Pain Responds to Exercise and Not Rest!
Is it possible to get rid of pain without a pain-killer pill and no rest? 
 
Take this as a case report, if you are one of those conventional scientists, or as my personal saga, if you are an ordinary man like me. The conventional wisdom in medicine is that when you are injured, even if you are able to move about, you are asked to take rest lest the healing should take a longer time than needed. This was believed to hold for other illnesses also, say, a heart attack. The latter ended when General Eisenhower had a heart attack at the end of the third year of his presidency. For his doctors, Sam Levine and Paul Dudley White, it was a big dilemma. The General was a very popular president and had a sure chance of re-election for a second term. A year or so earlier, Nobel Laureate Bernard Lown had published the chair treatment idea after a heart attack  which involved putting heart patients on a chair, against the prevailing orthodoxy of complete bed rest.
 
The president’s doctors took a very bold stand—that he should not only be mobilised early through chair treatment but also should run for the second term. History is a great teacher; he did very well, got his second term and went on to live for many more years. Early mobilisation after a heart attack and heart surgery became a mantra, since then. What of other injuries? We still do not have clear guidelines and doctors take the safer route for themselves by asking patients to take rest after any injury.  
 
I had a freak accident at the Bengaluru airport a couple of weeks ago. I was, as usual, sitting and looking at my emails when the announcement of my flight came on the public address system. I got up from my seat in that small cubicle where the chair and the table are so close to each other that there is hardly any leg space. 
 
The aisle was on my left and in the aisle was a granite table. My left leg could easily get out of the cubicle while my right leg was still inside the small leg space. In my hurry, I didn’t realise that and tried to move on. Naturally, I was thrown forward on the left side—my head hitting the granite table and also my left forearm. Providentially, instead of my forehead hitting the hard granite table my chin hit it so hard that I had a big bump there along with a painful swelling of the left forearm in the middle.
 
Eventually, when my right leg came out, my right knee fell and hit the leg of the granite table, giving me a big swelling and severe pain the right knee joint. People started rushing to help me but I told them not to do any such thing and I got up with difficulty myself and made my way slowly to the flight. In retrospect, I do not know how I made it. I must have been a sight for the Gods and the co-passengers. Sitting in the plane was difficult but it was just 25 minutes to Chennai where I was headed. 
 
I had no handbags and walked slowly, without help, to the luggage carousel. The Jet Airways boys helped me to pick up my bag and I walked out of the terminal using my trolley bag as a crutch. I had to go to our research centre for a meeting and seeing patients which I did with some difficulty, but the pain and the swelling were slowly getting worse.
 
We have a Varma Kalai specialist in our team, Suresh, who is very good. He came in the evening when I had finished my day’s work. He worked on me so well for nearly an hour and half with his special oils and intelligent use of the pressure points (102 in all) and I was a lot better at the end. The pain was 50% but the Varma point pressures were too painful to bear when applied. I was not sure if I would be able to sleep with all the pain. However, all went well and I had a good night’s rest. The next morning, as usual, I went for a walk with some difficulty but did not cut down my walk time; I had my full quota. I went back to work as usual and did whole day’s work going up and down the stairs to see patients and to attend meetings. In the evening, Suresh had another go at me; this time, it was more painful than before. My pain disappeared almost 90% and I could walk freely. All the swelling had gone but I could not fully bend my right knee to sit in vajra asana.
 
The following day, I was in Mangalore for my father’s death anniversary celebrations. During the puja there, I had to sit on the floor and get up at least 20 times. That took a toll on my back muscles that had to contract abnormally while sitting down with one knee almost disabled. The back started hurting so much that it was unbearable; but I went on as usual and went to Udupi and many other places by car in the following two days before leaving for Delhi with the backache in full intensity. I had a very busy schedule in Delhi and had to go back via Chennai where I had a lecture at IIT Chennai. My friend, Suresh, had two sittings with me and my backache has almost come down 99%.
 
A week later, I was in Delhi and was able to do all asanas normally as well as take my usual one-hour walk. I am writing this note at the India International Centre, Delhi, with all my pain gone for good (I suppose, touch wood!). In essence, I did not take a single pain-killer pill and had no rest at all after the accident. My experience tells me that it would have taken much longer for the pain to disappear, if I had taken rest after the accident. I am wondering if early mobilisation is a good idea in post-accident periods also. Will the concerned people listen and do a larger study acceptable to conventional thinkers? Interestingly, there is now a rethink on our conventional reductionist large cohort studies most of which have not delivered the goods. Even the journal Science advocates one-for-one study in place of large cohort studies. This is a one-on-one study, if you like. I did not have to take any informed consent from the patient, as I was the patient myself.
 
Knowledge advances, wrote Karl Popper, “Not by repeating known things but by refuting false dogmas.” How very true! Disease, rest and recovery need a fresh look to see if we should change for the better. Having said all that, I do not want the layman, a novice in the field, to decide what exercise or rest that he needs with any pain as s/he will not be able to assess what brought on the pain in the first place. If you have your family doctor and discuss the details with him, he will guide you. If you try on your own and come to grief, do not blame me.
 
“Exercise is done against one’s wishes and maintained only because the alternative is worse.”— George  A  Sheehan
Comments
Ganesh Johnson
9 years ago
Dear Dr. Hegde, you are SPOT ON!

I have had similar experiences of pain management.

Here's an example of last few days. About 10 days ago, may be due to incorrect posture while travelling/driving, or some extra strain on account of swimming, my lower left back (which has been vulnerable always) muscles started complaining; the pain started getting worse and would not subside even after a night's sleep. Bending became painful. But as is my experience I went for a triathalon (cycling/walking/running) set of exercises for 2 hours yesterday evening; the pain had subsided quite a bit after that. As of now the pain is manageable; and i would be further exercising to reduce and eliminate this episode of back pain.

Again, zero pain killers. In fact I am really afraid of pain killers, after having seen an elderly aunt of mine destroying herself over the last 20 years due to being habituated to pain killers (which were prescribed to her by her allopathic doctor son-in-law by the way).

So I totally agree with you!
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