My story: a Restorative and Resilient Body that Still Breaks

Today's post is for all my patients that I have unfortunately canceled on in the last 2 weeks; sharing this personal post is an attempt to reconcile the inconvenience that I've caused you! I hope to provide a little overview of my own personal pain journey and through that provide you with rehab tools to better understand your own. If the personal anecdote underwhelms you, skip to the end of this blog for clinical resources on the latest in back pain science. So as for that personal anecdote, here goes...

I grew up doing all sorts of fun gymnastics and body contortions, with many such party tricks under my sleeve! There was nothing quite like showing my friends the human pretzel to get everyone laughing. Despite the fun, as time passed, I began to learn that this hyper-mobility, or extreme flexibility was actually the reason for my chronic back spasms, consistent running injuries and intermittent yet paralytic lower back pain. As I was studying health sciences after my B.Sc for entrance into varying medical programs, my on going back pain led me to be interested in the rehab sciences and thus the physio aspiration began.

The next 2 years of pain culminated in 2010 when one morning I actually could barely get out of bed, walk, toilet, dress myself yet alone work. I had extreme nerve like pain on the right side of my lower back that shot out of nowhere and paralyzed me when I would try to bend over, yet alone lift anything. Yet somehow for the next 1.5 years I continued to work as a personal trainer, at times standing on stage teaching the entire exercise class wearing my metal boned lumbar corset; verbally describing every possible exercise that I couldn't demonstrate. I understood so little about all that I was experiencing and all I knew was that the pain remained.

Pain without understanding can kill your sparkle…

It would often send me to tears; I would refuge in the gym bathroom composing myself prior to meeting my next client. As the symptoms escalated to incontinence, finally one day when I was in full tears after work, I walked over to the ER, my fastest route to imaging for answers. I had been through 3 physios that all slapped varying electrical pads on my back and told me to strengthen my core. It had been 1.5 years of persistent and disabling pain.

The Doctor in the ER gave me all sorts of medications such as gabapentin, hydropmorphone and tramadol, none of which worked and lead to feeling even more awful. Finally, I underwent a CT scan which confirmed disc bulges, spinal stress fractures, arthritic change and a condition called a spondylolisthesis involving a permanently displaced spinal segment which placed the nerve root under minor compression.

Finally, I had answers but no idea how to manage such a thing. I finally got accepted into Physio school after 9 sturdy years of university preparation but they wouldn't accept a medical deferral. I had no idea what this condition involved and knowing that I couldn't sit or bend with ease, I didn't meet the physical requirements for the program. I withdrew my acceptance, knowing very well I would plan to re-apply, re-interview and fingers crossed get a second chance at a program that had an 83% rejection rate.

I found a physio on my fourth attempt; he did very gentle osteopathic therapy which helped me gain some range and somewhat eased the pain. But more so, he EDUCATED me. He educated me on spinal biomechanics, positioning and breathing dysfunction. He educated me on pain science, on how pain is protection and not detection. My aims was to calm the alarm system down, and find as much encouraging motion as I could. Windows open when a patient feels like they have tools to self-manage; instead of depending on machines, pills or some other intervention, I vowed right then to make my own clinical practice about self-management and empowerment.

It took almost a year to be able to have confidence in my movement again, bend with ease, front squat a 50 lb kettle bell and sleep through the night. I celebrated getting a second chance at my Masters in Physio with a surfing trip around Europe. Don't get me wrong, I still had pain every day, but when one has tools, one can manage it. The journey has never ended, physio school was very hard, I stood in the corner as I couldn't sit through lectures. This actually started an awesome standing culture where many of my classmates joined me!

What matters most is that we learn the triggers for our alarm system, mine are napsacks, sitting, couches, soft mattresses, passive spinal twists, doing dishes haha... We don’t hold those triggers too tight, and aim to slowly expose ourselves in a graded fashion. What matters even more is that we LEARN ALL THAT WE CAN DO, and lean into that daily. road running can trigger my alarm system, but I can climb stairs for an hour with only my lungs holding me back. Back squatting can trigger, but front squatting feels like it ignites my core! I can't sit for long periods but I can hike the chief in 45 min.

I've somehow had a regression as of late, after a year of great fitness. 3 weeks ago bending to pick up a sock, wham I felt immobilizing pain. Believe it or not these passive mindless bends and rotations are typical mechanisms for injury, there’s some understanding that they put the discs under pressure, the mechanism isn’t entirely certain.

I've treated an elite varsity sprinter who injured his back doing the same. How long will it take for this to pass, I do not know. Point being I’m leaning into what I can do and what needs a graded approach. I'm also acknowledging that pain is a bio-psychosocial experience, and doing some personal reflection on my relationship to it.

To outline a few simple strategies for anyone else suffering from an acute onset of back pain, here are a few clinical pearls:

1) LAY DOWN on a firm surface with 2-3 pillows under your knees, for a few 20 min intervals on the first day, hot pack where ever you need it. Some like to lay flat, you’ll know what position is your bias.

2) MOVE AND OFTEN in all the pain free ways that you can, walking, knee to chest, upper body stretching/strengthening. My favourite is to get in the water. Water makes you buoyant; the stress is taken off the spine and it allows you to move freely. Motion is lotion, offering nutrition for joints and preventing further stiffness. After the pain is less irritable find some loading strategies that activate things that feel good. I’ve always loved lat pull downs, hip abduction/side planking and chest press when my back was stopping me from doing things.

3) GET COLD, this has worked wonders for me since 2019. I try to follow the cold protocol and find it lessens my over all pain, nausea and gives me a mental boost.

If it’s uncomfortable, then it’s probably working!

4) PRACTICE MINDFULNESS and BELLY BREATHE; the latest research in pain science is revealing that mindfulness strategies are one of the most effective strategies in managing chronic pain. Deeper breathing engages in the lateral and anterior expansion available to our lungs; which allows the musculature that is most likely tugging to let go. I personally like the headspace app , they even have a guided series on pain management.

5) SEE YOUR PHYSIO, of course I'm partial to this, yet this isn't the cookie cutter answer only part of the pain experience. Seek support is the bigger picture from someone that empowers you with tools.

So despite all of our bodies on the majority being resilient and quite restorative; we still all break from time to time. Injuries and pain are actually part of every day life. You might as well be fit and injured and then unfit and injured. So keep moving, stop avoiding and stay empowered.

Thanks for reading, and stay strong in your very own RESTORATIVE AND RESILIENT BODY

As always, thank you for your interest in science and rehab.

Kindly,

The Cancer Physio