The Kelsey Report

The Pain Game – Part II

In Part I, I explained that pain is, in fact, ALL in your head despite how convinced you are that the pain is in the area of the body you feel. And I covered Five Ways to Use Your Mind to Decrease Your Pain.

I mentioned that I had tangled with the Thanksgiving dishes and lost; that I ended up with a nice bout of lower back pain and was a little freaked out about the whole thing.

In this article, I’ll explain in detail what I did to survive my “back attack”.

So, just to set the stage, I felt fine until I sat down the Saturday morning after Thanksgiving to do a breathing exercise that my trumpet teacher had given me. And as I tried to stand up, I had a sharp, stabbing, take- to-you-to-your-knees kind of pain.

I had to sit back down.

And then it started.

I felt the mental and emotional landslide from three years ago when I fell while snow skiing, herniated a disc, and spent the better part of a year putting myself back together, and oh, yeah, gaining about 20lbs of fat too.

Ok, so I know that pain is three dimensional: physical, mental, and emotional BUT when you hurt, all that knowledge flies right out the window. You have no access to that part of your brain. You emotions close the door to the rational, logical regions.

Your mind runs the game. ((Polatin, P. B., R. K. Kinney, et al. (1993). “Psychiatric illness and chronic low-back pain. The mind and the spine–which goes first?” Spine 18(1): 66-71))

It’s almost as if your emotions are begging you to acknowledge them to allow you access to the thinking part of your mind. So, that’s what I did first. I just talked to myself. Well, muttered is maybe a better word. I talked myself off the ledge with words and deep breathing.

Then, once I had done this, I started formulating a plan to recover physically. About the last thing I wanted was another six to nine months of relative inactivity.

The process breaks down like this:

  • control symptoms and heal the tissue
  • re-establish motion
  • improve balance and reaction time
  • maximize strength and endurance

First step, stop the bleeding. Get control of the symptoms and facilitate the healing process. I refer to this as Recovery.

With almost any back problem, you’ll feel better if you lower the pressure exerted on the spine. So here’s what I did:

  1. I tried to sit as little as possible. Sitting has very high compression loads in the spine and if you damaged just about any structure in the spine – the intervertebral disc, ligaments, muscle, tendon – the extra pressure is like standing in a sprained ankle. Doesn’t feel very good and doesn’t help the tissue heal.
  2. Instead of sitting, I was either lying face down, on my back in a 90/90 position of the knees and hips, or in my inversion table. I basically spent three days – Saturday through Monday in one of these positions. My wife had to pick up some extra work (thank you Elle) so I couBest brace for low back painld rest my spine.
  3. I wore a sturdy brace to reduce any bending movements of the spine. I really like this brace. I hadn’t used it for three years but as a tool to aid recovery, it’s the best one I’ve tried and I’ve tried a lot of them.
  4. When I was on my back, I gently practiced a breathing technique to help turn on the deep muscles in my spine that help control small movements.
    These muscles go into hibernation almost immediately after an injury or surgery and don’t come back unless you force the issue. ((Hides, J. A., C. A. Richardson, et al. (1996). “Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.” Spine 21(23): 2763-9)) The key to this technique is to not work too hard. Just go easy. It doesn’t take much effort for it to work.
  5. I used these pain patches to distract my brain (and it may also have some medicinal effect but I’m not a practitioner of Eastern Medicine and don’t understand how the ingredients work). These things feel really good. Not like a Ben gay patch though. They have a different quality – very soothing.
  6. I called my coach. Yep. I know better than to go it completely alone. I ran my plan by Christine who agreed with my overall plan and also suggested I stop playing my trumpet (and that was possibly the hardest part of the whole thing). Duh. Trumpet is a very physical instrument and creates a lot of pressure in your trunk / back. Not such a good idea in the “stop the bleeding phase”.

After three days of doing these things, I no longer hurt much at all. I had very mild pain only with bending forward. So, I moved to phase II – Restoration.

Phase II

Restoration is getting back the basics – motion, balance, and neuromuscular coordination. I wasn’t quite ready to dive into a training routine though. Even though I felt okay, I knew I wasn’t okay.

Since I had written a book on how to build a rock-solid core, I thought it might be a good idea to follow my own advice. So, I just started working my way through the drills in the book.

I started at the beginning and progressed through the drills fairly fast. Each week, I would re-assess my condition and adjust.

After a little over three weeks, I felt fine and was able to do the drills in the book.

From there, I moved back to the Elements to start the strengthening and endurance building I needed. I started at Carbon and just gradually added more and more Elements.

Now, I feel fine. I can do just about whatever I want – but I don’t. Not yet. I’m careful with how much I sit. I make sure I use spine friendly drills and once a day, I hop into my inversion table and decompress. When I play trumpet, I wear the brace – just as a precaution (and I’ll do these things for about another three weeks). I know that I still have a little ways to go until my tissues are sturdy enough to tolerate, say, 5  x 40 yard sprints or repeated jumps at a basketball rim.

In retrospect, the severity of the injury was probably less than what I felt. That’s one of the problems with pain. The magnitude of injury doesn’t always correlate with the amount of pain you feel. If I stuck a sewing needle under your fingernail, you would howl like a wolf at the moon. But, how much actual tissue damage occurred? Not much.

Some practitioners argue that I would have improved whether I did anything or not. In fact, this notion, that back pain gets better on its own, is so entrenched in medicine that a lot of folks who go to their doctor with back pain, get dismissed with a, “You’ll be fine” attitude.

But here’s what most doctor’s don’t know. Nearly 90% of people who have an onset of acute back pain, will still be complaining of some degree of pain and/or disability one year later. ((Croft, P. R., G. J. Macfarlane, et al. (1998). “Outcome of low back pain in general practice: a prospective study.” Bmj 316(7141): 1356-9))

So, in other words, don’t ignore it.

Previous Post The Pain Game: Why Pain is NEVER Where You Think It Is and What To Do Next Post How to Increase Your Strength Without Increasing Weight
Omar says

I had a back attack on Wenesday. It was most likely from a training error. Ever since I banged my left knee on a rock during some winter hiking over the holidays, I have been shorting my priming. I have been avoiding the fire hydrants, bird dogs and anything requiring kneeling. So, I was likely not warmed up when I started Northstar. During my second set of side sliders I felt something in my lower back and stopped immediately. Another strong possiblity was I was sloppy with my form and not keeping my back as straight as I should with the 25lb weight in my hand.

So now, I feel spasms and twinges of pain in my lower back when I stand and walk around. And I tend to want to walk hunched forward. Standing straight up is a bit of effort. And in particular when I get up after sitting for long periods of time it is worse. But today is overall better than yesterday. I have been skipping all workouts since this happened. And lying down on a heating pad in the evenings. I’ve been avoiding the NSAIDs. I’ve been trying to stay relaxed and calm.

I’m telling myself that if I adopt a patient stance and not rush back into anything that I should be fine soon. I’m adopting the the self image of an athlete and not a lame duck. I’m thinking that if I feel pretty good tomorrow morning, I’ll take a few long walks this weekend and maybe start into some of the core drills…

    DD Kelsey says

    Omar –

    I’m sorry to hear about that…but the good news is that it sounds like you’re on the mend and maintaining a positive mindset. Likely a lot of what I wrote in this post will help you. You’ve put in a good amount of time on yourself so I suspect you’ll bounce back fairly fast by doing the simple things. Hang in there and if you need something, let me know.

      Omar says

      There has been marked improvement in my lower back/butt since my back attack one week ago. Key facts in my story: I took a rest from workouts for about 5 days and was as careful as I could be not to further the injury. This meant minimizing how often I carried my 2 year old. Hard to avoid! But I did try to get some short walks in over the weekend (no backpack this time!) I applied a heating pad on my lower back during the evenings while elevating my legs. On the 6th day I was walking with much greater ease, so I started to do some priming drills and hip mobility drills. Once I keyed in on DK’s advice to start working through “Rock Solid Core”, things started to really come together. In particular, the hip burners and bridge drills started to work their magic.

      And the main take away is that after some short but effective rest, I got back to focused movement as soon as I could. In less than a week! Movement is your friend and setbacks need not take you out of the game for long….Thanks DK, for sharing the knowledge that speeds recovery!

      One thing I learned from stepping through RSC is that single leg bridge has always been too hard for me. I always felt it in the hamstrings rather than in the butt/lower back. So I had been effectivelty shorting my “Tin” element, and very likely NOT been stregthening my lower back and butt as well as I should have.

      So I encourage everyone here to revisit and refresh on the “Rock Solid Core” periodically. Remember, It’s FREE for tribesmen and you can find the link to it in Carbon. It is a great check of your progress. I actually wish I had done so earlier.

Dan says

You didn’t mention any sort of massage. I wonder why.

I like the Thera-cane and the Backnobber II. I like the handles on the Thera-cane better, but the Backnobber is stiffer, which works better when the muscles are not so tender. Each one is less than the price of one massage.

    DD Kelsey says

    I was using my particular situation as a way of explaining options. I have a device like the Thera-Cane and use it but I have found it to be more effective on less acute situations than the one I described in the article. So, yes, massage and variations on that theme can be quite helpful especially for trigger points.

    Thanks for your comment.

Comments are closed