I revisited this wonderful little info nugget called "Recovery Strategies Pain Workbook" by Greg Lehman. It's described as a workbook "designed to help therapists and patients deal with injuries and persistent pain. The book can be used alone or can be used with a therapist." I actually found this several months ago, but when I started to read it I kind of wrote it off. I don't remember why. Maybe I was in a bad mood, or maybe I thought it was hog-wash. Ha! I reread it recently and it really improved my outlook! Much of the advice is exactly what my Australian DPT has told me, just really spelled out in detail. I find it very applicable to my case, but of course it's not supposed to be right for every single person or situation. I also like how it's called "persistent pain" and not "chronic pain." Makes it sound like pain is only temporary! Here is the FREE download link: CLICK It doesn't into go into the neuroscience behind pain, but breaks pain down in an easy to understand manner with key take home messages. Here are just a few of the blurbs I've copied and pasted from the PDF that resonate with me. The body is designed to respond to the physical stresses we place on it and get stronger and more resilient. Physical stress (exercise, gardening, lifting weights) all cause slow changes in people to allow them to do more. One of the amazing things about people is how we can tolerate and adapt. Habituation means that the same input over time leads to a smaller output. With finding your contributors to pain you want to reflect and consider if you are doing too much too soon for what you are currently ready for. There are three things to look at or consider changing: 1. How much you are doing 2. How quickly you progressed 3. What are you currently ready for We try to find the balance of doing enough to make us adapt and not doing so much that we overload our system, get sensitized and pain or injured. First, understand your beliefs about your pain and try to get some insight if those are contributing to your movement habits. Then, start exploring movements. Usually, nothing is off limits its just our tolerance initially. Your body is built to move in a number of different ways. Try those out. (NOTE: except of course stuff where you need rigorous ACL return to sport testing) Avoiding meaningful activities, like hobbies or time with friends, can increase your sensitivity by increasing social withdrawal, a depressed mood or sense of hyper-vigilance. Meaning, you just don’t trust your body anymore to be strong and robust and you feel it needs protecting and safe guarding. And remember what pain is all about...its about the perceived need for protection. AVOIDANCE COPING: If you are worried that raising your arm over your head or going on long hikes will cause damage or more pain then you might avoid these things. But because of the way the body and you adapt if you continue to avoid those things you might actually become fearful of them and sensitized to them. Your fear and avoidance end up “triggering” your pain response even if you are no longer damaging yourself. Biographical Suspension is when you aren’t "you". It's putting your life on hold. Ask yourself, "what would you be doing if your pain was less of a problem for you?" Poking into mild discomfort and doing the things that are meaningful helps to turn down the sensitivity of that alarm. In general it is a good idea to start with just poking into pain for a few movements or minutes. A success is that you don’t have a massive next day flare-up and your pain remains stable that day too. Because you can poke into pain too much. Like many things it's finding the balance of how much to persist and how much to avoid. And that balance will change over time. You stop doing things that are meaningful and important to you. Avoiding activity, social withdrawal, time off work and loss of contact with family and friends can sensitize you. Consider what it is that you are missing. Consider how this can affect your physical and mental well being. We also recognize that you might have flare-ups with pain. This is normal and part of recovery and living well again. We should not expect to always avoid flare-ups. Rather you can manage them and keep doing what is important. Section 4 of the workbook are the strategies and questions to ask yourself so you can help gauge and regulate beliefs and thoughts. I haven't written anything out yet, but it is thought provoking. I started thinking back to all the situations where I cancelled or backed out of because I was worried it was going to hurt me more, or I would pay for it for days! Yes, there were probably some things I wouldn't have been ready for, but sometimes it was just dinner with girlfriends where I'd be sitting. I certainly have isolated myself during this recovery.
What is also surprising - and it comes from my DPT as well - that the goal is to NOT avoid flare-ups all together. Say what???!?! This is really shocking to hear honestly. I feel like it's to mission to not flare-up mainly because it's so hard to handle the lows. But the advice is that it's OK, the body/knee will forgive you and you will adapt. So far it has been true in every single flare-up. Gotta use those tactics. Then also - doubly shocking - keep moving when in a flare-up! That seems pretty hard honestly, but next time I'm going to try my best not to let it stop my life. Two days ago I did a bike ride after work. I set off without my knee wrapped. For about 20 minutes I constantly debated, "Should I go back and get it?," because every stroke of the pedal I felt the front of my knee hurting. I wondered if I was going to make it worse especially on the uphills. Thinking back to the workbook, I decided to stay with the feeling, let a little bit of stress get applied (obviously it wasn't stopping me from biking, just distracting). Well by the end of the 1.5 hour ride, I can say it felt much better! Maybe the whole "exercise is an analgesic" thing came true for that ride? Maybe I was habituating things as well? Anyway I'm on day three of not wearing the Ace bandage on my knee. I still tape for weights. I would like to stop relying on this bandage for functionality. Maybe I just need to start habituating that feeling. Side note: I would like to do more midweek aerobic stuff - I just rehab during the week and bike on weekends. I need more movement, need to get endurance/fitness, lose some pounds! That bike trip is in 46 days, still unsure of it all!
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AuthorA 45 year old active female who tore her ACL in January 2017 (at the age of 40). Reconstructive surgery in February 2017 with bone-patellar tendon-bone autograft. Archives
November 2022
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