What I learned from going to see a nutritional therapist

I had to go back into hospital for some manipulation under anaesthetic due to the limitations on my movement from the scar tissue after my hip surgery. I had been dutifully massaging the scar tissue on the outside but came to realise just how much scar tissue there was on the inside that was reducing my range of movement and potentially one of the causes of pain. This led me into a journey to look at what I could do with nutrition to try to help my recovery.

So, for the first time ever, I went to see someone for dietary advice – with the specific question of whether I should be taking supplements to help my healing, and if so, which ones.

Layering the different aspects

I had previously thought that nutrition was mostly common sense, but I learned a lot from the way that Saffron (the nutritional therapist) layered what I needed:

  • Starting from a well balanced diet – with 7-a-day vegetables and fruit, plus a good split at each meal of complete proteins, good fats, and wholemeal carbohydrates as well as maintaining good hydration. She also specifically asked about how often we eat fish, and especially oily fish – as apparently the British are standardly very short of the long-chain omega 3 fatty acids. The ideal is apparently at least two portions of fish per week, with at least one oily fish.
  • Then looking at my age and lifestyle to get a sense of the hormonal pressures and tensions, as well as the aging factors on all of my tissues.
  • Whether I have had any blood tests to give information on nutrient shortages. These are very useful for things like anaemia (shortage of iron) and vitamin D shortages (common in Northern Europe, especially in winter or for people who stay inside a lot).
  • Checking for any food allergies or intolerances, or specific dietary requirements. I am very lucky with the robustness of my digestive system, so it means that I can draw on most foodstuffs – I just need to be organised enough to plan the right meals, shopping, and preparation! (I am sorry – I realise that some of this advice is not going to be so helpful for vegetarians, but a nutritional therapist will work with everyone’s dietary requirements).
  • Building from there to the current medications that I am taking – and talking me through the receptors that these medications block and hence what dietary changes and vitamin supplements may be needed to reflect this. For instance, the need for extra fibre for the constipation from painkillers, sulphur if taking ibuprofen, and extra B-vitamins (B6 and B12) when taking muscle-relaxants and antidepressants.
  • Then looking at the injury and the surgeries to understand what tissues are trying to heal – in my case covering bone, joints, cartilage, muscles, ligaments, and fascia, as well as scar tissue.  She talked about the importance of protein and zinc to help the muscles and ligaments repair. So a quality protein with each meal, and a wide range of pulses, grains, seeds, and nuts for the zinc. Getting nutrients to the bone and joint is more challenging – so I will come back to this theme below.
  • From the symptoms that I am still experiencing what extra may be needed. For instance, Magnesium is the mineral involved in relaxing muscles (whilst Calcium is involved in muscle contractions), so extra Magnesium can help with the muscle spasms and cramps. Magnesium-rich foods include spinach, avocado, seeds, nuts, yoghurt, banana and best of all: dark chocolate!
  • Then we talked about inflammatory foods, vs anti-inflammatory foods. Whilst inflammation is an important process in the initial weeks after the injury and surgeries, now months down the line there is a chance that swelling and inflammation is getting in the way of healing. Hence foods can help as one of the factors that can reduce inflammation. Overall, processed foods with high fat and processed sugars are inflammatory, plus fizzy drinks and nitrates, and nitrites in processed meats like smoked bacon and ham (you can buy nitrite-free versions), and of course, mild toxins like caffeine-based drinks and alcohol. The anti-inflammatory foods include tomatoes, leafy greens, olive oil, nuts, fruits, and oily fish.

Reducing scar tissue

As I said, reducing the scar tissue internally is a big goal for me, as I think that it will improve my mobility and potentially reduce the pain.  Saffron recommended proteolytic enzymes which are supposed to help minimise and reduce scar tissue after the surgeries.  These need to be taken away from food for best impact (either 30 mins before a meal, or an hour after a meal). Natural enzymatic foods include pineapple and papaya (yum!)

Rebuilding the bone

Of all of the injury and surgical aspects, we spent a lot of time talking about how to get blood flow and nutrients to all of the damaged tissues. Obviously, the bones are one of the most difficult to reach and the only access in the joint is via the synovial fluid. This points to the importance of movement in healing, as this only happens with movement that increases both blood flow to carry the nutrients around the body, and synovial fluid movement and regeneration.

The nutritional advice is to bring bone broths into my diet – using them instead of stock.  She counselled that it might seem weird to begin with but that you can get bones from butchers – they just give them away (I think that they normally assume they’re for a dog…) https://wholefully.com/bone-broth/

Normally your body will synthesise the necessary building blocks itself for bone synthesis and (to a certain extent) repair but it does get more difficult as we get older and we have less of the ‘whole’ ingredients in our diet such as animal skin (like on chicken etc), marrow, offal etc.  So this is where a supplement may be easier. 

Dealing with continued inflammation

Turmeric has become one of the anti-inflammatory supplements of choice for athletes. There is a lot of discussion about the format, and whether it is needed to be activated with black pepper or not. There is not a clear answer. The focus is probably best on getting one with sufficient amounts of the curcuminoids that create the reduction in inflammation. It needs to be taken with omega-3s for impact, which given the frequency really means using a good quality supplement.

More that we could have talked about

I have to admit that there was so much more that we could have talked about – and maybe I should go back in a few weeks once I see the impact of a few changes.

For instance, many people say that having had 7 general anaesthetics, rebuilding the gut fauna with a good probiotic is a priority to ensure good absorption of nutrients.

In summary

I came away with a much clearer view of what I should be doing in my base diet and the things that I should be eating more of and the things to avoid. I also finally answered the debate that I had been having with myself about supplements – and decided that the extra demands of this recovery phase meant that a few specific supplements would really help me.

But more than this, it was a real wake-up on the complexity of nutrition and how everything works together. It has been a great insight at this stage of injury, medication etc. But when life changes again, I think that there is a real value from getting expert insight on the body’s nutritional needs and how to meet them effectively. I really hope to be back to sport and when I start training would definitely go back again, plus at different physical lifestages as hormones change, or lifestyle changes. I had not previously realised the benefit that one can get and I would recommend it to others.

Affirmations and Mantras for healing

Self-talk is known to be one of the most important parts of mental strength. Athletes consistently use it (often together with visualisation) to help with performance under pressure. My suggestion is that it is just as important when you are injured and facing the challenges of recovery and rehabilitation.

Are you wondering what is self-talk? I define it as the voice in your head that chatters constantly, about all kinds of things and at times can escalate to a full-on internal debate. But there is good evidence that the mind takes these messages and images very seriously, driving changes in the hormonal system and the nervous system which in turn have very significant physical impacts (as well as changing your thought patterns going forward).

Affirmations or mantras are usually short, pithy phrases to insert positive messages into the mind. I would also be remiss not to mention that in the Hindu faith and yoga mantras are chanted, with specific mantras to generate powerful sound waves that promote healing, and the relaxation from the ancient practice of gong therapy or ‘sound bathing’.

This is something that many people write about. I especially enjoyed Carole’s blog from 2014 where she talked about Dr Coue’s mantra (or autosuggestion as he called it) where in conjunction with their medical treatment, they would say over and over to themselves 20 times in the morning and 20 times in the evening ‘Every day, in every way, I am getting better and better’. Read more on this inspiring story from over 100 years ago, plus some great tips and book recommendations in Carole’s blog:

What kind of mantras help?

When I was running ultramarathons and doing Ironman triathlons, I used mantras a lot and found:

  • It needs to be positive. I had a spin teacher who used ‘mine is the power and the glory’ as a mantra, and I know that many people find these universally positive exhortations very useful– hence the Ironman slogan of ‘Impossible is Nothing’.
  • It needs to be realistic at that moment! For instance, telling myself ‘I love to run’ is true, but in the final stages of ultra-marathons or long-distance triathlons the voice on my shoulder would scream back ‘I don’t right now – I want to stop!’ so I would use simple exhortations like ‘run for home’ or ‘nice and steady’.
  • It is better when it is process-based.  There are times in a long race where the final finish line seems too far away to engage with, and so process-based mantras worked better for me. This seems a strong parallel with the uncertainty on outcomes in recovery and rehabilitation. So just as I would focus on technique points in races like ‘keep my rhythm’, ‘nice and light’, which brings the benefits to keeping good technique at a time when tiredness can reduce form. In the same way in the tough part of recovery focus on the exercises, release work, nutrition, hydration and sleep patterns can reinforce the positive habits that will make a difference.
  • It is not helpful to set specific goals that you then miss. Whilst I have spent many races setting myself a challenge for the next split time, or the person that I would overtake, these are only useful when you hit the goal and then set the next goal. Missing them really can really drag you down, as it allows the internal critic to keep saying that today is not your day and you may as well just give up.

How do I apply that to my recovery?

It is really useful to reaffirm your strengths and the resilience that you bring to this situation: from the factual such as ‘we have a good plan and next steps with the medical team’ or ‘we are focused & determined and will get to the bottom of this’, ‘I have what I need to get through this’, ‘all of this strength and conditioning will make me a better athlete’ to the more aspirational ‘we will beat this’, ‘I’ll be back’, ‘my body is amazing’ and ‘I’ve come through tough times before and I will again’.

Also to recognise all of the people on your side and rooting for you: ‘I am in great hands’, ‘I am surrounded by love and support’, ‘I stand shoulder-to-shoulder with my team’, ‘I am enveloping my body in love and kindness’.

Reaffirming the sense of progress – even when it is too small to see: ‘every day of careful nutrition and good sleep helps my body to rebuild’, ‘little by little my body is healing itself’ and ‘every step towards recovery helps me’, ‘cell by cell my body is rebuilding itself’.

Some people find perspective very useful – for example: ‘whilst this is tough, people are facing much worse than this and getting through it’.

Some inspiring quotes

This link includes some inspiring quotes for injured athletes that could be used as mantras:

https://www.theodysseyonline.com/25-quotes-inspire-injured-athletes

So why not try it?

How about choosing a favourite mantra and use it every day for a week – repeat it under your breath over and over at key points in the day, write it on a post-it and put it on the bathroom mirror or under your pillow, close your eyes and smile gently as you visualise it… the mind is a powerful thing.

Your body and mind are amazing – ‘Every day, in every way, you are getting better and better’

Another self-help technique for back pain – the McKenzie method

I had lots of people getting in contact after my blog earlier this week on back pain, so wanted to quickly share this additional technique that has brought relief and recovery to many. I hope that some of you find that it helps.

For a lot of people (especially runners and cyclists it seems) back pain comes and goes episodically. For most the issue is a disc bulge (most people over 25 or 30 years-old seem to have them to some level), and the disc bulge moves slightly, compressing one of the 4 key nerves at that lumbar vertebrae level and sends white-hot pain, pins & needles and/or numbness down the leg, sometimes with symptoms in the bum cheek or hip as well.

Each nerve has a role for areas of the body and internal organs. If you are interested in understanding the link between the level of the spine (which vertebra) and the body, have a look at the spinal nerve chart: https://millerchiropracticclinic.com/spinal-nerve-chart/

A lot of people have found great relief through the McKenzie method

First of all, take this simple self assessment – answering yes or no to each of the questions:

  1. Are there periods in the day when you have no pain? Even 10 minutes?
  2. Is the pain confined to areas above the knee or above your elbow?
  3. Have you had more than one episode of low back pain or neck pain over the past few months or years?
  4. Do you feel worse during or immediately after prolonged bending or stooping; as in making beds, vacuuming, gardening, concreting, etc?
  5. Do you feel worse when sitting for prolonged periods or on rising from the sitting position, ie after watching TV or working on the computer?
  6. Do you associate your pain with any one particular activity but are generally pain-free when not engaged in this activity?
  7. Do you feel worse when inactive and better when on the move?
  8. Does your low back feel better when lying face down? (You may feel worse for a minute before the pain subsides, in that case, the answer to this question is yes).
  9. Does your low back pain feel better when you are walking?

The McKenzie Institute claims that if you have answered yes to more than 4 questions, your chances of gaining benefit from the McKenzie method is very good.

They say that if you answered yes to 3 or fewer, then you may require specialised assessment and treatment.

The McKenzie method is built on gentle spinal extension exercises

The theory behind the method is that most discs bulge out backwards, and therefore gentle extension exercises encourage the disc to change shape with more of the disc-matter at the front and take the pressure off the nerve that it is compressing.

Robin McKenzie’s book ‘Treat your own back’ is inexpensive and practical – giving a do-it-yourself plan for relief of lower back pain through postural changes, ergonomics, and simple exercises. It also provides a clear understanding of the causes and treatments of persistent back pain.

One last key tip

I think that anyone who goes to a physiotherapist with back issues is given spinal extension exercises. But I am not sure that everyone talks about technique, and it is really important. If you simply move into the spinal extension, then all of the muscles in the lower back shorten as you peel up. But if you engage your abdominals (especially the deep Transversus Abdominus) and then do the back extension, then the same muscles go into extension due to the reciprocal inhibition of the muscle pairing with the abdominals. This is what you want.

Back Pain? You really need to read this book before you do anything at all!

I challenge you to find better explanations and practical advice on back pain management anywhere!

Even though the pain can be so bad that you may not be sure that you can live through it, do not panic! Back pain affects 80% of UK adults at some stage in their lifetime (and usually in mid-life) and for the great majority of them, this passes within a week. For the 10% that it lingers more than a week, the scans and the words used by consultants can seem very scary.

I remember my Dad impressing on me the importance of avoiding spinal injury when I was a kid who loved climbing, abseiling and mountain biking. He was right that the back is a complex mix of bones, tissue, and nerves that drive everything, and the challenge is that the central nervous system is not very good at healing itself (medical experts are divided on what is possible vs impossible).

And back problems are not the end of your sport. 85% of male gymnasts, 80% of weightlifters, 69% of wrestlers, 58% of soccer players, 50% of tennis players and 30% of golfers have had back problems and the large majority of them have come back to their sport – albeit, for some of them, this has taken a little time.

Crucial advice for you before you go to any health professional!

This book ‘Back Mechanic’ by Stuart McGill claims to be ‘the secrets to a healthy spine your doctor isn’t telling you’. I would suggest that every athlete with back pain needs to get it and read it cover-to-cover twice before they take any action. It is very readable and contains truly excellent explanations, evidence-based plans, and case-studies from athletes where he has led their rehabilitation.

In the ‘Back Mechanic’ book, he explains why:

  • your pain may worsen after trying physiotherapy, especially with significant manipulation
  • why you can seem to be OK and then try to do something and be knocked out for 3 days straight
  • why it makes sense if you find walking faster is less painful than dawdling
  • why you may get told that the pain is in your head (which he completely refutes)
  • why just keeping a diary of your pain levels and painkillers is not enough
  • yoga and pilates may be recommended to you but may increase your pain
  • and many more questions answered!

A structured self-assessment and practical toolbox

The mid-section of the Back Mechanic book leads you through a highly diagnostic structured self-assessment of your back pain in static and dynamic movements.

From this, you can build up basic movement tools for simple, small, pain-free movements.

Then he moves into spine hygiene so that you can expand your pain-free abilities, with further sections on building a resilient back and restoring the hips, as well as specific conditions.

Will this help me avoid surgery?

There is a whole section on avoiding surgery, and the key decision points that will lead you to build an evidence base that suggests that you may not be able to move forward without surgery.

How to recover and trust your back

Many athletes who have come back from back problems say that one of the biggest challenges is regaining confidence in your spine. The second book – ‘Ultimate Back Fitness & Performance’ (which is more expensive and you may have to order from Canada or USA) gives a really excellent guide on building up from the end of the first book into using your back in performance situations but is a longer and harder read.

In summary

The message is – do not panic, don’t rush to the Doctor yet – read the ‘Back Mechanic” book and create a plan that you believe fits with your specific symptoms and responses to the static and dynamic tests in the book. It may take some time, but a good path to take given that 40% of people after surgery have ongoing pain and often end up having second and third spinal surgeries (each with considerably lower probability of successful outcomes).

Surgical skill or bedside manner?

We had a great debate over breakfast the other day. The question was –  if you had to choose, would you prefer a surgeon with great surgical skills and average bedside manner, or average surgical skills and great bedside manner? Of course, one hopes that you never have to make this choice, but it was a good debate!

My argument was that I wanted great surgical skills, given that I am unconscious at that point and once you are opened up they need to deal with whatever the situation actually turns out to be (which may be rather different from the best guesses on the scans). Having seen how incredibly thin and fine things like nerves are in many places, the fine-motor skills of dealing with this feel very important (and obviously in things like arthroscopy are one-step removed like a computer game!) I have to admit that I was only conscious once as I got wheeled into theatre (the other 6 times I was in a small ante-room with just the two anaesthetists) – but I was completely stunned to see 10 people and realised what a team leadership role the surgeon has!

But the counter-argument for the importance of bedside manner was a great one. The sad statistic is that many people continue to have pain after surgery (for instance, failed back surgery is said to run at about 40%, according to Penn Medical in the USA). So what you most need is to find a person who has the depth of skills to really understand what is going on in your body, and what interventions are most likely to help the situation. Therefore, someone who has a good ‘bedside manner’ to truly understand what is going on and whether surgery is a good option is what you most need. It can save you a lot of trauma and uncover a much better path.

The argument goes further. If you do have the surgery, the recovery phase is critical. Being able to explain what recovery and rehabilitation approach works best, and adaptations to make really increase the chance of recovery. Not to mention the softer factors, such as the level of trust and belief, which many would argue also play a key role in the mentality of the patient and therefore their biochemical make-up during the recovery phase.  

Supporting evidence that bedside manner may be much more important…

Having had four male surgeons, I was somewhat stunned that there was a statistically significant difference in the outcomes by the gender of the surgeon in this British Medical Journal comparison of postoperative outcomes amongst patients treated by male and female surgeons via a population-matched cohort study. It showed that fewer patients treated by female surgeons died, although there was no statistical difference in the proportion that were re-admitted to hospital or had complications within 30 days, compared to the matched group treated by male surgeons. If everything in your mind is screaming out that this cannot be true, then I will leave you to read all of the statistical analysis in the paper (including the interesting finding that the same pattern was true in emergency surgery, where the patient did not choose their surgeon):

https://www.bmj.com/content/359/bmj.j4366

But perhaps more interesting is the why’s, which the paper says need more study. But they already suggest that there is a gender difference in how male and female physicians practice medicine, such that it can affect patient outcomes.

They say that there are 4 core components of surgical practice:

  • Knowledge
  • Communication skills
  • Judgement and
  • Technical proficiency.

Obviously, post-surgery there are more people involved in the care so there are more factors too – and a previous study of beneficiaries of US Medicare that were treated by female general internists in hospital had lower rates of 30-day mortality and readmission than those treated by male internists (Tsugawa et al), which they attributed to female doctors being more likely to:

  • use a patient-centred approach and
  • to follow evidence-based guidelines

So what could this mean for your surgery?

Having never been in this surgical world before it was thrust upon me, I had no idea how to move forward. So here are a few tips that I would say now:

  • If you have Medical Insurance, ensure that it allows you access to the maximum pool of consultants (they generally operate in a number of different hospitals and each of them is self-employed, so worry about the surgeon access, not the hospitals)
  • Always try to find a surgeon who has worked with sports people.
  • Get recommendations from people in the know. There is no meaningful data that you can access on the outcomes by different surgeons, but nurses and people in the hospitals know it. Call on your network shamelessly to try to understand the real story. Take time over this – for all that you probably feel that you do not have time on your side in your situation, it is really worth doing lots and lots of investigation.
  • If you have to wait, it is a good sign. Whilst none of us want to wait when we are in pain, it is much better to be seen by a surgeon with a full plate and lots of patients, rather than the one with lots of gaps. Firstly, it is an indication of their reputation. And secondly, if they are busy, human nature suggests that they may be more balanced in whether surgery is the best option for you.
  • Don’t be afraid to ask for a second opinion. Many people say always go for a second opinion before surgery, and that surgeons should not be offended as they should also recognise that it is a big decision. I would say that if what they say doesn’t seem to fit, or you want to have more comfort before making a big decision like a second or third surgery, then a second opinion really helps. They say that the key is not to tell the second person what the previous diagnosis is so that you get a genuine fresh pair of eyes on the issue.
  • Go into the appointment with a list of questions and a second person in support. My experience is that almost all of the surgeons that I have met are extremely introverted and tend to say very little. Therefore it is down to you as the patient to elicit responses, and to keep asking the questions until you feel that you have understood the answer adequately. This is why I always take someone else to the appointments who also has the list of questions and understands what we are trying to understand from the appointment, as I have felt quite intimidated and not managed to get all of the responses that I was looking for when I was alone.
  • Always go to another medical specialist too. The old saying is that when you have a hammer in your hand, everything looks like a nail. So the surgeon is always likely to come back with the choice of wait and hope it gets better, or do surgery. Hence getting an alternate view of how another specialism would approach your issue is very useful – go to:
    • a good clinical physiotherapist (one who has done cadaver work, reviews scans, and works across a range of techniques that are not just manual therapy and strengthening exercises),
    • a chiropractor with a good track record (who again reviews scans and uses more approaches beyond the classic ‘twist and crunch’)
    • a sports rehabilitation specialist (who again reviews scans and does screening to present a treatment plan that shows clear milestones with review points for reassessment and case studies of where this has worked before with/without surgical intervention)

So I changed sides on the debate

Through the debate (and long after I had finished breakfast), I realised that the core of the issue for me is that I was falling into the trap that I think many of us fall into – the idea that surgery is a quick intervention that creates an instant fix.

Once I articulated that I believe that surgery is sometimes one step in the rehabilitation path, it becomes clear that the communication skills to make the right decisions with the patient are much more likely to get to a better outcome. And since communication is a two-way street, we as patients also need to do lots of work to make sure that we communicate and understand well through the process.

“You just fight with your brain, to get the body ready to fight against the illness”

I am not a big Formula 1 fan, but I do listen to a lot of radio at the moment. And so I came to understand a little more of the amazing story of Niki Lauda, who passed away yesterday, aged 70.

Niki Lauda was Formula 1 world champion three times (1975, 1977 and 1984).

“My brain was the only thing that I could control”

But in 1976 he had a crash at 150mph on one of the bends at the German Grand Prix and suffered third-degree burns on the majority of his body. He was rushed to hospital, technically ‘died’ twice before being resuscitated each time and had a priest read him his last rites.

His mental toughness is credited for not only keeping him alive, but also getting him onto the start-line at the Italian Grand Prix at Monza just 40 days later (in incredible amounts of pain, but still contesting the world title race which he had been leading by some margin).

You can hear about it in his own words on this video:

https://www.theguardian.com/sport/video/2019/may/21/niki-lauda-looking-back-at-the-life-of-a-formula-one-legend-video-obituary

“The mind leads and when it can the body follows”

For an injured athlete who is having a hard time, this may sound corny – like one of those motivational posters hanging on the wall of the gym such as “your attitude defines your altitude” or the like. But there is not only Niki Lauda’s inspiring story, but the increasingly considered ‘BioPsychoSocial Model’ in medicine which shows how interlinked all of these aspects are.

So even if your body is not responding to therapy for you right now, keep working on your mind. Amazing things are possible. You could be back in the fast-lane sooner than you think!

Good luck to all, and of course RIP Niki Lauda

Do topical treatments work?

When the problems are joints and muscle cramps, there are a lot of topical treatments that are marketed at you. But should you use them?

I am not medically qualified, but I have tried a lot of them out and read a lot of labels, so here is my layperson’s view:

There are probably two underlying reasons that you are looking at topical treatments:

  1. For pain management
  2. For localised healing

These two things are linked by the need to reduce inflammation – key for the early stages of healing, and inherently linked to localised pain.

I think that there are better ways to get to pain reduction?

Many of the medicated creams and patches are delivering ibuprofen or a similar drug. These are strong drugs that can have a major impact on your organs (especially if you are not well hydrated). So my recommendation is that if you need that pharmaceutical, take it orally and monitor the dose carefully. Trying to understand the dose from cream or patch is much harder.

Some help pain relief by delivering warming, or heating component via a chemical reaction. Temperature management is a great way of helping the body with pain. But personally, I would prefer to do it with a wheat bag (for heat) or an ice pack (for cold), rather than a chemical reaction.

But massaging the scar tissue with a suitable substance seems a good plan

It is universally agreed that massaging the scar tissue is key for helping the healing of scar tissue. And massaging in nutrients that are going to help seems like a good plan. Although it should be noted that every substance can have side-effects, so you should read all of the labels and look up the potential side-effects so that you know what to look out for.

Whether these are crushed Epsom salts in olive oil (for the Magnesium – to sedate the nervous system and draw out the toxins from the muscles). Or a magnesium sulphate spray or cream for the same effects (but a more expensive price tag! Reflecting the convenience of not having to crush the salts in a polythene bag with a rolling pin and mix in the oil!).

I also realise that there are different views. I love to read the blogs from Paul Ingraham on painscience.com and this one on Epsom Salts is apparently one of his most read:  https://www.painscience.com/articles/epsom-salts.php . I think that he does accept that some things can cross the skin, but is sceptical on the impact of magnesium sulphate. You can read his blog and decide for yourself (and indeed if Epsom Salts in the bath works for you – who cares if it is a placebo effect if it works for you?)

Or maybe Aloe Vera or Arnica-based creams/patches to reduce the inflammation and support the next stage of healing. I have to admit that I prefer the creams – as the patches do not encourage the massaging, and this is really important for the benefit to the scar tissue. Additionally, with the creams you see and control the dosage a little more – which is not so clear with patches.

Probably the best option is a skincare product with vitamin D (like Bio Oil) to moisturise and care for the scar tissues when you massage them. And always make sure that you put a high factor sun cream on the area for any exposure to the sun, as the new skin is very vulnerable.

When the pain goes down the leg or arm

The challenge of a lot of the nerve-based cramping is that the pain in the muscles put into continuous cramping can be completely debilitating. Massaging in muscle-relaxing gels or creams can help to reduce this secondary issue, although obviously, it is short-lived as it does not address the nerve issue that is causing the cramping.

Oral muscle relaxants do work, and again may be a better treatment for the issues (depending on how bad the symptoms are).

Overall

So in summary, I am not sure whether the topical treatments are the best way forward, as I think that a clearly dosed oral approach may be better. But for sure you need to find the skincare product that encourages you to massage the scar tissue to keep helping it to remodel properly. And a high factor suncream to protect the tissues in the sunshine.

Should I be taking painkillers?

Pain is such a difficult topic and in all of the people that I have asked, no-one is really able to give any clear answers. I have written some other blogs on pain itself. In this blog, I wanted to explore the topic of when to take painkillers. It is the question that I have asked every single medical practitioner that I have come into contact with and not really got any consistent or clear answer.

So here is my summary.

Pain as the protector

Pain is there for a reason – it is there to protect our tissues from damaging actions. So taking painkillers in order to be able to ‘push through’ and walk/sit/stand or even do more energetic actions is likely to be a bad thing. The physiotherapists generally seem to sign-up to the ‘listen to your body’ school of understanding the pain signal.

When we are trying to release the tension in over-active, tight muscles with stretches/releases, there are some tricks like using the contract/relax form of stretching that uses the inverse stretch reflex, or activating the antagonist muscle during the stretch to use reciprocal inhibition to enable the muscle to ‘turn-off’ and stretch.  But if the releases and exercises (to activate the under-active muscles) hurt such that you have trouble adhering to the physiotherapy regime, then the GPs seem often to recommend taking enough painkillers to get through these in order to support recovery.

Pain as the problem

When pain stops you sleeping and leaves you in a permanent state of stress (racing heart-rate, perspiring etc), then this is clearly a problem for your body as well as coping with life. For the body to have any chance of healing, it needs the parasympathetic nervous system activated (the one that goes with calm and balance), not the sympathetic nervous system (the fight-or-flight system). Therefore, if you are not sleeping or not reaching a state of calm, then it would seem necessary to take enough painkillers to manage this situation. Certainly the osteopaths and chiropractors seem to subscribe to this view of management – ideally without synthetic drugs, but definitely calming the system and getting it out of the hyper-vigilant or over-alert state that it can get into. Homeopaths will also suggest treatments that can help here.

Which is fuzzier – pain or painkillers?

A lot of painkillers seem to leave you feeling mentally very fuzzy and unable to focus and concentrate, but pain can also leave you feeling like the world is a long way away down a dark tunnel. So you need to find the type and dosage of painkillers (or none) that give you the best effect physically and mentally. Obviously, painkillers are more effective if you take them over a period, so taking them as the pain comes on, rather than when it is totally unmanageable will help – which I know is sometimes easier said than done.

Drugs are not the only solution

Research that shows that pain is worse when we are low and lonely, less active or less busy and feeling less good about ourselves. For some great explanation of the science behind pain check out these brilliant and simple explanations of understanding and managing pain at  https://www.retrainpain.org/

There are also all sorts of mental and physical techniques that you can try and see what works for you and your situation. There is no simple solution that works for everyone.

But what about the question of if/when to take painkillers?

You need to find what works for you. But I think that the principle of listening to and understanding your pain, and then recognising what you need to give your body in order to manage the pain and the recovery is really important. Painkillers may have to be a part of this, especially in the early stages, but the quicker you can get to other, more sustainable, solutions the better it is likely to be for your body.

I hope that you get out of pain soon. I know just how exhausting and enervating it is.

Why Injured Athletes need to actively manage the dangers of Social Media in their recovery

The power and privacy lapses of social media are big news at the moment, with regulators and Governments looking closely at issues such as Facebook’s deal with Cambridge Analytica. But leaving that bigger picture to them, how about the micro-picture of how social media fits into the lives of injured athletes, and how to manage the pressures and harness positives for recovery?

Most athletes will have Facebook, Instagram & Twitter friends and groups, Strava & Garmin groups and WhatsApp messenger groups that all rotate around the next training session and race. For some these will support the agreements with their sponsors. But for all they will be an important source of information and connection. The whole identity of athletes is often wrapped up in the exercise-driven world – this is their tribe. And every time they open any of these apps (which they probably did many times per day prior to their injury), it is a stark reminder of all that they have lost.

As I say on the opening page of this Injured Athlete website – this hits hard at the level of our human need of belonging, as well as our identity of who we perceive ourselves to be and how we achieve our physical and mental balance. Fighting all of those at once is pretty overwhelming, so you need some coping strategies!

Can you stay a part of your tribes?

Is there any way that you can stay a part of your tribe? Can coaching or supporting fill the gap for you? Can you be a social member? Is there anything behind-the-scenes that you can get involved in?

If not, then much like Jonathan Livingston-Seagull in the beautiful fiction book, you probably need to accept that you do not fit in the tribe any longer and find a new tribe… hopefully just for a little while, whilst you get better.

Form new groups

Can you make the walking group? Or the book group? Or the Friday or Saturday coffee group? Or even the injured athletes’ group!

Remember that the Facebook echo-chamber is not the real world

When it is very hard to get out and see people, social media can become the way that you keep in touch with what people are up to. But it gives a very fake view.

For most people, their Facebook status is an update more of the life that they would like to be living than the one that they are actually living. So you can get the impression that the world is having a brilliant time whilst you are not. And it can bring you all of the updates of where you want to be, but are not.

You need to decide what kind of content, on what kind of frequency is helpful to you. Then you can choose what platforms you want to visit, and via which devices.

Be careful about getting hooked on Social Media responses

Then there is the question of what you post yourself (or someone else on your behalf) and when.

I have seen some people who have gone beyond giving recovery updates on Facebook, into comments many times per day on their latest problem or mood. Maybe this works for them, but I sense their need to get even more comments and likes for each one of these comments, which I know don’t translate into real support or a good two-way conversation with someone who cares. And in order to keep getting comments and likes (which can become a focal point for people), there is often an escalation in the magnitude of the problem.

This addiction to likes and comments from others can happen to even the most unlikely of people when they are at the top of their game and do not look like they need the validation – so anyone can succumb to it when they are down and vulnerable!

It reminds me of the strategies that companies use when marketing a product – in order to be in the minds of the shopper the brand often increases the frequency and drama of their communications. This builds so-called top-of-mind awareness, even in ‘light buyers’ (infrequent purchasers of the product – or distant friends in the case of Facebook). But sustaining that level of exposure becomes a constant workload. I rebel against the thought that we have to keep marketing ourselves like this.

Maybe it is a reflection of my own vulnerability, but I would rather have many fewer friends and know that there was a meaningful bond in our friendship than measure myself in clicks, likes, and comments.

Finally – stating the obvious

To come full circle on the start, the reality of everything in the social media space is that whatever privacy you think that you have baked into your settings – this is not guaranteed.

Asking for the support that you need from your friends is so important, but this level of disclosure on a social platform with privacy lapses and making money from profiling you (including your vulnerabilities) may have consequences for you that are not easy to see right now. So I would suggest that the old-fashioned principle of ‘would you be comfortable with this being on the front page of the newspaper’ is a sensible one.

In summary

Overall, what I am trying to say is that I suggest that you approach social media to make it a tool in your recovery and rehabilitation. Unpick what it is about it that works for you and what does not.  Then put your plan into action and feel good about it.

Do you ‘Walk like a Man’?

Not a gender-specific criticism – I promise!

I just love Frankie Valli songs and had to use one of his song titles for this blog! That he can still be out there doing his Farewell tour and perform at 84 years is already amazing – and when we add in his vocal range, it is an inspiration that shows how training & technique can keep you going for a long time.

But this blog is all about posture – the muscle memories that we learn from young in how we stand, walk and sit.

A little game to play

Here is a little game to play next time you are in a place lots of people are standing – whether in a bar or waiting for a bus and a train. Have look at how people are standing. Specifically, look at their legs and the back of their knees. Are their knees locked out backwards? My experience is that at least half of all people stand like this.

It is often called ‘sway back posture’. Standing with the knees locked back pushes the thighs and the hips forward, which in turn means that the pelvis is tilted forwards (posterior tilt). This means that the lower spine has to counteract this by flattening (which is actually increased flexion vs the natural curve) and then the shoulders are back, but the head has to balance – so it leans forward, sometimes leading to a rounding of the shoulders. In terms of the muscles, this is tight quads, psoas and up the spine, with underactive glutes & abs, and probably short and tight hamstrings. All of this from simply locking the knees back – a habit that was probably learned from the day that they started to stand & walk – and is now embedded into decades of muscle memory.

And extending this to walking

Now watching people walk, it is striking how many people walk with the legs leading the way. Almost like cartoons. Where their legs and lower body lead the way and then the body catches up (see Robert Crumb’s ‘Keep on Truckin’ image for an exaggerated view.) This movement is simply an extension of this quad-dominant posture. Watch a crowd walk across a road and see what a large proportion of people have this walking posture – with the hamstrings, glutes and abs taking a holiday whilst the quads and spine do all of the heavy lifting (literally). 

A walking posture that looks after the spine and the posterior chain feels a bit like the POSE running technique – as though you are almost falling forward each step, with your leg coming under you to catch your body just in time. And with it, the pelvis moves gently compared to the rest of the body every stride (like a bucket maintaining stability to ensure that its content does not leak out) and the rest of the muscles work around it. A clue that you are on the right track is that you can feel the abs activated with every stride. Plus you may feel that you are taking fewer steps, with a higher cadence (more per minute) – which can be a very efficient way to walk.

If you are really keen to understand it, get a friend to video you walking – watching you from sideways on. The camera never lies!

Things that you can do

Changing how you stand and walk every day accounts for a lot of hours, and can really make a difference. So here are a few tips that may help:

  • Correct how you are standing every time – and as well as breaking at the knee, move it around – move into a small split stance and move the weight around
  • Think about how you are walking all of the time
  • Give friends and family the permission and request to comment on your walking, so that you can all work on it together
  • Stand tall, and find some moments to stretch in the day
  • If you are sitting for long periods, make sure that you stand and walk at least once per hour (ideally a lot more than that!)
  • Always try to sleep stretched out, not curled up or with your legs bent up
  • Make sure that you keep your feet parallel (not turned out) with every step when you walk

For more detailed guidelines and support, check out Jonathan FitzGordon’s advice on https://corewalking.com/

Obviously – as the song title suggests – how you walk projects some of your personality. But making sure that it is functionally kind to your body should keep you out of pain for a lot longer.

Best of luck – walk tall 🙂