A body that has been pushed and has a story to tell. This is my story.
Being a sports therapist and former nurse, I focus my energy, rightly or wrongly, supporting others on their journey from injury to fitness. Often to the detriment of my own body! To some extent, I feel we make our career choices because we are trying to fulfil an unmet need in ourselves, or are we trying to help ourselves.
I sustained an ankle injury orienteering 15 years ago that was misdiagnosed and subsequently ignored. I continued to run, climb and ignored what I now realise are all the classic signs of an unstable structure due to a complete rupture of the deltoid ligament!
Perhaps in hindsight, this contributed to me requiring a partial medial knee replacement six years ago due to the loss of the cartilage. My consultant also pointed out that many years of Long-jump at County and Junior England level played a part!
Like many of my patients, I have treated, I am guilty of delaying that initial and early treatment. Maybe I didn’t want to face the truth? Or accept the fact that I am getting older and my body is telling me to alter something!
None of us likes to face the truth about ageing, but it is a normal process. Our joints develop arthritis and discs bulge. They are our wrinkles on the inside, so to speak. This normal process does not necessarily lead to pain as seen in this study when reviewing MRI scans from asymptomatic patients.
What I do find alarming is how much of a negative impact investigation such as x-rays and MRI can have on our experience of pain. Further compounding a fear-avoidance of movement and catastrophising thoughts that “I’m weak, not strong enough”! especially when Doctors and Consultants use such scary words describing the results as bone on bone and degeneration!
Really, what does that all mean, apart from frightening you into having a major operation? If that can happen to me, where does that leave our patients?
If anything, it has made me realise how important it is to listen and involve our patients when discussing results and investigations. To think about the words we use in the correct context to empower our patients, especially with those in pain.
In my enthusiasm to continue with movement, strength and exercise, I overlooked the increasing pain and decreasing mobility symptoms. Believing my message of “motion is lotion” and to my detriment, failing to recognise that I needed to have a review with an Orthopaedic consultant.
Recognising and accepting that medical and surgical interventions are required when we can no longer manage pain and everyday activities are being affected, is an important discussion to have with our patients.
To take a quote from Matt Philips(Runchatlive).
”Insanity: doing the same thing over and over again and expecting different results ”.
Ignoring the warning pain signals that our body is shouting at us, to modify the amount and load we are doing. We mistake these sensations, at times, believing we need to stretch, or keep doing the same activities, and wonder why the area is not improving. When what we need is a, guided, graduated, strengthening rehabilitation programme! This involves improving strength and loading, starting with isometrics and isotonic in non-weight-bearing exercises, progressing to weight-bearing and compound movements.
In addressing the whole of the kinetic chain, capacity and biomechanics are important, introducing hop, skip and jumping strategies to manage loading around the joints. Especially reviewing the ankle and calf complex and retraining the movements to distribute the loads.
Claire Minshull (getbacktosport) signposted us to a fantastic YouTube piece that demonstrates wonderfully how with training 80-year old ladies with osteoporosis were able to deadlift! How inspirational is this? With the correct, positive messages and guided training, we can achieve anything.
Orthotics have their place when used correctly and for the right reasons. Firstly as part of managing an acute situation for pain relief then gradually decreasing use. Orthotics are beneficial for offloading the tissues rather than realigning the joints by reducing the pressure and load. The other scenario, as in my case, is the permanent use to support and offload and changing the forces through soft tissue in the right areas.
Having that improved working knowledge helped me understand and accept why Orthotics have their place in the rehabilitation process. Before, I felt that wearing supports and Orthotics would delay or not offer any benefit. How wrong have I been!
As Mike James (The Endurance Physio) quotes “the rehab road is seldom straight and true” especially when you set yourself unrealistic expectations of what is involved. It is vital to communicate this to your patients, setting honest, and realistic expectations, making the journey less bumpy and shorter.
My journey, unfortunately, took me on a rather bumpy road. As the saying goes “never work with children or animals”. I think it also applies to health professionals. We are hard work!
I have lost count how many times I have said under my breath, “I should listen to my own advise”. Who in their right mind decides it would be a good idea to go from no running to park run, to 10km all in 5 months, yep you read that correctly. Ok, I teach Pilates and have a variety of other activities but didn’t build up with a programme, for example, the couch to 5k, or run with my Local club. Classic mistakes, no wonder my ankle started to complain!
On top of that, my running pal persuaded me, which didn’t take much as we were raising funds for her granddaughter, to jog/run 33km, our local Coniston to Barrow walk, part of the longer Keswick to Barrow walk.
We did the right thing and commenced training and gradually built up our distance. I must admit I did enjoy the experience. I will not repeat another long-distance, as the consequences have taken their toll, forcing me to investigate my ankle injury.
So, What Does Your Body Say About You?
Having gone on this journey, reflected on the ups and downs, I realised I have been great at “getting in my own way”! Now I have realised this, it is so much easier to begin the rehabilitation journey afresh.
I am now in the process of returning to running with the understanding that I have a complete rupture of the deltoid ligament from the orienteering injury 15 years ago. The plan is orthotics to stabilise the heel, support as required and gradually reintroduce my activity.
I am now progressing with the couch to 5K programme wearing my ankle support and orthotics, to take the pressure of the tibialis tissue and reduce the chronic tendinitis. I enjoy the variety that Pilates brings to my training sessions, not only for its movement but strength, cardio and relaxation.
This journey has certainly been a bumpy but interesting one.
Anything is possible once I had accepted what my body was trying to tell me. Then took the time and patience to gradually strength, load and build up the tolerance of my knee and ankle to the demands of running again. My body needs that extra support from the orthotics and the ankle brace so that I can go out and perform an activity I have always loved.
There is nothing wrong in ensuring that you have the correct equipment to support for the right reasons. Follow a realistic rehabilitation plan that is progressive and tailored to your needs and reviewed regularly. Be prepared for anything, but most of all, have fun.