As a physiotherapist with 15 years experience I know most back pain is nothing serious (ref). I know that severity and intensity of back pain is poorly correlated with the amount of pathology (ref). I know that most back pain resolves spontaneously regardless of the treatments and interventions used (ref). I know that imaging for back pain is not necessary for the majority and may even be harmful for some (ref).
Yet despite knowing all of this I want to share with you how flipping scary and frightening an episode of back pain can be, and how it can screw with your mind and convince you that there is something really, really wrong even when you should know better.
This is my own personal story of an episode of severe back pain I had a few years ago. I was reminded of this recently after discussing the difficulty we have trying to reassure patients there is nothing seriously wrong when they are in pain and distress.
So a few years ago I was training in the gym as usual and had just finished my deadlift and squat session. All was going well and I thought I would finish off with a few rapid kettle bell swings. However, during the third set of these I was struck, hit, hammered with sudden, searing, stabbing pain in the left hand side of my lower back with a shooting pain flying down the back of my left leg.
I screamed like an actresses in a budget horror movie, and crumpled to the ground like a cheap suit. I lay there for a few seconds in an ugly sweaty mess dazed, confused and wondering what the hell just happened. Had someone just snuck up and stabbed me? Had I been a target of a rogue sniper attack and been shot? No blood anywhere, ok, so can’t be that then.
So clearing snipers and psychos as a reason for my sudden pain I attempted to stand up, but WHAM immediately I was struck by another bolt of hot, sickly searing pain in my back and down my leg, I let out another squeal and down I went again.
This happened about four or five more times before I finally managed to get to my feet, and hobbled out of the gym bent over like the hunch back of Notre Dame, whimpering and whincing with every painful step, trying as best as I could to put on a brave face in front of the other gym users looking on in a mixture of confusion and amusement.
I attempted to get into my car to drive home but try as much as I could I could just not sit in the seat and drive. I eventually had to call my wife to come and pick me up, much to her annoyance.
Once home still doubled over, still whimpering and now cursing and swearing like a drunken sailor, I spent the next few hours trying to get myself straight.
But no matter how much I tried to do this, lying on my back, front, side, getting my wife to push and pull me in all directions I just could not, the pain was all consuming and unbearably excruciating.
Eventually I calmed myself down a little, put my physio head back on and did a self evaluation. Lumbar movement grossly restricted and painful into extension, lateral flexion, and rotation bilaterally, flexion eased symptoms. Dermatomes; no loss of sensation in lower leg. Myotomes; no loss of power in the leg or foot. Bladder and bowel; no issues. Slump test +ve for pain and restriction on the left, -ve on the right.
With my self check complete what I should have concluded was that I had an acute episode of mechanical low back pain with no sinister signs that would most likely resolve in around six to eight weeks.
However, what my psyche actually concluded was “fuck that” this amount of pain and level of disability means you have clearly suffered a massive lumbar disc herniation. In fact I bet you have probabaly suffered a huge disc explosion and have nucleus pulpous splattered all over your nerve roots like shrapnel from a bomb blast.
Now I am exaggerating a little here for comic effect, but on reflection my thoughts were not too far from this. I thought I simply must have suffered a serious structural lumbar pathology and my guess with a disc herniation.
So long story short, things eased a bit, but after four weeks of debilitating, annoying and worrying pain, and still unable to sit or stand up straight for any length of time, I rather embarrassingly talked myself into getting an MRI which I paid for privately and have shown below.
Now, as you probably guessed you can see that there is absolutely NOTHING wrong with my lumbar spine MRI! In fact its in remarkably good shape for a man my age with my level of previous of activity and life style.
But I still had severe pain, and still unable to walk or sit for more than 10 minutes, and still had leg and buttock pain. Where was this coming from, what was the reason? I don’t know, I still don’t know. Pain is a confusing complex and worrying bitch.
Looking back on this episode I can clearly see that even despite me knowing that pain and pathology are poorly correlated, and even though I had no signs of anything sinister, my thinking was just so focused on the certainty of damage as a cause for my pain, I couldn’t think of or consider anything else, that’s despite knowing what I knew.
When I reflect on how I was thinking and feeling during this time it does make me wonder if I could have been convinced by anybody that I didn’t need a scan, and that everything would be ok in a few weeks. Would I accepted someone telling just to keep moving, and give it time. Absolutely not!
This experience does highlight to me how scary pain can be, even with a good understanding of it and it’s complexities. This experience also makes me realise the incredibly difficult job we have in trying to explain and reassure people in pain that all is ok when they are scared, confused, disabled, and thinking the worst.
If I was unable to convince myself when in pain, I wonder if I am any better in convincing others?
As always thanks for reading
PS: As suspected and predicted I made a full recovery in approximately six weeks and have not had any issues since, but I still don’t like kettle bell swings that much!