I have been known to preach a little about the work it takes to control pain. It is not about taking a pill or just going to therapy and it will all be better. I often offer advice and I rarely cut people a lot of slack. I also do not like opioid medications, but that is for obvious reasons related to effectiveness and addiction. But most people wonder if I actually understand pain. The answer is yes, I deal with my own issues daily, but my patients are not paying to listen to me complain. The reality is I had to learn what works for me to manage my issues.
My Pain Story
My story started in medical school. Keeping in shape was important just to have the energy to spend countless hours in class and studying. At one point, a housemate convinced me to try weightlifting. The second time I tried I had the weights in the wrong position, lost my balance, and took out my back. I probably herniated a disc in my lower back, but there were no scans available then. I did therapy and over months it became manageable most of the time, not slowing me down if I was generally careful and not doing stupid things.
In my mid forties, 20 years later, my back started to become more noticeable. I had regular low back pain, and it started to frequently radiate down the leg. I gave up on running since that set it off, and just tried to keep in reasonable shape. This worked until I was in my late forties, and then finally I had a MRI scan that showed a significant slippage at the bottom of the spine, a disc that was pretty much shot and a lot of narrowing where the nerves exit the spine. The radiologist that read the scan had only one question for me, and that when was I thinking about having surgery. Surgery had not crossed my mind since my issue was pain. I decided to follow the advice I had given others; If there was no weakness and no loss of bowel or bladder control, surgery was not the answer.
Conservative management was my goal. I had a couple of lumbar epidurals that brought down the worst pain and I did a few physical therapy sessions and they gave me a ton of exercises. The exercises were repetitive, and they seemed to be focused on the same muscles, doing all of them took about 40 minutes and they were boring. As the pain improved, I gave up on the program. Within 18 months the pain was again bad and I had another epidural, but I thought I needed to condense the exercise program. I narrowed it down to a set of core exercises that were all different parts of my core muscles, and I added a stretching regimen. Core work was about 10-20 minutes depending on what I did, and stretching was only about 5-10 minutes at the most.
My kids were hockey players, and my daughter had scoliosis and had exercises and a balance board. When I tried the balance stuff, I was terrible and it proved to me I needed to work more on core. I also felt since I was getting old, general strengthening would be a good thing to add to my workouts to reduce muscle loss. Lastly, I needed to also throw in general aerobic conditioning to maintain cardiac health.
Finding What Works For Me
The workout for the last few years has been pretty consistent. I start every day pretty early to get it done. After I climb out of bed, I stretch for a couple of minutes, and my dog gets a belly rub while I loosen up my back. After that comes core work that includes planks on a balance board, sit-ups, leg lifts and upper body/core with rubber tubing. I use a universal gym machine for additional strengthening and a roman chair device for abdominal work and pull-ups. Cardiac/aerobic workouts rotate between an elliptical, bike and rowing machine doing intervals. The rowing machine is the most recent addition. It supposedly works 85 percent of all your muscles, and it really seems to loosen things up and get the body moving well without stressing things out. During the summer I get outdoors and bicycle. Since I have a big dog, she gets twice a day walks daily year around.
As with everyone, as we get older, we all start to gain weight. I like to eat, and often enjoy snacking on junk food. Eventually my wife convinced me that I needed to change my habits. I had to stop eating as much carbohydrates, eat more vegetables and protein, and get rid of sugary drinks and snacks. I am no where near the weight I was in college, but I think I probably have more upper body muscle and some extra gut, but I have lost a few pounds.
For most people with back pain, sleep is a huge problem. Like many, I never feel well rested. I used to be a stomach sleeper, but with my back, extension is the worst position and that is absolutely out. Side or back sleeping is feasible. Multiple pillows are my best friends keeping my knees bent while on the back, between the legs while on the side, and adjusted under my neck to keep that in a neutral position. A good memory foam pad adds to the comfort level to help relieve pressure points. I am not a deep sleeper, and after four hours stiffness often wakes me up. Instead of fighting it, I get up and stretch for just a few seconds, and then go back to bed and I can sleep for several more hours. For me, sleeping over 7.5 hours just hurts my back, so I get moving after that amount of time. To fall asleep, I do not do work right before bed, I do some reading and try to clear my mind of anything serious.
Like everyone else who has back pain, I have to take care of my back. It is not easy to do, but it is a priority to stay healthy. It would probably help me if I could figure out how to get more sleep at night since some experts say this is good for general health. Maybe I should try to meditate, but this would also take time, and I am not yet into that either. I may spend to much time exercising, but a large part of it is walking my dog, and someone has to do it. Eating a more healthy diet has reduced my weight slightly. To lose more weight, another major change and reduction in calorie intake would be necessary and no fun. Life is a matter of balancing multiple options. If you have pain, one of the best treatment options is a comprehensive exercise program. There will never be a magic solution for pain, it will always require lifestyle choices.
Thomas Cohn, MD
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