Read PART ONE of this two part blog? If not, click here. If yes, keep reading....
Then I began my physio studies. By mid-2015 we began learning about the science of pain; probably some of the most important and eye-opening lectures I’ve ever had. I, like most other people had always assumed that as soon as I felt pain I was damaging something. But pain is more like a warning system. It’s our bodies way of letting us know we’re in danger to prevent that damage from occurring. You definitely do feel pain when tissue is damaged but that’s not always the case. We discussed the phenomena of sensitisation, where an injured area becomes more attuned to stimulus, even after it has healed, and more likely to issue a warning - which we perceive as pain. That sounded pretty familiar! I realised that after almost a year and a half, there was no way whatever was originally damaged was still injured. Our bodies are incredible at healing themselves and I was well past the expected healing time-frame. This helped change my frame of mind to thinking of myself as someone with a damaged back to someone with a more sensitive back. A seemingly small difference but one that had a huge impact.
We talked about the kinesiophobia; the fear of movement. I realised that I had become so obsessed with learning to brace and stabilize my back that I had stopped letting myself move which was creating other compensations.
Lastly, I learned that physical aspect of pain is only one component of a much larger picture. My own thoughts, expectations and fears were also playing into how I perceived my pain. I had begun catastrophizing; believing that my back pain would last forever and affect the rest of my life. I also had a heightened expectation of pain. I would convince myself an activity would be painful even before I had attempted it. My constant desire to protect my back was preventing me from using it. The more I protected it, the more it became accustomed to this “safety” and the more regular movements would be interpreted as a threat.
There was also a social aspect to the pain I was experiencing. As with most chronic pain it was never constant. Sometimes it would be extremely noticeable and other times it was barely there. Looking back, I can see a distinct correlation between the “peaks” of pain and events at the time. Moving to the other side of the world and trying to establish a new life was a bit stressful, and that was a peak. Exam periods were another time that pain crept up more. There is a well-established link between our stress levels and how we experience pain. Being aware of this can allow us to be more pre-emptive by predicting or acknowledging stressful times and taking extra steps to prevent them from influencing our pain.
All of these factors played a huge part helping to reduce my back pain. When I did feel something, I didn't let it worry me. I knew that I wasn’t causing more damage. I began to think of my back pain as something useful. When I was working out, the appearance of pain became a signal that my technique might be compromised. I would make whatever changes were necessary and continue rather than quitting and resting. I focused on moving more, and not worrying about constantly try to stabilize my back. If there was pain, I understood that it wasn’t indicative of damage and it was something I could work through. Over time, with more movement, my body began to realize that these movements were safe and not harmful and that dampened the alarm. I started lifting weights again and was able to work up to a 300+lb deadlift for the first time in years.
My journey with pain lasted the better part of 2 years. While this is technically considered chronic, I was lucky and managed to break the cycle early. Some people live with back pain for the majority of their lives. Once you enter a cycle of chronicity, it tends to feed into itself creating more fear of movement and more sensitization that becomes harder (but not impossible) to break. At this point, approaching 4 years from my initial incident, I don’t consider myself to be someone with back pain. I do get the occasional twinge but it disappears instantly and I would hardly consider it a pain. I attribute this to some lingering sensitization and think of it as a friendly warning from my body that whatever I’m doing might need adjusting. I’m able to run and jump without any adverse feelings in my back at all. I’ve even been able to increase my deadlift PR to 365lbs completely pain free.
When I think back to my little journey I think about what I did right, and what I did wrong and what I would do differently if it happened again.
I addressed the biomechanical cause of my pain. Without changing how I moved and identifying my weaknesses, my back issues would have kept recurring. Although I didn't seek professional help for this, it would have been much more efficient if I had.
I focused solely on the biomechanical cause of my pain. In my mind, there was a movement that was causing me pain and fixing that movement would fix the pain. I, like most other people wasn’t aware of how complex pain is. There are so many factors that play into the pain experience and it is equally important to address them.
I focused on the anatomical cause of my pain. As humans, we tend to think that knowing more is better. By knowing exactly what was damaged, I could treat it. I spent a lot of time researching back pain and various injures to try to determine exactly what I had done. I didn’t go as far as getting an x-ray or MRI but the thought did cross my mind. I now know that it really wouldn’t have mattered for my presentation. An x-ray wouldn’t have told me that I was moving with an arched back and an MRI wouldn't have found weak core muscles. Even if I had identified a specific cause of the pain (disc, muscle, ligament) it would have made no difference to how it was treated.
I catastrophized my pain. I let the thought of pain take over my life. I was constantly worried about it and worried about making it worse. Even when I wasn’t thinking about the pain, I was looking for ways to fix it. Unbeknownst to me, this contributed more to my fear of movement and actually made my issue worse and likely contributed to it becoming chronic.
I didn’t seek guidance. The things I needed most were reassurance and education. In the initial stages I needed someone to tell me that I had not done anything serious to my back and that it would heal. I needed someone to explain that back pain can be tricky and there likely would be “flare-ups”, but that these weren’t something to be afraid of and could be easily managed. I needed someone to educate me about pain and the importance of movement. I needed someone to show me that my back wasn’t the frail, damaged structure I thought it was.
This is just my story and everyone’s will be different. However, whenever I see someone in pain, I always try to remember what it was like to be in their shoes. I focus more on reassuring them that their back will get better and they don’t need me to “fix” them. I try to teach them what pain is and what it means. I look for dysfunctional movement patterns that may be contributing to their pain and focus on things that they can do over things that they can’t. I do what I can to make their back feel better at the time but my ultimate goal is to stop them from traveling down the same path as me and not allowing their pain to evolve into a chronic condition.
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