Episode 19: Pain flares don’t mean you’re damaging yourself, with patient voice, Jamie.
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, Dr JP Caneiro and Professor Peter O’Sullivan welcome patient voice Jamie to the podcast to discuss low back pain fact number 9: pain flares don’t mean you’re damaging yourself. We also welcome back patient voice Joe, from episode 14 where he discusses his journey with flare-ups… some truly insightful knowledge.
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Episode Show Notes:
Male Host: Did you think that was it? You were sorted?
Jamie: Yeah, yeah
Male Host: Yeah right. so how did you feel yeah when the pain came
Jamie: Yeah, it was scary, yeah. Scary because I found myself slipping back into the old way so quickly. So quickly.
Male Host: Welcome to another episode of the Empowered Beyond pain Podcast proudly brought to you by Body Logic Physiotherapy.
We are quickly approaching the end of our very first season and we plan on going out with a bit of a bang. So, stay tuned for what we have coming over the next few episodes.
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Episodes with patient voices seem to be very popular, and we can see why. There’s not much that’s more powerful than hearing info from someone who has the lived experience. This week’s episode is no exception.
Some of you may recognize today’s guest Jamie, from the popular “painHEALTH” videos. He has also appeared on the podcast on Episode 4 and 5 and was the topic of a paper that we discussed with Dr Sam Bunzli, all about how beliefs influence pain back on episode 10.
Jamie’s story is particularly special. He had been off work with disabling back pain, had tried strong medications, injections, and was booked in for a spinal fusion. But, there was a small fire in him that kept fighting. And luckily he managed to find the right physio who helped coach him on a journey
to get back to living.
But, as is common once people recover, there are often ups and downs and Jamie has had his fair share. These pain exacerbations or flare-ups is the topic of today’s episode. We’re lucky enough to have two world-renowned musculoskeletal pain specialists in the form of Professor Peter O’Sullivan and Dr JP Caneiro, sit down with Jamie to discuss his journey.
Jamie talks about episodes of intense, sharp pain he named “flash grabs” and how terrifying they were. He talks about how his pain was associated with depression and negative thoughts and how in the end there was only one person that could help him…himself.
So, as I mentioned, Jamie’s story is powerful and his video is on the West
Australian government-funded website “painHEALTH”. This is one that I send
many patients to, and I will link to that video and all the relevant resources from this episode on the show notes page which you can find at www.bodylogic.physio/podcast
As I mentioned, reach out to us via social media at EBP Podcast to let us
know if you want another season. If you can leave a review on iTunes and
let us know if you find the podcast valuable. We’d really appreciate it.
We’re going to start today’s episode hearing “Fact 9” from the popular “10 facts every person should know about back pain”, presented by Jamie himself. And then we’re going to get into the conversation with Jamie, Pete and JP.
Then I’ll also play a patient voice — Joe’s reflection on his flare-up from
episode 14. Or, I should say flare-ups!
We hope you enjoy this episode of the Empowered Beyond Pain podcast and remember to ask “is there more to pain than damage?”
Male Host: Pain flares don’t mean you’re damaging yourself. While pain flare-ups can be very painful and scary, they are not usually related to tissue damage. The common triggers are things like poor sleep, stress, tension, worries, low mood, inactivity, or unaccustomed activity.
Controlling these factors can help prevent exacerbations, and if you do have a pain flare-up instead of treating it like an injury, try to stay calm, relax and keep moving.
Male Host: So this podcast is a discussion about pain flare-ups or pain exacerbations and those can occur in a situation where you have ongoing pain and you get like a spiker pain. or they could also occur at a time where your pain is resolved and then it re-emerges. like suddenly re-emerges. And we’re really lucky to have an expert in this area, Jamie.
And I think one of the things that’s really interesting about your story, Jamie, is that you’ve had both of those experiences. And, you know, your story is well captured in the “painHEALTH” website, where you, kind of, talk through your journey. Where you, kind of had really quite disabling and distressing pain.
And I want you if you can, to tell us about what happened in that first part of your journey because you’ve got a few chapters. You kind of had the journey into real trouble. The journey out of trouble. And then a period where your life was really good, and then you had the re-emergence of pain again.
So, I’d like to grab hold of a few of those chapters and let you talk to us through how that was what was going on for you.
Jamie: OK, well, so I wanted to dunk myself into the hole pretty quickly. I was doing that, I was doing weights and I hurt my back. And then I continued to do weights and then it got to the point where I thought I couldn’t.
Well, it was, my back was getting sore but I kept going and then it just went. I don’t actually know. Like I said, I was, I dug that hole pretty quick and it went from that to driving to work with my foot just buried on the sill. From trying to keep my weight off my back to sitting with a towel behind my back, like everyone said, and stuff like that. It just, it was always on my mind. Like I’d watch someone sit down and I’d think “I used to sit down like that”, you know, and I’ll be like “ow”.
And you just think of everything as it gets worse and worse and then it got so bad that I just had to lay down all the time — stop going to work. Yeah, and that was it.
And then I started going to the doctor. So, I went to the doctor, got prescribed lots of different medication. You know, some doctors were saying, oh I remember one in particular… as I was getting onto the bed she said “um oh good to see you’re guarding your back,” because I was stiff — like stiff as anything.
So I got on Lyrica and Meloxicam and, what’s that other one? Tramadol that’s one and Tramadol. So then I was on them and just zonked out, bought myself Netflix just to lay there. And I’d get up and try and go for a walk every now and again. But, I had a picture of my back that it was, I guess, really fragile, and like I say, like a glow stick. Where you snap it and the glass shatters and if I would sneeze or something like that then I would think of that happening to my back. Because it was like, it grabs like that and because you’re so tense.
Anyway, and then if that would happen I’d think “OK, I’ve set myself back for no
reason.” I’d be like, “no one told me this”. I’d just come up with this. And on reflection, maybe it’s because I was on the drugs. Maybe that is what made me think that as well or, you know, online a lot of stuff. And seeing, we’ve seen physios that weren’t helpful because I never had sciatica.
I just had lower back pain, and yeah. So, it was like they didn’t understand it. If I didn’t have sciatica, then what’s the problem, kind of. So, I was hearing about everyone with sciatica and I’m like “no that’s not me.”
My back is sore, you know, just my lower back. So then I dug that hole real quick
and got into laying down real quick, so.
Male Host: It sounds like at the beginning, you know, you were like pushing yourself hard. Hurt yourself doing weights, try to keep going and then your world slowly started shutting down and in that process, you were trying to guard and protect yourself while you were doing everything.
And it wasn’t working
Jamie: Yeah that’s right, yeah.
Male Host: Yeah, and then you kind of got to a point where you just couldn’t keep digging that anymore and so you’re, you were kind of left lying down.
Jamie: Yeah that’s all I could do.
Male Host: Yeah right
Jamie: At that stage, yeah.
Male Host: And how scary was that for you?
Jamie: Terrifying, yeah. It’s not like a real active person, and I couldn’t go to work. So you feel guilty about not going to work because you’re ringing them up, and you know, they were really good though. So I had it good like that, but you know, and I was still getting paid.
But I feel guilty I couldn’t pick up my kids, couldn’t help out, do you know, stuff like that so yeah.
You’re scared and you feel guilty. You’re on drugs I suppose, which is changing the whole way you think about stuff as well, and you think it, you know, “am I going to get out of this?” you know.
Male Host: And did you have a sense that you were stuck in that space?
Jamie: Yeah definitely. So I saw a neurosurgeon and then I ended up getting a discectomy. And then that didn’t help because, you know, it probably was something I didn’t need, because nothing changed anyway.
But, I didn’t know that and then I was booked in to have a spinal fusion. Yeah, and then that was one week out of getting a spinal fusion when I came to a physio with a different approach.
Male Host: With a different approach. So how was it when you were thinking “my back is at the point where I need to get a fuse.”
How did that feel for you?
Jamie: I was like, everyone around me was saying “get the fusion” and I was going “no I don’t want this.” So I put it off for as long as I could and then it was just like “whoa.” OK, what else do I do? Everyone’s telling me to do it except for my dad actually. And he was the one that rung and found a different physio for me.
Yeah, so I tried up to probably four but, also the neurosurgeon that I saw. And you know, thanks to him being kind of honest or whatever, but I did ask him, I said to him on the MRI, I said, “have you seen people with a back look worse than mine that you know, got away with not having a fusion?” And he said, I said something or “have you seen worse?” yeah. And he said, “yeah, I have.”
And I was like, OK well you know not everyone’s better, I’m better than, I’m gonna be better than most people. I’ve got more drive to not do this. So they’re all, yeah, but I didn’t know what to do with that.
You know, so I just went home and laid down, and then went for a little walk and then had a sneeze and thought oh [ __ ] here we go again, you know?
Male Host: So those pain events, you know, when you were in that dark place
where you’re, like, stuck on the bed and those little pain spikes that you had.
What did they mean to you? What did you think? You know you talked
Jamie: Yes, yeah, it meant I sat back. Yeah, that meant that and, as I say, I made this up, and I don’t know why I made it up. But, every time that happened, because I used to call them “flash grabs, I had a name, I even named it — I’d say it was like a flash grab because it did tense through your whole back and
because it was so tense everywhere already, it was just like, yeah. And so I
even named it.
And when it happened, I had a plan. OK, that set me back probably two days or so. That’s two days I have to lay down, that it was like a setback all the time. So I remember going into the backyard and there was, out of the whole backyard, there’s one piece of really slippery, slippery, like mason?
What do you call it? Like you have your benchtops?
Male Host: Yeah, stone?
Jamie: Yeah, there’s one piece like that and it was under long grass and I stepped on that and slipped because it was had been raining. And I was just like “ahh.” Out of the whole backyard, a sprawling backyard, I’ve stepped on this. I’m the only one with other people, I’ve stepped on this.
This is going to set me back a week or so, you know, it’s just like, you know, the world’s conspiring, yeah, against you.
Male Host: And what did you think was causing that pain, you know, when that happened? I know you gave that image of that, you know, snapping the, yeah, flashing stick sort of thing. But, what did you think was happening in your body when that happened?
Jamie: I just thought, well damage, I suppose. Like I just thought it was. I know it hurt, so I thought it’s damaged.
Male Host: Yeah can I just say, well, for you, pain meant “I’m doing harm.”
Male Host: Yeah, and so it made total sense that you would lie down, yes, and not move of course and guard your back. Because you were thinking that would
protect you against doing more harm?
Male Host: OK, so you talked about, like coming up to the point of having
the fusion and you decided to go down a different path and
that path was really different. What was different about that path?
Jamie: Movement. Movement straight up, like get on the exercise bike, throw away the towel from — I mean, my wife drove me and I was laying in the seat like, you know, had it pinned back, and you know, and then if I did have to drive somewhere I said I’d have the towel behind my back.
And then, yeah, I was told throw the towel away. Chill out. Get on the exercise bike, do these stretches, do this yeah, yeah, yeah. So by then, I’d stopped taking tablets. I’d stopped all the drugs, but I was drinking every night. I’d think “oh I’ve made it till four o’clock, I’m gonna get a drink.” So I’d drink wine and see if I
could replace the medication which was probably, very, yeah, counterproductive as well, but I thought I was doing the right, well, yeah.
As, in terms of weaning I suppose, or something like that, so yeah, might have been there.
Male Host: So did it make sense to you to do the opposite? Did it make sense
to relax and move when you were that sore?
Jamie: Nah, but I liked the idea, that was good, yeah. No, it didn’t make sense, right, because if you thought this is a damaged bag, then moving it, exercising it wouldn’t make sense to you. No, and I’ve been laying down for six months at that stage, out of work, laying down six months right.
Male Host: So how scary was it to start to move again?
Jamie: It was scary. Yeah well, it was scary.
Male Host: Yeah right.
Jamie: It was scary but really exciting as well
Male Host: Yeah OK, so they’re kind of two different thoughts. You’ve got to braid, you’ve got the part of your brain that’s saying “I want to get back to living again.” And the part of the brain that’s saying, “protect this really painful part of your body.” Working against each other.
Jamie: Yeah. And, it’s weird because there were moments. Like, it wasn’t six months of just, like I say, I was laying down and I was — but there would be
sometimes when I wasn’t sore. And I’d be like “what’s going on here?” and then I’d wake up. So you know, and it was really confusing. Really confusing. I didn’t like.
Male Host: Yeah, OK.
Jamie: But, I’d go from my room to the toilet. So, I’d get to the toilet and I’d
be like, I was puffing, and I’m like “what’s going on here?” But, I’d held my breath the whole way there because I was, you know, always so on edge, you know.
And there’s a step, and I’d be worried about stepping down the step, like, it’s a step!? No trust in your body basically, no, none at all.
Male Host: How long did it take you to get trust back in your body again?
Jamie: I don’t know. Probably as about as much time as it took me to get in. Six months, six months, yeah. But like, it didn’t just, I didn’t just get out. It was out in steps, and then back. And then I’d do something a bit too much, do too much of something, and then, yeah.
Male Host: So it must have been very brave for you to kind of, go from protecting, guarding, avoiding to relaxing, moving, engaging.
Jamie: I don’t know about brave. I was just really happy that there was a different, there was an alternative, yeah. So I just, you know I knew that I could. If I mean, once I was told that I could do it, then yeah, I thought so, you’re going to delay with it, yeah.
Male Host: That you could do it even though your body was saying this is a really bad idea?
Jamie: Yeah, because somewhere, at times during that six months I kind of thought what am I doing? Is this, there were glimpses of am I doing this to myself? Is this a — sometimes I thought even, “is this a depression? Is this a form of depression?
Because I was surely depressed, yeah. And I thought, is this a side effect of that? Or, is this, you know. or is that the thing and depression’s a side effect? I don’t know. I don’t think about it a whole lot, so it’s, yeah. no not at all now yeah so, it was. But yeah, there were times there when I’d be going “what am I doing? What am I doing?
Male Host: So what I’m interested in Jamie, is when you were going in that six months. Where you were thinking, every time you hurt you were doing damage.
But then, the next six months where you kind of did the opposite. And you were moving, and you were getting active, and you were doing stuff which previously would have hurt you.
How did you change the meaning? The pain changed too? Did you watch the meaning of the pain change to you? Like, you were saying you thought every time you were doing something it hurt. You were damaging yourself more, how
did that, how did the meaning of the pain change to you?
Jamie: Just by moving and going, “OK, I can”. Or, I can squat down and I can feel it, it just felt awesome to start stretching outright. And to feel like, you know, when I feel it, and when my back cracked as well. Because I was so excited if I’d turn one way and my back would crack — I’d be like because that feels like a tension going, you know?
And I’ll be, like, OK, things are letting go. But it took so, so long for everything just to let go.
Male Host: So do you think that the tension was a driver of your pain?
Jamie: Yeah. Yeah, it’s like when I first come to the physio and he said you don’t need a fusion, you’ve given yourself a fusion, right? And I was like, OK. That makes sense because everything was so tempting. Everything. You know, crouching down like this.
And, yeah, just not bending. Not fluid, so the meaning of the pain changed. Instead of thinking, I’m damaging myself, to go, “I’m clenching myself” that’s a different thought.
Male Host: yeah yeah yeah and one’s less scary. Is that right? You have control over it.
Jamie: Yeah, well I just did not want a fusion. Well, I didn’t need one. And knowing now, but everyone was saying, “you’re laying down again, you need to do something about this. You need to get that fusion.”
Even a physio I went to, he said, oh he saw the neurosurgeon. He said, oh if that guy says you need a fusion — you probably need a fusion. So, that’s really hard things to push back on. Yeah, as well as a bloke at work, at the same time this was going on. He was in the process of getting a fusion. He went to a neurosurgeon that gave him one, and he said that he was better after that.
And so I’m going, what am I doing? Am I doing the right thing, you know? Everything’s telling me “don’t do it”. Yeah, everyone’s telling me to, but I’m telling myself not to. And this guys just got better, yeah. Maybe I should do the same thing, yeah.
Male Host: So then you had a period of three years when you were going. Like, what did life look like for you?
Jamie: That’s just normal like, it didn’t look like anything. It was just normal life. Just well, not thinking about my back, yeah. Just, yeah, and not a thought. Like I say, when you see someone sit down, it doesn’t occur to you that, oh I used to do that.
Or, I wish I could, when they slump in a chair, you know? Because everything would be like, like an invalid or something, sitting down. You know, so, not concerned.
And, that’s the idea, to not think about it, you know, relaxing. It’s not thinking about doing all your normal activities.
Male Host: Doing what?
Jamie: Weights, everything. Bouldering, yeah, boxing— everything. Everything.
Male Host: Did you think it was in the forest? Did you think that was it, you were sorted?
Jamie: Yeah, yeah, yeah
Male Host: Right, yeah, so how did you feel when the pain came back?
Jamie: Yeah it was scary. Yeah, scary because I found myself slipping back
into the old ways just so quickly. So quickly.
I mean the forest, yeah, I was digging a trench and it just, I felt it cut across my back. The same pain, right? That I had before. And it was real, it’s you know, it was real pain. And so it didn’t have, not the sciatica again, it was just back pain. And so I went and I laid on the couch, right? And because I was pretty hungover as well when it happened, so I needed to rest anyway.
I laid on the couch, then I found myself, as I’d move on the couch, when I had that before when you move it hurts and so you use your legs to kind of lift. So that you spin over, and you get that pain all again, and that hurts more than walking around. That’s the bit that really hurts you.
And so that bits, that’s what scares you and scared me back right into going “well OK, it’s on again”. You know, and because it took so long, I mean, I knew that it probably wasn’t going to be as bad, but because I didn’t know how quickly I could get out of it, I was thinking long term.
I was thinking a couple of months or something like that, you know? But I couldn’t get hold of my physio so I was starting to stress and I’m going, “OK”.
Male Host: So what did you do in that week?
Jamie: Well, I thought about getting Stan because I hadn’t. I had already done the video right now, and then I’m going like “what are you talking about!?” What are you thinking? You got Netflix last time, zonked out, and now you want to get Stan? And it’s just like, “what are you doing?” But because I was laying down and I was
doing those movements I was going “no, this is bad. This is pretty bad.” Right?
Male Host: Because every time you move, you were thinking you’d done damage again?
Jamie: Yeah, yeah, yeah, yeah.
Male Host: Yeah, OK. So your body was giving the same warning signs that you used to do before. But your head had two experiences now that you kind of counteracts.
Jamie: Yep, that’s right. Yeah.
Male Host: So then what happened? So you were thinking two months?
Jamie: I was thinking, yeah I was thinking something.
Male Host: And you went to bed again, yeah?
Jamie: Yeah well that lasted for a week until I got in to see the physio. And when that happened, well he just said, “what are you doing?” pretty much. And I was like, “Yeah. I know. OK, tell me what to do.” I mean, because if I could have afforded it the first time, if I could have, I thought I wish I could just take the physio home, and just tell him.
That’s what you think you need. You think you need someone to watch you the whole time and tell you, “you can’t do that — oh don’t do that.” That’s what you feel you need. But then I come in and I was just like, do this and do this.
Male Host: So what kind of things did you do?
Jamie: Real heavy like squats. Not heavy with weights, but squats. Like deep down squats, and I’m like “ah”. You know, crouching down. I’m going, “are you sure?” and he’s “yes, yeah, I’m sure.” You know, the open book and stuff like that. And just the things I’ve done before. Yeah, it made me mad.
Male Host: So, your brain was saying don’t move? Your body was clenched, it didn’t want to move?
Male Host: So quickly. You’re so quick. You put your trust in someone to say yeah, move.
Jamie: Yeah, I knew I had to. I knew that was right on.
Male Host: Yep, and that you knew that was right because you’d done it before
and it helped.
Jamie: Yeah, I’ll say that’s the opposite this time.
Male Host: So you went home with a plan and did it.
Jamie: And executed the plan and I think I was only off work for a week. So it was during Christmas time. So I had, there was a week off anyway. And then, so I saw the physio and then I was off for a week. I went back and I wasn’t moving as quickly as I normally do.
Like, I remember walking from the gate to our workshop and I was moving slower.
Male Host: Sure, but so how long did it take you to get over that second event?
Jamie: Probably two weeks I reckon.
Male Host: Right, two weeks. Did you have a lot of treatment over that time?
Jamie: No, just once.
Male Host: You saw the person once? They gave you a plan, you did it and your body recovered?
Jamie: That’s right.
Male Host: So, what do you make of that?
Jamie: It’s movement, isn’t it? It’s movement. It’s not locking up. It’s not taking drugs. It’s movement, right?
Male Host: Yeah, keep going. And does it make sense to you?
Jamie: It does now yeah. It does, of course. Because for a lot of people, I think we’ve got a population that’s conditioned to think if it hurts it’s something damaged. You need to protect it. You need to stop. You need to rest it. And it’s really hard when you that’s your mindset to go against the grain. Yeah, well I mean I almost did it again.
Male Host: Right, so yeah, it is huh. And, have you had another event since?
Jamie: No, I have. I’ve twinged my back and that but it’s like, yeah okay, nothing. So, I just can’t, I’d continue what I do but, you know, not stupid! I won’t whack
another 10 kilos on the bar or anything like that. I’ll just say, OK that’s a bit sore.
I’ll just do something else you know, and if I do, if I ever do get a twinge in
my back then I’ll do squats and stuff like that. Not with weight or anything but
deep squeeze exercises. Yeah, exercise that area for sure.
So move the painful bit yeah, in a gentle repetitive way. And you can feel it draw out and it feels good. It’s good.
Male Host: It’s a good thing. OK, so if you were to, you know, talk to people who’ve hurt their back, what advice would you give them? Because we know back pain is like, the leading cause of disability in the world. It’s the number one of any health condition.
Jamie: Yeah right, it really buggers people’s lives up
Male Host: Yeah, it impacts their work, you know their social engagement, family. So all those things and the ability to engage in physical activity. Yeah, and it’s scary for people. It’s a genuinely scary thing and I think we’re conditioned to believe all the things that you describe.
Jamie: Yeah. That’s like, you know if I’m hurting. I’m damaged. I need to protect it and avoid. And there’s heaps of messages that reinforce that as well. You go online in the community. It’s like everything.
I think I’ve said it in another video, so if you go on Google, I think people are trying to compete about who’s had the most operations done. If you look on there, because it was like I’ve done this four, five times” then “oh yeah, but I’ve got this, and one, two, whatever they are, you know?
And so yeah, that stuff is not good to look at.
Male Host: So what would you recommend for pain?
Jamie: I recommend, well, finding someone that can help you to move. Not someone that will load you up with drugs and say, just, you know, “lay down” or whatever.
Male Host: Yeah, get a plan to move. And so, how confident would you be if you had another night out on the town and dug another trench?
Jamie: I would have to say, I’m confident. But as long as I’m close to the phone I suppose, yeah.
Male Host: Yeah, and that kind of makes sense. So, like that idea of being able to have someone who can give you some support when you need it. But it sounds like the key thing was knowing what you could do. Because you were motivated to do it as well.
And that’s what, that was another scary thing. To get your head around. Is that you realise that there’s only one person who can get you out of this in the end. Like, you can draw up as many plans, or you can get as many plans or whatever. But unless you actually do it, then it’s not going to happen.
Male Host: And you can choose. That is a road that you could choose, and you know, if you don’t, in some ways it’s kind of easier. To just lay down and take drugs and not worry about anything, you know. And you could do it. Could you worry about nothing?
Jamie: Doing that? Oh, not me. No, I don’t think so, no. But I don’t know. Maybe some people can, not many. People are doing that online. They’re not worrying yeah, I suppose.
Male Host: So it’s actually most human beings needs to move. To feel good about living. Definitely, but yeah, so I’m interested in because you’d seen lots of different healthcare practitioners over the time, what would be the message that you would want them to give someone in pain?
Jamie: I don’t know. What should they, what, to like a physio or something? Yeah, yeah, doctors…physios.
Male Host: I mean, you saw doctors, physios, surgeons. Like a whole bunch of people. And if you wanted to get them to give a different message, not the messages that you got into trouble. The messages, if it’s well in my mind, it sounds like the thing that switched for you is like movement is not damaging.
Jamie: Yeah, movement is the thing you need to get. It was, and that was even though I hurt. So, yeah, just well, because I was mismanaged, and I don’t hold anyone responsible, it was me as well as a lot of mismanagement I guess. Or, bad advice. So, I don’t know, can you say stop giving bad advice?
I suppose that’s, you know if someone comes in and they’re guarding their back when they sit down, so maybe don’t do that, you know? Maybe try and move a bit freer or something, you know? Because there’s lots of ergonomic advice out there for people.
Male Host: Yeah, lifting advice from people which all goes to guard your back, protect your back right?
Jamie: Yeah, and I don’t know, I think the message I’ve heard the message from other sources as well and it’s good to hear it. It’s getting out, that’s great, so there’s a general shift.
Male Host: Yeah, yeah.
Jamie: It’s well, yeah. I’ve heard a couple of times so maybe it’s getting out. Slowly I think. It’s very slow. I don’t know, but as long as you’ve got, you know…
How much money is invested in neurosurgeons and, you know? What all happens there? And MRIs without, you know, without people getting MRIs and CAT scans, how many people are going to lose their job?
Male Host: I suppose it’s tricky because we do know that for some people surgery is the right thing, yeah? You know, if you’ve lost power in your leg and you’ve got, you know, losing power and sensation and you can’t pee and those kinds of things.
That’s a clear reason for, that’s a reasonable surgery. And the thing that was interesting, as you described, is that you had some stuff on a scan but it didn’t kind of relate to your presentation. Well, so your pain was in the back, not the leg?
Jamie: Well, when I found the physio that I found, he was the first guy that, because, he said “oh, can I see your MRI?” and I was like “oh, OK.”
And I give the MRI summary report, he said, “no, no, MRI”. And that was the first out of four or five physios, he was the first one to actually put the report up and check it out. It’s like, ah OK, looks like bone, I think bone stress was, you know?
And he said, you know you’ve got protruding discs, but you know, you’re a 40-year-old bloke. Who isn’t going to have something like that on there, you know?
And, so well, that was, that’s what happened to me anyway.
Male Host: Yeah, it was kind of less threatening. First of all, was a good education around MRI, but also it wasn’t threatening information about what was happening.
Jamie: No, no, that’s right. And it was a relief to hear. OK, I can see something, not just read the report. And then, you know, I thought “OK, this guy knows his stuff”, you know? And he said, yeah, good confidence.
Male Host: Definitely, yeah, sure, so one of the interesting things that you’re, like, as you said, you dug a hole and you’re in trouble for six months and then you came out of it. But it sounds like you came out of it and you went back to doing everything you did. Plus more things.
Jamie: Yeah, like it was a steady way out it wasn’t just the edges.
Male Host: So, yeah, it gave you confidence to go because you said you’re going harder. Just getting stronger again.
Jamie: Just like the feel of using my body again and, you know, being able to stretch and everything. Everything just moving again and that.
Male Host: And during, because you said it was about six months, right? Then now that afterwards, the kind of rehab process was about six months. And then by the end of that process were you concerned about your background?
Jamie: No, no.
Male Host: Did you feel like you needed to protect it, or didn’t you?
Jamie: No not at all, not at all. Not until I heard it again, and yeah
Male Host: Yeah, and that’s what rattled you?
Jamie: It rattled me big time, yeah. More than I thought it would. Yeah, I guess, but yeah.
Male Host: And what do you think of the key points during that rehab that allowed you to get out of the hole? What are the key things? I mean, you say that pain has a memory, I suppose, so getting out of pain must also have a memory right? Or the way that you can do that?
Jamie: When I had that plan, when I got that plan, I was like, “I can do this”. You know? And so I just went home and did it, you know? Every, I think, twice a day, I’d do my exercise. I didn’t do it more because in the first six months when I first got hurt, I used to do it more than this. You know? And then I’d wind up getting sore again.
And then that was kind of a backstep. So, I just, yeah, pretty much followed it and then it was good, you know? And I think it’s to do with the timeframe.
It’s gotta be, you know, that was only sore for that long before I started moving again. Not that long, and then it all comes together.
Male Host: During the six months of that rehab, and you said you were kind of, was steady? And you had a few steps and you kind of went back, and you had some flare-ups along the way.
How important do you think were, for you to have those flare-ups during the rehab while you’re being coached to be able to move forward?
Jamie: Important to have them or? Oh no, that was terrifying to have them, yeah. Because it, but then it’s like, I just wish I could have had someone with me 24 hours a day saying you know, “that’s OK, don’t worry, just do this and you’ll be OK.”
I thought, you know, that would have been great. But, that’s just not possible so you know, so did I get back home? Yeah, I’d get back on the phone if I didn’t have an appointment already. I’d make one. And going to the physio was more like getting coached through it, I suppose. Because it was never hands-on, like, you need a massage or anything like that.
I think the most hands-on that I did was lay down on your stomach, and he’d just, press on my back. And I could feel it, you know, and I was like, “holy, is that alright?” Like, is this kosher or, you know? And that was it, but then you go home and you do your damn exercises. That’s it.
Male Host: So what did that that made you feel like? When someone wasn’t, because it doesn’t sound like he was being careful with your back?
Jamie: Yeah, he was actually just putting pressure on it.
Male Host: Yeah, what did that make you think?
Jamie: Fearful, but like, at that stage I had pretty much complete, well not pretty much, complete trust that he was doing the right thing. I mean, he told me I didn’t need a fusion.
Male Host: That was, the big box straight away?
Jamie: Yeah, big time man.
Male Host: So when he was doing that, did it feel to you, like, gave you confidence in your body?
Jamie: Yeah, yeah.
Male Host: Yeah, so it sounds like someone that, you know, looks at your scan can explain to you what’s happening. Listens to your story then handles your body, or uses your body in a way that demonstrates that confidence. It wasn’t feeling scared of doing that and gives you a plan that is clear. And that is achievable, and you could do it by yourself.
They sound like were important things for you?
Jamie: Oh yeah, to this day, sometimes, every probably six months, I just email the guy and say “man, thank you, thanks so much”. Because, like, he saved my life. But I honestly believe that because at some of the worst times I was like, “ I can’t do this anymore.” You know? So no, definitely that’s what it was about for sure.
Male Host: Thank you for sharing your story, thank you very much. I think one of the things we know about back pain is it’s really, really scary. And you feel like no one else has walked that journey. So to have someone like yourself share that story is really, really valuable.
And you know, we had some other podcasts and already people contacted us to go, “that story really gave me hope.”
Jamie: Oh cool.
Male Host: And, I think that’s the one thing that often isn’t out there. People just lose hope.
Jamie: Yeah, well like I said, to see all these people, and I wasn’t done at all. Yeah, there was nothing for me on Youtube or reading. There was nothing but bleak, bleakness.
Male Host: And do you think you know the painHEALTH website, because your video is up on that as well. Do you think that’s a good source for people to go to? To have a bit of a different understanding of what’s going on, if it’s going to perpetuate the teachings of you know, movement.
Jamie: Yeah, it saved me anyway. So, you know I can’t speak for anyone else, but yeah, if anyone else has got back pain the same kind of way that I had…if I can do it, then they can do it. But you just need to know what to do.
That’s all, and if they’re telling you what to do then that’s a good thing. And, having a coach you trust, and a plan. And a plan, and doing the plan.
Male Host: Yeah, exactly. And that’s probably the other thing, you were really disciplined but from what you’re saying is, to do that plan.
Jamie: Yeah, well, like I say there’s only one person going to get you out of it. And you’ve got to realise that and that can be really scary. That you know, you sit down and have that moment, that “no”. Yeah, this is on me, I’ve done this, now I need to do that.
Male Host: Coaching is important isn’t it? Because it supports you along that journey of course.
Jamie: Yeah, for sure, yeah.
Male Host: But, it’s interesting. You only needed the one session the second time.
Jamie: Yeah, because it just doesn’t get back on track, and it was like, “what
are you doing?” And I knew that anyway, I just needed to, I did, I needed to hear it otherwise I’ll be still on the couch probably scared of rolling.
Male Host: It’s quite interesting some of the things that you say. They really reflect what we see in the literature of people developing pain. And people, you know, you get these body sensations there as you said before. Or I’ve got this zing in my back so that means I’m out for two days. Or you kind of make these associations between symptoms and consequences.
Male Host: Yeah, and you have your thoughts and that builds a memory that is a threat-memory. And it sounds like over those six months you’re slowly building these new skills of how to use your body.
Jamie: Yeah, as I said, I’ve never learned that. No one taught me that. I did it myself. You know, what an idiot, dig in the hole, “oh no I did that” thought process to myself. Like no one, I never read anywhere that “oh if you’d hurt yourself you should do it”.
I just, you know, it was weird.
Male Host: And then that period of where you’re kind of learning this new, kind of, safe memory where you’re learning how to use your body in a more confident way. In a more relaxed way which is completely against what you’re doing before, but it took a bit of time for that memory to overcome the threat.
Jamie: That’s right. I feel terrible for anyone that’s been in it longer than six months because I’m sure there’s a lot of people that’ll probably take even longer. Or, you know, maybe it won’t. I don’t know, but that’s what it took for me. And I’m just glad I got out of it so quickly because there’s a lot of people that have been in it for longer.
They’ll probably look at my video and go “ah, six months, he did nothing.” Two, you know, three, four years or so, you know? I don’t know.
Male Host: I think everyone’s journey is a different journey. I think that’s very true. And the factors that kind of get you caught are kind of similar actually, so that’s what the research tells us. That, you know, as JP highlighted, when something’s scary the body will go on to protect them.
It’s really natural, and the problem is the brain can’t work out if it’s tissue damage, or if it’s broken bone. Like, a muscle spasm can feel like it’s a cramp. Like muscles, but it’s as excruciating as a broken bone. But you know from a cramp you need to stretch that muscle and get it moving.
Where the broken bone, if you do, that’s going to not work at all. And the brain can’t do that with the back very easily and so you have to relay that to healthcare practitioners. And relying on the history is really important as well as the presentation.
But, also part of that process of working with people is, as people start relaxing and moving if it’s a broken bone it feels worse. Or, if it’s not damaged it will feel better. And I think what you highlighted in that second event is you got onto it quickly.
Male Host: And very quickly everything settled down which highlighted you hadn’t done major damage to your back. It’s just that the body had gone “oh my god, it’s that thing again.”
It’s gone into massive protective mode and that’s a really hard thing for people to understand, is that we often hear this “how could I be in that much pain and not be damaged, how does that even work?”
Jamie: Oh I know, I did it to myself. I know you know, that my mind did it, but then, as I say, every now and again my brain would give me glimpses of “I think you’re doing this” and I think this is partly on, you know, you’re doing this to yourself. So it wasn’t without a couple of warnings, but I didn’t know what to do.
Male Host: And it’s interesting, the other thing that I think is worth just
highlighting is the things that, from the research, that we know are predictors of a back pain event. Often, as you said, overdoing something. So doing something you’re not accustomed to. Doing something suddenly or awkwardly, or doing something when you’re run down, under pressure or, you know, under stress.
Or not sleeping, or your other stresses in your life but your body’s just more vulnerable. With that time when it sounded like the dig in the ditch was, you were hungover and you went to town on it. And your body’s going “no, that’s not so cool.”
Jamie: Yeah. Now look, I just remembered another thing. That, I was always putting time on myself, like, I think, if I can do weeding for, you know, two hours then I’m closer to getting back to work or whatever. You know, I put time limits on everything.
As if, you know, I’d get set back that far. I remember telling the physio, like, I’m weeding for two hours and this should mean…and he was like, “do you weed at work?” Like, is that what you do for work? What are you doing that for, you know?
I’m like, oh I don’t know, it just made sense at the time I guess.
Male Host: I think it’s often when you’re in a really stressed state that you just do stuff. Do weird stuff. That’s, I think, quite a natural thing. It’s obviously good to bounce that stuff off as well as drugs. As well like, if you’re taking those drugs. You know, like Tramadol.
Jamie: Yeah, it’s pretty heavy stuff. I didn’t know that Lyrica was actually a really strong drug. I just thought it was probably a nerve drug which I didn’t need, you know? It’s, I think, it’s a native drug. So yeah, I never had nerve pain and I was on that stuff, you know?
Male Host: Jamie, given your experience with so many health care practitioners, how do you feel? How was the professional’s response to your pain? Did you feel like they were confident to give you stuff to do? Or, were they scared themselves?
Jamie: I think confusion. Because I didn’t have sciatica it was like, well what do we do with this dude? You know? Like, get him an MRI, get him a CT scan. I had a nerve sleeve injection, but as I say, I never had never pain. Well, unless you get nerve pain down the bottom of your back or whatever. But, I never had that before, so yeah.
I had that for nothing, you know. CAT scans, MRIs where they put the stuff in the fluid, and stuff like that.
Male Host: You know, were they confident to get you moving? Or were they “no, no, no?”
Jamie: I think when they saw, because, I could still bend down and touch my toes. And the physios were, some of them were going like, what, no? One was lifting my leg and he’s got it past the point. So where I wasn’t bending down, touching my toes, he lifted my leg and it got past the point where he supposed I would have sciatic pain. And he said, “oh, you actually can move your leg quite far”. And I said, “yeah”.
I haven’t got leg pain, it’s my back. And there seemed to be a lot of confusion around that. And that stuff that I’d read on, there was very little literature, sorry on the website, for just that particular back pain. In the lower back, I couldn’t find a hell of a lot. It was mostly sciatica and that.
Male Host: And the other cool thing in your story which again reflects the literature, is that we see that it’s kind of important for people to have when they have flare-ups, and especially if they’re being coached by someone. Because as you experienced, you have the flare-up, and all those bad thoughts come back.
And, the behaviours come back and if you have someone coaching you, it’s a way of relearning the new skill and that strengthens the new skill. And that’s probably what happened to you over those six months of rehab. Where you had little flare-ups and then you learned a new skill. And you managed to practice that, and then when you had a flare-up, it’s almost like you’re squishing the threat memory. And strengthening the safe memory.
Jamie: Yeah. And who knows if I get a flare-up again, I might not need to call anyone. I may get through it, and maybe it would get to that stage. I don’t really want to find out but it may be that way, you know? I could try, but I think I can imagine I’d probably want to talk to someone. Just, you know, out of habit, I supposed. And, if you’ve got someone that you trust, why wouldn’t you?
Male Host: Yeah cool that’s great. Thanks for sharing your story.
Jamie: No worries, it’s been awesome.
Male Host: So, as we mentioned flare-ups are common and back in episode 14 we spoke with another patient voice, Joe. He’d been through several pain flares throughout his journey. And I actually interviewed Joe back in 2018 while he was in the middle of one of the worst of his flare-ups.
So, we played that back to him during the episode and it resulted in some
incredible learnings. But, for your convenience here is that section of the podcast, if you haven’t listened to that episode it’s all about imaging and scans for back pain.
Joe, you kind of mentioned before there was a little bit of a period there where everything was going great. You were back to doing everything that you loved and then [ __ ] hit the fan, yeah?
Joe: OK, so, I mean about a year after I started coming good and I got some really good advice. I ended up having a pain flare and I think almost, the sailing was a little bit too smooth for the 12 months before it.
Because it just, it came out of nowhere and it absolutely hit me. Hit me for six. So, essentially I’d been going good for about 10 to 12 months and then out of nowhere, there was just a tiny little niggle.
And then over about an hour it built up, built up, and then the familiar sensation of my back going into spasm was there, and I was all bent. And, I was just in a lot of pain and I couldn’t relax, and my mind was going back to, you know?
Oh God, just trying. I was still trying to move as much as I could but my mind was going back to “oh what if, what if?” I started just getting a few more negative thoughts. Which then, I mean the pain probably only lasted about a week.
But the negative, it just made me feel vulnerable again. And the negative, mental sort of, side of things hung around for months and months and months. And I started having just a few more pain flares and things just sort of started to unravel.
Male Host: So, we, I was lucky enough to catch up, well yeah fortunate enough to catch up with you at that time. I actually recorded a little bit of a video which I want to play for you now.
Joe: Yeah, yeah absolutely.
Male Host: Yes, because I think it sort of highlights certainly, how when you have a pain flare lots of your old beliefs come rushing back.
Male Host: So, let’s have a quick watch.
Recording of Joe: It’s, unfortunately, my subconscious because I had that vulnerable period, and there was a period where my brain was anxious and still is a little bit. At the moment it’s going through negative possibilities.
Like that, the disc bulges are bigger, that the regeneration is still there. That, you know, that these things do mean that pain should be. It’s just giving it meaning. It’s giving it power.
Male Host: So, that was about two years ago. One or two years.
Joe: Yeah, yeah I guess. Yes, probably more than two years ago now. Yeah.
Male Host: So, watching that back now, what’s going through your head?
Joe: Just, I remember it like it was yesterday. You know, like the rapid progression and then all of a sudden I just had these pain flares. And I was right back where I started. And I just started being really worried again. And, I mean, it was like, you know, you’re building a house, or a tower stack, or a stack of Jenga, and you just start taking pieces out.
Every flair-up was like taking pieces out of that foundation that I’ve worked so hard and done, you know, helped build up. And, I guess what happened is the pain flare.
Although the original pain flare lasted a week or two, it got me worried again and then that worry fed back into not only making the pain worse but also wondering what was behind the pain.
And then when that started happening, maybe my movement started being affected. I started becoming a bit worried to do certain things again. And then, you know, I stopped doing things that were distracting and fun. And I just ended up it… was just a downward sort of spiral down. And everything sort of fed back into making the pain worse. Then, the pain fed into my mental health and then the mental health just has an impact on everything.
Male Host: So, what would you say to that Joe now?
Joe: Don’t worry about it. I don’t know. I like to think I’d listen to myself. But, no. Look, I mean honestly if I saw into the future at that point in time. If I looked forward to the future and saw where I am now, that it would have been a two-week problem, I would have taken it a little bit easy while the pain was bad.
While it was flared up. And then I would have just got on with it because, you know if the worry’s not there about the loss of function, and identity, and physical activity, and work and that sort of stuff.
If the worry’s not there, then pain’s easy to deal with. I mean, if you think, “well
pain doesn’t mean anything”, the pain itself isn’t really a problem. It’s what the pain means. And so, if you look forward and go “oh if I saw myself in 80 years and I was jogging down the street, I wouldn’t have a care in the world. Until I probably got to 80, then I’d start worrying again.
Male Host: So did you get another scan then?
Male Host: Why? Because given that you were worried about it, why didn’t you?
Joe: Because I had some really good people in my corner telling me I didn’t need to, right. And I didn’t, but also, even though I was back to, I got really bad, I spiralled all the way back down to, not quite where I was, but pretty close. But, I still held on to some of the key messages from all of my time and experience from the progression before. And so, I knew that, like, you know, I was still telling myself all the right messages.
You know, “pain doesn’t mean damage, movement’s good for me”. I still had all of these positive messages going through my head which I didn’t have before. But, they were just getting overwhelmed by the other side of things. Which was that, but I still had some really good people in my corner telling me, “you’re going to get through this.”
And I ended up, you know, it was a while, I mean, a two-week problem became a six-month problem. But, you know, slowly got back on top of it and then, and I’m just, I’m away now, so it’s all good.
Male Host: So, if you had another two-week event, do you think it would be different?
Joe: Oh, I’ve had a week-long event about six months ago actually. And, it was weird. I just thought, I think, the more experience that you have dealing with this, and the more tools I’ve been given, and the more I’ve been sort of, you know, you live the experience. And, once you’ve done these things a few times before, as I said, I think the first time the sailing was a little bit too smooth.
But now that I’ve had a few rockier sort of seas, it just helps you know?
Male Host: So, what did you do differently the last time, six months ago?
Joe: I just didn’t worry. I just distracted myself. I just went, “you know what? This will get better.” I can’t do XY and Z for now, but as soon as I can do those things I’m gonna do them. And I sort of went “well I’ve been so much worse than this before, why is this going to be any different to the last two, three times? Where, you know, I got back to being awesome.
Male Host: You got back to being fantastic. And, what if it didn’t get better in a week, what would you think?
Joe: I still am, I’m really, really happy that I know when things get really bad, I’ve still got some really good people in my corner.
Male Host: Yeah, right. So did you go and see anyone?
Joe: I didn’t, I didn’t.
Male Host: You did it yourself?
Joe: I did it myself, and as you said, you know, because it only lasted a week, maybe that if it lasted a month or two months…I mean, it’s some help. Yeah, well absolutely.
It’s, you know, I didn’t seek help. Maybe a week wasn’t long enough. I was able to navigate that myself. But, I don’t know if it had been going for two weeks or a month or two months I would have started to call in some, I would have
started to mobilize the team.
Male Host: So, there you have it, the end of another episode. As I mentioned at the start, hit us up via social media if you want more.
Share the podcast, spread the good word, write a review on iTunes, and help
support us, so that we can support you. My take-homes from today, flare-ups
while certainly not pleasant, are unfortunately common and a pretty normal part of recovery.
While they can be terrifying in the moment, they don’t last forever and can be an incredibly important learning opportunity. They are usually more related to things that sensitize our system like poor sleep, stressful times, being more sedentary, working longer hours, not having time to recover, or doing too much too soon, and infrequently relate to creating further damage.
Even though it may be really painful, and although it can feel like a big step back and that you’ve undone all your progress, this is rarely the case. You may find it helpful to think of it as a temporary pause on your progress and certainly not a restart.
What were your take-homes? We’d love to hear them. Share them, and tag us via EB Podcast on social media. And, until next time remember to ask, “Is there more to pain than damage?”
Please note what you heard on this episode of Empowered Beyond Pain is strictly for information purposes only and does not substitute personalized high-value care from a licensed and trusted healthcare practitioner.
We are all individuals and need to be assessed and managed as such.
Theme music generously provided by Ferven and Cash.