Overview of 2010 and hopes for 2011

A reminder of the 2 weeks of deep snow and freezing weather conditions of this December. It's a little Blue Tit just outside the patio doors, wishing he had a bit more branch to perch on!

I can't believe another year of 'rehab' has gone by....

This time last year, my body/muscles weren't capable of swimming. The most I could do was lie on my back and do flutter kicks for a short time (1-2 lengths). My frozen/dysfunctional left shoulder made it impossible to do any arm strokes (coupled with the fact that my shoulders were generally very weak and unstable). The weakness in my hips/core made me susceptible to injury if I attempted anything too vigorous or complex with my legs. I had to be careful and deliberate in all my movements.

Yesterday, I was at the pool and swam 20 lengths (10 backstroke, 10 breaststroke) (500 metres). Initially, nothing hurt, which was wonderful! After about 10 lengths, I was getting pain in the front of my left shoulder and battling cramp in both feet. But, there has been clear progress to get this point at the end of the year.

Below is the graphical summary for this year.

For the first 7-8 months, the average daily exercise continued to increase. However, I was still getting a lot of niggling pain/injuries. For the latter part of this year, I opted for a "less is more" approach and reduced the avg daily exercise to allow my muscles to grow/recover/repair between activities. I think it was important that I spent a good 18 months getting my body to do more and more - I guess it was essentially about getting my muscles/nervous system etc back 'online'. Now, I seem to be in a new phase where I can do less and concentrate on actually developing more strength.

Below is a graph showing the trend for the average daily exercise for the past 2 years. It clearly shows the steady increase until the peak and, latterly, the reduction to allow for muscle growth/repair.

The biggest issue through all of this rehab has been how to manage injuries and pain. There are a number of chronically problematic areas: the LHS lower back; left glutes/hip; right upper thigh/groin/hip and left shoulder.

I had hoped that by the end of this year the hip/back problems would have settled down but that's not the case. However, I am learning to manage them better. In particular, I think I've finally found the perfect stretch to target the LHS lower back tightness/pain:

Since I started using this stretch, the back pain has become more manageable (and, dare I say, is decreasing in frequency/intensity?!).

I definitely have more range of motion in my left shoulder now although it's still restricted and painful on abduction, in particular.

So, for 2011....let's put down some hopes/aims even if they evolve into other things...

• Be able to swim 1/2 mile (32 lengths)
• Get to a point where the back and hip pain are essentially gone
• Get full range of motion in my left shoulder without pain
• Continue to gain stability and strength in my shoulders and hips

Finally, this year, I have relished the involvement in table tennis and always felt like it symbolised tangible progress. Here's hoping 2011 has something of this tangible progress in it too.

Labyrinthitis

A week yesterday afternoon, I had this sudden episode of intense vertigo (feeling like the room was spinning) which then waxed and waned through the afternoon/evening. At the time, I put it down to tiredness and not sleeping well when I had a guest staying. On the Saturday, I took it easy, not wanting a repeat experience. Sunday, I went out for a great walk, 4.5 miles, which felt like a real achievement (although it aggravated and hurt my right upper thigh/hip/groin).

Anyway....by Wednesday, I'd developed further symptoms all connected with my ears. They felt blocked but my hearing was hyper sensitive. I was still getting short but regular experiences of vertigo and difficulty visually processing sudden movements especially on the TV. It kinda felt like my eyes would suddenly be spun around in my head and I'd have to wait until they stopped spinning. I made an appointment with the GP for the following day.

Thursday, my ears still felt blocked and my hearing was acutely sensitive. Every sound produced in my ears the sensation and shock of shattering plate glass. I'm having to whisper when I speak because the sound of my own voice is too painful to hear. Boiling the kettle, flushing the loo, every sound feels like it is hitting the raw nerves in my ears. The waiting room at the GPs was virtually empty but what noise there was was almost unbearable to process and it was the impact of the sounds in my ears which made me feel nauseous and dizzy just sitting there.

The GP confirmed that my middle ear and ear drum were fine and healthy, and diagnosed Labyrinthitis - an inner ear infection. It's viral so I just have to wait for it to clear up. Today, my ears are still blocked and my hearing is still just as painfully sensitive. It seems that the virus is affecting the cochlea portion of the inner ear worse than the vestibular system. I'm trying to make sure I protect my ears as much as possible from experiencing sounds that 'hurt' - I don't know whether my hearing is more susceptible to damage from sound in this state or not?!

(image from Link)

Quiet Week

No bird picture today (the light has been awful) - instead, thought I'd post a picture of my latest creation (?!) from my pottery class. It's hand-built using coils, in red terracotta clay, biscuit fired and finished off with beeswax.

It's been a fairly low-key 10 days in terms of rehab. The weather has been freezing cold/icy/snowy etc so I've not really wanted to go out on long walks. The hospital gym session was cancelled on Tuesday cos the physio was off sick. I improvised at home and felt suitably achy afterwards. Plus, this week, I had a friend coming to stay whilst she did a course in London, which meant I kinda had to save my energy for that.

The LHS lower back tightness/pain has continued but I'm hopeful that it will eventually settle down once the hips/pelvis get a bit stronger. My left shoulder has been particularly achy/painful and is also causing pain down my arm and through the hand. I shall be so pleased to get back to the pool and swimming after Christmas!

P.S. For any Open University friends who read this blog, I have finally been cut off from FristClass access after 2 years of not studying. If you'd like to get in contact, feel free to leave your contact details (email address) in a 'comment' and I'll delete it when I moderate it (all 'comments' remain private until I authorise/moderate them), thanks!

First Hospital "Gym" Session

Well, I survived. I spent yesterday feeling quite nervous about going to the hospital. I really had no idea how my body was going to react to the exercises and I had no idea what to expect in terms of what I could manage. The strength and ability of my body is still so unknown to me.

I made it to the hospital through the snow and ice and was one of two people working with the physio yesterday. He took us around the equipment, showing us what to do and then left us to do it at our own pace (whilst keeping an eye things).

The circuit was as follows:
5 mins on exercise bike
10 reps glute bridges
10 reps 'press-ups' against the wall (I did this with my feet away from the wall, making a 45 deg angle)
2 x 10 reps leg extensions (can't remember the weight lifted)
2 x 10 reps leg press (can't remember the weight lifted)
1 minute on wobble board
10 reps bicep curls with lower back flat against the wall
20 reps step-ups
10 reps hip abduction, adduction and extension using red theraband
2 mins sitting on exercise ball

My LHS lower back was painful anyway yesterday so it was no surprise that from the bike work onwards it was tight/achy. However, I was very careful and caused as little extra pain as possible. I came home and iced it, which helped.

The bizarre thing about all of this is that even doing the circuit, it all felt easy. My brain was telling me 'this is nothing, I could do this in my sleep'. But, in reality, once I was home, I could feel my body had 'worked out' and I was tired. There is no way I could manage anything more demanding or brutal. That was my maximum and yet, that was way below what my brain thinks is do-able. I can't seem to accept or understand that even though my appearance hasn't changed, the internal make-up of my body has obviously changed dramatically. I am a looooong way from being the person who could play county hockey or 2 hours of tennis or not really think about how many reps I did at the gym.

It does seem to me that the scale for recovery is enormous. What I mean is that we're not talking about getting from 0 to 10 in terms of strength/fitness. It's more like getting from 0 to 5000, where each increment of '1' takes weeks and sometimes months to bring about. I'd say I'm at about 1000 for my lower body, a fifth of the way towards reaching normal strength/fitness. For my upper body, I guess I'm at about 500, just a 10th of the way there. It seems that the complexity of the nervous and musculoskeletal systems mean that innumerable mechanisms and architecture need to be brought online, trained, synchronised, strengthened and so on before it's all up and running properly. And, it takes a long time! My shoulders and upper body have quite a way to go yet.

I slept until 10am. I feel ok today. I'm aware my legs worked out yesterday but I'm not really stiff as such. The LHS lower back tightness/pain is 'there' but only minimally, which I'm very pleased/surprised about. All in all, so far, so good....

New Info on "Frozen" Left Shoulder

Overhead Squat Test

I skipped the pool last Wednesday cos I needed to save my energy for a weekend away. But, I did take full advantage of an opportunity to get free advice from experts at the posh health centre. I wasn't expecting a great deal from it, but came away with some very useful tips/information.

First thing I did was a simple muscle imbalances test: the overhead squat test (see this excellent PDF which gives the details). You perform the exercise shown above and depending on the position your body takes up, various muscle weakness/imbalances can be identified. For me, it's weak upper back (trapezius muscles etc) and tight/short lats and pecs, which I knew about. There was also some tightness/weakness around my calves and mild weakness in the glutes. I was shown some good stretches for the lats/pecs muscles, advised to do more rowing-type strengthening exercises, and told to use a foam roller to stretch out my calves. Seemed good to me, lol.

But, the star of the show was the physiotherapist. He was exceptionally professional, caring and helpful. I asked specifically about my frozen left shoulder. Told him the history (out of action for 8 years, severely traumatised, psych drugs etc and two years of physical rehab). He examined my shoulder thoroughly and told me that he was 100% sure I did not have a frozen shoulder!?! I was too young, I wasn't the right type of person/build/etc, even considering the years of incapacity, a frozen shoulder was extremely unlikely. He explained why I didn't have a frozen shoulder, showing me the positions he could get my arm into whilst it was passive, which would normally be impossible with a frozen shoulder (and had been for me up until a few months ago). He did say that there was clearly a great deal of muscle wasting. He could see there was a significant dysfunction to the use of the shoulder but it needed to be examined and dealt with by an orthopedic shoulder specialist. He talked through some of the things they might want to look at: particularly nerve function through the shoulder, muscle/tendon attachments and so on. He basically thinks it's quite a complex problem to do with the way the nerves/muscles etc are firing and recruited. He also said that significant weaknesses which haven't been addressed/understood yet might be contributing.

If I had health insurance, I could get it all investigated properly. However, he did suggest that if I wanted to go back down the NHS orthopedic route, I should try specifically to see a shoulder specialist (not just a general orthopedic person) and I should try to get to Guys & St Thomas' in London. He gave me the name of a consultant to look out for if I get the opportunity. He thinks there's a great deal more that could be done to restore proper function and strength to the shoulder.

He was like a breath of fresh air. He was clear, very caring and understanding, and everything he said made good sense of the pathology I've experienced. However, I suspect that there must have been some element initially of adhesive capsulitis for it to be diagnosed a 'frozen shoulder'. I did have significant restriction in passive external rotation and abduction for a good 18 months. But, who knows? Anyway, I'm not sure I'll do anything about it just yet. I might simply try to see if the regular swimming and the new stretches begin to make a difference. As he said, I've got bigger things to worry about than a dysfunctional shoulder, but it's great to finally have a better idea of what's going on.

As usual, the manipulation of my shoulder caused me to feel extremely faint. I had to do the whole 'head between my knees' thing, glass of water etc etc, but the physio was very understanding. He said that it wasn't surprising considering the number of nerves through the shoulder.

It took me about half an hour to feel well enough to drive home again but I was very pleased to have made the effort. If I had loads of money, I'd get the shoulder sorted out but, as I don't, I'll just have to pray for a miracle, lol.

Unfortunately, my shoulder still hasn’t recovered from the minimal manipulations the physio did. It’s been very sore, achy and painful to sleep on. I’ve been taking painkillers every night. To be frank, I’m not sure I can handle any treatment because coping alone with the pain for days afterwards requires more resources than I have. I’ve been pretty upset and confused about what to do now. Obviously, I want a shoulder that works! That would be superb! But, achieving that may well be more than I can manage on my own at the moment.

Had a headache for over 3 weeks now, caused (I think) by tight/exhausted neck muscles. Kinda fed up with it!

Tomorrow is the first session at the hospital rehab gym. The last 7 days have been almost free of LHS lower back and left hip pain. I expect that will change tomorrow evening but we shall see….

Swimming - a better recovery (21 Lengths)

The low point this week was after the NHS physio (or not) session on Monday. I'd been shown around the gym machines and had done a few leg extensions and leg presses after a 2.5 min warm-up on the bike. Of course, a few hours later, once I was home, the LHS lower back and left hip pain kicked in and has been a problem all week. I did try to arrange one last physio appointment for the day after the first 'gym' session but the physio isn't at the hospital on that day. It really worries me that just a few of those gym exercises aggravated the pain - I dread to think what it's going to be like with a full hour's work-out!?!

I used another of my 'free swims' at the posh pool on Wednesday. It was bliss. I did a short warm up (10 mins) in the 'baby pool', running through 20 reps of the hydro exercises (the ones that were possible with the facilities anyway). Then I went into the main pool and swam 21 lengths (10 backstroke, 11 breaststroke). I had a lane to myself and thoroughly enjoyed the uninterrupted nature of it all. The swimming felt fantastic. I then immersed myself again in the hot 'baby pool' to warm down, showered and came home for lunch. It was a really enjoyable morning.

Three things I did to try to mitigate the post-exercise crash: I had a large breakfast (bowl of granola/milk, followed by a boiled egg and two slices of toast). During the time in the pool, I tried to actively relax my muscles when not in use and I stopped for 15-30s after every length to breath/relax and recover. Finally, I took an iron tablet with lunch in the hope that it might boost recovery somehow.

I was wiped out for Wednesday afternoon and Thursday but I didn't feel the need to sleep during the daytime on those days. Apart from a bad headache which I've had all week, I feel like I recovered quite well after the swimming. I coped ok with pottery on Friday.

Tired so will leave it there.

NHS "Back to Fitness" Class

One from the archives to cheer me up. A Redwing from last winter in the local park. They've arrived back in the area but I've not had a chance to get any new pictures.

....ok....so I went along to my 3rd physiotherapy appointment this afternoon for my left hip/back problems. Session 1 had been the (rushed) assessment (no treatment); session 2 had been treatment on the tight right adductor muscle. I had hoped that session 3 might be a start on the back/hip treatment.

....mmmm....nope. She never even assessed or examined the LHS lower back and I'm out of the proverbial physiotherapy door. In their defence, I have been referred to the 6 week 'back to fitness' class which is basically an hour's gym session under the watchful eye of a trained physiotherapist. I can't decide whether I'm gutted or pleased although the 'I feel like I'm going to burst into tears' scenario maybe gives it away?!

All I wanted was someone to make my back and hip stop hurting or tell me how I can make it stop hurting. Neither of those things has happened.

I have a horrible feeling that the gym sessions are going leave me in agony. What I wouldn't give for 'normal' muscle soreness. And, I do know what normal, healthy muscle pain feels like and that's not what I experience. However, getting that message across seems to require some kind of special dialect which I don't possess.

Oh well, I can but hope that all of this works out for my benefit. Here's to an optimistic embrace of the NHS 'back to fitness' approach and here's hoping I come out the other side stronger and healthier.....

Drained by Swimming

No birdie pictures today. The weather has been too dull and wet. In keeping with that, I've felt like a soggy lettuce for most of this week! It basically took me a good 7 days to recover from the swimming.

Tuesday, I attempted some DIY (replacing a broken bath tap). I was 99% successful but needed someone who didn't have a frozen left shoulder, and wimpy left arm muscles, to come and maneuver themselves under the bath to tighten up the nut attaching the cold tap to the water pipe (only reachable with the left arm). Thankfully, an old work colleague came to the rescue and that's now sorted out. However, it did nearly finish me off.

Wednesday, I didn't have it me to get up early and head to my normal pool, 17 miles down the motorway. However, I remembered I had "3 free swims" from British Gas which could be used at participating health clubs. I printed off the vouchers, had a large breakfast (in the hope it might reduce the post-exercise crash) and headed to a local health club, late morning. I was very pleased to find that the water in the children's pool was well over 34 degs C. It was like being in a hot bath! I did as much of the hydro exercises as possible and then warmed up with some swimming before trying out the 'big pool'. The main pool was cooler but surprisingly nice to swim in. I didn't push myself too much - I was still feeling very headachy and exhausted. But, I enjoyed the experience.

Thursday, I was completely wiped out, as usual. Slept for an hour in the afternoon. Didn't do anything except watch telly, rest and eat. Friday, I was still tired and a bit headachy but coped ok with pottery, and yesterday managed a short walk.

Muscularly, I think the swimming is doing me a lot of good. I'm still getting the LHS lower back tightness/pain and left glute/hip ache but I can feel my joint stability improving. My core strength and range of motion in my shoulders is also improving gradually. Speaking of shoulders, the left has been quite painful and twingey this week but the DIY antics contributed to that.

Overall, the swimming obviously wipes me out but, for the moment, the benefits outweigh the costs. That might be short lived but we'll see.

20 Lengths & Exercise Intolerance

I keep trying to get decent pictures of the Nuthatch that's visiting the garden but these are the best I've managed so far. Not great quality but there we go. The poor light during winter isn't particularly good for photography at long focal lengths (and small apertures). Maybe in the Spring I'll get a better shot.

Ok, so this week, I reached what I realised was a very significant milestone, which I'll get to later. Generally, I was very tired during last weekend and even into the beginning of the week. I had physio on Monday and I asked her to take a look at the right upper thigh/groin problem. She concluded that the pain might be caused by some friction on the tendons and that loosening up the adductor muscle might help. She massaged the inner thigh muscle and showed me some suitable stretches. She also joked (half seriously) that I really need daily physio treatment [well, yup, tell me something I don't know]. Anyway, I also asked her about the possibility of starting to run. She suggested that I start off extremely carefully - 5 minutes walk, 30 seconds running, 5 mins walk, 30 seconds running etc - and just see how that feels.

Tuesday, I went out for my 45 mins walk and incorporated 2 bursts of running (30s and 1min). I was very pleasantly surprised to find that cardiovascularly, it was easy - it hardly raised my heart rate and I didn't feel puffed out at all. On the other hand, it did seem to aggravate the right upper thigh pain. Anyway, it was a start. I skipped table tennis in the evening - I was still tired and wanted to be as fresh as possible for the pool in the morning.

So, to the milestone: I hit the pool on Wednesday morning, as usual. I did 20 reps of each of the hydro exercises and then started to swim. My hope was to do 20 lengths (500 metres). Overall, the swimming felt good. I continue to be quite careful with the breaststroke leg kick - I did feel some twinges/pain through the pelvis/pelvic floor(?) muscles but nothing that felt 'injurious'. By, 10:15am, I had reached my milestone: 20 lengths (10 on my back, 10 breaststroke)! When I touched the end of the pool on the 20th length I literally cheered! I was so chuffed. I had no idea how significant it would feel but, I suppose, the fact that it has taken me 19 months to get to this point - where I have sufficient joint stability, range of motion and muscle strength to swim 500 metres, is reason enough.

Thursday, I was completely wiped out. Slept for over an hour on the sofa in the afternoon. Didn't do anything except eat and rest. Friday, I still felt pretty drained but I went to pottery and just about managed. Today, I have that exhaustion 'hangover'. I think it'll be another rest and telly day. Hopefully tomorrow, I'll feel better and get out for a little walk.

I've done a fair bit of reading on 'exercise intolerance' since Wednesday. There are a few interesting theories out there (mitochondrial dysfunction, neurally mediated hypotension, etc, see this thread:Link) but nothing that I'm going to try to pursue just yet. I think I simply need to keep going the way I am. Increasing muscle strength (and volume, if possible) and stretching my limits. The swimming obviously absolutely exhausts me for at least 2-3 days but I have to believe that ultimately, it's beneficial.

So, my next aim is to swim 32 lengths (0.5 miles). I guess, for me, I'm looking at a 6 month progression towards that. Incredibly, for 'normal people', it takes just 6 WEEKS to go from zero to swimming 1 mile (see:Link). How I wish that was the case for me! The human body and mind is indeed a complex and delicate bit of kit!!

Edit 15:30: I meant to note that my blood pressure has been doing all sorts of weird things again this week. It's mainly a problem of keeping enough pressure not to faint. I think it's exasperated by tiredness.

Less is More & More Swimming

Not the best of shots, lol, but it was a garden first and a life-time first this week. A flock of 6+ pretty Brambling came into the garden late one afternoon. They stayed for perhaps 10 minutes before moving on and I've not seen them since. I'd never seen one before and certainly never seen one in the garden. It made my day!

I'm tired this afternoon so this may read worse than usual.....

Anyway, my rehab strategy has evolved. After 2 years of daily physio, followed by weeks filled with almost daily exercise of one sort or another, I'm taking a new approach. I reckon I've laid the foundations and the way forward is "less is more". Something the physio said a couple of weeks ago has prompted this I suppose.

So....for the moment, I'm putting my energies into the pool work. This week I tried doing 25 reps of the hyrdo exercises followed by 18-19 lengths (9 on my back, 9-10 breaststroke). However, I think keeping the reps down to 20 and aiming for 15 lengths is probably best. I felt almost ill with exhaustion afterwards on Wednesday; was good for nothing on Thursday and slept for an hour in the afternoon. Friday I was still drained and thankfully it was half term so didn't have pottery.

The main issue this week has been the right upper thigh/groin ache/pain. It was very bad after table tennis and the pool, and I had to take painkillers to be able to sleep. It has settled a little since then but something needs sorting out!

I turned up for my physio appointment on Monday only to realise I was a week early....D'Oh! So, back at physio tomorrow afternoon.

Still getting the usual deep tissue pain through the rotator cuffs and down my arms - is it nerve pain? Who knows.

Tired.

Back in NHS Physiotherapy & Back at the Pool (15 Lengths)

I was very pleased to get this photo of a sweet little Long Tailed Tit perched on the Rose bush outside the kitchen window this week. It was one of those 'lucky shots' where you've got a few seconds to get 1 maybe 2 photos before the bird flies, and this was the result.

It's been a mixed week. I started off feeling optimistic. Managed 25 mins on the exercise bike last Sunday, pushing quite hard, and it felt really good. I came off the bike feeling energised, strong and 'fit'. I didn't feel any particular right groin/front of hip tightness/pain (which was a minor miracle!) or LHS lower back pain. Monday and Tuesday morning, the normal groin/glute/back pains were minimal and I realised what life might feel life without constant pain!

However, Tuesday afternoon was my first appointment back with the NHS physiotherapy dept for the left glute/LHS lower back problems. All I can say is that I came away not knowing whether I was disappointed or got exactly what I expected, nothing. Essentially, the physio said I was doing all the right things and that it was unlikely she'd be able to do anything else for me. As ever, it's a case of prescribing exercises/stretches without seemingly to apply any real anatomical expertise. I suppose, actually, I was gutted. I wanted to see a really experienced physiotherapist who would follow the paths of causation/pain and then tell me what the problem was. Unfortunately, that's not what I got.

In the spirit of fairness, maybe the physio will be more forthcoming/helpful tomorrow (the next appointment). And, I did glean something useful in that she said it may help to reduce injuries if I have 2 rest days per week rather than 1. She also said my left hip strength was good (which I was delighted to hear!) and there was no reason why I shouldn't be able to swim safely.

The left hip assessment exercises aggravated the LHS lower back pain.

Wednesday, I was back at the pool after another 4 weeks off it. I've decided to try a new approach from now onwards. I reckon the 18 months of persevering with the 50 reps of each exercise will have conditioned the structures enough to 'move on'. This week, I tried doing just 20 reps of each exercise (as a warm up, maintenance of movement) and then gingerly started swimming. I was terrified of straining the right pubic bone muscle or right ab/groin area again. I was very careful not to apply any real stress to the breaststroke leg kick and mainly used my arms to propel me forward.

I have to say I was very pleasantly surprised! My arms/upper body felt fresh and stronger. I easily managed about 15 lengths (7 breaststroke, 7-8 on my back with flutter kicks). By the end I was getting the usual cramps in my left foot/calf and the right ab was a little twingey, but overall I was extremely happy. The break had done me good. I felt stronger.

Thursday was the usual exhausted, rest day. Friday was pottery and, physically, I coped well but must have stood over my pot in an awkward way because I strained a LHS mid back muscle which has been stiff/painful ever since! Yesterday, I didn't do my usual 45-50 mins walk. I was tired and scared of not letting my body recover enough from the swimming. I tried the new physio exercise (see below) but that's aggravated the right groin/front of hip pain/ache.


I didn't sleep well last night. I was worrying about the state of my body. Also, I somehow pinched a nerve (in my neck?) which caused sharp pain through the back of my left hand (the area before the thumb and index finger). If I lay on my right side, the pain intensified to the point of intolerable so I had to turn over, release the nerve(?), and the pain subsided. Very odd!

So, generally, today, I feel discouraged and frustrated. It's been a very up and down week. I can't take anything for granted. One minute, I feel like I might just have a chance of one day being fit and free from pain, the next minute, all the old problems are back and nothing seems to be improving.

I guess, fundamentally, I am getting stronger. The problem is the nerve pain/hypersensitive muscles. I dearly hope that that will all settle with time and continued use of the structures.

TWO YEARS

If I'd taken my camera on my walk this morning, I would have been able to upload an image of a beautiful hovering Kestrel but, as I didn't, it's another garden Blue Tit!

So, it's two years today since I started the NHS physio for the hips/back/core. Over those 2 years, my strength and stamina have improved although nowhere near as much as I would have liked. Unfortunately, the pain levels are seemingly as bad as they were back then. Maybe this will change over the next 6 months. I re-read my post for this time last year and one of the obvious improvements is the significant reduction in exhaustion. I do have more energy these days (even if I'm kinda tired today!).

I start back in NHS physio this Tuesday for....my hips/back/core...again! I think I'll be very disappointed if s/he gives me the same set of exercises/stretches as 2 years ago! I have been working my butt off incorporating all of that into these 2 years and, to be frank, it'll ring serious alarm bells if I'm given the same routines again.

This week has been a little better than the previous 7 weeks. I managed the 25 mins on my exercise bike last Sunday without aggravating things too much. I made it to table tennis on Tuesday and played for about an hour. I missed the pool on Wednesday as I needed energy on Thursday but overall, I feel like I might be getting back on track. The right lower ab pain/twinges are still there but I'm treating it as though it's nerve pain which just needs to settle. If it's anything more serious it'll become clear as I try to get back to the pool work/swimming.

7 weeks ago I was averaging between 45-50 mins exercise per day (total: 5hrs 15 mins - 5hrs 45 mins per week). Over the past 7 weeks, I've dropped back down to 30 mins per day (total: 3 hrs 30 mins per week). It's quite a significant drop and I hope I can get back up to the higher level before Christmas.

Pain

Another Blue Tit. They continue to come into my garden in delicate swarms and this little chap posed nicely on the branches of the Japanese Maple, just outside the kitchen window. One of these days I'll get some shots that aren't 'through the double glazing'.

It's been another week out of the pool, away from the table tennis table and off the bike. I have done a few decent walks though. I was pleased to manage 1.5 hours on Wednesday with a steep incline through the last part of the walk. Although there was pain/twinges through my groins/glutes and down my left leg, the big muscles (quads, hamstrings and calves) coped really well, I didn't get puffed out and I wasn't exhausted in the afternoon. My energy levels recovered 'normally' even if the pain intensified.

And, that's been the dominating issue. The pain. The LHS lower back tightness/pain, the left hip/glute ache/pain referring down my left leg through my groin; pain through the pubic bone muscles, pain through my right front of hip/groin, pain, essentially, through connector tissues around my hips. Plus, the other deep tissue ache through my rotator cuffs. I can only assume that this is all nerve related one way or another. At one point this week, the pattern of pain reminded me of the growing pains I used to have as a child - that deep ache through the pelvis down the legs. As far as I know, that is sciatic nerve pain so perhaps this is similar?

Below is a record/indicator of roughly where the worst pain is located (shown by yellow/red areas)


Anyway, I was very pleased to finally receive my letter from the hospital this week inviting me to make my first physiotherapy appointment. That'll be 19th Oct so not too long to wait now. Increasingly, I'm not sure they'll be able to help but perhaps they'll send me in the direction of where help can be found.

Yet Another Week "Off"

It was one of those moments where the little Blue Tits come into the garden like a wave of confetti and flutter about in every conceivable plant, including the ones just outside the patio doors. This little fella perched precariously on the branch just long enough for me to grab the camera and take a few shots. I was chuffed with how it came out.

Unfortunately, it's been another week trying to give the right lower abdominal and pubic bone muscle strains a chance to heal up. No table tennis, no pool work and I won't be getting back on the bike today. I've done a few decent walks but even they result in the usual right front of hip/thigh tightness and pain. I've not done any bicep/tricep strengthening either as that needs the abdominal muscles as stabilisers.

My pottery class started again on Friday, which was great. As usual, I didn't know I was missing it until I was back there enjoying it. I was encouraged to find that kneading the clay was a lot easier (all the deltoid and arm strengthening is paying off). And, I was standing, working over my piece, for the best part of 3 hours without getting lower back ache. My frozen left shoulder and left side of my neck were painful and fatigued by the end, and, in the evening, I had the usual deep tissue ache through my rotator cuffs, down my arms, but overall, I was happy to discover I've made progress physically.

Yesterday was a bit of a surprise though. In the morning, I went out for my usual 45 mins walk and did my stretches. But, by the afternoon I felt awful - drained, hot/cold/shivery and dizzy. I don't feel much better this morning. I was hoping it's just fatigue but maybe I'm coming down with a cold or something.

I plan to rest the strains for another week and then slowly get back to everything again, hopefully.

Disappointing

No birdie photos today (although that might change if I manage to get something half decent later).

Essentially, it's been a disappointing week. I hoped that the 4 week break from the usual exercise routines would have allowed things to strengthen up and heal up. Unfortunately, that doesn't seem to be the case. The pubic bone muscle strain has improved although the right lower ab/groin area is twingey and painful, and makes me think 'hernia' every time it grumbles.

Table tennis on Tuesday was the first disappointment. It very definitely aggravated the right groin/thigh pain so that it was as bad as it ever gets. Wednesday's evening commitment was cancelled so that meant I could go to the pool in the morning. I stuck to the basics. All I did was the hydrotherapy exercises that the hospital taught me 18 months ago. I didn't attempt any swimming. Right from the start the right groin/thigh was problematic and then I strained the left inner hamstring doing squats. The right lower ab/pubic bone muscle area was tender. Generally, the whole pelvic structure felt twingey, painful or strained! I came home baffled.

I have been doing those hydro exercises for 18 months. There is no way they should cause any strains or problems. It defies belief that I'm still nursing injuries from doing the pool work! The last physio I saw before I left the hospital suggested I do the hydro work for another 6 months before heading into the gym. I've stuck at it for 18 months and I'm still not ready for the gym?!?!?! So, yes, I was very disappointed after Wednesday's session.

Thursday, I was as tired as ever (which again was disappointing because I'd done a lot less than normal on Wednesday). The left hamstring strain seems to have healed up, which is good, but the right groin/thigh/lower ab area is chronically painful.

The best thing to come out this week was that table tennis helped reduce the LHS lower back tightness/pain.

On a completely different note, I caught the end of xfactor last night and Matt Cardle's "The First Time Ever I Saw Your Face" brought tears to my eyes. What a spine-tinglingly beautiful voice. You hear something extra-ordinary like that and you're transported out of the tangle of your own problems and reminded there's beauty in the world. Does you good.

Still Nursing Strains

Got my first half decent photo of a Chiffchaff yesterday morning. This pretty warbler came into the garden briefly but I only managed a few distant shots through the window, this being the best. It's only the second garden sighting of a Chiffchaff in 5 years so I was delighted.

It's been another frustrating, emotional week. The pubic bone muscle strain (from 4 weeks ago) does seem to be improving but I've done very little to test it out. The LHS lower back tightness/pain and left hip ache down through my groin and leg are back with a vengeance, having done so little exercise. I'm pretty sure now that it's an irritated/trapped nerve in the lower back. The deep right groin pain is also still present. Again, I wonder if that's nerve related too.

I'm on the waiting list (10 week wait) for more physio for hips/back. I'm not sure what they can achieve given that I have been keeping up all physio/strengthening exercises for the past 2 years. I think it's getting to the stage now where I need a scan to see what's going on. Maybe there's a bulging disc or something.

So, I've kept off the bike, out of the pool and away from the table tennis table again this week. I've done a few walks but generally I've been feeling absolutely drained for some reason. I've been forced to take painkillers at night for the hip/back pain to be able to sleep. My muscles have felt 'brittle' and as though they could be strained far too easily.

I plan to go to table tennis tomorrow and see how that goes. I'll miss the pool because I have a commitment on Wednesday evening that I need energy for. I guess it'll be a case of just testing things out and seeing how everything copes.

Tears and a Nuthatch!

In the 5+ years I've been noticing my garden birds, I've only ever seen a nuthatch visit the feeders once, until now. To my delight, the above beauty (not really shown in all its glory due to the ropey photos) has been visiting the feeder daily for the past 3 days. Hopefully I'll be able to get some better photos at some stage. Nuthatches seem to be quite elusive around here. I've only ever heard them a handful of times in the local woods and caught a glimpse of one once. So, I'm chuffed to bits to have one come into the garden.

Apart from the mood-enhancing Nuthatch (I wonder if you can get those on the NHS?!), it's been a fairly tough week. I spent most of Monday and Tuesday in and out of tears for various reasons. I'm very disappointed by the rehab set-back. The strained muscles/tendons(?) attached to my pubic bone are still stinging and strained, and the bike work I did last Sunday didn't help. I'm having to be extremely careful not to aggravate the injury, which means no table tennis, no pool work and no cycling. And, I have a horrible feeling it's going to be weeks yet before I can get back to exercising.

I guess I've been completely baffled (again!) by how fragile my muscles/tendons etc are. I cannot comprehend how, after nearly 2 years of solid rehab, I can still cause myself these kinds of injuries with so little effort. I just don't understand it. I'm extremely careful to increment my level of effort and activity at a pace that's safe, and yet, here I am, feeling like I'm back where I started! Every time I think I'm finally making progress, getting stronger, more resilient, something happens to undermine it. There have been times this week when I've wondered if my musculoskeletal system is responding at all to the rehab. Maybe my mind says 'I've done x amount of exercise so I should be stronger/fitter' when in fact there's something fundamentally wrong, like a lack of growth hormones or something, preventing it?! (Yes, I know, at times, keeping things in perspective proves a little tricky, lol).

I went to sign up for my pottery class at the local college on Tuesday. They informed me that they had cut back on the number of courses where they offer a concessional rate. Instead of the £30 I'd budgeted, I was going to have to pay the full price of £210. I burst into tears and left. If they'd told me this in May I could have saved up for it but instead they just sprang it on me. I know I won't be the only one effected.

The great thing about reading Adrian Mole, The Prostrate Years is that how ever bleak your life feels, Adrian's is ten times worse and he still survives. I finished the book last night.

Note added 26/09/2010: signed up for the pottery course and just hope that the car sails through its MOT/service in January!

Resting Injuries

It's been a thoroughly depressing 10 days. The only thing I've done is gentle walks. No table tennis, no hydrotherapy and no bike work (until today). I've been icing my inner thighs (which, admittedly have improved) and groins regularly. I did some gentle core exercises yesterday but the right, lower ab/pubic bone strains are still painful. I'm worried I've given myself some kind of 'sports' hernia (Link & Link), which is infuriating. Both groins (right, especially), inner thighs and the right hamstring are all painful and/or twingey. Something always hurts when I walk. I'm so fed up with the right ab/groin pain. *sigh*

Pain/Injury Update

Well, it seems I've definitely overdone it. On Saturday evening, I discovered that my inner thighs (medial hamstrings?) were excruciatingly sore when palpated. It's in the same position on both legs (see image above). I tried massaging the swellings/points of extreme tenderness and found that the aching right groin pain reduced. However, I also found that I'd strained muscles across the right side of my pubic bone to the right groin. So, essentially, since Wednesday, walking has been a delicate, painful affair! I've been resting everything as much as possible and icing the inner thighs and right groin 3x a day. I had to take painkillers again last night (for the pubic bone/groin pain) to be able to sleep. I'm hoping that whatever is causing the pain will settle this week. I guess I have to be a lot more careful about doing too much breast-stroke! Maybe I need to do more ground work before trying to swim - some abductor strengthening etc? Who knows. I do worry that the more injuries I sustain, the more weak points I acquire and the more difficult it is going to be to return to full fitness....

Pain and Post-exercise Recovery

Another not so good photo of the juvenile Song Thrush on the garden fence. I've not had much opportunity to take new photos of birds recently. The light and weather have been pretty rubbish.

ok, so,...still experiencing a lot of pain.

The problem area has shifted this week from the left glutes/hip and LHS lower back to the right groin/deep in the front of right hip/pelvis. In fact, I've had 5 consecutive days without LHS lower back pain! But, the right groin has been another of the chronic problem areas, recurring regularly for the past 2 years. This week it has been particularly bad. I knew I'd aggravated it during the bike work on Sunday (it's always a bit tight/painful afterwards) but then it was a lot worse after table tennis on Tuesday. I think the lunging for balls and shifting of weight entirely onto each hip/groin is the reason. I've been icing it regularly all week but that's not made a great deal of difference. It's difficult to get to the pain as it's deep in the groin.

Anyway, on Wednesday, I pushed pretty hard in the pool and swam 13 lengths (325m total). My arms/shoulders felt stronger and coped much better with the breast stroke but I didn't realise how much stress I was putting on my hips/groins. By the afternoon, I was in a fair amount of pain and for the last 2-3 days have found it quite difficult to walk. Everything has been stiff and painful and I ended up taking painkillers on Thursday night because the right groin/thigh was stinging/aching so much I couldn't sleep.

I reckon the left glute/hip, LHS lower back and right groin pain are all connected somehow. There's some kind of instability or irritation of nerves/tendons which causes problems first on one side of the pelvis and then on the other. I'm not sure how to remedy a situation which has been going on for 2+ years! I keep hoping that increasing the strength will increase the stability and tolerance of the structures but, so far, that's not happened. The pain is as bad as it ever was.

The good news is that I think my frozen left shoulder has 'thawed' a little more. The swimming is really helping. The range of motion on external rotation has improved by about 10 degs. If the full range is 180 degs, I could previously just about manage 90 degs, but that has now increased to around 100 degs. Plus, the pain is a lot less now.

For the past couple of weeks, I've taken to eating a Lucozade Recovery Bar after I come out of the pool. It's designed to give an immediate source of first class protein, carbs and fat to aid recovery. I'd read an interesting study (Flakoll et al, 2004) in Nancy Clark's Sports Nutrition Guidebook, which suggested that consuming just 8g carbs, 10g protein and 3g fat immediately post-exercise can make a significant difference to recovery (Link). Essentially, carbohydrate stimulates insulin release (a hormone which helps build and refuel muscles), and, when combined with 10-20g of protein, cortisol (which breaks down muscle) is reduced and muscle rebuilding is enhanced. Anyways, I think it's actually really helped with recovery after the hard work out on Wednesdays.

This week I think I need to take things very easy. I've not done my ab/core exercises today due to various twinges esp lower right abs. I won't do any bike work tomorrow and I may miss table tennis too. I think I need to give my groins/thighs a proper chance to heal up or recover.

Pushing Hard

Not the best image quality but this pretty juvenile Song Thrush turned up in the garden this week and I couldn't resist grabbing a photo when it landed on the bench outside the (filthy!) patio doors.

I think because of the lack of expert support in all this muscle rebuilding, I tend to find it quite hard to get the balance right. I never really know if I'm pushing too hard or holding back too much. The same applies with the calorie intake. I don't really know if I'm eating too much, too little, the right balance of protein/carbs/fat and so on. Sometimes, it really does drive me nuts! I tie myself in knots trying to figure out how to make the optimum progress with the least amount of injuries. Just when I think I've got the balance right, I read something else on the net which suggest otherwise or I acquire yet another injury. I've found myself getting really angry with the NHS again. Angry that I'm given no nutritional advice, no training advice and no injury management advice. Do they not realise that the longer this rehab goes on, the longer my life remains restricted, isolated and 'on hold'?! If I was obese and trying to lose weight would they give me support then?

*sigh*

Anyway....I pushed hard last Sunday on the bike. I pushed hard at table tennis on Tuesday and came away with niggling groin, hamstring and hip stabiliser strains. Then on Wednesday, I really wanted to add another length (12 x 25m) to the swim at the end of the hydrotherapy work out, so I pushed hard again. And yes, I've been nursing various hip/groin/thigh strains since. The left glutes/hip problem is still pretty bad, causing sharp pain in the hip on footstrike and an ache deep in the hip when sitting. The LHS lower back tightness/pain has been bad too. I've made an appointment with my GP about the left hip/back problems because I reckon that 22 months of rehab should have 'strengthened it' enough! I think there's a tendon/nerve/ligament which gets irritated somehow and needs some intervention. Having said that, I don't hold out much hope of the NHS being able (or willing!) to help.

I'm wondering if it's time I saw someone else privately. Perhaps get a physio on board who I could see once a month to check on progress, injuries etc.

I keep up with Andy Murray's progress on the Tour and can't help feeling completely jealous of the nutritional, training and physio support he gets. If I could just borrow his team for a month, I reckon I'd be up and running in no time, lol. Actually, simply to borrow his massage therapist would be good a start! There isn't a muscle/tendon in my body that couldn't do with some treatment. Part of this recovery is wondering when I'll be free from constant pain. It's rarely disabling but it is fairly constant. My shoulder girdle is permanently 'sore', as are the structures around my pelvis.

Oh well....one day.

RE: calories. I found this article on the web which suggests that 0.5lbs of lean muscle per month is very good going. That kinda leaves me with having added 2.5lbs of unwanted fat over the past month then....just flipping great...Grrrrr. I'm cutting back on calories a bit to try to limit the amount of fat I put on. I know I still have to eat excess calories to even think about building muscles but getting the balance is really tricky!

A Short Break

I had a week away, staying with a family member and an old friend, last week. A low cost summer holiday. It did feel good to have a break from the usual rehab routines and get away from my own 4 walls. But, it's also been good to get back home this weekend and get back to it. I guess that's what holidays are all about - coming back refreshed and ready to work hard again.

Plus points from the holiday were that I coped pretty well with the physical and mental demands of it all. On one of the days we did a 5.5 mile walk which is the furthest I've walked since trying out a rambling group 2+ years ago. My left hip did ache quite badly afterwards and my LHS lower back tightness/pain has been aggravated again (and is still gnawing away).

I've put on about 3lbs in the last 3 weeks, which feels like good going. It's the first weight I've put on in, well, decades! Hopefully some (most!) of it is muscle!!

Is The Tide Turning At Long Last?

It's 22 months since I started the physio for my hips, back and core. It's 17 months since I started hydrotherapy. And, I think I'm finally getting to the phase in rehabilitation where my body and mind are learning to once again put on muscle! Over the past 2 weeks I have been able to tolerate eating 2500+ calories a day (with the aim of putting on 0.5lbs per week). For the last 2 days, it has felt noticeably easier to accommodate that amount of food which is something that's not happened previously. At various points along the way I have tried to eat more calories but even giving it 4-6 weeks to adjust, I've not really been able to tolerate it. Now, it seems my body/mind are ready.

There have been other significant indicators. On Tuesday, I played 80 mins of table tennis and for the first time, since I started 8 months ago, I didn't come home and immediately need to ice my rotator cuff. Normally the muscles sting and I have little strains through the ribs under my arm but, this week, it felt 'ok' enough not to bother icing it. On Wednesday, the pool work felt good and the swimming at the end actually felt easier. I managed an extra length, making it 11 (275m). I would have loved to have done more but I didn't want to push it and I had cramp in my left calf and foot.

After the bike work last Sunday, during my short walk (25 mins) on Monday, my legs felt as light as feathers! It was a qualitative shift in how I experience my body. My legs felt strong and powerful. That aspect of things has stayed with me all week which is superb. Generally, I'm feeling more substantial; recovery time after exercise is improving and muscle/nerve pain is reducing. It feels like this is the start of a new phase in recovery and, dare I hope, an increase in the rate of progress.

In terms of aches and pains, I've been regularly icing my left glutes/hip this week. It's still twingey and painful and causing pain at times through the knee and ankle when walking. It also seems to affect the coordination of the leg so that sometimes, it feels like I'm having to consciously recruit the right muscles to move it. My left calf has been crampy all week. I've been putting a hot water bottle under it when I go to bed but so far that's not had any beneficial effect. The LHS lower back tightness/pain is generally a lot better but flares up in connection with the left hip/glutes. My shoulders continue to need a fair amount of TLC - icing and the hot water bottle at night.

Overall, I'm quietly relishing these subtle but qualitative improvements and tentatively hoping they will blossom into substantial changes for the better. I dare not presume.

[The photo was taken at Barton-on-Sea, Hampshire, during my first summer holiday in 10+ years, in 2007. It was during this holiday that I was pretty ill with the undiagnosed iron deficiency and was prompted to see my GP when I got home. The rest, as they say, is history]

A Good Week

This beautiful Kestrel was being housed at a rescue centre in the Lake District (visited last Summer). I'd love to get a picture like this of one in the wild.....one day....

Getting back to the rehab routines this week felt good and I've been pleased to experience 'just noticeable differences' for the better. I'm pushing a bit harder on the bike each Sunday. Upping the resistance from 2-3 between 10-17 & 20-22 minutes, and upping the pace from 60rpm to 70rpm for 2 and 1-1.5 minutes during those intervals. I can actually feel my muscles changing as they warm up, fill with blood and work consistently through the session. The higher pace intervals feel fantastic!

At the pool, I persevered to manage another 10 lengths (5 breast stroke, 5 flutter kicks on my back) after the usual hydro exercises. Again, this week the breast stroke lengths felt a little easier and my arms weren't burning with fatigue as badly as before during each length. I had been to table tennis on Tuesday evening but it had been an easier week than normal - not having the opportunity to put much pace/power on the ball (due to whom I was partnered with).

The main problem areas this week were my left glutes/hip again. I iced my butt a few times to try to ease the ache. I think it's a tendon problem which then radiated down my left leg. Also, my left rotator cuff (infraspinatus muscle?) has been aching pretty badly and causing intense pain down through my left elbow. I took painkillers last night to be able to sleep with it. I'm hoping that these pains will just settle on their own eventually. I'm taking good care of them without hindering the rehab schedule. Heat and Ice, as usual.

The other change this week is that I've finally worked out how to be able to eat 2400+ (useful) calories a day. It's basically about having a bigger breakfast (600+ calories), so, I have a bowl of granola with milk, an egg (boiled/fried/poached) and a couple of slices of toast with a cup of tea and orange juice. I've also added in a slice of toast at 4pm with peanut butter or jam depending on whether I need more carbs, protein or fat. Every day I feel stuffed to bursting and have to force down the extra calories but I figure it's the only way I'm going to actually put on muscle.

Just noting that I'm still regularly getting cramp through the arches of my feet and calves, predominantly at night.

Stamina is Improving

A proud looking juvenile Starling.

Good news. It seems that the rehab is paying off. Last week I did 'normal life' stuff - visiting family and staying with a friend I'd not spent time with for 6 years. Just 18 months/2 years ago, the thought of all of that would have exhausted me. I didn't have the mental or physical capacities to cope with new environments, travelling, different routines, being in company, being away from home etc etc. And, if I did attempt these 'normal life' things, I'd end up needing at least a week to recover where I'd be absolutely wiped out, feeling as rough as anything and looking like death warmed up. This kind of reaction is normal in severe deconditioning, as described in the article referenced at the start of my blog (Link). It's basically severe exercise (or exertion) intolerance - doing anything that puts stress on the body/system is poorly tolerated.

Anyway, the whole point of this physical rehab is to recondition my body (and mind/nervous system) to tolerate stress (specially physical stress, exercise).....and thus, to not just tolerate being alive, but to thrive. To be able to enjoy (rather than endure!) doing 'normal life' stuff like travelling to visit old friends, going out for day trips, enjoy chatting and walking and, well, life!

Admittedly, my resource and well-being levels weren't even throughout the time away. I had dips and times when I didn't feel so great. But, overall, I was able to tolerate it significantly better than in the past and that's encouraging.

Over the weekend, I've been getting back to the usual rehab routines. The left glute pain/ache is still problematic and my rotator cuff muscles/tendons are achy, especially refering pain through my left elbow. I'm looking forward to getting back in the pool this week. I always feel soothed from being in the water.

Weight loss (!) and Left hip

Another of the garden juveniles - this time one of the collared doves. There's a pair who have spent the week in the garden, sitting together on the fence or on the bench outside the patio doors. They're very confiding and this one let me come outside and take its photo (hence the rather suspicious expression).

In spite of the continuing RHS inner thigh/groin problems, I had a good session on the bike on Sunday. I did the usual 25 minutes but upped the resistance from 2-3 between 10-17 & 20-22 minutes, and upped the pace for 2 mins and 1.5 mins during that time. The other change I've made is to do the bike work at about 3pm rather than 11:30am. The morning session would mean I'd be overwhelmed with tiredness and the need to sleep during the afternoon. However, with the afternoon session, I've had a large lunch and although I do feel tired between about 5 and 6pm, I then have a large meal at 7pm and that revives me.

My left hip/glutes have been bothering me all week. Very achy and twingey when walking. I skipped table tennis on Tuesday so as to be fresh(er) for the pool on Wednesday morning. I pushed myself hard by doing a couple more lengths of swimming after the exercises. It definitely worked my shoulders (in particular my left shoulder, which was the main aim) but it has also probably overworked my left glutes/hip, hence the bad left hip pain/ache which at times radiates down the leg.

The rest of the week has been spent nursing the left glutes/LHS lower back and recovering (I was very tired on Thursday - slept for an hour in the afternoon).

I weighed myself at the beginning on the week, hoping I would have put on a pound or two. To my horror, I'd lost 2 lbs, which is definitely not the aim of the game! I'm a skinny bean and losing 2lbs is 2lbs too much. To be frank, I was pretty gutted (and worried) because I am eating as much as I can possibly stomach/digest and doing all this rehab work but not seeing any results! I did some more reading and research and I guess I need to eat more carbs but just how I manage that is debatable. I have stuffed myself to the point of discomfort all week and not enjoyed or looked forward to eating. It's felt like a chore to force another meal down into my stomach. But, having weighed myself this morning, I've put back on the 2lbs, thankfully. Maybe I just have to face the fact that I need to endure the nausea and discomfort and force feed myself for a while to put on this muscle weight. It is very frustrating though.

I'm off to visit family and then an old Uni friend over the next few days. It's another chance to allow my body to rest/recover and build muscle (yes, I live in hope!!).

Heat and Ice

One of the many little juvenile Blue Tits that are 'stretching their wings' in and around my garden. This little chap landed on the rose bush just outside the kitchen window, giving me a rare photo opportunity.

It's a scorcher again today, 27+ degs outside. But, as ever, I shall be taking my hot water bottle to bed with me....

I thought I'd write a bit about my routines for controlling and easing muscle, joint and nerve pain. Basically, I try to avoid painkillers unless it gets unbearable. After years of being doped up on all sorts of horrible stuff, I prefer to keep a clear head and listen to my body, even if it's complaining. That leaves me with the main options of heat, cold and rest.

One of my routines is that every night I go to bed with my hot water bottle. Initially, whilst I'm reading in bed, I have it stuffed down behind my LHS lower back. The aim here is to ease the chronic tendon/ligament/muscle tightness and/or get a good blood supply to that area to provide any healing/growth needed. Once that's been in place for approx 20 mins, I then put the hot water bottle behind each scapular in turn. This is to ease the pain in the rotator cuff muscles. Once I've finished reading and settle down to sleep, I then alternate the application of heat to the front of both shoulders to promote good blood supply to the vulnerable tendons and bursa through the front of the shoulders and pecs muscles. If one shoulder is particularly painful, I'll keep the heat on it longer. Finally, if my hips/glutes are aching I'll apply the heat there as well before I eventually toss the hot water bottle out of bed and go to sleep. It may sound like a right old palaver but I think it's helped over the last 2 years and, even in this heat, I'll keep it up!

The other thing I do regularly is when I get home from table tennis on Tuesday evening, I immediately apply an ice pack to the right scapular and round the ribs, under the arm. Again, I'm targeting the rotator cuff muscles which are often stinging and fatigued. The aim is to help the soft tissues to eliminate waste products and recover more quickly, so that the arm/shoulder is ok enough for the pool on Wednesday morning. I'll keep the ice pack on for a good 30 mins making sure the whole shoulder structure is treated. I'll do this again once I get back from the pool on Wednesday morning.

Whenever I do my left shoulder physio (3 times a week), I put a heat pack around the joint afterwards for 20 mins. This really helps to ease the joint pain and hopefully promotes a good blood supply to aid healing of the 'frozen' capsule.

Finally, the other thing I do regularly is ice my right groin/inner thigh. It's another chronic problem and, I guess, some kind of tendonitis. When it flares up, I'll ice the area for a good 20 mins, 2 or 3 times a day.

The LHS lower back pain has eased off again this week which I'm extremely please about but I dare not get too excited. Time will tell.

Suddenly very tired so will leave it there.

A weekly update

I finally have my PC back - it went in for a DVD/CD-drive repair over a week ago. It has been very strange to be offline and I'm glad to be back in the world of cyberspace. On Sunday, I took a trip to a local nature reserve and finally saw and photographed my first Reed Warbler. I've stood by the reedbeds there many times listening to the screeching and chattering from the pairs of Warblers which breed there. But, over and over again, they've stayed out of sight, in spite of my many attempts to see them. Anyways, I cut a lucky break, and the above bird flew to the trees with a beakful of insects for young (I presume). The picture isn't great but I was pleased to get anything that was vaguely in focus and not just a dot in the distance.

As for the rehab....it was an 'ok' week last week. The extreme tiredness wasn't so pronounced but the RHS inner thigh/front of hip/groin tightness and pain was a lot worse. It seemed to be aggravated by table tennis last Tuesday - lots of lunges for the ball I suppose. Anyway, I've been nursing that quite intensely - regular icepacks to the groin and thigh - but it's still just as bad. As I've said before, I don't think it's an injury as such, more likely some kind of tendonitis.

The other niggles last week were stinging minor strains to my abdominal muscles (again!) and to the pecs muscles. I've essentially taken this week to allow them to heal up. No table tennis and no longer walk yesterday (to rest my groin/thigh problem). I skipped the pool this morning simply because I'm off to visit family again at the end of the week and can't afford to be wiped out. My left glutes/hip are twingey/achy at the moment and my left calf muscle is slightly strained so, all in all, the week's reduced exercise regime is a good thing!

I had a positive session on the bike on Sunday though. I did the usual 25 mins but upped the resistance from point 2 to 3 between 10 and 17 mins and also increased my speed/intensity for 2.5 mins and 1 minute during the time. It felt good to push myself and, as ever, I thoroughly enjoyed the exertion (even if I am paying for it a bit this week!). The other plus point was that last week, the LHS lower back tightness/pain was barely evident. It's flared up again today but I had a run of 7 days when it didn't bother me at all, which is encouraging.

Stress etc

Extremely tired, almost constant 'exhaustion' headache all week and the inability to sleep well beyond 5/5:30am. I guess I'm stressed about various things not least of which was picking up the new car and getting rid of my beloved old one. If I could have kept my old one on the road I would have done but it was beyond economical repair. My brain doesn't cope well with change. Every little aspect of the pros/cons of significant decisions/situations/etc are analysed over and over and over again without any real control of those obsessive thoughts. I quite literally feel like I'm going nuts during those times.

Anyways...hopefully things will calm down a bit over the next week or so.

For now, I'm just absolutely drained but trying to keep up with the rehab schedule. Weirdly, I don't think it's my muscles that are tired out. It's my brain that's struggling to keep up with the nervous system demands of incorporating the different uses of the body. The brain and nervous system are certainly ingenious but I guess I have to remember that my nervous system has kinda been burnt out once already and needs to be 'handled with care'. Pushing myself (my brain) rarely pays off. I have to go at its pace.....slower than slow....

Still Struggling with Tiredness

Another one from the House Martins series of shots. These two were gathering little stones (on the left) and wet mud (on the right) for nest repairs/building. I love having these birds right on my doorstep.

It was good to get away last weekend and, as it turned out, I had a break from the main physical rehab stuff. Whether it was as a consequence or just coincidence, I did have a week of very bad LHS lower back ache/tightness/pain and left hip ache. Nothing would relieve it although lying down and/or applying heat helped. I'm convinced that there's some area of irritation - nerve/muscle/tendon/ligament, which flares up regularly and I seem to just have to sit it out until it calms a bit again. I try not to take painkillers otherwise I'd be on them daily.

Anyways, it felt great to get back to the pool this Wednesday. My muscles were fresher than usual (no table tennis the night before) and I had a session where everything functioned well. For the first time ever, I didn't have left shoulder bursa/infraspinatus tendon pain when doing the 5 lengths of breaststroke (alternating with the 5 lengths on my back using flutter kicks). I came away feeling encouraged and pleased with how my body coped. My breaststroke strokes are still 'gentle' because I'm not sure I've got the shoulder stability yet to exert full force, but it's all progress.

I've been pretty wiped out through the end of this week mainly due to mental stresses rather than physical exertion. Also, my brain still hasn't figured out that sleeping beyond 5:30/6am is preferable! That aspect is definitely wearing me out. I've had the old 'overstimulation' headaches where it feels like my head is about to explode unless I lie down in a darkened room and sleep for an hour, and I've had reduced resources for coping with anything out of the ordinary. One of the 'stresses' is that my beloved, 13 year old Ford Escort has reached the end of its life and I've been frantically searching for a new car. Thankfully, I have now found one and pick it up next Friday but until that feels resolved, my poor little brain cannot stop obsessing about every possible facet of what I should consider in buying a new car.

........tired out.

Hamstring Stretches

Ok, so that little guy isn't stretching his hamstrings....One of numerous speedy House Martins around my house, collecting a beak full of wet mud and little stones for nesting material.

This beauty came into land and I just love its fluffy, feathered legs and feet.

The hamstring strains are still evident but not too bad. I've decided to add hamstring stretches to my almost daily back and hip stretches, done after a walk (i.e. when my muscles are warm). I tried the stretch from this 'yoga for runners' website (Link):

At the moment I can only get my leg up to about 25 degs off the ground so there is a way to go!

I may also try this one out from Runner's World (Link) - maybe when I've progressed a little.

Skipped the pool this morning. I'm off to stay with family tomorrow and don't want to have my usual end of week wipe-out. It'll probably do my body good to have a break from the routine for a few days.

Infuriating Injuries!

Popping in to vent! Ok, I finally had a little bit of energy yesterday and had a short 20 mins walk, followed by some stretching. My target currently is to lengthen my hamstrings. Long story but essentially they're short, rigid and restrictive. Ok, so I followed the stretching instructions on the net (Link) - I did the stretch in figure 2 (see below):

Today, I've got multiple stinging strains at various points along the hamstrings, behind my knees and down my right abductor! Typical! I've been trying to lengthen my hamstrings gently for months now, essentially following the procedure on that website. But they're still short and tight and don't seem to be letting up. Looks like I'll have to miss table tennis tonight as a result of more minor but infuriating injuries.

Ok, the 'long story'. I have finally gotten hold of a second hand WaterRower which arrived last week. Very pleased with it. Nice smooth action. Great bit of kit. But, I hadn't factored in my short hamstrings. As soon as I try rowing, the stress on my lower back is huge. I basically haven't got the flexibility to use the machine yet, which is, well, 'annoying' is an understatement. Anyways, the solution is to get to work on improving the flexibility, particularly lengthening the hamstrings. But, I can see that once again, it's not going to be a simple case of doing stretches for a few weeks. This, as usual, is going to be a one step forwards, three steps back affair until the structures start to respond as they should. Patience, patience, patience.

In the meantime, I have a great rower taunting me, lol.