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What happened when I met a rock-star physiotherapist!

Regular readers of my blog will know that one of my pet topics is how do you know which Health Care Professional (HCP) to go to? How do you work with them for a good outcome? And how do you know when to run out of the appointment and never return to that person again?

My lumpy rehabilitation journey has allowed me to build up a larger-than-average sample of interactions, create a picture of myself as a ‘failed patient’ after two years of never managing to succeed on two successive weeks of physio exercises, and now I am delighted to say that my quest has led me to meet a rock star physio (and actually succeed!) So I wanted to tell you all about it…

How did I find him?

Part of spending months and years incapacitated has led me to want to really understand what is going on for me physically. So I have attended every single free seminar/webinar/TED talk etc online that I can find related to recovery. It has been fascinating and illuminating.

Paul Hobrough has written two books (‘Running Free of Injuries’ and ‘The Runner’s Expert Guide to Stretching’) and is so famous that even my Mum has heard of him. Initially I thought this is because he is based in Northumberland (where my parents live), but actually it is because he has a great common-sense column in one of the national newspapers! I heard him speak on an England Athletics webinar and when I heard that he was doing tele-medicine appointments, I had to give it a go….

Sharing the history

After years of being in and out of treatment rooms, I think that I have my history giving down to a pretty good delivery. It is definitely a learned skill that requires years of practice and improvement before graduating to professional patient level, but I hate the oral tradition of history taking. Here’s why:

  1. All HCPs are pressed for time, so when you have a complex history (as I have) I have seen the panic start to rise in their eyes and them start to look for straws to grasp at – which means that landing the holistic overview of the situation is hard. And any glancing contact with something that they have been taught is a red or amber flag leads to them jumping in with an early diagnosis and potentially the whole appointment and interaction is derailed as you either succumb to a snap-judgement that you think has already been investigated, or you try to have a respectful debate with someone who is (and wants you to know that they are) so much more of an expert than you are.
  2. In my experience the majority of HCPs are very bright, studious people with a strongly introverted approach to life. This means that they are brilliant at really thinking deeply about issues and working out great solutions – but only if they are given the time to do this. Hence the extrovert’s style of iterating through oral history-giving has to be bad for them. Additionally, they need time to consider how they are going to share their views back with you (the patient), so that you can understand them.
  3. From a patient point of view, there are times when I am in such a mess that I can barely string a sentence together let alone a complex history under time pressure. Because pain makes you live in the moment, it can be hard to step out of the moment and give a balanced overview at that point of time.

This is why I always email my history over before an appointment. Almost every time I have done this the HCP has pre-read it and come in with questions (only one did not – they proceeded to read it aloud in the appointment and then lecture me on what a pathetic specimen of a human being I was for not understanding what was needed – for a whole hour without me getting a word in edgeways – that was an appointment where I should have stood up, paid and left).

What was the difference that a rock star physio made?

Here’s the parts that blew me away:

  1. EMPATHY: Paul created instant connection between us by making a very humble joke about his presentation at the seminar that I had attended. I went from being very nervous to laughing in seconds, and I also understood that the ground rules were that it was OK for me to ask anything – which completely changed the power dynamic in the appointment.
  2. DIAGNOSIS: In the first 5 minutes he not only summarised his diagnosis of what the issues were, but also how he thought I understood them – he repeated back to me the language and things that I had said in my email.
  3. UNDERSTANDING: We then spent another 5 minutes where I was able to question him about this more – and I felt like I was having a personal medical masterclass, where he simply and clearly laid out medical theory, practice and levels of certainty in lay language that genuinely made sense to me and where it was also OK for me to say where I did not fully understand it.
  4. REFRAMING: Within this he completely reframed my expectations. I saw the medical process as me vs pain – with success as elimination of pain. He got me to talk about triathlon racing and the normal types and levels of discomfort in training and racing.  From there we agreed that it was about control, pacing and self-management of pain – which seemed so obvious (but was a new insight for me).
  5. GOAL-SETTING & OWNERSHIP: As we got to the midway point, he moved me into goal-setting. At the time I was in the split mentality of “I want to return to Ironman Triathlons but think that will be impossible – and my day-to-day is governed by so much pain that I often cannot walk to the corner shop”. He gently nudged me to explore a goal that I thought was an impossible ask, and he saw as a very viable 3-month goal. It was so exciting!
  6. DETAILED PLANNING OVER 3 MONTHS: Then he moved into explaining to me the specific movements that were going to be challenging, how to dose them in, what signs would show that it was working and what would show that I needed to regress the progress. He was completely unapologetic that it was a lot of work – that even writing the excel sheet with the programme on was a lot of work – but even that was exciting to me. I wanted to be a part of this and I was completely signed up to whatever work it took.
  7. SETTING UP SELF-MANAGEMENT: So having specified the programme in detail, he delegated me to write it and email it to him for review and any feedback/changes within the next 3 days. I did, but he had explained it so clearly within the appointment that no changes were needed.
  8. TRANSMITTING CONFIDENCE, BELIEF & HOPE: Then he wrapped up with the ‘piece de resistance’. He said “I back my opinion and experience and I really think that with this plan, you can make this goal in 12 weeks. But it won’t be easy – I think that you will have a number of setbacks – and we’ve talked about what it looks like when you need to regress, how to monitor symptoms, how long to rest it and how to move forward again each time. I also accept that no-one can truly know what is going to happen and in the event that in 12 weeks this really hasn’t worked then there is another more interventionist path that we can take, that has good scientific evidence behind it and has worked for a lot of people.” In that closing minute he had imbued me with his sense of confidence, belief in the plan, readiness for setbacks and knowledge that even this plan was not the end of the road – so there was always hope. If I was summarizing it as a mantra it would be ‘you’ve got this!’

What happened next?

I followed the plan – it happened 100% as Paul said. It was hard work, it took patience and tracking. I had set-backs and had to follow the approach that we had talked about. I doubted at times, but always thought back to his confidence to reassure myself and follow the exact detail that we had agreed. In 12 weeks I hit the goal that I had only dared to dream could be possible.

All from one 30-minute appointment – where an incredibly intelligent and kind man with a wealth of knowledge gave me the keys to the castle, to unlock so much of my misery.

I haven’t seen Paul since – and I feel bad that I only paid him for that one appointment. I can only reassure myself that by not clogging up his agenda with more he has been able to change so many more lives for the better.

Thank you Paul.

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And breathe (out)!

One of my goals for 2021 has been to get back to blogging. I think that it is fair to say that everyone has found the last year tough, and that there are still some hard yards to travel. But the outlook is so much better with the amazing work of the scientists to get to vaccines.

There has been a theme recently that seems to pop out at me from so many diverse areas that I wanted to learn more about it. And the theme is breathing! It seems to be a part of every aspect of life, from how to lose weight, to how to manage difficult situations, to getting to sleep and staying well. But is all of this an over-promise?

I became very conscious that I personally had stopped breathing much deeper than the top of my ribs because the pain of moving my ribcage was substantial. This was such a contrast from the deep belly breaths that I used to take when I was doing sport that it was striking. But since my activity levels had dropped so much, these little sips of air seemed enough, and they just made it all hurt a bit less (or so I thought!)

But reading this book – Breath from James Nestor – opened my eyes to the fact that breathing is just so important. And especially important in engaging the parasympathetic system, which we need for healing. And that actually it is the out-breath that is the most important part for engaging that.

It’s a fabulous book, with well-explained examples and analysis. Some of it is pretty mind-blowing! Who knew that we have a Nasal Cycle across each day where we use our nostrils differently and then switch?!

And if we are not already standardly nose-breathers, then the importance of grooving that habit!

But it led to me deciding to work on how I was breathing. Across many months and multiple times across each day (rather than just when I was struggling to get to sleep). So I thought that I would share the journey that helped me to find some of my favourite exercises – in case they are helpful for others.

  1. I started by training my body to let air into my rib cage and to expand the diaphragm down into the stomach space – and to do this in different positions. So I would lie face-down on the floor, with a little ‘fist pillow’ to hold my head straight but nose off the ground, and I used the sensation of my body on the floor to feel the air coming into my ribcage and also my stomach expanding and then the opposite when I breathed out. Over time I played with the order of the chest vs stomach expansion (to give the body a sense of control, and even playfulness, with the breathing).
  2. Then I started to use the breath as a signal to my body to release. So in my physio exercises, I would start with a minute of deep breathing exercises. And in each of the rehab exercises, at the point of maximum stretch, I would then look to do 3-5 deep in- and out-breaths, counting to 5 on the way in, 3 at the top, and 7 on the way out. I’d feel the breath impact on the tissues as they settled into the most difficult parts of the rehab exercises.
  3. I also discovered the Box Breathing app on the phone. Box breathing has been made famous by the military as a technique for creating calmness, focus, and readiness – even under the most extreme conditions. The technique is simply that you use the same count for breathing in, holding at the top, breathing out, and holding at the bottom. You have to focus on it and work on control. Over time you can increase the count. (The app counts out loud for you and also gamifies the amount of work that you have done on improvement).
  4. By now I had started to get a little bit hooked! So I started investigating all of the different breathing techniques from yoga. I had done a few in my weekly yoga class before my injury and with the help of YouTube, I rediscovered these and more.

There are a whole selection of videos on the site related to the book: https://www.mrjamesnestor.com/breath-vids

So 6 months on from my hilarious ambling through breath in every context, what have I actually integrated into life?

I have to admit that I have not stuck to all of those complex techniques, although I tell myself that if I do get back to yoga classes again then I would embrace them with enthusiasm.

But I have:

  • Become very focused on the benefits of breathing with movement to manage the pain in my body – and found T’ai Chi as the tool that brings me the most success here.
  • Kept the daily discipline of ‘resets’ in the day where I take 3 minutes to do some box breathing before starting something new. Whenever I go to get a drink, I use this as a cue for one of these breathing breaks.
  • Made the 5-3-7 pattern the start and consistent focus in my rehab exercises, as the way that my body can absorb the challenges of these movements and not fight back with fear and tightness.
  • Used a deep sighed out-breath and then 3 deep, slow breaths as my step into calmness when I notice the mental or physical signs of stress creeping up on me (the shoulders coming up towards the ears, the tight feeling in the pit of the stomach or an increase in my heartrate as I anticipate what might happen next)

I’m interested in whether breath management has been a part of your rehab journey, and what your experiences have been with it?

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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.

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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!

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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.

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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!
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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.

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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:

Healing Mantra’s To Help An Illness:

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’

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The skinny on scar tissue

Scar tissue sounds like one of those things that you can do very little about. But actually it is a little more complex than that!

Scar tissue is laid down in the key ‘proliferative’ phase of healing and then remodels during the maturation phase of healing. If you want to read more on this, read my blog ‘How do you heal after invasive surgery?’ http://www.injuredathlete.co.uk/how-do-you-heal-after-invasive-surgery/

This image is my simple visualisation of the haphazard scar tissue on the left, and then how it settles into the correct structure after remodelling on the right. This gives a sense of why the scar tissue feels tight, solid and lacks the usual movement and elasticity of the remodelled tissue on the right.

A simple demonstration symbolising the multi-directional aspect of scar tissue on the left, and the linear nature of remodelled tissue on the right.

But not everyone lays down scar tissue in the same way!

It transpires that different people lay down scar tissue in different ways, and therefore can get more complications from the adhesions and slower remodelling.

How can you know if you are one of those people?

It is probably difficult to know, if you have never had any surgery before, but a couple of signs that would be worth looking at are:

  • Do you still have lots of scars from cuts and grazes from your childhood? Or have these faded away now?
  • When you have had cuts or grazes over the last few years, has the mark (both in texture and colouring) lingered for a year or more?
  • And if you have had surgery, did the scar fade to an almost invisible light white line within 6 months or linger on?

If you are on the longer ranges, you could be someone who lays down stickier scar tissue and takes longer for it to remodel into the usual tissue, with usual movement and function.

What can you do about this before surgery?

If you already suspect this before your surgery, do talk over with the surgeon your previous healing and the types of movement and sport that you want to be able to return to. The choices that they make can really change your scar tissue – and counterintuitively, sometimes a larger scar can mean less scar tissue.

And if you are having keyhole (or arthroscopic) surgery, so not underestimate the scar tissue. If you can imagine, it is like a sticky rope of scar tissue that goes from the point of entry to the point of surgery. And that can be quite a distance. In areas like the hop there are lots of different muscles, tendons, ligaments and bone for it to stick to and in the abdomen there are also organs.

Straight after the surgery

As soon as the surgery is complete, the surgeon and physiotherapists will often get you moving through as much of the range of movement as you can. This is to gently tear the sticky scar tissue off things that it should not be sticking to and is especially important with joint mobility.

As soon as the wound has sealed up, there are four things that you can do to help the scar tissue to start to remodel:

  1. Massage it for 5 minutes at a time, using your finger tips and moving in all directions with as much pressure as feels comfortable. Remember that the surgery will have cut through 7 different layers of tissue and they each need to remodel.
  2. Rub in some Vitamin-E based oil, such as Bio Oil to help the process
  3. Protect it with a high factor sun protection cream if you are going out in sunshine, as it will burn really easily and this will damage the healing (as well as discolouring it)
  4. Keep drinking lots of water and eating a good high protein diet, so that there is lots of collagen for the body to call on. There are mixed views on whether a collagen supplement help, or whether a diet with things like oily fish and chicken broth are sufficient.

Through the next phases of healing, gentle movement through the range of movement (with no weight or resistance) will be key in order to get the sticky fibres to only stick in the right place! If you start to get into a lot of pain, you should be:

  • Talking with your physiotherapist and surgeon about the risk of unwanted adhesions and sharing what pain you have at different parts of the range of movement.
  • Showing them your scar – especially if you feel that it is too raised up from the surface of the skin, or too indented.

Best of luck – do not be despondent if you are someone who lays down scar tissue differently. The body is an amazing thing, and it will do the remodelling. It may just take a little more time, and that may mean a longer recovery phase for you and sadly more pain for a while, plus needing to keep focusing on range of movement for a little longer before you progress back to your activities and sports.

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HELP YOURSELF! TOP TEN TIPS

When you are injured, the level of incapacity can be overwhelming. Here are my top ten tips of things that you can do to help yourself:

  1. Go online – get your groceries & goods delivered and your banking & services online. Whilst you may not have had the time previously to set this up, it is so easy, and when you are injured, you are home all of the time for things to be delivered!
  2. Find nutritious prepared meals. When every movement is an agony and being on your feet is hard – find the meals that just need putting in the oven and taking out.
  3. If you are really struggling, ask someone for help. A lot of your friends will want to help, but be unsure what they can do. So call them up and ask if one or a group of them can help with cooking a few meals and freezing them, or coming in and stacking the dishwasher every couple of days, walking the dog, taking the kids to school, or whatever that task is.
  4. If you cannot bath or shower, can you get to the leisure centre? Most leisure centres have a shower block which does not involve any steps, and a shower with a seat. So if you can borrow a wheelchair, or get in there with your crutches, you can have a much safer shower than in your own bathroom (which probably has a ton of accessibility challenges). PS – if there are wounds that you really need to keep dry, clingfilm around the area does not work, as the water just goes behind it! You will need to get a large enough waterproof dressing. I found that our local independent pharmacy were really expert on wound dressing and management (so worth phoning around to find who can help you once you are out of hospital).
  5. Set up call-barring for nuisance calls. You will have your phone right next to you as you try to get the appointments that you need and talk with the experts on your injury, but nuisance calls are wearing!
  6. Can a family member do the medical appointments for you? One of the most debilitating things is that there are a ton of phone calls, documents and follow-up with the medical profession. When you are out of it on pain medication, this is close to beyond you! If someone can do this for you, it will be a huge help!
  7. Have a pad on hand and write lists and notes. When you are drifting in and out of shallow sleep, and have taken lots of painkillers, you really struggle to keep on top of things. So just write things down – including things that are worrying you, how you are going to talk with the Doctor tomorrow, things that need to get done etc.
  8. Get a sticker on the door to stop cold callers. You may be happy to struggle to the door for the thoughtful parcel or flowers from friends, but the cold caller is truly frustrating. You can get the sticker from your local police, Neighbourhood Watch or Trading Standards.
  9. Hairdressers etc will all come to you. Whilst you will have been used to rushing around and doing your chores on the run between other things, there are ways that almost everything can come to you.
  10. If you need more help than your friends and family can give, ask for help. Have a look at this website: https://www.nhs.uk/conditions/social-care-and-support-guide/ and talk with your GP and also Citizens Advice can help you.

I really hope that these make you feel less alone in facing the challenges associated with your injury. You will come through this and there are people and mechanisms there to help, if you can track them down.