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!

Why I asked for my money back on the FAI Fix

The FAI Fix was recommended to me by a friend of a friend. It was developed by two Personal Trainers (PTs) in the USA – Shane and Matt – who both had significant hip issues and manage to overcome pain, impingement and poor Range of Movement (RoM) without surgery – although they do admit that this has taken up to a decade of daily work! It comes with a number of success stories on the website: https://www.thefaifix.com/ and is supported by some really excellent YouTube videos and emails that made me really feel that Shane and Matt understood the issues and challenges of hip pain, and also explained the anatomy aspects of it really clearly.

However, when I was thinking about signing up for the programme I could not find any impartial reviews of how people had got on with the programme. And I saw tweets and messages of others looking for the same. So I thought that I would write about my experiences in order to support others.

The programme

There are 2 levels of the programme. The basic one is the FAI Fix Basic for $129.95 USD – a one-off payment that then gives ongoing access to the exercise library. There is then a further payment to do the more advanced programme for athletes who want more hip movement (eg powerlifters). But they are clear that this is a much smaller group, and is a progression from the first programme once you have resolved the pain in your hips in usual daily activities.

On the homepage, they explain their TSR system – Tissue Work, Stretching and Reactivation. This is a common (and well-proven) structure for many rehab programmes:

  1. releases with the foam roller, ball, knobbler etc to release the overactive muscles
  2. stretching to lengthen the tight muscles
  3. reactivation to activate and strengthen the underactive muscles

It is impressive how much more RoM you can get by doing targeted muscle releases before stretching that area.

There are a minimum number of tools that you need in order to be able to follow the programme – a foam roller, a strap (which could be a belt from a dressing gown), a lacrosse ball (or small, hard ball – there are different levels of hardness in therapy balls and the idea is that you progress) and possibly a ‘knobbler’:

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

When the programme link arrives there are 13 tests which are meant to narrow down which of the 5 key muscle groups is the issue. Then there is a TSR exercise set for each muscle group and a 6th workout that is a combination across muscle groups.

My experience with the programme

In advance of signing up for the programme, I was uncertain whether it was suitable for me given that I was 6 months on from hip arthroscopy surgery. However, I got a response that looked like it was a response from one of the 2 PTs reassuring me that it would be suitable – although looking back, I now think that it was probably compiled from a series of standard paragraphs.

Working through the programme is quite intense – the diagnostic exercises take quite a lot of set up and checking the form and RoM in front of the mirror. If you or someone in your family are not quite experienced in Personal Training and muscle groups it would be quite difficult to work through. And the challenge for me was that the tests were not discerning for me – all of them were painful and all of them had less-than-ideal RoM, so it was hard to diagnose where to focus.

I diligently followed the programme daily for 4 weeks. The good news is that I did see an increase in my RoM, but no reduction in the pain before, during or after the exercises. Therefore, I followed the process to get advice from Shane and Matt. I wrote a summary of how I had interpreted the 13 tests and what I had been doing, but got only a 2-line response from someone other than them telling me that I needed to choose just one muscle group and focus on that, but no further details on how to make that choice or how to better understand the diagnostic tests (given that all were painful and low RoM).

I followed the advice for another 4 weeks and then got in touch again, but did not get any response this time. In the meantime, the general emails from them changed. In the first couple of weeks, they had been bits of advice and case studies which were definitely motivational – especially on fixing the body through movement rather than surgery. But after that, the emails continued to come 3-4 times per week, but were now trying to sell more stuff (tools, personal coaching, other programmes etc). 

So, I decided to ask for my money back (which in-line with their no-quibble money-back guarantee they refunded immediately – although interestingly they did not ask for any feedback on what had worked and not worked, or why I was asking for my money back).

My summary

The exercise video library is good (there are probably 50 exercise variants covering the 5 muscle groups), but I would suggest that the money is much better spent with a Movement Trainer who specializes in Corrective Exercise and can really help you to diagnose which are the problem movements and then focus a personalised programme on just what you need. This should actually start to address where you have the pain and monitor development and progress you see with the exercises, in order to then make choices on how to progress.

That said, the overall message that you can make progress on your hip pain without surgery is profoundly supportive. Plus there is a strong sense of realism in the sense that they are clear that it will take work and time.

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

My experience with hydrotherapy

I have not blogged for a while whilst I have been trying new things, doing lots of research and trying to make progress on reducing my pain and increasing my ability to cope with day-to-day tasks and activities. It has been an interesting voyage where I have become clearer that there are many paths to recovery – and no-one has the universal answer, so you have to try lots of things! With this in mind, I thought that I would share in a few blogs over the coming weeks some of my recent experiences.

Hydrotherapy was one of the things that was suggested after each of my surgeries. It is 45 mins drive to the nearest hydrotherapy pools and there are none in my local authority area. Plus you have to have a medical referral form and go through some extra checks to get access, so it all took a bit of organising. But I think that is was well worth it, as I think that it reduced pain in the short-term and had an incremental improvement in the Range of Movement (RoM) in the scar tissue and the affected muscles.

What is hydrotherapy?

The hydrotherapy pool is kept at 37 degrees Celsius, which consistently feels very pleasant and after 30 mins of doing structured exercises feels positively hot!

It is about shoulder depth and about 10m across, so it is easy to get the benefit of the water resistance as well as the immersion.  There is also easy access, including a hoist so that you can get in and out even when your body is not working well. Given that there is only space for a small number of people, it is key to reserve the slot and be there changed and ready in time.

You can work with a physio in the session, but once you have a routine it is relatively easy to work through the exercises on your own. There are ‘weights’ made from floats to create additional resistance by pushing them down in the water and inflatable ‘noodles’ for support.

How is it better than a normal pool or hot tub?

I had tried both the normal pool and hot-tub, and would say that the hydrotherapy pool is much better.

Doing my exercises in the pool was hard work (remember that 1 litre of water is 1kg – so there is lots of weight in the water resistance), and the cooler water temperature that makes it suitable for swimming means that there is not the therapeutic benefit of the muscle release that helps with RoM and probably with the pain reduction too.

I had also used the pool to try a little aqua-jogging with the float-belt (as shown in the photo). This is used a lot by elite athletes when they have injuries and it is claimed that you can keep 80% of your running fitness if you put the same hours in at the pool. This should work really well for lower limb injuries where you need to keep the muscle memory, but avoid the impact (especially in stress fractures and some soft-tissue overuse injuries). But given that for me the inflammation affects the movement pattern, I found that it was too tough at this stage.  

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

The hot tub is useful for me for the muscle release and for managing some of the pain. But it is not deep enough or large enough to do all of the exercises, so it is not as good as the hydrotherapy pool. I think also that the 30 mins slot, where everyone else is also working on their exercises, brings a level of focus that really helps.

Did it make any difference?

My own experience was that it was a very supportive environment – everyone there is working on getting better and is very willing to share what they have had success with.

In terms of the physical impact, the warmth definitely had a positive impact in terms of reducing pain for a few hours (just like hot water bottles etc when at home). My understanding is that this is not universal – some people find that the pain is reduced with cold, others with warmth.

Plus, I found that 30 mins of hydrotherapy definitely improved RoM for a period of 24-48 hours and if I did it 3 times per week, I saw real progress on my land-based exercises. That said, it was positively hard work – after 30 mins the combination of the temperature and the hard work was very tiring and I was keen to get out and have a nice drink of water! And the travel on top made it quite a bit harder. So, I would say that if you have a hydrotherapy pool nearby, do make use of it in your recovery and rehabilitation.

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.

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.

Starting to move without pain

A local triathlete told me how Somatics had changed her life, with just a couple of treatments.  For her, it had made the difference in terms of the pain in Carpal Tunnel Syndrome, which is very much linked with the nervous system and had led her to extensive suffering for a long time. Plus she said that it had freed her lower body movement, such that she could consistently put out an extra mile per hour on the turbo trainer.

So I thought that it was worth some more research.

The somatic part of the nervous system is the part that is associated with movement and the techniques of the Somatic approach was initially developed by Thomas Hanna, who sadly passed away in 1990 aged only 62. But others such as Martha Peterson in Colorado, USA have now picked up the baton and there are practitioners in the UK.

I was struck by the part of her website that talked about the fact that she prided herself on not having repeat clients, because once  people have learned the techniques they become self-sufficient.

Martha Peterson’s book ‘Move without Pain; is excellent and explains the techniques very well, which are simple, accessible and need only take 15-20 minutes.

For you to have a go yourself, have a read of the website, and you can sign up to the 5 day online course for a taster that will teach you 4 techniques and give you a chance to see whether it makes a difference for you. If you are unable to move without pain, the investment of an hour across a week seems a good return on effort to check this out!

http://essentialsomatics.com/hanna-somatics-overview

Whilst Thomas Hanna is the founder of Somatics, I have to say that I found the pictures in his book rather hard to follow. So Martha Peterson’s book of ‘Move without Pain’ was much more accessible and easy textbook to put the techniques into practice.

Why you need to get out of pain, right now!

It sounds obvious doesn’t it? Getting out of pain has to be one of the key goals, if not the over-arching goal! But if you are badly injured, pain can become your constant companion – whether you are lying inactive, or trying to move around.  And when this situation lasts months or even starts to be measured in the years, getting out of pain seems to be impossibility. You get so used to the fact that even breathing hurts and you can start to lose sight of the goal of getting out of pain. But it is really important, and needs to remain front and centre.

You may have thought that pain is just an electrical signal

Back in biology class at school, you may have been taught that pain passes as an electrical signal up through the nervous system, in order to get the body to move away from the source of pain. More recent work has proved that even the electrical components of this are more complex (Pain Gate theory), as well as the fact that there is a chemical cascade that is set into motion by the nociceptors (the scientific word for the sensory receptors for painful stimuli in the nervous system). The nociceptors release Substance P and this triggers a release of histamine. Both of these chemicals are neurotransmitters, and the histamines are also involved in the inflammatory response.

The bad news is that these two chemicals have additional impacts – they increase the sensitivity of the nociceptors to pain, and the excess histamine has been linked to increased anxiety in the brain and inhibiting the release of serotonin and dopamine (classic feel-good chemicals in your system).

So if you get into long-term pain, the chemical soup is working against you  

Once you are into the chronic pain (pain that has lasted more than 3 months), you are likely to become more sensitive to pain for these chemical reasons. You can start to hurt in new places. And of course the impact on your mental coping strategies for the pain, and the loss of sleep can lead to irritability and depression.

This is why sometimes the medical team talk about taking blood tests to understand the levels of your inflammatory markers, in order to understand your situation better. On the basis of the imbalances (deficiencies or excesses) of neurotransmitters such as serotonin, GABA, dopamine and norepinephrine, the clinician can develop the right treatment plan for you.

How chronic pain can link to depression

Depression and chronic pain share some of the same pathways in the central nervous system of the brain and spinal cord, and the same chemical transmitters are involved.

In addition to some of the chemical reasons why chronic pain can make you feel very low, there is another negative cycle – pain creates anxiety, irritation and agitation in everyone. This tension and stress on your system , which can cause sleeping issues, physical incapability, loss of appetite and a sense of not being able to cope with all of the other issues.

Articles suggest that perhaps half of people who complain of pain to their Doctors are depressed. And depression makes pain feel worse. This in turn is even more depressing.

If you are worried that you have a lot of the symptoms of depression, do talk to your GP about it. Hopefully this blog has set up that a combination of the chemical and physical realities are the reason that people end up in this place. And hence a combination of medication and Cognitive Behavioural Therapy (also known as Talk Therapy) can help .

This is why you need to break the cycle

I found this excellent Pain Management guide from NHS Ayrshire and Arran – with full recognition of the excellent work from the NHS team there. I think that you may find working through it is a breakthrough for you.

https://www.nhsaaa.net/media/5071/pain-management-workbook.pdf

Within it, I would strongly recommend that as an injured athlete you turn to the section on ‘Managing Activity’, which starts on page 22. Mapping your activity and pain cycles may seem a little difficult, but if you keep some notes over a few days and then draw them out as a graph over time the patterns become very clear. Are you yo-yo-ing through an Over-Under cycle? Or pushing too hard with an Over cycle? (You can read more about these on pages 22 and 23).

You have got to get your activity down to a sustainable level

Whilst you may find these low levels utterly ludicrous and frustrating, you must give your body the chance by getting your activity down.

This means looking at your day and:

  • Planning – not going on feel and overdoing or underdoing it
  • Prioritising – you will not be able to do all of the things that you want or need to do, so prioritising will help you choose
  • Pacing – breaking things into more manageable chunks with more rest

This should help to avoid flare-ups, but they can still happen. So you also need to have in mind your plan of how to avoid them, and then how to minimise the impact and calm the system down again. For instance, if you go out – can you take a car or have the numbers of friends who might be able to pick you up if you need to get home quickly to manage a flare-up in pain levels.

You will have your own pattern of what causes flare-ups and how you can manage them. But having a plan can reduce the number and impact of flare-ups. (There are also some good worksheets in the booklet on pages 29 and 30 for this).

In summary

So in summary, don’t keep pushing through as the challenge of getting out of pain will only increase. There are things that you can do and it is both the right goal, and an achievable goal to get out of pain – even if you have to involve your GP and other clinical support.

Best of luck in your journey to pain-free!

When should pain stop my running?

Most of us have seen track athletes lying writhing in agony with the lactate in their legs, or even track cyclists suddenly vomiting from the amount of lactate that they have built up. And endurance runners always talk about it being painful and ‘pushing through the pain barrier’, so how does anyone know when they should actually stop, recover and rehabilitate? The goal of this is to help to create good training habits in terms of injury management and resilience for runners, triathletes and those who do a lot of running mileage as a part of their training (but it does not cover the impact of high lactate levels from very high intensity work using the anaerobic system).

The key is learning to understand the signals from your body

Development in training is built on the principle of progressive overload of the muscles, and so there is likely to be a level of soreness when you are training hard. This can be during and immediately after the run, or 12-72 hours later in the form of Delayed Onset Muscle Soreness (DOMS).

The reason that you get this muscle soreness is that exercise creates micro-tears in the muscle and with rest these recover and grow back even stronger, ready to do the challenge again. This cycle is called adaptation. You can help this process by doing a few good things:

  1. Getting some nutrition into the muscles within 30 minutes of finishing your workout. The muscles need protein to build the muscle and carbohydrates to replace the glycogen stores that you have used up. Testing of 4:1 ratio of carbohydates to protein have found these to be good at building lean muscle mass and restocking the glycogen – so things like chocolate milk can be very good (especially as liquids get into your system a little faster than solids)
  2. Giving your body enough time to recover with quality sleep and rest.
  3. Compression clothing on the legs has also been shown to have benefits immediately after exercise (as long as the foot is also covered), which is thought to be from reducing blood pooling in the leg muscles, and pushing all of the waste products out of the muscles and into the bloodstream.

DOMS is an additional level of soreness and lasts much longer. It is often characterised by agony going down stairs – check out the DOMS Stair Test within the Fellrnr wiki: https://fellrnr.com/wiki/Delayed_Onset_Muscle_Soreness.  Many people find that gentle movement is best – walking or very slow recovery runs on smooth, flat surfaces will help to flush out the toxins and let you recover. If you are routinely experiencing DOMS, then you are probably progressing the length and intensity of your runs too quickly, so scale back and replan your training.

But what about those pains that are not just soreness?

There is a different territory of pain: sharp, spikey pains with clear pain centres, or any pains that you would describe as burning, prickling, cramping or spasms. These words tend to match pains that go beyond the muscles, into the harder-to-repair areas of tendons, ligaments, joints and nerves.

I am in the process of writing other blogs on nerve pain, and reviewing some of the excellent material on the impact and treatment of nerve pain for runners and other athletes. But in the meantime the headline is that there are dimensions of pain that if you find yourself describing them with these words, the indications are that it is a lot more than muscle soreness.

This is where a good training logbook is worth its weight in gold

Hence these are all pains to take very seriously and get straight onto monitoring. If you keep a training logbook or diary, you should note down any level of aches and pains, so that you can look back and see when did you first have even a minor twinge in this area, how fast has it progressed, and is there is a pattern of low-level pains. For instance, is there a pain that you get only when running on certain surfaces? Or at certain intensities? Or distances?

In turns out that there is no measurable unit of pain

Whilst most things in life have a measurable scale, pain is sufficiently complex and individual that it has to be scored individually and subjectively. There are lots of different scales https://paindoctor.com/pain-scales/ but the most common one (and used by most UK healthcare professionals) is scored by the individual on a 0 to 10 scale, where zero is no pain and 10 is the worst pain that they have ever experienced.

It is really hard to think about this when you are in pain, so here are some words that might help:

Pain Level Description
0 No pain
2 Pain, but it can be ignored
4 Pain interferes with tasks
6 Pain interferes with concentration
8 Pain interferes with basic needs
10 Pain requires bed rest

But what does this mean for running?

I know how hard people find it to decide when to stop running, so here is my personal suggested scoring for pain:


My table of pain scale and what it means in running, with a suggested recovery action for you to take

I would suggest that whilst racing may take you to all of the way up to a level 5 (where in training you should stop immediately), you need to listen to your body and know whether this is a race that you should choose to DNF or ease back to simply make the line, vs hanging in there at all costs.

And I really hope that in training, at a 3 you would be walking and deciding whether to get your phone out and get a lift home to let your body recover for another day.

I always believe that the mark of a great training plan is the consistent build-up of sessions that progress you, but leave you ready to do the next session with quality, to get yet another progression.

Best of luck out there on the roads and trails! Make good decisions and look after your body!