As a physiotherapist with years of experience I know that most back pain is not serious (ref). I also know that the severity and intensity of back pain is poorly correlated with damage and pathology (ref). And I also know that most back pain resolves spontaneously regardless of the treatments and interventions used (ref). And that imaging for back pain is not necessary for most and may even be detrimental for some (ref).
Yet despite knowing all of this I want to show you how all this information means very little when the low back pain is your own, and how bloody difficult it is to convince anyone with back pain that they don’t need a scan, that things will get better, and that there is nothing serious to worry about.
I also want to show you how sometimes having more information isn’t always better, and how back pain can be as scary as hell and really screw with your mind, convincing you that there is something really, really wrong even when you should know better.
So my story of low back pain began on a Wednesday evening in May 2012. I was training after work as usual and had just finished my weekly deadlift session. All was going well and I thought I would finish off the session with a few sets of kettlebell hip swings just to fatigue the posterior chain properly.
I did the first two sets and all felt good and I thought I’d do one last set and call it a day. However, about half way through the last set I was suddenly floored with the most severe, searing and stabbing back pain I have ever felt in the left side of my lower back.
Now I’m not proud to admit that I collapsed to the floor like discarded wet rag and lay there crumpled on the ground in an ugly sweaty mess, dazed, confused and wondering what the hell just happened. My first thoughts were I must been stabbed or perhaps a target of a rogue sniper attack, had the elite manual therapists sent the assassins for me? But after a quick check I found no bullets wounds and no ninjas standing over me, so what the hell had just happened?
I finally managed to get to my feet and hobbled out of the gym, wincing and whimpering with every painful step, trying as best as I could to put on a brave face in front of the other gym users now looking on in a mixture of confusion and amusement. Once home I spent the next few hours trying to get myself together, but I was in agony and felt like I couldn’t move at all.
Eventually I calmed myself down and started to do my own self evaluation. My findings were…
- All lumbar movement grossly restricted and painful, but mostly into extension, with flexion being the most comfortable.
- I had no distal or neural symptoms
- I had no loss of sensation or power anywhere in my leg or saddle area.
- I had no bladder or bowel issues nor any other features of severe neural compromise
With my self assessment complete what I should have concluded was that I clearly had an acute episode of low back pain with no serious or sinister signs and that this would most likely resolve in a few days and probably take a few weeks to return back to baseline.
However, what my anxious and worried mind actually concluded was… “this amount of pain clearly means you have suffered a massive lumbar disc herniation” and my frantic mind was NOT happy with just this oh no, it decided to go further and give me other thoughts as well… “I bet you’ve probably suffered a massive lumbar disc explosion and now have nucleus pulpous splattered all over your nerve roots like shrapnel from a bomb blast and you will be crippled and weakened forever”
Now I am exaggerating a little here for comic effect, but honestly upon reflection my thoughts were not too far from this. I was thinking due to the severity of my pain that I must have suffered a serious structural lumbar disc pathology even though I knew I didn’t have any of the key clinical signs or symptoms.
After 2 weeks of frustrating and annoying back pain and still feeling convinced of a lumbar disc explosion, I talked myself into paying for a private MRI and consultation with a spinal surgeon for what I was convinced was going to be a surgical lumber discectomy . Even though in hindsight I can now see I was recovering and feeling better during this time, and still had no clear signs or symptoms of neural compromise!
Now thats embarrassing!
Now, the really embarrassing part, as you can see from my MRI images below there is absolutely NOTHING wrong with my lumbar spine at all, no major disc pathology, no herniation, not even a slight bulge, or any other issues, and certainly no disc explosion that I had convinced myself I had suffered.
So here I was an experienced physiotherapist with years of knowledge and training about back pain and its signs and features, its prognosis and its management, now sitting in an surgeons office after an unnecessary MRI anticipating surgery for something I should have known didn’t warrant or need it. Did I feel foolish… you bet I did and I still do!
However, looking back on this episode I have now learnt a lot from it, and can appreciate how all the knowledge in the world sometimes can’t replace first hand experience. As Einstein said ‘the only source of knowledge is experience’ and as the great philosopher Henry Rollins also once said ‘knowledge without mileage, is bullshit’
There is no doubt that this experience with severe acute back pain has taught me a lot, such as pain tends to cause us worry, concern, and to think the worst. Also how much of an incredibly difficult task us healthcare professionals have in trying to reassure and convince those we see who are in pain that there’s nothing seriously wrong or to worry about. I mean, if I couldn’t convince myself of this, what chance do I have in convincing my patients.
When I think about how I was feeling during this time it does make me wonder if anybody could have convinced me that I didn’t need a scan, and that everything would be ok in a few weeks, and that I just need to keep moving, and give it time. I doubt it!
However, I do also recognise that sometimes too much information can be a dangerous thing, and that perhaps my exposure to many patients over the years with severe disc injuries and issues, plus my awareness of all the worst case scenarios skewed my perception and primed me to expect the worst rather than taking a more calm and calculated look at things.
Anyway, I’m pleased to report that as predicted my back pain improved in a couple of weeks, my activity returned to normal, and I have had no further major issues issues since. Although I will be honest and say that I did associate my back issue with the kettlebell swinging, and rather foolishly I avoided any further kettlebell swings for a good while afterwards.
However, I’m pleased to report that all is now rectified and I am back to swinging those bells happily and comfortably and so far without any other further stealth ninja assassin attacks.
As always thanks for reading