This is long.
Just sayin'.
You might want to print it out and take it with you.
We (clinicians) like to compartmentalize process. We like to think of
treatments and procedures and sometimes fail to see that the injured, hurting person is not
a collection of compartments but a whole being and that being is what
needs help; not just his back or his knee or his shoulder. In other
words, your back doesn't hurt. You do. And, you need to do a lot of things to put your "self", your whole being, back together.
I did at least 54 things to get to my current state of "being".
The result? I feel a lot better. In fact, over the past month, I found my self wondering if I actually had an injury My Oswestry score ( a measure of functional disability due to a spine injury or surgery) is 4% (minimal) compared to over 60% (severe) in March 2008. I know I had an injury, but the pain and misery of the past few months seems very distant. I still am careful though and in particular about seating. Restaurants, meetings, a friend's home may or may not have seating that I feel I can not only be comfortable in but also not injure my self. So, although I feel a lot better, I know I'm not completely recovered. However, the memory of pain has faded (what a great thing that is - once again something I would probably not think of had I designed the human body). When I run into people I know, they always ask, "How are you? How's your back?" and I think they expect me to say, "Well, not so hot really. I blah blah blah......" but when I tell them I feel good, have no symptoms, have put almost everything back into my life, they really seem stunned.
Then they ask," What did you do?" and what they're looking for is something simple.
But, the answer is I changed my life and it's a change that will be with me forever. I didn't do just one thing: take a pill or, have someone yank and twist my spine or, do one particular exercise. Anyone who tells you that if you just do this _______________(insert technique, surgery, pill, exercise, machine, etc) and that one thing will fix you, is seriously misleading you (you'll see why in a minute). And, there's no shortage of claims running amok over the Internet.
If you want to know what I did, you can get an overview by clicking on "Rebuilding DK" under the categories section on the right hand side of the The View. This will sort through all of my writings and return only those related to my injury and recovery. But, some details are missing, I know, so over the next few weeks, I'll be adding more information about the exercise regimen, activity modifications, environmental modifications, medicines, other practitioners and the people who helped me. Bottom line though, I did a lot of stuff.
Here's the summary of what I did to avoid surgery and come back from a large L4-5 disc herniation (a sort of table of contents and not in order necessarily) which covers the time period from the injury in February 2008 through July 2008. Future Views will expand on some of these topics and I'm sure there will be more to explain as I move into the next phases of rebuilding.
- I said, "Ok, I need help. I can't figure this out on my own." Of course, this was after I tried and failed first.
- I found out what was wrong and why I felt the way I did.
- I decided what I really wanted (this is actually much harder than it sounds).
- I was coachable (mostly - you can ask Christine...she'll tell you).
- I worked on my attitude and it looks like this will be a life-long adventure.
- I admitted my fears.
- I acknowledged my feelings.
- I removed sitting from my life ( as much as possible) for over three months.
- I added spinal decompression (in the form of an inversion table) and used it everyday.
- I consulted with someone I think of as a "Life Coach" - Dale Goldstein - to help me process the mental and emotional injury.
- I obtained two surgical opinions.
- I enlisted the help of a chiropractor, Trish Gregg, who is a member of NUCCA (and Dale said had "healing magic" in her hands).
- I changed my work environment allowing me to lie down and still use a computer.
- I did no lifting, twisting, pushing, pulling of anything heavier than about 5 lbs. for nearly four months.
- I focused on staying well hydrated.
- I used supplements.
- I cried.
- I walked nearly everyday.
- When I laid down on the floor, I had found the exact angle for my hips and knees as well as the amount of lumbar support to prevent nerve pain and remained in this position for extended (hours) periods of time.
- I took pain medication to help me sleep.
- I took an anti-inflammatory for the first several weeks.
- I took an oral steroid in the first two weeks to reduce the inflammatory response.
- I spent time with people who cared about me; who would listen to me but not try to solve my problems or tell me what I ought to do.
- I tried to get perspective of the magnitude of my problem relative to other people.
- I wore a special brace nearly all the time including when I slept (at least initially).
- I spent a lot of mental and emotional energy staying focused on the "now" and not the past or the future.
- For my rehab program, I started working from the inside out. I had to master the basics like getting my transverse abdominis muscle to work and using exercises to facilitate disc healing.
- I did not stretch - especially my hamstrings.
- I mentally worked on letting go of fear: the fear of pain, lack of sleep, weakness, loss of independence. I learned that fear's tactic is to make you believe an illusion, something that has not yet happened, is real and as soon as you buy that lie, you suffer needlessly.
- I listened to music to help me relax, to inspire me, to sooth me. A lot.
- I avoided bending first thing in the morning (because disc pressure is already high in the morning) which meant I had to get dressed without bending forward to put on pants or shoes.
- I got rid of regular shoes and wore shower shoes so i wouldn't have to bend over to tie and untie the shoes.
- I didn't wear socks for weeks (for the same reason in #31).
- I was disciplined (well, mostly - except for #35).
- I used a crutch in the house for the first few steps after sleeping or lying down although I put up a pretty good fuss over it.
- I didn't cook, go to the grocery store, or clean the house for over three months.
- When walking was no longer a challenge aerobically, I added Chung Shi shoes to increase my speed so I could increase the physical demand with a mild increase in physical load.
- I bought a pair of Spira shoes to wear for everyday use to reduce the impact of walking on my spine.
- I train 6 days a week for three weeks and take a one week recovery cycle.
- I have follow up tests done regularly to tell me where I am physically and what I need to work on.
- I read "Emotional Resilience", "Emotionally Free", and "Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life" to help me better understand the emotional elements of healing.
- I practiced my guitar lying on my back. It made me feel good.
- I used (and still do) a lower back support in chairs and in cars (this is actually a Zafu - something you sit on while meditating but i use it as a lower back support).
- I change the pressure of my mattress (a Sleep Number bed) based on how I feel.
- I use three pillows to sleep: one king size, extra firm, to place between my legs; one regular size, firm, to place in front of my chest; one tempurpedic pillow for my head.
- I have three work areas: a zero-gravity chair with a special support stand for my Powerbook; one on the downstairs bar so I can sit on the edge of a bar stool; one at a regular desk where I sit on a swiss ball.
- I work for no more than 45-60 minutes then get up and move around.
- I sit and stand in meetings.
- When I sit without a support, I always use the "Cello Pose".
- I pushed my self too hard more than once but discovered the "edge" and then learned to respect it.
- I looked at set backs as challenges; not failures (but I wasn't 100% on this...plenty of times my mind would win the negativity war and someone, something would yank me back).
- I meditated on what I wanted to achieve.
- I started a gratitude journal.
- I wrote about the whole process and was as honest as I could be.
There may be more things, probably are, but these are the ones I could recognize easily and say with certainty that they made a difference.
None of the things on my list were just random choices. I've met and talked with thousands of people over my career with a lower back injury and in nearly every case, their stories have at least one common theme: experimentation. They've tried lots of things: acupuncture, massage, stretching, icing, traction, and the list goes on. When you chase pain, the process can quickly succumb to entropy. Before long, you're ordering some weird, wacky gadget off the Internet and look like Kevin Costner in "Tin Cup" as he tried to fix his golf swing (and some of the things I listed do help people who hurt - no argument from me on that one).
I own a particular "lens" through which I view injuries, surgeries and the complaints that often come with them. It's something I developed over my career, understand, and I know it works more often than not to resolve complaints and return people to a higher level of function. It's based on science but is, in many ways, an art form (as all art is the implementation of science). This lens has woven itself into me in such a way that I no longer notice it. It's me and I am it. Nearly everything I look at, I'm looking for the connecting threads. An exercise, a technique, a surgery, an emotional angle, books, movies, music - whatever - I seem to always look for the essentials that form, create or restrict movement. How does this work? How can I use this? Where's the framework? Where's the difference? Similarities? But, it's not the only lens in the world; not the only way to look at injuries and certainly not the only way to deal with pain.
I believe you have to have a lens though; something to help guide your decisions. If you don't, then the process turns into just a whole lot of guessing-gobbildygook; trying one thing after another followed by periods of intense frustration and doubt. I can't think of something else, that really works, that is based on such randomness. Well, dating, maybe. No, wrong about that. I take that back.
Each thing I did connected to some part of the underlying decision framework. So, rather than just try something, I (or Christine) would first determine if the item fit and how (now, that is not how I first started out in practice...I was much more in the "let's try this today" group). For example, I knew that the herniation was large, posterior and lateral (meaning the protruding disc material had moved to the back and side of the spine). Lying on my back would make this worse as the force of gravity would cause the disc material to slowly seep out since my lower back was unsupported or slightly arched off the floor. The force of gravity would stretch the injured area (imagine how stretching an ankle sprain would feel). But, if I used a support under my back, I could reduce or eliminate the stretch by filling in the space between the lower back and the floor.
And to give you an example of how powerful emotion was (and always is) in this whole thing, had I really processed the data, the facts, through my "lens", I would have used crutches or at least one crutch right from the beginning. But, I refused. I refused because I felt it made me look old, weak and made me face my own vulnerability and it was too intense. Of course, all I said, as my lovely bride gently reminded me that help was in the corner, was,"I WILL NOT use a crutch" and then stumbled across the room as if my ankles had been hobbled.
So, this is probably enough for now. I have more to share and hope it helps you. Thank you for reading. Thanks to all of you who have sent me good wishes, good vibes, and your comments.
It all helped and it's all good.
Make today count.
Doug Kelsey
