A pain in the back

by Matt Langford

Posted on March 12, 2018 at 10:00 AM

What does a back doctor do when they get severe back pain?

I recently found myself crippled with back pain in my own treatment room. It was like I had been struck by lightening, I was suddenly unable to stand. As my sympathetic nervous system kicked in, I felt my heart racing and beads of sweat on my brow. I had never experienced this level of pain or disability in my life. As the first wave of panic flushed over me, I started to think of the worst, ‘my back must be broken’. This type of extreme emotional conclusion can be normal when sky-high adrenaline levels are running through your veins and having the effect of making you momentarily forget any medical training as well as the rational sense of deduction. The pain was so intense that whenever I attempted to move, my body was entering a neurological freeze response, like I was prey under control of a predator. How would I get home? How would I work tomorrow? How will I work ever again? My mind was creating scenarios with an emotional mix of panic, anger and despair making matters worse.

The irony was almost as shocking: the expert therapist was marooned with extreme back pain in the place patients normally come to relieve their back pain.

In such high moments of stress or panic, the trick is to control your breathing. Sometimes referred to as “tactical breathing” or “combat breathing” these techniques are employed by the military to manage some of the most stressful situations known to man.

Tactical breathing is simple and effective.

Breathe into your belly. Using your diaphragm to draw air deep into your pelvis. Think of your stomach like a balloon, filling with air as you breathe in and smoothly emptying as you breathe out.

Breathe to a beat. Breathe in through your nose for a count of 4. Hold for 4. Breathe out for a count of 4. Hold for 4. Repeat until you feel yourself calm down.

Assess without bias.

Acute body pain causes a huge release of adrenaline; a powerful natural drug that can highjack your rational self. It took determination (and lots of breathing) to quell these highly emotive thoughts driven by the pain. It was hard and took much more determination than I had first thought to maintain the calm beat of my breathing. Once the momentum was back in my favour, I came down from the adrenaline high and was able to think clearly.

My symptoms were crippling lower back pain when sitting or standing – the only position in which I was not in acute pain was laying flat on my back. All my bodily systems were functioning and I had no pain when lying still on my side. My life was not in danger however when I tried to move I suffered acute pain.

At home that night I needed to use the bathroom. How would I do this when I could neither sit nor stand? I crawled to the bathroom and as I attempted to stand I collapsed. My partner found me, grimacing with pain on the bathroom floor. I could not do this alone. I required nursing level assistance for 48hrs to perform the most basic of human functions, especially visits to the toilet.

I took painkiller medication (paracetamol and ibuprofen), used ice to lower inflammation and rested. Medium term I sort 6 sessions of osteopathy and looked at long-term changes in my life-style.

What really went wrong?

Sherlock Holmes, a great investigative mind, observes without prejudice and establishes the facts; this often paints a different picture than your assumptions. The process of recovery, after the inflammation and acute stress subsides, gives you signs that are usually linked like a storyboard and help lead to your root cause analysis. Once a story base is established, patient memories usually corroborate and hence confirm the diagnosis.

As I lay recovering, I was able to isolate which muscles had spasms. My back pain was due to two main muscle spasms with epicentres in my hamstring and upper back. My lower back is equidistant between these two spasms hence it felt the strain. Just like pulling on an elastic band stresses the middle of the rubber, my lower back was the middle of a muscular band called the ‘superficial back line’.

Memories came flooding back of ‘tweaks’ I had felt in the muscles that now were suffering full blown ‘spasms’. My body had tried to give me the warning signs in the weeks and months preceding this incident. At the time I felt I was “too busy” to deal with it. A lesson I will cover in a future blog!

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