TALES FROM THE WATER COOLER: GETTING THROUGH BACK PAIN
TALES FROM THE WATER COOLER
To look at him, you’d consider Fitness Guru and personal trainer Matt Linsdell to be the pinnacle of health, with a physique people would pay good money for. Yet a hidden pain hampers his joie de vivre. He shares his hurt in the hope that we can avoid such pain ourselves.
Chronic pain can be a terrible, distressing affliction. Is there ever a time when you need to eschew evidencebased treatments in favour of alternative relief, or rely on the adage that time is a great healer? Fitness Guru Matt Linsdell reflects on his own agonising lessons.
In 2008 I developed tremendous back pain. The pain travelled down my left leg and restricted my normal daily activities. After several months, it had begun to diminish when, one day, I was out running and it appeared again. In fact, the pain came on so strongly it felt as if I had been shot with an arrow. My girlfriend forced me to take a bath with eucalyptus-scented Epsom salts. For the record, there is no scientific evidence that Epsom salts do anything other than make the bath water salty. And now I hate the smell of eucalyptus. Despite my girlfriend’s loving efforts, the pain persisted and so I finally went to a walk-in clinic. The attending doctor referred me to an orthopaedic surgeon – setting the wheels of the Canadian healthcare system in motion. Full of jokes, the surgeon examined me thoroughly. He explained that one of the inter-vertebral discs low down in my back had bulged and cracked, and now its juicy centre (known as the ‘nucleus’) was compressing the nerve root in my spine – hence the pain down my leg. Not really a laughing matter. I was destined for the Vancouver Spine Clinic. However, before the surgical consultation finished, the jovial surgeon lowered his voice and his face took on a very serious expression: “Matthew, if your symptoms become worse – if you have any loss of control of your bladder – then you must go to the emergency room immediately. It is possible that the nerve in your back could become irreparably damaged. If that happens you will never have control of your bowels again and you will never have an erection again.” Things got real for me right then. It became clear that this injury, although common, was more than a mere inconvenience – for me or my girlfriend.
Pain? Wait until the surgeons get hold of you
Several consultations and a CT scan later, I was offered both surgery and a ‘nerve root block’ – a steroid injection into the nerve that is causing the pain. Neither was a prospect I fancied: you don’t really want to mess around with sharp objects when the spinal cord is involved. I opted for the less risky nerve root block first. To make sure the needle goes into the right spot, the docs use X-ray imaging. Which is comforting to know. It hurt. Only for a few seconds – but during those seconds it felt like a fire hose was under the skin of my back leg. And the hose was turned on full blast. I endured it, but my symptoms persisted.
Back to normal: the long road
Months later I went for the surgery – a procedure called a discectomy (basically cutting out a bit of the broken vertebral disc). My recovery after the operation was slow and I still experienced some pain down the back of my left leg – although thankfully less than previously. 18 months had passed from the time of my first symptoms to the day of the operation – and I learnt that when a nerve is aggravated continuously for this long it becomes hyper–sensitive. So even though the pressure on the spinal nerve had been relieved, it continued to send pain signals. In my case I had low-level ongoing pain. I was lucky. For some people the pain is continuous and extreme. My sister’s ex-boyfriend was one of the unlucky ones. Tragically, he committed suicide because he couldn’t bear the agony. What I want to stress is that some injuries to nerves, if dealt with in a rapid manner, can have much better outcomes. Through my experience as a personal trainer, I know people who have had the same injury as me, with the same surgical intervention, and their recovery was complete. This may have because they only waited weeks, rather than months, before seeking help. Maybe they are just the lucky ones.
Avoid the quacks
‘Non-Specific’ Lower Back Pain is a catch-all term used by medics for this very common malady. Doctors all over the world see people with it every day and often it resolves naturally: the pain restricts what you can do, you take it easy, and so it goes away. The symptoms commonly occur when the pain is from over-stressed muscles, rather than nerves. Because these problems are so common, and often get better over time, they offer ripe pickings for quackery and odd therapies.
Confusion arises when muscular back pain is ‘treated’ and then gets better. Most people will attribute their recovery to their treatment – whatever it was. This leads many victims to the ‘logical fallacy’ Post Hoc Ergo Proctor Hoc – translated ‘After therefore because of’. (Check out Sceptic Guru’s (Daryl Ilbury) excellent guide to logical fallacies on page 18). When you are in pain you feel desperate. I know. You are prepared to try anything – and if you try something and notice a lessening of your pain, you sing the praises of the treatment and declare it to be a cure. Everyone is susceptible to this tendency because this is a part of human nature. All manner of quack nostrums have arisen because of this – with sensible-sounding claims of being able to cure back pain. I’ll stay humble: maybe your treatment did help, but maybe it didn’t. Time tends to heal most issues. And time is what passes after we swallow a pill, have a massage, get our backs cracked, stick dozens of little needles in our skin or rub stinky balms all over our body. All these ‘treatments’ have something in common: the passage of time. I was fortunate to make a good recovery, but my pain lingers like a drill sergeant. If I do everything by the book, it won’t bother me. As soon as I stop following the advice given at the Spine Clinic, the pain flares up like that in-your-face shout-fest popularized by American war movies. It should be noted that not all shooting lower back (or ‘sciatic nerve pain’) requires surgery. But by sharing my story I hope to impart some knowledge to all Guru readers about a condition that is very common. This article is a recollection of experiences, not medical advice. My hope is for you to think critically about whatever course of action you take. Is your chosen remedy likely to be a placebo, or is there evidence to support that it works? Did you get better because of the treatment or did enough time pass that it went away on its own? Is your condition serious enough to merit a trip to an orthopaedic surgeon or will a few days of kicking back with a TV remote fix you up? Let my story ring in your ears next time you feel a stifling pain in your back. I sought out evidencebased medical science. I didn’t want just to feel better – I wanted to be fixed. And if I had to do it all over I would do the same again, only sooner. And I’d skip that nerve root block. Damn that hurt.