This is the book and the community that I had been looking for. And I would recommend that if you know an injured athlete, then this book is probably the best gift that you could give them.
I came across it when I was listening to one of the podcast series that I often listen to and heard it mentioned: ‘Rebound: Train your Mind to Bounce Back Stronger from Sports Injuries’ by Carrie Jackson Cheadle and Cindy Kuzma. As well as reading it cover to cover, and going back through it over and over, I also discovered the Podcast series and the Facebook page under the title of ‘The Injured Athletes Club’.
The book has
forty-nine mental drills that map against fifteen key mental skills that you
can build to aid recovery from injury. It is built from real experience helping
athletes through successful rehabilitation from injury – and the core belief
that one can rebound from injury.
narratives describing athletes’ journeys through injury, including the key inflection points
Scientific explanations of the underlying psychology
Key points to take away and work on
Specific mental drills that you can incorporate into your recovery
the community is the most important part
The book opens
with talking about the fact that you are not alone, and that with that pillar
in place – there is a path forward.
community allows for the stages of grieving – accepting and defusing the negative
emotions, finding the clarity and support for the steps needed for your
progress and then having a genuine cheerleading group to celebrate the simple,
baby-steps steps of progress towards your bigger goals.
really like about the book
What I really
like about the book is the fact that it is flexible and multi-faceted, so you
can keep coming at things from different angles and building up even as your situation
evolves and changes – whether that is progress or a slip backwards.
I hope that
it brings you or your friends support and strength when this is most needed.
It has been quite some months since I last wrote a blog.
The back end of last year was a hard road of trying to get the pain medications
to the balance that made the basics of getting through the day possible, and working
out how to shrink life to the things that I could get through. Then facing up
to the surgeon’s persuasion that a tenth surgical procedure was the best way
Through this time I struggled to find a way to share my
experience in a way that I felt could help others.
Plus, I have to say that I found various bloggers and
communities who are sharing their experiences and I felt were sharing a lot of
the things that I had been searching for over the last two years.
So I wanted to blog to share links to some of them – in
the hope that this is helpful for people reading it.
Jo shares her experience of over a decade of pain stopping
her ability to work as a firefighter and to run and pursue the sport and life
that she loved. She has gone on to do a huge amount of study about posture,
musculoskeletal issues and pain, now sharing this with others in her beautiful
and inspiring blog posts and also as a patient advocate at international
Just as Jo has pioneered the path in Canada, Tina has
done the same in the UK. Tina’s accident was over two decades ago and she
shares her experience of how to live well with persistent neuropathic and
musculoskeletal pain with lots of practical tools and advice from her own
experience. These come in the form of blog posts on specific topics and most
recently as a patient advocate, she has written a guide for patients called
‘Making the most of Physiotherapy’.
Pete attended a pain management programme in 1996 and
since then has dedicated himself to sharing the best information and knowledge
with both patients and clinicians across the globe dealing with persistent
pain, especially back pain. He has a great website and has written a number of
excellent guides on pain. Most recently he has set up a monthly Pain Toolkit
Online Café on Zoom, where anyone is welcome to digitally ‘pop-in’ and chat or
listen to others working with similar issues to their own.
Barbara’s experience of her own neurological illness and
also caring for her husband meant that she saw up-close-and-personally the
life-changing impact that a serious health issue can have. This led her to use
her coaching experience to restore emotional wellbeing and look positively
towards the future. Her blogs and self-help tools help across: managing the
health issue, reclaiming emotional health, reclaiming relationships, returning
to work, reclaiming meaning & purpose in life, reclaiming hobbies &
interests and support for carers and supporters.
Jo is bed-bound as a consequence of the health issues
that she suffers from. She writes her blog to give other people in the same
position a bit of hope. She says “My life isn’t easy, but it is worth living. I
may cry a lot, but I also laugh a lot. I may get depressed, but I’m also
optimistic. No matter how bad things seem right now, they will get better. You
can take back control and give yourself hope for your future”. Her blog is
frequent, searingly honest and brutally insightful on topics that others may
shy away from.
Sheryl lives and blogs from Singapore, living with
multiple lifelong illnesses. Her blog sets out to help other sufferers with a
toolbox, but more widely to raise awareness of long-term illnesses from a
number of perspectives and encourage empathy amongst all facets of society, and
not just healthcare. Her blogs are frequently very practical, covering both the
physical and the emotional challenges with equal frequency.
This is like a medical version of Facebook and there are
different groups that you can sign up to. One of the groups is Pain Concern (a
charity that also have a helpline that you can call and lots of other support
tools that you can access at www.painconcern.org.uk)
Anyone can post a thread and expect to get genuine
responses from others. The tone is universally helpful (in my experience) and
can get some good insights. Obviously, this is not professional healthcare
advice, so it needs to be seen in that context.
The Injured Athletes Club on Facebook
This community was set up by Carrie Jackson Cheadle and Cindy Kuzma to go with their book ‘Rebound: Train your mind to come back stronger from sports injuries’. They moderate and facilitate the group to get to a mix of being able to vent about challenging times, ask for advice/perspective and celebrate progress, with ‘Winning Wednesdays’, Monday Motivation and Friday Feeling themes running most weeks.
I hope that you find some of these inspiring and helpful, just as I did. If you have others that you think are excellent, then do share!
finally being able to move a little can feel like a release from incarceration
and make you want to re-explore the world that you once knew, the reality is
that it probably needs to be much closer to home!
You need to
be ready to stop and rest, or stop and return home at any stage – as pushing
through pain can lead to a major set-back. So, I have built loops with benches,
coffee stops and quick routes back to the car (in order to return home).
I think that I now know the distance to all of the benches within a half-mile radius of home! And even bought one of those walking sticks with a pop-up seat. It was surprisingly inexpensive, and actually comfortable enough for a little rest and recovery – although you would not want to sit on it for a long period!
goal, but being flexible on the way of achieving it
Initially, I struggled because the goals seemed ridiculous – for instance 4 laps of 200m in a day and then a rest day seems petty when you have run marathons and ultra-marathons.
And then I
struggled even more because I could not complete them without being
doubled-over with the strobing pain – the other part of the goal was without
any increase in pain level.
are really important – as they help you to make and monitor progress over time,
without over-extending yourself. And I learned to stop deriding how petty they
were and to start to think of little rewards if I managed them, like a square
of dark chocolate or a cup of coffee.
learned how to regress it when I could not achieve it – either by reducing the
distance, or by increasing the rest interval. So I would walk to the bench with
my book and if my body was not ready to walk back, I would either sit for a
while or read for a while and then head back. And then do the same later in the
psychological benefit of a change of scenery
also drive to wooded areas so that even very short loops looked and felt
different as I walked them. And the opportunity for a nice cup of coffee as a
reward sitting at a different café and taking in a different view!
number 1 – leave the watch at home!
I have to
admit that the only time I would do laps was as a part of training – whether a
track, road or off-road loop – the goal would always be to look at the splits
of each lap! This mentality of constantly pushing yourself is not at all the
mode of gently listening to your body for the early cues of progress or issues
– so it is important to leave the watch at home, and avoid cheeky glances at
the lap times!
hardest parts & my coping mechanisms
that I struggled with were:
Stopping in time – since often the worst pain would be later in the day, I struggled to find the cues of when to stop if the session needed to be curtailed. The two insights that helped a little were: (i) spotting the very early signs of fatigue and stopping whilst there was at least one more lap in me and (ii) leaving enough time for my body to settle in between each one – so I would plan to sit for at least 10 minutes and at times 30-40 mins and even an hour to let the body settle and see how it felt.
Keeping the discipline and only
doing the plan, even on days when I felt I could do more – because I couldn’t wait to be
better and make faster progress, it was hard not to over-extend by adding an
extra little walk to see something when I was feeling great. Especially when I
was with friends, for whom so little activity was quite boring and their
natural temptation was to tacitly or explicitly encourage you to go faster or
do more. My two coping mechanisms were (i) for all that it was lovely to see
people, doing these was better done alone and meeting them for a coffee later
(ii) keeping a log of all of the exercises and what level and type of pain I
had was a useful tracker for the programme and to talk with the medical
Sometimes these leave me very
inflamed and I then struggle to sleep – so I always do the sessions in the earlier
part of the day in order to give the body more time to recover.
In summary – celebrating the circles!
probably gather, I found the process of going round and round in small circles
rather hard to get my head around. So planning for it and finding ways to
celebrate is key – every single one marks progress and is an opportunity for
some fresh air and seeing different things. So well worth celebrating!
exercises, with the frequency that you agreed?
say that 80-90% of people do not do them. And I know of a physio who when
injured admits that she does not do them! So what hope for the rest of us?
stop us from doing the things that we need and want to do. And the time and
hassle of travelling to appointments is a further drain. So, what stops us from
doing the exercises that can help us to get better?
was interested in a tweet from a US-based physio at the end of August where he
wrote to the Twitter-sphere “I genuinely don’t understand. The activities I
gave you help a lot with your symptoms, they take 12 minutes, but you “don’t
have time” to do them? Can’t you get up 12 minutes earlier in the morning?
Can’t you do them during all of those Netflix programs you tell me I should
watch?!” This led to some interesting
points on Twitter, and made me want to write this blog post.
ourselves that we do not have time. But is that really the reason? What is
underpinning our procrastination and how can we find ways to overcome it?
Are we rebelling against the homework?
This is a
moment to be honest with ourselves. When we know that it is doing the exercises
consistently and correctly exercises, do we still want to rebel and not do them?
have given ourselves the pep talk to get on with it and ‘eat the frog’, how do
we find the mechanisms to help us to do it each day? Some things that work
and writing down the time in your diary to do the exercises each day
an alarm on your phone for the time to do the exercises
a paper-tracker and star chart on the fridge or mirror as a reminder
tracker of the exercises each day, with reminders
yourself a reward for completing the exercises (eg a cup of your favourite tea)
them early in the day, so that they do not hang over you
accountable to someone – letting them know that you have done the exercises
the physio know that you really want to spend the first few minutes of each
appointment reviewing how the exercises have been going, and then using these
insights to progress the exercises after each appointment (you could even email
an update to them before each appointment)
else could work for you?….
Do we not believe in the exercises and the process?
believe simple narratives and I sometimes think that for injuries, this is ‘the
experts will fix me’. This is sadly not true and we need to replace it with a
more realistic ‘my body needs daily help with the healing that is required, and
I need to do these things every day as there are no short-cuts’.
As we think
more deeply about this barrier, we may come to the conclusion that we do not
believe in the current path – maybe we think that it is not yet the right
diagnosis, or the right treatment plan, or the right person to work with. If
these are the issues, then now is the time to talk these over with the physio,
or go to see someone else for a second opinion.
often seen this loss of belief happen when an athlete has been seeing the same
physio for over 6 weeks and is not seeing progress. I would suggest that the
longer you leave making a change, the longer it will take to make a recovery –
especially as I generally see the adherence to the exercises drop off with
longer periods where there is no observed progress and no change in the
exercises or approach. Obviously, the first stage is to talk over the concerns
with the current physio, but a fresh pair of eyes generally provides a fresh
perspective (and scarily frequently a completely different diagnosis and
simply, we may not understand why we are doing the same exercises, week after
week. A good therapist will explain what the goal of the exercises is, and the
test for seeing whether your body has made progress against that goal. This
context is key – for instance after joint surgery doing the exercises through
pain is key to stop scar tissue (which the body throws out in every direction)
from forming across the movement planes of the joint and therefore limiting
Range of Motion for good. Knowing that helps to push through the pain – but needs
someone to explain it!
Do we fear the pain?
do joke that the exercises are more painful than the injury. But really we
should be in search of the ‘Goldilocks zone’ (as I blogged about in some detail
last week) – enough to push and develop the under-active muscles or release the
over-active muscles, but not putting ourselves so deep into the pain zone that
we set the healing back, or push the body back into the ‘alert’ state that
could lead to more guarding and defence.
event that the exercises are very painful, message your physio and when you
next see them:
them to watch your form and be very specific on the exact movements and where
exactly you should be feeling the benefits
the number of reps and sets that you have managed to do (including when you
have done them early in the day, when you are still relatively unfatigued) and
discuss some more realistic targets.
in mind that every single exercise can be regressed to make it easier – so get
them to show you the regressions and agree what the triggers would be to move
up through the various progressions.
if there are ‘warm-up’ movements that you can do to get the releases and
mobilisations before the exercise, in order to give your body the best chance
stick with it and do not beat yourself up if you do not manage all of the sets
and reps – every exercise that does not put you deep into the pain-zone will
Are we uncertain of what we are meant to be doing?
Many of the
exercises are quite complex and when we are in pain we do not always listen and
watch all of the form points. So if there are videos of the exercises – then
watch them again and write down a note of the key points to remember in order
to do the exercises correctly.
It may be
embarrassing to have to admit that we are not really sure what we are meant to
be doing – but it is in our benefit to clarify, so ask away! A good physio
should be delighted that you are checking and clarifying. Do this at the start
of the appointment, as if you only discuss the exercises in the last few
minutes of the appointment, they are under time pressure and need to get you
out of the door to get to their next patient.
If it is not any of these reasons, then what is it?
We owe it
to our body to get to the bottom of why we are not doing the exercises, and
then put in place. So keep taking a positive, inquisitive, collaborative and
learning approach to your programme and your rehabilitation.
Looking back at the time since my injury, I feel like this
has been one of the areas that I have learned the most about – and so I wanted
to share it with you.
In training, I think that you are always looking for that
‘Goldilocks zone’ – where you are stretched and make progress, but not to the
level that it breaks you and forces you back. So that across your week’s
training it is not too easy, and not too hard, but just right to get the
adaptation that you are looking for.
When injured, this zone is even harder to find because there
are no benchmarks. Indeed all of the normal benchmarks that you have are based
on your previous, un-injured self and lead you seriously astray! It can be so
hard to leave your ego behind in terms of what level is worthy of effort and
exhaustion. An additional difficulty is that my sense is that the gap between
stretch and stress is much narrower when you are injured, so you need to be
more precise and wary of the smallest signs of over-reach, before the body
stops you in your tracks. And these ‘tells’ may be completely different from
those that you got when you were in full-on training and the onset may even
come hours later (especially in the case of nerve-pain).
My own search for Goldilocks was a long one! In spite of
constant commitment and tracking, I had a very long period where week after
week I failed to get through the ‘simple’ exercises that were set – sometimes
collapsing or passing out with the pain, sometimes just completely seizing up
and suffering for the rest of the day and night before my next attempt. So managing
to do the prescribed exercises consistently for the whole week between
appointments really was a big deal.
I had no idea how much it had been torturing me. Realising
this issue and actually managing to do seven days in a row of completing the
prescribed exercise and actually managing to progress the reps, I now feel so
much lighter in mood and belief. I start to believe that I am starting to
recover and starting on my way back to life. Even though I know that these
exercises are easier than a good proportion of my previous exercise sets,
completing them means so much.
Why the breakthrough?
I still have a file of all of the exercise sheets that I
have failed to make over the last 18 months (a few of them across 2-3 months of
appointments with constantly trying and failing, and almost all of them still
beyond me today). I should probably have put them in the bin, but have been
keeping them for the day when I improve enough to get through and make the
progress to be able to underpin the basics that could mean a return to life and
sport. Looking back over them compared with what has worked for me over this
last week, these are the things that stand out as differences:
This exercise routine is broken down into a
daily gentle mobilisation routine and the progressive part of the set is only
every other day to allow for a recovery day. Many of my other programmes were
up to 3-5 times per day, and always daily, which seems to have been an
intensity that my body could not cope with.
The first few months of the programme are all
bodyweight movement exercises and only progress to include weights once I have
built up to that.
There is a ramp into the reps and sets, as the
body adapts – with the first set very easily within my current capability.
A golden rule is to always stop with at least 2
reps still in the tank. And never, ever going to the point of failure – as that
can put the body into a state of alert and lead to more ‘guarding’ behaviour
from the muscles (which can take weeks and months to then unlock).
Every single exercise has one or more regressions
to make it easier, in case the pain gets worse and I start to struggle – so I
can do drop-sets, or easier sets. I have learned that every exercise has
regressions, and what a difference that makes! Previously the exercises had
been much more binary – it was do the exercises and if you fail early, then
We have gone through all of the key form points
and gone to the point at which compensation sets in. For the compensations that
we went through, I have a physical cue to keep the body on form (such as a
roller balanced in the small of the back, a strap to keep under tension at all
times, or the knees in contact at all points of the move etc)
There is a clear goal to be able to breathe
deeply and calmly throughout, not straining or bracing, or pushing through pain
(but it is OK for the muscles to get tired or ache, as they used to when
training). This is really useful, as there have been so many different views on
whether you ‘push through the pain, as it is just guarding behaviour’ or ‘stop
and respect the pain, as it is there for a reason’.
We’ve got a clear commitment between us to keep
to the recovery interval, reps and form precisely, even if that means a ‘fail’
– as this helps us to get to the root of the issues quicker and more
accurately. This makes it feel like a partnership where we are both working on
the problem together, rather than me feeling that as the patient I am the
The programme follows a clear and specific order
of releasing overactive muscles and gently activating the specific muscle and
then integrating it into the wider movement. This does make it a longer
programme and means that there are no short-cuts, but really makes a
difference. It also only works at the end-range for a short time, as this is
very demanding indeed.
is a path forward with really small increments for the progression, such that
there is a clear glidepath for progress, with check-steps and alternatives to
take a different approach to address lack of progress. This fits into an
overall ‘treatment’ plan that looks like a training plan, complete with blocks
each with their own objective, quantitative progress testing every 2 weeks and
a clear functional progression thread underlying all of it. Naturally every athlete wants to know ‘how
long until…’ but I have really learned now to trust the process and just to
focus on the progress in each of the 2 week testing blocks and making fast
interventions when something happens that is not what we expected.
Why did not managing
to complete the exercises come to have such a big meaning for me?
I have to admit that I am only just starting to pick away at
and release the layers of blaming myself that I feel for letting everyone down,
not managing with the basics of life, and for not recovering as expected. This
is all psychologically very difficult.
As an athlete I had always believed that consistent and hard
work would be rewarded. And that in a recovery context this meant doing always the
exercises from the physio – no ifs and no buts. Early in my recovery a friend
who is a physio told me that the level of adherence to exercises from the
physio is only thought to be about 20% (and actually admitted that even when
she goes to see a physio herself, she rarely does the exercises!) I vowed never
to be one of those 80% not doing their exercises.
So when pain overtook me over and over again such that I
would collapse weeping with the pain and retire to bed or lying on the floor to
recover, I felt that I was letting myself and everyone else down. That I did
not deserve to recover.
But that is all in the past now! And I think that if I had
known the questions to ask (based on the 10 bullet-points above), I could have
got there more quickly.
So what should you do
if you are currently struggling?
Even if not injured, I think that we are all in search of
the Goldilocks zone and can apply these principles in our training to get to
the stretch zone, but not the stress zone! In rehab we probably need to dial it
even further back – to ensure that we are progressing, but not getting into the
Having now spent a lot of time studying corrective exercise
and reading a lot of books, and doing online study, I have learned that there
is literally no exercise that cannot be made more basic – moving it right back
into exercises lying on the floor and building from key underpinning exercises
of the correct muscle recruitment in breathing. So always ask how to regress
(and progress) an exercise; you also learn a lot in the process too! I realised
that I did not ask this enough – I would tell the physio how I had got on and
we would either just try again the next week without changing anything, or they
would tell me to stop doing anything for a week.
And when doing the exercises, always focus on form and the
correct rest interval – stopping as soon as the form slips. This ensures that
you get the real benefit. Plus see the sense of achievement with the
progression. This does mean becoming more of a Strength & Conditioning
(S&C) student than ever before! Watching athletes do S&C I’ve seen that
strong athletes’ bodies often (effortlessly) find another way around by using
the synergist muscles rather than activating the main muscle – so knowing the
cues and checks is important. Things that your body could get away with before
injury can put you deep into pain post-injury and relying on dominant muscles
misses a lot of the benefit of the exercises!
Finally, I would say that often the focus is on strength
(which is about the muscles) but can be about the recruitment (which is the
messages from the nervous system). So it is worth understanding which of these
it is, as that should change the pace and type of movements in the exercise
The FAI Fix
was recommended to me by a friend of a friend. It was developed by two Personal
Trainers (PTs) in the USA – Shane and Matt – who both had significant hip
issues and manage to overcome pain, impingement and poor Range of Movement
(RoM) without surgery – although they do admit that this has taken up to a
decade of daily work! It comes with a number of success stories on the website:
https://www.thefaifix.com/ and is supported by some really
excellent YouTube videos and emails that made me really feel that Shane and
Matt understood the issues and challenges of hip pain, and also explained the
anatomy aspects of it really clearly.
However, when I was thinking about signing up for the programme I could not find any impartial reviews of how people had got on with the programme. And I saw tweets and messages of others looking for the same. So I thought that I would write about my experiences in order to support others.
There are 2
levels of the programme. The basic one is the FAI Fix Basic for $129.95 USD – a
one-off payment that then gives ongoing access to the exercise library. There
is then a further payment to do the more advanced programme for athletes who
want more hip movement (eg powerlifters). But they are clear that this is a much
smaller group, and is a progression from the first programme once you have resolved
the pain in your hips in usual daily activities.
On the homepage, they explain their TSR system – Tissue Work, Stretching and Reactivation. This is a common (and well-proven) structure for many rehab programmes:
releases with the foam roller, ball,
knobbler etc to release the overactive muscles
stretching to lengthen the tight
reactivation to activate and
strengthen the underactive muscles
It is impressive how much more RoM you can get by doing targeted muscle releases before stretching that area.
There are a minimum number of tools that you need in order to be able to follow the programme – a foam roller, a strap (which could be a belt from a dressing gown), a lacrosse ball (or small, hard ball – there are different levels of hardness in therapy balls and the idea is that you progress) and possibly a ‘knobbler’:
programme link arrives there are 13 tests which are meant to narrow down which
of the 5 key muscle groups is the issue. Then there is a TSR exercise set for
each muscle group and a 6th workout that is a combination across
My experience with the programme
of signing up for the programme, I was uncertain whether it was suitable for me
given that I was 6 months on from hip arthroscopy surgery. However, I got a
response that looked like it was a response from one of the 2 PTs reassuring me
that it would be suitable – although looking back, I now think that it was
probably compiled from a series of standard paragraphs.
through the programme is quite intense – the diagnostic exercises take quite a
lot of set up and checking the form and RoM in front of the mirror. If you or
someone in your family are not quite experienced in Personal Training and
muscle groups it would be quite difficult to work through. And the challenge
for me was that the tests were not discerning for me – all of them were painful
and all of them had less-than-ideal RoM, so it was hard to diagnose where to
diligently followed the programme daily for 4 weeks. The good news is that I
did see an increase in my RoM, but no reduction in the pain before, during or
after the exercises. Therefore, I followed the process to get advice from Shane
and Matt. I wrote a summary of how I had interpreted the 13 tests and what I
had been doing, but got only a 2-line response from someone other than them
telling me that I needed to choose just one muscle group and focus on that, but
no further details on how to make that choice or how to better understand the
diagnostic tests (given that all were painful and low RoM).
I followed the advice for another 4 weeks and then got in touch again, but did not get any response this time. In the meantime, the general emails from them changed. In the first couple of weeks, they had been bits of advice and case studies which were definitely motivational – especially on fixing the body through movement rather than surgery. But after that, the emails continued to come 3-4 times per week, but were now trying to sell more stuff (tools, personal coaching, other programmes etc).
decided to ask for my money back (which in-line with their no-quibble
money-back guarantee they refunded immediately – although interestingly they
did not ask for any feedback on what had worked and not worked, or why I was
asking for my money back).
The exercise video library is good (there are probably 50 exercise variants covering the 5 muscle groups), but I would suggest that the money is much better spent with a Movement Trainer who specializes in Corrective Exercise and can really help you to diagnose which are the problem movements and then focus a personalised programme on just what you need. This should actually start to address where you have the pain and monitor development and progress you see with the exercises, in order to then make choices on how to progress.
the overall message that you can make progress on your hip pain without surgery
is profoundly supportive. Plus there is a strong sense of realism in the sense
that they are clear that it will take work and time.
with getting to the bottom of your hip pain and finding the key to unlocking
I have not blogged for a while whilst I have been trying new things, doing lots of research and trying to make progress on reducing my pain and increasing my ability to cope with day-to-day tasks and activities. It has been an interesting voyage where I have become clearer that there are many paths to recovery – and no-one has the universal answer, so you have to try lots of things! With this in mind, I thought that I would share in a few blogs over the coming weeks some of my recent experiences.
was one of the things that was suggested after each of my surgeries. It is 45
mins drive to the nearest hydrotherapy pools and there are none in my local
authority area. Plus you have to have a medical referral form and go through
some extra checks to get access, so it all took a bit of organising. But I
think that is was well worth it, as I think that it reduced pain in the
short-term and had an incremental improvement in the Range of Movement (RoM) in
the scar tissue and the affected muscles.
What is hydrotherapy?
hydrotherapy pool is kept at 37 degrees Celsius, which consistently feels very
pleasant and after 30 mins of doing structured exercises feels positively hot!
It is about
shoulder depth and about 10m across, so it is easy to get the benefit of the
water resistance as well as the immersion.
There is also easy access, including a hoist so that you can get in and
out even when your body is not working well. Given that there is only space for
a small number of people, it is key to reserve the slot and be there changed
and ready in time.
work with a physio in the session, but once you have a routine it is relatively
easy to work through the exercises on your own. There are ‘weights’ made from
floats to create additional resistance by pushing them down in the water and
inflatable ‘noodles’ for support.
How is it better than a normal pool or hot tub?
I had tried
both the normal pool and hot-tub, and would say that the hydrotherapy pool is
exercises in the pool was hard work (remember that 1 litre of water is 1kg – so
there is lots of weight in the water resistance), and the cooler water temperature
that makes it suitable for swimming means that there is not the therapeutic
benefit of the muscle release that helps with RoM and probably with the pain
I had also used the pool to try a little aqua-jogging with the float-belt (as shown in the photo). This is used a lot by elite athletes when they have injuries and it is claimed that you can keep 80% of your running fitness if you put the same hours in at the pool. This should work really well for lower limb injuries where you need to keep the muscle memory, but avoid the impact (especially in stress fractures and some soft-tissue overuse injuries). But given that for me the inflammation affects the movement pattern, I found that it was too tough at this stage.
The hot tub
is useful for me for the muscle release and for managing some of the pain. But it
is not deep enough or large enough to do all of the exercises, so it is not as
good as the hydrotherapy pool. I think also that the 30 mins slot, where everyone
else is also working on their exercises, brings a level of focus that really
Did it make any difference?
experience was that it was a very supportive environment – everyone there is
working on getting better and is very willing to share what they have had
In terms of
the physical impact, the warmth definitely had a positive impact in terms of
reducing pain for a few hours (just like hot water bottles etc when at home).
My understanding is that this is not universal – some people find that the pain
is reduced with cold, others with warmth.
found that 30 mins of hydrotherapy definitely improved RoM for a period of 24-48
hours and if I did it 3 times per week, I saw real progress on my land-based
exercises. That said, it was positively hard work – after 30 mins the
combination of the temperature and the hard work was very tiring and I was keen
to get out and have a nice drink of water! And the travel on top made it quite
a bit harder. So, I would say that if you have a hydrotherapy pool nearby, do
make use of it in your recovery and rehabilitation.
One of my best friends, Liz, has a quote on her wall saying “Do not wait for the storm to pass, instead learn to dance in the rain”
It’s a concept that I love – and my husband and I have
talked about it over and over across the last months. But I have been
struggling with it too; constantly asking myself whether this level of acceptance
is giving up on the goal of getting better. Like so many aspects of recovery, I
have had lengthy internal debates about it and not reached any clear
conclusion. Then this week I came across this very impactful TED talk from the
amazing New York Times writer Suleika Jaouad; it has given me another
perspective and perhaps helped me to slay a dragon and move forward some more.
She challenges us to think again. Her premise that the
separation between being sick and being well is not the simple, binary divide
that we often paint it as. But that the border is porous. And that with the
increased life expectancy of today, most of us will spend much of our lives travelling
back and forth between the situations of being sick and being well, and living
at least some of the time in the middle.
She finishes with the powerful thought that every single one
of us will have our life interrupted… by something that brings us to the floor.
We need to find ways to live in that in-between place managing whatever body
and mind we currently have.
Powerful thoughts for
There were a number of themes that struck me as very
powerful. But a few stuck out:
of connection and shared experiences – her example of the prisoners in
solitary confinement calling out their moves for the board games that they had
made out of torn pieces of paper. It made me realise that the shame and
inadequacy that we feel about not getting better and not keeping up is a dark
shadow that we can (and need to) chase out with the bright light of friendships
importance of dreaming big on plans for the future – her example was the
girl in Florida who plans someday to go camping in spite of her fear of bugs.
When the whole world seems to be turned on its head, all dreams evaporate in
the face of survival. But holding on to some things and keeping dreaming about
them, and knowing that one day you will do them is a shining ever-present
beacon of hope.
of taking the risk of opening up to new things – her example was the
retired art history Professor in Ohio living through a lifetime of constant
pain and disability, who in spite of all of the uncertainty of his health got married,
had Grandchildren, taught, and danced with his wife every week. In spite of a
situation that could have gripped him with constant fear and worry, he found
meaning and built a beautiful life encapsulated in love.
Thank you Suleika for sharing your wisdom. And here is to learning to dance in the rain, through the different stages of the storm – in the eye of the storm, in the pouring rain and on the days where the thunder & lightening start to recede.
One of the scary parts of being injured is that you realise how little we really understand about the human body, and how much of medicine is guesswork and a process of systematically working through likely causes in a logical order, and observing how the body responds.
This brings us to the injured cat analogy used by one of the rehabilitation coaches that I have been working with – Matt at APS Fitness http://apsfitness.co.uk/
Be kind to your body!
Matt’s analogy is that if your cat was clearly ill, you
would be nursing it and nurturing it – even though it could not tell you what
was wrong (just like your body cannot). And you would be giving it food and
rest, and trying to see if gentle movements help. If the cat showed signs of
pain or discomfort, you would immediately back off.
What a great analogy for your body!
The limiting mindset
as athletes is that we have been constantly used to pushing our bodies
As athletes we build limiting mindsets like:
“it’s not worth putting my trainers on if I am
going to run for less than 30 minutes”
“ If I don’t feel that I have pushed myself,
then it is not a session”
“Aqua aerobics is fine for old people, but not
You can probably add your own ones in too…
But back to the injured cat – as an injured athlete your
body is not happy, and it needs you to forget all of the past and respond to
its needs right now.
The bank account
analogy is about pacing
The analogy is that to live a stress-free life, ideally, we live within our limits – so we do not spend more than we have.
So now that your body is injured body, your ‘energy bank
account’ has been severely dented and you have a lot less to spend each day
than you used to have. So you need to choose where to spend your ‘energy coins’
across the day – which activities and for how long. And once you are getting
down to your last few pennies, you may need to save them in case something
unexpected comes in at the end of the day, so that you can be sure not to go
overdrawn. Because overdrawn often means a relapse where little or nothing is
possible and you have to rest up until you have put enough coins back into the
account with some quality sleep.
This analogy is really helpful, as it enables you to start
to be honest about how much energy different activities cost, and help you to
make a proactive decision in advance of whether you are able to cope with
And it also helps you to measure your healing. Although your
progress may seem slow to you, the energy cost of activities will go down and
you will start waking up feeling that you have more in your energy bank
account. Staying within your limits will help this process go faster.
The body’s ability to
heal is amazing – but you have to give it a chance!
Working out what is going to get you out of pain, and able
to build up your ability to move again may not be simple. You may have to keep
trying lots of things, and have to keep taking it down to the level that you
can manage to not over-extend yourself, plus back off and change tack when they
are not right at that time.
But stay humble and curious – it may seem mysterious, but
you can crack the injury code, but only by being kind and responsive to your
There have been many firsts since I got injured, but
spending over 4 hours on a late Saturday afternoon and early evening at a
‘Psoas Release Party’ is one that I thought you would all like to hear about!
The workshop was led by Jonathan FitzGordon, who started out
as a yoga teacher in the USA but now works on rehabbing people in terrible
pain. He freely admits that most people come across him at 3 in the morning,
when they are at the end of their rope and don’t know what to do to get out of
pain. This is exactly how I came across him.
What is the psoas?
Jonathan’s theory is that the illiopsoas is the most important muscle in the body. The ‘psoas is a really interesting compound muscle, as it is very difficult to reach and touch, as it starts deep in the back (up near the ribs) and loops around the inside of the hip before attaching at the front top of each of the legs in the groin area. For all its inaccessibility, it is a large muscle and is one of only 3 linking the front and back of the body, and attaches in 6 places – so pretty complex. It is often simply called a hip flexor, but it has a role in much more than this. Jonathan attributes the majority of long-term pain in the hips and back, plus the knees and feet, and even the shoulders to how the psoas is behaving.
I read Jonathan’s book ‘The Psoas Release Party’ and was struck with some of the concepts and case studies. I tried some of his stretches and releases and felt that I had started the journey. Then I saw that he was coming to the UK and was doing a workshop…
The description of the workshop said: “The psoas is the most important muscle in the body
acting as the main hip flexor and the engine of walking. A free and happy psoas
allows the body to move with peak efficiency and little strain. Issues with the
psoas can lead to any number of problems throughout your body—both physical and
emotional. Lower back pain and other joint discomfort as well as disturbances
to the nervous system can be linked to the psoas. This is not a yoga class. You
will spend the afternoon awakening, learning about and releasing the Iliopsoas
muscle group and understanding its core function within the body.”
So that is how I ended up being one of 16 people crammed into quite a small yoga studio just near to Wimbledon studio on a late Saturday afternoon. It was mainly women, with a few men and the ages spread from early 40’s into 70’s – and every single person in the room was in pain, and wanted to do something about it.
How did the party get going?
Jonathan did an amazing job
of making the anatomy really interesting and memorable, and before long we were
all evaluating our dominant muscle patterns when standing still. He looked
especially carefully at the balance between the front and back muscles, and the
angles down the body: from head to shoulders, from shoulders to the lower
thoracic spine at the bottom of the ribcage, from this point to the hips and
from the hips to the ankle and into the foot.
He had a wonderful manner
of wandering around and gently pointing out individual muscle patterns–for
instance, the level that each of the hips were in the sockets, the level of
internal/external hip rotation playing into the weight distribution in the feet,
overall muscle imbalances and the level of tension in the glutes (butt) and
And what was interesting,
was how we all had to be coached for the tell-tale cues and signs – even though
almost everyone in the room (other than me) had a yoga or dance training,
making them very body aware and elegant in their movement (but still in pain!)
What were the tell-tale cues?
Overall, the biggest message that I took from the workshop was that we all hold too much tension in the wrong places. Given that as soon as one muscle is tight, the opposite (antagonist) muscle simply cannot do anything until the first muscle releases. And this is important because some of these muscles (like the psoas) are large and connect with key processes like breathing, staying continent(!) and movements like sitting, walking and standing.
So stay loose and relaxed!
To do a body check yourself
and see whether there are any ah-ha moments across the day:
Think about your butt when you are standing and walking – are the muscles tight? (if so, the psoas cannot do anything). A friend of mine tried this for a week and was stunned at how often across the day she found that all of the muscles in her butt were tensed up!
Think about your rib cage – if you sigh out a deep breath does the tension change? (if so your latissimus dorsi may be overworking)
Are your hips forward and your thighs extended when you stand? (if so, your hamstrings are constantly short and may get persistently tight)
Was there anything
It was pretty much all practical! The four hours simply flew
by – we did not stop for any breaks, and yet there was not a moment where I was
not learning, making notes, trying different movements and learning more about
the cues and signs of my muscle patterns.
The last 90 minutes was spent on 8 gentle stretching movements – most of which were held for a very long time (we did some for 15 mins, and Jonathan can recommend an hour or more at times!) in order to allow the psoas to truly let go. Whilst I had tried almost every single one of these from the book, the specific tuition on the important points of form was incredibly useful and I understood why I may have been missing out the benefits through simply trying it on my own without perfect technique. And the good news is that they are very easy to do at home (indeed one we even talked could be done in a break at the office, if you have a role that requires sitting at a desk all day – which of course is very bad for the psoas due to spending so much time in hip flexion).
Overall verdict – worth
I have to admit that I thought about whether to attend for
weeks before I committed – the hassle of a 45-minute drive to get there, no
parking at the location and the £65 workshop fee. But my husband was kind
enough to drive me and drop me off at the door, and benchmarked against other
treatments that I have had, it was worth the money.
And like all of the best parties, with the late finish we
were locked in!
I would strongly recommend Jonathan’s book – but the workshop took it to another level for me in terms of the personal insights and advice, plus the detailed coaching on the correct technique for the exercises. If you are not able to get to a workshop, Jonathan does do Skype consultations and I cannot over-emphasise the level of knowledge that he brings to your personal situation and his commitment to getting you out of pain. I am not at all surprised that he has helped and supported so many people to incredible recovery and rehabilitation.