Scars

I've started treatment with a new physiotherapist for a long-standing injury. The problem began a couple of years ago with a muscle tear in my right groin (acquired pushing a heavy mower out of a ditch). At first I was impatient with my slow recovery and eager to prepare for two overseas trips I'd booked (to Chile and Bhutan) so I began my activities again (walking and cycling) and built up the intensity. But soon my groin became sensitive, then painful and then intensely painful and I was forced to stop. So I rested for a while (days perhaps weeks), then began again: but each time I built up my activity, the pain would return and the unhappy cycle would repeat. I became stuck in a series of peaks (rising activity) and troughs (pain and depression) – the pattern of a chronic injury.

I ended up having to cancel my overseas trips and claim the money back from insurance. Then I became seriously ill and all thoughts of such activities evaporated. This year, as I recovered, I began to walk further and more often. Stupidly, I managed to pull the muscle in my groin again working in the garden. I rested for a while, then returned to easy walking and started to do more. But the old problems quickly recurred and again I found myself stuck with a chronic injury. I began to fear that I would be unable to do hillwalking and cycling ever again. These were activities I had enjoyed for many years; I valued them and I wanted to be able to have them in my life. So I resolved to try all available treatment options before I abandoned hope: I went to a physio, then an osteopath, an acupuncturist and most recently to a new physio.

The new physio started out my treatment in a different way, by explaining what was happening to me in the chronic injury cycle. I thought that each time I got to the point of intense pain I was re-injuring myself – and this had happened again and again. She said no: the level of pain in my groin was a warning sign (the level of tissue damage was a good way beyond). And each time I exceeded the level of pain (before backing off), I was actually lowering the level at which my groin would become painful the next time. In effect I was teaching my brain to become more and more hypersensitive about my right groin.

In her opinion the injured tissues in my groin should have healed up some while ago. Her treatment strategy was twofold:

Firstly, to get me to do gentle and regular stretching to correctly align the underlying postural muscles around my pelvis.

Secondly, to get me to do my activities at much lower levels of intensity and in a much more controlled way. I should build up carefully and slowly to the point of sensitivity and then scale back. Importantly, I should not stop at this point, but do my activity again the next day (or the day after) and carefully build up to the level of sensitivity again and scale back again. In this way I would progressively be raising my body's threshold of sensitivity and expanding my level of pain-free activity.

I've been following this new approach for just a couple of weeks – so far so good.