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.