CRPS Several Months On: Work, Sleep and Returning to Sport
CRPS after a cartilage injury to the knee, undiagnosed for around eighteen months, where stiffness and restriction dominated rather than burning pain.
Nadia is a real patient of mine. Their name and identifying details have been changed to protect their privacy.
“Not simply a knee that feels better, but a life in which Nadia no longer needs to organise herself around her knee.”
The goal we kept returning to
Symptom profile
Nadia's CRPS followed a cartilage injury to her knee and wasn't diagnosed until around eighteen months afterwards. Her presentation didn't fit the stereotype of severe burning pain. This may be familiar if you recognise:
- Marked stiffness and restriction rather than dominant burning pain
- A walking tolerance that has shrunk substantially
- Swelling and colour change that follow activity
- Changes to hair and nail growth
- Patches of both heightened and reduced sensation
- Sensitivity to deeper pressure specifically
- Real uncertainty about what activity is actually safe
How this affected her daily life
The scale of Nadia's disability was greater than her pain intensity alone would suggest. She'd already been through PRP injections, medication, sympathetic blocks and physiotherapy elsewhere by the time we met, and her pain specialist felt she'd reached the end of standard medical options short of a spinal cord stimulator, which she chose not to pursue.
Sleep was badly disrupted. She was managing a demanding senior role with responsibility across several sites, and the physical demands of that role — combined with the sport she used to do regularly — felt entirely out of reach.
Priorities across the phases of treatment
Understand
Mapping her sensation, sleep, response to compression and activity tolerance before deciding what to do about any of it.
Reconnect
Sensory discrimination work, graded motor imagery and whole-body awareness training aimed at reconnecting with the leg rather than simply desensitising it.
Expand
Walking analysis, weight transfer, tai chi-based movement and progressively more resistance work as her confidence grew.
Return to life
Returning to a demanding job without letting rehabilitation become another full-time occupation, and deliberately holding back from her sport until she had genuine physical resilience — not just the ability to attempt it once.
Length and rhythm of treatment
We've been working together for around four to five months so far, and this is still ongoing. Early sessions came closer together while we were mapping her presentation and building the foundations. As the work moved into the return-to-life phase, we settled into a steadier, less frequent rhythm, with regular check-ins to keep the plan aligned with the demands of her working life.
Setbacks, and what they taught us
Compression helped enormously at first and later became simply irritating — which was a success rather than a failure. It meant her needs had changed, and we adjusted accordingly rather than sticking rigidly to what had worked before.
A particularly stressful working day coincided with a real flare in her symptoms, which could easily have been read as work damaging her knee. Instead we looked at her total load and shifted towards managing capacity rather than avoidance. She continued to have fluctuations throughout treatment, and learning to interpret these as information rather than evidence of failure was itself a significant part of her progress.
How we worked together
Nadia responded well to being treated as a genuine collaborator in figuring out what her own data meant — her sleep tracker, her sensory maps, her laterality scores — rather than being handed a fixed programme. A lot of our later work happened around her real life, her working day, her walking, rather than confined to structured sessions.
We were also honest, together, about what mattered enough to keep doing and what had become just another task on an already overwhelming list.
Benefits of working together
- A collaborative, data-informed approach that respected her analytical way of thinking rather than working against it
- Permission to let go of things that had stopped helping, like compression, without treating that as giving up
- Practical strategies she could use inside an ordinary working day, not just inside a treatment session
- Support in aiming for "the best version of enough" rather than either overworking or avoiding activity altogether
- A realistic, honest timeline for returning to sport, based on genuine readiness rather than pressure to rush back
More case studies
Acute CRPS in a Teenager, Following a Minor Medical Procedure
A rapid, severe CRPS presentation that began within hours of a routine blood test, and the gradual, patient rebuilding of movement, sleep and confidence.
Complex Persistent Pain With Multiple Medical Involvement
Long-standing, complex persistent pain alongside several other medical conditions, years of medication use, and a careful, collaborative reduction in codeine.
Could this approach help you?
Your presentation will have its own shape. Read more about how I work with CRPS, or book a free discovery call to talk through your situation.