Central Sensitization, Chronic Pain, Creative Writing, Pain Neurophysiology Education, Pain Science, physical therapy

There is reason to hope.

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I saw a comment on Twitter today which really broke my heart, so I wanted to write this and make it clear:

If you are experiencing pain hypersensitivity (through central sensitization), there is every reason to hope.

If your nervous system has changed one way, it is possible to change it back.

It won’t be easy, and the way forward won’t always be obvious.  But you can do it.

If you are experiencing central sensitization (as the result of an injury, a trauma, or other extreme physical or emotional experience) you have become more sensitive to pain than you used to be.  Your body is using pain as a way to protect you, but it is treating you like you are made of glass.  It is trying to protect you from everything.

Scientists are still researching the myriad of ways in which this happens.  So far, they have identified multiple different mechanisms within the nervous system which can cause this extreme response to pain.

However, the good news is that we don’t need to know everything, yet, about how this process occurs to start treating it.  (Although our treatments will only get better in the future, with more knowledge).

But you can start, right now, by learning what your body is capable of, and identifying the things your nervous system is warning you about that aren’t actually dangerous.

For me, it took a really smart and capable physical therapist who had studied with Neil Pearson.   I expect that you will need a guide as well– someone who you trust, who can walk you through and help identify the ways it is safe for you to try to push through the pain.

Your best bet will be a physical therapist who has advanced knowledge of recent pain science.  (A PT with this knowledge might not easy to find, at first, but luckily it’s becoming easier and easier.  If you email me at sunlightinwinter12@hotmail.com, I can help you get started).

What you need is someone you trust, who you will believe when they tell you your body is capable of more.

Someone who is able to think flexibly and come up with more than one way to do an exercise, if you tell them the first way they gave you doesn’t seem to work.

Someone who will understand that it’s not only about what they learned about the body in school…  it’s also about you, your nervous system, and your experience as a patient.  Your nervous system has to be convinced that your body is safe, before it’s going to stop making things hurt.

Changing your beliefs about pain can have a direct impact on the pain you ultimately experience.  When you truly learn and understand that your body is giving you pain in order to protect you, it stops being so threatening.  This is known as changing your pain from the top down— from the brain to the body.

But then, of course– it’s equally important to keep working on your pain from the bottom up– from your body to the brain.   

If you have chronic pain, or have suffered from some type of injury, your muscles are probably tightened into protective spasms.  This, in turn, will make them weak, if it goes on for long enough.

If you are weak, you are going to have pain and be at risk for additional injuries.  (This is why I went on to develop so many additional problems after I first suffered from compartment syndrome as a teenager, because I had ended up so out of shape).

So you have to work on the pain from both angles.  You need to calm your nervous system down, and help it understand that not everything is dangerous.  But you also need to give your body what it needs, and do everything that you can to help it function optimally.

***

Doing both of these things is a balancing act.  Getting back in to shape is not about pushing through the pain.  It is not a “no pain, no gain” mentality.

Instead, it is about being mindful.  Being careful.  (And again, ideally, having a trusted coach by your side).

To respect your nervous system, and to accept your body where it is currently at.  Not trying to do too much, too soon, but instead starting where you can.  If you can only walk for 5 minutes, walk for 5 minutes.  If you need to ice your injured knee before you work out, ice your injured knee.

It’s about bringing all of these different things together, and figuring out what works for you.

***

I touched upon this once in an earlier post, and I have to say, I think I phrased it really nicely:

“There is a middle way, where you learn to respect your body’s pain without automatically assuming you are injured.  This means you respect the pain and don’t try to push through it, but you also know not to freak out because you recognize that your nervous system sometimes gives you false alarms.  It’s about being okay with the possibility that maybe you strained something and need to take it easy, while knowing that you probably didn’t.”

This is the balance you eventually need to find, and having a trusted coach by your side who can help you understand what’s going on in your body can make all the difference.

This is the physical therapist I hope someday to be.  The person who understands and can walk you through, even when the path ahead seems scary.  I have been there myself and I know what it’s like.

I also know what it’s like to regain trust in your body.  To go from feeling as though you are made of glass, to knowing what you are capable of– while also knowing your body has limits, and learning to honor them.

This is the balance you need to find.  It won’t be easy, but it is possible.

Central Sensitization, Chronic Pain, Pain Neurophysiology Education, Pain Science, physical therapy, Treatment Approaches

What is pain neurophysiology education?

In a nutshell, pain neurophysiology education is the type of treatment for chronic pain that changed my life and inspired me to become a physical therapist.

I’ve mentioned it in passing on this blog, but I decided it’s high time I give the topic its own post.

***

In my series “How a physical therapist helped me through my lowest point,” you can read the story of how my life had ground to a halt because of chronic pain, until I finally met Tim, a physical therapist who had studied with Neil Pearson.

Tim treated my pain in an entirely different manner than all the physical therapists and doctors I’d seen previously.

He explained to me that after all my body had been through– running 45 miles a week, only to develop compartment syndrome and barely be able to stand, to live like that for two years, and then to undergo surgery– my nervous system had gotten confused.

All the pain doctors hadn’t been able to explain– it wasn’t because I was crazy.

In fact, the reason I was feeling all this pain was because my body was trying to protect me.

My nervous system had decided the world was a dangerous place.  It was tired of me taking chances– it didn’t want to have to deal with another injury.  So it was making everything hurt.  It was making me feel as though I were made of glass.

But I wasn’t made of glass, Tim assured me.  My body was strong; it was capable.  And this attempt on the part of my nervous system to protect me had over-served its purpose.

Tim explained that the surgery I’d had for compartment syndrome had been successful, and despite how much my legs might hurt at times, I wasn’t going to be able to bring it back just by walking down the street.

***

The pain neurophysiology approach worked when nothing else had, because it gave me a real explanation for the pain that actually made sense.

Before that, all the physical therapists I’d seen (and I’d seen a lot) had taken one of two approaches:

A) You have some underlying soft tissue problem or scar tissue or whatnot that we have to fix with a special treatment, or

B) I can’t really find anything wrong with you, so the pain must be in your head and you should probably see a psychologist.

Neither of these approaches ever made a difference for me.  The “special treatments” for the hidden, subtle issues in approach A never fixed anything or reduced my pain (except temporarily, because I felt like I was doing something).  And approach B never fixed anything, because ultimately these problems were not reflective of my overall mental health.

Instead, I learned, my pain was the result of a specific phenomenon that occurs within the nervous system: central sensitization.  Basically, the underlying principle here is that the more practice the nervous system gets at sending signals, the better it will get at sending those signals.  And that is true of pain signals, along with everything else.

***

Tim didn’t really use the words “pain neurophysiology education” while I was seeing him for treatment.  Instead, I first found this phrase while I was looking through Neil Pearson‘s website, as Tim had urged me to do.

From there, I discovered the names of other physical therapists and researchers who had contributed to developing pain neurophysiology education, or PNE as I’ll be referring to it in the future.

Names such as David Butler of the Neuro Orthopedic Institute, and Lorimer Moseley of the research group Body in Mind.

From there I have discovered so many interesting resources, and articles, and interesting people doing work on the subject.

***

For 2017, I’m trying to get back to my roots on this blog.  I started blogging to educate people on the science of chronic pain, and I really enjoy doing that.  So I’m planning to start channeling more energy towards that again.

So I’m going to start fleshing out this section of the blog again.  I’ll be providing a lot more explanations, linking to great resources, and also quoting excerpts from articles that I think explain things really well.

And I’ll be telling my own story, when it comes to my struggle to understand my body, and learning to deal with central sensitization.

***

For now, I want to leave you with two posts I wrote on some of the main concepts I learned through my experience with PNE:

Understanding pain as your body’s alarm system

Understanding pain as an overprotective friend

These posts tie in a couple of anecdotes from Neil Pearson and Lorimer Moseley that I found particularly helpful.  (Let me say, once again, that I am so, so grateful for their work!).

***

I hope you find this post, and the related articles I linked to, to be helpful!  I’m really excited about the things I plan to write about in the future, and I hope you stay tuned!

Creative Writing, Favorites, Inspiration, Uncategorized

A Returning

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“I have been away.

I have often thought of how to begin this blog again after a long hiatus and then more time would pass and there it stood waiting for me to speak, write, and reach out.

The reason for my silence is the same reason for beginning this blog. Living with chronic illness permeates everything we do. It is the scaffolding of which we build each day. It determines our daily plans, what we take on, and what we leave unfinished. As I dedicated each day to doctor’s appointments, physical therapy, medication changes, and rebuilding my life after a health storm, this unfinished blog provided comfort knowing that it was a place for me to return.

As the months passed, I was forced into long stretches of bed rest, breaking from work, my passions, the world, and my voice. This is the cycle, after all, of the chronically ill. It is a sequence of retreat and victory, of silence and stories, and of mining the telos of one’s spirit.  What incites us to account our narrative to others relegates us to silence in other moments in a life lived with chronic illness.

I have to admit that at first my silence was “put upon” me. I was so engulfed in pain, fatigue, and just getting through one hour after another that I had no desire to communicate about the latest health trial. Yet, resignation turned towards choice, as I again reimagined and redesigned a future. It is a truth we face when dealing with an incurable disease that we must rewrite our future story after it is continually malformed by our bodies.

The poet Carmen Tafolla wrote: “I was the fourth ship. Behind Niña, Pinta, Santa María, Lost at sea while watching a seagull, Following the wind and sunset skies, While the others set their charts.” This post is dedicated to the future, to the reciting of a livable future, and to exploring the why in a life filled with medical chaos.

Illness is an invasion of identity. Since living through surgeries, a nine medication regimen, and too many medical procedures, I have searched for an explanation, a pathway, and a satisfactory answer to why. Why did this happen? Why me? I have done everything from pretending that the illness part of my life is nonexistent to studying the mechanisms and pathologies of the body; nonetheless, illness continues to lead its assault.

To live with a chronic degenerative disease one must constantly engage in meaning-making. Why? It is because illness is unremitting and untrustworthy. A medical crisis can topple all that you have worked towards in a mere blink.

Therefore, we are professionals at reconstruction and rebooting our future.  Often times, it is a future tinted by professional and personal sadness. Professional goals wane under the weight of the body often causing an individual to lose their job or relinquish ambitions. Illness demands a personal reimagining of what family looks like sometimes forcing an individual to move in with a family member who subsumes a caregiver role or surrendering the dream of having a family and experiencing parenthood.

Illness fractures identity and makes us feel less complete because completion is continuously interrupted.  I believe searching for the “why me” is not out of anger, jealousy, or pity but out of the attempt to take all these futures interrupted and find fulfillment in a life that no longer looks like the life originally intended.

Chronic illness mandates that the individual who lives with it coat themselves in an extra layer of depth because it is a permanent state and the human mind has forever raised questions about immutability.

I spent the last year in renovation.  It’s frightening; isn’t it?  There’s a trauma processing that must be completed in order to move forward in life.

When I was first diagnosed with endometriosis and a chronic pain condition due to a spinal injury, I had no idea nor was it explained to me that I was going to have to go through a continual cycle of insecurity. I was oblivious to the fact that I was going to have to live my life in a temperamental space.

It is of my opinion that chronic illness patients do not fit easily into the usual experience of loss because our loss is not consistent.  The future is unpredictable and so our stories are discontinued and resumed and this process repeats infinitely.

Thus we are forced to mourn each time and rebuild our futures anew holding our breath again that the house will not collapse with us inside. Our narratives remain disjointed and so without any desire for it we gain a level of complexity that is difficult to communicate and share with others even those we love the most.

I don’t know if there is a way to rid ourselves of this anarchy that illness brings. What I am still learning is that inside this chaos we must pledge to coming out of the other side of it. We must promise to find our voice again.

I have been away but now I am returning.  Each one of us can say that.

Although it may appear like a small triumph, I am proud of my return and I am proud of yours too.”

***

The above post was written by my friend C. over at her blog Para Las Fridas.  I have re-posted it here with her permission because it is quite honestly one of the most amazing accounts of life with chronic illness I have ever read.  From the moment I first read it, I was struck by the way C. managed to put into words aspects of my own experience that I had been afraid to face, much less articulate to myself.

Like the feeling of having lost time, of living according to a completely different calendar than everyone else.  Of knowing I’ve disappeared from the world, for months and years at a time, while life has marched on unrelentingly for everyone else.

The feeling of resurfacing, of returning, without knowing if it’s an illusion, or for how long I’ll be allowed to stay before disappearing again.

The feeling that I’ve become an expert at remaking my identity: after each disappearance and returning, constructing meaning again as best I can, assembling the pieces that make sense, filling in the gaps in a way I hope no one else notices.

C.’s words give me the courage to come on my blog and tell my own story, when I’m afraid it’s been too long, or no one will be able to relate.

I am not the only one who feels this way; I am not the only one who has disappeared and returned.

***

You can check out the rest of C.’s writing at Para Las Fridas!  It is simply incredible.

I also wrote this post outlining some of posts C.’s site that meant the most to me.

Lastly, you can also see what C.’s up to on Twitter.

Inspiration

Because the world needs you

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For the first time in, oh, slightly over ten years, my health issues are not seriously obscuring my ability to deal with life.

Mostly through learning about the body, and getting stronger, but also adjusting the way I do things, and my expectations… I’ve come so, so far from the places I once was.

I was telling a friend, a week before the election here, that I was beginning to feel my ability to pay attention to politics and the world at large return to me.

For so long, my health problems forced my gaze to become myopic.  Suddenly, it seemed like 95% of my energy and will to live, really, was going towards simply getting through one day to the next.  Putting one foot in front of the other– even walking from one room to another became a huge task.

My mind was clouded by thoughts of pain.  Forget about work, grad school– I couldn’t think straight.  Sometimes I was in so much pain it was all I could do not to scream.  The daily annoyances of trying to do even the most basic of tasks when my body couldn’t function piled up like a brick wall, blocking my attention from anything else.

So I stopped paying attention.  I checked out, and did what I needed to do to overcome the cards I’d been dealt within my own life.

About month ago, I finally felt something finally click into place again.  I guess it was pretty easy, right before the election and all of the emotions it stirred up for everyone, to begin to feel passionate again.  But I felt the old me come back– the me that couldn’t tune it out, didn’t want to tune it out.

And then I opened my eyes again, to find the whole world seems to be on fire.

This post isn’t supposed to be about me.  I want to tell you all of the things I’m thinking, now I’m tuned in again.  But quite frankly, I’m not sure I’m ready to deal with angry Internet commenters on here.

I’m not sure where to start, but I need to do something.

I guess I’ll begin by sharing a few thoughts:

First, I will remind myself about how we all can play a role in helping each other, in creating a better world.  That there are many ways to contribute.

And that there is simply, utterly, no time in judging ourselves for the problems that we do have.

I struggled for a long time with the fact that my health problems were not “that bad.”  That other people had it worse.  Even my former-favorite doctor said the same thing to me once: “I see other people with worse problems, you know.”

For so long, I felt guilty, selfish.  I had all the time in the world to devote to my health.  I had a roof over my head, a family that supported me.  Was it all in my head– was I  making a big deal out of nothing?

Years later, now that I stand on the other side of the abyss, having finally found answers I needed, I can tell you unequivocally that way of thinking is stupid.

Yes, other people have “worse” problems than I had.  But if there’s anything I’ve learned in all of my studies of the body, it’s that sometimes, even if one little thing goes wrong, it can have far-reaching effects.

The problem is there; pretending it isn’t takes away energy that could be going to actually solve it.

And if it is a “small” problem, isn’t that all the more reason we should be taking steps to solve it and get it out of the way?

When I look back, I know that if I had managed to redirect half of the energy I spent judging myself towards doing my own research and getting second and third opinions, I probably would have gotten to the point I’m at now a lot sooner.  The point where I am able to pay attention to the world at large, and hopefully do something to make it a little bit better.

Instead of thinking of a problem as “small,” maybe we should be thinking of it as “more likely to be solvable.”

Life is too short, and too precious, and there is too much time going on, to judge yourself for an experience you didn’t ask for.  It is what it is– take time the time, do you what you need to do to find a solution, because you need to move on.

Because other people have problems worse than you.

Because the world needs you.

Creative Writing, eating disorders, My Story

A Clearing

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So I’ve been clearing out all the old stuff from my storage unit.  Finding so many reminders of all the plans I once had.

The high-heeled boots I bought senior year of high school, right before the Halloween dance.  My friends and I were all going to go as “sexy cops.”  (I know).

My running “spikes,” as our cross-country team called our specialized lightweight racing shoes.

It’s bittersweet, to look back and remember all of the optimism I had towards my goals– goals I would never reach.  Especially when I can recognize that some of those goals were pretty unhealthy.

Why did I need to wear high-heels?  They were only making things worse, as I was developing compartment syndrome.

Why did I need to run?  I truly loved it… but at the same time, I wasn’t truly listening to my body, and ran it into the ground.

So much pressure, to be thin, to be pretty.

So now I’m clearing out my storage unit, and there are just so many clothes.  So many clothes, in just about every size.

My size 2 clothes– the last clothes I bought before my health issues spun out of control and a medication forced me to gain weight.  At the time I thought it was horrible, but now I can see it was a blessing in a disguise.  It took something overpowering, and dramatic, to truly break me out of that way of thinking.

Chronic pain finally pushed the obsession with being thin out of my head.  There was no room for anything else; there was only survival, from one minute to the next.  I’m not sure if anything else could have done that– not without it taking years.

***

But I’ve held on to my old clothes all this time.  I loved them, because they were my way of telling the world, at 16, that I was an adult.  (An adult that wanted to dress just like Buffy!).

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My outfits, at the time, felt like works of art.  Handbags, sweaters, dresses– everything perfect.  My mom had picked out all of my clothes for me as a kid, and in the cutthroat world of high school girlhood, it took me a while to define my style.

Once I did, my clothes became my way of making a statement.  I discovered that the better I looked, the more power I had in the social world of high school.   If I looked perfect, it was harder for other girls to make fun of me.  My clothes became my armor.

When I gained weight at first (right after high school ended), I held on to all my old things because I thought I’d eventually be a size 2 again.  Then, once I realized I never actually wanted to be a size 2 again, I continued to keep them simply because it felt strange to part with them.

They’d helped me to define myself as an adult.  At one point in time, they’d protected me.

And they’d been waiting for me for so long, like a lost bookend, marking where I could find the life I’d been waiting to come back to when things finally got better.

I wasn’t ready, until now, to let them go.

But I don’t need or want that life anymore.  I no longer feel like I need to wear high heels in order to be a true girl.  I don’t want to put on eyeliner every morning like it’s war paint.

And I don’t need to weigh 115 pounds, or to be able to see the outline of my hip bones perfectly, in order to be attractive.

I just want to be me.

My Story

The road to physical therapy school

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It occurred to me recently that I really haven’t talked much about my progress towards becoming a physical therapist on this blog.

So, if you’re curious, here’s my deal:

I have a Bachelor’s degree in the humanities.  My concentration was social theory, with an emphasis on gender studies.

My goals, when I was in college, were focused in a pretty different direction than the path I’m on now: I wanted to study social policy, and travel abroad working for various non-profits and human rights agencies.  I also wanted to become a psychotherapist.

I started down that road immediately out of college, working at a mental health agency so that I could gain experience before grad school.

Before this, I’d already had a lot of struggles with chronic pain, and had to have surgery for compartment syndrome.  Yet after college, I’d managed to reach some kind of holding pattern where pain didn’t cause me to miss work.  That was, until the awful winter of 2010, when a few things happened in a brief span of time that caused my pain levels to flare way up.

That was my breaking point– when I tried, anew, to get answers.  Finally, after months of searching, I found my physical therapist Tim, who had studied pain neurophysiology education with Neil Pearson.

***

Ultimately, I was so inspired by everything I learned from Tim that it led me to consider becoming a physical therapist.

I’d always found physical therapy to be a fascinating field.  As a high school runner, I’d had a few serious injuries where I really needed PT to get up and moving again.   I had formed some great relationships with my therapists, and hung on every word they said.  A part of me was always a little bit sad when they told me I was doing well enough that I didn’t need to come back.  I would have gladly come back back every day, just to hang out and learn.

When I was a freshman in high school, I partially tore my hip flexor during a cross-country race and was on crutches for months.  It was a physical therapist who helped me overcome my fear and eventually start running again.

Then, when I was 19 and had surgery for compartment syndrome, it was a physical therapist who got me back up and moving again.  While I’ll always be grateful to the surgeon who fixed my legs, my PT was the one who gave me the confidence to actually start using them again.

And now, when my life had ground to a complete halt at age 25 because of constant, debilitating pain, it was a physical therapist who gave me my life back again.

I’d always had so much appreciation for PT’s.  Now, the idea dawned on me: why don’t I try to become one?

***

Growing up, I didn’t really consider myself that much of a science person.  Looking back, I think a lot of that has to do with the environment at my school, and how our science classes were taught.

Once I started looking into becoming a PT– taking classes, shadowing practicing PT’s– I realized I always had been interested in health science, and exercise physiology, and human anatomy.  It had just taken a different form.

I’d always wanted to do the best thing for my body.  I loved when my running coaches talked about strengthening, building endurance, the benefits of stretching.

And I’d always been interested in nutrition, and being healthy overall.

It’s just that when I was younger, I didn’t have the healthiest mindset, and took some of these interests too far.  But my eating disorder was not all of me– it was a snapshot of a specific place I was in, at a certain point in time, at a certain age.  Although I had some distorted beliefs, that does not mean I wasn’t also genuinely interested in health and fitness at the same time.

The difference is that now, I am able to come at it in a much healthier, stable, and more grounded manner, and know that I will be able to help others with similar struggles.

***

Five years later, I can say that I ended up loving all of my prerequisite classes, and I’m so glad I made the decision to take them.

It’s been an incredibly long road.  You see, some of the classes I needed to take had prerequisites of their own.  At the same time, due to my SI joint issues, there were periods of time where I found it incredibly difficult to walk, drive, or even stand up for more than a few minutes.

Despite of all of this, I’m finally at the point now where I’ve basically taken all of the classes I need in order to apply to PT school.  (I might need to take one or two more, depending on specific programs I might try to get into, but most of my bases are covered).

And honestly, I’m so glad I made this decision.  I realized that, while the humanities will always be my first love, I am also a science person, and have been all along.   I couldn’t see it at the time, but I know it now.

Creative Writing, Inspiration

Reading List: Vulnerability

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This is the question that has consumed me recently: how do people take their most precious and guarded memories, and spin them into stories, unfurling them to the world?

It seems so easy when other people do it– when you read a famous, heart-wrenching novel for class, and analyze its themes. “I could do that,” you say. “Someday maybe I will.”

But it’s so different when you begin to try– shockingly different. In real life, I haven’t begun– I’ve only hinted at my most personal stories. I’ve only begun to write them and tell them in my head.

In the morning I wake up too early, in a panic, short of breath. “What have I done?” I gasp. Then I relax. I haven’t actually written anything yet; haven’t hit publish.

I have so much respect for those who have. I’ve always loved and looked up to writers, but now I do so with a respect that is so much more real now that I’ve begun to consider the task myself.

So here, my readers, are a few things I’ve read recently that have inspired me:

Rian Kerfoot, Truth and Cake:

Mary Gelpi, Fibromy-Awesome: Getting Clean Real talk from a girl with fibromyalgia who talks about how, somedays, bathing is just not on the agenda. I’ve been there.

Bianca Sparacino: “You Are Not for Everyone.”

Beauty Beyond Bones: I love her whole blog, but I’ve recently discovered her early posts, which send chills through me. I so want to tell my story like this. (I was never hospitalized for my eating disorder, but her words resonate on so many levels).

Sade Andria Zabala: I discovered her a few months ago when I was heart-broken, and her words ripped me apart more and then healed me at the same time.

All of these pieces of writing are breathtaking — check them out!

My Story

Sense of Place

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Ironically, I have a feeling this is going to be somewhat of a meandering post… because I have a lot of thoughts I want to share on the topic of staying in place.

I moved somewhat recently (last spring) after living with family for several years. I didn’t move far (still in the suburbs of Boston, only closer to the city now).

However, it’s been a time of big change for me, because I’ve been trying to figure out how to do a lot more things for myself rather than relying on my family. This is true of things that everyone has to learn to deal with at some point (for example, putting my own furniture together; installing my own curtain rod). Just those boring, annoying adult things.

For me, there is an added layer of difficulty, because of my sacroiliac joint issues. As I’ve mentioned in previous posts, I am doing better than I was a few years ago, but I know from past experience that times of change are when I’m more likely to inadvertently push myself too far, and have a setback. It takes time to adapt to a new place, to a new routine; to figure out what works for me, and what I should avoid.

It’s been my grand experiment. It hasn’t always been pretty.

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One of the questions I’ve asked myself is, what is family? For so long, I relied on my family members for help, assuming they were the only ones who would be willing to help me with the kinds of favors most people don’t have to ask for.

My friends knew about my struggles, but I mostly tried to avoid asking for help, except for the times when it couldn’t be avoided.

However, I am not a scared and confused 20-year-old anymore. I am 30. (And no, 30 is not old. I feel amazing, and so excited about the future!). But it’s time to start branching out– to find new ways to do things, and new ways to relate to the people in my life.

Can friends be family? Or, in other words, can I redefine my relationships with my friends, and come to count on them the way I have counted on my family?

I definitely have not done it perfectly. It’s been a learning experience.

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Something I’ve learned is how far people will go out of their way to avoid hurting your feelings. They’ll do things that ultimately hurt you more– they’ll talk behind your back, they’ll plan a trip that involves a lot of walking, and won’t invite you– anything other than tell you to your face.

I’ve had to get better at reading between the lines. I’ve found it to be helpful if I can just take a guess at what might be wrong and offer an apology, even if the person insists everything is fine. I’ve had to get better at clearing the air; at addressing the problem as promptly as I can rather than letting it fester.

Things get awkward sometimes, because I can’t always repay a favor the way people would normally expect. For example, if one of my friends comes over and helps me carry my new mattress inside, I can’t go over the next week and help her move her couch. I have to find another way to contribute to the relationship.

Obviously, people do things out of the goodness of their hearts. It’s not as though, the very first time someone does me a favor, they expect something in return.

But over time, it’s important to show that you are also willing to help, and how much you care. There have been times where I thought I was doing a good job of this, only to realize that in some cases, my efforts weren’t really noticed.

It’s been frustrating for me, because the truth is that I put a lot of time and dedication into my friendships– to be there for people, to listen to them. I’ve come to find out the hard way that this effort isn’t always recognized.

I think it’s partly because listening comes so naturally to me. I actually love sitting down with people and sorting out their problems (it’s why, when I was in college, I wanted to be a psychotherapist). Because I enjoy it so much, and (let’s face it) I’m good at it, people don’t always realize that it can be excruciatingly hard work at the same time.

So, I’ve had to learn how to communicate better. To let people know how and when I am putting in effort, because they don’t always see it on their own. It’s all about being open, honest, and direct, while maintaining a non-confrontational stance.

What I’ve learned is that you can redefine your relationships with people. You can become closer to people, and ask more of them. But you have to be willing to put in more effort yourself– and to be prepared for people not to notice it, especially if it’s not in a form they’d expect. When that happens, you’ll need to find a graceful way to point it out.

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Although this post is about people more than it is than geographic location, “Sense of Place” is the only title that makes sense to me. After all, it’s other people that form so much of our sense of place– the feeling that we belong, the knowledge that we will be okay.

But I do love the area I moved to– I am somehow still surrounded by conservation land, trails, and parks, am yet much closer to the city than I used to be. I love it– the hustle and bustle of life around me, yet against a backdrop of so much natural beauty.

As I’ve mentioned previously, over the course of the past few years that I haven’t been able to run, I’ve learned to find peace in standing still. So, over the past few months, when I’ve felt overwhelmed, I’ve turned to the natural beauty around me, and drunk it in.

When things haven’t gone my way, when I’ve felt that my “sense of place” in the personal sense was still under construction, I’ve always had my internal connection to the natural world, and that has been my anchor.

It took a while– to learn the area, to feel at home, to re-evaluate my connections with the other people in my life. It’s a work in progress, but it’s working out.

 

 

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***