This is THE book!

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’.

Practical support

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.

The book includes

  • 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

But perhaps 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.

The 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.

What I 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.

Recognising other bloggers who have cast helpful light and perspective on my own challenges

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 forward.

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.

Joletta Belton – My Cuppa Jo (www.mycuppajo.com)

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 conferences.

Tina – Living Well Pain (www.livingwellpain.net)

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 Moore – the Pain Toolkit (www.paintoolkit.org)

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 Babcock – Return to Wellness (www.returntowellness.co.uk)

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 Moss – A Journey through the Fog (www.ajourneythroughthefog.co.uk)

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 Chan – A Chronic Voice (www.achronicvoice.com)

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.

The Princess in the Tower (www.princessinthetower.org)

This site has a number of useful resources for learning about chronic pain and how to manage it and reduce it. The blogs focus a lot on the emotional impact, and ways to manage this.

Then, I also discovered some really useful communities:

HealthUnlocked (www.healthunlocked.com)

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!

Round and round in circles

My experience of rehab is lots of circles!

Whilst 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!

Having a 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.

The goals 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.

I also 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 day.

The psychological benefit of a change of scenery

I would 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!

Rule 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!

The hardest parts & my coping mechanisms

The parts 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 experts.
  • 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!

As you 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!

Are you doing your physio exercises? If not – it is really worth working out why not!

Are you doing your physio exercises?

The actual exercises, with the frequency that you agreed?

The figures 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?

Injuries 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?

Indeed, I 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.

We tell 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? Really?

Once we 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 include:

  • Scheduling and writing down the time in your diary to do the exercises each day
  • Setting an alarm on your phone for the time to do the exercises
  • Having a paper-tracker and star chart on the fridge or mirror as a reminder
  • Phone-based tracker of the exercises each day, with reminders
  • Giving yourself a reward for completing the exercises (eg a cup of your favourite tea)
  • Doing them early in the day, so that they do not hang over you
  • Being accountable to someone – letting them know that you have done the exercises each day
  • Letting 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)
  • What else could work for you?….

Do we not believe in the exercises and the process?

Often we 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.

I have 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 treatment approach!)

Or more 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?

Many people 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.

In the event that the exercises are very painful, message your physio and when you next see them:

  • Get them to watch your form and be very specific on the exact movements and where exactly you should be feeling the benefits
  • Bring 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.
  • Bear 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.
  • Ask 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 of success.
  • Then 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 help!

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.

Good luck – and get those exercises done!

Finding Goldilocks!

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:

  1. 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.
  2. 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.
  3. There is a ramp into the reps and sets, as the body adapts – with the first set very easily within my current capability.
  4. 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).
  5. 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 stop.
  6. 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)
  7. 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’.
  8. 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 problem.
  9. 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.
  10. There 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 overload zone.

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 programme.

Good luck in your search for Goldilocks!

Why I asked for my money back on the FAI Fix

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.

The programme

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:

  1. releases with the foam roller, ball, knobbler etc to release the overactive muscles
  2. stretching to lengthen the tight muscles
  3. 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’:

The tools! The ‘stick’ was an optional extra, and the blue one is the ‘knobbler’ – but most of the programme could be done on the floor in front of a mirror with the foam roller.

When the 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 muscle groups.

My experience with the programme

In advance 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.

Working 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 focus.

I 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). 

So, I 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).

My summary

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.

That said, 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.

Good luck with getting to the bottom of your hip pain and finding the key to unlocking the pain.

My experience with hydrotherapy

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.

Hydrotherapy 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?

The 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.

You can 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 much better.

Doing my 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 reduction too.

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 aquajogging float belt clips around you to keep you upright without your feet touching the bottom of the pool (you need a pool deep enough for this!) and you can add difficulty by holding a waterbottle in each hand and changing the amount of liquid in it for more difficulty.

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 helps.

Did it make any difference?

My own 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 success with.

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.

Plus, I 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.

Learning to dance in the rain

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.

It is a talk that applies to everyone – not just those struggling with injury or illness. Do watch it for yourself here (just 17 minutes of beautiful and impactful viewing): https://www.ted.com/talks/suleika_jaouad_what_almost_dying_taught_me_about_living

Living well ‘in the middle’

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 ‘in-betweeners’

There were a number of themes that struck me as very powerful. But a few stuck out:

  1. The power 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 and fun.
  2. The 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.
  3. The importance 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.

I hope that you find this as inspirational as I have – even if it took a few months for me to go the journey!

My Saturday night at a ‘Psoas Release Party’

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 rib-cage.

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 practical?

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 the money!

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.

And there is even a summer retreat in Italy…

Fascinating reading, with useful explanation and practical exercises