Paradigm shifting books, part 1: Back Sense, by Ronald D. Siegel, Michael H. Urdang, and Douglas R. Johnson
To kick off 2018, I will be writing a series of posts about books that have radically shifted the way I look at the world. A forewarning: this post will contain a personal (and long) story of my struggle with back pain.
I don’t remember ever thinking about my back until I injured it. As a high school cross-country and track runner, I’d been sidelined by all manner of leg and ankle injuries, including a stress fracture in my femur, but had never once had an issue with my back. And then, in the summer of 2010, I started having back pain. I’d joined a gym that provided free personal training sessions, and my trainer was intent on having me do CrossFit exercises, including Olympic weightlifting moves like deadlifts and snatches. One day, I was doing deadlifts when I started to feel a persistent ache in my lower back. I alerted the trainer, but he told me to keep going. So I did. A week later, I moved to Brazil for a six-month stint in my law firm’s São Paulo office, and found myself consumed by lower back pain. What started off as constant achiness in my lower back soon spread to my pelvis, and I worried that I had some sort of reproductive system ailment, like endometriosis. I made an appointment with a rheumatologist and, after several MRIs, it was determined that I didn’t have endometriosis: I had a herniated disk in my lower back, between the L4 and L5 vertebrae.
The day I found out that something was structurally wrong with my back was the day I started thinking of myself as a person with a Bad Back. And, in keeping with my expectations, my back has been a source of pain, both physical and psychological, ever since. In the seven and a half years since my initial diagnosis of a herniated disk, I’ve had ups and downs with my back pain. There have been long stretches of relative painlessness, in which I’ve been able to run, swim, bike, and practice yoga. But there have also been periods when I’ve had to curtail some of my activity because of pain. But until this past year, I was always able to remain active, even if I couldn’t do all of the things I wanted to do, like run longer distances or bend myself into certain poses in yoga.
The lowest of my low points, however, started last year when I was pregnant with Ewan. At 34 weeks pregnant, I sprained my sacroiliac joint (the joint connecting the sacrum with the pelvis) and for the last six weeks of the pregnancy, could not easily walk or climb stairs. The pain was searing, almost electric, unlike any backache I’d had before. I couldn’t pick up Lucia or do any physical activity. It was really, really hard. After I gave birth, the sharp pain went away and I was able to resume running and swimming. But then, in the spring of 2017, the pain started up again and I decided to seek the advice of medical professionals.
After many MRIs and x-rays, it was determined that I had seven (SEVEN) bulging disks in my back and neck, plus spondylolisthesis (a “slipped” vertebra), plus scoliosis. In other words, the experts told me, my back was fundamentally messed up and I might not be able to fix it. One physical therapist listened to my diagnoses, glanced at my MRI report, and told me that we could try to fix the issue through physical therapy, but it was likely I’d need to get surgery. And, she added, if I got surgery, I’d probably need to keep getting surgeries since they wouldn’t permanently eradicate my pain. I sought advice from three different physical therapists, a chiropractor, an orthopedic surgeon, and a physiatrist. They all had different, confusing advice. Some told me not to bend forward. Others told me not to bend backward. Several told me to avoid picking up or carrying my children. Some told me to swim. Others told me that swimming could severely injure me.
I tried everything to get better. I got a cortisone shot in my lower spine. I went to physical therapy twice a week. I bought back braces and ice packs. Nothing helped. In fact, things got worse. By the summer, I’d started to have traveling paresthesia: my arms and legs would go numb and tingly and I’d become lightheaded. It was frightening. Sometimes it would be my right leg and left arm, other times my left arm and right foot, or both arms, or both legs. My chiropractor became concerned that I might have multiple sclerosis, and ordered MRIs of my brain, cervical spine, thoracic spine, and lumbar spine. I spent three hours in an enclosed MRI machine, wondering if I would eventually end up in a wheelchair.
As it turns out, I didn’t have MS, or anything noticeably wrong with my nervous system or brain. A neurologist and an infectious disease doctor both gave me a clean bill of health. But I still felt awful.
I was so miserable, Al and my parents gently encouraged me to seek therapy. On my first session with my therapist, she handed me the book Back Sense and asked if I’d be open to trying it. I said sure — I had nothing to lose — and read it in one day. As soon as I read it, my pain started to lessen and my entire attitude shifted. A few months later, I am free of all neurological symptoms and can do many physical activities that I was sure I’d never be able to do again.
The premise of Back Sense is simple: what you think is causing your back pain is probably not causing your back pain. That is, most of the “structural” issues that people with Bad Backs are told are to blame for their pain are not actually the culprit. The real culprit is stress. In a certain type of person (and I am one of them), stress manifests as tense muscles in the back. The more stressed you become, the tenser the back muscles become, and the greater your pain. The way that you alleviate the pain is to practice mindfulness. You might still have some back pain, the authors point out, but that’s okay. Some muscle soreness in the back is normal and tolerable, and is not to be feared. And, most importantly, you must remain physically active. Inactivity will only make your pain worse.
I was initially resistant as I read Back Sense. I was convinced that its premise could not apply to my situation, given all of the many and competing structural issues I had in my back. However, the authors handily provide an index that lists many back conditions and explains why each is probably not to blame for back pain. This index includes bulging disks and spondylolisthesis. The authors point out that 60% of people with no back pain whatsoever have a disk abnormality (such as a bulge). I found this incredibly eye-opening. If there are so many people out there walking around with my exact condition and no pain, something else must be going on.
The more I thought about the mind-body connection, and how I was dealing with (or not dealing with) stress, the more things started to make sense to me. Months after reading the book and resuming my physical activity (and my normal life), I can look back on my low point this summer and see that almost all of the anguish I was experiencing was psychosomatic. It was real pain, and was actually happening in my body. But most of it was caused by my brain, not by any structural abnormality in my back. The most telling thing, to me, is that the horrible neurological symptoms I was experiencing — tingly, numb arms and legs and spells of lightheadedness — went away entirely and have not returned since I started cognitive behavioral therapy and read this book.
I highly recommend Back Sense to anyone with chronic back pain who is feeling hopeless. It is truly a paradigm shifting book, in that I now see my back — and thus myself — in an entirely new light. I no longer think of myself as someone with a Bad Back. I think of myself as someone who occasionally experiences back pain (and that’s okay). If you’re thinking that this book won’t apply to you and your specific back issues, it might not — but it probably will.
(One caveat: the authors do not address one spinal issue that I do have, which is sacroiliac (“SI”) joint dysfunction. This injury is very common in pregnant and postpartum women, and SI joint sprains, in particular, are very common among women in their second (or later) pregnancy. My non-alarmist physical therapist told me that the SI joint stays loose for up to two years after giving birth. When I’m having a bad back day, I’m now able to tell whether it’s generalized lower back achiness (which indicates muscle tension caused by stress) or localized pain in my SI joint. Even though the book does not address this particular injury, its framework has allowed me to take my SI joint twinges on board and not panic about them. Some back discomfort, I remind myself, is normal. My back is tough. This will be okay.)