Navigating Potholes: My Back Pain Experience

Sarah Al-Khayyal
July 6, 2018
Reading Time: 6 minutes
Table of Contents

    I will spare you my lengthy back pain origin story and set the scene in 3 bullet points:

    • Pre-back pain, I was a pretty killer athlete with a promising future in powerlifting and strongman.
    • Also pre-back pain, I partially tore my hamstring tendon, which led to hamstring and hip pain. I rehabbed my way back to the platform from this injury, but its lasting impact lay in the consequent mistreatment of my back pain by medical professionals.
    • One day in the Spring of 2016, I “tweaked” my back on a heavy axle deadlift in a strongman show. I finished the competition and even won my class, but I also took home another trophy that day: a one way ticket to the Back Pain Experience.

    It’s not a fun trip; I don’t suggest it. But if you’re already on it, hopefully learning from my experience can help to make yours a more pleasant one. Who knows, you might even be able to score a return ticket back home.

    I should note that a key part of my recovery has been in-depth research on pain science and treating non-specific low back pain, and I would suggest starting there. There are tons of articles, websites, podcasts, etc. (many of which live on the Barbell Medicine site) to explore in order to achieve a working knowledge of what pain really is and how you can begin to navigate it.

    However, there comes a time in which you can have all the book knowledge in the world about something complex like the low back pain experience, and you’ll still feel at a loss applying that knowledge to your real life experience. Science without empathy won’t get you too far when it comes to this stuff. Now, let’s relive a few milestones and major realizations from my own back pain experience, and hopefully you can walk away feeling less alone and more prepared to face your own pain experience.

    Without further ado, here are the top four things I wish someone told me before I experienced chronic low back pain:

    1. Nip it in the freaking bud. Do not let acute back pain become chronic pain.

    If you’re reading this right now and haven’t experienced chronic and recurrent low back pain: congratulations! You’re fortunate. Try to keep it that way.

    I dilly-dallied for months on end, attempting to trial-and-error my back pain away. Had I known a thing or two about pain science before I experienced my first severe back tweak, I’m confident that I would’ve been in a very different boat right now (probably in a nice tropical location with a fruity beverage in my hand).

    So whether or not you’ve experienced some sort of back pain, start learning now about how pain works. Build up confidence in your back. Learn what nociception is. Unlearn your fears of back pain. Learn what catastrophizing is (and don’t do it). Achieve an understanding of all the basics, so that when you do experience a back tweak or your next flare up, you have a mental first aid kit ready to go.

    2. Don’t bother spending all that money on a chiropractor and/or a conventional physical therapist. Spend it on a strength coach who understands pain science and how to adapt loaded movements to accommodate pain.

    I’m embarrassed to admit that I spent far too much money on chiropractors, ART therapists, and physical therapists. I tried everything.

    I saw chiropractors weekly for several months. They told me my SI joint was rotated, and I believed them. (Turns out sacrum movement is so minuscule that there’s no realistic way for someone to feel it upon palpation… great. Well that was a waste of time.) When chiropractic adjustments didn’t work, I saw an Active Release Technique therapist every other week for several more months. When that didn’t work, I tried the McGill Big Three, religiously. When I saw little improvement there, I finally visited an orthopedic doctor who diagnosed me with unilateral hip rotation that was causing SI joint pain (unsurprisingly, he associated my condition with my past hamstring tendon injury). He prescribed 3 months of physical therapy and told me to do this stretch where I leaned against the wall and stretched my obliques.

    Each week, my physical therapist would “put my hip back in place” and then we’d do exercises to strengthen the muscles “holding my hip in place”. I put these things in quotations because I now know what a crock of crap that was. My doctors relied too heavily upon the structural model of pain diagnosis, and were too quick to tell me that it was my past torn hamstring tendon and “consequent” rotated hip that inevitably brought about the back pain. The truth is that my, and your, skeleton is pretty dang resilient, and no one can “put my hip back in place” with their two hands and a few supplementary exercises. Plus, my right hip might’ve always been slightly rotated forward! There’s no way for us to know now, which means that definitively diagnosing a rotated hip as the cause of back pain is simply irresponsible.

    In the end, I wasted an entire year and thousands of dollars paying people to treat me, and ultimately my back felt no better for it *le sigh*. Don’t be me.

    And don’t get me wrong– there are good, well-informed doctors out there who are up to date with the research and not afraid to adapt (Austin and Jordan being prime examples). However, your standard run of the mill doctor or therapist at this point in time is possibly going to hurt you more than they help you. This is why I urge you to do your research, and look to someone who understands both the principles of progressive overload and pain science to help treat you. No one else is worthy of your time or dollars.

    All of that said, I experienced more progress in 1 month working with Austin than I did in that entire year of foolishness combined. The barbell is seriously medicine when dosed effectively.

    3. Progress is never linear.

    We say this about strength training all the time, but it applies to recovering from back injuries and chronic pain too. There isn’t a magic pill to make you better– it takes time and effort, and more patience than you thought you could ever muster. You could be dealing with this for the rest of your life, but know that so long as you’re making the effort, you are making progress.

    It took me awhile to get comfortable with the idea that I could experience repeated flare ups and still be making progress. I spent too long pining for the day that I would be “cured” and never experience low back pain again. And each time I tweaked my back, I’d feel disappointed. I felt like I was jolted back to square one.

    But I wasn’t back at square one. I learned to notice how I’d bounce back faster from flare ups, and how they were becoming less frequent, and how I could now tolerate more movements and heavier loads in training, all despite my flare ups. The road is long and paved with potholes, but with time you’ll learn to maneuver around them.

    4. Don’t let your past athletic accomplishments be the yardstick you measure yourself up to.

    Once upon a time, I was repping out 350 lb deadlifts. These days, I’m ecstatic to do a set of block pulls at 250lbs.

    When I began training under Austin, one of my goals was to deadlift 300+ again from the floor, without pain. In those early days, I envisioned my big comeback. Surely I’d make it back to my old numbers, and then surpass them. I thought, I’m young, my body is resilient, I’ll bounce back in no time now that I’ve found pain science and Austin is my personal guide on this journey.

    To my dismay, I learned that it’s not that simple.

    I made leaps and bounds of progress training under Austin, but I was still experiencing periodic  flare ups, and man oh man. My patience was being tested. I slowly realized that I had to let go of these expectations that I would match my past athletic performance. It wasn’t aiding my progress, mentally or physically.

    Will I one day pull 300+ again from the floor? Maybe! But I’m not putting a timeline on that. I’ll continue to meander my way there. Progress isn’t linear anyways, so what’s a few more detours along the way?

    These days, I’m more concerned with how my quality of life compares to that which I experienced at the peak of my back pain. These days, I can sneeze without fear of back pain. I can take a long road trip without worrying about how stiff my back is going to feel at the end of it. I can bend over and pick up a 45lb plate without bracing my core and squatting it up. I can spontaneously play a game of rec league softball and know that my back isn’t going to get painfully sore from it. All of these little things make the biggest difference in my life and my identity– not whether or not I ever make it back onto the powerlifting platform again.

    Ultimately, I appreciate my low back pain experience for the perspective-building opportunity that it is. In many ways, gaining this sense of perspective on health and wellness at the ripe young age of 24 is a gift. I’ve still got nearly my entire adult life ahead of me, so I’m grateful to have pain management expertise in my toolbelt for whatever lies ahead on this journey, potholes and all.

    Sarah Al-Khayyal
    Sarah Al-Khayyal

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