Recently, I was treating Simon - of Mobility Monday fame - for an acute back injury and he mentioned how different it was to be in the patient vs physio position. This got me thinking about some of my previous injuries and some of the similarities and differences between managing my own pain vs helping to manage the pain of others. Our fearless leader, CLG, has done a similar blog about her quad injury, but I thought I’d share my own story of my battle with back pain.
Back pain is estimated to affect 70-90% of all people at some point in their lives. 30% of those people will go on to develop chronic back pain. I sit in that 30% and although I’m not particularly happy about it, it definitely has given me a better appreciation for the struggle of dealing with chronic pain.
My story begins in early 2014, and like a lot of people, I was lifting something. More specifically, I was in the gym deadlifting. I was lifting attempting 275lbs (about 125kg) for sets of 4 (a pretty heavy lift for me, 85-90% of my 1RM at the time). The first set went pretty well, the weight moved quickly and my form felt good so I headed into the second set with confidence. This one didn’t go quite as well. I completed all four reps, but by the third and fourth I could feel myself fatiguing and my back was starting to ache. Not thinking a whole lot of it, and much more worried about my ego than my back, I refused to remove any weight. For the third set, the first rep came up fine, but the second rep was the veritable straw that broke the camel's back, and the more literal deadlift that broke mine. Nothing popped, nothing snapped but there was an instant pain. In hindsight, the pain wasn’t even that bad, maybe a 5-6/10 but it was more the feeling that I had done something very very wrong to my back. I stopped my workout there and struggled through the rest of my day.
*Artistic representation of my deadlift
Over the next few days my back was a pretty sore and achy but I figured it would probably settle down on it’s own. I took some time away from heavy gym movements like squats and deadlifts to let my back heal but never bothered getting it professionally checked out. I was right! The pain almost completely disappeared within about two weeks. This is pretty usual and known as the “natural history” of back pain. Almost all acute episodes of back pain resolve within three months and most within the first 6 weeks, often whether you treat them or not. So far so good!
Sub Acute Phase (3-6 months)
At the time I was working as a personal trainer, and even though my back felt pretty much normal, any time I went to lift something from anywhere off the ground, I would immediately feel it in my back. Just a minor pain, but more of a constant reminder that there was still something wrong with my back. Again, I figured that it still needed some time to heal. This stayed pretty consistent for the next few months. I was able to complete all of my regular daily activities pretty normally, I just need to be cautious with lifting and certain quick movements.
Through this time I tried to get back into some heavier weight lifting but I was still having trouble with squatting and deadlifting. Even at almost no weight, I would immediately feel my back and not want to push any further. Fortunately, at the time of my injury, I had been video taping my sets (don’t worry - it was solely for technique purposes, they never appeared on social media) so I went back to see where I went wrong. Unfortunately, I’ve since deleted the videos but what I found was interesting. My first set was pretty technically sound and my back position was almost a straight line, similar to the right-hand picture below. As I looked at my second and third set, I started to notice a more pronounced curve through my low back, like the middle picture.
This is known as an extended lumbar position. As I fatigued, my low back came closer and closer to its maximal extension - the point where the small vertebral joints physically can’t move any further - not a great position to be in with a couple hundred pounds hanging off them. So now I knew what had potentially caused my problem in the first place, but why had it happened? The answer was my core control, or more accurately, my lack of. I had taught myself an abysmal “bracing” strategy over the years, relying more on holding my breath to create stability than effectively activating my muscles. This lack of strength and control allowed my back to droop into an extended position as I fatigued, putting my spine in a more vulnerable position where the bones and ligaments started to take the brunt of the force.
I went back to square one. I completely relearned how to activate some of my deeper core muscles. I learned to use my core to help control my low back positioning and I incorporated dedicated core strengthening exercises (which I had naively been neglecting previously) into my training. And low and behold, it worked! I started squatting and deadlifting again, beginning with light weights and gradually working my way up….to a point. My back was completely fine until I reached a load of about 250lbs. Anything above that would instantly “flare up” my back and put me out for a few days.
Chronic Phase (6+ months)
This pattern continued for over a year. Build up the weights, flare up, take a little break and repeat. I couldn’t figure out what I was doing wrong - my form was good, my core was much stronger but I was still getting back pain. I assumed that each time the weight became heavy enough, I was re-injuring the already damaged tissue and setting myself back. But no matter how slowly I went, I wasn’t able to avoid it. Through this time, I also began to notice some other activities that brought on my pain. Any type of quick rotation or side bending from a seated position would elicit a sharp low back pain. I also started getting back pain when I ran or jumped. The impact of each step would send a sharp pain up along my back. Practicing my abdominal activation and back positioning would help a bit, but I couldn't shake it. It got so bad I had to stop running all together. This was when I started to get really worried. It was the start of 2015, I had just moved to Australia and even though I had taken a few months off from the gym my back seemed to be getting worse. I started to get pretty concerned - maybe I shouldn’t have been so arrogant to think I could fix myself. I should have seen a professional to at least get a diagnosis. Maybe I had a herniated disc and needed an x-ray or MRI. Here I was at 25 years old, with some type of permanent back injury that clearly wasn’t getting better. What if I was never able to run, jump or work out again without pain?
Then I began my physio studies....
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