Blood, sweat and fears... Part IV

'The very things that hold you down are going to lift you up' Timothy Mouse, Dumbo

So, today marks a whole six months since a certain car driver sent me flying across the road. It's long enough for normality to feel like hospital and Physio appointments are a way of life! However, given the RTTC National Closed Circuit Champs were also held on Sunday (21st October), the 2018 racing season is pretty much over for everyone, well other than those brave souls giving it full beans up Pea Royd Lane next Sunday in the RTTC National Hill Climb. Now that is one race that I'm happy not to be contesting!

How we as athletes deal with injury depends on so many interconnected factors that Marshall & Paterson (2017) describe the theoretical models that attempt to make sense of this area as 'looking like spaghetti and meatballs'! Marshall goes on to describe the general injury roller coaster; where some days athletes are calm and accepting and others more akin to a psychotic Medusa with a passive aggressive streak. I'm sure anyone who has been injured can relate to feeling grouchy, having the odd mood swing, some level of frustration, depressive tendencies or social withdrawal - particularly if your social life is/was actively taking part in the sport in question. Meanwhile your significant others are treading on egg shells wondering what the best thing to say is... Its fair to say that injury can bring fire and brimstone even to the most optimistic and positive of sporting households.

As much as I know all too well how lucky I am to be alive, that my injuries could have been far worse and the damage permanent (we hope that it isn't), I still have plenty of 'what if...' moments. Ranging from what if I hadn't gone out that morning, what if I lose all my fitness (that much is pretty much granted already), what if I do regain my range of movement and strength, get back on the bike and get hit again...

The obvious difference for me this time around is, it's not an overuse injury (I've ignored the warning signs on a fair number of those previously in my running days) - this is something that someone else has done to me (whether intentionally or not) resulting in an acute impact trauma. Plus the actual consequences of this have been far greater. Its not just been a lost racing season, which lets face it is ultimately just a very enjoyable but time-consuming hobby, it's also been additional worries and concerns over very real issues: Time off work, cost of treatment, transport to appointments (I haven't been able to drive since April), loss of confidence, loss of a social life and to some extent the level of social support to get through the tough times. It's really hard to empathise with someone if you've not been in that situation before, so it's very easy for friends who've perhaps had a more straightforward 'off' to gloss over it and expect you to be back training within a couple of months. Little do they realise that I've been busily 'training' to grapple with using cutlery to eat dinner rather than trying to turn everything into finger food!

On the plus side I have become what Marshall & Paterson (2017) describe as an 'active patient' rather than a passive patient. Sadly not in the sense that I would usually term active, but by constantly researching pain management, shoulder instability, funky exercises, whether hydrotherapy would benefit me now or later... Most of the time the answers are as diverse as our individual responses to injury - it varies greatly! However, even if my efforts don't actually impact my treatment or recovery pathway I'm sure they help with navigating the emotional journey, even if only by means of distraction.

Top tips to support yourself/someone you know through an injury:

1. Empathy not sympathy! One of the most natural things is to dole out the sympathetic platitudes 'you'll come back even stronger', 'don't worry, you'll be back in no time'... Although well intentioned, these are seldom helpful. If you don't know what to say, why not take the time to listen by opening up the opportunity: help me to understand what it feels like to... [have to deal with this], you must be feeling... [pretty overwhelmed], [anxious], [frustrated], it sounds like you're... [worried about...] [frustrated by...] etc

2. Injury dependent, you may be able to focus on something that has gone by the wayside due to lack of time or another focus in training. A regular sports massage for tight muscles might be suitable as long as it doesn't jeopardise your present injury recovery. Or there might be another weakness that you could hone in on - visualisation for pre-race anxiety perhaps. Maybe something totally unrelated to sport or your injury might be better, for example a good book...

3. Social support plays a big role in buffering the emotional effect of injury. As a friend, family member, colleague or teammate you can play a really important role in helping to ensure that your injured athlete doesn't become socially isolated. If you know of someone else who has been through something similar, then putting them in touch might also be useful. Imagine how you'd feel if you were sidelined - you probably wouldn't want to hear all about how well someone else's training is going or perhaps you would!

4. Don't be tempted to ask others how someone is, why not ask them yourself? They are likely to feel much more valued that way.

If you are sidelined or on the sidelines trying to be there for someone who is, hopefully there might be a useful tip or two amongst my latest ramblings. If you've something to share I'd love to hear it and even more so if it relates to shoulder recovery!

Blood, sweat and fears... Part III

"Fear is a reaction. Courage is a decision" Sir Winston Churchill

When rehab hasn't really progressed things and the NHS seem to want to send you down the slow route whilst noting that you are a long way off having a fully functioning shoulder, there is really only one route to explore. When you are talking shoulder injuries it seems pretty unanimous that there is only one person to consult - Professor Len Funk aka The Shoulder Doctor. An MRI scan confirmed his suspicions - that my shoulder was not going to improve on its own! Given how fast the private healthcare system operates (no pun intended), no sooner had we agreed for 'The Prof' as I affectionately call him, to do his thing then it was operation fix Fiona day.

Looking a little peeky after a couple of hours in theatre

I'm not the calmest patient at the best of times and given the experience of being sedated with Ketamine back in April (see blog post Blood, Sweat & Fears: Part I) was still all too fresh in my mind, I walked down to the anaesthetic room with trepidation. Going for surgery always creates mixed feelings - you know that (all being well) you are going to come out the other side with a far greater chance of improvement having been 'made better', however you know there is a whole lot of discomfort to come in the meantime. Dr. Hundle, the anaesthetist, helped to settle my nerves; he went off to get a surgical hat to cover my long locks and then proceeded to put it on over my eyes (you had to be there to find it amusing!). Anyway, no sooner had he told me that he needed to set up the cannula in my hand and got me on the subject of breakfast cereal (he happened across one of my pet subjects!!) then I was coming around in the recovery area.

Hospital Hair: the result of plaits for a week! I'd highly recommend it when you can't reach your head .

It was a far more stressful experience for Paul than it was for me. Whilst I was in theatre there was a thunder storm rolling around outside, disrupting the power. I was gone for 1 hour, then 2... Obviously there was no power disruption in the hospital but when you are anxiously waiting for someone to return it's easy to over-think the minor details.

I'd taken the advice of The Prof and Dr. Hundle and had a brachial plexus nerve block, so when I came around I couldn't feel anything from my shoulder to my fingertips on my left arm. It sounded slightly scary in that there was a small chance of it going wrong and my arm being paralysed. However Dr. Hundle assured me that he does in excess of 800 of these every year and would not consider having this type of surgery done himself without one. That was enough to convince me!

I'd never realised how heavy a 'dead' arm was until now but I certainly wasn't complaining as the main benefit was 12-14 hours of no feeling and therefore no pain! Having been in constant pain since that fateful day on April 22nd this was actually a fantastic experience - it was a shame I was so feeling so dopey after the general anaesthetic, or I could have capitalised.

Important to start moving gradually within 24 hours

Prof Len came by to see us later in the evening to say that he hadn't found anything unexpectedly 'nasty' when he opened up my shoulder, which is always a relief. He and his team had done their bit so it was down to me to follow his instructions for the next 3 weeks... The first few days were definitely the worst, I've never tolerated general anaesthetic particularly well so I knew to expect being very sick. I had forgotten just quite how sore the tubes make your throat though - this all made taking a veritable pharmacy of tablets more challenging. Both Prof Funk and his Pain Specialist Assistant kept tabs on me over the first few days which was nice.

Step by step rehab on Shoulder Doc website

The Shoulder Doc website is an excellent resource for both shoulder patients and physios alike. I was to work my way through level 1 exercises over the coming weeks. There is a whole host of articles, shoulder animations and other interesting shoulder related stuff - it's a hub for medical professionals as well as a comprehensive patient resource. If you know someone who is struggling with a shoulder problem then it is definitely worth a browse.

There are a few basic but really useful things that I learnt that might be handy to share:

1. Managing Pain:
The art of pain management lies in being one step ahead. Despite being nerve blocked for 12-14 hours and therefore having no pain during this time, the anaesthetist explained that it was important to accept pain relief so I had plenty on board. It is too late once you start to feel pain as you will have already entered into that vicious circle of playing catch up. I had a variety of painkillers, some of which were 'staple' meds and some were to help manage that 'breakthrough pain' when some of the painkillers are starting to wear off but it's not quite time to take the next dose... We all respond differently to different groups of painkillers but prior to surgery I was struggling to tolerate Tramadol so the anaesthetist switched me onto oral morphine. I was dreading taking it as I'd already decided that it was likely to taste vile - as it happened, it was more like the cough medicine Benylyn so not unpleasant at all. A potential result there; pain killers that taste ok and actually do what it says on the tin (or bottle in this case)... as long as it is spaced far enough away from the other opiates, or combined they also make you feel sick. Who knew taking analgesics was such an art form, definitely not me until recently.

It was also instilled in me that pain management is an equally important part of rehab and recovery as Physio, rest and follow up appointments. After all, if I'm in pain I'm unlikely to be able to tolerate the Physio exercises and risk regressing or at least not getting the most out of the surgery. Clearly my hitherto attitude of try and get by on as few pain meds as possible was not going to cut the mustard!

2. Managing Medication:
When you have a host of different medications to take, e.g. multiple painkillers, anti-inflammatories, anti-sickness etc they inevitably need to be taken at different times of the day, some without food and some after. Whilst initially you might think it sounds straight forward you soon realise that this is actually far from true. However, making yourself a simple Meds log makes it a whole lot simpler to remember. It needn't be complicated; just the date, time and what you've taken should suffice. It will alleviate that 'was it 8am or 9am when I took those painkillers', 'can I take the morphine yet'...? Even if you usually have a good memory, the after effects of a general anaesthetic, lack of sleep, and having different medications with different requirements that you're likely not used to taking all work their magic to confuse you!

3. More is not Better:
Whilst this also applies to meds, I am actually referring to rehab exercises! When your exercise sheet says do 8-12 of these x 3 a day, the athlete mindset kicks in and you think well, surely if I do 12-14 x 4 day I'll get better quicker... WRONG! Pushing myself to the limit and trying to squeeze in as many little exercises as I could muster, I thought that I must be helping myself. In fact I was doing the exact opposite - creating more inflammation in the area and slowing down the healing process, not to mention increasing the pain levels and then having to take increasing amounts of morphine to try and settle it down.

A useful guide - if you think of a visual analogue scale (VAS) where pain is 1 - 10 were 10 is excruciating, you should not be jumping up by more than 2 points when you are doing your exercises. So, if you were a 6/10 before you started, you might find yourself at 7 or 8/10 during your exercises but within a few minutes of finishing you should be back at that 6/10 again.

Don't forget, we are all different and every mechanism of injury sets us off on a different path or rehab trajectory, so just as we wouldn't share prescriptions for pain medication don't be tempted to share exercises that aren't prescribed for you either.

Good luck to anyone else on a rehab journey, don't forget to use the support around you, be honest with your Physio if things aren't going as you'd hoped but be honest with yourself too! x