Margaret has been looking for an answer to her severe ankle pain, severe wrist pain and severe lower back pain for 15 years. She had been through an intimidating list of different practitioners and treatments that spanned everything from the scariest of the scary (like orthopaedic surgeons) to the weirdest of the weird (like crystal light colour angel therapy star child therapy drops). At some points along the journey Margaret had experienced some very temporary relief. There were also points where treatment actually appeared to make Margarets condition worse.
Margaret had what you might call a lot of nervous energy, she was the type of person that some people would love when they met her and others might call a bit odd. To me she just seemed very anxious and probably quite tired.
Margaret’s ankle pain bothered her more than her back pain and her wrist pain. The ankle pain bothered her most because it stopped her from being able to exercise which she had found over the years was a significant from of ‘release’ that helped her a lot with her mood and mental state. This meant that the ankle was affecting her sense of well-being in quite a serious way. The back pain was more of an intermittent ache that she had got used to and the wrist pain she had learnt to work around so it felt less limiting than the ankle pain.
I worked with Margeret for about 6 months. During that time her back got slightly better overall and often felt very good for several weeks at a time after treatments. Her ankle pain however didn’t improve despite all the treatment and exercises she did, eventiually we decided between us that we probably weren’t getting anywhere and I discharged her with some recommendations about what she should try next.
Why I Couldn’t Help Margaret & What She Taught Me About Ankle Pain
Without going into unnecessary details the reason I couldn’t help Margaret was most likely more emotional than physical. We used a barrage of treatments which when combined nearly always bring significant relief to people with her exact physical issues. When the treatment failed we switched to rehabilitation exercise and successfully strengthened up all the muscles that support her ankle. People with ankle pain respond very well to these approaches across the board, especially when they follow through as Margaret did.
The 2 most noticeable things about Margeret were the level of anxiety she exudes almost constantly and the fact that she didn’t respond to treatment. The 2 were most likely connected. She had experienced a very emotionally traumatic life event in her early 20’s after which her health had never been the same since.
What I learnt from Margaret and many others like her over the years is that whether we have ankle pain and back pain like her; or headaches and shoulder pain like many others; we can’t expect to get better solely through doing biomechanical work if much of our pain relates to traumatised emotions.
Margarets ankle pain was definitely real, she had real scar tissue, real pain, real inflammation and real muscle wasting, the only thing was her pain didn’t reduce as they reduced because it was being driven from deeper inside her nervous system. I did my best for Margaret despite knowing from the beginning I was up against it. Looking back maybe I should have sent her to a therapist at the beginning instead of at the end of our time together. If she had worked with the mental and emotional aspects of her chronic ankle pain before working on the physical parts of her ankle pain the outcome might have been different. Who knows maybe she is at that point now.. hopefully she is feeling better these days.
Dora was a bubbly good natured mum of 1 in her late 40’s. She lead a seriously busy single mum life and had a well paid job that I suspected she was probably very good at. Dora by her own admission had not looked after herself over the years. She had eaten most of the foods she knew didn’t best serve her on a consistent basis for 20 years and barely exercised in that time either. In other words the stresses of parenting, divorce and professional life had kicked her square in the health department as they do for so many of us.
In her mid 40’s Dora had discovered triathlon though a friend and really taken to it. After a year or so of joining in training with a masters triathlon group she started competing in small triathlon events in a spirit of participation. If she finished she was happy, if she didn’t come dead last she was delighted was her basic policy, in itself it was a really positive move for her.
When we first met Dora had developed quite bad ankle pain that had come on gradually while she was training and developed into something quite stubborn. The ankle pain wasn’t so bad that it was stopping her from training or competing but it was slowing her down and it worried her. She was scared that if it progressed she wouldn’t be able to continue to exercise, the triathlon thing was her only hobby at that point and it was also her social life, it had become very very important to her.
Why I Couldn’t Help Dora & What She Taught Me About Ankle Pain
After 3 weeks of treatment Dora had improved significantly and decided she was going to sign up for a half Iron Man. Despite me expressing the strongest possible reservations. She was already causing overload of her ankles by running further than they could handle. She was adamant that Iron Man was what she wanted to do however.
Once the level of training went up Dora’s ankle pain stopped improving despite having more treatment and ultimately started to go backwards. I pleaded with Dora to reduce her training. She didn’t want to and expressed that she thought the treatment just stopped working. After a time we parted company, she was still suffering with a lot of ankle pain last time we spoke.
Dora taught me that sometimes we can only heal the hard stuff like stubborn ankle pain if we are willing to make healing a priority and our strongest value. Dora with many others also taught me the value of a patient understanding their ankle pain thoroughly. I honestly believe that if she understood the harm she was doing she would have slowed down for a bit.
We know the value of resting broken bones because it is really easy to picture why that’s not a good idea to run on them. Ankle pain along with all the scar tissue and muscle wasting that cause it hurt but they harder to get your head around than broken bones. As well as being more interested in the immediate buzz of what she wanted to do than in healing I felt that she didn’t really understand the likely long term repercussions of continuing.
Dave was an engineer. Dave was fit and ran a lot. He had been struggling with sharp ankle pain and a series of sprained ankles over a 2 year period. He was experiencing sharp pains during the weight bearing part of his gait cycle in his left ankle during the latter part of every run and it was slowing him down.
Dave had largely been self managing his pain without much success but a friend had recommended me so he reluctantly agreed to give treatment a shot because he wanted to progress with his running. It was hard to talk to Dave about his ankle in the normal way that I do with a new patient because he had a lot to say and was quite confident that he already knew what was causing his ankle pain. Dave’s explanations of what was causing his ankle pain and why it wouldn’t go away we’re quite logical but they differed from my assessments in quite fundamental ways.
After about 4 visits Dave had experienced some limited relief from his ankle pain but he decided to stop treatment. Dave’s assessment was that treatment wasn’t working fast enough to continue and I haven’t seen him since.
Why I Couldn’t Help Dave & What He Taught Me About Ankle Pain
I couldn’t help Dave because he felt that he already knew the answers to all the important questions that were on the table during our time together. From the moment we met, literally every time I offered a perspective on Dave’s pain he overruled it with his own differing perspective. Dave refused to let me do any acupuncture on him because he believes it isn’t scientifically proven. Dave didn’t want to do the exercises I gave him because he already had some he was doing. I could go on… but you get the picture.
Dave taught me that trust and open mindedness are everything when it comes to managing stubborn pain conditions like ankle pain. Working with him felt like trying to pour nice hot coffee into a cup that was already full to the brim with cold instant.
Dave’s physical problem was a relatively simple one. I have daily success treating people with Dave’s exact kind of ankle pain but he pulled the pin just as he was showing the classic early signs of improvement.
You would struggle to catch a simple 10 minute Uber ride with Dave’s level of trust let alone manage chronic pain. You’d start the journey with your own strong opinions on everything from how to change gears to the correct route and possibly end by asking the driver to pull over and getting out half way. What chance do we have with complex and nuanced healthcare processes that takes months if we aren’t able to relax and trust those who are guiding us? Almost no chance!
I have no hard feelings towards Dave for not trusting me, my feelings were just those of frustration for him and his poor ankles. When it comes to healthcare we are truly buggered from the get-go without trust!!
The number of factors that have to come into play if we are going to heal stubborn ankle pain or any other pain for that matter is huge.
We need to be well enough in our bodies and minds to heal our ankle pain. We need to be committed to healing our ankle pain. We need to give our bodies enough rest so that our feet and ankles can restore and replenish their cells. We also need to be open to new incoming information when we are struggling or we will keep doing the same old stuff and getting the same old answers. And perhaps most of all we need to find trust. Not only trust in those who are trying to help us, but trust that there are answers and that healing is even a possibility that exists for each and every one of us.