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?

Like what you read? Please comment and share below!

Advertisements

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.

Mental toughness as your arsenal

I could spend days and months describing my personal struggle to overcome chronic joint pain. I have gone through years of pain medications, blood work, x-rays, MRIs, CT scans, surgeries…and the pain persists. One doctor told me to workout with less impact (i.e., swim). I felt worse. Another doctor told me that if I lost 15 pounds, the pain would significantly subside. My response – 15 pounds from where?? Unwilling to manage my pain with medications for the rest of my life, I had to explore my alternatives. I knew pain medications would only temporarily mask the problem, so I found other ways to manage and cope with my pain.

A change in lifestyle…

photo (2)Determined to improve my quality of life, I modified my lifestyle. It worked. The stronger my muscles became, the better my joints felt. For years I would not workout without my knee brace. Did I need it? Maybe not, but I thought I did! Further, I was afraid of pain. I had lost my ability to distinguish between good and bad pain. With the guidance of an AMAZING trainer and friend, I was able to modify my exercise routine. And look at me now! I maintain the body and the training level of an elite athlete, but in all reality I exercise because I must.

In addition to exercise, I modified my diet. I limit foods that trigger my pain, such as sugar, alcohol, and red meat. I take a multivitamin, fish oil, and amino acids. I feel the difference! I spent years trying other supplements and nothing compares. One of the many benefits of fish oil is reduced inflammation and I cannot begin to describe the difference I have seen and felt. NOTE: Everyone has individual dietary and supplementation needs, this is just an overview of what works for me.

Mental toughness

I have been asked how I can do the workouts I do if I am in pain. First, I have become incredibly in tune with my own body, knowing what is good or bad pain. Second, mental toughness. Whether you are recovering from an injury or managing a major health concern, mental toughness is your arsenal. Mental toughness will help you cope with adversity.

Cope: to contend with difficulties with the intent to overcome them.

(The American Heritage Medical Dictionary, 2007).

My daily ability to cope with my pain is directly related to mental toughness. Don’t get me wrong, there are days, nights, and weeks of weakness. But I have far more good days than bad. The following tips can help you contend battles with physical pain and injury:

  1. Be informed. Ask questions and know your diagnosis and prognosis of your injury.
  2. Use imagery. Imagine yourself performing the skills you are working to recover.
  3. Maintain a strong social support system. Having strong social support can help you cope with the stress, whether by having someone attend physical therapy with you or by watching a movie to distract you for a time.
  4. Practice physical and mental relaxation. Release tension and clear the mind.
  5. Practice gate control methods. The physiological benefits of self-massage, tapping, etc. are proven and effective for many.
  6. Partake in alternative physical activities. This will allow you to benefit from the positives of exercise. Dive into the pool or get into a yoga or Pilates class.
  7. Communicate. Let the recovery team (e.g., physicians, therapists, trainers) know when you are in pain, when you have made significant gains, etc., so that adjustments can be made to the program if necessary.
  8. Get plenty of sleep. Inadequate rest can lead to fatigue and poor judgment. Note: While you are sleeping is also the time your body and muscles repair themselves.
  9. Maintain a positive attitude. And practice self-talk. The Law of Attraction: People with positive attitudes tend to approach problems with more hopeful and optimistic views and attain more positive results.
  10. Maintain realistic expectations and goals. Having unrealistic expectations can lead to pushing too far or hard, resulting in setbacks and/or delays in recovery.
  11. Celebrate. Recognize goals and milestones that you have achieved! Track your progress and see how far you have come.
  12. Maintain interests. Having external interests can keep you socially connected and help keep focus off of the injury and the pain associated with it.

The bottomline

Injuries and pain, chronic or acute, can get the best of you. It can be a daily struggle, navigating, “how do I best cope today?” However, you do not have to let pain consume you. Few people who know me or meet me know about my struggles – nor should they! I have provided these tips, but that is just the beginning.

References

Albinson, C., & Petrie, T. (2003). Cognitive Appraisals, Stress, and Coping: Preinjury and Postinjury Factors Influencing Psychological Adjustment to Sport Injury. Journal of Sport Rehabilitation, 12(4), 306-322.

Moran, A. P. (2004). Sport and exercise psychology: A critical introduction. New York: Routledge.

Cope. (n.d.). In The American Heritage Medical Dictionary (2007). Houghton Mifflin Company.

Pain management – It is within your control

What is pain? How much of pain is physical and how much is mental? We all deal with pain differently. Some people turn to prescription pain killers, while others will do anything and everything to not have to take them. After years of medications that didn’t truly work, I’m the latter. One of the hardest things I have ever had to learn in life is pain management. Acute pain can be disruptive, limiting our training and ability to partake in the physical activities we love. Chronic pain can be debilitating. So, how do we deal? Have you ever wondered why you immediately rub your leg after running into the coffee table?

The science of gate control

Pain is such a subjective term and an experience that varies person to person. Why does one person experience pain and another not when presented with the same pain-inducing stimulus. The Gate Control Pain Theory states that pain is a function of the balance between the information traveling into the spinal cord through large and small nerve fibers (Melzack & Wall, 1965). Large diameter fibers (associated with touch, pressure, and vibration) and small diameter fibers (such as pain) meet at two places in the spinal cord: T cells and inhibitory cells (Melzack & Wall, 1965). Melzack and Wall (1965) explained that both large and small fiber signals excite T cells, and when the output of the T cells exceeds a threshold, pain exists. These T cells are said to be the gate to pain (Aronson, 2002; Melzack & Wall, 1965; Taylor & Taylor, 1998). Inhibitory cells act to inhibit activation of the T cells and have the ability to shut that gate (Melzack & Wall, 1965).

When large and small fibers have been stimulated, they will activate T cells: opening the pain gate. The large fibers will also activate the inhibitory cells: closing the gate. The small fibers will block the inhibitory cells: leaving the gate open (Aronson, 2002; Melzack & Wall, 1965). Meaning, the more large fiber activity relative to thin fiber activity, the less pain you will feel.

This explains why we tend to rub our skin when we run into something. We rub the point of impact. And for as long as one rubs that point of impact, pressure will be perceived, rather than pain, because the message of pressure (large fibers) is ‘closing’ the gate and preventing the message of pain (small fibers) from passing through (Aronson, 2002). If the amount of activity is greater in these large fibers, there should be little or no pain. However, if there is more activity in small fibers, then there will be pain (Aronson, 2002; Melzack & Wall, 1965).

The science in practice

The Gate Control Pain Theory can explain all types of pain, although it is quite often used to explain chronic and phantom limb pains (Aronson, 2002). The ‘gate’ plays a very important role in pain management. As mentioned, we inherently respond to certain pain situations by rubbing or applying pressure to the point of impact, closing the gate. This theory also can explain the effectiveness of other pain management techniques, such as applying ice or analgesic balms. These treatments change the perception of pain by activating more large fibers, sending the message of pressure instead of the message of pain (Aronson, 2002).

The bottomline…

As I have struggled, and continue to struggle, with chronic pain, I love learning about the science and the reality of pain. Physiological pain can quickly and easily manifest into psychosomatic pains. How can I best manage my pain – acute and chronic – in a way that prevents me from losing control my gate? For the person who suffers chronic pain, stubbing a toe can quickly elicit negative thoughts, feelings, and sensations. I know I want to limit and control the negative! If I know rubbing and kissing a ‘boo-boo’ will make it feel better, I’m sure going to use it!

References

Aronson, P. A. (2002). Pain theories: A review for application in athletic training and therapy. Athletic Therapy Today, 7(4), 8-13.

Melzack, R., & Wall, P.D. (1965). Pain mechanisms: A new theory. Science, 150, 971-979.

Taylor, J., & Taylor, S. (1998). Pain education and management in the rehabilitation from sports injury. The Sport Psychologist, 12, 68-85.

Unexpected, only mildly welcomed, pain

DOMS. Delayed Onset Muscle Soreness. I have been known to experience limited DOMS. In the past, I attributed this to proper training and conditioning. But since the first of the year, I have been experiencing more DOMS than usual. Currently, I am recovering from some of the worst! Two days ago, I completed a posterior workout, focused on corrective techniques to inhibit, lengthen, activate, and integrate, as I have been having significant issues with my LPHC (lumbo-pelvic-hip complex). I anticipated slight trap, gluteal, and hamstrings DOMS. Surprise, surprise – DOMS is isolated to my calves (gastrocnemius) and everything else is fine.

I can barely move. I have to stand up slowly and let my muscles extend at their own pace. I had to adjust yesterday’s workout because of the cramping that occurred when I tried to run. After a week of torturing my body and pushing through the mental barriers to reach my physical limits, my body has taken control and is screaming, STOP. REST. I am not one to rest without reason, but I am quick to listen to my bodily cues and I consider myself quite ‘body smart.’ I know that if I don’t rest, I will be on the DL for much longer than I would like.

photo (4)Ask my best workout partner ever, Emily, and she will tell you that she hates me for how often I am NOT sore and she is. My soreness does not interfere with life! We have all heard things like no pain, no gain. Some of us think that being sore is indicative of a great, effective workout. But I hate being sore like this. I hate being slow to stand up and having difficulty moving. In my Training for Life, constant DOMS would be a deterrent. I need optimal functioning capabilities! And with proper training, DOMS can be significantly reduced, if not eliminated.

So why the DOMS now, when I haven’t had it in the past?

My physical training from June 2012-December 2012 was minimal – in relation to my typical training regimen. With big goals set for May 2013, I have kicked it in gear and my calves have screamed, YES – WE’RE STILL HERE. So, while I am not enjoying the pain today, I appreciate the nudge. I will now pay more attention to my full-body Training for Life. This amount of pain will not occur again any time soon!

As for treating my DOMS? Rest, water, and moderate movement.

My precious calluses

As of current, I’m physically deconditioned. Among other activities, I have not done kettlebell training, olympic lifting, or serious pullups in nearly nine months. As a result, my calluses are gone. Like pain, calluses are protectors. I have added some Olympic lifting to this week’s training. Before my first attempt, I sought out the smoothest bar I could. You see, most bars have a roughness that assists with gripping. To the deconditioned hand – this can mean anything from cuts and scrapes to blisters and flapping skin.

In the past, I have compared battle wounds with the women I’ve worked out with. Many women, and few men, resort to using gloves to protect their palms. I used gloves for a couple of years, and eventually found them more detrimental to my workout – they became an unnecessary distraction and bother. I suffered through weeks and months of blisters, leading to the development of calluses. I didn’t realize until recently just how precious those calluses were to me.

callusesThis image does not do justice. I took this immediately after my workout and the redness and swelling only became worse (that’s my body sending it’s healing to my palms!). You can see that I still have some callusing at the crevice of my middle digit. And my skin is slightly broken across the palm. I’m actually quite impressed with myself – I selected a gentle bar!

But today, I miss my precious, hard-earned calluses. Throughout my workout, I had to distract myself from the pain. I had to focus on the minutia of the lifts (I’m sure this actually added to the quality of my workout). I’ve had friends state that my calluses make me less feminine, “don’t you want feminine hands?” I want useful hands. I want strong and powerful hands.

Calluses are thickened layers of skin caused by repeated pressure or friction. The thickening of the skin is a protective reaction. I’ve often been described as having a callus attitude or personality. Over time, I developed a protective layer – placed strategically between me and all who could possibly cause me pain. Years of emotional abuse from family, friends, and significant others has made it difficult to trust – or sometimes to care at all. I want to maintain my physical calluses – I don’t want the pain associated with my daily workouts. But can I work to heal the calluses of my heart? I let my physical calluses heal for a season – so I know that healing is possible.

For this people’s heart has become calloused; they hardly hear with their ears, and they have closed their eyes. Otherwise they might see with their eyes, hear with their ears, understand with their hearts and turn, and I would heal them.’ – Matthew 13:15

Do you have calluses that need healing?

Where is God when it hurts?

For I consider that the sufferings of this present time are not worth comparing with the glory that is to be revealed to us. – Romans 8:18

I’ve been reading, Where Is God When It Hurts?, by Philip Yancey. For the girl who has tried to manage chronic pain for all of adulthood, this book is proving to be incredibly enlightening and powerful. It quickly occurred to me that I had NO IDEA what leprosy actually was! I had read about it and heard about it and believed it was a disease of the skin. But many who suffer from leprosy have numbness or a lack of feeling in their hands, feet, or legs (disturbingly similar to diabetes symptoms, huh?). While leprosy is caused by a bacterium, it is worsened and difficult to manage due to the absence of pain or sensation in the extremities. Yancey describes individuals who put their hands in fire and wear shoes that wear down toes because they do not feel the warning signs those of us who feel pain heed. Can you imagine? How dangerous is this world for those who may not feel pain??

I know pain. Too well. I spent a great deal of my time, energy, and money trying to manage my physical pain throughout 2007-2010. This came after years of trying to ignore or self-medicate this pain and suffering. My first recollection of pain is from middle school – sitting in the bleachers for a pep rally, hiding the tears that built up because of the pain in my knees. My mother disregarded this discomfort as growing pains. So I silently dealt with it. One morning when I was 16, I could not get out of bed. My back hurt so badly and I could not sit up. I eventually got up and my mom took me to the urgent care – x-rays, muscle relaxants, and steroids were the answer! The cause? According to the x-ray, I must have been dropped on my head as a baby (seriously!) and my spine was being compressed. A few days later a specialist called. After looking at my x-rays he suggested that I seek additional treatment or suffer extensively in the future. I tried chiropractic adjustments for a while, but then I came to rely on unhealthy doses of ibuprofen to make it through my days.

Fast forward 6 years or so to 2004, I was no longer taking regular doses of ibuprofen – I was silently suffering. I was introduced to water aerobics and as I became stronger, the pain lessened! It was not gone, but it became more tolerable. I fell in love with exercise – leading me to where I am today. I learned what my body could and could not handle. I learned what made my pain worse and what made it better. I learned to be in tune with my body. Being a master at ignoring pain – I ignored it too often and by 2007 I had done damage to my knees. I was in agony. I made a too-quick decision to have surgery in December 2007 on my right knee. While this surgery led to a miserable year of pain and suffering, it forced me to rest and protected me from doing permanent damage to my left knee – which exhibited ACL and PCL strains.

2008 was the year of great suffering. I had complications following surgery that significantly limited my rehabilitation, exacerbated pain, and led to a second surgery. Doctors and specialists told me that I would never run, jump, or squat again. I was told to stop exercising (or anything that caused pain – living caused pain at that time). At the same time, I was told to lose weight (at 5’7″, 155lb.) and to do so without exercising or much physical activity at all. I was recommended to try an experimental antibiotic regimen that had been shown to help osteoarthritic patients – I declined. Going into 2009, I was told that I would spend my lifetime managing my pain with medications (which by the way did nothing to alleviate my pain) and that the chances were good I would require joint replacements and invasive surgeries as early as age 30.

I was angry. I could see how my pain and suffering were molding me into the wonderful professional and woman I am today, but it was difficult to cope. I now know my body better than most people you will ever meet. That little tweek in my hip means no heavy lifting. The pain in my right temple is actually my trapezius screaming for a rest. I will not give up. I will not stop. I will use my pain as a barameter. I will love my pain – as it protects me from evil, injury, and even death. So where is God with it hurts? I don’t know about you…but I’m thinking that I may be safely protected in His arms when it hurts. It’s certainly something to consider!

…nine months of waiting and preparation, intense labor, then the ecstasy of birth. – John 16:21