As you may know, I recently had an acute episode of low back pain with some left leg radiculopathy when deadlifting a few weeks ago. As painful and frustrating as this was I thought it would be a great opportunity to document and share my experiences of the ups and downs of an episode of back pain and you can watch this on my Instagram page here.
This journey has been a painful, stressful, and frustrating one, but also an enlightening experience that has highlighted and re-iterated some important things for me. The first and most important thing is never underestimate just how bloody hard it is to tolerate and endure severe pain for extended periods, nor how easy it is to worry and think the worst about what’s causing it, and if it will get better.
Knowledge without Experience is Bullshit!
Despite my training, knowledge, and 20+ years of clinical experience managing people with all types of pain, and knowing that the research shows many episodes of back pain and radiculopathy improve favourably over time. There is NOTHING like some first-hand experience of living with searing, unrelenting neuropathic pain to really put things into perspective about how this information doesn’t make things feel any better or stop you from worrying any less.
Despite knowing things heal and recover with time, I didn’t care that much at 3 am in the morning whilst lying on the living room floor trying to find a position that eased my agonizing leg pain a little. Despite knowing my pain will improve and my prognosis is good I still had doubts, concerns, and occasionally thought the worst.
These last few weeks of severe pain, lack of sleep, and bone-deep fatigue have hammered home that if I’ve struggled to reassure myself at times, just how good am I at reassuring others? This episode has also reminded me that when pain is severe, constant, and unrelenting it can take control of you and your thoughts, and no matter how tough, resilient, or double hard you think you are it adversely affects you.
Cringe!
I cringe a little now when I think back to the times I have tried to reassure those with similar pains to mine, by carefully and compassionately explaining how they have no signs or symptoms that indicate they have anything to worry about or need further imaging or invasive treatments. And how they will feel a lot better in a few weeks and should try to reduce and control their pain with some simple exercises, a bit of analgesia, hot or cold packs, and by staying as active as much as possible.
This recent painful episode of mine has made me think, how effective was/am I doing this, and does it actually help anyone? Well, judging by some of the messages I’ve received it seems that it does as many have told me they found it really useful to hear me talking about these feelings and emotions publicly, and by simply acknowledging and normalising these doubts and concerns it has helped others understand that it is perfectly normal and natural to have them as well.
I have also been really grateful for all the kind, encouraging, and supportive messages I have received over these last few weeks as these have really helped me stay positive and motivated through some tough times. These messages have also re-iterated to me just how important and useful some simple, honest, kind, genuine, support, and encouragement can be when you’re in pain, tired, frustrated, and thinking the worst.
Positive and Negative!
However, what I haven’t enjoyed, nor was I expecting when sharing my updates were the number of attacks, accusations, and nasty comments I got from others. Don’t get me wrong, I’m not naïve enough to think I wouldn’t get any, as I know you can’t put anything on the internet these days without some troll posting something hateful, and I’m well aware that I’m not everyone’s ‘cup of tea’ rubbing many up the wrong way with my views and opinions on things.
But I did not anticipate that I would get so many nasty, snide, and snarky comments from so many so-called kind, caring, and compassionate clinicians who are clearly revelling and rejoicing in my current predicament. Again, don’t get me wrong, I expected and hoped for some piss-taking and teasing, but never did I think so many would be so excited to see me hurt or use this episode as an opportunity to attack me and my reputation.
During these last few weeks, I have been accused of being unprofessional, inexperienced, and a shit physio, and these are just the comments I have seen as I’m also told many more have been said in closed forums and private social media groups. It seems that some turd juggling wassocks out there think physios should never get back pain or be injured, and if they do it somehow means they are less skilled or knowledgeable than others. I guess this also means these useless fart bubbles think doctors shouldn’t get sick, surgeons shouldn’t need operations, and professional athletes shouldn’t get injured either.
You Deserve It!
I have also been told by some so-called ‘therapists’ that I deserve my pain and have earned my injury with my reckless approach to training and terrible lifting technique. This is even though theres no evidence that any lifting technique increases or reduces the risk of back pain (ref) heavy lifting is not a common cause of discogenic back pain (ref), and this is my first significant lifting related injury in nearly 30 years of continuous deadlift training whilst doing a near-maximal effort 2.5 x bodyweight lift.
It seems that these arse biscuits think all injuries are avoidable and if you do get injured when exercising it’s your own fault. These mouth breathers also seem to think their so-called perfect form and correct lifting technique they demonstrate with less than bodyweight loads is the solution to the prevention of all back injuries.
Well, newsflash bell ends, anyone can maintain a pretty looking posture when they lift light-weights, but trust me it will soon turn ugly when you increase the load or the intensity, which they would know if they actually did that from time to time. What these comments highlight is just how many dumb arsed therapists are completely oblivious to what heavy intense exercise looks and feels like.
When these idiots expect everyone to move the same way lifting heavy-weights as they do lifting light-weights, they are as clueless as someone who thinks a runner should sprint the same way they jog. These clowns fail to recognise that all movement is complex and hugely dictated by the task which includes the loads, speeds, intensities, and complexity and that all injuries are multifactional and never due to a sole factor alone.
Yes ok, maybe higher loads, speeds, and intensities may have higher injury risks, and yes, you may reduce these risks by reducing loads, speeds, and intensities, but don’t kid yourself for one second into thinking this eliminates it.
Fearful Physios
These comments also demonstrate how fearful and risk-averse some therapists are to exercise and training. Don’t get me wrong I’m all for being sensible and I do like to build things up steadily and progressively in most people for most things. But to think you should always move the same, or always avoid high loads, high speeds, high intensities to avoid injury is both ignorant and impractical.
During these last few weeks, I have also been accused of being in denial, stubborn, ignorant, arrogant and some more colourful things ending in ‘T’ for not getting assessed or having a particular type of passive treatment for my pains. Some of these odious little cretins have even tried to accuse me of being dangerous and reckless, and even tried to blame me for making my symptoms worse, despite them improving, as well as the growing global back pain epidemic.
It seems that these dripping dishrags think a physio with 20+ years’ experience who has read widely around pain, pathology, and its treatment cannot make a rational, informed clinical assessment and judgement of their own condition. And it seems some of these egotistical flap dragons think that they can assess and manage me across social media from thousands of miles away far better than I can manage myself.
Heal Thy Self!
And to those who think they are being clever by quoting ‘a physician who treats himself has a fool for a patient’ also need to shut the hell up because physicians can and do treat themselves when they have signs and symptoms of simple common illnesses. And just as a physician can recognise the signs and symptoms in themselves of simple common illness that has favourable natural history, doesn’t need further investigations or interventions, so a physio should be able to do the same with a common and simple musculoskeletal injury or pain.
What these comments highlight is just how many therapists do not understand normal healing and natural resolution times, and how they do not, or cannot accept that there are many people who do not want treatment straight away, who are happy to wait and see how things go, and who can carry on despite their pain rather than rush to reduce or remove it.
These comments also highlight how arrogant and insecure many therapists are in not wanting to accept or admit that they are not needed as much as they think they are, or the reason why many of those they see and ‘treat’ get better with it often instead just time working in the background.
All these accusations and attacks also highlight how petty and pathetic some can be when they see others saying or doing things they disagree with, and how some have very delicate and fragile egos combined with large inferiority complexes meaning they quickly get jealous, vexed, and bitter towards anyone who questions what they do or achieves more than they have.
Conclusions
Finally, this back issue of mine has confirmed to me yet again just how much variation there is in physiotherapy practice, with so many different opinions, ideas, and suggestions of tests, investigations, and treatments for something as common and relatively ‘simple’ as an acute episode of low back pain with a touch of radiculopathy.
As much as I understand variation in all things is often a good thing as it gives options, if we as a profession can’t agree on some simple core principles of who, how, and what to do for the most common musculoskeletal issues, then we are in serious trouble. Because as much as I know, there is variation in other areas of healthcare such as medicine, and many doctors have many different ideas, opinions, and suggestions about how to manage something like a common cold, I’m sure all would agree that a common cold doesn’t need complex assessments, unnecessary investigations, or regular expensive treatments.
Until we can get a better handle on this variation within physiotherapy there is only going to be increasing confusion and chaos around our assessments and treatments, which I fear will lose us the trust and respect of not only other healthcare professionals but also the public. And if we lose the trust and respect of the public physiotherapy will be quickly pushed out to the fringes of healthcare along with the other quacks and nutjobs who claim miracle cures and quick fixes with their trinkets and charms.
As always thanks for reading
Adam
SPECIAL ANNOUNCEMENT
If you would like to learn more about an evidence-informed, no bullshit approach to the assessment and management of low back pain then I am running a short webinar on Tuesday 28th Sept at 7pm BST.
To find out more or to reserve your place please click the image below or this link here
Way too much victimhood attention-seeking. Toddler time.
You’re Awesome Adam. I respect your humility and honesty. A physiotherapist in Australia.
I had a similar episode earlier this year. I was rotating my tires, lifted one tire up over the jack rather than lift the handle out of the way and roll it. I did not have radiculopathy but it took my breath away. I figured it was an opportunity to try what I teach. I wanted to see what exercises would work most effectively. I did only 2 things: bird dogs once a day and e-stim on my abdominals and paraspinals. I was at 100% in 5 days. I expected it to take at least 10 days to begin to get better and was pleasantly surprised. But each individual will be different and I may have just been lucky.
Im all for the active approach. I did do it on my shoulder some years ago (took me 1.5 years to be able to 1-Arm-Hang again). But people like you and me – who are for the all active approach are easy to fall in their own bias. By not trying some passive treatments, you missed the unique chance to feel the bullsh*t on yourself. I tried it back then, just because of curiosity what it would do. And I was surprised that its not all the same bullsh*t, but that there is better – even a little helpfull BS – and crappy BS.
Keep moving and take your time – embrace the struggle. It was my companion during the shoulder rehab, and we had fun and not so fun times, but you grow with it ?
Hey Florian
Not sure if you are talking to me or Ron here, but I have tried all sorts of passive/hands-on treatments before for many other pains and have found them all pretty ineffective, so I think I can say I haven’t missed the chance to experience them first hand at all.
Cheers
Adam
If there was clear evidence that HOW you lift matters, we’d have some decent studies showing it, and reduced rates of acute low back pain. We don’t.
After 30 years in this work, I am utterly astonished that there are STILL people who think LBP is something we can “prevent” (we can’t) and that we can’t self-manage LBP conservatively (we can).
Kia kaha Adam, you have done the PT profession SO much good by documenting your progress AND by flushing the fearmongers and unprofessional attitudes out into plain sight. The kind of behaviour I’ve seen towards you from so-called helping professions just shows that for some people, a job that doesn’t involve being with people is a good option.
Adam, when you refer to “confusion and chaos around our assessments and treatments” and loss of trust etc., these problems extend well beyond health care professionals.
A few of us have been dismayed about the accuracy and quality of the advice being provided to consumers by Painaustralia – our peak consumer body.
In particular, we feel that the page “What is pain?” and the accompanying reference material contains misinformation that is inaccurate tends to trivialise the pain experience.
Painaustralia is well aware of our concerns.
Perhaps you would like to comment as a recently recovered pain sufferer, even though you were not advised that your pain was protecting your bodily tissues and that you could have been shown how to “unlearn” your pain.
Best wishes
John
Link: https://www.painaustralia.org.au/about-pain/painaustralia-what-is-pain
Hi John, I think the key factor here is that my pain was acute and related to a clear mechanism of tissue injury. Pain is clearly protective, very beneficial and adaptive in these situations and I dont think anyone including Pain Australia have said or promote otherwise.
However, when pain is not acute nor related to tissue injury or pathology then pain’s protective role can become maladaptive and potentially harmful for some. This is what I believe Pain Australia are targeting and trying to help with, and I dont think this is trivialising anything at all.
And I have no wish to get into any argument between them and yourselves about this.
Kind regards
Adam
Adam, thanks for your response. But I cannot accept the idea that an experience such as pain is “clearly protective” of bodily tissues. Moreover, how is it known that such a so-called protective phenomenon can become “overprotective” (= maladaptive). I think this is just speculation.
No doubt in due course Painaustralia will carefully explain these matters to consumers.
If you think pain is not protective then what purpose does it have John?
Adam, to the person who is torturing you, the purpose of pain is to extract information, or perhaps to force you to recant your views.
On the other hand, Christian theologians would give you completely different answers as to the purpose of pain.
This extreme variation suggests to me that the experience of pain serves no intrinsic purpose.
Therefore the oft-repeated assertion that it has a protective function makes no sense to me.
That makes no sense, why would we evolve a complex system that serves NO protective purpose. What about when we place our hand into a fire or step on something sharp, pain has no protective purpose then? Come on John you’re being ridiculous for a man of your knowledge and understanding!
Whatever the purpose of pain is- personal, direct, brutal pain experience it is a perfect teacher to become (or stay) a humble while compassionate MSK healthcare professional for patients in pain however you might professionally call yourself. Adam, really sorry to read here at your blog about the malicious joy and spitefulness on social media (which I quit and therefore missed) about you sharing your RP experience, what a mess. But- if you go to a brothel don’t complain meeting whores.You pissed over so many idiots shoes – nicely founded by literature knowledge and for me as practitioner&prescriber a pleasure to read and to pump up my tires for daily discussions about BS prescriptions. But if you then hang out your butt off he window in a vulnerable phase those folks take the chance to kick it in that terrible social media mixture of hate, stupidity and desperation. Adam wish you a quick recovery -and if not, a skilled surgeon- as you remember the bright guys at the BCP mentioned that early surgery is best surgery;-)
Take care and all the best!
Hi Adam,
Really glad you got better without resorting to imaging or manual therapy for your back pain. Many thanks for documenting and sharing your journey and recovery with us. I have being following your blogs since I read your blog many years ago on SIJ assessment and mobilisation. It was absolutely brilliant and shaped my practice of physiotherapy.
I have experienced acute onset of severe back pain and I tried all the exercises I usually advised patients to do – knee rolls, bridging, bird dog , etc and NOTHING worked. PCM/NSAIDs did nothing either and I stopped taking them after 1 week. I just got on with life and began to feel significantly better after more than 2 weeks of agonising pain.
This made me really re-think the advice I normally give patients with acute onset of back pain.
Having experienced severe back pain than kept you up at night, I would really value your opinion on the short term use of stronger analgesia like codeine and tramadol to manage acute back pain without significant neurological deficits/ red flag signs/symptoms. In retrospect, do you think you would have benefited from the use of such medication? Would you advise patients to consider taking this medication to help them sleep better and keep them in work whilst they recover, especially when when the usual suspects – heat/cold/ pcm/nsaids – have been ineffective? I find that patients who recover after taking time off work are usually very hesitant to return to work and feel activity/exercise would make their pain come back.
I look forward to your response and keep up the good work. I really do think you have more admirers than turd juggling wassocks who create fear and peddle pseudo treatments 🙂
Great article to read. Thank you for this.