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Transformation and Hope—The Means to
Recovery
By Kathleen Campbell, M. Div
APPENDIX 2: Physical Therapy Exercises
Circles, Drawing, Pumping, and Flexing
While sitting at my desk throughout the day, at least once
an hour for the first 3 months of therapy, I circled my foot
to the right and to the left and pumped the ankle up and down.
I drew the alphabet in the air with my toes, and spelled out
my name in block letters and cursive. With my shoe off, I'd
then flex the toes up and down through the day. Basically,
I was told to develop a "nervous" foot - keep it
in constant motion.
The Beach Ball
I pushed my toes and metatarsals onto a beach ball for five
minutes every waking hour for the first three months also.
I would sometimes miss an hour but never went longer than
two hours without doing this. Hence, I brought the ball to
work, church, my kids' piano lessons, and family activities.
After a few weeks, I realized that if I pushed on the ball
with the sides of my foot, over time it helped me tolerate
the pressure of the bed mattress so that I could lay my foot
on both the right and left sides, enabling better sleep.
Therabands
I placed my foot in yellow, red, and blue Therabands and circled
my foot to the left and to the right, and pumped my ankle
with the bands. I did 3 sets of twenty times each when I got
up each morning and before bed each evening for the first
five months. The darker colored bands are thicker and require
more force, and so were used later. When I got to the blue
one, I decided to tie it underneath a pullout computer keyboard
shelf at my desk at work. I wasn't using the shelf for my
keyboard, and having the Theraband looped under my desk at
work meant I could keep my foot moving throughout the day.
I was constantly looking for ways to integrate therapy at
the office to free up time for taking care of my kids when
I got home at night.
Rocking Side-to-Side, and Front to Back
While making photocopies at work or washing dishes and brushing
teeth at home, I would stand and shift weight from the left
foot to the right foot. Over time, this helped distribute
my weight evenly on both legs. In May I added rocking backwards
and forwards, shifting weight from the heels to the toes.
This helped me put weight more evenly on the front of my foot
as my heel was carrying about 80% of the weight on my right
foot when I began this.
The Treadmill
This was crucial to produce a normal gait. I walked the treadmill
every day at the fitness center for 13 months. Often, it meant
getting up at 5:00 to drive to the gym, walk, and drive back
home and shower in time to get my kids up at 6:30 for school.
The early mornings meant I had to cut out most every church
and school volunteer activity I'd done before getting CRPS.
It was essential I get to bed as soon as the kids were down
so I had energy the next day for work, parenting and therapy
exercises.
I began the treadmill using just my CRPS foot. I put my left
foot on the metal track next to the revolving belt and let
my right foot and leg practice a normal motion, setting the
speed at 1.0 mph for 5 minutes a day. After a week of this,
I was able to walk with both feet on the treadmill, still
at 1.0 mph and 5 minutes a day. I added a tenth of a mile
per hour every few days and added another minute or two every
few days also. After two months I reached 2.3 mph for 16 minutes
a day. When I then began working with Roger Allen in therapy
he had me reduce my speed to 1.8 mph and shorten the time
in order to increase the grade. A 7% incline would force me
to roll through the toes when walking. I began with a 3% incline
and added a higher grade each week until reaching the required
7%.
After one year of walking the treadmill, I reached 3.0 mph
(average walking speed) and was walking 24 minutes. By then,
I also was walking a couple of minutes each day backwards
on the treadmill. Backwards meant landing first on the toes
that hurt, and helped with my desire to move in different
directions for liturgical dance at church. It also meant I could recover if I stumbled or tripped, being
able to move well in both directions.
Leg Presses
These were done on a Total Gym at the therapist's office or
the Leg Press at the fitness center each day primarily to
strengthen my leg and knee. Normally this was 5 minutes a
day and with 5-15 pounds of weight. For 30 seconds to 1 minute
I would push up on my toes as well. Except for pushing off
the toes, this was gentle and easy to do. It didn't seem to
add much in the way of muscle strength but helped reactivate
"muscle memory" of how to bend up and down with
my legs.
Recumbent Bike
I added the bike at the second month, beginning with 5 minutes
and increasing a minute or two each week until I was up to
20 minutes. The bike helped with overall aerobic conditioning,
and helped achieve my goal to ride my bike around town again.
I "rode" the bike most every day for the next two
months, though if pressed for time I would skip it to be sure
I had time for the daily treadmill workout. After two months,
I was able to ride my regular bike from home to the store,
a 5 mile round trip.
Shoving Paper on the Kitchen Floor
It was pure agony bearing weight on the front of my right
foot. Roger asked me to put a piece of paper on the kitchen's
linoleum floor and then shove it backwards using the front
of my foot. This exercise was one of the first that stretched
my tolerance for therapy. Doing it each morning and evening
was always an act of courage. I hated the pain and was not
good at it early on, but did it anyway. Courage meant determination
more than strength and ability. Courage meant trusting it
would help me accomplish something on my wish list. The paper
barely moved on my first attempts each day. I couldn't press
hard enough. Eventually I got the hang of it, and several
pieces sailed under the stove and refrigerator during these
weeks of pushing paper.
Grabbing the Washcloth
I took a warm wet washcloth and laid it on the floor with
my heel in one corner and toes diagonally across to the other
corner. The task was to try to "gather up" the washcloth
by pulling it with my toes toward the heel. I did this ten
times each morning and evening for 3 weeks in the spring and
then again in the fall after I fractured a bone in the CRPS
foot.
Twisting Toes
One of my first assignments with Roger was to grasp the bottom
and top joint of all five toes between my thumb and center
finger. I would then twist both bottom and top joint of each
toe twenty times. I did this every morning and evening. Still
holding each toe between my thumb and third finger, I moved
both joints up and down, also for twenty repetitions each
morning and evening. The purpose for this was….?
Standing on the Bathroom Scale
Roger's research with CRPS and approach to therapy involved
lots of measurements to see how I was progressing. Early on
he wanted to see if I had symmetry when standing. That is,
did I bear weight equally on my left leg and my right (CRPS)
leg? To assess this, we laid two bathroom scales side by side.
I stood with one foot on the left scale and the other foot
on the right scale. This was easy, as I had spent the last
two months rocking side-to-side at the copy machine and while
brushing teeth.
I suspected, however, that I was not bearing weight equally
from the back to the front of the foot. To assess this we
put the two scales at the right and then placed a book the
same thickness as the scales next to the scales on the left.
This created a "triangle" with the book at the left
and the two scales on the right. I stood with my left and
unaffected foot on the book and then placed the back half
of my right CRPS foot on the bottom scale and the front half
of my CRPS foot on the top scale. My weight varies between
125-130 pounds. The right leg should normally bear half my
weight, or 62-65 pounds. This amount should be shared equally
between the front and the back of the foot for standing and
other weight-bearing activities. Our first assessment showed
I was only putting about 12 pounds or 20% of my weight on
the front of the foot.
Newly aware of the imbalance, I began standing on my bathroom
scale at home each morning and evening and gradually increased
the weight on the front of my CRPS foot until I was able to
reach 30-35 pounds or 50% of the weight carried by my right
leg. That's all Roger said was necessary, but for a long while
I tried to get to the place where I could take my full weight
on the front part of the CRPS foot, and so while holding on
to a towel bar in the bathroom, I kept trying to add more
pounds each week and got to about 80 pounds before giving
up. It was just too hard. I wanted to reach 130 pounds to
give me more moves for dancing. I also wanted to be able to
reach for something on a high shelf at the office or home
by pushing up on my right toes in the same way I could do
with my left foot. It was not a necessary function since I
could grab the just-out-of-reach object by pushing up on the
toes of my left foot, but it would mean a lot knowing I could
do the same activity with the right foot.
The same week I was discharged from 16 months of therapy,
I discovered I could do it. I pushed a container of frosting
to the back of the top shelf in the kitchen so I couldn't
reach it standing on flat feet. With my unaffected left foot,
I stood on the toes and grabbed the frosting. I pushed it
back to the same spot and tried the same with my CRPS foot.
Taking a deep breath, I pushed up on my right toes, and got
the grail!
Swimming
As a child I grew up in a small town and two blocks from the
public pool. I took lessons in the morning, swam in the afternoon
with friends, and returned often in the evening with my family.
My favorite family vacations were to the beaches at Ocean
Park. During college I chose swimming over coffee to help
stay awake through long nights of reading and writing. I swam
through the ninth month of my pregnancy with both children.
After five weeks of therapy, I figured out on my own that
I could swim in spite of the foot pain. The pool was not just
a place for physical therapy. It was the chance to be immersed
in familiar memories of home. The pool was the only place
I could move during the day without pain. It was the only
activity that wore me out, and thus helped reduce stress and
made it easier to sleep at night. Occasionally I'd practice
walking in the pool because the buoyancy of the water took
weight off my foot as I practiced walking. Mostly, though,
I just swam to add joy to my day. Once started, I swam between
3 to 6 days a week. For about a month in the winter I began
having neck pain, which seemed to worsen at the pool. Adding
new neck and shoulder exercises has allowed me to return to
the pool three days a week.
Throwing a Golf Ball
Why Roger suggested I learn to throw a golf ball I'll never
know. This exercise was a particular challenge as I couldn't
pick up a golf ball with my good foot, much less throw one
with my CRPS foot. After two months of futile attempts, I
finally managed to spread the toes wide enough to get around
the ball and tolerate the hard surface well enough to toss
it across the living room. While it had no functional utility,
it was nevertheless delightful when I finally had something
I could do with my foot that my kids couldn't do!
Biking
The first real bike ride felt like flight! The recumbent bike
at the fitness center helped me regain strength and motion,
but the gym is boring, noisy and smells like sweat. The freedom
to ride gave me a huge boost of confidence. I was surprised
that it seemed fairly easy once I started. In fact, it was
much easier to ride the bicycle than walk because walking
required rolling through the toes and metatarsal heads that
hurt so much. I was able to bike around town a full year before
I was able to exchange the treadmill work at the gym for walks
on real ground. It baffles me why it is also less painful
to ride the bike than drive a car. It may be because riding
requires more dynamic motion than operating the car, and this
may help ease whatever causes the pain of CRPS.
Rolling on balls - Pressure desensitization
This began late in therapy after a consultation with Dr. Jim
Robinson at the University of Washington Pain Center. He noted
in his report that while I was able to tolerate his gentle
stroking of the foot after 10 months of therapy, I was still
wincing and experiencing significant discomfort when applying
pressure over the bottom part of the foot under the metatarsal
heads. It meant it still hurt to drive the car. It also meant
that even though I wasn't limping, my goal to walk pain-free
seemed impossible. To desensitize this part of the foot to
pressure, I began a schedule of rolling different balls under
the toes and metatarsals. The first week it was 3 minutes
rolling a fuzzy and soft tennis ball, 2 minutes of rest, then
another 3 minutes with the same ball. The next week I rolled
an "Incrediball" for three minutes, followed by
2 minutes of rest, and then 3 minutes of the prior week's
tennis ball. The third week was 3 minutes of Incrediball,
2 minutes rest, and 3 minutes of Incrediball. The fourth week
exchanged a softball in the first 3 minutes and kept the Incrediball
the last 3 minutes. I continued this pattern of adding a new
and more irritating ball every other week for three months.
The pain and pressure increased weekly as I moved to harder,
smoother and smaller balls. I progressed through following
balls: tennis ball, Incrediball, softball, baseball, wooden
croquet ball, golf ball, and a metal ball sold at Asian markets
and normally used to roll in the hand while meditating. (It
was the same size of the golf ball, but smoother and colder.)
During the weeks of rolling balls under my foot I'd come
to therapy and press on a dynamometer with my foot. The dynamometer
has a dial to measure pounds of pressure. The needle on the
dial moves like a clock hand when pushing the "pedal"
attached to the meter. Roger strapped the dynamometer to a
block of wood with several layers of duck tape. We put this
contraption on the floor to imitate the gas and brake pedal
of a car. I would come each week and see how much pressure
I could apply to the dynamometer pedal. The pressure desensitization
was a huge success as eventually I was able to push the needle
off the scale. More significantly, I was able to drive farther
with less pain. And even better, was that I found my goal
to walk pain-free was possible. The process of increasing
pressure on the balls meant that I could take more pressure
on the sole of my foot. This was the most joyous breakthrough
of my entire 16 months of treatment when I realized the same
was true in walking each morning. The distance I could walk
pain-free expanded each week.
Pliometrics
In the last couple of months I was finally able to work on
pliometrics — exercises which required more force on
the foot such as stepping off a box, hopping and bouncing
back and forth between each leg. Pliometrics would allow me
to run again for soccer in the backyard with my daughter.
I started with about 1 minute each night, making small leaps
from one foot to the other, adding 15 seconds more each night.
These leaps became more varied each week, as I began hopping
side to side, then in diagonal patterns and around in circles.
Dribbling a Soccer Ball
I started with a soft Koosh ball as the impact of a real soccer
ball brought on too much pain. I kicked the Koosh ball 20
times each night against the wall of the garage for a couple
of weeks. Once comfortable with that, I switched to a rubber
ball for another couple of weeks. Finally, I was able to tolerate
the impact of a real soccer ball. I also worked on my aim
with my daughter volunteering to be a goal post as I tried
to shoot the ball through her legs. Having done the pliometric
hops for several weeks, I then began dribbling the soccer
ball for a couple of minutes each night in the yard in my
final weeks of therapy. I still keep it to just a few minutes
a day. That's enough to allow me some time to play with my
daughter again as soccer team practices begin this summer.
Walking the Neighborhood
After a year of work on the treadmill, I wanted to see if
I could walk without a limp by practicing on real ground.
I began with just 20 minutes, a few minutes less than I was
doing on the treadmill. The real ground would be more tiring
given the varying surfaces and steps up and down at curbs.
I walked daily and each week I added another block to my route.
I would also step off the sidewalk and walk instead along
the grass to help the nerves and muscles respond to uneven
surfaces. I now walk 2.8 miles each morning in 45 minutes
- which is 3.7 mph and faster than average pace. I sometimes
think this distance is not necessary to keep CRPS symptoms
away, but with early signs of osteoporosis that runs in my
family, it feels important that I continue to walk these longer
distances.
Walking Barefoot on the Wood Aerobic Floor at the Gym
Dancing to the End of Therapy
This was an exercise I developed myself. I wanted to do liturgical
dance for an Ash Wednesday service at church, and it meant
moving across a wood floor barefoot. The choreography seemed
easy compared to tolerating the pain on the floor. Having
learned that getting over the pain means moving through it,
I spent time each morning at the gym walking on the wood aerobics
floor. For five minutes each morning I walked forward, backward
and sideways, trying to desensitize my foot to the hard surface
that was similar to the sanctuary floor at church. After six
weeks at the gym, I spent the last week at the sanctuary reviewing
the dance movements in my bare feet every day for 15 to 30
minutes.
It was really too much, as I pushed the time on the wood
floor faster than a quota-based therapy method would suggest,
and the foot ached more that week. But the night of the service
made the effort worth it. Those longer walks on the wood floor
meant that I'd managed to move my feet in a way that brought
hope and inspiration to others as I danced to Be Not Afraid.
This service also included an anointing and healing service.
There were others that night that were more overwhelmed by
life than I: a friend going through chemotherapy, a woman
mourning the death of her husband and daughter, and a woman
with CRPS in both feet and legs. We all understood the victory
of faith and healing as I danced,
Though you pass through raging waters in the sea,
You shall not drown.
Though you stand amidst the burning flames,
You shall not be harmed.
Though you stand before the power of hell and death is at
your side,
Know that I am with you through it all.
Be not afraid, I go before you always.
Come, follow me. And I will give you rest.
I danced again four months later on Pentecost, this time
inviting 20 others to join me. The syncopated rhythm moved
quickly and the lyrics were about the transforming Spirit
of God, which gives vision and strength to preach good news
to the poor, to bring release to the captives, recovery of
sight to the blind, and liberty to the oppressed. It was a
fitting song to celebrate my own release from therapy and
the accomplishment of all goals on the list I made 16 months
earlier.
Introduction
» Onset and
Diagnosis
»
Transformation and Hope
»
Things That Didn't Help My Recovery
» Challenges
and Setbacks
» Appendix
1: My Goals for Therapy and Recovery from CRPS |
