Should I Move if I Hurt?

By James N. Dillard, M.D.

A few of years ago, I was asked by an internist colleague to consult about his patient who had just been admitted to the hospital. She was 66 years old and was brought in because she might have had a stroke. I had two other consultations to do that evening, so rather than sitting down to carefully read her medical chart first, I just bundled it under my arm and found her hospital room.

I was totally unprepared for what I found. Lying on the bed was a 430-pound woman wrapped in four hospital gowns. Betty was alert, talkative, and quite pleasant, but she was too weak to lift her legs off the bed. She could hold her arms up for just a moment. I sat with her for almost an hour to understand her story and then examined her. It was an hour that I will never forget.

Eight years before, she was a bit overweight, but she was holding a job and getting around just fine. Then she broke her left ankle. It required surgery and pins in the bone to make it stable. She had tried to do physical therapy after the surgery, but she said it was just too painful. She hadn’t received good pain care at the time.

After a couple of months of hobbling around, she decided to put herself to bed. She had been there ever since. Her devoted, if somewhat misguided, husband had put plastic sheets on the bed and had placed a small refrigerator on a stand right next to it, with rolls of paper towels. She could eat whenever she wanted.

He would wash her when he got home at night, and changed her sheets and clothing. It was remarkable that she was still alive. Betty had not left that bed even once for the past eight years.

I asked her what she did all day. She told me she watched TV, mostly a home shopping channel. Sometimes she would buy something, but not too often. I asked her if she was happy. She said she was okay, pretty happy. She loved her husband. I asked her if she would like to walk again, if it were possible. She said, “Not really.” I asked her if there was anything that I could do for her. She said, “Help me get home.”

The paramedics had sawed a section out of the doorway to extract her from the bedroom. It took seven men to carry her down the stairs. But she wanted to go back up just the way she had come out.

I went back to the nurses’ station and wrote a detailed note on the chart. With her weight, weakness, solidly fixed joints, and poor surgical risk, there was little choice but to send her home to the life to which she was accustomed. Her limbs were so stiff and contracted that she could not bend her knees up, or touch the top of her head. She refused to go to a nursing home.

I saw Betty several more times while she was in the hospital, and we got to like each other. It turned out that there had been a “mini-stroke,” also known as a transient ischemic attack (TIA). This was not a good sign. Betty would probably succumb to cerebral vascular disease (a real stroke), but perhaps not for years.

Many people in the hospital, including social workers, physical therapists, psychiatrists, and protective services workers, were jumping up and down, demanding that we rescue this lady from herself. It would not have worked.

First off, she did not want to be rescued. She had a perfect legal right to refuse treatment. Besides that, she had made a series of decisions that had put her into a box canyon. There really was no turning back for her.

I was able to convince her internist and cardiologist to send her home on blood pressure pills, blood thinners, and a modified diet. Her husband hired a moving company to get her back into the bedroom. She was pleased.

I tell you this story because sometimes I remind myself of Betty in little ways. Maybe there is a particularly grueling sport that I don’t do much anymore, or little ways that I let myself slip. I’m tired at the end of the day, so I don’t go for that bike ride. I’ve got lots of reasons.

Maybe there is a little bit of Betty in each of us. It is often damn difficult to fight back against the pains, disabilities, and inertia that dog us. Sometimes it feels as though we don’t have any choices other than to simply go downhill. We get tired. Sometimes we can’t make the right things happen.

But I want to encourage you not to go this way. If you let yourself slip, or have an injury that is not fully rehabilitated, then you might be less able to get around and do things in your life. If this situation is allowed to continue, you’ll find yourself permanently stiffer and weaker than before. This is not good. There are other options; you just might not have found them yet.

I have a patient who loved to play tennis, until his shoulder rotator cuff gave way. He had a couple of surgeries, but it was never the same. I had a devil of a time getting him to do anything else — he liked only tennis. But he was slipping, and he needed to stay in shape for his later years.

Even my younger runners can lose ground when they are on the injured list. While they are healing I get them to do running in a pool, swimming, rowing, or stationary biking. Appropriate medications, massage, and acupuncture can help with the pain, and some may have to consider injections or surgery to get back to former activities. Tai chi, yoga, meditation, hypnosis, biofeedback, or psychotherapy can help with stress and emotional issues — whatever it takes. Just don’t give up.

Life is motion, and motion is life. Generally, we heal better in motion (except for bad sprains and fractures, of course). Cancer patients who stay in shape live longer than those who don’t. Our bodies evolved and healed successfully over millennia of running, jumping, and climbing.

Each of us needs this motion to live. Without it, we get heavy, weak, stiff, depressed, and ineffective  in our lives. Most of us will face health challenges in the future, and the better shape we’re in going into those challenges, the better the outcome will be. So don’t settle for reasons to back off from your activities, to back off from your life. I know it’s not easy, but it can make all the difference in the long run.

Now you’ve got me thinking about Betty, so I’ll wrap it up. I’ve got to go out for a bike ride.