Hooves on the Ground: Muscles, Testing and Function with Posture and Pain, (Kendall, McCreary, Provance)

It’s been a while since I’ve reviewed a book, not because I’ve not been reading but because I’ve not been feeling social and like sharing anything, so it’s possibly a very good sign that the first book that I go to review is one which I had dragged out to find a diagram for a bodybuilding pal.

 

It has, as the title suggests, two major components – Posture and Pain, and Testing and Function – and both of these sections are great. They can be read individually, but being a layman I ended up cross-referencing from one to the other a lot – Reading and observing posture, then finding the diagrams for the individual muscle groups mentioned, and testing them for length/shortening and weakness/strength. One of my favourite things about this book is that for a lot of things it does use cartoons, not photographs, so it’s a lot easier to see the movement and shape of muscles when the one that you’re observing is highlighted in red and the others are all just outlines, as compared to if they’re photographs or more exact diagrams.

The posture section shows, as well as the “problematic” postures, the  explanation for how each of them affects the muscles underneath, and which muscles thus need to be strengthened and which need to be counterbalanced in order to correct the posture (Not just for aesthetic reasons either, it explains how the various postures can translate into muscle weaknesses and pain later in life). It’s all extremely well laid out and presented in accessible, readable language, with photographs and diagrams, and technical terms explained in a glossary.

A long, extremely useful section of the book takes each of the muscles in turn, describes its placement and function, and also how to both flex and relax the muscle as far as possible – This is good for a handful of things; Finding relaxed or comfortable configurations for individual sore muscles, devising exercises to specifically strengthen individual muscle groups, and working out which muscles are compensating and “taking over” for other muscles during a movement, which is extremely common in hypermobile people; Archetypally, using ones latissimus dorsi to “stabilise” arm movements that should mostly be affecting the biceps, resulting in soreness and inefficient movements, but the same applies to basically any movement where a larger muscle can compensate for weakness in a smaller group. Near the end of the section is a series of diagrams of the superficial nerves, which is also extremely useful for trying to localise hard-to-describe pains.

Throughout the book there are worksheets and explanations of how to record a patient’s performance and presentation, which are extremely useful when you’re looking at yourself and trying to objectively assess how bad something is, or how good it is.

As with most textbooks, this is a book to drop in and out of, focusing on the system or the movement that you need. I’ve been using it mostly to work out which muscle groups I need to address more in my workouts, and to make sure that the things that I do to “help” when I’m relaxing aren’t actually making things worse in the long run.

I’d definitely reccommend this book, possibly as the first book to get when assessing your own body’s condition especially in relation to the pain that comes with hypermobility. As much as doctors are often too quick to turn to “deconditioning” as an answer to everything, there is absolutely power in knowing where all your muscles are and how to use them correctly, and thus to know which ones are underperforming and need work.

Exact details of my copy: Muscles Testing and Function, Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, with Posture and Pain first and second editions by Henry Otis Kendall, 4th Edition, 1993. Second hand, £3.45.

Disclaimer: Nothing said above is intended as a substitute for qualified medical advice, or to supersede the advice of a qualified physician. This is my personal review of my experiences with a book, as a layman. I am not a medical professional, of any kind, and any health issues should be discussed with a doctor or other appropriate professional.

Advertisements

Thunderfuck

I am a very sickly Zebra today.

The day before the General Election was a long one.

Physio first. Very kind, very honest, community physio – Asked me all the right questions, was incredibly sympathetic, spotted my popped hip from the far side of the room and through a tracksuit, knew what EDS was and had treated EDS patients before when he worked for rheumatic physio… And admitted straight away that I was too complicated a case, and he couldn’t help me under the remit of the community physio. He also volunteered to chew the ear off my last physio at CA, the same as Dr D did, so that man is going to have the most in-demand scalp in the county. Sixteen-plus years of ongoing pain, with the hypermobility complications, needed more time and effort and specialist knowledge than he could swot up on, so back to the hospital for me. He was what I’d call a “proper physio” – A grey-haired ex-rugby forward, who enthused about keeping fit and said that I was doing all the right things by aiming for ten kilometres in the pool per week,  assured me that missing that goal wasn’t the end of the world, and that even trying was better than most people would do, and said that he wished me the best of luck, regretted that we couldn’t work together, and that if anyone was ever going to recover completely, it’d be someone like me.

I’m not sure if that’s just a platitude that everyone says to every patient, but a hell of a lot of knowledgeable people have said it to me, so it makes me feel a lot happier and more encouraged than otherwise.

I actually felt encouraged enough that I went for a swim. I’m continuing my strategy of taking neither crutches nor morphine to the pool, so that I can’t overwork myself in the opiate hubris zone and end up collapsing on the way home. 500m in about 15 minutes, with the limiting factor not being myself, but the fact that the pool was bedlam – Seven to a lane, one of the ropes completely slack, Medium lane full of slow people, Fast lane a combination of pissbreathers (Those people who swim in such close formation that they must be right in eachother’s stream if someone suddenly feels the urge), people doing deadly serious drills (whom I didn’t want to interrupt), one incredibly elderly water-polo player (who was covered in what looked like WW2-era forces tattoos with whom I had a lovely chat about both water polo and the history of the local pool) and me (he of the incredibly erratic split time, even more erratic accel/decel out of turns, and tendency to stop in the middle of the lane every few dozen lengths to reassemble).

Deciding that I was better off taking the small prize rather than knackering myself in a suboptimal pool, I called the 500 a win, and went home.

Then the GP, which went really well – Dr L, someone I’d not met before. Nice, genuinely approachable, said to give her a week to do her reading, then come back and get a referral. Next appointment on the 20th.

Upon returning home from the GP, I found that Dog had eaten a full bar of Bournville. I’d been gone for literally twenty minutes, at most. Panic stations immediately manned, I dragged him off to the vet to get an injection of abomorphine (a REALLY potent emetic), then sat stroking his back and making generally reassuring noises as he vociferously chundered all over the vets’ car park. Whole bar accounted for – Seriously, it looked and smelled like a patissier with a grudge had iced the whole yard in cheap chocolate fondant – We went back home and sat in the kitchen, him looking terribly sorry for himself and me terrified that he was going to have some theobromide still in his system and have a heart attack. He’s a very old man, in greyhound years (He’ll be ten on the 4th of July) so this wasn’t a stupid fear.

Did not sleep well that night – Every whuffle and twitch from Dog woke me up in a panic.

Next day was the General Election – Tasks do do; Get to the vet to sign my insurance paperwork (To keep that bar of Bournville from being the most expensive that I’d ever purchased), and go and do some democracy. The local polling station is at the end of the road, so I thought I’d do one round-trip; Up to the vet, then back down to the church hall, then home. After the previous day, and the night earlier in the week where I’d been awake for something like 40-odd hours having a bit of a manic episode, I was anxious as fuck for a number of reasons. So, I took along Dog in his semi-official capacity as my assistance beast. Not a joke – It’s all there in my psych notes that due to fairly nasty PTSD I sometimes need to have Dog with me in order to function like a normal human being, and most people are fine with this (He’s lazy unto the point of appearing well-behaved, quiet, doesn’t shed too much, and doesn’t leave my side. The lead is basically for show – I’ve led him through a field of lambs with the only tether being a piece of wool from my wrist to his collar, and it didn’t even go taut once.)

I knew in advance that anyone is legally allowed to take their dog into a polling station (There’s no chance of my dog being a paid shill, swaying my hand to vote for his candidate instead of mine) so I walked in through the newly-opened disabled entrance with him at heel. Only to have his lead taken out of my hands (No asking, just taken) with the explanation of “The other attendant is scared of dogs”. I started to panic, and as I do when on the verge of having a massive PTSD meltdown I saw the path diverge – One path said “Deck the shitheel that’s taken your dog”, the other said “Become compliant and get your dog back”. Thankfully, since I have no choice in which road I go down, my proverbial BIOS sent me to the DOS of total basic obedience, rather than the obscure Linux distro of uncontrollable violence. I’m pretty sure that at this point I went to the bench, took my papers, marked them both appropriately, then got Dog back, since the next thing I remember particularly clearly is sitting outside the polling station with my face in Dog’s shoulder, shaking like the proverbial shitting greyhound.

I made a mental note to go back and correct the attendant (You don’t just *take* a man’s dog, you ask if you *may* take it. Not all service dogs wear the big yellow harnesses. Not everyone’s dog is comfortable being handled by strangers, so you could well get bitten. I can only assume that if a blind person came in avec-chien, then the dog-hating attendant would have to leave the bench. Assume that as the priority one solution next time) but didn’t have the strength to do it. Instead, I just went home and tried not to think about the election much. I failed – Slept from about 2am to 4am, woke up to a world of nightmare.

So, yesterday, the day after a Tory government of only borderline legitimacy took power (That’s a tiny minority, and that’s even with the constituency boundaries largely favouring them), I woke up feeling like shit.

At first, I took the pain in my abdomen to be just the continued saga of this fucking coil. By about 13.00, I was concerned enough that I told Dearest and Best Friend that I might be going to hospital. And then the gastric distress started, and I shelved that idea. Somewhat like a bloke with lymphatic filariasis localised to his cock, first I was pleased, then a bit concerned, then incredibly concerned, then I wished I would just die. For context – First I thought that I was just reasonably disimpacting after what had been a horrible week, then I thought that I had a spot of diarrhoea, probably from the severely dodgy out-of-date popcorn and absinthe I’d had for tea the day before, then I thought that I might be having an adverse reaction to the doxycyclin… By 3am, when I was literally passing nothing but bile, stomach acid and water, every ten minutes, uncontrollably, with so little warning that I couldn’t leave the bathroom, I didn’t care what it was, I just wished I was dead. It hurt (Hydrochloric acid failing to neutralise as it passes through the digestive tract will do that), I was getting cramps from the rapidly-changing pressure and bloodflow in my already-tortured abdomen, I was trying to vomit but nothing was coming up, I was utterly knackered and dehydrated.

Oh, and did I mention that this is on top of terrifying chest pain and heart palpitations after trying to ward off a weather-induced migraine with an ill-advised Sumatriptan at 17.00? I was so ill with that (unable to move, curled up in bed, sweating, shaking, struggling to breathe, vision going blue and grey from lack of air) that Dearest ended up cancelling his night out to look after me. I’ve had bad reactions to Suma/Imigran before, but never this bad. Suffice to say, since I genuinely thought I was going to die, I am not taking it again.

So, yes, by 3am I wasn’t sure if it was going to be the heart attack or the dehydration that would kill me first. Drowning myself in the bath was a close third.

I must have got to sleep with the aid of a lot of morphine (Good for both the pain and for stopping the bowel from moving) and diazepam (good for slowing the heart rate and relaxing the intercostals, letting me do a few breathing exercises) because according to Dearest I was singing the Russian national anthem very loudly at about 4am, but he thought it would be unethical to wake me up since it’d taken so much effort for me to get to sleep in the first place.

I woke up at about five, had a brief conversation with Dearest (Reassuring him that I was all right, and not actually about to drive a military parade of rockets on floats down Briggate), and have returned to my nest on the chaise longue.

Today has infinite chances of being better than yesterday. In a bit, I’m going to see if I can drink anything without feeling as if my heart is being stepped on, have another shower, ring NHS Direct to see if I should be worried (And to ask whether I can just stop taking the doxycyclin, since another week of this would literally kill me since I can’t eat or drink), and bizarrely hope for a migraine (The surefire sign that I’ve metabolised the Imigran out of my system and that the chest pains will stop).

So, yeah, my awesome Saturday plans are “Have a migraine” and “Try to drink some ginger beer.”

Then, Sunday is the cricket, Earnshaw willing.

Sun and stars to me.

Monday was my first swim in a month. Literally a month. 28 whole days.

I got in the water with a plan in my head;

Don’t count your distance, don’t set the lap clock running when you get in. Swim until you feel well-stretched and notably tired – But not so tired that you can’t get dressed. At the first sign of pain, lack of enthusiasm, or coldness, stop swimming.

This is something that I learnt from bodybuilding – As much as people talk about “Oh, you’ll want to train once you get there, you just have to push through the laziness” there is something distinct from laziness that sometimes just makes training impossible, and it’s a completely valid reason to not train. There’s the feeling, when you’re training sometimes, of just distinct unease, of complete loss of motivation. Of “I don’t want to do this, I can’t go another inch, I don’t even want to change into my fastskin, never mind swim in it” – It’s not always accompanied by pain, or even by tiredness, it’s just a sort of cold, grey slurry that creeps up and smothers your heart, empties your lungs, and makes so much as shifting your gaze from the lap timer to the lane end into a painful slog. It’s like the worst excess of depression, but instead of being directed at everything, it’s purely directed at physical exertion.

Listen to it. It’s not laziness, it’s not cowardice, it’s the Body telling you that it’s had enough for now, and that you need to take it home and mollycoddle it. Put it in bed, with clean sheets, a cup of cocoa, an audiobook, and probably a large glass of brandy. It’s done enough. If more people were honest about “I don’t want to” as opposed to “I can’t”, and if more people understood that this kind of “My whole body has stopped responding” was a definite “I can’t”, we’d probably have a healthier sporting culture. Less PE teachers barking at over-worked bairns that should probably have sat down and had a protein bar half an hour ago. Less amateur clubs where the line between “committed” and “casual” is viewed as being about moral goodness (Casually joining in on a game of cricket, or a short jog, is a good thing. You’re not a bad person for only going once a week, you’re just doing a thing you enjoy at the level you enjoy it at). Less mistrust between athletes and non-athletes (Self-flagellating body-shamers and feckless wastes of good myosin, respectively).

My be-gentler-with-myself-at-training plan worked. I swam for probably about half an hour, and felt better afterwards than when I got in. I did the same again today, at the midday session. Both in the medium lane, both times swimming steadily, making sure not to try keeping pace with anyone else.

Sadly, the day in the middle was a pain day – Dislocated hip on Monday evening which kept me up all night, then day-sleeping for much of Tuesday, on a cocktail of diazepam, morphine and gin and tonic. But I recovered, quickly enough.

I’ve said before that I’m basically a dugong in a malfunctioning human-suit, which a friend corrected to being more like a selkie (Still unconvincingly human on land, but in a more appealing way). The thing with selkies is that they always want to get back in the water, and honestly that had been my problem for a while – For most of last year, swimming was an addiction rather than a hobby; If I swam until I couldn’t walk, I didn’t feel good, I just felt normal. If I missed a day, I felt horrendous, and hastily rearranged my life to try to fit in another session. It felt a lot like when I was in serious training as a teenager – Where the only options were either “Overwirked to the point of near-death” or “Punishing myself for not working hard enough”.

Hopefully this year I’ll do better. Short swims. Not looking at the lap timer. Not counting my lengths. Just doing what I feel like.