The day I broke my back
Back pain can be debilitating. I know. I’ve been there.
I remember waking up one morning with horrific pain shooting through my back. The sort of explosive pain that stops you breathing and feels like a full body explosion. I lay there for hours until I realised I needed to get help. I slowly rolled out of bed, carefully manoeuvring myself to the ground to then crawl to the door to the phone. This was the “olden days” when phones were attached to walls. I didn’t know what was happening but I knew it was serious. I knew it was serious because A) it was my back and B) it was excruciating pain. Everyone knows how serious a back injury is. It’s my back after all. Back injures can be crippling and I mean literally crippling. The pain was some of the most intense I have experienced. So lets now fast forward to the doctors surgery.
He looked up from my back X-ray with a worried look on his face and said something that I will never forget.
I learnt a lot about my back that day. Not from the doctor however – that was mostly useless.
The first thing he asked was “How long ago did you break your back?”.
What the??? He quickly re-assured me that it had healed nicely. That’s good because a back injury is serious and crippling. Isn’t it? Crippling, painful at all that? Well apparently not.
Life Lesson 1: Not ALL back injuries were serious, crippling or even painful.
Then he proceeded to explain that he had found a “boney growth on the spine” as well. Now EVERYONE knows growths are never good and a growth on the spine just makes it worse right? He also pointed out that this type of thing ends many fast bowlers careers and then casually also drew my attention to the scoliosis (curvature of the spine) that I had. I vaguely remembered being told this when I was young but had forgotten about it completely.
So Doctor, what was the cause of the pain? I got a couple of possibles & maybe’s but nothing that explained why now. None of this was new or an injury so he couldn’t confirm a cause. I probably had all these things for some time even though I was as fit and healthy as I had ever been.
Life Lesson 2: Backs are resilient things that can be twister, cracked, gnarled yet adapt well to serve us well without pain.
So the doctor prescribed some pain drugs and tried to ‘prescribe’ some ideas about me being damaged, deformed and fragile. The drugs I swallowed, the beliefs I didn’t.
A few days later the pain had stopped and I got on with life. Forgetting about it all, just as I had apparently forgotten that I once broke my back. Strategic amnesia is a powerful force in recovery and health.
This true story highlights what is behind a recent push in Australia to avoid unnecessary testing like X-rays and scans for lower back pain (“Choosing Wisely Australia”).
“Just to be on the safe side” might sound nice but can do more harm when it comes to back pain. This is due to the risk of misinterpreting the “normal abnormal” findings as causative, when they can often be incidental findings. Interesting but irrelevant.
Lower back pain is one of the most common reason someone goes to a doctor in Australia AND it is almost never about the structure. (the nerves, the discs, the spine, the vertebrae, the gaps and openings that ‘should’ be there or the gaps and openings that ‘shouldn’t’, the thinning or the thickenings, bulging or compressions). It is so rarely about structure that evidence now suggests that ‘non-specific lower back pain’ isn’t even worth getting scanned.
Most of us will have irregularities in our bodies – thin bits, sticky-out bits, protruding bits. Our bones, muscles, nerves are alive and adaptive. So there is constant adaption to the life we have lived and we are incredible robust. We can have all these wonderful irregularities or changes through out our lives and never feel pain. A third of us are walking around right now with slipped discs/herniated/bulging discs and there is no pain. Its just not that big a thing.
Many people at this point will be a little lost. But there IS pain so there MUST be something wrong. A scan is the only logical test. Or the other reasoning is that because there is something on the scan and there is pain, THAT must be the problem.
It all comes down to this common misunderstanding of what pain actually is. Our shift in thinking around both pain and the brain has been so large and swift that most if us are running on an outdated view of what pain is.
You can have damage and have no pain. You can have no damage but pain. Pain is merely part of the body’s protective warning system. It is created in the brain and takes into account many factors before it decides to turn on pain AND is vey easily influenced by a wide range of factors – stress, beliefs, thinking styles, childhood experiences, the context, what else is going on in our lives.
Pain is a little like a smoke alarm. It’s to protect you. Pain is not the fire but the alarm to get your attention and the alarm can go off when there is no fire.
The effectiveness of the protection system requires accurate information being relayed to the brain. The brain needs to know what is happening in the body. And here is the clincher. Stress hormones AMPLIFY the message that gets to the brain. So the things that the brain previously would have safely and correctly choose to ignore (slipped discs, boney growths etc) now gets the brains attention and it fires off the warning bells.
Unless we understand the subtle and wonderful workings of pain, we can begin a long drawn out and often unnecessary attempt to “find it and and fix it”, with our attention commonly directed to perfectly safe/normal irregularities rather than addressing the other factors that are increasing the sensitivity of the nervous system or getting the brain to misfire a pain alarm.
If you had a over sensitive fire alarm going off every time you cooked toast or had a steamy shower would you call the electrician or the fire brigade?
Back pain is serious and debilitating. But the sort of back pain that sends most people to their doctor/physio is rarely about an injury. The modern understanding of pain, the biopsychosocial model, allows us to see a bigger perspective of what might be going on that has put our wonderful protection mechanism on ‘high alert’.
Unneccessary X-rays and scans don’t just clog up the system and waste money. If I left that doctors office with a belief that movement was dangerous, then that belief around the ‘threat of movement’ could have made sure the brain keeped protecting me with unnecessary pain.
Thank you but not today BRAIN.