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.