Though this article goes a bit beyond my usual scope of technical and mental game running related topics it is a follow-up to previous posts. My brother Jim forwarded me a link with a lengthy article on the topic of Lyme disease and all its related complications. Of note, there is a section on physical rehabilitation. This is special because very little about regaining physical condition – especially for athletes – exists. Though this does appear to be targeted at athletes it does appear to be more aggressive than is often recommended (or at least from all that has been passed along through personal experiences).
Here is an excerpt from that article:
Please enroll this patient in a program of therapy to rehabilitate him/her from the effects of Lyme Disease. If necessary, begin with classic physical therapy, then progress when appropriate to a whole body conditioning program. Such therapy must be graded, carefully individualized, and be performed on a one-on-one basis, at least initially, to ensure the maximal amount of supervision and guidance.
THERAPEUTIC GOALS (to be achieved in order as the patient’s ability allows):
PHYSICAL THERAPY (if needed):
1. Relieve pain and muscle spasms utilizing multiple modalities as available and as indicated: massage, heat, ultrasound, TENS, “micro amp”, etc.
2. Increase mobility while protecting damaged and weakened joints, tendons, and ligaments, to increase range of motion and relieve stiffness.
3. Physical therapy alone is not enough. The role of physical therapy here is to prepare the patient for the required, preferably gym-based, exercise program outlined below.
EXERCISE Begin with a private trainer for careful direction and education.
PATIENT EDUCATION AND MANAGEMENT (to be done during the initial one-on-one sessions and reinforced at all visits thereafter):
1. Instruct patients on correct exercise technique, including proper warm-up, breathing, joint protection, proper body positioning during the exercise, and how to cool-down and stretch afterwards.
2. Please work one muscle group at a time and perform extensive and extended stretching to each muscle group immediately after each one is exercised, before moving on to the next muscle group.
3. A careful interview should be performed at the start of each session to make apparent the effects, both good and bad, from the prior visit’s therapy, and adjust therapy accordingly.
1. Aerobic exercises are NOT allowed, not even low impact variety, until stamina improves.
2. Conditioning: work to improve strength and reverse the poor conditioning that results from Lyme, through a whole-body exercise program, consisting of light calisthenics and weight lifting, using small weights and many repetitions. This can be accomplished in exercise classes called “stretch and tone,” or “body sculpture,” or can be achieved with exercise machines, or carefully with free weights.
3. Each session should last one hour. If the patient is unable to continue for the whole hour, then modify the program to decrease the intensity to allow him/her to do so.
4. Exercise no more often than every other day. The patient may need to start by exercise every 4th or 5th day initially, and as his/her abilities improve, work out more often, but NEVER two days in a row. The days in between exercise sessions should be spent resting.
5. This whole-body conditioning program is what is required to achieve wellness. Simply placing the patient on a treadmill or an exercise bike is not acceptable (except briefly, as part of a warm-up), nor is a simple walking program.
In comparing this prescription with the many comments from afflicted readers there may be some good guidance here. However, as my brother surmises (and I actually agree with him) to NOT do aerobic exercise seems counter-intuitive. In Jim’s case, he had diaphragmatic involvement. How else do you exercise the diaphragm? Sit-ups do not. My brother’s logic was to get himself to “breath harder” to exercise the diaphragm in a natural way. That of course means – aerobic activity. And how else does stamina improve other than through exercise? Be clear, we aren’t saying go run marathons while recovering; but getting out and walking and moving to the degree you can and progressing seems reasonable.
Anyway, we certainly do not have all the answers and would never “play doctor” in telling Lyme disease sufferers how to go about their rehabs. However, as an experiment of one – on a roller coaster recovery path; integrating aerobic exercise (to the degree possible) clearly has enhanced Jim’s recovery. [Last week he emailed me to say he ran 40 miles for the week. But he makes it clear he is NOT 100% and remains diligent with a holistic training program.]