Saturday 5 March 2016

anatomy of a bad back

My back is bad, in a quite different way to how it normally plays up.  We have long history, my bad back and I, although at first I did not know it for what it was.  It initially revealed itself in the form of brief sciatic episodes in my twenties.  Once they had passed I didn't think too much about them, which with the benefit of hindsight was a bad idea.  In my early thirties it presented itself in the form of a pain in my lower leg, which the company doctor diagnosed as split shin.  I protested that it couldn't be, since I hadn't suddenly taken up jogging or anything.  The physio the doctor sent me to eventually pronounced that there was nothing wrong with my leg, the problem lay in my back, and gave me back exercises.  Once the pain in my leg had gone away I stopped doing them.

Oh, the folly of youth.  In my forties the bad back reappeared in the guise of a most peculiar range of symptoms, the sensation of water splashing on my thighs, pins and needles in my feet, and roving pains through my pelvis.  None of the specialists I saw thought any of them had anything to do with my back, and I saw a gynaecologist, a bowel specialist, and an orthopedic surgeon who tapped my knees, watched me touch my toes, and pronounced that my spine was in better condition than his. After about two years of rogue symptoms I was convinced that my troubles were lower back related, for the simple reason that when I went and did any weeding or lifting in the garden they got worse, and when I spent all my time except when I was at work lying on the sofa they got better.  Plus by then the weird symptoms were accompanied by a tight pain across the very base of my spine.

I referred myself to a physio.  If you are able and willing to pay you can go straight to a physio without waiting for weeks for a GP's referral.  Of course, not everybody can afford to pay, but when it's a choice between spending all your spare time lying on a sofa and spending forty quid seeing if you can get your back sorted out most people would probably sacrifice almost all forms of discretionary spending in favour of the physio's fee.  They have a red light system of symptoms that they won't even attempt to treat, sending you back to a doctor instead, and my physio didn't initially like the sound of my symptoms, but after I'd promised her I'd seen umpteen doctors in the past two years and had recent blood tests she agreed to look at my back.

It is a forlorn moment, standing in front of a complete stranger in your underwear and hoping they can put your life back together.  I told her about the orthopedic surgeon's verdict and in her answer heard the first glimmer of hope.  Well, his back must be diabolical, she said, because yours is dreadful.  It turned out that the only reason I was able to touch my toes was that my hips were practically hypermobile.  My lower back was as rigid as a board, and  I was standing all wrong.  I had spent the first four decades of my life standing and walking all wrong.  It was not just that I carried my head too far forwards, as lots of people do, but that the tilt of my pelvis was wrong.  I lay on her couch and she told me to flatten the small of my back against the mattress.  I protested that nobody could do that, and she explained that people with normally functioning backs could, actually.

She kneaded away at my spine, vertebra by vertebra, to start trying to get the rigid block of muscle to relax, and sent me away with some simple exercises.  After several sessions I was no longer in pain, unless I overdid things in the garden, and a year or two after I stopped seeing her I thought I should adopt some kind of lifelong maintenance routine and found a Pilates teacher, who taught me more exercises and to take a more nuanced view of my posture.  For several years now I have been able to do as much as I want to in the garden without triggering any problems at all, most of the time.

Which makes the current episode all the more galling, since when it started I was not doing anything except lying down.  And it is an entirely novel experience, a new kind of back problem, though talking to the Systems Administrator a common one.  This time round it went into spasm, feeling acutely painful from the base of my spine to the bottom of my shoulder blades.  Sitting down was difficult, standing up again was difficult, shifting my weight from resting back in a chair to sitting forward over my lap impossible without using my arms as levers.  Rolling from my back on to my side in bed was difficult, and any unlucky twist of my pelvis produced shooting pains.  I had to work out a strategy before I could get out of bed.  And to think that two weeks ago I could lie on the floor, knees raised, arms stretched flat above my head, and rise to a sitting position without my feet lifting.  How is the carefully cultivated back fallen low.

Making a cup of tea at breakfast time I suddenly felt faint, and had to sit down at the kitchen table.  I'd have liked to lay my head flat on the table, if only I could have bent that far.  The SA found me and asked whether I felt faint.  I admitted that I did.  Did I feel sick?  I admitted I had felt sick, too.  Had I been lifting anything when it happened?  The kettle.  This, according to the SA, was entirely normal with this kind of back problem, or at least it happens to the SA and to the SA's closest friend, both of whom are long term back spasm sufferers.  I had almost certainly twisted my back slightly while concentrating on making the tea, and was feeling faint and sick with pain.  It was entirely possible that I might be sick in the early stages.  It was a relief to hear from first hand experience that back ache could do that to a person, so I could stop worrying about more sinister illnesses, but also demoralising.

The Systems Administrator is actually jolly good at producing relevant information at the right moment without seeming to supervise all the time, and now passed on the advice of the physio who treated the SA's frozen shoulder.  You cannot exercise your way out of spasm, counselled the SA. While muscles are in spasm all you can do is rest them.  Once they have stopped spasming gentle exercise will help loosen them.  Do not overdo the exercise in the early stages.  If the exercise starts hurting more than the muscles do already then stop.  If you send them back into spasm you will set yourself back and delay your recovery, not speed it up.  On that basis I'm afraid my early morning session with my spiky massage balls after my shower and before making the tea may have been a mistake.

I have spent the day sitting in an upright chair with good lumbar support, and periodically going for very short walks around the garden when it's not raining, or else shuffling up and down the house like C-3PO without the arm movements.  My back is slowly feeling looser, and I have not triggered any more spasms for several hours.  I hope that the total recovery time will not be too long.  After all, it was working perfectly well ten days ago and it's not as though I've ripped or pulled anything. After the amount I've invested in it over the past decade in blood and treasure it ought to be a Rolls Royce of a back.  My hat goes off to the SA, the SA's friend and all other back spasm sufferers, though.  It is awful.

Addendum  There is a moral to this story, which is at the first sniff of any kind of back trouble at any age to get your posture checked out by a specialist, get your core strength checked, learn any corrections or exercises they tell you, and practice them religiously for the rest of your life. Ignore incipient back trouble in your twenties and it may come back and bite you in your forties, as the natural resilience of youth wears off.  Go to a physio or Pilates teacher, who know what a well functioning muscular-skeletal system should look like.  Orthopedic surgeons mainly know how to do surgery, and I don't think posture takes up much space in the GPs' curriculum.  You'd probably be better off going to a finishing school.

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