Overview of 2009 and hopes for 2010

A White-tailed Eagle, taken at a Conservation and Rescue centre in the Lake District over the summer. It's a symbol of strength and hope and restoration (Is 40:30-31) and kinda what I want to have in mind going into 2010.

So....progress for 2009, below is a graphical summary


Essentially, things are improving but extremely slowly. Looking at the average daily exercise (orange line through orange circles), during the first 6 months, I was doing approx. 10 mins a day. This increased to approx. 25 mins per day during the latter 6 months (apart from the blip last week).

Aims/hopes for 2010:

• Increase weekly walking to 300 minutes
• Get to a point where I can comfortably sustain 30 minutes cycling per week
• Reduce (and hopefully eliminate) hip and back pain
• Feel an improvement in the stability and strength of my shoulders (although the pain may take 18 months to settle down).
• Get the average daily exercise up to 50 minutes

Finally, for a couple of years now I've been wanting to get involved in a racket sport. Badminton or Table Tennis seem like the best options due to my strength limitations. Table Tennis is probably the best place to start as it requires the least amount of strength and agility (relatively speaking). So.....here's to finding a place to do that in 2010.

And...that's about it....

Last Hydro session of 2009

Today's image is a Barn Owl taken in the summer at a Conservation and rescue centre in the Lake District. I'm hoping that in 2010 I'll have the opportunity to see one of these beauties in the wild.

I finally made it back to the pool this morning for a hydrotherapy session. I'd not been for 3 weeks so was a bit nervous about how my body would cope. For the most part, it went ok: I felt a bit tired/weak towards the end, the LHS lower back tightness/pain was aggravated from the outset and my left shoulder was painful/restricted so had to reduce exercises on that. As ever, it really is the LHS lower back and left hip which are the limiting factor. If they didn't hurt, I could comfortably do (and enjoy!) more.

Yesterday, I got back to doing the shoulder physio exercises. I've also decided to make a concerted effort to again do the hip/core daily physio but keep it down to 6 reps on each of the 8 exercises. It's the only way I can see of targeting the back and hip problems. Muscles take 12 weeks to train so I'll give it 3 months and then go back to my GP if there's no improvement. By that time I'll have also completed the year of hydrotherapy and will be in a strong position to demand more help, expertise etc from the NHS.

NHS Physio - Sixth/Last Session

In homage to the mighty snowfall here, we have a lone Blue Tit in the expanse of snow (again, in my garden). It also kinda represents how I feel about dealing with the severe deconditioning....lonely, cold and 'up against it', lol.

Anyways, braved the 12+ inches of snow to make it to the hospital for my shoulder physio session this morning. She checked the range of movement and essentially concluded that there's not a great deal of improvement. It was my 6th and therefore last physio session with the NHS. I was advised to continue with the daily exercises for a few more months and then reassess what can be done.

My hips/back are going through a painful phase again. LHS lower back tightness/pain, left and right hip stabiliser pain, and RHS front of hip pain/tightness. After Christmas I think I need to go back to daily physio exercises again for my hips/core.

Highs and Lows

....firstly I'm bored with the format of this blog so have decided to add my birding photos to the entries. Above are a couple of Starlings from today in the garden, perched on the 10 inches of snow! The caption: "You duck, I'll stand!"...or....it's the "Highs and Lows"....lol

....secondly, it's been a mixed couple of weeks. The first was going along swimmingly. Got out bird watching on the Tuesday and Thursday for 1.5-2 hours on both days. Didn't feel too exhausted at all and I hadn't aggravated any pains/strains etc. I'd managed more 'exercise' in that week than I had in any other week during the past year and I felt optimistic!

But....Sunday came and I was out bird watching with the RSPB group. It was bitterly cold and although I'd put on 2 fleeces and a down jacket, I stood and shivered for 3 hours. At the time, I felt fine. I was cold but I was happy/alert/energised etc. Once I got home, I warmed up, had some lunch and was then overwhelmed with extreme exhaustion. I couldn't do anything else except sleep. I had a splitting headache as well. Through the rest of the afternoon/evening I felt awful - drained, headachy, frazzled! I slept for 12 hours that night.

The rest of last week was spent recovering from Sunday. Until yesterday, I'd not done any exercise at all. Had to miss hydro on Wednesday cos I felt so lousy. The odd thing is that I wasn't aware of any fatigue in my muscles as such. The exhaustion seemed to be experienced in my head, like it was extreme mental exhaustion. I felt like my brain had been fried. The headache persisted until yesterday evening. I started taking my iron tablets again on the 18th Dec to see if that made any difference. To be fair, I have been improving since then but who knows if the iron is responsible or not. If it hadn't been so close to Christmas I would have gotten a blood test done to check my levels.

So...yesterday I managed 15 minutes on the bike and did my physio exercises for my hips/back and shoulders. The bike work aggravated the LHS lower back tightness/pain and I spent the rest of the day with a hot water bottle on it to try to ease it off. The tightness and pain is still present today but I've done another 5 mins on the bike in the hope that little & often will somehow enable the muscles (hip flexors?) to regain elasticity.....who knows.

Last week really knocked me for six. I had no warning whatsoever that those 3 hours in the cold would have such a drastic effect on me. I still don't really understand how/why it happened and I don't know how to guard against it happening again. I don't know if it was my brain/nervous system reacting badly to the stress of the cold or my muscles being exhausted.....

....well, we're nearly up to Christmas. I'll post a summary of the year's progress in a week or so. It's a shame that it's ended on such a low. I will have done as much exercise this week as I did in the first week that I started the log in January 2009! Mmmm....need to keep an eye on the big picture I guess.

Sundays are bike days...

Still nursing a tight/painful LHS lower back and if it hadn't been for that, the rather tender and restricted left shoulder and arm, strains round my ribs and the tight RHS groin, I would have dug my bike out of the mess in the garage and been out in the glorious sunshine this morning. It was sooo tempting.

As it was, I thought I'd gently try the exercise bike. I decided I'd stop every 5 minutes to stretch and massage the affected back muscle and just see how it went. Generally, it felt great. Only mild twinges through the RHS groin/inner thigh and no left hip pain (which is always significant). Anyway, I managed the full 27 minutes and then immediately stretched everything out and applied heat to my back. The problematic muscle is tight and painful but I'm hoping it's no worse than it was before.

I'm looking forward to a time when I'm not having to constantly manage injuries in a way that enables me to keep up the rehab.

What's worse...

.....the only thing worse than a recurring, chronic injury is.....a new injury. Yesterday was one of those tearful days where I wonder why I'm bothering to work so hard. More than a year of physiotherapy, hydrotherapy and general conditioning and I still manage to injure myself being shown a new (easy) physio exercise. This one is supposed to strengthen the scapular stabilisers using a more ecologically valid movement. Essentially, it's retracting the scapular (engaging the lower trapezius muscle), bringing the arm out in front and rotating a ball on the wall clockwise/anticlockwise 3 times (see Exercise #3 Ball on the Wall here: Link). That's all. At the time, it felt extremely difficult and a few hours later I realised I'd strained the little muscles through the ribs round to the back, under the scapular. By the evening, my shoulders and arms had that familiar post-physio deep, gnawing ache. I'd already iced the shoulder earlier to ease the tendon pain.

Everything is still achy and tender this morning so I guess I'll need to get the technician to knead my clay in pottery this afternoon. Hey Ho...

LHS lower back tightness/pain

It's the same old problem....On Sunday, I managed another 27 minutes on the exercise bike, taking care not to aggravate the RHS groin/inner thigh strains. It went fairly well. Only slight twinges through the groin, which I iced immediately afterwards. However, the LHS of my lower back started to ache pretty soon after I got off the bike and by the afternoon/evening it was well and truly painful (which wasn't unusual really!)! However, it's remained tight/in spasm ever since and 50 minutes walk into/around town yesterday only made it worse.

I went to my hydro session this morning but the LHS of my lower back limited what I could do. I ended up spending more time floating on my back, doing flutter kicks. It's so frustrating. The past 8 months of hydrotherapy are supposed to have strengthened my core enough to prevent this type of back problem. I don't understand why I'm still experiencing the same muscle spasms/injuries over and over again. Tired and in pain this afternoon.

Hydro - 8 months, done!

Well....as of today, I've completed the 'prescribed' total of 8 months of weekly hydrotherapy. Unfortunately there was no miraculous 'getting better' or even a sense of 'now that's done my muscles and joints will function healthily'. Shame it doesn't work like that, lol.

The RHS groin/front of hip strain/tightness (whatever it is!) was still around and I suspect that any kind of use of the hip aggravates it. I didn't do any walking backwards/forwards in the pool but I did do a few minutes of flutter kicks on my back which felt good. I probably pushed it too far and I guess my hips will complain but I was really struggling to stop myself from 'letting rip' today. Sometimes the urge to get some decent exercise is hard to resist even if it does mean I strain a few muscles in the process. I cannot wait until I can actually do some hard graft cardio exercise!

My left shoulder was pretty sore after physio yesterday. I knew it would be. She wanted to feel what was happening in the joint at the ends of the restricted range of motion. It was excruciatingly painful. At one point I jumped so much from the sudden pain that she practically had to scrape me off the ceiling! Anyways, the new exercise now is one where I'm mobilising the joint myself. You basically stick a small rolled up towel under the armpit and then pull the arm across your body thus levering it 'out of' the joint. Mmmm....

My LHS lower back was very tight/achy yesterday and walking produced pain in the left hip stabiliser. Oh for the day when something actually gets better, lol!

I've decided I will carry on the pool work for another 4 months and then assess injuries/pain/progress.

Groin strains still around

Back at the pool this morning. I can't really tell whether the exercises aggravate the RHS groin strain or not but I did the usual set. I avoided the walking backwards/forwards through the water because that seems to put the most stress on the hip connections at the front. When I came out both groins/front of hips were tight/painful but my LHS lower back and left outer hip were doing ok. No significant tightness, which was nice.

My shoulders/arms coped fairly well but I didn't overdo it. They were both twingey whilst showering afterwards.

Once home, I went to get my hot-water-bottle to put on my lower back/hips and discovered it had burst on my bedroom floor....D'Oh. Sodden wet carpet and underlay which wasn't smelling too pleasant, lol.

A really bad day...

Having a really bad day. Excruciating pain in some muscle or other attached to my 'sitting bones' woke me up this morning. I turned over, went back to sleep and it occurred in the opposite side, again waking me up from dreams in which my leg was being amputated and I was crying in pain!

Both shoulder/scapular/arm muscles are stinging with knots and strains. I've got stinging strains on my ribs. I've still got the groin strains and a painful stinging knot deep in the LHS glutes which I have to be careful not to catch when I sit down. And to top it all, I went to my pottery class this afternoon and I couldn't knead the clay because it hurt my shoulders/ribs too much.

....couldn't hold back the tears any longer. I am just so fed up with the recurring injuries, the constant pain, the lack of appreciable progress, the limitations that all of this places on my life, the total lack of NHS provision to treat severe deconditioning, the fact that no-one seems to think about actually treating the tight, spastic muscles in a way that leads to their return to health! I cannot understand why my obvious rotator cuff 'spasticity' (i.e. it's locked solid in spasm, I think) isn't addressed?! Found this info on the net, which makes me even more worried that I could end up with chronic muscle pain/injuries unless someone actually helps me recondition the soft tissues properly. My glutes and LHS lower back are, as ever, a big concern. They are forever going into tight spasm and I don't think that's going to resolve on its own. Someone actually has to treat the muscles to enable them to heal and function properly.

*sigh*

Just one of those days where I feel overwhelmed by everything, can't stop bursting into tears and wish someone would tell me what I can do to make things better.....I feel powerless and as though there's nothing anyone can or will do to help me. I'm scared my right shoulder is going the same way as my left and I don't know how to prevent it or treat it.

Another week

I had to take it easy in the pool today unfortunately. The recurring RHS groin/front of hip strain is back after I did 27 mins on the exercise bike on Sunday. It defies belief that I can strain something whilst exerting so little effort but there we go! My left shoulder is fairly static - no real improvement and I have to be ultra careful not to aggravate it by doing anything that causes pain. My right shoulder is now chronically painful when I lift the arm. I'm hoping that will eventually settle if I take care of it a little.

I've turned down the offer of help from the instructor at the sports centre. My shoulders aren't ready for swimming yet.

One nice thing from today was that I saw a lady at the pool who had the same build as me - everything long and slender. However, she looked strong and obviously had stable, mobile joints and I essentially got to see what I'm aiming for. It's strange how distorted ones perception of what's 'normal' can become when you're surrounded by people with very different body-types to you. I had visions of big, pronounced muscles but, in fact, my body won't ever be capable of developing those. I will always have long, slender muscles, however developed they become. It helped me to realise that being 'tall and skinny' doesn't mean you look weak and feeble (as I witnessed in this lady today - she looked very strong and athletic). It made me feel better about myself - more accepting of my physical make-up. I don't need bulging muscles - I need to focus on getting everything stable and functional.

....speaking of which, I rang the hospital today to see if the physio who had been overseeing my hips/back/core rehab was still around. Unfortunately, she's moved on. I'd hoped she'd be able to give me guidance as to how to progress rehab over the next 6-12 months but I guess that's up to me now.

Realistically, I think I have to keep plugging away with the pool work. If I'm still getting strains from it and still getting tired out from it, then my body has yet to adapt to its demands. I'm still gaining from it. At the end of this month, I'll have done 8 months of hydrotherapy so I may as well aim to complete a full 12 months. That seems like a good sort of place to then reassess progress. It would be great if I could eliminate these recurring strains around my hips/groins.

Hydrotherapy - The 8th month

Back from another session at the pool. And, I'm into the 6th month of hydrotherapy since finishing the 2 months at the hospital pool. The exercises felt good today and I did extra walking backwards/forwards. My shoulders remain the sticking point. My left shoulder/arm is still very restricted and painful and my right shoulder/arm is just about coping albeit with pain. My left hip/LHS lower back only ached mildly once I got home today. I'm applying heat as I write, lol.

Afterwards, I felt brave enough to talk to one of the instructors at the centre. I wanted to see if they could give me any direction as to how to progress the rehab. The lady I spoke to was very well-meaning and kind and, like so many people I talk to, she seemed to have a very narrow view of 'what I needed'. Swimming lessons were the answer....

There really are as many 'answers' as there are people I speak to. Some say gym work, some say mat work, some say swimming, some say bigger muscles, some say greater endurance....and so it goes on. It's tricky! Anyway, I'll see how I feel next week. I'm not sure swimming lessons are the way forward with one very restricted shoulder and one that is struggling to keep up healthy function!?!

Generally, I'm sleeping very badly. For the past 3 nights I've taken hours to get to sleep and then woken (or been woken by the next door neighbour's flipping tumble drier! 5:30am?!?! Who does drying at that time of day, I ask you!?) at 4am-ish. I'm getting, at best, 5 hours a night. After the pool work today, whilst speaking to the instructor, I came over extremely faint and had to make for the nearest chair. It took a while before I could stand again and I still don't feel too good - like I could faint at any minute. My body is doing weird stuff this week...

NHS Physio - 1/3 of the way through

I started with the NHS physio last week for my left shoulder (private physio is on hold until that's completed). As far as I know, the NHS only offer a course of 6 sessions(!).

This morning was my 2nd appt. Still no ultrasound, manipulation or massage. Just a series of test/assessment exercises and recommendations for new physio exercises to strengthen the lower trapezius muscles to stabilise the scapular. I came home and iced my shoulder.

Discovered this morning that my intercostal muscles through my rib cage are stiff/strained. And, judging by how they feel since the physio appointment, I know the cause, lol. The trouble with engaging/strengthening new muscles, is that these inevitably pull on shortened (and invariably) weakened opposing muscles which are then pulled taut and risk strain and continued stiffness. I think this is the problem with the structures around my shoulder. By continually retracting and stabilising the scapular, I've introduced a level of tension through the opposing muscles/tendons/nerves and they are struggling to accommodate and adapt to this. I suspect that the whole of the front of my shoulders and chest will take a long time to stretch out, adapt and become elastic at the longer lengths. In the meantime, I just have to put up with the pain and be careful not to induce injury.

Feeling kinda despondent. It's the complete lack of muscle which is depressing really and knowing that rebuilding the back muscles is going to take years, with all the associated pain etc. I've probably written this a million times already, but the major obstacle with severe deconditioning is this critical lack of muscle to begin with. It's so much easier to build muscles once you have the capacity to move the joints in a stable, controlled, pain-free way. If you don't have the strength and joint stability to even lift your arm above your head you've got a heck of a lot of ground work to do before even thinking about 'bigger muscles'!

Ah well....what's a few more years of rehab in the grand scheme of things....!

Bike work

Well, having worked my way up to coping with 25 minutes on the exercise bike, the private physio suggested that I could now split the time over 2 sessions (say 12 mins and 13 mins), and then build up each of those 2 blocks. My schedule had been Wed: Hydro, Saturday: Arms/shoulders, Sunday: Bike. This worked well because it took my hips/back/legs at least 3 days to recover from the hydro workout. I tried adding in another bike session on Fridays but my left hip just hadn't recovered enough to cope. Then, I started a pottery class on Fridays and that is a workout in itself - absolutely exhausting, lol. So, I tried shifting the bike sessions to Saturday and Monday but that doesn't work either. Mondays are therapy days and I'm just too rung out from that.

Soooo...after a lot of failed experiments, I shall get back to the way it was to begin with, lol. I think that the addition of the pottery class is enough of a step up in terms of stretching my rehab.

At the moment, my left hip stabiliser is going through a tired, achy phase with pain on foot strike. I guess I overdid it one way or another last week and it's not quite recovered. I iced it yesterday but that hasn't reduced the pain. Today, I skipped the second bike session of the week to give it a chance to heal before Wednesday's pool work.

ONE YEAR

Yup, it's a year today since I started physiotherapy/rehab for my hips/back/core. One year down, a few more to go I guess. Progress has been slow and painful. I'm still getting strains or pain through my groins, outer hips and lower back. I know I'd be feeling a whole lot more depressed about the lack of progress if it hadn't been for the reduction in hip and back pain after the last 3 hydrotherapy sessions. That has felt like a major milestone.

This morning, my left hip and lower back are achy/tight. *sigh*

At the moment, I keep experiencing overwhelming tiredness through the afternoon/evening and it's only relieved by sleep. I don't know really what's causing it - could be any number of things including the severe deconditioning/effects of rehab.

Too tired.

Shoulders

I had my 3rd physio session this morning. I mentioned that the shoulders and arms had been pretty tender and restricted since the last session and that I actually don't have the muscle strength to do as many assessment exercises as last time. The physio took all that on board and seemed to mostly do muscle and nerve mobilisation. At the time it didn't feel particularly painful or aggressive but since coming home my left shoulder and arm has ached/hurt badly and my right shoulder/arm hasn't been happy either.

I dosed up on painkillers and went to sleep for an hour this afternoon! I was completely wiped out. Not sure why - perhaps a combination of yesterday's pool work and this morning's physio. Who knows.

The physio mentioned that I have lost significant muscle definition on my left shoulder and arm and it'll take a while to rebuild. The deltoid muscles of both shoulders are still small and weak. Standard delt exercises are too advanced so I think I need to stick to pool assisted movements and perhaps some 'static deltoid contractions' as demonstrated by the chappy below (Link)

I picked up a mild RHS hamstring/back of the knee strain yesterday from the pool work. Iced it this morning and put on a support bandage. It shouldn't take too long to heal. Other minor injuries at the moment are trunk strains, mostly just below my rib cage on the sides/back. Again, no idea how I did them but they're there.

My mind is mostly preoccupied with how I'll get full range of movement and muscle function back in my shoulders and arms. It's the usual problem of there being so little muscle that it's hard to find exercises that don't cause strains or overuse but do promote growth. Scapula stabilisation is a key component but.....how....? Mmmm.....I'm sure it'll come with time and perseverance. But, it could take years before my shoulders and arms function healthily and strongly. *sigh*

....it's a long, hard slog. Just as I feel optimistic, I suddenly get a dose of reality and have to accept that the progress I envisage is a long way off.

Anyone else out there been through this rehab process....?

25 Minutes and No Pain!

It's been a beautiful, sunny October day. I headed out to go bird watching this morning and spent a few hours over at Amwell and Rye Meads Nature reserves. Walking felt ok - no sharp, left hip pain on foot strike and the LHS of my lower back wasn't too tight/painful.

This afternoon, I did the usual Sunday bike work. Today, I hit the 25 minutes mark AND I didn't experience any hip stabiliser aching or LHS lower back tightness and pain! It's the first time in the 8 months that I've been using the bike that I've not had any pain! I daren't celebrate too soon but I'm really hoping this is another sign of improving muscle/joint condition and a step towards real fitness.

On the downside, my shoulders/arms are aching and painful. I think the tendonitis in the left shoulder is playing up again but, hey, I can cope with that so long as it will eventually settle.

....25 minutes on the bike and no pain - hurrah!

Note added 07/10/09: Post-cycling, there was some aching/tightness in LHS lower back and mild groin strain/tiredness on RHS. However, relatively speaking, it's still significant progress.

Ongoing tiredness

Getting back to doing the daily physio exercises for my hips/core seems to be wearing me out big time. For the past 3-4 days I've either need to sleep in the afternoon or at least rest completely. My shoulders/arms have remained problematic/painful since the physio session last week.

...just tired out from all the rehab.

Physio session

Went for my second appointment for my shoulder today. The pain I get is mostly down the upper/back of the arm. The physio identified a number problems, all essentially relating to deconditioning: tight/deconditioned nerves, restricted acromioclavicular joint, and muscle knots at the back of the shoulder, just under the arm pit. She worked on each of them, mobilising the nerve, the joint and then trying to release the muscle. At one point I actually felt quite faint from the pain/manipulation but thankfully it passed. By the end of the session I knew I was going to be in pain this afternoon! And, once again, I'm aware of the general weakness of the whole structure. Just the assessment exercises of lifting the arms up in front and then out to the side are really hard work. They wore out my right shoulder/arm as much as they did the left!

....anyways....this afternoon I've dosed myself up on painkillers - the intense ache set in pretty quickly. A hot water bottle applied to the back of the shoulder is also helping. Strangely, I feel pretty wiped out by the whole thing. I hope it all feels better tomorrow....

Hydrotherapy - improvement

....just back from the weekly hydrotherapy session. It felt good today. My muscles worked smoothly and apart from the slight twinge on the LHS of my back, there was no pain. And, when I came out of the changing rooms, I could actually walk without pain! That is a first. Normally, my left glutes/hips muscles give off sharp pain on foot strike and the LHS of my lower back is tight and painful. But, today, there was a significant improvement.

Over the past couple of weeks I've returned to doing the original daily physio exercises to strengthen/stabilise my core muscles and recondition the hips. My hope was that this would relieve the chronic back and hip pain. And, it seems to be working. It's annoying though that the only way to get my core muscles working is to keep up the physio routines. I wonder how long I'll have to stick at this before my core just does what it's supposed to do!?!

My left shoulder/arm is having a painful week, lol. I'm seeing my physio again tomorrow. Hopefully she'll help ease things up again.

Edited 20:11: I've not felt tired/sleepy at all this afternoon/evening which is another real improvement.

Aching hip

The last couple of weeks have been dogged by chronic left hip/glute and lower back pain. I've kept up with the exercise routines, tried to massage out any knots, applied heat and rested when necessary. However, I'm now having to take painkillers to be able to sleep at night as the pain stops me from dropping off.

The bike work in particular seems to aggravate the ache. And, then, I can't sit for long periods because the pain intensifies. So, it eases when I move but as soon as I stop and sit or lie down, it becomes this gnawing ache through from my lower back, through my left hip, into my groin and even down my leg. I wish I knew what was causing the pain and how it might be stopped! I can't believe it's a lack of muscle strength any longer. Surely, by now, the glutes are strong enough.

I've started work with a private physiotherapist locally for my shoulder. But, I think I really need some help with my hip now....*sigh*.....

The pool work today felt good (aside from the annoying left hip/back twinges).

20 minutes barrier

...finally through the 20 mins mark on the exercise bike. I pushed it today. Yesterday, I'd had an active 3 hours at Amwell Nature Reserve and wasn't sure my muscles would be up to anything strenuous today. Certainly, I didn't fancy any more walking but I figured a little light *cough, cough* bike work would be ok.

My left hip stabiliser and lower back are still playing up, which really is getting very tiring.

But, when I got on the bike, I just thought s*d it and went for 20 mins. For the most part it felt good. My left glutes twinged at the beginning and my right knee crunched at one point (as is its way, lol) but overall, it was smooth and painless.

Now, I'm sitting here with a hot water bottle stuffed down my back, lol.

Edited 10:20pm: Left hip/glutes and LHS lower back ache intensified as the afternoon/evening wore on. Definitely paid for pushing things today.

Aching

I'm going through one of those periods where various muscle groups suddenly decide to hurt or that deep-tissue aching is the order of the day. There's no obvious rhyme or reason to it. It just happens. It started a few days ago with my knees, then it was my lower back and yesterday evening, it was my shoulder girdle. The knees and back are still aching/strained....

Tonight, the ache throughout my shoulder girdle is akin to 'restless leg syndrome' (Link). I can't keep my shoulders/arms still - the ache becomes so intense I have to move the structures. It aches deep down through the front, top and backs of my shoulders, down through my arms, through my elbows and into my hands. As I sit here, I keep having to stop to move everything around, straighten my arms, shrug and roll my shoulders, stretch my neck and so on. I'll head off for a hot bath later and hope that that will relax the muscle fibres.

I've not done anything new or different. Today's exercises were the usual weekly set, concentrating on the arms and shoulders:
2 x 10 reps 1.5kg bicep curls; 2 x 10 reps 3kg bicep curls; 3 reps 5kg bicep curls.
3 x 10 reps 1.5kg tricep extensions
1 x 10 reps 1.5kg shoulder shrugs
40 standing rows using the red theraband.

Post-Two Week Break

My body seems to have benefited from the break from rehab for nearly 2 weeks. Injuries/strains seem to have settled down and the only problem areas remain my left shoulder and left hip. It felt good to get back to the pool today for hydro exercises. I made sure I stuck to the usual routine - no over-doing it. I also tried out my new swimming t-shirt (a ladies rash vest) which helped enormously to keep me warm.

I've made an appointment with a private physio who's been recommended to me. She sounded great on the phone and I'll be seeing her in a couple of weeks time, when she gets back from her hols. The 3 month wait for NHS treatment is too long and I'm happier to go with the good recommendation.

This afternoon, I do feel tired and my left hip/LHS lower back are achy/painful but it's not absolute exhaustion like it used to be post-exercise.

New injury

*sigh*....yup....after 3 days of nursing aching hip stabilisers, lower back and legs, I've managed to strain the intercostal muscles through the back of my rib cage. I only realised today how I did it when I tried the exact same movement again and made things worse! Basically, I've been doing lots of stretching (once warmed up) and the stretch I do lying out flat on my back with my arms over my head, straight by my ears, is the culprit.

I really hope these strains are only minor and will heal up quickly. The pain is quite unique and I'm absolutely fed up with injuring myself doing rehab!!

Trigger Points and Bursitis

I was back at the pool yesterday, getting in a hydrotherapy session before going on holiday this Friday. Things had been feeling good and for the first time in I don't know how long, I didn't have any specific pain/restriction in my hips/legs whilst in the pool. Of course, this meant I tried to do a little bit extra. I did more walking and I did 10 extra reps of the leg curl/press exercise. I came out of the pool feeling like I'd had a good workout.....

….Will I never learn?!

An hour or so after getting home the aches started. At first it was my left hip stabiliser (gluteus medius), and through to my lower back on the left hand side. As the afternoon and evening wore on, the aching was pervasive, through my hips, lower back and down my legs. It ached like you wouldn't believe! I tried massaging the trigger points (Link) with the tennis ball, I applied heat and lay down for an hour to rest all the muscle. In the end the gnawing ache was reaching the point of unbearable so I took the maximum doses of paracetamol and ibuprofen. That didn't completely eradicate the pain but it certainly helped. I also developed muscles twitches at various sites all over my legs and hips. Basically, I’d fatigued the muscles beyond their limit.

The main trigger points seem to be through the Gluteus muscles, Tensor Fascia and/or the Quadratus Lumborum in the back. Most often they are particular to the left hand side.

Trigger Point Diagrams (taken from here)

Gluteus Medius

Gluteus Maximus

Quadratus Lumborum

This morning, the aches through my glutes and the lower back on the LHS are still present but not nearly as overwhelming as last night, thankfully. I’ve had a 5-10 minute slow/gentle walk and thoroughly stretched out my legs, hips and back; did some tennis ball massage again and applied heat. Hopefully, the muscles will recover in a day or two.

The other news today is I had the ultrasound scan of my left shoulder. Essentially, it’s good news. The main tendons are healthy and intact. They are below average in thickness which could be because of my slim build or because they need some building up, who knows. Anyways, they’re healthy. The main finding was inflamed bursa around the infraspinatus tendon. The bursa fill with fluid to protect the tendon when it begins to rub on surrounding bone, hence the inflammation. It’s probably what is causing the pain and restriction on external rotation and abduction. The doc is recommending more physiotherapy, an xray to check for bone spurs and perhaps guided aspiration of the bursa.

Edited 01/09/2009: Saw the ortho guy today. Ultrasound (US) also revealed mild Supraspinatus tendonitis and an x-ray confirms no bone spurs. So, it's now a course of physiotherapy and hopefully I'll avoid the US-guided bursa injection!

6 months on

Yes, it's been 6 months since I bought the exercise bike. Today, I hit the 16 minutes mark for cycling time and it felt great. I'm still on the lowest resistance level possible but it's about increasing the endurance of the muscles/tendons rather than strength (initially). My weak left hip stabiliser/glute is still the problem area. It began to ache towards the very end and ached/hurt afterwards. I massaged with the tennis ball and then applied heat but the pain continued for most of the day and also affected my lower back.

It's taken 6 months to condition the hips/legs to go from struggling to cope with 3 minutes on the bike up to the 16 minutes. The left hip is the limiting factor.

Although the hydrotherapy work does include arm muscle exercises I also do bicep curls and tricep extensions once a week. I think I overdid it today. As ever, I forget that although the bicep muscle might be strong enough to cope with the higher weight, the rest of the supporting structures aren't. My shoulder girdle and left arm really ache.

Improving

....another early morning to get into the pool before the children later in the day. Had a bad night last night. Woke at about 4am after nightmares and felt overwhelmed. Unable to control the tears but decided that sobbing in the dark was only going to make things worse so turned on the lights and wrote. It helped. Eventually went back to sleep for another hour before the alarm went off at 8am.

Anyways....the pool work felt good today. The exercises felt easier and I got through them pretty quickly. The improvised shoulder exercises are really helping my restricted/stiff left shoulder/arm. When I get out of the pool, I immediately have a lot less pain and restriction although it stiffens up again as the day goes on.

The downside today was I got really cold. After 30 mins of doing exercises I was shivering in the water and couldn't stay in any longer once I'd finished the workout. Thankfully, the nice shower was free and the water was toasty warm so I soon defrosted.

This afternoon, various muscles ache/hurt. My shoulders in particular and my right groin and Iliotibial band (ITB) (which has been stiff/problematic over the past few days). I guess they'll settle down eventually!

Feeling pretty sleepy and may head off for an afternoon snooze.

Note: heard from the NHS physiotherapy dept today - 3 month wait.

Pressing On

....just got back from my second session at the specialist swimming pool. I wasn't feeling too good this morning - lots of aches and pains and didn't sleep well - but I honestly didn't know which would bring the most benefit: rest or workout?! I opted for workout because at least when I'm doing that I feel like something constructive is happening.

My main concern at the moment (apart from my left shoulder!) is my left hip or, more specifically, the connections at the top of my left leg, from my groin round to the outside of the hip joint (oh! for a degree in anatomy!). Anyway, something very painful is going on and I can't rotate and flex the leg at the same time without causing excruciating pain. I'm hoping it's just a 'sore muscle/tendon' and it'll settle down, rather than any kind of tear/strain.

I was really glad to discover today that there is a bar running along the side of the pool so that I can hook my feet under it and do the 'leg press/leg curl' and 'side slide' (working the abdominal obliques) exercises. I came out of the pool feeling like I had really worked my legs today. Here's hoping I don't discover a whole host of new strains later!

I've improvised some hydro shoulder exercises (from here: Link) and I think they're helping to keep the joint mobile. Essentially, keeping my arms just under the water so as to keep the weight as low as possible, I'm doing the arm circles (arms straight out in front, circling arms clockwise/anti-clockwise, 10 reps); then front raises, 20 reps; lateral raises, 20 reps. I'll increase the reps as able up to the 50 reps used on all other exercises.

Anxiety & Different Pool

Not been doing so well over the past few weeks. Anxiety levels have been sky high and I've been perpetually struggling to hold back the tears. I saw my GP this week (tears streaming down my cheeks!) to try to get a little more support with the deconditioning rehab: perhaps access to physiotherapy for ongoing injury assessment/ultrasound treatment and so on. However that isn't really available. I did, however, get another referral for physiotherapy plus an ultrasound scan for my left shoulder. It's better than nothing.

I've realised that "problems without solutions" are the most depressing and anxiety inducing thing to us. Anything which causes a sense of 'helplessness' and 'trapped-ness' is triggering. Thankfully, I think I've found a solution to the problem of how to keep up with the hydrotherapy. I've discovered a specialist swimming pool in the area which maintains the water at a temperature of between 30-32deg. I tried it out today and it's better than my local pool. The 32 mile round trip and 2.5x greater entrance fee are worth it! I was very anxious before leaving the house (exam level anxiety) and even as I drove there, but once I got into the water and focused on the exercises I must have relaxed. I came out of the pool feeling calmer than I have in weeks. I'd forgotten how wonderful it feels when anxiety levels drop and you can breathe easily and your mind stops obsessing about anything and everything. Bliss.

Feeling very tired this afternoon and all the strains are achy, especially my shoulders. I'm looking forward to sleep tonight!

Two steps forward....Three steps back

....that's what it feels like at the moment. I'm trying to be really careful to avoid injury but it seems impossible.

Current Injuries:
RHS inner thigh/quad strain and groin strain
LHS groin strain, plus mild inner quad strain
LHS hip stabiliser and glute pain
Both shoulders are problematic. The left is worse than the right but neither is pain-free.
RHS trunk/ab strains which just don't seem to heal. They've been stinging on and off now for 4 months.
LHS pain through the hip (along some muscle/tendon, not sure which!). Actually both hips are suffering at the moment.
Generally, walking is painful.

What should I do? Muscle strains seem to take months to heal rather than weeks (the groin/quad strains happened a month ago). If I rest for 'months' to allow healing, I then risk deconditioning the muscle I've worked hard to recondition!

The injuries, associated pain and fears of 'getting worse' are taking their toll. I'm suffering again from bad anxiety. Been awake since 4 this morning, struggling to control thoughts of desolation, panic and fear. Shed too many tears.

It would be great to have access to ultrasound to speed up muscle repair but I don't suppose the NHS agree....*sigh*

Tiredness

One of the limiting factors in rebuilding my body is tiredness. The pool work a couple of weeks ago combined with stresses relating to a big social event have kinda finished me off this week. Half the time I don't know if I'm actually overdoing it or not on the exercise-front. Do I need more rest perhaps ? One article I read offered this interpretation of one type of muscle fatigue: ".....I call it body shock. The body is a holistic unit and hard intense training done for long time periods has a cumulative effect. After a while a uniform sense of overall fatigue is experienced manifested by an overwhelming sensation of tiredness. This tiredness envelops the whole body. When in the throes of body shock it seems as if you are moving through water. In my experience this type of fatigue is a direct result of an accumulation of intense workouts." (Link)

At the moment, I seem to be experiencing extreme tiredness. A few times this week, including today, I've given in to the overwhelming need to sleep in the afternoon. Went to bed for an hour. Yesterday, I'd made myself stay awake through the afternoon but it was a struggle and clearly didn't help.

It's very hard to know if my body is needing recovery time and thus less muscular strain or if I should actually persevere and ignore the intense tiredness. Tuesday, I took the 'ignore' route and did 15 mins on the exercise bike combined with hip and shoulder physio exercises. The bike work felt fantastic and I was chuffed to bits to manage it. However, I was soon overcome by overwhelming tiredness and slept in the afternoon?!

I'm skipping the pool work again this week. Hoping that the break will reduce the tiredness.....we'll see.

What now?

...finished the NHS course of 6 sessions of hydrotherapy. I've been advised to continue with the strengthening exercises in my local pool for another 6 months before moving on to gym work! Well, I did my first pool session today and it really wasn't very enjoyable. The water is way too cold for standing around doing exercises (I kept getting cramp in my feet) and there's no bar along the side of the pool to hook my feet under to do the 'leg press' type exercises. I tried to improvise but it didn't feel great. Plus, there are other people in the pool wanting to get around me. I stayed in for about 35 minutes, 10+ of those were spent walking backwards and forwards making use of the water resistance. The shower afterwards was cool, yucky and not much more than a trickle. All in all, I'm not sure I really want to keep it up for 6 months - might be way too depressing.

However, the upside is that it does provide strength training without the added pain and wear/tear on joints. That is a significant plus point, even if the water is chilly. At the moment, my left hip is really problematic with sharp, intense pain deep in the joint on foot strike when walking. I'm guessing it's a muscle knot/trigger point or inflamed bursa. In the water, that isn't a problem. My left shoulder/arm is worse than it's ever been and my GP is referring me to a shoulder specialist. I know the root of the problem is severe deconditioning causing instability but there might be something that can be done to alleviate any inflammation/strains caused by doing the strengthening exercises. Anyways, I digress....

This afternoon, I've felt overwhelming tired. Went to bed for an hour and actually slept. I still feel wiped out so whatever I did this morning, it worked something. Hopefully, it wasn't just the fact that I was on the brink of being 'cold' throughout the workout!

So, what next? Do I focus on the positives of water work and just grin and bear the cold, the inconvenience to other swimmers, and the yucky, rubbish showers? OR, do I find an alternative way to work out - gym ball, gym equipment, something else?? Whatever it is, it needs to be a full-body strength training programme for use with no muscles, lol.

Food, food, food

I've been trying to keep my calorie intake up to at least 2000 cals per day, and, for the last week, up to 2300 cals per day. But, I'm perpetually stuffed! I am having to force myself to eat and I'm not enjoying it. My appetite and body work fantastically well at desiring and consuming only what's sufficient for my needs. I'm one of those lucky people who can eat what they like, doesn't have the urge to over eat and never really has to worry about calories. Except now....when I'm trying to 'bulk up', I'm watching every single one!

The aim is to eat around 70-100g protein per day, 250-290g carbs (of which 90g-100g sugars) and 70g fat (of which 20g saturated). Based on my age, gender, build, weight, activity level, etc, I should gain about 0.5lb in weight a week if I eat at least 2000 cals per day. I used this calculator if anyone's interested. I wish it was possible to tell the calories to go and build muscle (rather than the likely alternative of depositing the excess fuel in fat!). Ah well.

Mostly taken it easy today. Wore the ankle weights for a couple of hours and did a little bit of gardening. My lower back and left hip ache and my left shoulder is painful/achy.

Stiffness and Bicep Tendonitis

Yup, felt very stiff yesterday after the hydrotherapy, especially in my hips and legs. It was good stiffness though - that sort-after 'delayed onset muscle soreness' (DOMS) (link). I made sure I stretched out the stiff muscles and generally rested. Today, the stiffness is subsiding.

Unfortunately, my impinged left shoulder is consistently problematic. After a bit of research, one of the symptoms is definitely bicep tendonitis, specifically affecting the short head which passes along the front of the humeral head and attaches to the coracoid process on the scapula.



For more information on bicep tendonitis see: link

I guess all I can do is rest and ice it, which is thoroughly annoying since I need to strengthen various surrounding muscles in order for the impingement of the shoulder to resolve! Maybe part of the reason for the inflammation is the stretching of the tendon as the scapula is retracted during the strengthening exercises....who knows...

Hydrotherapy

4th session today in the hospital hydrotherapy pool. I found it surprisingly tiring. My muscles just didn't seem to be up to the job - they felt very tired and fatigued quickly. I've aggravated the right abdominal muscle strain....again! Since the session, it's been difficult to use various big muscles without causing them to go into cramps/spasm. My hamstrings are tired...everything's tired! I'm a little concerned that my muscles really aren't refuelling properly or able to metabolise exertion properly. I think I need to monitor this to make sure it isn't getting progressively worse rather than showing the expected improvement in stamina.

Below, is a picture from the internet to give an idea of how the hydro works - we use 'woggles' (foam, roller floats) to help provide buoyancy and target particular muscle groups:


The water is very warm (34 degs?) which means that the muscles are supple and receive a good blood supply, further reducing pain and stiffness and injury.

Post Script 12 April 2013: For a detail description of the hydrotherapy routine I did, please see

this post.

Ankle weights

In reaction to another day nursing strains to my MCLs, painful knots/trigger points deep in my left hip, a very tired, achy lower back and a sore, strained shoulder girdle, I bought some ankle weights!

I guess I just had to do something 'constructive'. I got the smallest weight possible 1lb (just under half a kilo). The plan is to wear them around the house and perhaps on walks that I want to be more strenuous. So far, they feel just right.

Here's to more leg muscles!

Impact of severe deconditioning on muscle biology

Although I've put a link up to this information elsewhere, I reckon that it's important to put this info in full view.

Taken from: WAGENMAKERSC, ANTON J. M. (1999), 'Chronic fatigue syndrome: the physiology of people on the low end of the spectrum of physical activity?' Clinical Science 97, (pp.611–613) (link)

Severe deconditioning affects the blood flow to the muscles:

"...deconditioning plays an important, and so far under-appreciated, role in the abnormal physiology that is seen in CFS patients. Saltin et al. [9] have shown that 20 days of bed rest by healthy subjects reduced cardiac output and oxygen delivery to working muscles by 15–20%. Muscle blood flow during and following exercise is also reduced in elderly subjects [10]. This has, in part, been explained by a reduced vasodilatory capacity and in part by the decreased capillarization, which again is a consequence of the reduction in physical activity and deconditioning that are seen during ageing [10]. The development of abnormal autonomic or peripheral control of muscle blood flow is not limited to CFS patients [7,11] but also occurs in healthy subjects in the adaptation period to acute and long-term deconditioning."

Severe deconditioning adversely affects the biology of muscle and its ability to metabolise exertion:

".... some, but not all, patients with CFS show a severe loss of mitochondria. Six of the patients with the lowest mitochondrial activities performed a graded incremental exercise test on a cycle ergometer and had a dramatically reduced exercise capacity (maximal work rate 60–120 W; 20–50% of the normal controls). They nevertheless achieved heart rates and blood lactate concentrations normally found with maximal exercise [12,13]. These data indicate that these patients showed a metabolic adaptation to severe deconditioning, and that the adaptation to deconditioning may be as large as, but the reverse of that reported in trained subjects [14,15]. This implies that these patients experience the stress of maximal exercise during normal daily activities (20–80 W) and this again provides a reason to avoid exercise, so that they spiral down in a vicious circle of inactivity and exercise intolerance [12].

"One of the consequences of low mitochondrial density is a reduced oxidative capacity. This again leads to a reduced rate of resynthesis of creatine phosphate following high-intensity exercise [16]."

So, reduced blood flow to muscles, loss of mitochondira and the reduction in resynthesis of creatine phosphate (which is probably a consequence of the first 2 factors) all serve to cause deconditioned muscle to be fast fatiguing (i.e. significantly reduced endurance capacity) and slow recovering (i.e. requiring significantly longer to refuel and repair).

For further contextual information about creatine phosphate and its role in the biology of muscle fuelling and refuelling see: Link

Overdone it

It's a recurring problem. I think I can 'just manage one more' and I strain something. Yesterday, I upped my bike time to 8.5 mins (rather than the planned 8 minutes) and then later did 32 wall squats (as apposed to the planned 30), 14 single leg calf raises, 9 reps with the leg theraband and a few stretches (lunges, piriformis and psoas stretches).

This morning, I've woken up with stinging strains at the crest of my pelvis on the RHS of my back. I guess it's strains of the thoracolumbar fascia(?). Plus, mild MCL strains on my both knee. I knew I'd done those during the squats.

My left shoulder was extremely painful yesterday evening. Pain radiating down my arm. I did some 'tennis ball' massage on the trigger points (link) on my scapula but ouch! it hurt. Will rest everything for the next 2 days before hydrotherapy on Thursday.

CFS sufferers beware

I've thought long and hard about why this muscle wasting has happened to me. And, the best I can come up with is that it's come about through an unlucky combination of factors, these being:

1. The debilitating effects of the mental health problems (including poor quality sleep for years)
2. The debilitating effects of medication taken for the mental health problems
3. The iron deficiency which probably went undiagnosed for some time due to the masking of the first 2 factors
4. My physical make up. I'm what body builders would call an ectomorphic body type - I find it hard to put on weight or muscle. I've always been a 'skinny bean' no matter what I ate
5. A poor diet during the most difficult years of the mental health problems. I probably ate enough calories but they were perhaps 'empty calories' meaning they contained little vitamin or mineral nutrition.

And so, for years I was significantly under active and 'ill'.

What worries me is that the likelihood of disabling muscle atrophy is not publicised to those who are most at risk. I was never warned about the possibility. I had no idea that, for example, if a muscle isn't used for 12 hours it begins to waste. It takes just 12 hours! Nor that once a muscle starts to waste, other muscles 'come to the rescue' and start to take over the work of this wasting muscle, thus adding to the original problem. It is not difficult to see how large pockets of important muscle then begin to waste away leaving just a few doing most of the work. I have been left with literally just sinews of muscle holding my joints together, leaving them unstable, easily fatigued and strained. If only I had been warned and given appropriate advice as to how to prevent muscle atrophy I would not be looking at 2 years of concentrated, painful work to rebuild my body.

There's an interesting article explaining how sufferers of Chronic Fatigue Syndrome are at high risk of muscle atrophy and all that this entails (link). I very much hope that GPs are helping CFS sufferers to manage both their illness and the unseen effect that the enforced body rest has on their muscles.

Patience

It's been a frustrating sort of day. Managed a 30 minute walk but my left glutes were complaining right from the start. They kept going into tight knots and causing sharp, intense pain deep in the hip joint during every foot strike. I came home and stretched out my hips (the usual piriformis and psoas stretches) and hamstrings. My lower back has been complaining today as well, connected to the tired hips, I guess. And, the right side of my trunk is still slightly strained and tired.

My shoulder girdle still aches. I've only done 1 set of physio exercises today. The muscles need some respite.

Today, I have energy and 'get up and go' but no muscles with which to expend it. After years of incapacity it is hard to be patient with my body....but patient I must be. I have dreams where I can run or swim like an athlete. One day, I'll have the muscles and stamina to put my heart and soul into lengths of front crawl or a sprint across open countryside, and I'll feel the life and blood coursing through me and I'll feel truly alive and real. I can't wait....

7 Minutes

I'm finally up to 7 minutes on the exercise bike, every other day (or there abouts). Initially, I could barely manage 3 minutes without my hip flexors and glutes aching like crazy. Today was the 3rd time this week I've done 7 minutes and I made sure I stretched out my hips (piriformis and psoas stretches) afterwards before applying heat. This seems to be the key - stretching and heat. The anticipated aching hips haven't been too bad at all this afternoon.

Also managed 3 x 10 reps wall squats (link) and 2 x 7 reps single-leg calf raises (link).

Just getting back to using the theraband to strengthen glutes and hips. Managed 8 reps in all directions on both legs [i.e. hip abduction (link), hip adduction, hip extension (link) and hip flexion]

Today, my shoulder girdle is aching, tired and strained. Not sure my muscles can manage the physio exercise demands, unfortunately. According to one website, I need to "Pay attention to pain. This is a difficult one. Pain can mean that the painful area is damaged and you should not move it until it has healed more, but it can also be much less important. If your joint is stiff, you will need to stretch it and cause some pain if it is to loosen up.Good pain is not too severe and settles down quickly. Bad pain is severe and takes a long time to settle down after. If you cause pain on exercise, and you may have to to succeed, make sure it is good pain." http://www.thephysiotherapysite.co.uk/physiotherapy/exercise/exercise-advice

My shoulders have 'bad pain' tonight....

Discovering I have "severe deconditioning"

It's been 7 months since I started physiotherapy for, initially, left hip pain and strained medial collateral ligaments (MCL). It's been 4.5 months since I started physio for an impinged left shoulder.

Within a few months of starting physio in Oct 2008 it became clear that I was suffering from "severe deconditioning" (pervasive muscle atrophy or wasting) due to years of significant underactivity. From 2000 onwards I had been dealing with the delibitating effects of Complex PTSD (Link), depression and a severe dissociative disoder (Link), and later, an iron deficiency. During those years, my body simply didn't work properly. I was easily exhausted by any stimulus be it emotional, cognitive or physical. Being dosed up on various anti-depressants, tranquillisers and sedatives only added to my incapacity.

With this in mind, it is perhaps not surprising that the muscles in my body began to waste away, however, the inevitable weakness came as a real shock to me. I had always thought that once my brain started to work properly and was able to regulate my body correctly, then my muscles and strength would be 'there' waiting for me to use.

Not so.

According to my physiotherapist it's going to take 1-2 years of hard graft to rebuild the muscle mass I've lost throughout my body and recondition the nerves/tissues to function correctly. Until an abdominal strain 10 weeks ago, I was doing 2 hours of physiotherapy exercises every day. It was exhausting!