March 8, 2018

That Email I Always Write

A friend of mine "threw her back out" a week or two ago and emailed me for advice. I realized as I answered her that I seem to write this email a couple times a year, so I thought: "I'll edit this lightly and post it." 

I asked a few questions to see if it was likely to be a serious injury or a degenerative condition: it wasn't. No numbness, no functional impairment beyond the pain. "What she'd done to it" was crouch down to load the dishwasher. So I wrote:

Yeah, this is a pretty typical onset.

First thing to know: this is very common and it is very likely to resolve of itself within a week or two, regardless of what you do. It is more like a headache or a cold than like a degenerative condition. And it's more common at your age [parent-of-toddler age] than it is at mine [sixty]

Second thing to know: disks do not "slip." Spines are not fragile. They are incredibly tough structures that it generally takes enormous forces to injure. In the absence of obvious trauma what you've likely got is a pain problem, not a back problem. Which can be totally as debilitating in the short term, for sure, but it's important to think about these things accurately.

The reason it's important is that when your unconscious brain is deciding whether to throw the panic pain switch, it consults your opinion on how serious this injury is. It does this without you ever being conscious of it. The first thing you know is an explosion of pain. But back there behind the conscious mind, your unconscious mind is flipping through the files on "back pain" and deciding whether to escalate the twinge to the whole pain explosion. If it finds a bunch of old info about fragile backs and slipping disks and degenerative conditions, it's VERY likely to throw that switch.

And as you know excruciatingly well, you do NOT want it to throw that switch.

I used to have this back pain a lot, mostly before I worked at the Foundation. The worst episode, I missed about ten days of work. I had to crawl to the bathroom. I get it, believe me. The pain is totally disabling when it's bad.

So the general rules: stress makes an episode more likely. Lack of sleep makes it more likely. Lack of exercise makes it more likely. (Of course, what this pain does is 1) stress you out, 2) make it hard to sleep, 3) make it impossible to exercise. Catch-22. I hate it.)

You don't want to get the switch thrown again, but you want to move as much as you can without setting it off. Right now you mostly just wait and let it calm down. If you have a tub -- and can get into it in your present state -- a hot bath can work miracles.

And in a day or two you should have a friend come over and do some gentle massage work on it :-) Your big job right now is to convince your back that it's okay, that nothing overwhelming is going to be demanded of it, that it actually still can move and all will be well. Which it will.


I realize that I could capitalize on back pain by saying I could fix it. But really I don't see massage doing a lot for it, and especially not in the acute phase -- that is, in the first day or two. After that, yes, massage helps the nervous system settle down. Even better is massage before it happens in the first place. Nonspecific back pain, like a lot of stress-related conditions, is a lot easier to prevent than it is to treat.