The
healing journey back to full enjoyment of cycling requires some degree of
psychological adaptation to the injury and to the event that caused it. |
Rehabilitation
Full Rehabilitation of the Person from Injury Should Honor the Body, The Psyche and Spirit.
This is called Integrative Medicine. Our Top Section deals with the the Traditional Western Medical Approach to Healing Injuries. Scroll down for our Alternative Medicine Section.
Rehabilitation - Traditional Western Medicine Modalities
Physical
Therapy
Any injury that sidelines you from cycling (be it a fractured bone, dislocated joint, strained ligament or torn muscle) will cause disuse of your cycling muscles with loss of muscle bulk, tone and strength. When adults stop exercising their daily production of Growth Hormone drops, and this contributes to degradation of muscle tissue. They also lose aerobic capacity from lack of cardiovascular exercise. The temptation is always to return to cycling too fast and too hard for your weakened muscle system, which can aggravate the injury and prolong the period of disability. Massage therapy from a CMT and/or adjustments from a licensed chiropractor can help ease pain and promote the healing process. Diminished pain is not a license to return to cycling, because you still need to undergo a re-strengthening program for your muscles. It is risky to determine on your own when you are physically ready and safe to return to cycling. Rather than trying to gauge this on your own, it is better to hook up with a physical therapist who is also a cyclist, still better if the therapist is certified trainer with specialization in cycling. This person can assess the impact of the injury on your capacity to cycle comfortably, safely and efficiently; design a rehabilitation program of stretching, core stengthening and exercise with a gradual return to cycling via the home bike trainer; and do hands on body work to ease spasm. Some physical therapists also sequential bike fits, adapting the bike to your body as your graduall recover from injury and make gains in strength, flexibility and body symmetry. For cyclists wanting to see a medical doctor, there are some orthopedists and physiatrists in the Bay Area who ride bikes and enjoy helping injured cyclists recover from traumatic injuries. Clients of my office will be provided with names of treaters who focus their physical therapy, chiropractic or other healing practice on injured athletes.
Rolfing
Rolfing is a method of head to toe "structural integration" of muscle tissue and fascia developed by Ida Rolf. To obtain certification Rolfers must study anatomy and physiology. They must undergo very rigorous training in the analysis of and correction of deficiencies in the body mechanics of standing, walking and sitting. For this reason the term Rolfing is a registered trademark, as it protects a unique method of education, training and treatment from people who might adopt the term to describe different, less scientifically validated practices. Rolfers use observation and palpation to assist them in ascertaining how tight vs. relaxed your muscles and fascia are, how the condition of these tissue affects your posture and movement and how movement of one part of the body affects these tissues in other areas. Rolfers use deep tissue release work to free up or unstick the areas where scar tissue has physiologically glued your muscles to your fascia which restrictst mobility. they also use movement work to stimulate nerve impulses to muscles in a healthy pattern in conjunction with breaking up scar tissue. The benefits of rolfilng from a really good rolfer border on the miraculous. They can reduce muscle tightness and pain, produce symmetry in your shoulders and hips, open up space in the vertebrae of your neck or back, allow you to hold your head high with chest open and stand taller, to sit upright instead of slouching, to walk in a springy fashion with longer strides, and so forth. A bicycle is a totally symmetrical machine. The more symmetrical you are, and the more your muscles are healthy, flexible and well supplied with blood and oxygen, the better you will ride over a sustained period. A rolfer in your area can be found through www.Rolf.org In Oakland, there is an an excellent rolfer named Amy Lynn Larimer who can be contacted through www.Amylovesrolfing.co
Self-Massage
If your HMO, PPO or automobile
medical payments coverage will pay for a good CMT who works with injured athletesto
massage you that is ideal. Unfortunately some injured cyclists have no health
insurance or even car insurance to pay these bills, or their coverage is quite
restrictive and they can only go a few times. The good news is that you can do
alot on your to own to roll out muscle spasm with a foam roller or a small ball.
You
can seek instruction from a PT or CMT on how to use them or puchase a book or
DVD. The inventor of the Yamuna ball has a website for self-massage. There is
an excellent DVD called Small Ball Release Program by Cheryl Soleway, PT of Fitball
USA that you can get. No one knows your body better than you. As you work more
and more with the foam roller and/or small ball, you become very attuned to where
you hurt and how much pressure you need. There is much satisfaction in sealing
healing with these tools. A caveat, of course, is that if you have broken bones,
dislocated joints, inflammed joint capsules or other serious injuries you should
not be working on your own, but should consult your treating doctor.
Using a Home Bicycle Trainer
Home machines called bicycle trainers that allow you to ride your own road bicycle in place are readily available for purchase on the Internet and are affordable in price. The least expensive are roller devices, which are great for developing balance. Fluid resistence trainers are more expensive. Magnetic resistence trainers are the most expensive. These days you can even buy a virtual reality trainer which lets you use a flat screen computer to display changing images while you cycle up and down virtual hills and cycle through virtual fields. If your goal is rehabilitation from cycling injury, then it would be best to have your sessions on the trainer crafted by a physical therapist or personal trainer who is experienced in rehabilitation of cycling injuries. The best known cycling trainers are the CycleOps used by the US Postal Team. These are available for purchase at www.performancebike.com or www.bikeline.com For good prices on magnetic trainers take a look at www.NetSweat.com To purchase the I-Magic virtual reality bike trainer go to www.tacxtrainers.com
Medication
The pain cycle refers to how pain can prolong itself by disrupting normal activities such as sleep and exercise. It is during deep, restful sleep that our bodies release growth hormone and other tissue repairing substances while allowing the contracted muscles to relax, lengthen and engage in fluid exchange that promotes nutritional healing and elimination of inflammatory chemicals. Pain disrupts sleep which in turn causes insomnia and fatigue and retards healing of damaged tissue. Pain also inhibits the ability to exercise, so the injured person loses the opportunity to stress his muscles through exercise and rebuild the torn, weakened tissue. The pain cycle also refers to how pain wears us down, darkens our mood and causes depression with irritability. The neuro-chemical aspect of this process is that pain signals our brain to produce stress hormones (cortisol). Chronic pain causes a persistent increase in the amount of stress hormone (cortisol) produced by our pituitary and adrenal glands. The more miserable we feel, the less able we are to block or ignore pain signals and the less likely we are to feel like exercising. In order to break the pain cycle you have to decrease pain, reduce inflammation causing pain and promote deep, restful sleep. Cleary, an injured cyclist needs good pain relief to lower physiologic stress, allow healing fot occur and to begin exercise and biking again.
Pain signals get processed in the brain, where
they become conscious, through transmission via the spinal cord from the damaged
tissue. Some injured athletes use a TENS machine to block these pain signals.
The machine does not heal the damaged tissue, but does help break the pain cycle,
and can be useful. The machines are expensive to buy, and can be rented. Rentals
may be covered by health insurance. Whether or not you try a TENS unit, it is
worth considering medication. Minor injury from muscle inflammation may respond
well to OTC medication such as aspirin, tylenol or motrin, and to warming ointments
like BenGay. Minor to moderate injuries also respond well to manual therapies
such as chiropractic, PT, Feldenkreis and Rolfing. These can help relieve pain
and restore function.
With significant injury that produces peristent
pain, despite OTC pain meds and/or manual therapies, you will want to consider
prescription medicine. Family doctors, orthopedists, physiatrists and pain medicine
specialists are all equipped to prescribe pain meds. When taking pain meds, its
always a good idea to err on the side of more information rather than less. It
can be eye opening to check out your doctor's recommended pills on the Internet
for adverse reactions and contraindications. In the late 1990s many injured athletes
benefited from arthritis drugs with Cox II inhibitors like Vioxx and Celebrex
that had powerful anti-inflammatory effects without causing irritation or bleeding
of the stomach like aspirin. Unfortunately in 2004 Vioxx had to be pulled off
the market because of studies showing it increased the frequency of heart attacks.
All Cox II inhibitors are now under suspicion by the FDA. Even Naproxen (a non-steriodial
anti-inflammatory) is now under some suspicion by the FDA. For safety sake, ask
your doctor which anti-inflammatory is now reasonably safe to take, and be sure
he knows your cardiac risk profile. While some Tylenol is good, any heavy use
of Acetominophen drugs on a long terms basis can cause severe liver damage. Prolonged
use of any OTC pain reliever, including Acetominophen, is associated with increase
in blood pressure, more so in women than men.
For relief of severe pain there are opioid medications like Vicodin that really help, but these make people tired, even a little dazed, and should be taken just before bed. Chronic use of vicodin not only tends to cause constipation, but can lead to addiction. As an alternative one can try a fentanyl skin patch that delivers pain medication gradually in very small doses during the day. Some physicians prescribe tranquilizers like Valium to reduce muscle spasm and promote sleep. Some physicians use anti-depressants like Trazodone for relief of nerve pain and promotion of sleep to assist healing. Nerve pain is a problem area, becaus many of the medications prescribed for it were first developed to prevent epileptic seizures, and tend to have side effects on the central nervous system including impairment of thinking, coordination and balance. A cyclist with nerve pain should exercise great care and caution before agreeing to use a medication like Neurontin. Orthopedists and physiatrists (doctors of physical rehabilitation medicine) are the primary experts in use of pain medication to break the pain cycle. In most cities you can find a sports medicine clinic where specialists in both fields work together, frequently with a physical therapist and even a pain psychologist.
Aquatic Therapy
Any gentle, gradual return to movement can assist the process of recovering from injury. With significant injury, it may hurt too much even to do Yoga. One form of therapy that holds promise is aquatic or swimming pool therapy. Water is a bouyant substance that supports your weight. When people are in a pool, they feel very little, if any, pain from standing or moving. Moving stiff limbs in a pool is a good way to increase range of motion without pain. You can even exercise and strengthen injured muscles with very little pain in a pool. Some people use a long styrofoam "noodle" by sitting on and straddling it just like a bicycle seat and then moving their legs in a fowards and/or backwards pedaling motion.
A Warning About Steroids
Anyone who watches professional sports (like football and basketball) on TV knows that many a high priced athlete will be taken out of a game for a steroid injection into an injured muscle to get him back in play. This seems to happen so frequently we can equate steriod injections to something harmless like bandaids. Don't believe it. Steroid injections are toxic and cause muscle damage. The reason inflammed muscles stop hurting when injected with steroids is that some of the injected muscle tissue dies, so it can't send pain signals to the brain anymore. Obviously muscle toxicity will vary with the dose, the number and frequency of injections and so forth. However, if your doctor recommends one or more steroid injections, you should ask him about the potential for muscle cell death and ask about less harmful alternatives.
Rehabilitation - Alternative Medicine Approaches to Healing
Therapuetic Nutrition
Common cycling injuries involve the skin (road rash) and musculo-skeletal injuries that produce inflammation and stress the immune system. There are whole foods that can be consumed to help you heal. Blueberries support collagen production to heal the skin. Foods with zinc like turkey and oysters promote faster wound healing. To reduce inflammation and boost immune function, you can consume whole foods with with zinc, with flavinoids (like blueberries, blackberries and rasberries), with carotenoids (pumpkin, tomatoes, carrots) and Vitamin C (orange juice, oranges, broccoli, spinach). Along with foods like salmon, spinach, flax and oats, they also promote cardio-vascular health, which is a good thing to boost after injury. To combat inflammation, you can add certain spices to your food such as tumeric, ginger or cinamon. After a fracture you want extra Calcium and Vitamin D in your system. While you can take supplements, you can get your extra dose by consuming tofu, salmon (which has bones), spinach, milk, sour cream, yogurt and other dairy products. Yougurt is a great choice if it has live bacterial cultures like acidophilus because this promotes the health of your colon, eliminates constipation and reduce the risk of colon cancer. A word about water. Any time you have an injury, its always a good idea to drink lots of water to help flush out the toxins caused by inflammation. Whole Foods puts out a powder called Stardust which can be mixed with one gallon of water to create a mildly saline solution with a touch of sweetness from Stevia. This water is more hydrating than tap water because it has a little bit of salt to help your cell membrane's open wide to admit the water. Whole Foods also puts a line of nutrient dense products made only from whole foods that can be consumed all day long as healthy snacks. When you combine these snacks with the Stardust water, you will obtain complete hydration and healthy nutrition from easy to consume whole food products. This will let your body rest and free up lots of energy to help your injured tissues, instead of going to the digestion and elimination of meat protein, sugary drinks and other foods. For more information see www.wholefoodfarmacy.com I have a reseller's number and I can help you buy your first order at a discount.
For cyclists looking for custominzed, one on one nutritional help, contact JILL TARVER, M.S. of Sacramento. She is a sports nutritionist and a triathlete. She can help injured bicyclists with their physical recovery through nutritional assessment and advice. You can contact her at www.JillTarver.com Jill understands the metabolic demands of the normal body, the performance athlete's body and the injured body. She has trained herself to participate competitively in triathalons. She is able to adminiiter VO2 max testing and metabolic testing. She is an excellent resource.
Mental Imagery and Self-Hypnosis
The lead article in issue #238 of Peak Performance, a sports research newsletter, discusses the positive role of visualizing optimal performance. Simply imagining oneself performing proper technique will activate nerve impulses from the brain to the muscles and strengthen neuro-muscular circuits required for optimal real world performance. The effect is enhanced during self-hypnosis which is simply a self induced state of deep relaxation in which the left brain (the analyzing/calculating part of the brain) is quiet and the right side of the brain (the creative, visuo-spatial part) is fully engaged. Elite athletes who win major national and international events and achieve celebrity status use mental imagery very effectively not just to rehearse and solidify technique but to rehearse winning and making themselves believe fully on an unconscious level that they will win a particular event. Such imaging is accompanied by inspirational music and intense emotion. How does this apply to the injured cyclist who is not a celebrity and not training to win the next Tour de France? When you are grounded by physical injuries and cannot ride because you are in a cast or sling, you can utilize mental imagery to help you recover as a cyclist both psychologically and neurologically. It helps psychologically, because imaging lets you see, feel and enjoy yourself out on the imaginary road. It helps physically, because you are engaging neuro-muscular circuits between your brain and cycling muscles. Mental imagery can be internal, as if you were riding with a camera on your helmet, or external, as if you were a spectator seeing yourself ride by from the grandstand or roadside. To serach out an expert to help you with this form of recovery from injury, try to locate a sports psychologist in your community.
Psychological Adaptation
Although many cyclists, especially male cyclists, do not like to talk about it, one consequence of injury that inhibits return to cycling is fear and loss of confidence. The injury causing event may well have been frightening. Sometimes you barely miss getting killed or suffering some form of catastrophic injury by a hair. This fear is imprinted biologically in your brain in an area called the amygdala. It may be hard to overcome it on your own. Even if the injury was totally beyond your ability to foresee or prevent, and was not by any means your fault, you may still start to second guess your ability as a cyclist. You may begin to wonder if you ever had what it takes to ride or begin having premonitions that if you return to cycling you are likely to suffer an even worse injury. All of these fears and self-doubts are common following a serious cycling injury. These fears co-exist with feelings of loss, regret and frustration. You may also be jealous of your old riding buddies who are still out there pedaling away and having a great time. Perhaps you are even a bit angry at them for not calling to see you are or for not visiting, something that makes you feel invisible. These are only some of the complex emotions and feelings that accompany a serious cycling injury, and which can inhibit recovery.
The healing journey back to full enjoyment of cycling requires some degree of psychological adaptation to the injury and to the event that caused it. For some people a lawsuit for damages can help serve as a vindication that the other party was the one truly at fault, and can reverse the passivity of being a victim with the activity of pursuing just compensation against the party who negligently inflicted injury upon you. However, in most cases the lawsuit is itself just another source of uncertainty, anxiety and stress. While I do my best as an attorney to reduce your anxiety by explaining and demystifying the lawsuit process, and by involving you in decision making, my recommendation is to pursue psychological adaptation not through the lawsuit, but through other channels.
One thing you can do is find someone knowledgeable to talk to about the event, the injury, its consequences and your fears. This could be a psychotherapist or a counselor. It could be a sports psychologist or a pain management psychologist. Taking one or more cycling clinics on how to avoid injuries can also boost confidence and ease fears of re-injury. In the Bay Area, one excellent provider of cycling safety clinics is Mike Cox who can be reached at mjcox@aol.com.
Reducing your pain and the mental stress that goes with it through medication will help. So will taking charge of your recovery by rebuilding your muscles with physical therapy. Watching cycling videos or reading cycling stories about the pros like Lance Armstrong, will certainly remind you that even the best cyclists fall and get hurt badly. In his books Lance talks about being run off the road and being hit by cars, but managing to get back up and ride again. This can help.
"The concept of self-healing physical injuries through positive thinking has gone mainstream. The 2/10/04 issue of the Wall Street Journal reported that nationally prominent cardiac surgeons are now playing audiotapes to their patients before, during and after heart surgery to boost their confidence that they will make a full recovery and enjoy a healthier, higher quality life when they go home. Statistical studies indicate that patients who hear the audiotapes tend to recover faster and more completely than those who do not. Can self-healing be applied effectively to broken bones? Yes. A colleague of mine who used to race for the 7-11 team suffered had a bad femoral shaft fracture with some splintering of bone during a race. He journied to Colorado where he worked on a daily basis for several weeks with a self-healing therapist. He not only felt better but his bone had completely mended on x-ray and he has returned (as a matter of choice) to recreational cycling, mountain biking and running, all of which he really enjoys. The Internet is a good way to locate a therapist who specializes in self-healing in your community. While this approach is certainly not for everyone, it is increasingly available as an option for people who are attracted to this way of recovering from injury."
Shining the Light of Consciousness on Pain Bodies
Eckhart Tolle has written and lectured extensively about how we make our lives worse by focusing on the past or future, rather than the present moment (The Now) and by inviting negative energy through unconscious activation of pain bodies. An injured bicyclist will frustate and delay his own healing by focusing on how amazingly capable he was and what a bright future he had before he was hurt and then allowing doubts about his future to creep in with thoughts along the lines of "I will never ride as well again or I will never make it back to my previous level of fitness or I will always be in pain when I ride." Such mental time travel is incredibly common, and there are very few people who live day to day without ever doing it, but it is not helpful to making a full recovery from injury. Still worse is unconscious activation of the pain body. The pain body, as Tolle describes it, is a "little entity... a center of negative energy that feeds off human pain, both the pain of all humanity and the past personal pain accumulated by the individual over his lifetime." In the untrained mind, almost anything can set it off, such as a negative thought about future performance on the bicycle, a sensation of pain coming from the injured body or the experience of tightness, weakness or spasm in an injured muscle while riding. Once the pain body is activated, the mind will go through a stereotyped script of negative thinking that has repeated itself over and over again for decades. An example might be "I knew bike riding wasn't going to work out for me. Everything I do to try to make my life better ends in failure. If only I had gone to the movies that day with my friend instead of riding. But that's the way it goes for me. Now I'm on crutches and I can't get around. Why do I even bother to leave the house?" Tolle says that the pain body can only activate and stay energized if we remain unconscious and feed it with more negative thinking. As soon as we shine the light of awareness on the pain body it de-energizes, quiets down and stops bothering us. Practice meditation and other forms of awareness and watch for theatrics of your own pain body when it starts to activate. You can shut it down. Focused breathing is an excellent way to shift energy from your pain body to your life giving breathe and begin to relax the nervous system long enough to retake control.
Breathe Work
How much oxygen you take in while riding your bike and how much oxygen you can effectively utilize while under the escalating physiologic stress of riding can be measured and is called VO2 max. Lance Armstrong had the best V02 max on the planet when he won the Tour de France 7 times. You can have your VO2 max measured by contacting michael@DOUVO2.com
There is a whole other aspect to the breathe, mental focus and bodily relaxation. If you are riding up a long, steep hill and beginning to feel anxious about getting to the top in respectable fashion (without rest breaks and without slowing to a snail's pace) you will most likely tense up the muscles in your jaw, neck, shoulders and upper back and you will most likely engage in shallow breathing. Both of these repsonses will cut the oxygen to your tissues, increase lactic acid and increase muscle fatigue. Getting control over your breathing and learning to breathe in a focused manner that lets you breathe slowly and deeply will cure these problems and make you a better rider. Breathe work will also make you a more conscious, sensitive and alive person and take you out of the narrow shell that shallow breathers live in. Once you are hurt and stuck at home, you will have plenty of free time to learn how to breathe more slowly, more deeply and more consciously.
One way to learn breathe work is to buy CDs or DVDs on meditation. Some DVDs focus exclusively on breathe work such as Dr. Andrew Weil's Power of Breathe with 8 techniques for improved breathing. You can also study breathe technique with a teacher of meditation or yoga. The June 2007 edition of Fit Yoga magazine has a wonderful article, full of illustrations, on how to combine yoga postures with the "fire breathe" technique. The authors Ana Brett and Ravi Singh have a website where you can purchase their DVDs at www.raviana.com