Goal setting and recovering from chronic pain

I spoke in my last blog about how my pelvic pain had begun to improve. It was now seven months since I had given birth and it was nearly eight weeks, since I’d started working on my rehabilitation with my physio.

The stabbing pains and swollen, dragging sensation which I’d been experiencing ‘down below’ and yes I mean my vagina, were less intense. I feel like I’m back at school and have blurted out a rude word but I’ve finally reached the point when I’m just about brave enough to type the word ‘vagina’. I mean all females have them so I don’t know why I find it embarrassing to say, maybe fanny is easier, who knows!

Anyway the initial vaginal pain had reduced in intensity and frequency most of the time. I would still get pain every day but instead of it lasting 80% of the day, more often than not, it would come on just before, during or after exercise or when I had done too much in general.

I was still having disturbed sleep at night from numb hips (and a waking baby). Most morning’s I would wake up so stiff that it hurt to move. However it normally improved once I’d moved about a bit, which made it much more bearable than the vaginal pain.

The biggest improvement was that I had increased capacity to do more activity, before the pain started to get bad. I had even made it round the supermarket without having to give up half way, which doesn’t sound a big deal to most people, but it was to me. Chronic pain sufferers will understand how such a mundane task, which most people do without even thinking about, can become such an ordeal and is such a big achievement when you manage to conquer it.

I had been slowly reintroducing movement and touch and gradually exposing my brain and nerves to increased activity through stretches, short walks and easy spinning sessions. I’m not going to go into any detail but in case some one with vaginal/pelvic pain is reading this, for me sex didn’t increase the pain, despite me worrying that it would. And that is all I am going to say on the subject!

Stress management

I’d been trying to be more conscious of the stress I was under so I could try to pin point why my pain flare up’s may be happening. The idea was to understand my pain more, rather than just getting frustrated with it.

Like many people at the moment, most of our stressors at this point were due to job security and finances as a result of Covid. I was still on maternity leave at this stage and the sector I worked in had been impacted by the virus. I was unsure what consequences this would have upon my job when I wanted to return and the not knowing was causing me stress and anxiety.

Pete had however just managed to secure some temporary work for three days a week with the employer that he was due to start with before lockdown. Whilst it wasn’t permanent or full-time, it was regular work in a job he really wanted, which was very positive. Plus the job didn’t involve him being away all the time and the hours were really sociable so that was a massive win compared to our previous situation.

There was still a lot of uncertainty however after months of worry, I think I pretty much got to the point where I gave up. I realised that most things were outside of my control and worrying about them wasn’t going to change anything, it was only going to make my condition worse. I’d slowly become slightly more acceptable of the stress and more immune to it affecting me so greatly.

It also helped that the stresses of having a new born baby, which I had when the pain had started, were fading further into the distance. I wouldn’t say I knew what I was doing, but who does?! It certainly wasn’t as daunting now that he was bigger and I’d managed to keep him healthy and happy for this long. Plus we were out of lockdown so I could get out and about to see friends and family, which just made life better.

The next steps of rehabilitation

I ended my last blog saying that I had reached the point where I felt ready to step my rehab plan up another notch. Research has shown that aerobic exercise can help calm nerves down. Obviously a full blown work out probably wouldn’t help but 15-20 minutes exercise to get the blood and oxygen pumping through your body can actually calm your nerves down. So it made sense that I was starting to feel some benefit from the above changes and the low level, paced exercise I had been doing.

Goal setting

In previous physio sessions we had discussed my goal, which long term not surprisingly was for me to be pain free however my short term/more immediate goal was to return to running.

I’ve read articles and books which say that people with chronic pain often have no goals. The reason being is that it can seem impossible to set a goal when you can barely get out of bed in the morning or get around the house without being exhausted. For some people who have persistent pain, the goal seems so big that it feels out of reach and not even worth trying for.

I totally understand this and I’ve been there. I’ve had years when just to get through the day I’ve had to take a couple of naps a day or lay down just to battle through the pain and exhaustion.

It’s important that pain sufferers break goals into very small chunks which are achievable and also allow them to pace themselves. When I started my rehabilitation with Mrs physio friend, my goal of getting back to running seemed huge, even though it only involved me putting one foot in front of the other. The thought of actually bouncing up and down and moving at pace whilst in pain, made me feel like I would never get back to running.

Yet every part of my rehabilitation programme was designed to very slowly get me back to running again, in a way that my body could cope with. Each part of the programme was broken down into small chunks which took me weeks or months to achieve and build upon. Yet every exercise was introduced with my end goal in mind.

More about these small chunks…

It was seven months since I’d had Isaac and I was really struggling with the fact that my stomach looked like I was still pregnant. I still had a bump and my stomach was flabby. I hadn’t been able to do enough exercise or work on my core, so my stomach was still lacking any attention after giving birth.

I know this doesn’t really matter in the bigger scheme of things however my weight and calories has always been a big psychologically bug bear for me. Of course I would look at Isaac and think it was totally worth sacrificing my very average body to have him, yet my stomach still massively played on my mind and effected my self confidence. I hated looking in the mirror, naked or clothed!

So I was delighted when Mrs Physio Friend said that we could introduce some other exercises to turn my muscles back on and get me moving a bit more, which would hopefully start to help with my stomach. These activities included squats, lunges, bridges and leg slides, which I did three to four times a week. I combined the exercises with the spinning and walking I was already doing.

It was also time to think about introducing some pelvic floor exercises. After finding out that my pelvic floor muscles were overactive, I had spent the last three months or so trying to relax them down so I hadn’t been exercising them. I was now tasked with exercising them but ensuring I was fully relaxing them afterwards which wasn’t easy for me.

I had recently returned to the NHS physiotherapist. They had started to see patients again after lockdown 1.0 and I needed an internal examination to see if my pelvic floor muscles had improved. The physio said my muscles weren’t as tense but my deep pelvic muscles were still hanging on slightly, which could be contributing to the continued pain. The physio suggested that I start pelvic floor exercises, to allow the muscles to get used to being activated again.

It’s not easy to feel your pelvic floor muscles relaxing. It took quite a lot of practice and concentration. I definitely needed instruction from Mrs physio friend to help me co-ordinate my breathing and when I should be squeezing and relaxing. I was only doing a few squeezes once a day to start with, to slowly start engaging the muscles.

Every week I would increase my walks by five minutes and every spin session by another couple of minutes and I wasn’t having pain flare up’s. This was progress! It was painfully (literally!) slow but I had to remind myself that it was indeed progress.

In my last blog I had reached the point of being able to spin for 20 minutes. By mid August I was managing a 45 minute spinning session which felt amazing and a massive accomplishment. I wouldn’t normally get much pain when spinning but I would feel discomfort afterwards. I’d be limited on what other activity I could do for the rest of the day but the fact that I had exercised meant I didn’t mind as much.

It was mid summer and temperatures were soaring. My spinning bike was in our spare room so I was sweating buckets every time I did a session. Although this was great for calorie burning it did make it hard to motivate myself to do it, when it was 30 degrees outside. I just wanted to exercise in the fresh air and summer sun so I started to look to buy a real bike.

This would have been an easy and quick purchase had the whole world not gone cycling crazy over lockdown and wiped out the the stock of all the bike shops in Norwich.

So after a few weeks I had my brand new shiny bike. I looked a total wally in my new helmet but doesn’t everyone?! Plus I really didn’t care I was ready to embrace the freedom of the open road and the fact that I had 100% ‘me time’, with no one else interrupting my exercise. It was a momentous occasion so obviously I had to take a photo to mark it.

In reality it’s much less invigorating than it should have been. On my first ride I only went out for ten minutes, just to get my body used to it. Yet my my brain couldn’t cope and went ‘what the hell do you think you are doing’. Despite the fact that I had been managing to do hard 45 minutes spinning sessions, three times a week, when I got on a road bike and went for a much easier bike ride for less than a third of the time, my pain flared up.

Although I didn’t feel pain when I was actually cycling it started when I got off the bike and lasted for the next couple of days. However I knew this was often the case when trying anything new and I knew the drill. I had to keep doing it and very gradually increase the amount of time I was cycling for, in order to desensitise my nervous system to the stimuli of going for a bike ride.

After a couple of weeks I was feeling much less pain after cycling and just felt discomfort rather than actual pain and this was with increasing my distance. I was also able to do a walk in the morning and a bike ride in the afternoon with a bit of normal life in between, as long as I paced it so that was all highly exciting.

Strength and conditioning for running – the bit I was waiting for

This all felt like a significant improvement. It was now the start of September and I decided to ask Mrs physio friend for another physio session. Once we had chatted through my latest progress, she said that she was going to go through some exercises with me that would work on my strength and conditioning for running.

She also said between each set of exercises, I could do a short run in the garden. This made my ears prick up and made me excited and nervous at the same time. Running was the one thing I wanted to do over any other exercise but I was equally nervous about how the pain in my vagina (again made me cringe typing this word) would be.

The exercises she gave me were building on the squats I’d already been doing, by introducing weights and holding them for longer. There was also sets of wall squats, backward lunges, deadlifts, scissors and kneeling plank. After doing three sets of each exercise I got to do the exciting part of jogging to the tree and back.

The distance was no more than 40 metres, yet this tiny distance was a big deal for me. I was already preempting how awful it was going to feel when I ran for the first time since giving birth, even though I had successfully been doing all the other exercise.

Mrs physio friend said to do a week of the exercises without the running and if it felt ok, then introduce the tree runs, which is what I did. As I left our patio doors and headed towards the tree at a gentle jog for the first time, I was waiting for the awful and painful feeling down below to come but it didn’t. It felt normal!! It felt how it did when I used to run.

This was obviously a massive relief and a positive step in the right direction. The reps and sets of the exercises combined with the runs made me out of breath, which made me happy. For the first time since being heavily pregnant, I could also feel that my stomach muscles had actually had a work out.

It was so good to feel that they still existed! I was hopeful that the scissor exercises, combined with the running would help me gain some control of my baby bump.

After a couple of weeks of running slightly further round the garden each time (our neighbours must have thought I’d totally lost it), I progressed to running up and down the street outside our house. This was only slightly further than what I’d been doing but every little extra counted. This went on for a few weeks more until I was getting half way up the road.

I’d get pain afterwards but not when I was actually running or doing the stretches and on a day to day basis, the level of pain was on average the same.

Once I was happy with running a short distance, Mrs physio friend suggested that I start the Couch to 5k Programme. YAS!!! Despite the fact that this would be the third time I had followed this programme, it was music to my ears. The first time I did the programme was during my rehabilitation from my first episode of chronic pain. The second time I was pregnant and getting back into running after I’d taken a while off with shin splints and this was the third time.

Whilst it felt really good to be at this point, I also knew that I can run 5k at a decent pace so it’s slightly frustrating to have to go back through the whole programme again. Yet I know the programme works and I know that my chronic pain means that I have to pace myself and very slowly increase any exercise I do.

I started the programme on 7th October, on what was a stunning sunny morning. I felt slightly apprehensive ahead of my first run, even though there’s not a huge amount of running involved in the first few weeks of the programme, it would still be the most running I had done by far.

I plugged Micheal Johnson into my ears, I’ve used his voice on the app every time I’ve used the programme, I felt like it would be bad luck to change it. And off I went on my first run!

It felt good, it felt really bloody good. Good in terms of no pain whilst running and good to have fresh air, sun shine and me time. The sense of achievement afterwards was also immense. I sent Mrs physio friend the below photo after I had finished my run. I apologised to her, as I am apologising to you for my spots and unwashed hair. But I’d just been for a run and I really didn’t care what I looked like, I was happy!

Again, apart from a few twinges I didn’t have any pelvic pain whilst running or when I first got home. The pain and discomfort always comes on about half an hour after I stop running and I have very little capacity to do anything else. I have to sit down for several hours afterwards and do very little physical activity for the rest of the day, which isn’t easy with a baby to contend with.

Luckily Pete is very understanding of this. He fully realises that if I pushed through and tried to carried on, the pain would get much worse and I would ultimately cause a bigger flare up. I’m really hoping that the recovery time I need, will shorten as time goes on, as my body and brain get more used to it.

I’d had another appointment and internal examination from the NHS physiotherapist during this time. I was told my pelvic floor muscles seemed to be- relaxing better but when I was squeezing them they were letting go before I realised, as they were getting tired. My homework was to do very short squeezes and only hold them for 2 seconds, with repetitions until I felt the muscles tire. The physio also massaged the scare tissue from my episiotomy to make sure it was moving freely. It’s hard to tell how effective this has all been but I guess I’ll find out as time goes on and at my next appointment.

It’s now the end of November and I’m at the start of week five of Couch to 5k. My progress is slower than it should be because my shins have been feeling a bit sore. I tend to easily get shins splints. Therefore instead of doing three runs a week, as is intended by the programme, I’ve decided to do a spinning session between each run and leave two days between the runs/spin to give my legs and body more of a rest. So one week of the programme is taking about a week and a half to complete.

Yet I’m doing it! I set the goal to get back running and although I haven’t reached 5K yet and I’m running very slowly, I have achieved my goal of returning to running. A goal that eight to nine months ago didn’t feel achievable.

I still have pain every day and some days or weeks the pain will flare up to a heightened level. These days are hard to deal with and they normally send me on a bit of a downer. It feels like any progress I’ve made is whipped away from me.

About six weeks ago I had a particularly bad patch when it felt like I’d gone backwards and nothing seemed to be working. I felt really fed up and I just wanted something to help me so I ordered some CBD oil. I took CBD during my first episode of chronic pain so I won’t go into detail, as I’ve already talked about it in my first blog. I know there are mixed opinions about the use of it and if it actually makes any difference but I think for me, it does.

What is the reason for the continued pain? I don’t always feel sure I know the reason. My return to work after maternity leave wasn’t easy. I’m on flexible furlough and I’m working from home. Pete’s work is only temporary so there are still factors which are keeping my alarm system at a heightened state.

Even though I’m conscious the reason may be down to life stressors, over doing it or bad memories of my birth experience, it doesn’t always make it any easier to deal with. I just want to feel normal and be pain free again.

I do however realise that I am in a far more fortunate position than I was with first episode of pain and far luckier than many people with chronic pain. This time round, I’m not on medication, I can exercise, I have a baby and I have a supportive network around me and that I am utterly grateful for.

I really hope I can complete the Couch to 5K programme to smash my goal but who knows, I’ve learnt not to get my hopes up too much. I will keep posting about my progress and journey in the hope that it may help any one else in a similar situation.

As for being pain free, at the moment it feels like I may not ever reach that goal however that’s how I felt about my first journey with chronic pain. I will keep going and practice what I know. I won’t give up hope of getting back to normal, as I know full well that recovery is possible.

I will end by saying, if you are suffering from chronic pain and feel too worried to exercise, please get support from a qualified physiotherapist to help you form a rehabilitation plan. Both of my episodes of chronic pain have made me feel like exercise isn’t possible but with the right support it is. It’s dam hard and it won’t necessarily be pain free, yet it’s so important to your mental and physical health and wellbeing. It will make you feel so much better in many different ways.

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