I’ll start by taking you back to the beginning. I’m sitting in my first musculoskeletal course in PT school. Though I can’t say for certain, I’d assume that there was some sort of climate extreme going on outside (I was Chicago, after all). I’m doing my best to pay attention to what my professor is saying about the Cyriax approach to back pain, but can’t stop thinking about his pocket protector, “where does one even get a pocket protector?” I’m having a hard time maintaining focus, and the content of his lecture seems irrelevant to me. I reassure myself and validate my inattention, thinking “you don’t have to pay too much attention to this, you’re never going to treat back pain.” Boy, was I wrong.
Perhaps it’s my clinical experience and recognizing that spine dysfunction is implicated in nearly all cases of pelvic floor dysfunction. Or maybe it’s that my confidence as a practitioner has improved over time as I’ve gained clinical skills. But I’m guessing that it’s my personal experience with back pain that has led to my shift in attitude over the years – now, I love treating back pain.
Here’s the thing – the majority of people will experience low back pain in their lifetime. I know this. I knew it in PT school. But I never thought I would have low back pain, especially chronic low back pain. Hip pain? Sure. Knee pain? Definitely. But low back pain? No way. I have excellent body awareness and have been a Pilates instructor for over 10 years. Pilates instructors don’t hurt their backs.
Until they do.
If you know me personally, you know that I struggle with finding balance. What I mean is that I’m an all-or-nothing type of girl, and I typically err on the side of all as opposed to nothing. Exercise has always been an outlet for me (especially intense cardio). As I approached my thirtieth birthday, I was training as intensely as ever – doing upwards of 6-7 spin classes per week (and these weren’t just regular spin classes, they were named “HELLth” for a reason and often involved countless burpees and other intense forms of exercise). I was also getting back into resistance training at this time. Armed with the knowledge that you start to lose lean muscle mass after 30, I was bound and determined to put as much muscle on as I could.
In retrospect, I knew that I was doing myself a disservice. I was working out way too much and way too hard. I wasn’t taking rest days. I wasn’t foam rolling or stretching. I knew better. But somehow, I felt like the principles that I teach to my patients didn’t apply to me.
Then it happened. I was in a 5am class doing wall balls (a movement that I’d done hundreds of times) and at the top of one of my reps I felt a sharp, shooting pain go from my low back and into my left leg. I tried to continue on with the workout, but only felt comfortable on the bike, completely bent forward. So that’s where I spent the rest of the workout.
I had a sneaking suspicion that I may have a slight disc bulge, but I chose to ignore it. I’d do what I tell my patients – focus on what you CAN do. I told myself, “tissues heal, Amy.” “Listen to your body. Let pain be your guide.” And guess what? Things got better.
But let me be clear, I took ZERO rest. None. I did incorporate some stretching and foam rolling. I avoided exercises that hurt and carried on with things that felt good (namely, cycling). But, I skipped heavy back squats and deadlifts. I didn’t even notice that I started to lose the ability to bend forward appropriately.
Fast forward 3 months and it happened again. I felt that same, debilitating pain while performing box jumps in the middle of a WOD. Except this time, I could hardly stand up, let alone finish the workout. I took the rest of the day off of work, lying on my stomach in bed, which was the only position that I could tolerate. The next morning, I still could barely stand up, so I figured I’d make an appointment for a massage.
An aside – yes, I work at a PT clinic. Yes, I could have been evaluated and treated by someone there. But, my denial (and fear) were so strong, that I didn’t want anyone I knew to confirm my suspicions.
I arrived at my massage, told the therapist what had happened and she curtly stated, “it sure sounds like a herniated disc.” My immediate response was fear. All of my knowledge about anatomy, about the resilience of the body, and about rehab protocols went out the window. I was now someone with a disc bulge. Her direct language and use of the word “herniation” did exactly what I knew it had the power to – it sent me into a tailspin.
Now, fortunately, I have the one thing that is the best defense against chronic pain – education. My conscious, educated mind knew that this would heal. But, my subconscious refused to believe it. I did what I knew I needed to – a dosepack of steroids, 2 great manual therapy sessions with some intense dry needling from skilled PT’s at my clinic and implementation of a home exercise program. And things got better really quickly. I was able to return to work within days.
But, that subconscious fear persisted. Any time I’d step under a bar for a back squat (at a fraction of what I had lifted before), I’d pause. Was that my back I just felt? Should I stop? Am I going to hurt myself? The inner dialogue was almost paralyzing.
I slowly built back some confidence and was doing most of the exercise I had been doing before. It had been nearly a 2 years since all of this started and I was beginning to believe that I’d healed. And then I started getting lax about my mobility. I wasn’t foam rolling much, I was shortening up my warm-ups and I wasn’t paying any attention to the other factors that I knew contributed to pain.
People often ask me if I ever had an MRI. And I didn’t. I chose not to, because I knew that the MRI would should a disc protrusion. Most MRI’s show some sort of degenerative changes, even if the person is asymptomatic. I knew that if I saw a bulge on an image, my personal pain experience would be worse – simply based on my psychology.
Around this time last year, my boyfriend and I traveled to Chicago. It’s become our habit to get really long workouts in while we are on vacation. There’s something about the lack of time restraints and eating calorie-dense foods that makes working out one of the best parts of traveling, in our opinion. Unfortunately, on our second day of the trip, my low back pain returned. This time it was my third set of heavy deadlifts that led to the return of that all-too-familiar radicular pain.
But, it was different this time. I was able to change my inner dialogue to cope and understand my pain, rather than fear it. I knew that a few factors had contributed to this “injury.” (Note: I’m reluctant to call this an injury, as the word “injury” implies that there was tissue damage, which I doubt there was). First of all, we’d sat on a plane for nearly 3 hours and I didn’t take any standing breaks. I rarely sit for more than 20 minutes at a time, so this prolonged sitting was very out of the ordinary. I also had skipped any and all mobility work for my hips (a chronically tight area for me). The day prior to the return of pain, I had done a very heavy workout targeting my lats and rhomboids, so I was likely tight and fatigued in this area, impairing it’s ability to work. Lastly, we’d been eating a TON of gluten, sugar and dairy since our arrival in Chicago – all foods that we avoid when we are at home since they are known increase inflammation.
My point is this – I know what it takes to keep my back healthy. For me, that means keeping my hips and thoracic spine very mobile. It means getting plenty of sleep. It means being mindful with my training and designing my splits so that I don’t go into a workout fatigued. It also means keeping my diet clean and free of foods that I know increase inflammation. And more than anything, it means being aware of my mindset.
Everyone has different “triggers” when it comes to their pain. But when you’re experiencing intense pain, it’s hard to keep perspective. More than anything, it’s hard to keep the fear at bay. Especially when pain is meant to be an alarm. It’s meant to signal danger. So, when we feel pain, it’s totally natural to respond with fear.
But we must remember is that pain is complex, and it’s contextual. Our pain experience is totally dependent upon our own mindset. So, if you’re experiencing any sort of psychological distress, you’d better be prepared to be more susceptible to pain. Same story if you’re sleep deprived, or really stressed out.
I continue to struggle with this, almost every day. I’d be lying if I said that I didn’t notice my low back on an almost-daily basis. Most days, it’s totally manageable and hardly noticeable. Other days it affects what I do. But those days are becoming less and less frequent, and I’m becoming more aware of what contributes to my pain so that I’m more confident in my ability to manage it.
I know that I don’t have any tissue damage and that my body has healed, but I still have pain. I’m reluctant to admit that I have chronic pain, but I do. But my pain doesn’t define me. I know that there are days that I must handle my body with care and give myself the grace to opt out of things that don’t feel good, understanding that my body always tells me what I need. I just have to listen.