Episode 15: Low back pain fact 5 with patient voice, Megan: ‘Pain with movement doesn’t mean harm”
Low back pain is still the world’s most disabling health condition and costs more than cancer and diabetes combined. A scientific journal article covering 10 facts about low back pain was recently published in the British Journal of Sports Medicine (http://dx.doi.org/10.1136/bjsports-2019-101611). The origins and motivations for that paper, as well as patient stories, were covered in episodes 4 and 5 of the podcast. In this episode, Professor Peter O’Sullivan and Kevin Wernli welcome Megan, a person with a lived experience of low back pain. Together, they discuss low back pain fact number 5: Pain with exercise and movement doesn’t mean you are doing harm. We hope you find this podcast as insightful as we did!
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Episode Show Notes:
before if i moved and there was pain i would immediately stop because i was listening to my body and the pain meant stop stop whatever you’re doing that’s not the right thing to do the new movement was oh the pain’s still there but that’s okay you can still move and i kept exercising or um walking mostly walking when i was in severe pain welcome to episode 15 of the empowered beyond pain podcast proudly brought to you by body logic physiotherapy in today’s episode we talked to megan who had a history of debilitating back pain she had seen many health professionals and had three spinal surgeries but was still experiencing serious pain her pain had a dramatic impact on her life as a busy mum of four young kids and unsurprisingly was accompanied by panic and depression but about four to five years ago she finally found a health professional who was able to coach her back to living and a big part of that was reframing what the experience of pain meant we discuss her journey and the strategies she used to retrain her brain to detrain her pain in the context of fact 5 from the 10 facts every person needs to know about back pain research paper fact 5 as narrated by pain patient advocate tina was pain with exercise and movement doesn’t mean you’re doing harm when pain persists it is common that the spine and surrounding muscles become really sensitive to touch and with movement importantly the pain you feel during movement and activities reflects how sensitive your structures are not how damaged you are so it’s safe and normal to feel some pain when you start to move and exercise this usually settles down with time as you get more active in fact exercise and movement are one of the most effective ways to treat back pain and having a health professional coach you through the process can be helpful it’s great to have you here listening or watching this with us from wherever you are around the world thanks for taking time out of your day to learn about the new science around pain and what to do about it some of you may recognize megan from the west australian department of health run pain health website where she has done a patient story video previously you can find a link to her story which i refer many patients to as well as infographics and any other relevant links discussed in today’s episode on the show notes page which is www.bodylogic.physio forward slash podcast we hope you’re having a great day wherever you’re listening in from please share this conversation if you know someone with healed benefit and remember to ask is there more to pain than damage megan welcome to the podcast thank you we’re starting here with episode 15 of the podcast and um we’re addressing facts number five from the back pain facts paper this came about as a result of as you’ve heard in episode four and five several people with back pain going through a process where they covered and there was these 10 myths that kept holding people back and the myth we’re addressing today is pain related to exercise and movement is always a warning that harm is being done to the spine and a signal to stop and modify activity so you have a lived experience of you know these sort of myths holding you back so i was wondering if you could start just by telling um sort of summarizing your story of your your back pain experience okay for sure so i’ve always in my teens i started having a little bit of back pain when i overdid things it wasn’t terribly bad just once or twice i hurt my back carrying something heavy and then i had four children and in my late 30s and 40s my back pain got worse and worse every time i carried something heavy or lifted suitcases or um did something unusual and i would hurt my back and it would last for a few days i’d have a pain episode but it would get better and then i’d move on take a few anti-inflammatories move on but then in my mid 40s i was spending a long time um sitting at the computer and my back got worse and worse and worse and i lifted some heavy bee boxes one day um off the beehives and my back went and i didn’t get better i thought it would go in after a few days but it didn’t get better and it ended up with me having a back operation where i had a slip disc and it had the back operation and my rehab after that was fine got better quite quickly no problem and i did all the exercises i did all the bracing and then looked after myself when i was bending over and all the things i was told to do i did and my back seemed to be fine but then two years later it happened again and i ended up having two more operations and i didn’t bounce back after those operations and i couldn’t understand it because i was doing everything i was told to do and i would also rest they told me to when i hurt my back badly just to rest and it would come right and i was resting resting resting and it never came right and then i saw a series of um physios and nothing helped i would um try their different solutions and work and then i finally found one that worked for me and they took they taught me to unlearn a lot of the things that i’d learned and i learned that i could bend my back when i was picking up things i could exercise i could push through pain and while walking and pacing myself i could actually get through the pain um periods and i was much stronger at the end of it can i take you back um you said after the surgeries that you kind of got stuck what do you think was different because after the first surgery you said you were good yes what was different about your experience after the second and third surgery i think after the second and third surgeries uh my response to pain was a very learned one so in the beginning i would start to gradually feel pain and it would build up over time and i’d go from north to 100 over a period of time but the second time i’d go from nor to 100 in a few hours i just might it was like my body yes it knew how to i got really good at feeling pain and any little thing that happened to me if i tweaked my back suddenly i was in pain whereas before you tweak your back and move on but i had i think what was the learned response to pain immediately you would freeze and panic and think i’ve done it again it’s gone and i’ve gone down that rabbit hole it’s too late i’ve done it yeah and so that’s interesting you’re saying there’s both a learnt response but that’s a learned thinking response and an emotional response yes as well yes i think so so you talk about panic yes and fear like i’ve done it again and i’m going exactly i’m heading for the fourth operation yeah okay and those operations were scary for you well that whole process was scary because i’ve never had anything and what did you make of the fact that you had this ongoing pain and your circle being fixed by the surgery how did that how did you make sense of that i thought there was something wrong with my back right that i was there was some mechanism up in my back and i’d hurt it and i could never recover and i thought that once you had back pain you would always have back pain right and had someone told you that i think my mother always had back pain and she always had a sore back and so and when i was growing up i was always told don’t slouch don’t sit with your legs crossed um you know every time i picked up something i was told be careful watch your back so you had early messages from a very young age that your back was vulnerable need to be protected yes and if it ever got hurt to just stop what you do right and don’t do that do something else that um that won’t hurt your back yeah okay and so during that process when you felt like you would have trained the pain sort of what you’re saying isn’t it to become hyper alert to your pain unintentionally yeah what do you think was happening in your body because obviously they were the thoughts and the the feelings around your pain but what did you think was happening in your body at the time i think my body was sort of it would freeze it would get tighter it would be like um just get tense and tight and and exacerbate yeah okay so in a sense that learned pain responses also a relearn protective response yes were you guarding and protecting your body because of the fear of doing stuff and also because i didn’t feel i could make it come right on its own that i couldn’t heal it it was it was protecting it from any more degeneration yeah okay had you been told you had degeneration i think i was told that once i would always have a vulnerable back yes i was told that yeah okay and so were you given specific advice to protect your back given lots of advice okay so give me examples of what that looked like so as a small example when i was loading the dishwasher i was taught to stand up tall suck in my core and then bend from the knees and never bend my back and sort of lift the dishes out of the dishwasher never lift more than a six pack of fear this is the weight advice i was given lift everything yeah basically don’t bend over and that was after your surgeries you’ve been told that yes okay and we get ever told that that was just for a short period of time and that you could go back to normal at any time or was it is that told to you like this is your new future yes that was the new me right okay and so and i think i’m not sure if i was told her but i sort of believed it was something that was a downward spiral so this had happened i was now had a vulnerable back and then pain was inevitable yeah okay yeah and that must have been pretty scary for you because you you know you’re pretty young and you’re and you thank you you naturally with someone who had been very active yeah it’s well up until then yeah so how did that feel well i think i was quite depressed about it actually i thought it was the end of my life as i knew it i thought i will always be in pain i’ve just got to manage it i can’t do all these things i want to do and if i do want to do them i’ll have to do it with pain and i’ll have to make pain my friend yeah okay and i didn’t want to take all the drugs that were given to me freely and daily okay but um yeah i think it was very distressing yeah and so what was the explanation that you were given by the various people you saw for the reason you had this ongoing pain i think they said i was born like that it was just genetic and that was my lot in life okay and so you were thinking that wasn’t something that could change no it didn’t okay but there was still a little glimmer of hope that you could do something what what drove that do you think because you didn’t just accept it by the sounds well that does it doesn’t make sense so what that didn’t make sense it didn’t make sense that i could go from being very active and have a full life to suddenly having a vulnerable back and i couldn’t accept it that i was so young and it was also a bit of a bleak outlook you know i wanted to be able to do or and i also have four young children and i didn’t have time to to lie around because that’s what i was being told is to rest rest rest and i didn’t have the time to do that so i started looking for health professionals who had had lots of success with back pain and i thought there must be a different way to treat my back that didn’t involve drugs because also i had to try the painkillers and they didn’t work they worked in the beginning but not after a while the effect yes yeah so i just kept looking for another solution yeah okay so the kind of picture that you paint before you went down that other path was you know your back’s genetically vulnerable you know it’s now you’ve got a back you’ve got to live with and look after and manage and your management was to protect it and rest and yes you didn’t relate time for that and it didn’t go it went against your grain yes as well which is why you thought i need to do something different yes exactly right and that was impacting on both your emotional mental health physical health your ability to do stuff you know just do normal things with your children all of those things it’s a very lonely place to be because you can’t explain your pain to anyone else and a lot of people own pain and you just gotta suck it up you want to suck it up yeah but it’s always present yeah yeah so how was that how did that change then to go from a point where you were terrified and feeling panicked to have pain to build trust in your body again because that sounds like a tough journey well it is a it’s a long process and at the beginning i didn’t think it was possible but i did find um someone who was treating me who told me in our first meeting that he’d seen lots of people like me and that i would get back to totally back to normal and i remember crying sitting in the car afterwards crying because it also made me bend over in our assessment and that was something i didn’t actually do and i didn’t think i could do it without pain so i think my journey started with trusting him trusting his expertise and then allowing myself to take his advice and not be um scared of his advice so we did everything slowly so i got back in the gym and i would lift things but we started off with very light things they were just a whisper of a box and then by the end i was picking up a big box like my beehives and it was because that was one of your goals was that to go back to doing the lifting which was what you originally hurt yourself yes right so that was quite a potent and i was very afraid of picking up those heavy boxes because previously you’d hurt yourself and i also had this concept that a slipped disc that your disc was like a little round disc that kind of slid in and out of your spine and i felt that it was easy when you picked up a box for your disc to just slide out okay so i always had to be [ __ ] all those things but it’s not it’s a bulging disc it’s not there’s nothing slipped about it [Music] and once i was explained the mechanics and i got the confidence to pick up the heavy things but it was a process it was and how long did that take i reckon it took about nine months to be confident and i still have it i still go to do something and i think oh should i do that then i think you’re fine just pick it up don’t think about it bend your back don’t brace yourself don’t suck up any call just do it so it’s still an ongoing yeah so those things sneak back in like the doubt yes yeah so that’s something you have to update yourself with all the time constantly yeah yes and and during that process was it painful to do you know did you experience pain when you were starting to get moving differently and use your body differently and and how was that given that pain to you was a signal that and create a panic how was it just stay calm while you were doing that and trust that you weren’t doing harm to yourself well it’s pretty hard but i think i when i understood as well that pain or pain starts in your brain i was able to tell my brain to cut it out just stop and i’d be able to calm myself down and go you’re not actually in pain you’re not hurting yourself this might feel uncomfortable this might feel painful but it’s not hurting you so keep doing it that’s quite a hard thing message to swallow though that your your brain itself is trying to protect you because of a memory of something but that protection is now not needed it is but i think it is a very um it shows my age you know when we were when i was a child you were told if you had a brain injury or if you you know broke something in your brain it was never you would never be able to fix it that was it that was your love and laugh but now we know that a brain repairs itself yeah yeah so we know the brain is um plastic exactly and and you can teach your brain not to feel the pain you’ve got to get off that scene how did you do that because i know our listeners would love to know what tools you had to do that i think it’s practice it’s like any any activity you’ve got to practice it and you’ve got to [Music] everyone’s different so i used a lot of meditation okay a lot of breath yeah i i still do yeah i calm myself i calm my breathing and i’m also i’m a very visual person yes i use color yeah in my thoughts it sounds wacky but i do actually i breathe in blue and they could swirl around my brain and i breathe it out and uh uh when i teach my kids i say breathe in accept the pain and push it up so so that’s kind of like um in a sense using uh meditation and breathing and visualization to calm your nervous system yes before you engage with something yes that’s scary so it kind of inhibits your panic response while you do it yes because the response is really strong yeah and it is it can take over i mean i think that’s how we survive yeah and how strong is that panic response now in you if you look at where it was at the beginning and look at where you are now say for lifting and stuff oh it’s nowhere near right now in the air and it’s it’s wonderful to have it so small it’s still there i’m not gonna say it’s not there it does come back and sometimes like if i get a tingle down my leg i think oh then i have to remind myself it’s okay so it’s a definite it takes a bit of time and a lot of practice yeah and you go it’s like climbing up a ladder you go three steps forward two steps back three four and you just gotta keep keep going yeah and how long’s it been now that you’ve been kind of at the other side of this journey so i think about four and a half years yeah right and have you had any major events in that time no does that surprise you no no that i know what i know okay yeah and what do you do now to keep your back healthy so i the minute i hurt my back i do sometimes get tired and often my tiredness um i feel tiredness physical tiredness as backpacking and i now know that it’s not back pain it’s just me being tired so instead of resting like i used to i now go for a walk or do pilates or go to gym so you use activity physical activity is your mechanism of yes kind of rebooting your system rather than resting yes which is what previously you’ve been taught to do whereas before i just rest restrictions yeah right yeah can you take us back to i’m interested you know when you were unloading the dishwasher with all those strategies that you were told can you take us back to that time and sort of put us into your shoes and talk to us about the the things you were thinking are happening in your back i think what i was doing all the time was like a body scan no matter what i was doing whether i was unloading the dishwasher or in my car i was constantly scanning my back for any alarm any long signals so it was pretty all-consuming actually and every movement i made i would think about my back first whereas before i did any back trouble i never thought about them it just didn’t cross my mind so um i think now that i’m further down the line and i just don’t think about it anymore and when you were you know using those strategies and maybe you can talk to some of the things that you were told to do around you know you mentioned bracing your core and don’t bend your back was that helpful for you when you were doing it oh so when i was bracing and i was like no i think i did a lot of damage so that was uncomfortable or was painful for you why you were doing that yeah i think it was i think it was and i think when i used to pick up things i’d go down onto my onto my haunches and then i would stand up with them and it was really heavy and really uncomfortable and often hurt my back now when i just bend over naturally and pick something up it’s a fluid movement and there’s no pain isn’t that interesting compared to you know if we look at the common messages around back pain and around ergonomic advice it’s it’s all the stuff that you were doing and yet you were doing all those things and you still had pain in fact you sort of felt like you were doing more damage yes so can you kind of contrast you know back then you were thinking you were sort of scanning your own kind of threat detection mode you were looking for any sort of sign that potentially you were going to hurt your back what are the thoughts that go through your head now or how do you sort of overcome that so now i think i pretty much don’t even think about it but it it took a while for me to do that and sometimes i do if it’s something particularly big i i do consider it and then i just go through the process of going take a breath do it the natural way bend over and lift so i don’t have the fear because i know and i’m confident i’m not going to hurt my back so i think the fear exacerbates it and makes it worse and then makes your back pain even more worse so i remember you mentioned earlier um before we started recording this that you were at the beach once and you were doing some bending can you tell us talk us through that experience so i was just bending over and touching my toes and stretching out my back in a very natural way and a friend of mine who’s a doctor rushed over to me and said don’t do that you’re going to slip a disc again because he knew my history and it did i got it right and i stopped doing what i was doing and i knew he was wrong but because he was a doctor i i i don’t know i came and became a bit subservient and i was like oh and she made you doubt what you mean it did make me daddy because he does know what he’s talking about but um when i thought about it i just and then i spoke to my physio about it and he said no let’s you what you doing is right let’s keep going down that path and then i haven’t looked back interesting because i think what it highlights is that these messages that you know kev and you’re alluding to are everywhere yes but you don’t have to walk far in a workplace or in a manual setting to hear people advising around how you should hold your body and how you should protect your body how you should sit and all these rules that we have what are your thoughts on that now in kind of hindsight well i always want to stop people and correct them and say no you can’t actually do that and i have to stop myself sometimes that’s not my business but um no i think for me my thoughts are that it’s given me such freedom it’s given me a normal life i don’t have back pain it’s given me the tools so instead of hurting myself more i’ve got the tools not to hurt my back again so the other thing that i’d love you to kind of touch on is if you talk to others there’ll be lots of people who will listen to this um and maybe reflect on their own experiences or clinicians who are working with people who are in a similar situation and when someone’s in a lot of pain and they’re frightened and their bodies in protective mode what would you tell them what would you what would you say to them or for a clinician and maybe also for um a person who was in your situation given your experience what would what advice would you give the clinician and what advice would you give i would i definitely do refer them to the people that i i use because i think to have a strong healthcare team behind you who who talk about neuroplasticity and they talk about the new way of treating backs is so important also um suggest some of the books that i read on neuroplasticity and i also tell them to rethink how they have been thinking and we and we talk about the things we’ve been talking about now about the bracing yourself and i tell them to um walk just walk every time you saw just walk in even if you can only walk to the first street lighting back just to do that but then do ten times during the day and the other thing that we often hear is people when they have a setback lose trust yes and you must have had some setbacks on your journey how did you overcome them i did have a few setbacks but the flip side was going back to hide being before and taking the drugs they don’t work that doesn’t work and doing things the way i had been doing and didn’t work because i knew i was on the right path i really really believed that yeah and i still know i’m on the right yeah that’s interesting what would you tell healthcare practitioners who may see someone like you who’s had three spinal surgeries he’s had you know three history of three disc prolapses who’s fearful and guarded advice would you give them gently very gently suggest that maybe the way we we thought about things 20 years ago or 10 years ago even is not the right way things have changed enormously and i firmly believe if i had come into my current physio before my first operation i would never have had that one it just it’s my bad luck that i didn’t meet him before but i was still buying into all the old myths and the things that i’d learned as a child and as a young adult and i thought they were true and you everyone does the best they can that’s right yeah so i would say to those doctors or just to maybe speak to more people like me yeah you’ve done it both ways now yeah it’s interesting because you’ve had both journeys really haven’t you kind of like a tale of two stories yeah um and and i think too what the other thing we know about healthcare practitioners often they become frightened that they you know we don’t want to hurt people no we don’t want to do harm to people and so sometimes it taps into us as healthcare practitioners as someone who may have pain when they move is we’re often thinking maybe this is bad for them and that’s a really hard bridge as a you know it’s like a coach if we’re working as a coach and we’re asking people to do stuff that’s actually painful or that’s scary and that making someone panic it’s very easy to kind of back away from that but it sounds like taking you back to those things was the key yes and so actually having the confidence to go you know what we’ve got to take little steps but actually the confidence to go back to it and even if you ever he can’t go back to it again but do it in a way that’s not overwhelming but peter i wouldn’t have been able to do it on my own i had to have someone who i really trusted knew more than me yeah and i i had to have that someone holding my hand because i was really scared that i was going to do more damage so i think so that’s key then that is to trust this yes and then also doing your own research and for me it’s reading and youtube um videos finding other people who are in the same position and realizing that there actually is life after back pain and it gets better because if you they told me on that first day that in five years i wouldn’t be feeling back pain i would have found it hard to believe because it was so much part of my life yeah i get that yeah that’s cool so um i’m hearing that trust was a really really important part of kind of holding your hand and guiding you through that process you know we and and also like listening to other people’s stories and that’s kind of what we’re trying to do with this podcast is to showcase people’s stories that’s great and and we’ve let’s say we’ve got what we do lots of people listening here that might be experiencing back pain at this time and they might be worried about when they bend over that they’re causing more damage to their back and that pain means that you should stop what you’re doing and be careful with it if you look back at your journey and and back to those times when you were thinking sort of along those lines what were the maybe if we can summarize into a couple or a few of the key messages or the looking back the key lessons that helped you get to where you are now my key lessons was to move to um make friends with my back pain and and accept it but that would end and so to move on from it and to learn to also accept that it wasn’t a death sentence that it would change and the only person who could change it was me and i had to put in the time to change it and i had to keep practicing and keep practicing until it diminished and it did it just slowly started to diminish and then one day i woke up and it wasn’t there anymore and when you say move you know you said the first one was just move you know lots of people would say you got to kind of keep your back pain but you’re back moving and you go for walks and and that’s general advice for probably you were trying to move before you know you found you sort of found your way out of this sort of stuff what was different about then if we call it the new movement how would you contrast that well i think that the new movement was before if i moved and there was pain i would immediately stop because i was um listening to my body and the pain meant stop stop whatever you’re doing that’s not the right thing to do the new movement was oh the pain’s still there but that’s okay you can still move and i’m kept exercising or um walking mostly walking when i was in severe pain interesting and look it’s interesting i highlight this because there is some good research well there are a couple of things that you highlight which are really well evidence-based one is mindset is that you developed a positive mindset you talked about the importance of the positive mindset where before it was like i’m doomed this is it but you were able to create a positive picture of your back of your journey that you kind of had a positive view of that process which is we know is important it’s incredibly hard for people in that space to develop it and something and i presume that was something that slowly evolved was it wasn’t just there because it sounds like it wasn’t there at the beginning no i think i was in a dark place in the beginning and i thought it was hopeless i thought it would never get better and then when i started to see that other people were getting better and i started to see that you also think you’re the only person who’s ever had this back pain and that yours is when you hear someone else’s story you think oh mine’s worse because of x y and z and i’m different i don’t fall into that category but actually we can all get better and we can all and increment by increment we can all make the small little changes and you do get more hopeful yeah there’s slowly builds on itself like a snowball yeah fear builds on itself like a snowball exactly yeah we often talk about these parallel parts of the brain you know you’ve got your fear centers that could be really really strengthened or you’ve got these kind of positive centers that can be strengthened it sounds like you were here and it slowly started to do that exactly right yeah and the other part that i think is important is the um there have been some reviews of studies that look at people with pain engaging in physical activity that even physical activity that hurts them and we know they’re never worse from it well they’re not they’re not damaged and made worse from it and i think there’s a very common view that if it hurts it means that i’m doing harm yes and this idea of you being in pain because your whole nervous system is sensitized and your your brain is in protective mode around that area will not let you do it if you think you’re harming yourself um we’re in actual fact they’re engaging in those activities kind of teaches you that actually you can do it and you are not harming yourself and the more you practice the better you get and we we see this from arthritis research to back pain research actually engaging painful body parts with movement activity in a graded way is actually beneficial but it’s a really hard message to sell to people when what they do hurts and their brain saying don’t do it yes i totally understand that yeah and you have to teach yourself yeah and that’s the key with having a coach i think you can go hold your hand and go it’s scary but it’s safe yeah exactly yeah and i definitely couldn’t have done it on my own there’s no way i just wouldn’t have had the confidence yeah that’s awesome thank you so much for sharing your story thanks again for tuning in into another episode of the empowered beyond pain podcast wow what a transformation megan had gone through modern science has been telling us for a while now that our bodies are bioplastic meaning our biology neurology muscles discs joints cartilage and many other bodily structures and systems are adaptable and changeable in the right environment my key take-homes were megan’s reframing of pain meaning danger and stop to pain being okay and not a direct sign of damage was key her learning that all pain comes from the brain was important for her now importantly this doesn’t mean that pain isn’t real or that it’s made up it simply means that pain is a little bit more complex than being a direct reflection of the health of our tissues having a trusted coach to hold her hand was paramount for her turning her journey around and realizing that discs don’t slip as pain scientist professor laura mosley is quoted to say discs don’t slip ever and finally we should be skeptical of the ergonomic dogmas of keep your back straight brace your core and sit up tall they aren’t as evidence-based as what we used to think which we’ll discuss more of in the next episode of the podcast we hope you found this episode helpful if you did please share it with your networks and tag us at ebpodcast on the socials we wish you safety and health wherever you are and hope you remember to ask is there more to pain than damage [Music] please note what you heard on this episode of empowered beyond pain is strictly for information purposes only and does not substitute individualized care from a trusted and licensed health professional if you would like individualised high value care for your pain sports or pelvic health problem head to the body logic website and make an appointment fee music generously provided by ferven and cash