When it hurts to wear clothes

Pain is a major contributor to a perceived decreased quality of life. It is a reason not to workout or exercise – not to squat, not to run, not to lift weights, not to jump, etc. Nearly 100% of individuals that I talk to experience some kind of pain on a consistent basis. I wish I could write about a miracle to make the pain go away. I cannot. But the pain can be minimized and managed. I manage pain daily – through diet and exercise. One of my reoccurring pain experiences:

Sometimes it hurts to wear clothes.

It is difficult to explain. It is an incredibly superficial pain. Clothes hurt. Gently brushing my skin hurts. DO NOT touch me. There is no deep pain associated with this. The pain is regional – only occurring in my right leg, from my hip down. Sometimes it goes all the way down to my knee. Other times it only goes down halfway. Sometimes it is in the front through my quadriceps and other times down through the hamstrings. And I have determined no rhyme or reason for flare ups – while I know there must be a trigger and I am working to define this.

The cause

I have a partial nerve impingement. Given some of my previous diagnoses, I knew it was an inevitable occurrence.

The treatment

Resting is always a good idea.

Avoiding extended periods of sitting eases the uncomfortableness.

Dynamic stretching, hip mobility exercises, and nerve flossing can help to reduce the inflammation.

After years of medications, I avoid them like the plague. Not to mention, I have tried them and they do not work.

The bottomline

Stopped

I will not be stopped. I do not complain about or wallow in my pain – and I do not write this for pity. Friends and acquaintances often tell me – you need to workout less or that my exercise is making it worse. Sitting around makes it worse! I need to stay moving in a safe manner.

I am not immortal – despite what some think.

I simply WILL NOT be stopped.

How about you?

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Listen. Slow down. Rest.

My body has been telling me to slow down and rest. But my mind is fighting it – NO! I have difficulty with doing nothing – both physically and mentally. As my favorite surgeon noted, I am a “Go go go girl.” (Not to be confused with a go go girl.)

My back hurts.

My hip hurts.

My hands hurts, with small blisters beneath my calluses.

My foot hurts.

My knee has been popping (not a good sign).

There is a pinching pain between my shoulder blades.

My head hurts, pulling from my shoulder blades.

And yet, my mind does not want to slow down. I share this, not to complain, or to whine, or for sympathy. But to show that I understand and that I too fall into the trap. The trap of habitual exercise and not wanting to stop – for fear that you will not start again.

Slowing down and resting is something that I have actually gotten better at these last few years. Each of my injuries forced me to slow down – each of them designed for the function of forcing me to slow down (there is a reason for everything, isn’t there?). I have since become more in-tune with my body. I listen to it. While I am pretty good at slowing down or cutting back,  I am not so good at resting completely. I go a little bit stir crazy on rest days (although I force myself to take at least 1 rest day a week).

Avoid overtraining

Some individuals may suspect I am overtraining. I am not overtraining – simply managing a chronic, mysterious condition (narrowed down to being autoimmune). Most of my pain has nothing to do with my workouts. However, minor aches and pains can be good indicators to slow down and avoid overtraining. Has your body been sore for too many days in a row? Rest. Are you getting adequate sleep but still fatigued? Rest.

Avoid Injury

If your body is fatigued or you are experiencing some pain, there is a good chance that you will workout, compensate with other areas, and incur more pain or injury. Another injury does not appeal to me – I do not think it is worth the risk.

The bottomline

Listen to your body. Slow down when it needs it. Rest when it needs it. When it doubt, if you have been working out hard, rest.

Rest —

Do you have low back, hip, or knee pain?

Gluteal amnesia. Sure, it sounds funny – but it is real. The butt muscles have ‘forgotten’ how to work. If you work in manual labor, you have heard, “Bend at the knees and you will lift with ease.” But do you bend at the knees? More than likely, you bend at the waist and lift with the back – bypassing the butt muscles. Are you a regular exerciser who is prone to knee squatting? More than likely you are and you are bypassing the butt muscles. Do you sit all day? More than likely your butt muscles are disengaged for the majority of your day. Do you have tight and/or sore hamstrings (back of the thighs)? They are likely overcompensating for underactive butt muscles. These butt muscles are your gluteals.

Gluteals

Gluteal amnesia

Gluteal amnesia occurs when your body forgets how to properly recruit the gluteal muscles. You lose the ability to move your hips through their full range of motion and compensatory movements occur. Find a great, detailed explanation of gluteal amnesia here.

Associated injuries

Common injuries associated with gluteal amnesia include patella-femoral (knee) syndrome, iliotibial band syndrome, disc herniation, chronic low back pain, recurrent low back strains, and piriformis syndrome.

What to do about it

There are a multitude of methods for eliminating gluteal amnesia – all require form correction and mind-body awareness during exercise. Dr. Lecovin outlines the corrective exercise techniques and I therefore do not need to repeat – read here.

However, his post is not exhaustive. A couple of other exercises include:

ImageMindful Step-up – Place one foot on the step – this foot NEVER MOVES. Driving through the heal of that foot, and without pushing off with the bottom foot, step up to a full standing position on the top of the step. Return the trailing foot to the floor, maintaining control with the working leg. If this is not harder than your traditional step-up, try again, mindful that your are NOT pushing off that back leg.

Wall squats – these are NOT your traditional wall-sits, sitting with your back supported on the wall. Stand facing a wall, with your toes no more than an inch away from the wall (yes, you are face-to-face with a wall. If you are looking at a mirror, you WILL know if you need to clean up your eyebrows). Your feet are slightly wider than shoulder width. Push your hips back and squat, as if to sit in a chair. Note: It helps to hold a kettlebell in your hands for counter balance and progress towards using no weight.

The bottomline

I have gluteal amnesia – moreso in my right buttocks than in my left. No one is immune. I happened to also have low back, hip, AND knee pain. But I do not let this stop me. I perform the above two exercises deliberately and regularly, and my symptoms of gluteal amnesia have diminished significantly. Combine these exercises with corrective exercise techniques – such as inhibiting (e.g., foam roller) and lengthening and you will be as good as new!

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We NEED. More. Yoga.

Yesterday I practiced yoga for the first time in months. It was a basic practice – relatively speaking. Very different from the forms of power yoga that I prefer. But this practice was a gentle reminder of what I have been missing in my training regimen. Yoga. Stretching. Lengthening.

What we often miss photo (33)

Stretching. Lengthening. Decompressing – both physiological and psychological.

I am guilty of not stretching as much as I should. I diligently stretch after running – other than that, rarely.

Our muscles need stretching – especially if we are putting in the work. Weight lifting involves continually contracting muscles. While proper form also includes lengthening, this is not always enough to allow the muscles to reach full length. I will not pretend to be a yogi – I am far from being a yoga expert. But I have done my research! (Don’t I always?)

Injury prevention – Research has shown that yoga has injury prevention properties. I would attribute this to the lengthening of muscles. The National Academy of Sports Medicine’s Corrective Exercise protocols incorporate lengthening into the four step program design. Unfortunately, corrective exercise is often only incorporated into training regimen after an injury has occurred. Why not use yoga as a tool for injury prevention?

Yoga & mental health – Yoga is known to be a ‘mind-body’ fitness practice. Some view this as getting in touch with your soft, gooey insides. I argue that ALL exercise requires mind-body awareness (Markula, 2004). Yoga has been shown to improve self efficacy and confidence and reduce depression and anxiety symptoms (Junkin, Kowalski, & Fleming, 2007; Markula, 2004; Rahimi & Bavaqar, 2010).

Relaxation – At the core of any yoga  practice is centered breathing. This necessitates focus on breathing. This allows our minds to relax and be free of the thoughts and worries that bog us down. Further, focusing on lengthening muscles allows those and other muscles to relax. Tension melts away.

Pain management – The benefits of pain management are well known and widely accepted. Time and time again, research has shown that yoga reduces back pain and other chronic aches and pains.

The bottomline

We could all use a little more stretching. I like the structure of incorporating a consistent yoga practice – and now realize I need to add that focus back into my program. As with all fitness professionals, not all yoga instructors are created equal. I would strongly urge you to read the American College of Sport Medicine’s resource on Selecting and Effectively Using a Yoga Program. Further, it is my personal opinion that instructors with 500+ hours of training are leaps and bounds ahead of their counterparts.

Looking for yoga that you can do at home? Debbie Williamson is your woman, with both DVDs (kids too!) and downloads. After traveling the country and experiencing many different styles of yoga and instruction – she is by far my favorite!

References

Junkin, S. E., Kowalski, K., & Fleming, T. (2007). Yoga and self-esteem: Exploring change in middle-aged women. Journal Of Sport & Exercise Psychology29S174-S175.

Markula, P. (2004). “Tuning into One’s Self:” Foucault’s Technologies of the Self and Mindful Fitness. Sociology Of Sport Journal21(3), 302-321.

O’Donovan, G., Blazevich, A. J., Boreham, C., Cooper, A. R., Crank, H., Ekelund, U., & … Stamatakis, E. (2010). The ABC of Physical Activity for Health: A consensus statement from the British Association of Sport and Exercise Sciences. Journal Of Sports Sciences28(6), 573-591.

Rahimi, E., & Bavaqar, S. (2010). Effects of yoga on anxiety and depression in women. British Journal Of Sports Medicine44i68-i69.

Snow, snow, go away

photo (18)Do not come back another day.

I have about had it with the snow. I believe that we have all had enough. While the snow removal is annoying and driving is hazardous, the pain is unbearable. It is no wonder retired folks move south for the winter months. The older I get, the worse my pain is when it snows.

Human barometer

I can predict snow – probably better than a meteorologist. Between the lingering effects of my surgeries and my chronic joint pain, the snow-related flares can make me want to stick a fork in my eye. It is indescribable really – and medically unexplainable and therefore difficult to treat. I spent last night sitting on my heating pad, trying to get comfort to the innermost depths of my hip joints. It worked temporarily.

In general, the best treatment is distraction. I have to keep myself busy. If I am shoveling, I do not feel it. If I am working, I do not feel it. If I am immersed in writing or research, I do not feel it. It is important that I avoid excessive sugar, as this will worsen the pain. More than anything, it is a case of mind over matter.

The bottomline

If I were to focus on the pain and maybe what I could not do because of the pain, I would be miserable. Instead, I put on my deep thinking face (but that face probably never comes off).

How do you find comfort while enduring pain?

What, if any, distraction techniques do you use?

AWESOME wellness App – Recovery Record

I put a lot of time and energy into reading weight loss and fitness self-help books, using health and fitness Apps, and – of course – reading scholarly research. This is rarely specifically to expand my personal knowledge but for the benefit of my clients. I want tools in my box to offer my clients as a means of teaching them independence. I want to empower! Finding quality tools has proven difficult! The multi-million dollar industry is filled with a lot of, for lack of a better term, JUNK.

Therefore I have resorted to a lot of “use this, BUT” referrals. For example, I suggest that a client use MyFitnessPal as a food diary but I advise against tracking physical activity and exercise in the App. This follows with a disclosure of the risks of working for the calories that the App claims to you earn. Most calorie expenditure methods are frustratingly inaccurate.

BUT, I have found an App for my iPhone that I absolutely LOVE for self monitoring. (Keep in mind, that I am not a huge fan of Apps and I tend to gravitate towards a pen and paper when it comes to things like journaling, maintaining workouts records, and food recording.)

Background

In the process of my own self-improvement, no one App seemed to meet my needs. I found I would need to use 4, 5, or even more Apps in order to track everything that I wanted to track. This was not efficacious nor efficient. Further, it did not allow me to compare them all and I was looking for correlations. One of the most critical things for me to track has been my pain – how do my activity level, activity choices, and nutrition correlate with my pain. Is there a weather association? Mood? How do these all interact? I compiled my own worksheet for self-monitoring to meet my needs.

self monitoring

THE RECOVERY RECORD

I am excited to share that I recently discovered the Recovery Record App. It looks to me like someone beat me at my own game – this is my worksheet in an App! Initially designed for use as eating disorder therapy homework – do NOT let this deter you! With Recovery Record you can track:

  • Meals and snacks (e.g., what, where, when)
  • Emotions
  • Motivation
  • Self-Efficacy
  • Accountability
  • Goals & Achievements
  • Hope
  • Pain
  • Thoughts & Feelings
  • Eating behaviors (e.g., bingeing, desire to binge, dietary restriction)
  • Hunger
  • Physiological/Somatic symptoms

Fully customizable, you can establish reminders and rewards, find accountability partners, and share your information with others (e.g., dietitian, physician, counselor, family). While you can track disordered eating behaviors, you can also disable that tracking – along with any other logs you may not want to keep.

You also have the option of logging in via your computer, which I prefer if I want to add a lengthy note or track a significant amount of food.

Stop calorie counting

One of my favorite things about this App is that there is no built-in calorie counting. I discourage calorie counting and encourage mindful eating – and tracking everything that you put into your mouth is just as effective – if not more effective – than counting calories (Cooper, Fairburn, Hawker, 2003; Fairburn 2008).

Reminders

How often do we use the excuse, “I forgot!”? The reminders in this App are useful without being annoying. The App will nudge you to record your meals, but you are free to go back and record information later as well. the best part, you can disable the reminders you do not want.

The bottomline

This App will help you improve and monitor whole-body awareness. This is an App that will EMPOWER you. We know that how and what we eat and exercise are correlated with thoughts and feelings. How about where and when you eat? If you suffer from chronic pain or illness – do you eat more or are you restrictive during times of suffering? Do you avoid exercise? Once you are aware – you can work to change where you may see a need to change. And you can share this information with nearly anyone you choose!

And no, the developer is not paying me to endorse the product – she (they) do not even know that I exist. But they will soon! Kudos to developer Jenna Tregarthen – she may have made it to the list of individuals I want to meet in my lifetime.

References

Cooper, Z., Fairburn, C. G., & Hawker, D. M. (2003). Cognitive-Behavioral Treatment of Obesity: A Clinician’s Guide. New York: The Guilford Press.

Fairburn, C. G. (2008). Cognitive Behavior Therapy and Eating Disorders. New York: The Guilford Press.

Hays, K. F. (1995). Putting sport psychology into (your) practice. Professional Psychology: Research and Practice, 26(1), 33-40.

Do NOT tell me I can’t

Do not tell me that I cannot or will not do something. You are only asking to be proven wrong. This is particularly true when it comes to physical feats. I take great pride how far I have come and what I can do. I spent years training a body to do things that most individuals do not even think about – and I had been told I could not do them. So do note tell me that I can’t. I have asked my friends never to tell me that I cannot run a marathon, because I do not want to have to do it. (I will never run a full marathon, that is just silly!)

I spent years visiting doctors, being poked and prodded, trying different treatments. Pain in nearly every joint was depressing and at times overwhelming. Not that I would let it stop me – but I wanted answers. But the doctors did not want answers as much as I did. Several of them shrugged their shoulders and handed me a prescription. The rheumatologist told me not to exercise and to lose weight. The orthopaedic surgeon told me that he had done all that he could (after my second surgery on my right knee) and that I would never run, squat, or jump. The chiropractor (also a CSCS and brilliant) told me to avoid overhead movements (e.g., shoulder presses, overhead squats, snatches), barbells on my back, heavy weights, jumping, and the prone position (e.g., pushups, mountain climbers). The combined opinion was that I would need to manage my pain – most prominent in my knees, hips, and back – by decreasing my scope of activity and taking pain medication and/or experimental drugs.

Between the activities that the surgeon told me I would never do again and the recommendations of exercises to avoid, the message was clear: STOP EXERCISING. Stop exercising? Ha! Fat chance of that one. Sure, I could build workouts around that list of no-nos, but that would have been boring – little variation and little fun.

Proving them all wrong

Mind you, the chances are – having dealt with chronic pain for most of my life – that my pain tolerance is higher than most. Nothing about what I have accomplished was easy. Nothing was pain-free. I have endured some pain – and maybe too much in some instances – in order to prove them wrong. But in the long term, my pain is better and well managed.photo (8)

No squats – I managed to max out at 300 pounds in 2010 and have set a goal of re-achieving this in 2013.

No jumps – I jump all the time. For fun. For exercise. I just like to jump. Sometimes, like yesterday, I even jump with a barbell on my back.

No running – since my last surgery in 2008, I have run countless 5Ks, two half marathons, and numerous relay marathons – including a Ragnar relay. I will attempt my 3rd half marathon this May.

No overhead movements – well, let’s just say that I take some risks here…but I listen to my body and I stop if I need to. I can do 54 pound single-arm kettlebell snatches. Weighted overhead squats tend to be a different story. So I listen, and I stop when m y body screams.

No barbells on my back – clearly I ignore this. BUT! I use progressions to warm up. And I have definitely cut back my everyday weights to reduce painful aftermaths. Again – body smart!

No heavy weights – I don’t know what that means. Friends do not let friends use light weights. The fastest way to fat loss is with heavy weights. The easiest way to weight maintenance is heavy weights. The fastest way to sweating is heavy weights. The best way to cardiac fitness is heavy weights – – – need I go on?

No prone position – I enjoy pushups and planks. Back/hip flexion is actually what gives me the most difficulty so I tend to avoid the dynamic movement (yeah, no burpees).

Inspirational transformation

My story is mild in comparison to many. Arthur Boorman completed an inspiration transformation:

Overcoming obstacles

What are your obstacles? Which are excuses and which are real? Just because it is difficult does not mean it is not possible. I know this because I have lived it. I know this because I have watched others live it. It is not going to be easy. It will not happen overnight. But are your obstacles worth tackling? One day at a time! Just like Arthur, you might fall down. But do not you want to get back up?

Exercise is medicine

There are days when my body aches. There are days I experience superficial burning in my thighs because my nerve is impinged. There are days when my knee buckles and clicks. Some of these days I rest, but more often than not I exercise. Exercise IS the best medicine. Exercise releases adrenaline – the natural pain killer. Being body smart, I use corrective exercise techniques to work with and around my disabilities. These are not the days for barbell complexes nor running. But these are the best days for building mind-body connections. These are the best days for being body smart.

The bottomline

You tell me I cannot do something and I will do everything in my power to prove you wrong. I can do ANYTHING I put my mind to. And so can you!

Lose the excuses. I know pain, I live pain – pain is an excuse not to exercise and eat well. When exercise and eating well are the cure for pain. You see, I am off all maintenance pain medications. I found the best treatment – so maybe all those doctors knew what I needed to hear after all!

Did Arthur have a right to excuses? Doctors told him that he would never walk or run. And look at him now.

What is your excuse? And what things will you never do?

If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.  ~ Hippocrates