Looking back at the time since my injury, I feel like this has been one of the areas that I have learned the most about – and so I wanted to share it with you.
In training, I think that you are always looking for that ‘Goldilocks zone’ – where you are stretched and make progress, but not to the level that it breaks you and forces you back. So that across your week’s training it is not too easy, and not too hard, but just right to get the adaptation that you are looking for.
When injured, this zone is even harder to find because there are no benchmarks. Indeed all of the normal benchmarks that you have are based on your previous, un-injured self and lead you seriously astray! It can be so hard to leave your ego behind in terms of what level is worthy of effort and exhaustion. An additional difficulty is that my sense is that the gap between stretch and stress is much narrower when you are injured, so you need to be more precise and wary of the smallest signs of over-reach, before the body stops you in your tracks. And these ‘tells’ may be completely different from those that you got when you were in full-on training and the onset may even come hours later (especially in the case of nerve-pain).
My own search for Goldilocks was a long one! In spite of constant commitment and tracking, I had a very long period where week after week I failed to get through the ‘simple’ exercises that were set – sometimes collapsing or passing out with the pain, sometimes just completely seizing up and suffering for the rest of the day and night before my next attempt. So managing to do the prescribed exercises consistently for the whole week between appointments really was a big deal.
I had no idea how much it had been torturing me. Realising this issue and actually managing to do seven days in a row of completing the prescribed exercise and actually managing to progress the reps, I now feel so much lighter in mood and belief. I start to believe that I am starting to recover and starting on my way back to life. Even though I know that these exercises are easier than a good proportion of my previous exercise sets, completing them means so much.
Why the breakthrough?
I still have a file of all of the exercise sheets that I have failed to make over the last 18 months (a few of them across 2-3 months of appointments with constantly trying and failing, and almost all of them still beyond me today). I should probably have put them in the bin, but have been keeping them for the day when I improve enough to get through and make the progress to be able to underpin the basics that could mean a return to life and sport. Looking back over them compared with what has worked for me over this last week, these are the things that stand out as differences:
- This exercise routine is broken down into a daily gentle mobilisation routine and the progressive part of the set is only every other day to allow for a recovery day. Many of my other programmes were up to 3-5 times per day, and always daily, which seems to have been an intensity that my body could not cope with.
- The first few months of the programme are all bodyweight movement exercises and only progress to include weights once I have built up to that.
- There is a ramp into the reps and sets, as the body adapts – with the first set very easily within my current capability.
- A golden rule is to always stop with at least 2 reps still in the tank. And never, ever going to the point of failure – as that can put the body into a state of alert and lead to more ‘guarding’ behaviour from the muscles (which can take weeks and months to then unlock).
- Every single exercise has one or more regressions to make it easier, in case the pain gets worse and I start to struggle – so I can do drop-sets, or easier sets. I have learned that every exercise has regressions, and what a difference that makes! Previously the exercises had been much more binary – it was do the exercises and if you fail early, then stop.
- We have gone through all of the key form points and gone to the point at which compensation sets in. For the compensations that we went through, I have a physical cue to keep the body on form (such as a roller balanced in the small of the back, a strap to keep under tension at all times, or the knees in contact at all points of the move etc)
- There is a clear goal to be able to breathe deeply and calmly throughout, not straining or bracing, or pushing through pain (but it is OK for the muscles to get tired or ache, as they used to when training). This is really useful, as there have been so many different views on whether you ‘push through the pain, as it is just guarding behaviour’ or ‘stop and respect the pain, as it is there for a reason’.
- We’ve got a clear commitment between us to keep to the recovery interval, reps and form precisely, even if that means a ‘fail’ – as this helps us to get to the root of the issues quicker and more accurately. This makes it feel like a partnership where we are both working on the problem together, rather than me feeling that as the patient I am the problem.
- The programme follows a clear and specific order of releasing overactive muscles and gently activating the specific muscle and then integrating it into the wider movement. This does make it a longer programme and means that there are no short-cuts, but really makes a difference. It also only works at the end-range for a short time, as this is very demanding indeed.
- There is a path forward with really small increments for the progression, such that there is a clear glidepath for progress, with check-steps and alternatives to take a different approach to address lack of progress. This fits into an overall ‘treatment’ plan that looks like a training plan, complete with blocks each with their own objective, quantitative progress testing every 2 weeks and a clear functional progression thread underlying all of it. Naturally every athlete wants to know ‘how long until…’ but I have really learned now to trust the process and just to focus on the progress in each of the 2 week testing blocks and making fast interventions when something happens that is not what we expected.
Why did not managing to complete the exercises come to have such a big meaning for me?
I have to admit that I am only just starting to pick away at and release the layers of blaming myself that I feel for letting everyone down, not managing with the basics of life, and for not recovering as expected. This is all psychologically very difficult.
As an athlete I had always believed that consistent and hard work would be rewarded. And that in a recovery context this meant doing always the exercises from the physio – no ifs and no buts. Early in my recovery a friend who is a physio told me that the level of adherence to exercises from the physio is only thought to be about 20% (and actually admitted that even when she goes to see a physio herself, she rarely does the exercises!) I vowed never to be one of those 80% not doing their exercises.
So when pain overtook me over and over again such that I would collapse weeping with the pain and retire to bed or lying on the floor to recover, I felt that I was letting myself and everyone else down. That I did not deserve to recover.
But that is all in the past now! And I think that if I had known the questions to ask (based on the 10 bullet-points above), I could have got there more quickly.
So what should you do if you are currently struggling?
Even if not injured, I think that we are all in search of the Goldilocks zone and can apply these principles in our training to get to the stretch zone, but not the stress zone! In rehab we probably need to dial it even further back – to ensure that we are progressing, but not getting into the overload zone.
Having now spent a lot of time studying corrective exercise and reading a lot of books, and doing online study, I have learned that there is literally no exercise that cannot be made more basic – moving it right back into exercises lying on the floor and building from key underpinning exercises of the correct muscle recruitment in breathing. So always ask how to regress (and progress) an exercise; you also learn a lot in the process too! I realised that I did not ask this enough – I would tell the physio how I had got on and we would either just try again the next week without changing anything, or they would tell me to stop doing anything for a week.
And when doing the exercises, always focus on form and the correct rest interval – stopping as soon as the form slips. This ensures that you get the real benefit. Plus see the sense of achievement with the progression. This does mean becoming more of a Strength & Conditioning (S&C) student than ever before! Watching athletes do S&C I’ve seen that strong athletes’ bodies often (effortlessly) find another way around by using the synergist muscles rather than activating the main muscle – so knowing the cues and checks is important. Things that your body could get away with before injury can put you deep into pain post-injury and relying on dominant muscles misses a lot of the benefit of the exercises!
Finally, I would say that often the focus is on strength (which is about the muscles) but can be about the recruitment (which is the messages from the nervous system). So it is worth understanding which of these it is, as that should change the pace and type of movements in the exercise programme.
Good luck in your search for Goldilocks!