"Life's a maze, you twist and you turn through it The driest of droughts, maneuvered and I earned through it" ― Clipse
I've changed the title but the series is the same: previous four parts were about 2018, this one will be about 2019.
I've read a few years ago that the effectivness of modern torture lies within breaks from pain. Precisely, it's the anticipation of pain that does the most of psychological damage. The theory went that the aim of the torture is "learned helpnessness". CIA employed that type of program post 9/11 attacks.
I like to think of it as an apt metaphore for a chronic health issue I had. The psychological toll comes from an anticipation of a sudden health decline. It does stop you in your life's tracks.
For me specifically, the constant worry about health and how it might ruin every plan I would make manifested the most in what I called "eating my brain". The first victim was my sense of humor. I never was particularly funny (big growth area here), but I lost any trace of it. I'll come back to this idea.
The new beginning
Early of May 2019 I boarded the plane from San Francisco to Europe. I got work's approval to spend three months in Munich and with the goal of solving my adductor tension that was ruining my life.
On my way to Munich, I stopped in Warsaw to visit my dentist - I had a long-running dental treatment from my old ski accident (a tough story). The dentist had bad news for me: my jaw lost its position and I was rubbing away my temporary crowns. During the accident I broke the temporomandibular joint (the one connecting jaw to your skull), and suddenly it lost its stability. Most likely, I had to go through an orthodontical correction program. One more diagnostic he would run would confirm that guess; the results were due to come in a few days.
I was just preparing for an intense, focused treatment of my muscle disfunction. And now this?
I told my dentist, I'd need to think about the next steps and I would call him in a few days. The next day, I finally boarded the plane to Munich and the same day I went for to the clinic to see Dr Wagner and Dirk, the osteopath. Predictably, they said my lower back didn't look good. The whole series of compensations kicked in and I was quickly slipping to the same state as when I came to the clinic for the first time.
This time around, we had the luxury of more time and frequent visits so we could perform my treatment more interactively. We moved quickly from the get-go. For the first few weeks we agreed that I would see dr Wagner twice a week, Dirk once. In addition, we would schedule both physical therapy and athletic training in alternating fashion; one day PT and another athletic training. Effectively, I had an appointment every day.
On that first day in the clinic I had my shots done. I forgot to write down the exact count in my notes, but I remember there a small cart rolled into doctor's office, and on it there was a metal tray covered in glass vials. It was a forrest of vials. This time around, I didn't ask what exactly I was getting but I just surrended myself to what needed to be done. I left the office with a dizzying head from the number of shots I got and a mixure of pain and fret. "What am I doing with my life?" was the question on my mind as I was getting ready for work.
The next day I had an hour the athletic training. The key word I'd use for my training would be a fantastic precision. In contrast to American way of training which is often very showy and focused on pushing through reps, my German trainers focused maticously on small muscles and steady adjustments. The interesting thing I noticed that the exercises were slow, and not very impressive but highly targetted. Paul (again, not his real name), my athletic trainer would examine my muscle compensations from the rotated pelvis, and devise a plan how to undo them one by one.
At the beginning I was pouring out sweat on seemingly trivial sets like walking lunages. The reason was that they were targetting the weak muscles that my body stopped using. I've done lots of walking lunges in my life, but here I would get constant feedback of sorts: "your foot is unstable and leaning 10 degrees inside when landing on the ground, your glutes release too rapidly on the way down". It was incredibly attentive. Paul was working with professional football players of Bayern Munich (one of the best football teams in Europe), and I could tell. The bar for what counted as a result was so much higher than your average gym.
I must admit that I underestimated the role of athletic training in my recovery. In retrospect, it was as critical component of the whole process. A subtle reprogramming of my muscle coordination that went heywire was the central task.
My first week was a warm up where we would learn the details of my current state. We didn't push me too hard just yet. At the end of that week, my dentist called me again and announced that my orthodental correction is indeed urgent. After a short discussion, we agreed I would have to show up every three weeks for an appointment in Eastern Poland. This is a bit aside, but you might wonder why I had such an odd and specific place for my dental work. A very talented dentist has been repairing the debris my ski crash brought ever since the accident; he was the only one that took on the challange.
In any case, the point I want to make is that stuggles have tendency to stack up. Not only I had the complex treatment of my slowly unearthed neuro-muscular issue combined with working remotely, but an intricate dental issue showed up that I couldn't ignore.
Remembering the well-put post Something New Is Fucked Up In My World Every Day by Bred Feld, I took a stoic approach and said to myself "eat me if you wish". Then, I decided I would book my flights to Warsaw every three weeks for the whole summer. Next, I opted for being strategically silent at work about this additional hiccup. I worried that I already appeared too much like a dumpster fire; one more health issue and life chaos surrounding it might be too much for people to digest, and I would have be shown an exit door - I thought. I also resolved to contain this particular fire in a tight space in my calendar and not let it affect my job duties.
The new schedule that combined work, treatment in Munich and trips to dentist was frantic. I often negotiated with my trainers to have my (strenous) exercises at 6am, so I right after I could hop on a train to the airport, and catch a plane at 9.30am to Warsaw. In the late afternoon I'd see the denitst. The next day, I would take another flight at 7am and be back at the clinic by noon. It was an exhausting way to live. In one-on-one with an engineer I deeply respected at work, I confided once "I don't recommend anybody the life I have".
Now, I want to get technical. As I said at the very beginning, my writing's aspiration is to be useful for someone navigating a similar medical maze. The high level lessons are important, but at the end of the day recovery is a million small steps, specific exercises done over time. You need to be in the weeds. I want to talk about the daily grind.
By the second week my Munich crew had a solid view of my body's ailments. We increased the intensity of my training and physio. The unraveling of my muscle disfunction began in earnest.
The goal was seemingly simple: fix my static pelvis position (undo the rotation), and ease the tension in the lower back. The complication was the closed-loopness of my condition. Each muscle was performing its proper function locally, but globally I was walking, running and even standing in an off position.
How do you reprogram the body? With the mechanical muscle strengthening, and with an increased muscle control. In training we worked on two foundations of my improved movement: stability and mobility. Stability exercises were about muscle control both locally and globally. In practice this meant lots of slow lunges, side-walks, and later on single leg hinges on unstable surfaces. The mobility exercises were all about range of motion and an active (when muscles are engaged) stretch. A few notable exercises in this category where active plunks (for opening my chast and stomach area), and various stretches (TODO: describe them).
When seen from the outside, most exercises looked pretty standard athletic practices. What differienated Munich people was dynamic sequencing and unparalleled precision. My trainers knew the outcome they wanted to achieve, and sequenced my sets according to my body's daily responses. We tweaked and corrected something in the program every day to counter a particular muscle weakness we would spot. However, the precision was what stood the most. I would receive constant feedback on my foot, ankle, pelvis, chest, lower back, upper back, head position up to tiny slips in my movement. There was no detail too small to correct. At the beginning I found it overwhelming. Over time I understood a simple truth: I was training not for reps but for results. All these corrections were there to shield me from fake effort.
The interesting thing happened somewhere between second and third week of training. I was occasionally feeling better in my adductor but I started feeling worse in other parts. Suddenly, my lower back started hurting and and I had strong muscle pull on the right side of my belly. It turned out that my illiopsoas muscle became tense. It's a long muscle located deep into our core (closer to the back), and it was the first time I heard about it. I learned from dr Wagner that it's actually a critical muscle in maintaining our body posture, and hip position in particular. It's also the muscle responsible for lifting a leg, e.g. while standing. As aside: most people with sitting jobs (all computer people, I'm looking at you), have that muscle too tight, and that's one the reasons for back problems.
Why did I start getting tension in yet another muscle? My body reprogrammed itself to take the rotated pelvis position as neutral. Now, as the training, physio and injections (more about them soon) started easing the tension in the adductor and rotating pelvis back into balanced position, I had a defensive reaction. Since adductor wasn't pulling as strong, illiopsoas kicked in to compensate.
There was a triple of exercises that we used to address it: an inchworm, a mountain climber, and a bear crawl. If there were only a few excercises I would be allowed to remember for the rest of my life, these three would make it to the list. I highly recommend them. So what happened when I tried them vigiorusly with my tense illiopsoas? The muscle kicked back with vengence; I was literally having painful spasms as I was doing the inchworm. Getting through the whole set meant I was drenching in sweat. It was hard and painful.
Getting the illiopsoas under control took over a month, and powering through real brick walls. On the other side, I was greeted with slighthly dislocated ankle (but not twisted!) and tension in the calf. Why? Again, compensation. You will hear this often that our muscles form an intricate system of highly connected, and tuned components. If one part goes out, other get affected and frequently take over the function.
My first few weeks were a game of whack-a-mole. If we got one body piece under control, another became rogue. The net progress appeared to be zero, in the race against my three months deadline, this was demoralizing.
In part three, I mentioned how I kept "tension scores" a year earlier, when I was in Basel. I returned to this technique. Here's how an example table looked for me
!(/uploads/tension scores munich 2019-1.jpeg)
Back in Basel, I used logging as a way to surface "if-then-that" links. This time around, I used it more prorgress tracking technique and for managing my psychology. One of the key things to understand, and you'll hear it from everyone who went through a difficult recovery, that it's not a straight line up and to the right. The blowbacks are part of the process.
The journaling enabled me to understand that, counterintuitively, new tensions meant the process was working. When I arrived in Munich, I was on a stable downward spiral. My muscle disfunction was set. Once we started poking at my body, the tower of compensations started to wobble. If I kept everything in my head, all I'd see would be more pain and disorder; writing it down cleared doomsday tendencies.
The illiopsoas tension brought another unexpected symptom: the front part of my quad was becoming numb. I had experienced this before in Basel, a year earlier. It was spooky and we never figured out the source of it. My regular appointment with Dirk coinicided, and I asked him about this new numbness offender. He smiled and immediatelly said:
- Yeah, I know what's going on. Your illiopsoas is tense and compresses the nerve responsible for sensory signals.
And then he pulled out an atlas of human body anatomy to show me the muscle and how a large nerve that originates in the spine crosses over the muscle.
He explained that his worry was more that illiopsoas was again pulling my lower back and my hip towards the wrong position, again, closing the Grand Loop of Tension. We would spend almost 8 weeks trying to break through that particular knot.
Which way do you run?
Roughly two weeks into my stay Dr Wagner asked me to resume my running. I was deeply surprised. I didn't feel like I was ready at all. He compared recovery to a series of humps one needs to get over; it won't happen without pushing oneself. Moreover, he said, the stress from running would act as a magnifying glass: we would surface all the issues more vividly.
The problem was that each time in the past I tried running I would regress to tension in full force. My sitting position would be ruined, and my sleep would be ruined. I loved running and one of the key reasons why I wanted to recover in the first place, was to experience runner's high again. Yet I was conditioned to equalize running with disappointment. On the other hand, I knew I couldn't blow the opportunity I had in Munich, and every day counted. Emotions couldn't get in my way.
Throughout my whole journey I discovered a simple truth: progress in recovery was tied my ability to sprint towards fear. Whatever was the risk at hand, or big decision to be made, I was always better off hitting it head on as quickly as possible.
The next day I went for a short run, where I covered maybe 500m total, mixed with walking. It turned out ok. Two days later, I went for a slightly longer run. I was a little tense, but nothing too bad. Dr Wagner asked for a longer, 3km run. And I did. Again, two days later I went for a 3km run and it didn't start or end well. My tension shoot up. I consulted the doctor and he told me to keep going so we can see if any other issues pop up.
I went for yet another 3km run along the Isar river that splits Munich into two halves. This time around, I started with the tension in my adductor. My gait was awkward as a result. Couple of minutes into the sprint, the tension in my illiopsoas shoot up. I had a strong pull in my abdomen, my gait became even more awkward. The leg was stiff. I decided to keep going despite being as far from running's pleasure as I could imagine. As I passed a small bridge, the pain ramped up and tears started running down my cheek.
That moment an old German lady sitting on a bench next to the jogging path spotted me. She saw my anguished face and waved at me with a gesture suggesting I should stop. I felt deeply embarrased, like a little kid. And not sure why, but I did take the break. She surprised me with her perfect English, and she asked me what's was happening and whether I needed help. I opted for transparency and I said I had an injury I'm recovering from, this a test run and it's particularly painful today but I'm ok. She wondered whether I should be running at all. I had no good answer except "hump crossing".
If you're wondering why I'm sharing such minutae detail, I want to highlight one thing: my recovery was an emotional roller coaster. Almost every week. Dealing with a chronic condition that eats you from the inside will seem unfair, and embarrasing. And when I was reading the accounts of other people struggling (Amelia Boone comes to mind) to see if I can learn something, I could only relate to writing that went deep into the fight.
I finished that run weeping because my confidence whether any of this made any sense cracked wide open. I reached a new nadir.
Next day, I had an appointment with my doctor. I was all tensed up and I confessed I was losing hope. He said two things:
- No more running for now
- I should talk to a psychologist
I immediatelly pushed back against the idea of getting a psychologist involved. My injury was neuro-musclar, not psychological. And until that point I operated under the "if the life gives me lemons, I make a lemonade" maxim.
Doctor Wagner suggested that a high base level of stress was making my muscles tense and hindering our work. If he was right, he said, this an unnecessary roadblock we would have to deal with. That summer 2019 the only thing I cared about was the speed of the recovery. If someone asked me to walk on hot coals provided they would help with the recovery, I would do it. With that in mind, I realized talking to a psychologist might not be that far fetched. I booked my first appointment with Henning Peters later that day.
Over the course of upcoming weeks I learned from Henning that I resemble him pro athletes he was used to work with. He said I scored high on motivation and grit. In his opinion, these traits helped with overcoming the physical pain and disability I went through, but equally put a tight seal on psychological scars from that period. He suspected I was holding dear some deep traumas that were causing hypertension. I won't go too deep into that subject because I think relating psychology is out of my wheelhouse, and it's also a notch too personal to share even for this highly personal story. What I will say is that we've made progress on surfacing the walls I put up but we ran out of time to access the traumas. Whether it helped me with my actual mission or was a nice-to-have is hard for me to pinpoint. As I mentioned earlier, a recovery is a lonely process and if anything, my sessions provided venue to just talk. For that reason alone, if you the reader, are deep in the hole, I recommend talking to a psychologist.
While my psychology sessions were humming along, my regular triple of meeting with dr Wagner, physical therapy and training continued. The new goal after my unsuccessful running attempt was to get my tension under control. It meant light stretching and a lot of functional training I mentioned earlier. And shots.
The third major tenant of my recovery were needles. Specifically, I had a mysterious cocktail of liquids injected into my lower back (most commonly) and sometimes into my Sacroiliac joint (a tiny joint connecting your spine to to your pelvis). In four, I mentioned how dr Wagner mysteriously dodged my questions about the shots I asked a few months earlier, when I came to the clinic for the first time.
When I asked about what's in the shots, I get as brief and as generic answer as possible. I couldn't help the feeling that something is not right, and the air is thick. I went ahead with the shots anyway. I reasoned that the famous athletes whose career was on the line couldn't be wrong all at once. I felt that pressing harder to learn about what these injections are about would lead me nowhere, the appointment would run its course and I wouldn't make any progress. Whatever the reason for the secrecy, I wasn't the chosen one to learn about it that day.
A few months later I learned the real culprit. It turned out that the main doctor from the clinic came under an assult by the head of the medical school in Munich who claimed the clinic was essentially a pseudo-medicine shop. Specific claim was about the use of Actovegin (also known as Solcoseryl), a young calf's blood extract; it was called a pure quackery. The head of the medical school lunched a media charge, and applied for a research grant to prove once and for all Actovegin didn't work. The heat was at its peak when I was pressing to learn more about the shots. Nobody wanted to discuss them not out of secrecy but out of an embarrasement of the high profile quarrel. Once I again I got reminded most of them time, whatever it is, it's not about you.
How did the campaign go? The scientist received the grant and got to work. The results were published here: https://link.springer.com/content/pdf/10.1007/s00421-020-04398-2.pdf The gist is that Actovegin works in reduction of inflammation but the details of the mechanism are unknown. In other words, it does something and the current understaning of biology doesn't readily explain it. So much for the snake oil. I learned about this results months into my treatment when I was convinced the Munich method was indeed helping me. What impressed me the most when I learned about that paper is that the author clearly had a different agenda going in, and turned around when the results came in. It's how science is supposed to work.
I mentioned that I was receiving a full cocktail of shots. The contents of my injections were: Ostenil (alendronic acid), hyaluornic acid, Traumeel (homeopathic drug), Discus Compositum (another homeopathic drug), Actovegin (known also as Solcoseryl, an extract from young calf's blood), vitamin B12 and a few other spells. The list was unconventional and it raised my eye brows. Homeopathic drugs? A young calf blood? Did I lose my mind to quackery? - I was asking myself at the time. How did I decide to go ahead and let this cokctail sink into my back? I assessed the possible downside. I probed about possible negative side-effects, and got a reassurance that, over the years, they didn't observe any serious downside to these shots. In the worst case scenario I this would turn to be just a waste of time, I concluded and gave the green the light.
Now, knowing that at least Actovegin has both clinical results and has been studied scientifically, I'm less skeptical of this list. Of course, it's very likely some of these ingredients are doing nothing, but have little downside to them too.
I received some combination of that cocktail many times over the course of 2019. My personal experience has been that they are fairly painful, but stabbing your back even with empty needles would get you dizzy. Other than that, I did feel like ran over by a rhino when I received higher doses (many shots) for a few hours after injections, and that was about it.
The general theory
Around the middle of my stay in Munich, the general theory of my condition finally emerged. The first bits were revealed to me during the initial diagnosis but the whole picture was a lot more complicated, and we would uncover it in outburts of my body's breakdown. What was the initial diagnosis? I had twisted pelvis that made the tiny muscles in my lower back to tense up. These