Physiotherapy isn’t actually all that fun, but I couldn’t resist the alliteration.
Sam has been doing lots of physiotherapy for her knees, and I have noticed increasing numbers of other friends who are doing physio for various ailments and injuries. My only experience until now has been after I broke my arm a few years ago.
Lately, however, my various aches and pains have been getting worse so I decided to see if a physiotherapist might be able to help me correct my posture or whatever it is I am doing wrong. It turns out I am dealing with arthritis in my knees, sciatica, some scoliosis, and trapezius muscles that are rock hard (not in a good way). This was not a complete surprise, but I had been in denial about naming the pains.
During that first session, I mostly got poked, prodded and stretched, which was surprisingly tiring. I then got sent home with a set of ten exercises to do every day until my next appointment. None of them are very big but they are surprisingly challenging. And I guess that’s the point.they are supposed to target my weak spots.
It feels weird to be doing something I associate with injury as preventive medicine, but it also feels wise. The more mobility I gain/retain at this stage, the higher the likelihood I will be able to stay active in future.
This post shares about general, non-specific body aches. My reflections are based on my personal experience. As everyone has different bodies and experiences, I welcome you to share your thoughts in the comments.
Body aches have become a common fact of my mid-life. My low-level, everyday aches are unique to my body and its history; yet, my friends and I seem to share an increased frequency of body aches as we age.
Body aches are mysterious to me because they can be (to use a word I am making up) contramonious. In other words, opposing causes can result in similar aches. Some examples:
I can ache from exercising too intensely or too often, or from not enough or not frequently enough.
I ache when am dehydrated, or when I feel I am retaining water.
Aches can come from new injuries, but also from old healed injuries.
Aches in the body can also present in contrasting ways:
Aches can be dull and generalized, or sharp and localized.
Aches can come from one’s body attacking its own healthy cells, as in an autoimmune disorder.
Aches can be uncomfortable but indicate nothing serious, or they can be symptoms of a condition that requires immediate medical attention.
Aches can be a mystery when their causes are not clear. My body has been been aching this week, and I can’t exactly pinpoint why. Maybe it’s because I sat all week at my desk. Or it’s because I went rollerskating in the mall on the weekend. It could be from recent my flu vaccine, or because I am getting sick and I haven’t hydrated enough. Perhaps there is a specific medical reason, or perhaps I am just tired and burnt out in general.
Body aches are literally a pain, but the small upside of mine is that they are a general warning light for me: inflammation is happening in my body, and things could get worse if I don’t take action. Aches force me stop and self-assess—how severely am I aching, what impact are these aches having on me, and what can I do to alleviate them?
I’m also happy that, though my aches may have many different possible causes, the treatment is fairly simple and standard:
Warm bath (or my heating pad!)
Light, safe movement
As I age, my low-level body aches are little mystery novels that remind me to do more simple self-care, no matter “what-dunit.”
What is your experience with everyday, low-level body aches? Is there an upside to your aching?
Like the rest of the English speaking world, I’ve been Wordling. And I gather, though it started in English, it’s spread to other languages. I have friends who do the French version, as well as Canuckle, the version with Canadian themed words.
Most days I do Wordle and then Wordle2. I’ve resisted the lure of non word based variants such as Worldle, Nerdle, Heardle, etc. And I don’t do the multiple versions like Dordle or Quordle.
Like many people I share my results on social media, since sharing is part of what the game is all about. The ubiquitous squares offer a glimpse into the way others play the game. That’s a big part of the appeal.
In my case though it’s also alerted friends to the fact that I’m up in the middle of the night. Why? What wakes me? I mean, aside from the state of the world. Mostly though the state of world keeps me up but it doesn’t wake me up.
What wakes me a few times each night is stabbing pain in both knees. I suffer from severe osteoartitis in both knees and the worst pain I experience is in the middle of the night. And then given the state of the world, it can be hard to go back to sleep when there’s war and a global pandemic to worry about.
I’ve read lots about why the pain is so intense at night but I don’t find the answers satisfying. People say it’s worse because there’s nothing else going on and you notice more. Also, inflammation is worse at night because there is less cortisol. “When you sleep, your body produces less cortisol. While high cortisol levels can lead to heart disease, healthier levels can help your body reduce inflammation.”
Finally, in a really annoying kicker–lack of sleep makes knee pain worse.
There a lot of stories and studies about the connection between disrupted sleep and knee osteoarthritis. See here and here and here.
Apparently it’s a vicious cycle where not getting enough sleep makes your experience of pain worse and then the pain disrupts your sleep. The lack of sleep can also disrupt your ability to get movement in your day and that too makes knee pain worse.
On the knee pain front, I try to remember to take ibuprofen before bed. I arrange pillows in just the right way to hold my knees in the right place.
But back to where this began, Wordle. For getting back to sleep once I’ve been woken up, there are limited options. I need distraction but not doom scrolling options. Enter Wordle. It’s a five minute exercise. I can focus on it. And when I’m done I post my score and go back to sleep.
If you’ve struggled with knee pain at night and you have suggestions, other than Wordle and its many variants, let me know.
As I was preparing for the Senior Canadian Curling Championships my recurring knee and shoulder injuries were making it hard for me to curl my best. On the ice, I was in constant pain. I needed to get help and to get help fast. A local physiotherapist was recommended to me, but I was skeptical. I’ve been to a dozen physiotherapists, without much luck. Many have made assumptions about my physical ability and age, which ticked me off. At the same time, I was desperate to relieve the pain. Why? It wasn’t so I could get a better sleep or take less Ibuprofen, it was so that I could curl better — full stop. That’s what a lifetime of competing, pushing, and playing does. The academic in me is critical of this. The curler in me is not. The aging woman in me … well the jury is still out because, I can’t lie, it’s getting harder.
I reluctantly made an appointment with my physiotherapist, Nelson, who turned out to be very young and very fit. This could go badly, I thought. As he was collecting information about me, he learned that I was a curler. He very quickly informed me that he is often mistaken for one of Canada’s most famous curlers, Brad Gushue (2022 Canadian Men’s Olympic Skip).
Connection made … check. Rapport built … check.
As Nelson was assessing my injuries, he told me that “the best thing for you to do right now is rest, but I know you are not going to do that so let’s see what we can do”. I liked this for a couple of reasons. First, there was nothing said about being a woman of a certain age and the importance of scaling back at that age; things that I have heard way too often. Second, he respected that I am an athlete who needs to curl, and to curl well.
Five weeks later and we were off to our competition. I felt a lot better. Not perfect, merely better. But then, what is feeling perfect? For me, there is not a day that goes by where I don’t feel physical pain. As I’m writing this post, my hamstrings are sore, different bits in my back are stiff, and my shoulders ache. As a society, our tendency is to attribute the pain I feel to the fact that I am a 56-year-old woman. But this kind of attribution is simplistic, essentialist, and quite frankly, ageist.
Ageist assumptions about pain permeate other domains of life too. Several years ago, my colleague, Kim Shuey, and I wrote a paper on aging and the perception of disability in the workplace. We found that workers who attribute their disability to aging are less likely to ask for workplace accommodations and are less likely to receive them even if they do ask.
Feeling “perfect” for me is living with some degree of pain, regardless of my age. It is difficult for me to know how much of my pain I should blame on aging or the spinal fusion surgery I had when I was 11 years old to improve a major case of scoliosis. My back is fused from top to bottom, and as a result, other body parts get stretched to their limits. I don’t think that I have lived a day since my surgery where I haven’t experienced pain. I’m used to it and I’m telling you this because it shows that we need to interrogate our assumptions about the relationship between aging and pain.
Interrogating, however, does not mean ignoring. Competing, pushing, and playing is getting harder. Particularly over the last 5 years, recovery time is longer, more body parts hurt at once, and injury is more prevalent. All of this makes the motivation to train more challenging; especially with a pandemic making it unclear whether my team will have an opportunity to play. Why continue? Because I love curling, the curling community, the exercise, and competing.
So, what says the aging woman jury? — Rest!
But I think not. I guess my identity as a curler is stronger than my identity as an older woman, at least for today.
I’ve been thinking a lot about pain lately as I emerge from the knee pain fog that took over lots of my life this fall/winter. At its worst I just couldn’t think about philosophy, work, relationships, or my kids while walking. That’s the usual stuff that fills my brain but my knee hurt too much to think. I used to think of my walks as productive time.
I enjoyed the freedom to think as I walked and often claimed I thought more clearly when walking. Like my standing desk, but better. Instead with my knee pain, I had to focus on breathing through the pain, paying attention to my gait to not make it worse. I’d count steps not with a tracker but in my head to help me make it to my office. The walk was 1.3 km and often I’d stop along the way and check messages, take photos of horses, and catch my breath and regroup.
There is nothing the world could do to accommodate this pain. I’ve wondered about how to think about injuries and disability and my knee. See this post on getting past the usual talk of injuries and healing. It’s not that simple. It’s not just a matter of inclusion/exclusion either. See Andrea Zanin’s post on pain and the what the social model of disability leaves out.
Now I think of myself as someone who is good with pain. And I’ve been thinking about what I mean by that.
I think that of myself I suppose because other people tell me that. That’s part of the story. I gave birth to three kids without pain medication. I’m not claiming I could handle difficult births without drugs but run of the mill uncomplicated easy births didn’t seem to need drugs for me. I hear it too from physiotherapists who make your body move in painful ways as part of the injury recovery process. I do exercises even though they hurt. And once, when a dentist couldn’t get the freezing to work for a root canal, I asked him how long the painful part would take. Not long, he said. Just do it, I replied. And yes it really hurt but I lived to tell and we’re still friends.
I’m also reading a really wonderful book about endurance and I especially enjoyed the chapter on pain. I’ve liked Alex Hutchinson’s work for years. His column Sweat Science is one of my fave things to read and share on the Fit is a Feminist Issue Facebook page. I also follow his work in The Globe and Mail. It’s not particularly feminist but it is evidence based reporting on fitness. That’s rare. His book Endure: Mind, Body and the Curiously Elastic Limits of Human Performance is well worth reading. Chapter Five is about pain and endurance athletes.
Of course, I’m also drawn to the chapter because it’s about cycling, the sport of pain. Cyclists have lots to say about pain. Lance Armstrong, “Pain is temporary. It may last a minute, or an hour, or a day, or a year, but eventually it will subside and something else will take its place. If I quit, however, it lasts forever.” Hutchinson goes for Jens Voigt, of “shut up, legs” fame. Among reasonably equally fit and talented cyclists a bike race is about the willingness to suffer. She who suffers the most wins the race. And the ability to suffer was Voigt’s claim to fame.
Hutchinson details some of Voigt’s successes including his career capping attempt at the record for The Hour. Voigt succeeded but he only held it briefly.
What’s the hour? Says Voigt, “The beauty of it lies in its simplicity. It’s one bike, one rider, one gear. There are no tactics, no teammates, no bonus seconds at the finals. The hour record is just about how much pain you can handle! It’s the hour of truth.” p. 85
What’s so tough about it? Hutchinson explains that for a trained athlete sixty minutes of all out exercise sits in the excruciating gap between lactate threshold and critical power. In other words riders need to find the highest metabolic rate that is also steady state. Done right, writes Hutchinson, the hour is the longest bout of painful high intensity exercise you can endure. p. 97
I haven’t done anything like the hour but I have done various distance time trials in a velodrome with a coach yelling “suffer” at me. If I finished and could walk away with a smile, clearly I hadn’t worked hard and suffered enough! Going fast on a track bike hurts. It’s not about bike fit or about things you can fix. It’s about working your body that hard. There’s definitely pain involved. Rowing was similar.
Hutchinson also reports on various tests of endurance athletes and pain. It’s true that athletes can take more pain than the average person. It’s not that they perceive pain differently. In the tests that Hutchinson reports on both athletes and non athletes report pain starting at about the same point. The tests involve non fun things like holding your hand in ice water or having a blood pressure cuff squeezed well past the point of comfort. But notably, for a given test, where the average person says “stop” at point n, the athlete is still going strong at 2n.
The gap between athletes and non athletes is striking. But so too is the gap between athletes in season and off season. It also makes a difference how you get in shape. Athletes who train using high intensity methods, repeated all out sprint drills for instance, develop a high tolerance for withstanding pain than no athletes who train at a moderate pace.
I’m going to his Guelph launch on Wednesday night. See BOOK LAUNCH: Endure! Award-winning journalist Alex Hutchinson launches his book, Endure! on Wed. May 30th at 7pm in the ebar. And I’m going to give him a copy of our book and hope he spreads the word.
We don’t reblog a lot around here but sometimes something just strikes me as so right and so important I want to share it. As I’ve been thinking about injury, disability, living with pain, and trying to come to terms with my left knee, I’ve been thinking about the social model of disability. Here’s Andrea Zanin on what the social model of disability leaves out.
I’m hoping to get Andrea to guest blog here about her return to yoga and biking and other things after years ago coping with pain and very serious health issues for many, many years.
Three things got me thinking about sports training and pain again.
The first was a series of ads for indoor training videos, Sufferfest. There’s something about indoor training whether it’s on your bike on a trainer or on an erg, or rowing machine, that’s particularly brutal.
And finally some female faces.
The second was a lively discussion with a friend on the age old question of whether being a masochist helps with sports performance. My answer, yes.
Triathletes can tolerate more pain than the rest of us, a new study confirms, which helps explain why they would swim, then bike, then run, all because they want to and not because they are, perhaps, being chased by a bear.
That’s interesting on its own, but there’s more: Researchers say that understanding how athletes can withstand the pain of a grueling endurance event may eventually lead to potential treatments and therapies for people with chronic pain.
“It’s a very masochistic sport,” said Jenna Parker, who was the top female finisher in the New York City Triathlon in July. She was joking, but only kind of. “I guess to some extent, I always wondered what it is that makes people able to compete at a high level in athletics. Obviously there’s something that’s different that makes us able to push our physical boundaries in a way that other people can’t.”
Recently I wrote a post for this blog about my daily running routine, which I think of not as training but rather as a non-negotiable, necessary, therapeutic part of my life that allows me to function well. The minute I see exercise as training it becomes an added stress, which is the last thing I need.
In light of these strong anti-training convictions, it struck me as odd that toward the end of my first pregnancy, I thought that somehow I could successfully train for labour. As an athlete, this made perfect sense to me: labour is a physical activity, one improves at physical activity by training (physically and mentally), therefore, by training for labour, I would be able to improve my performance during labour.
This light bulb went off for me about five weeks before I was due. I was at the gym on the elliptical machine and the television was showing the Giro d’Italia, a three-week annual bicycle race through the Alps. As I watched these world-class bikers perform athletic feats of Herculean measure, I was struck by their focus, their stamina, and the fact that they didn’t seem to be flinching even while performing the most grueling (and no doubt, painful) of climbs. I began to draw certain parallels in my mind between what these bikers seemed to be experiencing in terms of pain and perseverance and what I thought labour might be like.
(Note: in keeping with my very hands-off approach to pregnancy and childbirth, I read virtually nothing about either so I had no expert testimonies against which to compare my own intuitions about what I thought it would be like).
What I did know was that I was in excellent physical shape for labour since throughout my pregnancy I continued my daily running and yoga routine, but with my due date quickly approaching, I realized that I had done nothing to prepare myself mentally for the pain. In order to prepare for this part, my doula recommended that I put myself in very uncomfortable positions (like sitting in a semi-squat position against a wall and holding it). But this and her other recommendations did not seem sufficiently challenging or painful to me (I like holding that position). As a marathon runner and as someone who is accustomed to pushing myself physically, I wasn’t worried about the physical pain as much as the mental side of things.
So my idea was this: for the month leading up to the birth, while at the gym doing my physical workouts, I would also begin to prepare myself mentally by watching world-class bikers pedal through grueling terrain. I thought that somehow by attuning myself to their focus, stamina, and perseverance, I could train myself to focus through pain.
Now for anyone who has experienced the pain of labour, you are probably laughing right now. And rightfully so.
But for a neophyte who had read nothing about ‘what it is like’, this reasoning made sense to me. And my dear partner, doula, and midwives were all so supportive of me in every way that when, very excitedly, I told them about my plan, they encouraged me and told me that they thought this was a fantastic idea. With all of my enthusiasm, I don’t think that any of them had the heart to tell me that training (or, “training”) for labour doesn’t quite work that way.
And so not only did I get my daily dose of Giro for three weeks (my son arrived a week early), but I also solicited videos (“bike porn” as one of my biker friends called it) of impossible climbs and unimaginable races to help build my mental stamina even more.
The one person who vociferously objected to my training regime was my osteopath. After having told him about what I had been doing and planned to continue to do he laughed to himself and responded with four simple words that flew in the face of my strategy and that also turned out, in during labour, to be the most helpful advice I received.
“Surrender to the pain,” he said.
He continued: “In the moment, that is all you can really do. If you try to fight it, you will be fighting against your body. Just surrender to the pain and let your body do the work.”
My osteopath – who specializes in pregnancy and birth issues – is a wise man, both in issues of the body and also in reading characters. He knew me well enough to know that I thrive when I am in control of physical situations and he had the foresight to warn me that this would not be the case in labour. When we spoke about labour and birth, and even leading up to these events, I did not want to believe him. I could not conceive of a physical situation that would so completely overtake me.
But during labour, I very quickly learned that he was right.
All I could do was surrender to the pain.
No amount of mental training could have prepared me for the pain I was to experience (I gave birth at a birthing centre where medical interventions and medication were not options). There was no sense in trying to “fight” or “power” through it, for my body was in control, not I.
(Here I realize that I am making a false distinction between “body” and “self” but there is a real sense in which during labour and birth, I felt a split between my “body” and my “self” in that my body was doing work that my self was in no way willing).
In the end, surrendering to the pain was what I did. It was the best advice that I received.
One other important thing I have learned working with personal trainers (see my post Rediscovering my Body: Personal Training) is the importance of stretching. I used to never stretch. Unless you count stretching for 30 seconds overall proper stretching. I used to go straight from doing nothing to exercise, and from exercise to shower. Heck, I am a busy girl and who has time for stretching, right?
Sometimes I feel like a Formula 1 but this is not because I feel high performance. Rather, I feel like I need a whole pit crew to keep me going and take care of my frailty (yes, Formula 1 cars are very fragile). I have a crew of massage therapist, chiropractor, and osteopath to keep the vehicle going and fix it when it needs it. But I have been forgetting the role of the driver in taking care of her vehicle. Stretching!!!
When I was a little girl, I used to really enjoy my grandparents’ yearly visits. Every summer, they came to stay with us for two weeks. For those two weeks, every morning I would do my exercises with my grandfather. He would turn on the TV to some American channel where women wearing leotards and their best smile would make us do various stretching and other light exercises for 30 minutes. Grandpa and I would do them together. Once we were done, grandma would bring us breakfast (an orange, a toast and a cheddar cheese sun for me) and we would watch The Price is Right.
My grandfather’s morning stretching routine was not only a vacation one. He did that every morning of his life. He was right. Stretching is good for you. Getting into a relaxed state and moving every limb gently, waking them up for the day to come is the best thing one could do for oneself. If one trains or engages in more strenuous physical activity more seriously than he did, daily stretching becomes an imperative as is the pre and post workout stretching.
For years I have disregarded stretching. I am very flexible. Who needs to stretch when one can touch their knees with their nose, right? Wrong. Or so my aching body has been telling me. When I picked up running again with my personal trainers in January, my right knee started bothering me again. I mentioned that to my massage therapist (pit crew member, see above) and she offered to work on my legs rather than my back. What she uncovered was a real mess, a situation which, as she said, has been building up for a long, long time. I suspect all the bike rides I have done over the years, ranging from 30 to 120 km, without stretching either before or after, are to blame. Also to blame are all the gym workouts, elliptical, stepper and other devices used without stretching whatsoever (or just a little, once in the shower). Other culprits: the jogging sessions wrapped up with mere walking, no stretching. All of that has generated issues for me that I could easily have avoided if I had stretched properly.
I have learned many things with my personal trainers. A very important thing I have learned is to start and end every workout with stretching. Dynamic stretching to start, static stretching to end. Just get those limbs ready for the effort, you will be better at it and then relax your muscles when you are done, you will feel better after it. In short: stretch or bust!
I’ve been thinking a lot lately about pushing yourself, knowing your limits, and that moment when your body tells you that you absolutely cannot go on. You don’t choose to stop. You stop because you have to. You physically can’t do it. Or at least that’s what it feels like and it’s the way I naturally describe it.
I walked one of the hills in the Gran Fondo. I just couldn’t make it up that hill on my bike. Now maybe the Gran Fondo isn’t a great starting point for this since I was deliberately riding, not racing, it. But certainly there have been races and hard training sessions where I hit my limit.
There’s gallows humour associated with athletic suffering that cuts across so many of the sports I like. Rowing, cycling, and CrossFit workouts are all associated with jokes about throwing up and passing out. And they’re not just jokes. I’ve seen several bouts of barfing at training sessions during my time as a cyclist. Mostly during interval training at the track and interval training at the crit course, of course.
For all the talk I hear and read about people injuring themselves from overdoing it at CrossFit (see this article on CrossFit’s dirty little secret for example) I’ve never actually seen it happen. I’ve been doing CrossFit for a year and a half now and I’ve only encountered sane and sensible coaches who push people, yes, but not beyond their limits. Since I’ve only done CrossFit in Canada and New Zealand I’ve wondered if it’s a cultural American thing, this pushing yourself to the point of injury. Maybe not. All the boxes are independently operated and so I don’t don’t there’s some bad coaches or communities out there. I just haven’t met them.
What’s fascinating reading about this idea of limits and the role they play in athletic performance is the role the brain plays in it all. Tracy and I have both written about listening to our bodies but what’s tricky here is that it turns out our bodies and brains aren’t always the best judges of what we can do. It turns out that our brains send the “Stop now!” signal not our bodies.
Now that would be fine, the brain working as our internal governor, if we were all tuned the same way. But we’re not. In some people the “can’t go on” moment happens much sooner than it does for others, even with the same physical cues.
That’s why some athletes win even though the data (VO2 max, for example) suggests they shouldn’t.
Different people react different ways in different situations too. Some years ago I had my VO2 max tested (I forget the number but it was “superior” though not “elite”) and my max heart rate tested too. I wasn’t relying on calculated data. I had actual numbers.
But the funny thing was looking at data from my heart rate monitor during criterium races that I exceeded the max. There were these bright red spikes on the chart generated when I uploaded the data. On hills? I couldn’t make myself come anywhere near the max. Still can’t. And I know that’s psychological.
Knowing it’s the brain, and not your body, throwing the off switch doesn’t make it any easier to control though.
I said a similar thing about aging in my post Is aging a lifestyle choice? If the reason we slow down is psychological rather than physical, that doesn’t mean it’s any easier to keep going.
“Winning cyclists must believe in themselves—but be wary of trusting their own brains. Research shows that the brain lies to the body and prevents it from fulfilling its potential. The brain sends us alerts to slow down or stop in the form of fatigue and pain because it thinks the body might be damaged if you exercise past certain limits. Top cyclists, however, know through practice that they can ignore the warnings and ride through the “pain barrier” to finish faster (although utterly depleted).” Read Cycling Science: 7 Fascinating Facts About Bikes – Popular Mechanics
“In the last decade or so, the field of endurance-sports science has been turned upside down and set on fire over the question of what, exactly, causes suffering, which scientists call “fatigue.” Some scientists are even questioning such bedrock concepts as VO2 max and lactate threshold, as well as the very notion that an individual’s physical performance has absolute, physiological limits. The lactate-threshold test? Meaningless, some experts say.We’re not even sure anymore what suffering really represents, what causes it, and why some people seem to be so much better at enduring it than others. The old, purely physical view of suffering and fatigue—that your legs hurt because your legs hurt—is giving way to a much more complex model, where our performance, and our feelings of pain, and even what we think are our absolute physical limits, are all controlled by one fickle master: the brain.” Read Transcendent pain
“There’s been a revolution in running science in the last few years. For a century, researchers have focused on the role of the heart, legs, and lungs to explain the limits of human endurance, but they’ve ignored the brain. Turns out, that was a mistake. It’s not lactate levels in your blood or oxygen shortages in your muscles that force you to slow down, it’s how your brain interprets those signals. In other words, the effort of running is only as hard as your brain perceives it to be. Scientists have since demonstrated that seemingly absolute physical limits are imposed by the brain—not the body. But knowing it’s your brain that hits the brakes doesn’t help if you can’t overrule it. So a few researchers scattered around the globe have begun testing methods of harnessing the brain’s power: zapping it with electric current, modifying the activity of certain brain regions, or simply training the brain—much like runners train their bodies—to become more fatigue-resistant, so you feel less effort while running at the same pace.” Read How to build mental muscle