Fitness Trauma: when your patient can’t tell you where it hurts.
By: Anna Ka
Tags: Trauma, Physical Therapy, Body, Trauma Informed, Pyschology

What follows is a letter I wrote to my physical therapist:

I cried through my last week’s session, performing exercises while swallowing mucous and choking back tears. I had to pause at one point to go the bathroom and cry freely, embarrassed, angry, frustrated. I left today’s session in tears too. I tried to tell you, I did, but you had two other patients you had to see and I couldn’t get the words out and the tears were already coming.

I’m coming to you for a pretty simple problem. Pain. My knee and shoulder hurts. I’ve got weak muscles, you’ve got exercises. You prescribe them, I do them, and my pain goes away. Healing is not linear, there will be ups and downs, but what is shaking me to the point of crying, breaking down, getting nervous to even go to my sessions?

Can we talk about fitness trauma? I googled it and there’s no one talking about this, so I made up the term. I’m talking about elementary school gym class when I cried “running” the mile, crippled by cramps in my abdomen from not breathing properly, not knowing how to run. I ended up walking, it took me 13 minutes, by far the slowest in the class. I never knew what to do in gym class, I never understood it. Later, as an adult, I felt overwhelmed going to a gym or fitness center. I don’t understand the machines, but more importantly I don’t understand my body.

I’m not connected to my body. For the longest time, I didn’t have a relationship with exercise. The effort felt torturous. I tried my hand at CrossFit, even joined a weight lifting gym. I still felt disconnected from my body, flopping around, performing moves without any understanding of how or why, desperately needing to be closely coached and monitored. I never gained that ownership, and ended up quitting all of it.

Finally, two years ago, I fell in love with hiking, and learned how to run. Last year I added an intense yoga practice to the mix. For the first time in my life I understood the relationship between effort and reward. I developed a neurochemical connection to movement. I unlocked my hiker and runner’s high, exertion of a level that made my brain and body sing. I ran three times a week, longer and longer runs. I topped out at 12 miles. I backpacked a 125 mile section of the Appalachian Trail, and 26 Adirondack high peaks. I found my bliss in this life.

Then, a knee injury, followed shortly after by a shoulder injury. My knee hurt so bad I couldn’t run, couldn’t stand, could barely be in any position comfortably. Soon enough, I found that both my knees hurt, my shoulder, my elbow, both my wrists, and my foot. I felt broken and at a complete loss. Without proper insurance coverage, unable to afford physical therapy, I went to my chiropractor for help. He did some functional tests and gave me exercises to strengthen my glutes, quads, and core, to which I applied myself like my life depended on it, which it did. I worked at my exercises relentlessly, daily, picking up short weekly runs again after two months off. This summer, I hiked the high peaks again and my knees felt stronger than ever. I finally felt I had turned the corner on this awful chapter in my life.

I attempted another Adirondack hike a few weeks later. It was night and day. My knees felt worse than they ever had. Pain with each step, and 13 miles left to get me out of the backcountry. No cell service, no choice. I hiked out. After that I doubled down on my exercises, hoping to fix the problem twice as hard and twice as fast.

What might seem intuitive to others, which muscles feel the effort in an exercise, is not to me. I often cannot tell what part of my body is feeling something. I have a history of abuse and trauma, and my family has a strong predisposition to psychosomatic complaints. We all know our bodies can manifest our emotions. Some get headaches, some stomach aches, some tension in the neck and shoulders. When I get stressed out, my throat hurts, and I feel as though I have a cold. If I get really stressed, sometimes I dissociate, and my body no longer feels like it is mine at all. I’ve worked through some of my trauma in EMDR therapy, and my psychosomatic responses are getting milder and milder the more of my abuse I unpack. But if I cry, I’m still sick for 4–5 days following. Maybe you are starting to see the complex set of factors some of your patients may be dealing with?

When you give me an exercise, if I can’t feel it, can’t trust my body, I turn to my mind. I overthink it. I finally understand that rows are a back/scapula exercise, but does that mean it’s two moves, with the arms doing the first part of the work, then the shoulder blades/back performing the second part? Where should my feet be? What angle should all the parts of my body be at, which muscles should I keep tight, which loose? How do I talk to those muscles to get them to do that? Tell me exactly what to do, and watch me, because I can’t feel if I’m doing it right. You’ll see me with my hands on my body often, checking to make sure my hips are level, my core is tight, my glutes are squeezing.

I am slowly moving into my body, learning to inhabit it, learning to be comfortable here. Maybe this disconnection contributed to my injuries. Pushing past subtle signals of discomfort and pain that I didn’t even notice, or didn’t think were important. It has taken me weeks or even months to feel certain muscles working in my body. I had no sense of my glutes, scapular muscles, or core muscles for the first six months of working with them. I’m trying to honor my body now, not push it past pain, take care of it, make it feel safe with me at the helm. But I also feel completely over-attuned to my knee sensations, overanalyzing every twinge. I am in a paradox — both disconnected and overinvolved.

So when I’m given too many cues on a complex movement like a deadlift, I get overwhelmed. Not enough cues, though, and I worry about getting injured. Am I going to hurt my back doing deadlifts wrong? The coach at the weightlifting gym I was at would sit at his desk and describe the moves, never getting up to show me. When I balked, scared to do it wrong, scared to hurt myself, he laughed at me. “It’s easy”, his laugh said, “why are you making this such a big deal?”. He made me feel stupid and ashamed. Fitness trauma. I’ve even considered going to physical therapy school myself, just to finally be able to understand my own body. Do I need to study it? Learn all the names of all the muscles? Or do I need to listen to it? Feel it? Start to trust myself and my body for the first time in my life at the age of 32?

I need you, in ways I don’t want to, but I do. I need to fix these injuries, to reclaim my life. I am so self-conscious of being the troublesome, difficult, unpleasant patient. I want you to want to work with me, to want to help me. I want to be easy and cheerful and compliant. This is what I’m struggling with, though, and I am hoping that if I tell you, honestly, perhaps you can have some empathy and compassion for me as I fumble to tell you that “this week, uh, my knee felt weird, kinda on the outside, it doesn’t feel twisted anymore you see but, um, it kinda hurts, well, maybe pain isn’t the right word, it’s just, I don’t know, it doesn’t matter, let’s just get on the elliptical.”

I’ll see you next session, I’m doing my best.

Anna