Episode 19: Pain flares don’t mean you’re damaging yourself, with patient voice, Jamie.

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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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SOCIAL MEDIA LINKS:
FACEBOOK | TWITTER | INSTAGRAM | PETER O’SULLIVAN | JP CANEIRO | KEVIN WERNLI

Episode Show Notes:

O’Sullivan PBCaneiro JO’Sullivan K, et al
Back to basics: 10 facts every person should know about back pain
low back pain infographic
Jamie  in the video for pain health:
https://painhealth.csse.uwa.edu.au/pain-module/jamie-e/
Suri, Pradeep MD, MS∗,†,‡,§; Rainville, James MD‡,§; de Schepper, Evelien MD; Martha, Julia MPH; Hartigan, Carol MD‡,§; Hunter, David J. MBBS, PhD‡,|| Do Physical Activities Trigger Flare-ups During an Acute Low Back Pain Episode?, Spine: March 15, 2018 – Volume 43 – Issue 6 – p 427-433 doi: 10.1097/BRS.0000000000002326

Transcript

* Auto-generated*
did you think that was it you were
sorted yeah yeah
yeah right yeah so
how did you feel yeah when the pain came
back
yeah it was scary yeah
scary because um because i found myself
slipping back into the the old way so
quickly so quickly 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
what do you guys think should we keep
going and do more seasons are you
finding this valuable
let us know give us feedback and provide
suggestions for guests and topics via
social media
or by emailing podcast bodylogic.physio
thanks again for tuning in we’re honored
you’re investing in yourself by letting
us bring evidence to your eardrums and
help make sense of science
for you 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 pain health
videos
he has also appeared on the podcast on
episode four and five
and was the topic of a paper that we
discussed with dr sam bunsley all about
how beliefs influence
pain back on episode 10. jaime’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 jaime 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 canero 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
pain health uh this is one that i send
many patients to and 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 forward slash
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 nine
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
and 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
[Music]
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 so this
podcast is a discussion about
pain flare-ups or pain exacerbations and
those
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 um
and you know your your story is well
captured
in the pain health um 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 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
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 tell you to talk
to us through sure how that was what was
going on for you
okay well so how i wanted to dunk myself
into the hole yeah yeah pretty quickly
um
i was doing that i was doing weights
yeah and i and i hurt my back
and then i continued to do weights and
then it got to the point where
i i thought i couldn’t well it was my
back was getting sore but i kept going
and then and then it just went i i don’t
i don’t actually know
like i said i was i dug that hole pretty
quick and it went from
from that to driving to work with my
foot just
buried on the sill trying to keep my
weight off my back to
sitting with a towel behind my back
like everyone said and stuff like that
to them it just
it was always on my mind like watch
someone sit down and i think
[ __ ] i used to sit down like that you
know and i’ll be like oh and you just
think of everything
as it gets worse and worse and then and
then it got so
then it got as bad as i just had to lay
down all the time stop going to work
yeah and that was it and then started
going to the doctor so i went to the
doctor
got prescribed lots of different
medication
they 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 and then so
got on uh lyrica
maloxycam and um 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 i had i had a
picture
of my back that it was i guess really
fragile
and like i say like a glow stick where
where you snap it
and the glass shatters and if i if i
would sneeze or something like that
then i would think of that happening to
my back because it was like a like it
grabs
like that and because you’re so tense
anyway and then
if that would happen i’d think okay i’ve
um
i’ve set myself back for no for no
reason i’d like no one told me this i
just come up with this
and and like 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 that were because i
never had
i never had sciatica i just had lower
back pain
and um yeah so it was like they didn’t
understand it if i didn’t have sciatica
then what’s what’s the problem kind of
so
i was hearing about everyone with
sciatica and i’m like no that’s that’s
not me
my back saw you know just my lower back
so then i dug that hole real quick
and got into laying down real quick so
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
yeah that’s right yeah 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 line lying down yeah yeah that’s
all i could do yeah right at that stage
yeah and how scary was that for you
terrifying yeah it’s not like a real
active person yeah
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 so i had a good like that
but you know and i was still getting
paid so but i feel guilty i couldn’t
pick up my kids
couldn’t help out do you know stuff like
that so
yeah it’s it’s a it’s 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
am i going to get out of this you know
and did you have a sense that you were
stuck in that space
yeah definitely yeah yeah well so i
because i saw a neurosurgeon
and then i ended up getting a discectomy
yeah
and then that didn’t help because you
know
i 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
is when i come to a physio
with a different approach with a
different approach so how was it when
you were thinking
my back is you know at the point where i
need to get a fuse
how did that feel for you i was like
everyone around me was saying get the
fusion and i was
the i was going no i don’t want this so
i put it off for as long as i could
and then and then it was just like whoa
what a okay what else do i do everyone’s
telling me to do it
except for my 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 um look worse than mine that
you know got away with not having a
fusion and he said i i said something or
have you seen worse yeah and he said
yeah i have and i was like
okay well you know
not everyone’s better than 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 yeah and then went for a little
walk and then had a sneeze and thought
oh [ __ ] here we go again you know
so those pain events you know when you
were in that dark place
where you’re like stuck on the bed and
and those
little pain spikes that you had yeah
what did they mean to you
what did you think you know you talked
about that yes yeah it meant sat back
yeah that meant
that and like i say i i 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 grab i had a name i even
named it yeah i’d say it was like a
flash grab because it like
did tense through your whole back and
because it was so tense any everywhere
already it was just like yeah and so i
even named it
and when it happened i i had a plan okay
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 to into
the backyard and there was out of the
whole backyard
there’s um there’s one piece of um
really slippery slippery like mason uh
what do you call it like you have your
bench tops
yeah stone 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 ah 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 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 i just thought well
damage i suppose like i just thought it
was
i know it hurt so i thought it’s damaged
yeah can i just say well for you pain
men
i’m doing harm yeah yeah and so it made
total sense that you would
lie down yes and not move of course and
guard you back
because you were thinking that would
protect you against doing more harm yeah
okay so you talked about um
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
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 and if i was if i did have to
drive somewhere like
i said i’d have the towel behind my back
and and then you know 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 tablet i’d
stopped all the drugs but i was drinking
every night i think oh i’ve made it till
four o’clock i’m gonna get i’m gonna
drink so i’d drink wine and see if i
could replace the medication
which was probably very yeah
counterproductive as well so 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 so did it
make sense to you
to do the opposite to go did it make
sense
to relax and move when you were that
sore nah
but i liked the idea that was good yeah
no it didn’t make sense
right because if you were if your
thought was this is this is a damaged
bag
yeah then moving it yeah yeah exercising
it
wouldn’t make sense to you no and i’ve
been laying down
for six months at that stage like out of
work
laying down six months right
so how scary was it to start to move
again
it was scary yeah well it was scary yeah
right it was scary but
really exciting as well yeah okay 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 yeah
and the part of the brain that saying
protect this
really painful part of your body yeah
that were working against each other
yeah
and it’s 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 i wasn’t sore and i’d
be like what’s
what’s going on here and then i’d wake
up so you know and i’d be like
it was really confusing really confusing
i didn’t like yeah okay but i was say
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 yeah 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
how long did it take you to get trust
back in your body again
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 too much do
too much of something
and then yeah so
it must have been very brave for you to
kind of
go from protecting guarding avoiding
to relaxing moving engaging i don’t know
about brave i was just really
happy that there was a different there
was an alternative yeah
so yeah yeah i just you know i knew that
i could
if i mean yeah once i was told that
i could do it then yeah i thought so
you’re going to delay with it
yeah yeah that you could do it even
though your body was saying this is a
really bad idea yeah because somewhere
some like at times during that six
months i
i kind of thought what what am i doing
am i is this
there were glimpses of am i doing this
to myself is this like a
sometimes i thought even like is this a
depression am i is this a form of
depression because because i was surely
depressed yeah and i thought is this a
like 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 it’s it’s really 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
i’d be going what what am i doing
what am i doing 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 do did the opposite
and you were moving and you were getting
active and you were
doing stuff which previously would have
hurt you yeah
what how did you change the did the
meaning get the pain changed to you
did the 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 yeah how
did that how did the meaning of the pain
change to you
just by moving and and going okay
i can or i can squat down and i can feel
it just felt awesome to start stretching
out right
and to feel like you know when i feel
and and when my back cracked as well
because i i was so excited if i’d turn
one way
and my back would crack i’d be like
because that’s feels like
a tension going you know and i’ll be
like okay
things are letting go but it took so so
long
for everything just to let go and yeah
so do you think
that the tension was a driver of your
pain yeah
yeah it’s it’s like when um 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
okay
that makes that makes sense because
everything was so tempting
everything yeah yeah you know crouching
down like this
and yeah just not bending not not fluid
so 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
yeah yeah yeah and one’s less scary
yeah is that right you have control over
yeah yeah well
i just did not want a fusion well i
didn’t need one yeah
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 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 yeah as well
as a bloke at work at the same time as
this i
was going on he was in the process of
getting a fusion he went to a
neurosurgeon who said he didn’t need one
so he found 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
yeah everything’s telling everyone’s
telling me to but i’m telling myself not
to
and this guy’s just got better yeah
maybe i should do the same thing maybe i
should do the same thing yeah so
you then had a period of three years
when you were going
like what was life look like for you
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 do it not a thought like
not
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
you know when they slump in a chair
you know because everything would be
like uh like a you know like a
invalid or something sitting down you
know so just yeah
not not concerned and that’s the idea in
that to not think about it
you know relaxing it’s not thinking
about doing all your normal activities
and
yeah yeah doing what weights everything
um
bouldering yeah boxing yeah yeah
everything
everything yeah yeah yeah yeah yeah and
did you think it was in the forest
did you think that was it you were
sorted yeah yeah yeah
right yeah so how did you feel
when the pain came back yeah it was
scary yeah scary because um
because i found myself slipping back
into the
the old waist just so quickly so quickly
i mean the first
yeah i was digging a trench and um
it just i felt it cut across my back the
same pain
right that i had before yeah
and um and it was real like it’s you
know it was real pain
you know and so it didn’t have not the
sciatica again it was just back pain
and so i went and i i laid on the couch
right
and um because i was pretty hungover as
well
when it happened so i needed to rest
anyway so
late on the couch then i found myself
as i’d move on the couch when because i
had that before when you move
it it hurts when you move and so and you
use your legs to kind of lift
yeah so that you spin over and it’s you
get that pain all again and that 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 okay
it’s on again you know right and and
because it took so
long i mean i knew that it it probably
wasn’t going to be as bad
but because i i didn’t know
i didn’t know how quickly i could get
out of it but i was thinking
i was thinking i was thinking pretty
long term i was thinking a couple of
months or something like that you know
but i couldn’t get hold of me physio so
i was
starting to stress and i’m going like
okay and then so what did you do in that
week
well i thought about getting stan
because i hadn’t i
had already done the video right now
no but and then i’m going like what are
you talking about
what what are you thinking you know you
got netflix last time
zonked out and now you want to get a
stand and it’s just like
what are you doing but i was
because i was laying down and i was
doing those movements i was going no
this is
this is bad this is pretty bad right
because you every time you move to her
you were thinking you’d done damage
again yeah yeah yeah yeah i’d
yeah okay yeah so your body was giving
the same warning signs that you used to
do before yeah
but your head had two experiences now
that you kind of counteract yeah
yep that’s right yeah
so then what happened well so you were
thinking two months
i was thinking yeah i yeah i was
thinking
something and you went to bed again yeah
yeah well that
that lasted for a week until i got in to
see the physio
and then what happened well he he just
said would you what are you doing
pretty much and i was like yeah i know i
know okay tell me what to do i mean
because if if i could have
afforded the first time if i could have
oh i thought i wish i wish i could just
take the physio home and just him tell
him
like that’s what 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
do this so what kind of things did you
do because like because real heavy’s
like squat not hit not heavy with weight
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 and you know
the open book and stuff like that and
just the things that i’ve done before
yeah it made me mad yeah so your brain
was saying don’t move yeah
your body was clenched it didn’t want to
move yeah so quickly
you’re so quick you put your trust in
someone to say yeah
move yeah yeah and i knew i had to i
knew that was right on you right yep
and that you knew that was right because
you’d done it before
and it helped yeah i’ll say that the
opposite yeah this time
yeah well yeah so you went home
with a plan yeah yeah okay and did it
and executed the plan
and i think i was only off work for a
week
so it was that was during christmas time
so i had there was a week off anyway
yeah and then so then i saw come to the
physio
and then i was off for a week and i went
back i wasn’t moving as quickly as i
normally do
like i remember walking from the gate to
the um
to our workshop and i was moving slower
but sure but yeah so how long did it
take you to get over that second event
probably two weeks i reckon right two
weeks did you have a lot of treatment
over that time
no just once you saw the person once
yeah yeah they gave you a plan
yeah you did it yeah and your body
recovered that’s right
so what do you make of that it’s
movement isn’t it it’s movement
it’s not locking up it’s not taking
drugs
it’s it’s just movement right yeah keep
keep going
and does it make sense to you that
that’s
it does now yeah yeah it does it of
course yeah because
it’s 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 yeah
and it’s really hard when you that’s
your mindset yeah to go against the
grain yeah well i mean i almost did it
again
right so yeah it is huh and have you had
another event since
no i 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 not stupid i won’t whack
another 10 kilos on
the bar or anything like that i’ll just
okay that’s that’s a bit sore
i’ll just do something else you know and
then yeah
but 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 yeah
so move the painful bit yeah in a gentle
repetitive way yeah
yeah and you can feel it draw out and it
feels good it’s good
it’s a good thing yeah okay so
if you were to you know talk to people
who’ve
hurt their back what advice would you
give them because there’s we know back
pain is like the leading cause of
disability in the world
yeah it’s the number one of any health
condition yeah right
it really buggers people’s lives up yeah
it
impacts on their work you know their
social engagement family
so all those things and ability to
engage in physical activity
yeah and 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
yeah that’s like you know if i’m hurting
i’m damaged i need to protect it and
void and
there’s heaps of messages that reinforce
that as well yeah you
you go online in the community well yeah
it’s like everything
i think i’ve said it on another video so
if you go on
the 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 done l four five oh yeah but i’ve
got this
and c one two whatever they are you know
and so yeah that’s that stuff is not
good to look at
so what would you recommend for japan
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 you
know
yeah get a plan to move yeah yeah and so
how confident would you be if you had
another night out on the town
and dug another trench i would have to
say confident
yeah but as long as i’m close to the
phone i suppose yeah
yeah yeah and that kind of makes sense
so yeah 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 yeah
yeah
and that’s that’s what that was another
scary thing
to get your head around is that you
realize that
there’s only one person 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 yeah
but unless you actually do it then it’s
not going to happen
and you can choose that that is a road
that you could choose and
you know if you don’t if
and in 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 you could
you think you could worry about nothing
doing that oh not me
no i don’t think so no but i don’t know
maybe some people can not many people
doing that in
line they’re not worrying yeah i suppose
so it’s actually most human beings need
to move
to feel good about living yeah yeah
definitely but yeah so and
and i’m interested in because you’d seen
lots of different healthcare
practitioners over the time
and what would be the message that you
would want them to give
someone in pain
i don’t know what should they what to
like a physio or something yeah yeah
doctors physios i mean you saw doctors
physio surgeons
like a whole bunch of people yeah and if
you
if you wanted to get them to give a
different message
the messages that you got got you into
trouble back to uni
the messages if it’s well in my mind
it sounds like the thing that switched
for you is like movement is not damaging
you
yeah movement is the thing you need to
get well yeah it was and
and that was even though i hurt yeah
so yeah just well they’ve got because i
was mismanaged and i don’t hold anyone
responsible it was me
as well as a lot of mismanagement i
guess or
or bad advice so i don’t know can 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
you know 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
yeah lifting advice from people which
all goes to
guard you back protect your back right
yeah um
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 yeah yeah it’s well yeah from i’ve
heard
a couple of you know a couple 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
you know how much money is invested in
neurosurgeons and and you know all the
okay
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
it’s like
yeah i suppose it’s tricky because we do
know that
there for some people surgery is the
right thing yeah
you know if you’ve lost power in your
leg and you know you
you you’ve got you know losing power and
sensation and
you can’t pee and those kinds of things
that’s a that’s a
it’s a clear reason for yeah that 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 well
when i when i found the physio that i
found um
he was the first guy that just because
like he got he said oh
can i see your mri and i was like oh
okay and i give 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 okay looks like bone i
think bone stress was uh
you know and he said you know you’ve got
okay protruding discs but you know
you’re a 40 year old bloke
who isn’t going to have something like
that on
on there you know and so well that was
that’s what happened to me anyway yeah
it was kind of a less threatening first
of all was a good education around
mri but also it wasn’t a threatening
information about what was happening
no no that’s right and it was well it
was a relief to hear
okay i can see something not just read
the report
and then you know i thought okay this
this guy knows his stuff you know
and he said yeah good confidence
definitely yeah yeah sure
yeah yeah for sure so one of the
interesting things is that you’re
like you as you said like you dug a hoe
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 yeah like it was a
steady way out it wasn’t just the edges
so yeah it gave you confidence to go
because you said you’re going harder
just getting stronger again and just
yeah just
just like the feel the feel of using my
body again and
you know being able to stretch and you
know everything
everything might just moving again and
that yeah yeah
and during the because you said it was
about six months right then
now that afterwards the kind of the
rehab process was about six months
and then by the end of that process were
you concerned about your background no
no did you feel like you needed to
protect it or did you no not at all not
at all not until i heard it again
and yeah oh no no
yeah and that’s what rat told you it
rattled me big time yeah
yeah more than i more than i thought it
would
yeah i guess but yeah 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
um well i mean you say that pain has a
memory
and then i suppose so getting out of
pain must also have a memory right or
the way
the way that you can can do that so but
when i had that plan when i got the 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 i
thought okay i can i can do more than
this you know and then i’d
wind up getting sore again and then that
was kind of
backstep so i just yeah pretty much
followed it and then
and then it was good you know and i
think it’s it’s to do with the time
frame
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 come
together
during the the six months of that rehab
and you said you 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
um important to have them or oh no that
was
that was terrifying to having them yeah
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
oh that’s okay
don’t worry you you know you know just
do this and you you’ll be okay
i thought you know that would have been
great but that’s just not possible so
you know um so did i get back home
yeah definitely yeah yeah i’d get back
on the phone if i didn’t have a
an appointment already i’d make one and
go into the physio was just
more like just getting coached through
it i suppose because it was never
hands-on like you you need a massage or
anything like that
i think the most the hands-on that i did
have
was lay down on your stomach and it just
press on my back
and i could feel it you know and i was
like holy
is that all right like is this kosher or
you know and
that was it you know but then go home
and do the do your damn exercises
that’s it so what did that that made you
feel like when someone like
wasn’t because it doesn’t sound like he
was being careful with your back yeah he
was actually just
putting pressure on it yeah yeah what
did that make you think
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
that was take the big box straight away
yeah big time man so when he was doing
that did he feel to you like gave you
confidence in your body
yeah yeah yeah so it sounds like someone
that um
you know looks at your scan can explain
to you what’s happening
yeah you know listens to your story then
handles your body or uses your body in a
way that demonstrates confidence it
wasn’t feeling
scared of doing that and gives you a
plan that is clear
yeah and that is achievable and you
could do it by yourself
they sound like were important things
for you oh the
like yeah to this day sometimes like
every probably six months i just email
the guy and just say man thank you
thanks so much
because like he saved my life but i
honestly
believe that because at the at some of
the worst times i was like
i’m not i can’t do this anymore you know
so no
definitely yeah that’s what it was about
for sure
thank you for sharing your story thank
you very much
i think um one of the things we know
about back pain is it’s
really really scary and um
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
um you know we had some other podcasts
and and already people
you know contacted us to go that story
was really gave me hope oh cool
and i think that’s the one thing that
often isn’t out there yeah people just
lose hope
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 yeah yeah so yeah yeah
and do you think you know the pain
health website because your video is up
on that as well yeah yeah
do you think that’s a good source for
people to go to
to kind of have a bit of a different
understanding of
what’s going on if it’s going to
perpetuate the teachings of
you know move then yeah it’s yeah it
saved me anyway
so you know i can’t speak for anyone
else but yeah if if anyone else has got
back pain the same kind of way that i
had and
if i can do it then they can do it but
you just need to know what to do
yeah that’s all and if they’re telling
you what to do then that’s a good thing
and having a coach you trust
yeah yeah yeah and a plan
and a plan and doing the plan yeah yeah
exactly and that’s probably the other
thing
is you were really disciplined but from
what you’re saying to do that plan
yeah well like i say there’s only one
person going to get you out of it
exactly
yeah and you’ve got to realize that and
that can be really scary yeah
that you know you sit down you have that
moment that no
yeah this is on me yeah i’ve i’ve done
this now i need to do it
coaching is important isn’t it because
it supports you along that journey of
course
yeah for sure yeah but it’s interesting
you only needed the one session on the
second time
yeah because it just doesn’t get back on
track yeah yeah and it was like a what
are you doing
yeah yeah 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
rolling scared of rolling over yeah it’s
quite interesting some of the things
that you say they really
um reflect what we see in the in the
literature
of people developing pain and people uh
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 yeah yeah and you you
have your thoughts and and that builds a
memory that is a threat memory yeah
and it sounds like over those six months
you’re slowly building this
new skills of how to use your body yeah
like 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 no i did that
thought process yeah to myself like no
one i never read anywhere that oh if
you’d
hurt yourself you you should do it yeah
yeah yeah i just
you know just yeah it was weird
yeah yeah and then that period of where
you’re kind of learning this new
kind of safe memory where you’re kind of
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 to for that
memory to overcome the threat that’s
right yeah and i feel
i feel terrible for anyone that’s been
in it longer than six months because i’m
sure there’s a lot of people because
and that’ll probably take even longer
you know or you know maybe that 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 quick because yeah there’s a lot of
people that have been in it for a lot
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
i think everyone’s journey is a
different journey i think that’s that’s
very true and the factors that kind of
get you caught kind of similar actually
so that’s what the research tells us is
that um
you know as jp highlighted when when
something’s scary
the body will go on to protect them yeah
it’s really natural
and the problem is the brain can’t work
out if it’s tissue damage
like if it’s broken bone yeah like a
muscle spasm can feel like it’s like a
cramp
yeah like a muscles but it’s
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
and so you have to we have to relay
healthcare practitioners and rely 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 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
yeah
and very quickly everything settled down
yeah which highlighted you hadn’t
done major damage to your back yeah it’s
just that the body had
gone oh my god yeah it’s that thing
again it’s like
gone into massive protective mode and
that’s a really hard
thing for people to understand is that
we often hear this how could it be i’d
be in
that much pain and not be damaged that
how does that even work
oh i know i did it to myself i know you
know i know that my mind did it but then
like i say every now and again my brain
would give me glimpses of
i think you’re doing this yeah i think
this is partly
on you 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 and it’s
interesting the other thing that i think
is worth just
um highlighting is the things that from
the research
that we know are predictors of a like a
back pain event
often like you said over doing something
so doing something you’re not accustomed
to
yeah 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 yeah yeah
when it sounded like the uh you know the
dig in the ditch was
after you hung over and you went to town
on it and your body’s like going no
that’s not so cool but yeah
now look i just remembered another thing
that i was always putting time
on myself like to like i think
if i can weed do weeding for like
you know two hours then i can i’m closer
to getting back to work or whatever you
know i put
time limits on everything as if you know
or i’d get set back that far
i remember telling the physio like i’m
waiting 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 what are you doing
for you know i’m like
oh i don’t know it just made sense at
the time i guess yeah yeah
i think it’s often when when you’re in
that really stressed state
you just do stuff do weird stuff yeah
that’s i think it’s 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 and that like
yeah it’s
pretty heavy stuff i didn’t know that
lyrica was actually a really
quite a strong drug i just thought it
was a there’s probably a nerve drug
which i didn’t need you know it’s i
think it is a native drug in there there
we go so yeah and i never had nerve pain
yeah i was on that stuff you know yeah
jamie given your experience
with so many health care practitioners
how do you feel
uh was the the professionals response
to your pain did you feel like they were
confident to give you stuff to do or
they’re
scared themselves i think confusion like
um 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 a
cat scan i had a nerve sleeve
injection but like i say i you know i
never had nerve
pro well unless you’d 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
um cat scans mris where they
put the stuff in the fluid and stuff
like that and
you know um were they confident to get
you moving
or were they no no no
i think when they saw because i could i
could still bend down
and touch my toes and and physios were
some of them were going like what like
no they were lifted one was lifting my
leg and he’s gone and it got past the
point
of where he so no i wasn’t bending down
touch 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’re
actually
like i can move your leg quite far and i
said yeah
i haven’t got the the leg pain
it’s my back like and there was seemed
to be a lot of confusion around that and
that’s
what was stuff that i’d read on there
was very little
like literature sorry on the um
on the on the website for just that
particular back pain
in lower back i couldn’t find a hell of
a lot it was
mostly sciatica and that and the other
cool thing in your story is
which again reflects the literature is
that we we see that it’s
it’s kind of important for people to
have uh when they have flare-ups
and especially if they’re being coached
by someone because
as you experience you have the flare-up
and all those bad thoughts come back and
the
behaviors 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 is what
happened to you over those six months of
rehab where you
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 yeah and strengthening
that safe memory
and 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 i think i can imagine i’d probably
want to talk to someone
just you know just out of habit i
suppose and if you’ve got someone that
you trust
why wouldn’t you you
yeah cool that’s great
thanks for sharing your story don’t
worry it’s awesome
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
okay so i mean about a year after i
i started coming good and i got some
really good advice uh
i i ended up having a pain flare
and uh i think almost uh 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 um essentially
i i’d
been going good for about 10 12 months
and then
out of nowhere there was just a tiny
little
niggle and and then over about an hour
it built up built up and then the
familiar sensation of my back going into
spasm was
was um was 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
yeah
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 you know i started just getting
a few more negative thoughts
which um then i mean the pain probably
lasted about a week
but the the negative um
uh it just made me feel vulnerable again
and the the negative mental
sort of side of things hung around for
months and months and months and
and i started having just a few more
pain flares and and things just sort of
started to unravel yeah
so we we i was lucky enough to catch up
you well yeah fortunate enough to catch
up with you
at that time yeah yeah i actually
recorded a little bit of a video which i
want to
play for you now yeah yeah absolutely
because i think it sort of highlights
um certainly how when you have a
pain flare lots of your old beliefs come
rushing back
absolutely so let’s have a quick watch
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 um at the moment it’s
it’s
it’s going through negative
possibilities
like that the disc bulges are bigger
that the degeneration is still there
that you know that these things do
mean that pain should be it’s just it’s
just giving it
meaning and it’s it’s giving it power
and
so that was about two years ago one or
two years yeah yeah i guess
yes probably more than two years ago now
yeah yeah so
so watching that back now what’s going
through you
just it just i remember it like it was
yesterday
you know like just the the the rapid
progression and then all of a sudden i
just had these pain flares and and
i was right back where i sort of started
and i just started being
really worried again and i mean it was
it was like
you know you you’re building a house or
a tower or a
stack of jenga and you just start taking
pieces out every
every flair was like just taking pieces
out of that that foundation that i’ve
you know worked so hard and done you
know helped build up
and and i guess what happened is the
pain flare
although the original pain there only
lasted a week or two
it it got me worried again and then that
worry
fed back in to not only making the pain
worse but also
wondering what was behind the pain and
then 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 stop doing
things that were distracting and fun
and 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 so what
would you say to that joe
now 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 if i saw
into the future
at that point in time if i looked
forward into the future and saw
where i am now it would have been it
would have been a two week problem i
would have taken it a little bit easy
while the the pain was bad while it was
flared up
and then i would have just got on with
it because you know
if if the worry’s not there about the
the loss of
function and 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 if you think well
pain doesn’t if the pain doesn’t mean
anything
the pain itself isn’t really a problem
it’s it’s what the pain means and so if
you look forward and go
oh if i if i saw myself in 80 years and
i was jogging down the street
i wouldn’t ever carry the world until i
probably got to 80 then i’d start
worrying
again but so did you get another scan
then no
why because given that you were worried
about it why
didn’t you because i had some some
really good people in my corner telling
me i didn’t need to
right and i didn’t didn’t but and also
even though i was back to sort of i got
really bad i spiraled all the way back
down to
not quite where i was but but pretty
close
but i still held on to
some of the key messages from from all
of my time and my experience from
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
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
which was that but i still had some
really good people in my corner
telling me you’re going to get through
this and and i 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 i’m just i’m away now so it’s
all good so if you had another
two-week event do you think it would be
different oh
i i i’ve had a i had a week-long event
about six
months ago actually and
it was it was weird i just thought i
think
the 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 you live the experience and
once you’ve
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
few rockier sort of seas it it just
it just helps you know like so what did
you different the last time
six months ago i just didn’t worry i
just i just distracted myself
i just went you know what this will this
will get better
i i can’t do x y and z for now but as
soon as i can do those things
i’m gonna do them and and i sort of went
well
i’ve been so much worse than this before
why is this why is this going to be any
different to the last
two three times where you know i got
back to
being awesome you got back to being
fantastic and what if it didn’t get
better in a week
how would you think
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 yeah right
oh did you go and see anyone i didn’t
i didn’t you did it yourself i did it
myself and as you said you know
because it only lasted a week maybe
maybe that was if it lasted a month or
two months
yeah i mean it’s it’s some help yeah
well absolutely
it’s um you know i didn’t seek help
maybe a week wasn’t long enough i was
able to get
navigate that myself but i don’t know if
if
it had been going for two weeks or a
month or two months i i would have
started to
to call call in some yeah i would have
started to
mobilize the team so there you have it
the end of another episode
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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 really 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 ebpodcast on
social media
and until next time remember to ask
is there more to pain than damage
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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
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