Where would you start your journey back to health, if you have a disc herniation, cannot sleep more than a few hours or sit on the commode without your leg filling up with a numbing pain and are certain that there's an alligator clamped onto your right hip? Would you grasp for just about anything to get rid of the pain? I think most people would and I'm not any different - well mostly, I'm not.
In my teaching, we used to say,"Stop the bleeding" to help us stay focused on the first things to do with clients, like me, in acute pain. Pain management is really important. That probably seems obvious but clinicians often either overlook it or over treat it because they're so freaked out by how miserable someone is and they react to their own level of fear. I was probably in the "overlook it" category for a good portion of my career. It's just how I dealt with stuff that bothered me - remember? I stuffed it down deep to ferment. I once ruptured a client's surgical repair that he had had for a fractured patella. He had been placed in a cast for months so when he came out, his knee was nearly rigid; couldn't bend his knee more than a few degrees. The only option we had was to stretch and in my eagerness to help, I tore the tissue completely and nearly ruined the surgery. I can still remember the feeling and the sound of his knee tissues ripping. He screamed. I said nothing. I was petrified. Quite literally. I just stood there like a block of 6'3" 215 lb of granite watching and listening to him sob into the pillow. I felt awful, scared, awkward. I finally said, "Are you ok?" Great. That's a keeper. And, about two days later, we were back at it. So much for pain relief (and now you know why physical therapists have such lovely monikers as "physical terrorists" or "physical torturers"). Fortunately, I didn't start teaching others until I had figured out how to better manage pain (and don't worry, I'm really a lot better at a lot of things now).
I don't want to hurt anymore than the next guy but I also want to know what's going on and not be stumbling around in a medicated stupor. So, I want to feel better but not at the expense of not feeling at all. I decided that I would only take pain medication during the day if I felt like I had become Mr. Hyde or if my wife politely asked me, "Have you had a pain pill lately?". I felt like I could probably manage my activities and environment enough to keep the alligator at bay for most of the day light hours.
For rehab, the first thing you have to decide is what you really want which, trust me, if you had asked me at the right time I might have screamed, "Just give me something, anything! Now!" like a pregnant woman about to deliver her first baby. Deciding what you want seems simple enough: feel better. Or, is it to do more? Or is it both? Or do both happen at the same time? Or is it to just not hurt at all as fast as possible? I remember asking a client that once, a man in his late 40's with a disc herniation similar to mine, what he wanted. He looked at me like I was a complete idiot and yelled, "I want you to fix my f@%*ing back!" Hmmm...clear enough I guess.
A friend gave me a great analogy to use when talking about this topic of what you really want: a deck of cards. Imagine that the cards represent all of the things you could focus your energy on; things that could be really important to you. What's the top card? What's the most important thing? Pain is "A" problem; not "THE" problem - at least for me. It's the fifth vital sign as far as I'm concerned until it reaches a level of chronicity where pain becomes THE problem. For me, although at times it's really bad, it still is A problem. The pain is a reflection of what is happening in and to my body and mind and how I am reacting to it. So, while reducing and eliminating my pain is very important, it's not the top card. Getting my life back is the top card. Being able to jog, cycle, workout several days a week, lift weights, and yes snow ski again - that's the top card. Now, it seems like being able to jog would naturally be the result of no longer hurting - right? Some people fall for that trap - that if you just could get rid of the pain you could do all of those things. Nope. It just doesn't work that way. Here's why. Within just a few days of inactivity, and by the time I got to see Christine it had been a month, you lose substantial amounts of muscular strength and endurance that take weeks to get back and that's assuming you're able to and know how to train to get it back. Within about three days, the muscles that control the fine motions of my spine have atrophied and function at a fraction of their original capability and do not recover on their own even if you eliminate the symptoms. So, in other words, pain relief is important but being able to regain my muscular strength, endurance, coordination, balance and functional abilities is more important. What I'm looking for is something that does three things - controls symptoms, facilitates healing, enhances strength - and not just one thing: pain relief.
So, with that in mind, the top card, the next thing I need to know is what's keeping me from getting the top card back on top of the deck? By now you know I had a good sized disc herniation but that's only one piece of the puzzle. You also know that I had a pretty good sized wall around me, the wall of denial, that I had to tear down or at least knock a hole in it. I also have some other, pre-existing problems in my spine: joint disease and disc disease. So, Christine got a nice bundle of stuff to sort through. A 51 year old guy, who intermittently has the mind of a 12 year old, with a moderate to large disc herniation, multi-level joint and disc disease, lots of denial, trouble asking for help, highly competitive and her teacher. I can't imagine why this guy would be tough to work with, can you?
Christine did the right thing though by disarming me early on and getting the emotional issues out on the table. Then, she started the rehab program with the basics: jump start the muscles in my spine, get me moving and elevating my heart rate while controlling the compressive loads on my spine, and making sure I was not ignoring the pain and just trying to tough my way through it.
And, I'd like to emphasize just how hard it is for a clinician to feel ok with the basics; simple things. Just about everyone wants it to be harder (clients and clinicians). It makes you feel better as a client if the treatment is really complex as if you have a really tough problem - no wonder you feel the way you do. And, as a clinician, it's a great boost to your ego to choose complex treatment regimens with all sorts of stuff in them. It took me a long time to figure that out. I did a lot of stuff because it made me feel better about what I was doing. Of course, it helped people but why make stuff harder than it needs to be? William of Occam, famous for Occam's Razor, once said, "It is vain to do with more than what can be done with fewer." Enough said.
The first several sessions were really tough for me physically and mentally. I had only about three drills to do and that seemed like it was too simple (see? - and I know this already). I had trouble getting on and off certain pieces of equipment because I couldn't control the movement well enough and would "nick" my nerve sending a nice electric jolt down my leg. I felt weak walking on a treadmill while being lifted up by the very machine I invented - the Newton (this is an anti-gravity machine that enables you to do more - walk or run - faster and sooner than you otherwise could because of an injury) . And, I don't mean I felt physically weak. I felt like a weakling; like surely I could do more than this yet if I tried increasing the speed past about 2 mph or reducing the amount of lift, my leg hurt.
One of the exercises on my list of things to do was to strap what looked like a blood pressure cuff to my abdomen and then lie face down on a table. I inflated the cuff until the needle rested on 40 mmHg. My job was to suck in my belly enough to reduce the pressure on the cuff and move the needle as far down the scale as I could. The problem was the needle didn't move. I figured that there must be something wrong with the device so I got up and traded it out for another one. This one didn't work either. So, I checked it. And, of course it was just fine.
What I wanted to do was something else, something that was harder, like lift weights or throw something. About the last thing that I wanted to do was to face my limitations. Every session, there they were waiting to greet me. "Hey, K - glad to see you! We missed you! Now, remember, you can't walk faster than 2 mph, right? Remember that? And, oh yeah, your spine muscles? They want you to know that they can't do anything right now." Man, that ticked me off but it also gave me a new sense of what it was like to be in that sort of position; a lot of respect and I think a dose of empathy blended with a little humility. Everyone at Sports Center did a great job though of giving me just the right amount of encouragement without coming across as sappy sweet. Most sessions, I left feeling a lot better: a physical and emotional boost. I wondered, "How does anyone get through something like this alone?"
If I felt my frustration start to simmer while I was trying to master the treadmill and the thing that looked like a blood pressure cuff, I reminded my self about the top card. Just do the drills, focus, do them right. Just focus on today. Stop thinking about how you felt yesterday or the day before that, it doesn't matter, or how you might feel tomorrow. Just work with what you have right now. And, that is by far the toughest thing for me to do. And, I work on it a lot. I talk to my self, my dog Spencer, I write about it, I read about it. I think it may be the key, the thing that really makes the difference, in getting well.
You might be wondering though, how I'm doing. Am I any better? Do I still wake up at night? What's my life like now?
Well, coming up in future chapters, I'll give you an update - a sort of diary summary - and fill you in on things like how my follow up went with Christine, Dr. White, Trish, and what I'm doing in my rehab, what my home life is like and the wins and losses I go through.
But, right now, it's time to teeter-totter (so, there you go - you know that at least!). More to come.