Pain as a teacher.

After writing the blog entry about the Spinal disorder seminar, I would like to share some personal experience about back pain.

About 3 months ago, I helped a friend move his fridge down a couple flight of stairs. He was (actually still is) remodeling his house and needed the fridge to be moved to the garage. We carried the fridge on an oversized hand truck down the stairs, him at the top, and me at the bottom. In retrospect, that may not have been the smartest thing in the world to do. Ah well.

On the last step (why does it always have to be the last step?), the fridge fell on my knuckles. In a reflex, I lifted the fridge to free my hands, alas not exactly using proper lifting techniques (and swearing quite a bit as well). The reaction of my back was immediate. I felt a sharp, unbearable pain in my low back. I couldn’t straighten my back. I was bent over, trying to catch my breath and not panic. The latter was easier said than done. Images of slipped discs and debilitating pain flashed before my eyes. I didn’t know if would be able to work again and if yes, how soon. It is pretty much impossible to perform any kind of massage with a back seized up. I cursed myself for being so stupid and for knowing better than to try to lift a whole fridge with my arms.

After I managed to quiet my initial panic reaction (when in doubt, just breathe…), I tried to assess the situation. Movement and heat seemed to help. That is good news. I didn’t feel any shooting pain in my legs, and no numbness or tingling. Another good news. That’s when I remembered that I see many people every week with all sorts of back problems. It is easy to let such intense pain take over your emotional being (at least for me). I have been privileged to witness many amazing recoveries and the amazing healing abilities of the human body. So I calmed down and remembered: I will be alright. I will recover. It might take weeks, months or (shudder) years but I will recover. I will not let the pain take over me, define me, rule over me.
This affirmation changed my outlook on the situation. The pain, the injury became an opportunity, a teacher.

Let me clarify a few things. I do not pretend to a higher ground because of this decision, nor do I think it would work for everybody. I have seen the relentless erosion work that chronic pain can have. I completely understand the feeling of hopelessness that it sometime creates and I don’t think I am actually immune from it. But this pain, although probably the worst I’ve ever felt with the exception of some raging toothaches, was different.

I have been lucky to manage to go through life without ever experiencing serious back injuries. Because of my work, I need to understand the structures and mechanisms involved in a lot of back injuries but until now could not really understand the emotional and psychological ramifications of the pain. I now understand better how profound a back injury can be. Almost all major movements initiate in our core muscles, our low back and lower abdominal muscles, from our lower Dan Tien as referred to by Tai Chi practitioners. When your back hurts, almost every movements of daily life hurt. This can really be distressing. Also, the back is perceived as the strong side of our bodies, our shell. Don’t we turn our back to protect ourselves from a potential blow? The implication of our armor, the strong side of our bodies, our shell to be injured definitely feeds a sense of insecurity, of vulnerability.

This revelation allows me to be a better bodyworker, understanding not only the mechanics of back pain but also its emotional impact on the whole person. After all, it is all connected!
As for my back injury, after about 3 weeks of intensive care by massage, yoga and contrast therapy, it is healed, as expected :).

If you are interested to learn more about the concept of pain as a teacher, I recommend you read “The Gift of Pain” by Paul Brand and Philip Yancey. Check the booklist on my web site for more information.

Surgical and Nonsurgical treatment options for Spine disorders.

I love Seattle! I really feel blessed to live in an area of the country where we have access to so many resources about healthcare and well-being. One of the resources I recently discovered is the collection of community education seminars put together by the Swedish Medical Center. These seminars are open to the public and almost always free. Check Swedish’s web site for details (http://www.swedish.org/).

Last week, I attended a seminar put together by the Orthopedic Institute about surgical and non-surgical treatment options for Spine disorders. I see a lot of clients complaining about back pain in my practice. I thought it would be quite interesting to hear what orthopedic surgeons' take on the problem was.

The presentation was delivered by Dr. Alexis Falicov, an orthopedic surgeon for Proliance Surgeons. Dr Falicov went through a set of slides describing the basic anatomical structures making up the spine. He then covered some of the traditional symptoms associated with spinal problems and the most common spinals disorders encountered. He then reviewed non operative treatment and prevention options before explaining in detail the different surgical procedures available.

Far from being an advertising for surgery, Dr Falicov really emphasized that surgery should be your last recourse and should not be considered lightly. He mentioned that the United States performs 3 times as many surgeries as other ‘industrialized’ countries, primarily because it is a very lucrative industry (this is probably a good topic for another entry). His message was clear: surgery is a traumatic event for the body and should really be avoided if possible. This is definitely a message I agree with.

The section about nonoperative treatment options and prevention methods was particularly interesting to me.
The prevention message was clear: exercise is the fountain of youth when it comes to your spine. Flexibility and conditioning training such as yoga and Pilates are amongst the best thing you can do to maintain a healthy back. Also critically important is the use proper lifting techniques.
One statistic worth repeating was that 90 to 95% of all back problems can be treated without surgery. The secret: patience! It may take months and sometime years for the symptoms to completely disappear. Also, most back pains are a result of muscular problems along the spine which surgery will not help. Massage therefore can help a lot!

Dr Falicov’s approach to spine problems is rather simple: plenty of prevention, 48 to 72 hours of rest after a flair, use of heat and ice to calm to muscle spasms (or what I call contrast therapy), patience, the use of over the counter medications (if it cannot be avoided) and talking to your primary care physician.

It was also interesting to hear him talk about the use of corticosteroids injections. He said that the injection’s primary role is to hide the pain, not to accelerate the healing. The healing speed is the same with or without the injection. What changes is the patient’s comfort level.
When surgery is the only option, Dr Falicov outlined some general principles to remember:
· Arm and leg pain are more often relieved than neck and back pain
· Pain and weakness respond better to treatment than numbness
· Surgery is a physical stress and trauma to the body
· Psychosocial stressors dramatically modify pain and do not respond well to surgery (ie: if you are under a lot of stress at the moment, chances are it is the cause of your pain).
· It is difficult to restore motion. You more than likely sacrifice motion in the back to regain function in the limbs.

Another interesting fact I learned during the seminar is nerves actually can regrow. The process is extremely slow (about 1mm per day) and the recovery is rarely complete.

I highly recommend those seminars. They are truly a wonderful resource to help us take ownership of our health!