Recovery is forever
Fans of the show Elementary would have noticed a recurring theme of recovery. Sherlock is recovering from addiction and you get to see what it takes to keep it at bay. Watson in fact starts off as his sober companion.
I love the show for this additional dimension it brings into Sherlock's character. Critics say "It may be the best portrait of recovery on television".
Many of us have debilitating conditions that can take us down. Mental or physical illnesses, addictions, stress. They can kill the joy in your life and your productivity plummets.
Recovering from pain, physical or mental, needs a lot of work. It is easier to just give up.
As I work to get out of my latest episode of back pain, it brings back some painful memories.
The first episode
When I first got my lower back pain in 2002, the surgeons wanted to operate on the spinal disc bulges. There was no question of even referring me to therapy.
There was not much on the internet back then. Whatever information we did get suggested that these surgeries didn't relieve the problem in more than half the cases.
Even to this day the benefits are uncertain. Quoting from the article,
The biggest risk of back surgery: Not knowing for sure if it’s going to help with your pain.
We decided that surgery was too aggressive for someone who was not even 20 yet and passed on it.
Instead, I slogged through a month of bedrest. I read some books and watched every minute of Tour De France 2003 where Lance Armstrong won cheated.
I then got help from a Siddha practitioner in Chennai. The treatment was similar to Chiropractic practices. It also involved some oral concoctions that aren't evidence based but I took them without question.
I don't know if it was the rest or the Siddha treatment or both but I found relief. The problem was kicked down the road. My 20s were fairly uneventful for my back. But my habits had not budged. I never exercised. I was eating unhealthy and so on.
Around the time I turned 30, I had very little muscle mass, my fat percentage was up and my blood sugar levels were flirting with the pre-diabetic range.
My posture was bad. I used to sit for long hours in unhealthy positions.
Reaching rock-bottom
I tried some yoga but found it very boring. I thought sport was the answer. Some of you may know I am a huge fan of Rafa (yay!! for beating Djoker at RG 2022). Playing tennis was a childhood dream for me. So I took it up.
There is nothing more therapeutic for the soul than to whack tennis balls across a court!
Playing tennis greatly helped my cardio fitness. I was leaner. Several health parameters improved. I saw the work I needed to put in to burn calories so I ate healthier. Snacks and desserts were out.
Everything was looking great. Until it all broke down.
The problem was that I had zero conditioning. My muscles were subjected to loads they had never seen before. So in addition to lower back pain, I developed problems in my cervical spine. The muscles in my upper back, calves and hamstring had tightened and my shoulder felt sore all the time.
Tennis was bittersweet. It helped me develop some good habits but also fully broke me physically.
I got through my work days using a standing desk. On top of this we had a 1-year old to manage at the time. I got severe spasms during two separate vacations trying to manage the baby and the luggage!
I took several trips to orthopaedics (and physios they tied up with) but they didn't have a long term recovery plan in mind. Or if they did they didn't communicate it to me.
In a chat with my GP, she mentioned how her husband had struggled with back pain and worked with Gladson Johnson's clinic, sports physios who sorted him out.
I called them. They were so good in fact that the earliest appointment was 3 months away!
Desperation makes you stupid
Pain makes you desperate and bad decisions follow. I decided to check into an ayurvedic facility for 10 days. I had a bad fall on a stair just the night before the treatment. That didn't help matters at all.
After the first meeting with the doctor I realized they couldn't explain why their treatment would work. I went through with it anyway.
Their promise was the treatment would cure my problems and if it didn't I could come back for another round after a few months.
Such promises are usually red flags because if this were true, why would so many people struggle with these problems for years.
The treatment had a massage component and a medication component. The massages involved heat and probably aimed to mobilized tight muscles.
The latest evidence-based therapies show that cold therapies are better when muscles are sore and inflamed during acute pain. The reason being they slow down blood flow and reduce inflammation. There are certain situations where heat works better. Heat helps you before exercise to warm up slightly stiff muscles.
The medication component made no sense.
So at the end of this treatment I was still struggling with soreness and tightness. Most of my injuries were unresolved. There were still a few weeks before I could meet Gladson.
So I decided to try yoga. I started at the first place I knew with some individual sessions. I briefly wrote about these struggles around the same time.
The trainer I chose had a generic plan which I could not fit into. My muscles were way too tight for the kinds of exercises she had planned. I was also asked to do a lot of back extensions (spine bending backwards) which aggravated the radiating pain down my legs.
So I discussed it with her and stopped.
I decided just hang on till the physio could take a look. Meanwhile, my GP saw that my Vitamin D levels were low and I started on supplements.
My rehab journey
I had to navigate through Bangalore's terrible traffic for over an hour and a half to reach the physio's clinic. He did a physical exam first and found tightness all over. He asked me about my Vitamin D and B12 levels. I missed testing my B12 levels and that caused me some grief later.
But at last I had a plan. He put me through a 3 month recovery period with 10 sessions in person. In the first session he just taught me 3 stretches. He told me to do it twice a day for a week and then come back.
All the time and expense and just 3 stretches! But I went through with it. The next session he taught me 3 more stretches. Again to be repeated at home twice a day and then show up to him in a week.
He slowly migrated me from simple stretches to simple exercises. Given my all-round injuries he helped stretch out everything from my neck, arms, shoulder, glutes, calves and hamstring. The exercises also built strength in all these parts.
I was more than half-way into the program when he showed me an exercise similar to a yoga class. No wonder the yoga didn't work in my earlier condition!
By the 3-month mark I was feeling pretty good!
I had 2 questions for him.
I asked him how long I needed to continue these exercises. Forever was the answer! He said if I stopped I would slowly slide back into pain.
I asked him if I could start running and playing tennis. He said running or tennis are sports and sports need fitness to begin with. He recommended 4 sessions of working on strength training and conditioning for every session of sport!
Because I lived so far away, he recommended I go to Pooja Rao to keep this going. She had a studio near my home. She is a Pilates and athletic conditioning instructor. The great thing about working with her is she really understands each person's current physical condition and tailors the levels accordingly.
Pilates focuses a lot on strengthening the core muscles which can then take a huge load of your back.
In the 4 years I've worked with her I've had zero injuries arising from exercise. If you've ever worked with a trainer, you know that's a rare thing.
Fitness compounds over time so leveling up in small increments really works. But many trainers overpromise, push you too hard too soon. You then simply land back into rehab. This did not happen with Pooja.
My back pain first reduced to infrequent episodes and then completely disappeared. I even managed a few vacations without incident!
I did have some tightness on my left leg near my calf and under the foot. Based on almost a year of experiments I realized I needed to do 2 things to keep this under control: stretch my calf and hamstrings regularly, and keep my Vitamin D and B12 levels up.
I leveled up to her most advanced class in about 2 years.
The pandemic made things difficult but she soon started online classes and I kept up with it. 3 sessions a week was what I needed to keep things at bay.
Cut to the present
Things worked great until early this year when I got a bit complacent. We underestimate the mental energy to keep doing all this. It is just so easy to let things slip.
My exercising was down to twice a week for a few months. I started forgetting my Vitamin D.
My daughter has a longish break this summer as she moves on from preschool. We decided to do a 2-week road trip. Two weeks of no exercise meant my back pain flared back.
I was traveling again the next week for an advanced driving training on an actual race track. This was a lifelong dream for me to attend and I was in my worst shape in 4 years!
I would have already written about my racing training if not for my back pain. I started doing some simple stretches to retain some flexibility and somehow pushed through the 2 days.
We were supposed to do another family trip right after this so it was difficult to recover. I was about 50-50 that whole week till I got back home.
I started using cold packs to relieve the acute pain and inflammation. Then did stretches a couple of times a day. I also worked with Pooja and went back to beginner sessions at 3x a week. I've walked every day and did a couple of swimming sessions to keep the muscles gently active.
It has taken me almost 2 weeks to go from 50% to 75%. I am able to sit for 2-hour stretches at time and get things done.
The good thing this time is I know what I need to do and that is a relief. The flip side is that there are no miracle cures.
Recovery is hard work. Recovery is like being a mouse on a wheel. A lot of work to just stay in the right zone.
Recovery is forever.