The Chiropractor’s Back Pain Diary, Part 2
Welcome back to Mike’s story of how he dealt with back pain. If you want to go back and read Part 1 to find out how we got here, use the links below:
Part 2: What Did You Do?
So here I was, with a fully mapped out plan of what the problem was. Two children to parent, a facet joint or possibly disc that’s very angry and very limited movement. Now all I needed was a plan for the next 24 hours. So I dug into my toolbox:
Panic!
Yes, reader. Of course I did. All the usual things went through my mind:
“Is this it now? Am I just a back pain person?”
“What kind of Dad can’t pick their kids up”
“It must be cancer, pain isn’t this bad unless it’s cancer”
“Maybe I don’t have such a high pain threshold after all”
“What am I going to do for work? I can’t do anything else!”2 *[Googles “child malnutrition”]*
These weren’t helpful. They’re also pretty unavoidable. Mostly I just wanted to get across that no matter how well educated you might be about this stuff, no matter how many times you’ve seen this in patients and even yourself, there is ALWAYS a part of you that is panicking. It’s not a moral judgment on your pain threshold (a largely meaningless concept, but that’s for another day), it’s a biological fact.
The thing I had to remind myself over and over again was in regards to the intensity of the pain. Every time I made a movement my back didn’t like, it was like all the thoughts came right back in an instant, and it really tests the courage of your convictions. It’s well documented that severe pain doesn’t necessarily mean that severe damage has been done, and at times like this I found it really important to remind myself that although each spike of pain was immensely painful, it wasn’t getting in the way of progress or making the condition worse… It was just sore. And no one ever died of pain.
Painkillers
Despite my Jedi mind tricks, I am not one of those who will eschew painkillers for any reason. Paracetamol and Ibuprofen are my go-to and have proved effective enough previously so I fished some out of the medicine cabinet and took the max dose. Later I would buy slightly stronger painkillers from the pharmacy but I never ended up needing them. I would also be an advocate of prescription painkillers if the over-the-counter variety aren’t doing the business.
In my case, I didn’t get anywhere near pain-free, but I could function. I liked the idea of knowing how my condition was progressing and remaining consistent with my painkiller usage to facilitate that, although I have no idea whether that is a valid thought process! It’s worth pointing out that I’m an able bodied reasonably fit person who can find lots of different ways to get up from a chair or the floor, for example. That means I can learn what my back likes and what it doesn’t, and adjust accordingly in the short term. Not everyone has that luxury and that’s just one reason why their pain medication needs may be different from mine.
If I didn’t have alternative strategies for dealing with the pain, you best believe my GP would be the first to know about it!
Chiropractors
I’m in the very privileged position that a lot of my friends are chiropractors and several of them live nearby. Karen came from Cranbrook to help me out the same day and I went to Topsham to see Iain the following day. In both cases, if anything I felt slightly worse immediately after treatment! However it definitely felt as if I was moving easier. Where previously my back felt “locked”, there was some freedom there but it was still very sensitive to certain positions or movements.
What techniques did my colleagues use? Just about everything:
Adjusting & Joint Mobilisation
Massage & Soft Tissue manipulation
Needling
Taping
In short, we chucked a load of spaghetti at the wall and saw what stuck. How effective was each individual intervention? I don’t know, and don’t much care to be honest. Apart from anything it was nice to get assessed (as self-diagnosis is the biggest source of false positives!) and to have reassurance from knowledgeable professionals that this was indeed a painful minor injury rather than a serious one. Another source of succour was the realisation that every Chiropractor seems to have their own back spasm story!
Movement
Ask my patients and they’ll probably tell you they’re sick of hearing the catchphrases “movement is medicine” or “motion is lotion”, but moving is the best way to desensitise sore areas and rehab injuries quickly. But what if it’s painful? If you’re able to separate the pain from the movement, great. Usually I find that my body’s reaction to the movement ranges from mild improvement to severe reaction if I get it wrong, but that generally the range of movement will increase as a result - which is long term good. So what types of movements had I tried?
Walking
The undisputed king of exercise (in my opinion). Walking is the best first line exercise that I recommend to patients because it’s difficult to overdo, impossible to do it wrong and yet fundamental to how we move. Also, I can tell so much about the state of my body by how it moves - or doesn’t - when I’m walking. It might be that one hip moves more than the other or it will twist more one way than the other, and so often that will change over the course of a short 5-15 minute walk. These things can be really useful to help reassure us that whatever is going on will get better, just by showing us that it can be better.
Stretching
Even when the first spasm hit me in the clinic, my first thought was to go to some garden-variety stretching of the muscles around my hips. My glutes, hip flexors and groin muscles all felt like they were pulling progressively tighter by the minute, so of course I tried to counteract that. It felt better after I’d done it… For a few seconds maybe. Then I’d get another lightning bolt to the low back.
Similarly, once I was at home, getting on the floor and rolling around to test various movements and tringy to restore some lost ranges gave me a bit of relief. I always felt easier standing up again, even if the improvement was short lived. To be honest, in the initial phase when something like this is kicking off, I’m not convinced that there is much you can do to halt the onset - it’s going to be as bad as it decides to be. But once again I do think it’s important to maintain some level of movement rather than being avoidant of all things painful.
Pilates
In a previous episode, a couple of days in I had decided to go back in time to when my back felt bulletproof and do some Pilates exercises. I had been a regular in my 20s and on reflection, it seems like a pretty big piece of why I’d been so healthy back then (not forgetting the low stress lifestyle, and the abundance of sleep and other exercise).
Anyway, I figured it was worth a shot. Lo and behold, the abdominal bracing that I’d learned all those years ago had given me some relief and made my movements a fair bit easier.This time around it hadn’t proved quite so effective, partly because it already felt like my entire trunk was too tight if anything. The moral? Different episodes of the same type of pain often have different things that will help - it’s important to stay open minded and try different things and not become too attached to any one single solution, no matter how effective it may have been that one time.
Running…?!
“Running with a back spasm? Surely if you can’t touch your toes, the impact will just make things worse?? Don’t be stupid! You must look after your back, don’t push it or you might do some real damage!”
Sound familiar? It’s just about every caring spouse or child I’ve ever heard from second hand in the clinic. And yet, every time my back has locked up on me, a reasonably paced run has resulted in better movement and less pain afterwards. I type this 5 days after this latest episode started having run 7k this morning, and still having my breath taken away if I get the angle wrong when I sit. But the run has helped, plus I get all the other health benefits of exercising in addition to the painkilling effects.
What’s my point? There’s no “right way” to recover from these things, and well-intentioned “common sense” advice from friends and loved ones can actually get in the way of a timely recovery. If it helps you move, do it…
While all these things definitely felt like they were improving the movement in my lower back, it definitely felt as though my muscles were fatiguing quicker than usual and by the time I’d walked to town and back for instance, it really felt like I was in need of…
Rest
Nothing felt better than lying on my back. There, I said it. For all that I know and promote the virtues of moving, exercising and blah blah blah… All I wanted to do was recline and scroll my phone. If my wife could see her way clear to feeding me lasagne at the same time, I think we’d really be on to a winner.
And it was restorative. After exercising or being on my feet - which made me feel like I was moving better - 10 or so minutes of complete rest helped to ease my fatigued muscles and when I got up again, moving felt A LOT easier. And so I would rinse and repeat through the day.
The reality of this picture can be really hard to communicate to patients, especially when their thinking is clouded by severe pain. We would all like simple answers. What’s best for my back, moving or resting?
“Well, move as much as you can, but don’t forget to take breaks. How long? Well, as long as you can manage, but don’t be afraid to push yourself, and if it’s sore lie down. But don’t lie down all the time.”
Clear as mud.
Again I should probably check my privilege in having more information at my disposal than the average bear. In my mind, my muscles were becoming “fatigued” and not “closer to collapsing” as some would describe it. I don't know what that says about the way that I interpret body signals. It would be very easy to think that you were back to square one with every jolt of pain from an unguarded movement, that some poor distressed disc was edging closer to blowing out, but of course that is hardly ever the case. I am convinced that being able to rationalise the symptoms I was having with perfectly normal explanations helped to keep my pain levels lower.
I frequently see problems in longer term pain where patients struggle to disentangle different sensations or types of pain - almost everything gets bundled in with “the pain”. Everything hurts. How does a given movement affect the pain? “I don’t know, I just know that it hurts, and I want to avoid pain at all costs”. This approach, while understandable, only seems to push any progress further out of reach.
Support Belt
Confession time. In my desperation I ordered a neoprene pelvic support belt from Amazon the day it happened. Shock horror! Surely not? I thought you hated those things?
Yup. Well, not hate but certainly I wasn’t convinced of how much good they did. But if someone said that it helped them, I certainly wasn’t going to trash them. And in all honesty I didn’t know what I was hoping to achieve with this overpriced piece of elastic but I was desperately wondering how exactly I was going to work any time in the next three weeks!
The result changed my outlook permanently.
When I strapped it on, it was like my core muscles relaxed for the first time in two days. I confess that one of the first things I did was take a nap WITH THE BELT ON. It was the most comfortable I’d been in a while, and the rest felt significant (of course, when we're talking about rest, nothing is a better healer than good quality sleep.) I would never have advised anyone to nap with a belt on prior to doing it myself. Over the following couple of days, I weaned myself off the belt. Its utility diminished anyway, but that initial use really felt like it helped to break the cycle of tension and pain.
So much so that I have resolved to make them available to patients in future. That’s right, this chiropractor will do a sideline in pelvic girdle supports! I still wouldn't advise them as a long term solution, and you are definitely going to want to address the cause of the problem rather than papering over the symptoms, but when something works, it works.
So what helped, what didn’t help, how do we know what helped, and how quickly did you get better? Find out next time… Part 3: What Was The Outcome?