing that chased the dark clouds of depression away, and I was excited about the fact that, once track started, I was going to be in amazing shape.  Instead, by the end of the season, I was barely able to walk.

After these injuries, I’d sworn I was never going to let anything like this happen again.  How could I have been stupid enough to ignore all the warning signs?  My body had tried to tell me again and again that it was a bad idea, and I hadn’t listened.  So I promised myself I’d never ignore it again.

But now, in physical therapy, Tim helped me to realize that maybe I’d gone too far in the opposite direction.  There was a big difference, he said, between pain in someone who’s running 40 miles a week, and pain in someone who is basically sedentary.

My nervous system was functioning differently now, as a result of the physical traumas I had endured.  It was as though my body was looking at pain through a magnifying glass.  A little muscle spasm that I might have been able to ignore in the past was now debilitating.

I might have the same amount of pain now, just walking down the sidewalk, as I’d had running at seventeen.  But, Tim explained, I wasn’t subjecting my body to anywhere near the same amount of forces.  I might have the same amount of pain as I’d once had running, but it didn’t represent the same amount of “danger” to my body.

From running, I had learned that the way to respond to something that was agonizing was to stop and rest.  If something hurt that much, it must be on the verge of rupturing, of tearing… tendons were about to come unattached.  Right?

Wrong.  I was doing what anyone in my situation would do—taking the information my nervous system gave me at face value.  But Tim helped me to see that, because my body had adjusted its “criteria” for causing me to feel pain, I needed to change my own “criteria” for evaluating that pain.

Things just weren’t as dangerous, Tim promised me, in someone with my level of physical activity (or lack thereof) as they were in a long-distance runner.  I might be feeling a muscle spasm that hurt just as much as a pulled muscle when I was running, but– given the fact that my nervous system was revving everything up, and that I was not subjecting my body to anywhere near the same amount of forces– it was nowhere near as dangerous.

Tim urged me to stop thinking of pain as a sign that something was ripping or falling apart.  Those types of injuries were definitely possible when I was running a 5K race, or pounding down a track at 5:30 mile pace.  But they were simply not possible in a generally-healthy twenty-five year old who went for a walk a few days a week.

It seems obvious now, but of course, pain is specifically designed not to let us ignore it.  There’s no way to tell, based on sensation alone, whether or not a painful sensation is safe to ignore.  Pain doesn’t come with labels saying “this is inflammation in your joint” and “this is an overworked muscle.”  It all just feels dangerous.

What I love about Neil Pearson’s approach is that it in no part blames the person with pain for what has happened to him or her.  Instead, he suggests that the person in pain ask him or herself, “Is this really dangerous?”

Pain is designed to draw our attention to something, to make us change our course of action.  But that doesn’t always mean that we have to stop using that part of our body completely.  Sometimes, our nervous system just wants us to focus on something; to give it the attention it deserves; to make an educated guess about what is needed.

Maybe it means we decide to only walk for five minutes, instead of ten.  Maybe it means we promise ourselves that we’ll schedule that doctor’s appointment as soon as we get home.  Maybe it means we promise our aching neck that we’ll get a massage soon.  All of these things can actually have an effect on reducing pain.

When you stop and focus on what your body needs, it stops trying so hard to get your attention.  I’m not saying that this is a miracle cure and you’ll never feel pain again.  But you might find that the pain becomes manageable.

When your body sends you pain signals, it wants you to answer the question, “Is this dangerous?”  Your body doesn’t have all the answers; something that’s painful might not always be harmful.  It just means your nervous system thinks it might be, and wants you to find out for sure.

This is why something as simple as scheduling an appointment with a doctor you trust might actually reduce your pain.  Your body wanted you to answer a question, and you took a proactive step towards getting that answer.

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Of course, I probably wouldn’t have made as much progress if I had tried to use this approach on my own.  It really helped to have someone else there with a lot of expertise who could help me make an educated guess about what was really going on in my body.  I was completely terrified by the concept of trusting my body, and it really helped to be able to ask Tim what he thought the pain meant.

I trusted him because, well, he took the time to earn my trust.  He didn’t have me in the gym trying to do exercises on my very first day.  Our first four visits were all spent talking about the information in the Neil Pearson lectures, and about my past experiences with injury and exercise.

I’d had many other physical therapists in the past who’d expected me to just get up and do all sorts of exercises right away.   Based on my diagnosis, they said, I “ought” to be able to do all sorts of things.  And when I would refuse, saying I was scared, it would turn into a conflict.  I’d either end up doing the exercises, which would of course increase my pain because I was scared, or I’d get a lecture about how I had to listen to this person if I really wanted to get better.

Tim didn’t ask me to do any exercises until the fifth visit; only after he’d spent the previous four reassuring me that there were, in fact, a lot of exercises I could do safely, and that my body was capable of handling much more than I thought.

He started out by having me walk on the treadmill.  The first day, I only did five minutes.  The next visit, I did ten.  Of course, I was apprehensive, but the important thing was that I didn’t feel like I was being forced to do something.  I knew it wouldn’t turn into some kind of huge conflict or battle of wills if I needed to stop.

From there I gradually progressed to other exercises.  I had been terrified to use the elliptical trainer, although up until the pain became debilitating it had been my favorite machine.

One day Tim convinced me to get on for just three minutes.  Just to see how it felt.  “Is this dangerous?” he asked.  “No.  No way this is dangerous for you, in just three minutes.”

Three minutes ended up feeling so great that I ended up doing ten.

To be continued in Part 7!

**Track meet picture courtesy of oscarandtara on Flickr.**

Uncategorized

How a physical therapist helped me through my lowest point: Part Three

This is the third part in a series about an amazing new approach to physical therapy for chronic pain patients, and how the role it played in my life.  To start from the beginning, check out Part One and Part Two.

The biggest difference between the type of physical therapy Tim was introducing me to, compared to traditional physical therapy, is that it focused on the nervous system.

In the traditional model of physical therapy, the physical therapist prescribes stretches and exercises for the patient in order to improve function in one part of his or her body. For example, if it’s your back that hurts, your PT will give you strengthening exercises to build up the muscles in your back and abs. If it’s your knee that hurts, he or she will give you exercises to strengthen the muscles around the knee. This is why, when most of us picture physical therapy, we imagine a patient grunting and sweating in a gym while the therapist looks on.

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Tim, however, was drawing from a different treatment model. In this model, the patient’s pain is coming not from an injury in one specific part of the body, but from an overactive nervous system. Rather than focus on the function of a particular muscle group or joint, treatment actually focuses in on the nervous system, and helping to calm down the patient’s overactive pain response.

The best way I can try to describe this is with graphs.  The first graph below shows the way most people imagine pain to work.  It also shows what most physical therapists are imagining when they prescribe stretches and exercises to improve a patient’s function:

acute pain graph

You can see how, as the intensity of the injury diminishes (represented by the black line) the intensity of the pain diminishes as well (represented by the red line).  This matches our experience of pain in most minor situations: getting a tooth drilled, pulling out a splinter.  When the stimulus goes away, the pain goes away.

However, in situations involving chronic pain (generally defined as a painful experience that lasts for at least two to three months) the pain response works differently.  Prolonged exposure to a painful stimulus actually produces changes in how a person’s nervous system works.  It’s as if it sets off a feedback loop in which pain signals continue to be produced independently of the level of injury.  For this reason, pain persists even after the initial injury has healed:

chronic pain graph 2

This graph is also a good representation of the state I was in when I first came into Tim’s office.  I had a very high level of pain, but it was not correlated with a high level of injury in my body.  This is why I hadn’t seen much improvement with any of my past physical therapists– my pain was coming from my nervous system, not from a specific injury in my body.

“If pain is the patient’s primary symptom, then pain relief should be the primary goal of treatment.”

I once read something along those lines in a blog comment section, and it really stuck with me.

Most physical therapy programs are designed to improve function of a certain part of the body.  But when your pain isn’t coming from a problem with a certain part of your body, you can stretch and strengthen until the cows come home.  It still won’t change your level of pain.

This is why none of the physical therapists I had seen before had been able to help me.  They were all stuck on the idea that I needed to strengthen my back; strengthen my abs; strengthen everything.  Of course, in some ways they were right.  I wasn’t in the greatest shape.

But what Tim was able to identify is that there was a common denominator behind all of the pain I was experiencing in different parts of my body.  Rather than looking at each one as unrelated, he recognized them as the symptoms of an overactive nervous system, or, as he taught me, body alarm system.

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The goal of Tim’s approach was basically to help the patient’s body “remember” what an accurate pain response is supposed to be.  There are a few ways to accomplish this, and I will be discussing them in upcoming posts.  But the general goal of these various techniques is to help the patient’s nervous system get back in touch with with the reality of what’s happening in his or her body.

This graph shows the general goal of treatment:

input to nervous systemThe blue arrows represent the input you want to give to your nervous system.  You’re basically saying to it, “Hey.  Hey you.  You are freaking out for no reason.  This is reality, and it’s over there.”

The role of the physical therapist is basically to help the patient’s nervous system realize it doesn’t need to be on high alert all the time, and to slowly help it calm down.  The idea is that as time goes on, the discrepancy between what the person’s nervous system feels and the actual level of dysfunction in his or her body will slowly shrink.

Now, to be honest, I’m not sure you will ever be able to fully reverse the process of central sensitization.  It’s probably possible, but it hasn’t happened yet for me.  That’s why I didn’t draw the red line going all the way back down to the bottom.  An overactive pain response will always probably be somewhat of a factor for me, but it is a million times better for me now than it used to be.  I’d much rather have the red line close to zero than soaring way up high, totally out of touch with my physical reality.

I’ll be continuing my discussion of this approach to physical therapy, including the specific techniques that Tim taught me, in Part Four.  Stay tuned!

  • Strength training equipment pic: colonnade
  • Balance training equipment pic: kbrookes
Fitness

Things you should know about stretching

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When I’m at the gym, nothing makes me cringe more than watching someone walk out of the locker room, go over to the stretching area, and bob up and down doing toe touches.  This is what’s known as ballistic stretching, and it’s bad for you.

Over the past few years, science has revealed many new things about the best way to stretch.  Much has changed since the days when a four-year-old me bopped along to her mother’s Jane Fonda aerobics tapes.

Unfortunately, these new developments in the science of stretching don’t seem to have seeped into the public consciousness.  I see people stretching the wrong way almost every time I go to the gym.

Here is some of the newer information about stretching.  If you have fibromyalgia/chronic pain,  your doctor or physical therapist has probably told you you need to stretch.  Here is some information that will help you make sure you’re getting the most benefit from your stretches.

Ballistic Stretches are Bad

In a ballistic stretch, you use force and momentum to help you complete the stretch.  As I mentioned, one example is when people bend over and rapidly reach down to try to touch their toes.   They are using muscle strength as well as the force of gravity; it’s almost like they’re “falling” a little bit.  This extra momentum is supposed to help them reach a little bit further than they normally could.

This form of stretching was really big in the 80’s.  As I mentioned, my mother’s Jane Fonda video tapes were full of it.  But, actually, it’s really really bad for you.

Muscles are anchored to bone on either end by tendons.  When you stretch too far, you can tear fibers not only within the muscle, but within the tendons.   By weakening the tendon, you are making yourself more prone to injury, not less.

Your body normally uses pain as a protective mechanism to stop you from stretching your muscles to the point of injury.  But when you do a ballistic stretch, you literally “bounce” right past the point of pain.  This is why this type of stretch used to be so popular– people assumed that the farther you could stretch, the better.

Now we know that’s not true.  Only stretch within your normal range of motion.  If it hurts, you need to back off a little.

Don’t do ballistic stretches.  Just don’t.

Static Stretches are Bad Before a Workout

The other kind of stretching that most people know about is static stretching; the kind where you “stretch and hold” for at least 30 seconds.  If a doctor or physical therapist has told you to stretch, this is probably the kind of stretch they mean.

Back in the days when I ran cross-country and track in high school, I static-stretched religiously.  I stretched before every run, whether it was at practice or on my own.  I stretched several times throughout the day on race days.  My coaches told me to always stretch before a workout; that it would make my muscles work better and make me less likely to be injured.

Well, it turns out they were wrong.  Research has actually shown that static stretching produces significant reductions in both muscular strength and power.  These reductions don’t appear to be permanent, but they can last for a few hours after the stretch.  This is not the kind of thing you want to be doing before a workout or a race.

For more information on these studies, check out http://well.blogs.nytimes.com/2013/04/03/reasons-not-to-stretch/

Dynamic Stretches are the Best Pre-Workout Stretch

Dynamic stretches are sort of like ballistic stretches in that they are done while you’re moving.  But dynamic stretches don’t hurt (as long as you’re doing them right).  You aren’t using momentum to force your body into doing anything.  Rather, you are performing a specific, deliberate movement to activate the muscles you plan to use during your workout.

To understand dynamic stretches more, check out this video from Runner’s World.  All all of the stretches performed are within the person’s normal range of motion.  Dynamic stretches are not what we normally think of as a stretch.

Honestly, dynamic stretches can be a bit of a workout.  I found some of them to be challenging even during my running days.  If you think the stretches in the video look difficult, don’t be discouraged.  The video was made for serious athletes.  There are easier dynamic stretches too—if I find a good link for them, I’ll post it!

Don’t Stretch Cold Muscles

I really don’t understand why a lot of physical therapists don’t seem to get this.  I’ve seen what feels like a thousand physical therapists over the years.  They’ve all given me stretches to do, yet not one of them has suggested I do a warm-up first.

Studies have shown that muscles that have been warmed up can be stretched farther without the muscle fibers tearing. Some of these studies are kind of gross, but if you want to read about one of them you can check out http://www.nytimes.com/2008/11/02/sports/playmagazine/112pewarm.html

I have also found this through my own experience. Stretching before a workout just sucks. It doesn’t feel like something that could possibly be good for my body. When I stretch after I’ve warmed up, it’s another matter; I feel that “good stretch” that you feel people talk about.

How to Make Stretching Work For You

To boil down everything I just said:

1) Never do ballistic stretches.  Ever.  Every movement you perform should be controlled and deliberate.  If you feel pain, you have stretched too far and you need to back off.

2) Your stretches will hurt less and be more productive if you do a mild warm-up first.  If you are severely out of shape like me, a warm-up can be a 3-5 minute walk.  Just get your heart rate up a little bit.

3) The only kind of stretching you do before a workout should be dynamic stretching.

4) If you don’t like dynamic stretches, or can’t do them, it’s ok.  Unless you’re a professional athlete, you’re probably not missing out on too much.  The jury is still out on the benefits of pre-workout stretching as a whole; none of the articles I read made it sound as though there were truly dramatic benefits to stretching before a workout.  As long as you do a warm-up, you should be fine.

That’s all I have to say about stretching for now.  What do you think– had you heard some of this information before?  Do you agree/disagree?  Let me know what you think!

Sources:

http://web.mit.edu/tkd/stretch/stretching_4.html#SEC30

http://www.exrx.net/ExInfo/Stretching.html

http://well.blogs.nytimes.com/2013/04/03/reasons-not-to-stretch/

http://www.nytimes.com/2008/11/02/sports/playmagazine/112pewarm.html?_r=0

http://well.blogs.nytimes.com/2011/06/22/to-stretch-or-not-to-stretch/

Stretching cat picture provided thanks to FurLined on Flickr.

Fitness

Face to face with my lack of ab strength

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The only good thing about being out of shape is that it doesn’t take very much to get a good workout.

Ever since I’ve been having my lower back and hip problems, I’ve known that I needed to work on my abs.  I’ve been a physical therapy patient far too many times not to know that.  I knew my abs had to be weak—there’s no way you have back and hip problems and not have weak abs—but I never really noticed it as I went about my daily life.

But something happened that allowed me to see exactly how weak my abs are, and boy, was I surprised.

It was such a simple thing; I tried to float on my back in the pool.

I remember doing this countless times during various swim lessons when I was a child.  It’s not always easy; you have to keep holding your breath so your lungs stay full of air.  But once you learn that, the rest is a piece of cake.

That is, until you’re an adult whose ongoing injuries and physical inactivity have left her with almost no core strength.  It was incredibly hard for me to stay afloat.  My upper body was fine, but trying to keep my hips at the surface of the water quickly wore out the muscles in my abdomen and lower back.

You’d think it would be kind of depressing to realize that your abs are pathetically weak, but for me it was actually an amazing moment of clarity.

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When I first developed hip problems a year and a half ago, I had to stop doing exercises on land.   Everything I did, even my physical therapy exercises, just made me worse and worse as time went on.  Every time I lay down on the floor to try to do some simple movements, I ended up regretting it.  That’s when I followed the advice of my chiropractor and joined a pool.

For the past year, I’ve worked out exclusively in water, and it has seriously made all the difference.  Before the pool, I felt like I was getting worse and worse every week.  Working out in the pool stopped the months-long downward spiral I’d been caught in, and, eventually, I began to get stronger.

But recently I’d begun to feel as though I’d hit a plateau.  I’d made such exponential progress in the beginning, but I was struggling to figure out what I was missing.  They’d told me there was nothing wrong with my spine or joints, that I just needed to build up strength, but it seemed like I’d hit a wall that I had no idea how to get past.

That’s why I am so excited about this discovery.   I had no idea my abs were so weak.   I used to float on my back so easily when I was a kid.  It all makes sense now.  Of course I’m in pain all the time if I am this weak.

This was such a moment of clarity for me.  Sure, it’s a little bit frustrating to realize how supremely out of shape I am, but this is far outweighed by how relieved I am to have some kind of a concrete answer.

****

Of course, actually figuring out how to work on my abs is going to be a little bit more difficult.  Ab exercises have always been hard for me—if I do too many, I always seem to end up with lower back pain.

But if there’s anything I know about myself, it’s that once I am forced to see something so clearly, there is no way I’m going to be able to ignore it.  Realizing that right now I can’t even float on my back in a pool has made so much more of an impression on me than a physical therapist lecturing me about the importance of ab strength.

I’m going to have to figure this out.  Luckily, for now, I think all I will have to do is… drumroll, please… practice floating on my back.

That’s the one good thing about being extremely out of shape… it doesn’t take much exercise to start seeing improvement.  Since I have no core strength, all I have to do is float on my back for 20 seconds in a pool, and I’ve done a core workout!

So that’s it for now.  If I discover any other amazing core exercises that I don’t give me lower back pain, I’ll be sure to let you know!

**The person in the photo is not me!  It’s just a really great underwater shot that I found on Flickr.  Posted with a Creative Commons license by Ed.ward