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.

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

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

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

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

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

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

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

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

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

A structured self-assessment and practical toolbox

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

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

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

Will this help me avoid surgery?

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

How to recover and trust your back

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

In summary

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

Love your feet!

I guess that I should have known how important feet are, but I will admit that I took mine for granted. And so when I lost all feeling in my right foot after my accident, I was still way too nonchalant. After all, the Paralympians run like the wind with blades – I was sure that I would learn.

The foot is so complex

Each foot has 26 bones, 33 joints (20 of which are actively articulated) and more than a hundred muscles, tendons and ligaments. Wow! And feet can move in so many directions and with amazing levels of control. And these link all the way up the leg into the lower back.

This is all so important to us, as tiny differences in the pressure and our movement at the foot level are all multiplied up through the body as the distance from the feet increases – with compensating and balancing to ensure that we stay upright and are able to do what we want to do. Think of how crucial footwork is in any fast-moving sport like tennis, squash, football, rugby, hockey etc.

So what should we be doing?

Given the importance of our feet, we really need to invest the same level of body care as we would in the other major muscle and movement centres. I went to a seminar with a physiotherapist who was proposing that runners should really do a 15 minute footcare workout every day in order to protect themselves from injury!

The toes are very important – especially the big toes

I remember a friend having an accident when we were in our 20’s and after it being crushed on a building site, he had to have the first section of his big toe amputated. This meant that balance and running were always really difficult for him, and he almost always wore walking boots with ankle support to stabilise his foot.

But it does not need to be as severe as that for us to lose mobility – in our feet and all of the way up through our body. Here’s a quick test – can you do the ‘vulcan salute’ from Star Trek (splitting your fingers between the 2nd and 3rd fingers) with each hand? Can you similarly control each of your toes?

Toes are very trainable – you only need to type ‘painting with feet’ into YouTube to be inspired at dexterity that people can develop in their toes.

A couple of foot work exercises for the toes

When sat down, can you use your toes to pull a towel along the ground? (without lifting the sole off the ground).

When you are lying in bed – when your feet are pointing upwards can you move your big toe up and down without the rest of the toes moving? And then the other toes, without the big toe moving? And now when you move your foot to point your toes, can you do the same toe flex and curl?

Difficult? You can help your toe mobility by continuously challenging your toes. Do also massage under the foot – through the arch just below the pads in the forefoot, feeling each of the bone/muscle and ligament complexes that control each toe (go gently, as it is always tender in there!).  Then extend the massaging and movement to each of the toes – pushing against your hand in different directions and with your foot in different positions.

Also, do roll the arch on a tennis ball. Be amazed by the simple test of touching your toes and remembering how far your hands reach. After 30 secs of rolling the arch on a tennis ball, focusing on those gritty, grainy parts with smaller circles. Then touch your toes again and check your reach. Amazing! (Some people sneakily have a tennis ball under their desk to do this arch-rolling in the office during the day!)

The amazing ankle

For all that the ankle is a hinge joint, you can do so much more than just the dorsiflexion/ plantarflexion movement of pointing the toes. You can actually roll the ankle from side to side in the inversion/eversion movement where from the feet being parallel, you can then bring the soles of your feet together and then roll the soles outwards.

This movement is incredibly important and useful for stabilising in walking and all sports.

So exercising it is good. Sit on a chair and with our hands on our knees to stop them moving, roll the ankle from side to side, so that the weight is over the big toe and then over the small toe. This may seem difficult to at the start, but is very trainable.

The feet are controlled from the lower leg

A lot of what happens in the feet is influenced by the leg (and indeed all of the way up the body).

Releasing the muscles in the lower leg associated with the foot movement is also very useful. It needs a lacrosse ball and careful placement and flexing, but this is worth doing daily if possible.

More inspiration

If you are battling with this, I have found the following website and podcast interesting and useful. Best of luck with getting your feet supporting your movement in the best possible way – reducing pain and increasing performance. Best of luck!

https://corewalking.com/

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.

Would a chiropractor be able to help me?

If you have been lucky enough not to have injuries in the past, you may not have any clue of who may be able to help you with your injury. One of the most common questions is what is the difference between a physiotherapist, chiropractor and osteopath? I also cover this in my previous blog www.injuredathlete.co.uk/how-do-i-know-that-i-am-going-to-a-good-physiotherapist/ 

Chiropractors generally focus on the integrity of your nervous system

The British Chiropractic Association www.chiropractic-uk.co.uk  says that chiropractors specialise in back pain, neck pain and sports aches & pains:

“Chiropractors specialise in assessing, diagnosing and managing conditions of the spine. They are highly-trained in finding the cause of pain in the spine. In the UK they undergo a minimum of four years’ full-time training. Importantly, chiropractors are regulated by law and must work within strict professional and ethical boundaries.  Before starting treatment, a chiropractor will do a full assessment. This will involve taking details about your condition, current health and medical history, and performing a physical examination. Sometimes it may be necessary to refer you for other tests, such as X-rays, MRI scans or blood tests. It is important for your chiropractor to gather as much information about your back pain as possible so that the most precise diagnosis can be made.

“Your chiropractor will then explain what is wrong, what can be done and what you can expect from chiropractic treatment.”

How do I know that it is nerve pain?

Of course, it is really hard to work out the cause of pain. Nerve pain accounts for much of the pain that goes all of the way down the leg (sciatica is a classic of this, but there are also other nerves that take different paths down the leg). The words that people usually use for nerve pain include words like prickling, tingling, burning plus sometimes stabbing, spasming and cramping. At their worst they can literally take your breath away and leave you unable to speak, stand or so anything.

Many people fear that chiropractors will be very physical and involve lots of popping

There is a range of chiropractic techniques. Some use just their hands for manipulation and other techniques use tools that can help to rebalance the tightness of muscles, tendons, ligaments etc and enable the rebalancing and correct alignment of the spine and therefore the body, both at rest and in movement.

The short, sharp movement with popping for spinal alignment is just one technique, and if this is not what you want, then talk with your chiropractor. For more advice, this link is worth a read:

https://www.spine-health.com/treatment/chiropractic/questions-ask-about-chiropractic-techniques

When you are in pain, there is lots of compensating

The bad news about compensating behaviours is that you can start to get pain in parts of your body that were not involved in the injury. For example, most injuries are more on one side than the other. This means that you are not evenly balanced across the two sides, but the brain does not tolerate the eyes not being level at all times. So the top of the spine often takes a compensating role, and this can lead to issues in your head and neck, as well as the site of the injury.

More runners’ injuries are related to nervous system issues than you might think

Joe Uhan has written a series of very useful posts on how often ongoing injuries in runners are related to nervous system issues. You could start by reading his blog on the I Run Far website for trail running and ultra-running https://www.irunfar.com/2017/08/six-signs-that-your-running-injury-is-nerve-pain.html and then follow the related links into his related blogs on treating nerve pain in runners.

I especially liked his guide to a neuropathic approach to healing www.irunfar.com/2018/05/six-principles-of-naturopathic-running-health.html

But if you are needing help with the healing process, cranial-osteopathy may be a technique that helps reduce your pain. And chiropractic interventions may help to find that ‘reset’ button to get everything working together again to move correctly without pain. Many athletes swear by the support chiropractors have given to get them back on-track.

Best of luck with finding something that helps!

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.