"Never Be Ashamed Of A Scar. It Simply Means You Were Stronger Than Whatever Tried To Hurt You."
This is a 3-part series. Why? Because injuries are multi-layered. They're irrational. Complex. Throw surgery into the mix, and it gets even more hairy. The fact of the matter is, injuries suck. People try to make you feel better about them, through a coping mechanism of throwing new age rhetoric, spiritual advice, and inspirational quotes at you. If you're anything like me, its just pisses me off more. I'm already frustrated. I'm not asking for a sermon, a "Hallmark" card, or anything else, except for you to acknowledge that its frustrating and it sucks. Don't say you'll be there "for" me either. You can't. Its my journey, and mine alone. What a patient needs to hear you say is, "I'm here with you."
Why? Because, there will be many ups and downs. Tears of anger, frustration, fear and sadness. You cannot walk that road for me. What you can do is be a listening companion when the pitfalls and plateaus occur.
This is something important to remember. Whether you are a health care provider, spouse, partner, family member, friend, whatever...you cannot be there FOR someone. You can only be there WITH someone.
With that being said, this first part, of the 3-part series is focused on the physical. The other two parts will address more the emotional and mental components, because they are real. Very real. For some of us, even more real than the physical pain. Most athletes have a high pain threshold. There's even a little bit of "hurt-so-good" that we all even get off on. We have to, otherwise we wouldn't keep going back to our sport. To an athlete, the emotional and mental are much bigger demons to grapple with than any physical pain. Its why we're athletes.
But today, we will discuss some physical things you can do for pain, both pre-op and post-op. They're both equally important. I'll also share some physical tips that have helped me. Everyone's different, but over a decade in practice as both a licensed acupuncturist and personal trainer, have given me some insight on this topic. I've treated it, on both the pre and post op ends. I've also helped personal training clients regain their strength, agility, flexibility, speed and power, when they thought there was no hope. As a patient, I'm going through that rehab. process myself. I'm no longer a health care provider, whose on the outside looking in. I'm living it right now. Its painful, frustrating, heartbreaking, and a long haul. You have to search, everyday, for small successes. You have to clap for those small successes when no one is clapping for you. Its often an empty lonely feeling, and no one can sit in the fire but you. You get burned, charred, roasted...and then you get up the next day and do it again.
PRE-OP: Everyone's process is different. Some people will be able to get into surgery the day of the injury. I didn't have that luxury. I live in Bend, OR. for multiple reasons: originally, I moved here to climb at "Smith Rock State Park." I'm a climber, first and foremost. It has been a chunk of my adult life. Its the activity where I truly found my power, my mastery over fear, was able to glimpse what I was capable of in extreme conditions, and could test my physical limits. Bend is a mecca for the outdoor enthusiast. If you live in another part of the country, you could almost think of it as the "Aspen," "Mammoth," "Telluride," or "Moab" of the Pacific N.W. With top athletes, from all over the world, moving here for the outdoor access, comes lots of injuries. And, waiting in line for surgery. Sometimes for weeks, which was my case. I was in excruciating pain for weeks, until I was operated on. I passed out unconscious from the pain level, three times the first week, post injury. It was that bad. One time I vomited, so hard from the pain, I ended up passing out, hitting my head on the toilet, and waking up in a pool of blood. It must've occurred when I hit my head on the toilet. I don't remember. I fancy myself a girl with a very high pain threshold. According to my surgeon, "You didn't break your collar bone. That would be easy. You, essentially, threw a boulder through a glass window, and shattered it into a hundred pieces."
How did I manage the pain, as I had to wait in line for surgery? There were 20 mountain bikers ahead of me, all waiting for new collar bones. "Everyone needs a new bike and collar bone in Bend," my surgeon laughed. Sleeping became next to impossible. Sleep deprivation only throws gasoline on the fire of pain. I don't take pharmaceuticals, normally, but I know when they're needed. I tried everything the surgeon gave me. Nothing. No pain reduction of any kind. I was shocked. I really thought the strongest pain meds. out there would knock out a "light weight" like me. Not at all.
Finally, after consulting with my Naturopathic physician, I bit the bullet, and got some marijuana edibles. I'd never taken edibles before. I don't drink. I haven't smoked pot in years. It never really did anything for me, except give me a sore throat and make me feel lethargic. I'm too active for that. Sitting on the coach, eating junk food, living a hazy life, doesn't interest me. But, damn, was I glad for one tiny little 25 mg. chocolate marijuana edible per day. That one little chocolate bought me 8-10 hrs. of pain free sleep per day. It was truly a god send for me during those weeks leading up to surgery. I told my surgeon I was taking marijuana edibles. He approved. Each state is different, but in Oregon its legal.
I'd never had a judgement about people needing marijuana for pain. I've always voted in favor of it. But, hell, if I didn't have a whole new level of appreciation for it now. I also used the same 25 mg. chocolates for 2 days post-op, then nothing after that for pain. Side effect free.
PRE-OP, Hurting In A Big Way (I can still smile while I'm in pain)
If you need this level of pain relief, let you're Dr. know you're doing it. I spoke with my LNP and she approved whole heartedly. There was nothing else they could give me for pain. Go to a qualified, certified dispensary. Don't play with strains and dosage yourself, unless you really understand the plant, and all the science of its anti-inflammatory benefits. I have a graduate degree in herbalism, and I still don't pretend to be educated on this plant. Growing marijuana, and the resulting pain relieving medicine that comes from it is both an art and science. Don't pretend to know it if you don't.
I also went to the pool, every single day, from my injury to surgery. Why? Most people forget about the pool, and water's amazing healing benefits. I knew that one of the side complications of an upper extremity break is "frozen shoulder," or adhesive encapsulitis. This is problematic. I treat it with acupuncture often. Its better to prevent it, than treat it. To have your arm in one position, day in, day out, in a sling or otherwise can create this issue.
In the pool, there is little load on the skeletal frame. That means, if you have a fracture or a broken bone, even swelling from another type of injury, that you will experience relief in the water. Just ask a pregnant woman. She feels immense relief at the gravity being taken off her body, as she carries her own skeletal frame around, plus a baby's. This is why, often, water birthing tubs can bring such relief for women in labor. It takes all weight bearing load off her, so she can focus on the labor process.
For one hour per day, my body was free of pain in the water. I also felt safe in that weightless environment to take my arm out of the sling and slowly, gently, move my arm in various directions, to prevent "frozen shoulder." Keeping your arm in one position, 24/7, for weeks on end isn't wise. A number of complications can ensue from it. If you can, plan to be in the water, and move it slowly, every day, until your surgery. According to my surgeon, I went into surgery with the best range of motion possible. He was shocked. He asked me what I did. When I told him, he was amazed. "If all my patients did that, surgery would look different." I believe in the power of water in all ways: taken internally, for fitness, pre/post-op range of motion, breath control, there isn't much it won't do for you. My father taught me this. He believes water will cure, or assist most things. I think he's right. As soon, as I was cleared from my surgeon, post-op, to get back in the pool, I did immediately. Again, I'm ahead of schedule on where my range of motion should be. This is because of the water, and diligent, consistency with both physical therapy and acupuncture weekly. There's no question in my mind. These three things are a magic combination.
Some physical therapy clinics have hydrotherapy pools at the facility. Some physical therapists even get in the pool with you, and assist you with various exercises. If you have access to this, take advantage of it. If you don't, perhaps speak with your physical therapist about what exercises he/she recommends you do in the pool. You won't be sorry you did. Once my incision was completely healed, and I was cleared by my surgeon to get in the pool, I've seen exponential gains, daily.
Acupuncture and physical therapy should be considered "non-negotiables," post-op. Pre and post-op is even better. I treat many people, who come in with their "tail between their legs," saying, "Almine, I'm here because I wasn't consistent with my physical therapy, and now, a year later, I'm in bad shape." Don't let that be you. Do it right the first time. Give you body the environment and tools it needs to heal properly. Acupuncture makes physical therapy work even better, and vice versa.
And speaking of water...I've got news for you. As a certified fitness trainer, with 6 different certs. in water fitness, I'd like to invite you to think "outside the box," in the pool. Many people find swimming tedious. "Almine, please don't tell me to go to the pool. Swimming is so boring. I go up, I go down, up, down...I don't like to get my hair wet, I don't like to get my face underwater, etc." I've heard all the reasons why my patients and personal training clients squirm at the thought of getting in the pool. Think on this 'lil "nugget" of advice from my pool loving father: "Swimming is the one sport you can age with." True story. There is little, if any, downside to water fitness. I do want to stress the words "water fitness." If you want to read more in depth about this, you can visit another blog post I wrote on the topic: http://alminewellness.blogspot.com/2013/04/water-fitness-why-you-should.html
There are many ways to workout in the water. If you do enjoy lap swimming, and its a motion your physical therapist has cleared you to do, you can add a little fun to it by purchasing a waterproof iPOD. Download your favorite playlists, and match your cadence in the water to a motivating beat. SwimOutlet.com has got a variety of them to choose from.
Waterproof iPOD for a motivating beat while you swim
Also, "SpeedoFIT" is a system of fitness that appeals to a "CrossFit" coach, like myself. I like the high intensity movements of "CrossFit." One of the criticisms of "CrossFit," and I believe its warranted, is about form. Particularly, in the Olympic Lifting department. I agree with this criticism. You need to be able to look whatever system you adhere to/support, and be able to criticize it, also. The water forces you to slow all movements down. You have no choice but to concentrate on form. Doing kettlebell work, at the bottom of the pool is not only difficult, in the way of breath control, it also forces you to work on perfect hip extension, glute activiation, and posterior chain mobility. And, in case you were wondering, the added resistance of the water makes each movement even more difficult.
People have a strange concept that things in the water are easier. It couldn't be further from the truth. They generally don't account for the added 15-25x more resistance than they'll encounter on land. Its a full proof medium for fitness, with little to no injury factor. Its genius for rehab., and beyond. You can find some great ideas for water fitness at: http://www.speedousa.com/speedofit
Everything from kettlebells, resistance paddles, push plates, and barbell work can be found there. I'd also highly recommend you check out your local pool's class schedule. I used to teach an "Aqua Boot Camp" class, for years in Portland. It was not an easy class at all. That rope you typically see the kids play on at the pool? Yeah, you climbed laps up that, fell in the water, swam sprints, did partner carry work, kettlebells, etc. Many students couldn't complete one class, and this was at a top training facility, where elite "Nike" athletes trained. The water is a level playing field. Its improves everything, and everyone's fitness, no matter what sport you play.
More and more innovative ways to improve one's fitness, and decrease recovery time, are being discovered. Recently, I went to Las Vegas to the national "AquaBike" training facility. I met with the staff, discussed both rehab. and fitness possibilites, and tried out the latest water training equipment. For several days I ran and biked my heart out...under water. Yes, you read that right. The future of fitness is in the water. You heard it here. Throw a spin bike in the pool, and it'll feel like you're biking through deep snow. An underwater treadmill makes a "True Form Runner" treadmill look like a warm up. They were incredible pieces of equipment that were both difficult, and eye-opening, simultaneously. Again, emphasis, due to the resistance of the water, was on form. Like running in quick sand? It may not sound appealing, but the benefits are amazing. Think you're a good "CrossFitter"? Work out in water. A slice of "humble pie" is coming your way, and it tastes good :-)
Aqua Biking & Running In Las Vegas, POST-OP
Fitness is something I can't emphasize enough, pre-op. I was limited in what I could do daily. Brushing my teeth was exhausting. I couldn't brush my hair. Doing the basics "winded" me. I'd have to sit down, after going from one end of the house to the other. That's how much effort it took. To get off the sofa had to be pre-meditated. It would send so much pain through my body, if I did it even slightly at an improper angle, my knees would buckle, and I would involuntarily fall back onto the couch. The only way I figured how to do it, pain free, is with the "Turkish Get-Up" movement (see video). How did I know that movement, and have it down pat? From over a decade of "CrossFit." Am I advocating you do "CrossFit"? It may seem like it, but not necessarily. What I am advocating is that you make fitness a priority in your life. I had to carry heavy things, sometimes, when I was alone at home, with my "good arm." If that arm wasn't in shape, I would've felt helpless, many more times than I already did. Fitness is there for you, when your body is injured. If you injure one leg, be grateful you have a strong other one. Established fitness will help you feel capable at a time when you're at an all time low.
A Broken Wing Is A Sad Girl
Often, I treat people for their "good" limb, because the person was out of shape to begin with, had a surgery. Then, because the other limb wasn't in good shape to begin with, they injured that one too, trying to do everything with it. Now, we have two injured limbs. A strong, flexible, cardiovascularly sound body is a machine. It will "pick up the slack," when its injured. You'll be grateful the rest of your body feels capable and strong, when one part isn't. Fitness is preventative. Its also curative. Make it habit. It will give back to you a hundred fold.
Another system of fitness, that I've recently embraced has been "Barre." The founder of "Barre 3" was told by her physicians that after a serious injury, that she would never do the sports she loved again. She could not accept that. She sought out the best yoga, ballet and Pilates teachers in the world. She combined the 3 disciplines into a fast burning, strength building system that has been amazing for my recovery process. I love yoga. I taught mat Pilates for 10 years in Portland. I did ballet as a teenager. These were three combined disciplines I could get behind, and feel comfortable knowing I would stay strong, without the high intensity impact.
To put hardware in one's body entails critical stages where the hardware is vulnerable to be jolted out of place. My surgeon was serious in emphasizing this. One martial arts instructor busted all 10 screws out, just by teaching his students to "shadow box" last month. Several days prior to my one month, post-op appointment, a man hiking, came in with internal bleeding from his plate being jolted out of place. "All he did was hike down a hill," my physician's assistant said. "No backpack on either." There are critical junctures where even lower body activities, such as box-jumps, jumping rope, etc. are out of the question. The possibility of hardware coming out, while the bone is still healing, is still a high possiblity. "Barre" was the perfect answer for me. Lots of max static hold movements, while holding weights, makes for an incredible workout. "CrossFit" advocates training small accessory muscles. How many really do it? Few. How many know how to train them correctly? Few. Exercise such as Pilates, barre work, and yoga train your accessory muscles, force you to focus on form, and sweat buckets while holding awkward poses with complete balance. Its pure concentration, mixed with strength, flexibility, and body awareness. "CrossFit" is difficult with large motor movements. "Barre" and Pilates is difficult with small motor movements. Both are needed for complete fitness. They're yin/yang of one another. Train small and large motor movements, you have perfect fitness.
You can never do too much core work. You can never work on activating your glutes enough. My chiropractor speaks of "glute amnesia." This is a correct term. We overfire our quads and low back to make up for the lack of horse power our glutes need to be executing. "Barre" corrects this. I'm confident I will go back to climbing, martial arts, etc. with a stronger core than ever. I don't think I'll ever stop doing "Barre" from here on out. Everything about me feels stronger, more supple, with little possibility of jolting my hardward out of alignment, as my body heals. Max static hold work is just as important as fast reps., at high intensity. They both train your body and mind in different ways. They're both necessary. As Bikram Choudry says, "You're born with one of these gifts: flexibility, speed, or strength, but no one is born with balance. We must all work on this, every day."
I want to give one last "plug" for something that has been immensely helpful for me, both pre and post-op. That's "floating." This may, or may not, be available in your area. If you're local to Bend, you can go to "Float Central": http://floatcentralbend.com/
We're getting back to the concept of hydrotherapy, and water as healer, again. Floating is a different way that water can heal you, other than the pool. Sensory deprivation in a world of both audio and visual "pollution" is a welcome respite for the senses. When my body was in so much pain I couldn't think, I would float in a epsom salt saturated tank in the darkness. Again, the water's weightlessness provided relief for my tired, aching body. The darkness was pure bliss. Silence. Peace. The high concentration of epsom salts makes your post-workout epsom salt bath, at home, look like a warm-up. They mimic the concentration after the "Dead Sea" and the "Great Salt Lake." You couldn't sink if you tried. The salt concentration is sheer buoyancy. The saturation of epsom salts gave my aching muscles, that were trying to support a shattered bone, relief. I highly recommend it. Athletes all over the world are using these salt concentrated, sensory deprivation tanks to visualize a successful outcome, and give relief to both their body and mind.
Some people have difficulties meditating, and quieting their mind. Sensory deprivation tanks are a wonderful "training wheels" tool to assist with that. The quiet darkness is lovely, and forces you inward. There's nothing distracting you from going within. I'm grateful. I began meditating at 17 years old. I became a bit "addicted" to it, to the point where my teacher said, "You're going to have to integrate back into the world, and not just sit here all day." I love meditating. I don't talk about it a lot. Its personal and pretty private for me. I'm not here to be a guru, or self help teacher. There are great masters in this world here for that.
From an Eastern philosophy perspective, its best to seek out a "Mahatma," or great soul, for instruction. It seems as if every new Western self-help teacher, who has experienced some hard knocks in life, comes out the other side, believes he/she is qualified to teach others. I'm not a fan of this. Its a dangerous path, from my perspective. I'm not here to teach people to meditate, give you an instructional on how to do it, or even say its your path. I am here to say that silence, and quietness in the dark is something that everyone's nervous system can benefit from, in this sensory saturated world. Particularly, when you're in pain (of any kind). Sensory deprivation tanks offer 90 mins. of silence. Give it a try if you need to rest your weary body. I'm so happy I took the advice of one of my patients, and did.
My colleague, Dr. Kerie Raymond, Naturopathic physician, is a fan of the homeopathic, "Symphytum Officinale" for broken bones, tendon/ligaments strains, "phantom pain" from amputation, sprained ankles & "tennis elbow." I've been taking this remedy, along with Chinese herb formulas, since my surgery to speed recovery, also.
There are always adjunct things to do alongside these suggestions: essential oils, sauna therapy, compression therapy, etc. I would discuss these things with your qualified team of health care providers, to see if they can be a part of your physical rehab. program. If lavender oil on your temples helps you sleep at night, do it. If sitting in the sauna makes you feel better (not worse) afterwards, do it. There's wonderful options out there now. I work at a fantastic athlete recovery facility. I feel grateful I do. Its state of the art, with the best recovery equipment in the world. I utilize that equipment, according to the instructions of my phyiscal therapist, Dave Cieslowski, from "FOCUS Physical Therapy," the best in town. That, combined with the other above mentioned things should, offer you some tools to go into surgery with confidence, and to help you feel empowered throughout your rehab. process.
Look for part two, next month on how to navigate the emotional roller coaster of post-op recovery. Its a doozy and requires honest self-inquiry, and radical patience. Its is a lonely process, but an honest one. You won't be the same person, when you come out the other side. And, that's the point.
If you'd like further suggestions for acute injuries, you can go to a previous blog post I wrote: