The Problem Isn’t Always What You Think It Is

I had a conversation once with a gentleman who was curious if I could help him with his lower back pain. He was referred to me by a friend of his whom I had guided through a number of injuries and problems over the years.

John* (a pseudonym) was in his late 40’s and other than lower back pain was in good health. He was about 5’9″ tall and weighed roughly 155 lbs. He appeared lean, muscular. Some might describe him as appearing “fit”.

He’d had lower back pain for several years and had seen several practitioners – chiropractor, physical therapist (2), massage therapist, acupuncturist, orthopedist, and a neurologist – yet his pain persisted.

He was an avid snow skier often skiing several times over the course of a ski season. I asked him how he managed to do this since his symptoms were easily aggravated with basic daily life movements.

“Oh, I take Advil. Usually, I start several days before I leave on a trip,” he explained.

“And how much Advil are we talking about?” I asked.

“Well, usually 8-10 a day when I’m skiing. I still hurt but not as much. It’s not so bad that I have to stop skiing,” he replied.

“And when you finish skiing, what happens?” I asked.

“It hurts a lot for several days then it kind of settles down to its usual level,” he replied.

‘What did your doctors say about the Advil?” I asked.

“They told me that it was too much, that I shouldn’t take that much,” he said.

“So, why do you keep taking it?” I asked.

He looked at me like I had a second nose.

“Really? Well, how the hell am I supposed to ski without it?” he said in a rising voice.

“You could stop skiing for a time, give your body a chance to recover,” I said.

“Yeah, you’re like everybody else. You guys all say stop skiing and I tried that and it didn’t work,” he replied.

“What do you mean it didn’t work?” I asked.

“I mean I hurt when I went skiing!” he said forcefully.

“And what about the stretch of time you weren’t skiing? Did you hurt during that time period?” I asked.

“Well, no, not much and yeah, I didn’t hurt but the thing is, I did all that and as soon as I went back to skiing, it started all over again,” he replied.

There are two problems here.

First, is that by stopping the skiing and not doing anything to prepare his body to resume skiing, John is setting himself up for re-injury. Just because you don’t have symptoms doesn’t mean your body is strong enough to go back to something like skiing. I taught my students that the main problem, especially in someone who has symptoms a long time (and I am referring to orthopedic symptoms) is rarely the problem the person presents with as in this case, lower back pain.

And second, John’s main problem is his decision making, his mental model. He continues to ski knowing it will cause pain and then uses Advil to deal with the symptoms. Until he changes his behavior, he’ll continue to hurt and likely cause more physical problems.

Why does he do this? Does it seem rational to you?

If we’re honest, we’ve all probably done this – made a choice that we know is going to cause a problem.

So, why do we choose to do something that we know will create the very thing we’re complaining about?

And continue to do it?

A “mental model” is a framework for how to interpret our world. It helps us make decisions and there are a number of types of mental models.

Unless you’re aware of how you make decisions, your mental model is something that you developed over time from the various influences and situations in your life.

For most decisions around physical recovery, the Second-Order Thinking model is helpful.

Second-Order Thinking is a decision process in which you consider the consequences of a choice and the possible future effects.

It’s safe to assume that when you choose to do something you know will be harmful or not in your best interest, you’re not using Second-Order Thinking. You’re reacting.

A common reason for this kind of thinking – the reactive type – is that the activity (or other choices) helps counterbalance the load of some aspect of life. Maybe that load is a job you hate, a relationship on the skids, kids in trouble, employees, finances, or any number of things.

Running is a common form of “stress release”. People who run or exercise to “control” stress feel rising levels of stress and anxiety when they can’t participate.

Even if your body hurts when running or after, the physical pain of running is less than the emotional pain of life.

So, you run.

A scenario I’ve seen before goes something like this. You have an achy, painful joint and are forced into giving something up you love to do while you repair, rebuild your body’s capacity.

But this takes time. The body runs on an agricultural tempo and all too often we become impatient and start looking for a faster “fix”.

Surgery is sometimes perceived to be this faster fix so you abandon the program you’re on, even though it’s working, for the siren of surgery.

But, you don’t stop to weigh the risks of the choice, the possible outcomes, and to analyze your choice in light of prior progress.

Surgery might fix the physical problem but you still have the same mental model in place as before the surgery.

And, what do you suppose is going to happen post-surgery? Do you think it’s plausible that you’ll follow the post-operative instructions, the timeline to return to running? Doubtful since this would require a different mental model. And since you’ve not changed mental models, your symptoms are apt to come back.

I’ve seen this scenario over and over and in almost every case, the person ends up re-injured and very frustrated.

If you find yourself in this sort of predicament, I have a couple of suggestions.

One, acknowledge the issue and, if needed, find a professional or someone you trust to help you develop new coping strategies, new mental models. While you’re working on that, your body gets some much-needed rest and recovery.

Two, try this book – Liminal Thinking.  Liminal thinking helps you identify illogical beliefs and construct new ones based on facts, the truth. In a sense, liminal thinking “wakes” you up, makes you aware of your choices and helps you build new belief constructs for better choices. Most habits, like smoking, drinking, stress eating, stress exercise, are rooted in an unconscious belief construct. You do it but you don’t know why. When you know why you’re doing something, it’s much easier to change it.

Thanks for reading.

If you like this article, why not share it with a friend? If you’re interested in coaching services, please contact my colleague Laurie Kertz Kelly for a free, 20-minute Strategy Session by, clicking here. To get my Secret Weapon to fight knee, hip & back pain and stiffness, subscribe for free today.

Doug Kelsey has been a physical therapist and human movement expert since 1981. He is formerly Associate Professor and Assistant Dean for Clinical Affairs at the University of Oklahoma Health Sciences Center and the author of several books. He has conducted over 250 educational seminars for therapists, trainers, physicians, and the public and has presented lectures at national and international scientific and professional conferences. His professional CV is here.

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