I’ve yet to find a good meme about the physical therapy bills that go with the back pain though, probably because there’s nothing funny about bleeding cash in a battle that you feel like you can’t win, but seemingly have no choice but to keep fighting.
Lower back pain is one of the primary reasons why people go to the doctor and a leading reason for missing work, yet treatment options are often disappointing. For me, even with years of endless appointments and exercises—no days off!—my back still hurt. People kept telling me that back pain happens with age, but I couldn’t bring myself to just give up. There had to be a way to feel good again, right?
***
Since turning 30 I’ve had the usual back troubles of a person who spends too much hunching over a desk. But the real problem began just before the pandemic, when I hurt my back dancing. (I’m a terrible dancer, adding embarrassment to literal injury.) After the first bout of stabbing pain in my lower back, I spent the next few days struggling to stand up straight. I knew that most back pain resolves on its own within four to six weeks so I resigned myself to wait it out, self-administering the recommended salves of Ibuprofen, staying active, and giving it time.
Over the next few months, as the pandemic raged, my back more or less healed. But then the delta wave lockdown came, leaving us housebound for five solid months. This was necessary to curb the virus, but with the anxiety of the pandemic and the inactivity of lockdown, my back pain came back. It was as if my back was saying all the selfish things my rational mind knew not to voice: “Yes, I know I’m one of the privileged ones in this, and yes, everything about it is making me miserable and I’m losing my mind.”
At the time, I didn’t think of this misery as related to my back pain. But when pain turns chronic, simply looking at muscles and joints may not solve the problem, says Tawny Kross, DPT, a physical therapist at Kross Centered Care in North Carolina.
“The cumulative effect of emotional and psychological demands, not just the physical ones, can show up over time,” says Dr. Kross, pointing to things like work problems, relationship issues, trauma, depression, bad sleep, terrible weather, a cold. When stress piles up, it can show up in the body. “Pain, fatigue, or things like panic attacks then act as a cue to [get you to] decrease the loads that are stressing out your nervous system,” says Dr. Kross.
The long lockdown eventually ended, but my back pain did not. Willing to throw money at the problem, I made an appointment with an osteopath. He had an open, knowing demeanor and I liked him instantly. He told me I had one leg slightly shorter than the other, and a slightly misshapen spine—apparently the imbalance of everything had accumulated over time, leading to the problems I was now having. Oh, and I’m probably a little hypermobile too, he told me, which can lead to aches and pains that come and go, just for kicks. He gave me a comprehensive exercise routine for both morning and evening: “Do it even if you’ve had a drink,” he said, making me feel seen.
Of course the brilliant, expensive osteopath didn’t take insurance. My back felt great after seeing him, but after a while I started to feel resentful: Am I really supposed to spend this kind of money just to feel functional?
I felt almost silly when I finally went to another doctor (one that I didn’t have to hand over an entire paycheck just to see). That feeling proved justified when the first thing she said was that back pain is very common—happens with age! Doing some diligence, she asked: “Do you have pins and needles down your legs?” (I did not.) “Do you have bowel control? Sexual dysfunction?” (All good.) In a tone a little too cheerful for my liking, she proclaimed it to be “one of those things,” and told me to do Pilates.
Asked if back pain is simply a normal part of aging, Lauren Lobert Frison, DPT, of APEX Physical Therapy in Michigan, explains that the discs in our backs do get smaller and thinner and this can lead to irritation and pain, especially if you have weak musculature. “But just because you have arthritis or degenerative changes in your back, it doesn’t mean you have to have pain,” she says. “Aging is normal, but what’s not normal is when it starts to be debilitating.”
“Aging is normal, but what’s not normal is when it starts to be debilitating.” —Lauren Lobert Frison, DPT
Dr. Lobert Frison recommends finding a health practitioner who doesn’t make you feel hopeless. “Using those words that make you feel like your body’s fragile, that there’s things you can’t do, […] promotes a disability mindset. The research shows us this makes things worse.”
One reason for this is that after an injury, the body can get a little overzealous in signaling pain. If you hurt yourself while bending to the floor, for example, your body may start to sound the pain alarm when you bend to your knees, even though the injury has actually healed. “This doesn’t mean you’re not feeling pain, but the pain is kind of lying to you,” says Dr. Lobert Frison. The good news: By going slowly and carefully, it’s possible to teach a fearful body that it’s safe to move again.
On my way out of the doctor’s office I managed to wrangle a referral to physical therapy, figuring it couldn’t hurt to shop around. This guy was nothing like my charming osteopath, bringing the energy of a school nurse mixed with a CrossFit coach. After testing my reflexes with a little hammer, he spent the next 20 minutes making me do exercises lifted straight from gym glass. I hated gym class so much I still have stress dreams about it, and here I was, having that dream in waking life.
The hateful exercises proved effective, but over the next few months I started to feel like my back had a life of its own—the pain would come and go in a way that felt unrelated to what I was doing.
Growing frustrated from fumbling in the dark, I felt increasingly petulant, until one day I woke up and didn’t do my exercises. A day turned into a week, and then into two and three. What I was doing wasn’t working, and I was feeling increasingly angry with my body for not functioning properly. Stopping would at least be a break, if not from pain then at least from failure.
“If you want your body to do something, and if it’s not behaving the way that you’d like, then you can absolutely see it as being betrayed,” says Dr. Kross. She explains that overachievers may feel the need to “push through,” while their bodies are screaming at them to slow down. But Dr. Kross cautions against assigning blame: “It’s actually less about the body betraying you, and more that it’s trying to love you.”
“It’s actually less about the body betraying you, and more that it’s trying to love you.” —Tawny Kross, DPT
Unsurprisingly, feeling at war with my back meant it was soon in a worse state than ever. Desperate, I went to see a different physical therapist recommended by a friend. As she spent an hour examining my back and hips, asking me to balance, bend, and move toes, she determined that the problem was likely the L5 vertebrae in my lower spine. After digging into my hips with her hands and elbows, she handed me a small therapy ball and showed me how to massage myself. I’d told her how frustrated I was, and she seemed to understand that what I needed most of all was to feel like I had some control. I left her office with one simple instruction: “Move your body. Any movement.”
Agency! Self reliance! What a concept. For the first time in years I didn’t have a set of exercises. This left me free to think about what I actually wanted. I’ve always loved yoga, but everyone had told me it wouldn’t build the strength I needed. But it’s what I wanted to do!
So I did. Back on the mat I groaned at my loss of flexibility, but it felt great. In the weeks that followed, something wonderful happened: My back finally started to get better.
***
My original back injury happened over three years ago—it should be healed. My body could be hanging on to the pain out of fear or stress, or it could be a slipped disc—that’s what the final physical therapist thought, but unless I’m in enough pain to warrant injections (I’m not), there’s not much upside in diagnostic imaging.
Dr. Lobert Frison says you should be careful with MRIs for non-specific lower back pain: “There’s lots of people with horrible MRIs that don’t have any back pain. There’s also lots of people with MRIs that look pretty good that have terrible back pain,” she says—the cause and effect isn’t always clear cut. The treatment path isn’t always obvious either, as illustrated by new research on how trauma informs how we experience pain. The good thing about this is that regardless of what your MRI might show, no one is doomed to a life of pain.
I do yoga all the time now, because my body seems to love it. I use a little therapy ball to work on my muscles, and sometimes I do the exercises the osteopath gave me. I carry a backpack instead of a handbag, and I work at my desk and not in bed. I walk places. Last summer I started swimming outside, and kept at it through the winter—the cold water soothes everything, including my back. Life in general is a lot better. I still have Ibuprofen in my bag, but I take it a lot less.
My back isn’t perfect—it’s mostly somewhere between fine and good, but it’s different now that we’re on the same team. Instead of thinking of my back as trying to kill me, I try to listen to what it wants from me. Sometimes it tells me to rest, and often it tells me it wants to move. Instead of sighing and pulling out an exercise sheet, I ask myself, “What kind of movement would feel good right now?” And then I do that.
