Lessons From a Disc Injury, Part 1: Injury and Acute Phase
I just passed the 2 year anniversary of my disc injury, and I am reflecting on what a powerful teacher it has been. It has caused me to rethink everything I thought I knew about the body: bodywork, healing, gong-fu and the internal arts, about alignment and biomechanics, movement, longevity…about my passions, my profession, and my personal practice.
Through the lessons I have learned since bulging a lumbar disc, I feel better than I have in the last 18 years, since my first back injury. It’s almost embarrassing to look back and see the trail of injuries and compensations that have led to further injury, knowing now how it could have been so easily unwound at any step along the way. Please allow my hindsight to be your foresight.
This will be an article in several parts. I will begin by describing events that led up to my being incapacitated for several months with an intervertebral disc herniation at L5/S1 and a sacroilliac joint that fell apart. Next I will address the lessons I learned on my ascent from the fiery hell of spinal nerve pain. I will detail the logic and practices that became the crux of my rehabilitation from a bulging disc, and those which have become pillars of my practice to maintain and improve the overall health of my spine.
To begin with, my back had been bugging me [again] for a couple weeks. Not terrible, but I figured it was time I took my own advice and sought professional help. I was used to having intermittent flare-ups every couple of years, which would put me down for a few days with severe back pain. But this time it was a different feeling- not worse, just different- and I wasn’t quite sure what was going on in there. Two people I greatly respect had recommended a certain chiropractor, so I figured I’d give it a shot.
I made a couple of small errors that morning which I believe influenced the course of events to come. The first was that my appointment was right down the street from a jiu-jitsu class which I love but had been too busy to attend, and I was scheduled for chiropractic just after class ended.
"Perfect timing! I’ll just go train light, and then go get my back tended to,” I thought. Now, to the young bucks I trained with, “train light” meant something different than I had intended, which older buck like me should have known, and been humble enough to excuse himself from training when appropriate. But Pride goeth before destruction, and a haughty spirit before a fall. Meaning: I trained more intensely than was wise, and no doubt aggravated the pre-existing dysfunction, adding a new layer which would confuse anyone trying to assess my condition in the next few hours.
My second mistake was that I had taken my lady dancing the night before on a rare date. Which was great, except the next morning, with one car in the shop and an extra early wakeup to get everyone to work and school on time, competition for the shower was fierce! I decided to forgo the shower as I was going to get sweaty before my session anyway. Now, fresh sweat and stale sweat are not the same thing, and I can guarantee you won’t get the best possible care if your therapist’s eyes are burning from your fumes. Take heed: shower before any manual therapy appointment.
The chiropractic session went fairly well, until after one adjustment I mentioned that it hurt a bit more now. Watching someone’s face turn instantly white, as the good doctor’s face did at that moment, is a reliable punctuation mark on life. They knew what I was yet to discover: that I had just fallen off a cliff, I just hadn’t landed yet. Throughout the course of the day, the sensation in my back went from annoying to excruciating. And upon rising the next morning, my spine was side-bent about 30 degrees. As I looked in the mirror, I watched my own face turn white. Sure, the pain was excruciating, but I was quite familiar with many types of pain and I have learned to simply interpret most pain as information. But the loss of control of my own body was terrifying. I was broken.
“Fear fuels pain”
One of the interesting findings of pain science is that pain is intensified by lack of familiarity and lack of understanding. Meaning the experience of pain is lessened when you know what is causing it, and it is lessened even more when you have experienced it before and found your way out of it. Fear fuels pain. This is one of the many reasons that the original meaning of “Doctor” was more akin to “teacher”. Generally speaking, the more that patients/clients understand about what is going on with their body, the more successful the treatment will be.
And thus the reason for my compounded panic. Besides the pain and injury, besides the fact that my lady and I raise and provide for 5 kids, and that I would be out of work for the duration of the injury, what freaked me out the most was that I had no idea what was going on, how long it would last, or if I would ever fully recover. This was completely unfamiliar territory.
Bear in mind, at this point I had been practicing bodywork for 15 years, having spent more than 10 practicing structural bodywork for chronic pain relief, and close to 30 years as a martial and movement artist, with a primary focus on joint mobility and self-healing aspects (specifically as a means of recovering from my own previous injuries). Meaning-I had accumulated a fair amount of knowledge and experience about the body, but something had gone terribly wrong, and I wasn’t sure exactly what. As far as I was concerned, every one of my beliefs was suspect until I could prove otherwise. At first I was groping in the dark for any sign of a pathway out, unable to trust my own knowledge and senses, and every misstep had painful consequences. But as I gained familiarity, and my body became more forgiving, I began systematically evaluating my assumptions based on immediate need. Each stage of recovery provided a different lesson.
In the first few days of the acute disk injury, when I was unable to do much besides lie in a pile of pillows and dread having to go to the toilet, I researched my condition. What I found was that, when you get into the nitty gritty of it, there is quite a bit of disagreement about what the actual mechanics of a disc herniation are. And even more disagreement about the best course of treatment afterwards.
The general consensus is that the outer layers of the disc, the annulus fibrosis, dehydrate over time and becomes brittle, thus allowing for the inner layer, the nucleus pulposis, to squeeze out through the cracks and press outward on the remaining walls of the annulus. This alone is not painful or symptomatic unless it goes as far as to push against the spinal cord or in unfortunate cases even rupture (thankfully, mine didn’t). Barring a traumatic spinal injury, the majority of disc injuries are the result of years of accumulated stress and injury to the fibers of the disc, which eventually results in a critical failure, resulting in a herniation. Most of them are triggered by something as benign as sneezing.
There is mounting evidence that many disk injuries are preceded by an endplate fracture. An endplate is a thin layer of bone connecting the disk to the vertebrae. The fractured endplate creates disruptive changes in the fibers and chemical composition of the disc, predisposing it to bulge. This explanation makes some sense to me, as it helps to explain the strange feelings preceding the debilitating pain.
Either way, I can’t really blame a single adjustment for the injury, as in all likelihood the wheels were already set in motion by that time.
So there I was, bedridden, in agony, with a crooked spine. Figuring out how I got into this mess was less important than figuring out how to get out of it.
At this stage, what you really want is a magic fairy to come and make it all better. If that’s not possible, the next best thing is to already have a team of people you trust to help you out. This is not the ideal time to go shopping for healers. You might get lucky, or you might not. I strongly suggest you take the time when you are relatively healthy to find people you trust and respect. Lucky for me, my years as a clinical massage therapist had acquainted me with some exceptional healers. If it weren’t for them, I likely would have stayed in this state for much longer than I did. This acute stage can last for a few day to over a year in some cases.
I still have much gratitude for the many people who helped me and my family in various ways during this time. A few of the local healers in Asheville NC, which went above and beyond in terms of their time, compassion, and wisdom are (in order of appearance):
I will also tell you that this is the stage in which I have the least professional expertise, and I avoid working with people in this delicate condition other than to pass on lessons from my own experience. So here goes:
During the acute and subacute phases (when the injury is your whole world) there are 3 primary needs: Reduce pain and inflammation, protect the injury and avoid aggravating it, and encourage tissue healing. The attitude here is not to try and fix the problem, but to quiet the fire alarms going off, let the nervous system calm down and decrease pain so the body can rest and heal.
Here are some useful tips for each need:
1. Reduce pain and inflammation:
a. Ice- One of the few times I am emphatically in favor of Ice is when there is swelling and inflammation on the spine. Use it.
b. Anti-inflamatories- Especially those which aren’t too hard on your liver. NSAIDs (like Ibuprofen) are the most commonly relied on. However, due to the duration and dosage needed at this stage it is wise to use herbal anti-inflammatories as well, such as: turmeric, ginger, and boswellia. There are several excellent products available compounded for this purpose. In severe cases, this is what steroids are for.
c. Nervines are a great help at this point as well. I used valerian root en masse. At first I didn’t like how spacey it made me, but then I realized that as I was going to be virtually useless anyway, there was no need to be agitated as well.
a. Avoid stimulants and caffeine (sorry). Anything which excites your nervous system will increase pain.
d. Avoid muscle relaxants: Often, the muscles around the spine lock up as a protective mechanism around the injured disc, and attempts to release them may actually aggravate the pain and dysfunction.
e. Opiates can be a godsend or a road to hell. Do your own research. But understand that they also cause constipation, which can add compounding factors to a lumbar disc injury. Straining to increase intra-abdominal pressure is not your friend right now.
2. Protect the injury and avoid aggravating it:
a. Positioning is critical: this may be obvious, as your body will let you know clearly what it doesn’t like. But it is important to realize that this is not the time to tough it out. Maintaining a lumbar curve keeps stress off the disc, and decreases pressure on the spine. Every time you aggravate your spine, you will set back your healing time. With a disc injury, this can require very restricted movements and positioning for a while. Just accept that fact, and your body will thank you.
b. Use pillows liberally to take stress off the injured area: when lying on your back, place under the knees and the low back to help keep the curve in place and put slack in the muscles attached to the spine. When lying face down, pillows under hips or belly as needed. The specifics will vary with each person, but this is the time to embrace your inner princess and lie propped up with supports. If you can manage to get waited on hand and foot, even better.
c. External brace or support: as mentioned above, with an acute disc injury the muscles around the spine often lock up as a protective mechanism around the injured disc, and attempts to release them may actually aggravate the pain and dysfunction. Spinal braces or external spinal support are much safer ways to take the stress off the spine and give relief to the muscles.
d. Sex: proceed with caution. As mentioned above, positioning is critical. Issues around stimulating the lumbo/sacral nerves and increasing the intra-abdominal pressure during orgasm can increase pain and possibly aggravate a fragile disc. Be creative but cautious.
3. Encourage tissue healing: both of the above categories contribute to this, as well as…
b. Bone broth, drink it! This was recommended by a friend who has also dealt with disc herniations. I was skeptical at first, but at the first cup I could feel my body absorbing needed nutrients. Your body needs collagen to rebuild an intervertebral disc, and well-made bone broth provides this and other important building blocks.
c. Gentle modalities: acupuncture, electromagnetic therapies, and micro-current therapies of various types are of great benefit. This is not the time to try to “put something back in place.” Remember the part about muscles locking up for a reason? Even a gentle massage can do more harm than good at this stage.
d. Gentle traction and decompression, as soon as the body can tolerate it, are essential. If possible, work with an experienced practitioner with a traction table. The specifics of how this is administered will change as the injury moves from the acute to the sub-acute and remodeling phases. Several variations were important to my recovery, including an inversion table, and hanging from my arms. More on this later, as learning the importance of decompression was one of the treasures revealed to me by this whole process.
e. Get familiar with the anatomy. As stated above, the more you understand what is going on, the better off you will be, and this is a way to get your mind actively involved in the healing process. Of course, I did more of this than the average person needs to, but in addition to looking and reading, I began drawing the anatomy of all the structures involved in detail. This filled in the mental map of the corresponding areas of my own body, allowing me to better feel and visualize the healing process. Do not underestimate the power of your mind, as it is the organ that actually feels the pain.
This list is not exhaustive, but it is true. For anyone reading this while they are in acute pain with a lumbar disc injury, welcome to an elite club! I hope this information helps you pass through this phase quickly. Do your own research and listen to your body.
For everyone, regardless of the condition of your spine, the principles outlined above set the stage for the lessons to come about how to improve your spinal health and avoid the mistakes I made. In the following chapters I will lay out the most valuable insights and practices I have gained from my injury and rehab, as well as the misunderstandings and training practices I had adopted over the years which eventually set me up for a fall.