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.

Round and round in circles

My experience of rehab is lots of circles!

Whilst finally being able to move a little can feel like a release from incarceration and make you want to re-explore the world that you once knew, the reality is that it probably needs to be much closer to home!

You need to be ready to stop and rest, or stop and return home at any stage – as pushing through pain can lead to a major set-back. So, I have built loops with benches, coffee stops and quick routes back to the car (in order to return home).

I think that I now know the distance to all of the benches within a half-mile radius of home! And even bought one of those walking sticks with a pop-up seat. It was surprisingly inexpensive, and actually comfortable enough for a little rest and recovery – although you would not want to sit on it for a long period!

Having a goal, but being flexible on the way of achieving it

Initially, I struggled because the goals seemed ridiculous – for instance 4 laps of 200m in a day and then a rest day seems petty when you have run marathons and ultra-marathons.

And then I struggled even more because I could not complete them without being doubled-over with the strobing pain – the other part of the goal was without any increase in pain level.

The goals are really important – as they help you to make and monitor progress over time, without over-extending yourself. And I learned to stop deriding how petty they were and to start to think of little rewards if I managed them, like a square of dark chocolate or a cup of coffee.

I also learned how to regress it when I could not achieve it – either by reducing the distance, or by increasing the rest interval. So I would walk to the bench with my book and if my body was not ready to walk back, I would either sit for a while or read for a while and then head back. And then do the same later in the day.

The psychological benefit of a change of scenery

I would also drive to wooded areas so that even very short loops looked and felt different as I walked them. And the opportunity for a nice cup of coffee as a reward sitting at a different café and taking in a different view!

Rule number 1 – leave the watch at home!

I have to admit that the only time I would do laps was as a part of training – whether a track, road or off-road loop – the goal would always be to look at the splits of each lap! This mentality of constantly pushing yourself is not at all the mode of gently listening to your body for the early cues of progress or issues – so it is important to leave the watch at home, and avoid cheeky glances at the lap times!

The hardest parts & my coping mechanisms

The parts that I struggled with were:

  • Stopping in time – since often the worst pain would be later in the day, I struggled to find the cues of when to stop if the session needed to be curtailed. The two insights that helped a little were: (i) spotting the very early signs of fatigue and stopping whilst there was at least one more lap in me and (ii) leaving enough time for my body to settle in between each one – so I would plan to sit for at least 10 minutes and at times 30-40 mins and even an hour to let the body settle and see how it felt.
  • Keeping the discipline and only doing the plan, even on days when I felt I could do more – because I couldn’t wait to be better and make faster progress, it was hard not to over-extend by adding an extra little walk to see something when I was feeling great. Especially when I was with friends, for whom so little activity was quite boring and their natural temptation was to tacitly or explicitly encourage you to go faster or do more. My two coping mechanisms were (i) for all that it was lovely to see people, doing these was better done alone and meeting them for a coffee later (ii) keeping a log of all of the exercises and what level and type of pain I had was a useful tracker for the programme and to talk with the medical experts.
  • Sometimes these leave me very inflamed and I then struggle to sleep – so I always do the sessions in the earlier part of the day in order to give the body more time to recover.

In summary – celebrating the circles!

As you probably gather, I found the process of going round and round in small circles rather hard to get my head around. So planning for it and finding ways to celebrate is key – every single one marks progress and is an opportunity for some fresh air and seeing different things. So well worth celebrating!

Finding Goldilocks!

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:

  1. 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.
  2. 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.
  3. There is a ramp into the reps and sets, as the body adapts – with the first set very easily within my current capability.
  4. 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).
  5. 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.
  6. 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)
  7. 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’.
  8. 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.
  9. 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.
  10. 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!

My Saturday night at a ‘Psoas Release Party’

There have been many firsts since I got injured, but spending over 4 hours on a late Saturday afternoon and early evening at a ‘Psoas Release Party’ is one that I thought you would all like to hear about!

The workshop was led by Jonathan FitzGordon, who started out as a yoga teacher in the USA but now works on rehabbing people in terrible pain. He freely admits that most people come across him at 3 in the morning, when they are at the end of their rope and don’t know what to do to get out of pain. This is exactly how I came across him.

What is the psoas?

Jonathan’s theory is that the illiopsoas is the most important muscle in the body. The ‘psoas is a really interesting compound muscle, as it is very difficult to reach and touch, as it starts deep in the back (up near the ribs) and loops around the inside of the hip before attaching at the front top of each of the legs in the groin area. For all its inaccessibility, it is a large muscle and is one of only 3 linking the front and back of the body, and attaches in 6 places – so pretty complex. It is often simply called a hip flexor, but it has a role in much more than this. Jonathan attributes the majority of long-term pain in the hips and back, plus the knees and feet, and even the shoulders to how the psoas is behaving.

I read Jonathan’s book ‘The Psoas Release Party’ and was struck with some of the concepts and case studies. I tried some of his stretches and releases and felt that I had started the journey. Then I saw that he was coming to the UK and was doing a workshop…

The description of the workshop said: “The psoas is the most important muscle in the body acting as the main hip flexor and the engine of walking. A free and happy psoas allows the body to move with peak efficiency and little strain. Issues with the psoas can lead to any number of problems throughout your body—both physical and emotional. Lower back pain and other joint discomfort as well as disturbances to the nervous system can be linked to the psoas. This is not a yoga class. You will spend the afternoon awakening, learning about and releasing the Iliopsoas muscle group and understanding its core function within the body.”

So that is how I ended up being one of 16 people crammed into quite a small yoga studio just near to Wimbledon studio on a late Saturday afternoon. It was mainly women, with a few men and the ages spread from early 40’s into 70’s – and every single person in the room was in pain, and wanted to do something about it.

How did the party get going?

Jonathan did an amazing job of making the anatomy really interesting and memorable, and before long we were all evaluating our dominant muscle patterns when standing still. He looked especially carefully at the balance between the front and back muscles, and the angles down the body: from head to shoulders, from shoulders to the lower thoracic spine at the bottom of the ribcage, from this point to the hips and from the hips to the ankle and into the foot.

He had a wonderful manner of wandering around and gently pointing out individual muscle patterns–for instance, the level that each of the hips were in the sockets, the level of internal/external hip rotation playing into the weight distribution in the feet, overall muscle imbalances and the level of tension in the glutes (butt) and rib-cage.

And what was interesting, was how we all had to be coached for the tell-tale cues and signs – even though almost everyone in the room (other than me) had a yoga or dance training, making them very body aware and elegant in their movement (but still in pain!)

What were the tell-tale cues?

Overall, the biggest message that I took from the workshop was that we all hold too much tension in the wrong places. Given that as soon as one muscle is tight, the opposite (antagonist) muscle simply cannot do anything until the first muscle releases. And this is important because some of these muscles (like the psoas) are large and connect with key processes like breathing, staying continent(!) and movements like sitting, walking and standing.

So stay loose and relaxed!

To do a body check yourself and see whether there are any ah-ha moments across the day:

  • Think about your butt when you are standing and walking – are the muscles tight? (if so, the psoas cannot do anything). A friend of mine tried this for a week and was stunned at how often across the day she found that all of the muscles in her butt were tensed up!
  • Think about your rib cage – if you sigh out a deep breath does the tension change? (if so your latissimus dorsi may be overworking)
  • Are your hips forward and your thighs extended when you stand? (if so, your hamstrings are constantly short and may get persistently tight)

Was there anything practical?

It was pretty much all practical! The four hours simply flew by – we did not stop for any breaks, and yet there was not a moment where I was not learning, making notes, trying different movements and learning more about the cues and signs of my muscle patterns.

The last 90 minutes was spent on 8 gentle stretching movements – most of which were held for a very long time (we did some for 15 mins, and Jonathan can recommend an hour or more at times!) in order to allow the psoas to truly let go. Whilst I had tried almost every single one of these from the book, the specific tuition on the important points of form was incredibly useful and I understood why I may have been missing out the benefits through simply trying it on my own without perfect technique. And the good news is that they are very easy to do at home (indeed one we even talked could be done in a break at the office, if you have a role that requires sitting at a desk all day – which of course is very bad for the psoas due to spending so much time in hip flexion).

Overall verdict – worth the money!

I have to admit that I thought about whether to attend for weeks before I committed – the hassle of a 45-minute drive to get there, no parking at the location and the £65 workshop fee. But my husband was kind enough to drive me and drop me off at the door, and benchmarked against other treatments that I have had, it was worth the money.

And like all of the best parties, with the late finish we were locked in!

I would strongly recommend Jonathan’s book – but the workshop took it to another level for me in terms of the personal insights and advice, plus the detailed coaching on the correct technique for the exercises. If you are not able to get to a workshop, Jonathan does do Skype consultations and I cannot over-emphasise the level of knowledge that he brings to your personal situation and his commitment to getting you out of pain. I am not at all surprised that he has helped and supported so many people to incredible recovery and rehabilitation.

And there is even a summer retreat in Italy…

Fascinating reading, with useful explanation and practical exercises

Affirmations and Mantras for healing

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

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

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

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

What kind of mantras help?

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

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

How do I apply that to my recovery?

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

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

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

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

Some inspiring quotes

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

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

So why not try it?

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

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

To go for surgery, or not to go for surgery

This is the moment of truth! Sometimes there is simply no choice and the only thing to do is try to manage the process so that your recovery can be the best that it can be (do talk about scar tissue with your surgeon!). But I have talked with people who have said that it is much harder when the case for surgery is not so clear cut, and the diagnosis or outcomes are less certain.

With the informed consent rules, it can be very difficult to get any definitive advice from the surgeon on what the likely probabilities are for different outcomes, and whether in their expert opinion it is likely to help or not.

You can feel very alone, in pain and probably having been suffering for a long time and feel that you have lost out on a lot of things. What should you do?

Many athletes have surgery and regret it

Many athletes end up saying that if they had known what it would be like in the years after surgery, they would not have had it. Don’t let that be you.

Some of the reasons may be that:

  • We are positive and believe that we can simply ‘will’ ourselves better, so when we listen to the range of outcomes and timings, we always believe that we will be in the best and fastest group – and maybe even tell ourselves that we can beat those odds too! This rarely happens. So brief the person who comes with you to listen carefully to all of the range of outcomes and probabilities.
  • We place high demands on our body, so even a slight level of dysfunction is noticeable and impacts our lives. We need to remind ourselves that almost everything has a workaround solution – you only need to watch the Paralympians to remind yourself of the power of this.
  • We may subscribe to the ‘instant-fix’ mentality of today’s modern world and forget that there is a lot of healing that takes a very long time. We are not like a bike or a machine, and will not be ready to go as soon as the mechanics are fixed – because there is too much soft tissue recovery, body trauma and system re-patterning to do.
  • We think that because we will be out of hospital in a few days, it will not take long. This is not at all true – whilst you will be home very quickly (and by the way you should plan ahead to ensure that you can cope in that difficult post-operative stage), the time for the body to heal is long. They will often cut through 9 different layers of tissue (even with keyhole) and each of these need to heal. Those with less blood supply heal slower, as they only get what they need more slowly. Whilst there are things that you can do that will make it go slower, there is little that you can do to make it go faster!

So what if you are facing the decision?

You have to find your own true-north on the right path forward… And all at a time when (for sure) your judgement is impaired as a consequence of the pain and frustration of your injury.

 Some tips that might help could be:

  • Take someone with you to the appointment to ensure that you get a well-balanced view of the probabilities of the range of outcomes. Having two of you helps to ask more questions and also listen and take notes in the appointment.
  • Ask about the surgery itself and understand the impact of the incisions and the consequences for the healing process. Often the scar tissue can be as much a factor as the ‘fix’ itself. And talking this through and understanding it can help with the decision (and indeed if you go ahead, with the choices around the exact surgical approach – for more on this read my blog on scar tissue)
  • Would you want to watch the surgery on YouTube?  Many people think that this is seriously squeamish and scary. But for others seeing it and understanding the different aspects enables an understanding of the level of trauma and recovery. And some watch it before going to see the surgeon, as it prompts different questions that they had not previously thought of. You need to think it through for yourself.
  • What is the sentiment on the internet about recovery from this surgery?  Obviously every patient is different and the internet will not tell you the answer for you. But if the prevailing sentiment is that it is a very long recovery, and not a full recovery – what are the common themes? And are there questions that you want to ask your Doctor about the specifics (without referring to the internet, as that is always how to upset Doctors!!)

What if you are not sure?

It is completely normal to come out of an appointment with the surgeon and to be really unsure of whether you want to go ahead with surgery.

If you wrote two lists on the same piece of paper – reasons, why to have the surgery and reasons why not – what would the balance of opinion suggest is the right answer? Is there any more information that would help to make it clearer? Is there anyone that you can talk over the list with to add more insight?

There are a couple of challenges to be aware of:

  • You can feel a sense of momentum that means that you feel pressure to go ahead (whether coming from the medical process, or from family & friends, or your own need to move forward). Resist it! This is a big decision and it is your body. So you need to be happy with the decision.
  • You may feel that there are no other options. This is never true.

So what are the other options?

There are a number of other options – some of which are below. Which one you go for probably depends on (i) how confident you are of the initial diagnosis of the issue, (ii) the level of improvement that you have seen (or not seen) through the current work of rehabilitating it and (iii) the levels of risk and length of predicted rehabilitation from the surgery.

  1. Get another opinion from another surgeon. You are absolutely entitled to this, and no-one should make you feel bad for asking this question.
  2. Continue rehabilitation with another physiotherapist (or whatever rehabilitation specialist you are seeing). There is a huge variation in the approaches that different people in the same profession take. And I would say that if you have been seeing them for more than a couple of months and are not making progress, then a change would be a good thing.
  3. Try a different approach. There are a lot of different therapy approaches, and when you spend a lot of time with clinicians you realise the levels of uncertainty – lots of intelligent guessing because they cannot see inside your body, and the level of variation in people. So for all that many can be very sniffy about ‘alternative’ therapies – these may be what your body will respond to.
  4. Give it some time.  This is a hard one – but can often work. So setting a time limit and truly resting and nurturing the injury by keeping away from activities that trigger it.

Good luck!

Only you can make this decision for your body – take your time and make sure that you feel  that you have explored the details and the options fully. It would be really sad to be a year or two down the line and regretting this decision.

Is your body cheating on you?

I have been reading a lot about some of the latest advances in understanding the brain and Alzheimer’s Disease. One of the concepts that interests me seems to explain why dementia seems to be so much faster and more brutal in the people who developed and used their minds the most. Research says that this concept is ‘cognitive compensation’ – that when the brain is used to working hard and solving difficult challenges, it finds work-arounds that disguise a lot of the early symptoms and copes for so much longer. And it struck me that the body does the same – that muscles and compensating movements and loading kick-in to get us over the line physically too.

Being an athlete can actually work against us

This issue of compensating is clearly a battle at every stage – other muscles and body systems stepping in and getting us through. It can stop us from spotting the issue early and dealing with it.

It can also be a big challenge in rehabilitation.

We have to stay so focused on the process

When the challenge from the physio is to build up to a certain number of reps and sets, this can become an all-consuming challenge.  And having been so pathetic for so long during the injury, every fibre of our mind and body wants to achieve this and start to return to the person we used to be.

But compensation can kick in so easily! And quietly…

So we really need to ensure that we totally understand the correct form and ways to check that the right muscles and movement are activating. We need to check every rep and be really honest on when the compensation is setting in. And this is why it is really useful to have regular checks from a physio, or starting to work with a Personal Trainer with a Corrective Exercise qualification and focus.

Quality not quantity

Compensated reps are empty reps. So whilst we need to ‘control the inner chimp’ (Dr Steve Peter’s book and philosophy of the Chimp Paradox) about not hitting the headline goal – we need quality reps, followed in such a way that they are pattern forming for our nervous system, muscles (helping ‘muscle memory’) and movement patterns. And if we cannot do it, this is really useful medical information that we can develop a plan to address. But only if we surface the issue and work with it.

Good luck!

Is it time to learn from a flea?

Fleas are amazing athletes – with the ability to jump 50 times their body length!

But the inspiration for injured athletes comes from the oft-quoted experiment with fleas in a jar. It is said that if you put fleas in a jar, then they jump out. But if you put a lid on the top to stop them jumping out, you can remove it a short period later and for all that they could jump out they do not. And this lasts for the life of those fleas – they have learned their new limits and do not exceed them.

The path to rehabilitation involves false starts

The really hard part of rehabilitation is that we need to keep trying things and pushing the body to learn and adapt. Sometimes this can hurt a lot, and rekindle the kind of pain that has been so hard to cope with before.

But somehow we have got to find the discipline and strength of mind to keep doing the activities recommended by the Doctors or Physios. Even if previously this led to pain or set-backs. Because this time ‘the lid to the jar’ may have been removed. And we can only find it out by trying.

This is especially hard for athletes

Every single injured athlete that I have met has pushed themselves too hard in the early stages of recovery. We love to believe that we can always be in the top 5 or 10% of people, and always beat the timings and goals through sheer willpower and determination. Sadly that cannot always be true for our bodies.

So as time goes on, the people around us get used to warning us and holding us back. And we too often start to look on the more pessimistic side, in order to avoid slipping backwards and to protect ourselves. But when is the time to move on from this important protection and guarding behaviour? How can we know?

Keeping a diary of activity and pain is very useful

Just like a good training log, a diary of activity and pain levels really helps to show the trends and ensure a gentle progression, together with the right nutrition, hydration, sleep and rest. It can also help to look at the potential reasons for times when the pain is bad, or you slip backward.

So we need to learn from the fleas as we progress down the rehabilitation path and need to spot the moments where we are being too conservative and could be holding ourselves back. Our loved ones and closest friends can also be really useful advisers, and we should ask them to look out for signs of when we need to step up and leave our injured past behind in order to get to the recovering future that we want so much.

Gaining the lift to recover after a difficult injury can be very hard, and takes work both mentally as well as physically.

How do you heal after invasive surgery?

Just recently I had two athletes each bemoaning the fact that they were not successful in returning to training within 2 weeks of surgery. They had both had abdominal incisions and were having issues with the wound not sealing and a lot of pain in the surgical area.

So how soon can you start back to training?

I thought that it would be useful to understand the hard work that our bodies are doing in this time. The hard part of today’s ‘instant-everything’ world is that we are not giving ourselves a chance! But we can help ourselves by looking after the wound and the healing process.

The healing process is 4 stages – and last in total over a year and possibly two years!

The four stages of healing happen in an organised and sequential way – but they can progress better or worse, depending on factors associated with you (both as a patient and how you treat the wound). The second part of this blog will look at the factors for you to promote better healing.

Stage 1 seals the wound and is really quick!

The hemostasis phase closes the wound with a clot (usually in a matter of minutes/hours). Various components of the blood combine to create a mesh that forms a clot that adheres to the wound and closes it off. You need to protect that. There used to be a school of thought that you had to let the wound be open to air for the scab to harden properly, but the new hospital dressings allow it to do this without removing the dressing – so you will probably be advised by the hospital to keep the same dressing on for some time, in order to stop infection entering the area.

Stage 2 prepares the wound area for the growth of new tissue

The defensive/inflammatory phase focuses on destroying bacteria in the area and removing any debris, such that the wound area is all set for the growth of the new skin and tissue. White blood cells and microphages in the blood do this. It normally takes around 6 days and you can often see and/or feel swelling, redness of the skin, heat and pain. Obviously if the area keeps getting new infections into the area, then this period is extended. During this time it is absolutely critical to keep the scab dry – so you will need to find some good waterproof dressings or a different way of staying clean (wrapping cling-film over the area does not work!)

Stage 3 is the progressive filling and covering the wound, starting from the outside edges

The proliferative phase follows three distinct stages: 1) filling the wound, 2) contraction of the wound margins, and 3) covering the wound with new skin. You probably remember watching this as a child, as the new, pink skin forms from the shallowest and outside parts of the wound and eventually closes it up. It is a very clever process that remakes the blood vessels, tighten the open wound (often giving an uncomfortable feeling of tightness for a time) and then the skins cells work their way up from inside the body to form the boundary layer. This can all last anywhere from 4 to 24 days, and during this time dissolvable stitches on the surface should drop out. In order to protect the wound, it is still really important to keep the scan dry in order to protect it from damage, although to the latter end of the timeframe many nurses say that you can have a quick shower, but must keep away from baths and any kind of swimming pool/hot tubs etc until it is all completely sealed. Also across this time, a lot of nurses suggest gently putting Vaseline or moisturiser on the scab, in order to keep it flexible and stop it cracking and getting damaged.

Stage 4 is where the scar gains strength and flexibility

The maturation phase is where the tissues reorganise and remodel as they mature. During the proliferative phase the tissue gets laid down haphazardly, whereas the uninjured tissue is all lined up in a standard structure. Over the usual replacement of the layers of skin, this slowly gets addressed and as it does the way that the scar tissue moves stops being a big block and starts to move with the body and has strength. This phase can vary from 21 days to 2 years, and you can help it by gently massaging the wound and encouraging the tissue to realign. Also many nurses recommend rubbing in Bio Oil or a Vitamin E cream, which seems to visibly help the scar to fade in colour and settle back to flat with the skin.

So it all takes time

Back to our athletes – getting the wound to seal and be ready for the forces of movement in the area of the surgery is probably around 6 weeks, and within this time nurturing the area to maximise the healing will really help.

Things that you can do to encourage faster healing

There are many factors that mean that people heal differently. Some of these are inherent to you as the patient. Age has a direct effect on how fast we heal – as we get older, the skin is thinner and less elastic so we need to allow it more time. There are also factors associated with your body make-up in terms of how your body lays down the scar tissue, which you cannot change.

However, there are a number of things that you can look after.

  • What you eat is really important – You need to ensure that you are getting some good protein at each meal, and foods that are high in zinc, copper, vitamins A, B and C can also help the healing,
  • Good hydration really helps too, as this has a direct effect on the blood stream.
  • A good overnight sleep is key. The body’s repair mechanisms work hardest during the deep sleep cycle – so do make sure that you are getting your head down and getting a good quality 8 hour overnight sleep (or more if your body needs it)
  • Reducing inflammation – many people swear by arnica. Obviously the cream cannot be applied to open wounds, but I found major reduction in the bruising around where the cannula was inserted by using the cream on the adjacent skin areas. And you can buy oral arnica from homeopathic providers such as https://www.helios.co.uk/ and it generally does not have any interactions with other medication that you may be taking (although check with your own Doctor and/or surgeon)
  • Managing your weight – skin heals better when it has the blood supply into the tissue, which muscles give but fat does not. This helps the supply of all of the agents for the different phases of healing, as well as oxygenating the wound area.
  • Keeping the wound area dry and clean – this is so important for the right conditions for wound healing. This can be hard to do, but is a really significant factor. Try to get the right balance between waterproof dressings to stop external moisture and getting it open to the air if it is in an area of your body that stays damp and then covering it again.
  • Medication can slow healing down – some medications slow healing by impairing the inflammatory response, leading to a reduction in the collagen production which is key, especially in the 3rd and 4th stages. Treatments such as chemotherapy affect the new cells, so have a strong impact on healing, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) that you may commonly take as over-the counter drugs can also slow down the process. Obviously you are likely to need medication after major surgery, but it will help if you can keep it to the minimum that you need and bear in mind that you may need to allow longer for your body to heal. 

So best of luck with your healing – do nurture your amazing body to do its thing! And after a major surgery taking a good month or 6 weeks off training that involves the juddering of impact, or the strain of strength training could be well worth it. It is also worth saying that there are other factors from surgery – for instance, anecdotally many Doctors say that it takes around 6 months for the body to completely recover from a general anaesthetic.