I’m writing this piece to share my story not only as a physiotherapy student who has started to treat patients with persistent pain, but also as an individual having experienced several years of chronic pain in the past. My hope is that my own unique story will provide insight to both physiotherapists and patients alike. Although experiences with pain differ greatly, I suspect many reading this will be able to identify familiar themes that they can relate to, like I did whilst reading these patient stories at the start of my journey. I hope that this reflection helps deliver a sense of optimism for the future and demonstrates that people have the potential to reach a point whereby pain is no longer a part of their life, just like I did.
My Experience
Stemming from three patellar dislocations before the age of 18, I went on to suffer with persistent pain for over three years. It began with IT band pain and was later accompanied by sciatica and gluteal pain. Over the course of these three years I met with at least five healthcare professionals, all of whom articulated the same biomechanical issues to explain my pain:
“Your glutes aren’t firing.”
“You’re lacking pelvic control.”
“You’ve the strength of an 80-year old.”
As meticulous as I was with each and every rehabilitation programme, the pain never got better. The most frustrating thing was that I couldn’t identify what would make it worse and what would make it better; it seemed to have a very unpredictable pattern. Sometimes the IT band would hurt, then the back would flare up. Sometimes sport would make it worse, however I remember being at my very worst at a time when I was playing no sport whatsoever. It eventually got to a point whereby not only was it affecting my sport but also my daily life; my work, my mood, and everything else. And to be honest I didn’t see a way out from it. At 20 years of age, the idea of a knee replacement was pitched to me!
The Answer
I was eventually referred to see a physiotherapist in Limerick (Kieran) who explained that what may well have started out as a normal injury had now developed into a much more complex problem whereby my central nervous system (CNS) had become hypersensitive to pain, which provided an explanation for its seemingly unpredictable nature. Of course, I didn’t believe him at the time! But Kieran spent an awful lot of time educating me as to what was going on. He brought two major issues to my attention:
- Cautious movement: Over time, I became aware of how slowly and cautiously I had been moving all this time and how I was subconsciously guarding and protecting my left leg. I began to notice built-in strategies I had developed for myself. If I had to pick something off the ground I would single-leg squat on my right leg so as to ‘protect’ the left leg. When doing even the most menial of tasks (sitting down for example) I would grunt, groan or grimace, holding my breath as if I was attempting to move a boulder! Every little activity I did was laborious, carried out in a tense, rigid and unrelaxed manner.
- The importance of stress and systemic health and its effect on pain: Kieran helped educate me as to how important things like stress, lack of sleep, frustration and anxiety can play on our overall system. He explained that pain is a stressor and emphasised the importance of bringing the levels of things like cortisol (often called the ‘stress hormone’) and adrenaline to more normal levels throughout the day.
Recovery
By gradually learning to let go of this fear of further damage to my leg, whilst also learning to manage my stress levels a lot better, after nearly four years of constant pain I eventually managed to get to a point whereby pain is no longer part of my life. It all sounds very easy when I write it like that – but it certainly didn’t happen overnight! I thought it might be helpful to elaborate on two of the biggest hurdles I had to overcome, and the advice I wish I could give myself in hindsight:
- Appreciating the importance of stress and systemic health:
This is probably the single biggest issue I had trouble getting my head around. I remember being incredibly frustrated at the mere accusation that things like my stress levels could be contributing to my pain. Being honest, it felt like I was being told: “the pain is all in your head!” To all those out there in pain: I have no doubt that your pain is 100% real! Lorimer Moseley does a far better job than I ever could on explaining this issue, which I implore anyone out there suffering with pain to listen to. Although pain is very real, he brilliantly explains how it can be shaped and influenced by many different factors.
With the benefit of hindsight, having studied it both as a patient first and then as a physiotherapy student, it makes complete sense. The effects of stress are huge; we know it hammers the immune system and can be a driver of flare-ups. Adding stress to an already sensitised central nervous system is the equivalent of adding fuel to a fire. When you’re a pain-free individual you can get away with high stress levels to an extent, but when you’re somebody who is already in pain it can very quickly make it much worse. As the months went by, I reflected on the times where my pain would be at its worst. I recalled how I always used to be in pain for 3-4 days after being out late and drinking alcohol; when my whole autoimmune system would be run down. When I reflected on the worst episode of pain I had ever had, I remembered how it was around a time when I had started a new job working 16+ hours a day. The key here is to look out for patterns to your pain and try to identify why the bad days are bad. Sit down on the bad days and reflect on what’s going on in your life at that point – how have you been sleeping, what’s your mood like, how’s your general health, do you feel run down? The most frustrating thing about persistent pain is not knowing why it has escalated. Once you can begin to make the bad days less unpredictable, that is the catalyst to recovery. Nobody can eliminate all stress from their life, but we can get better at managing it and keeping it under control.
We know that unpredictable pain without a pattern is indicative of a hypersensitive system. However, if you’re still struggling to believe this, a snippet of wisdom Kieran offered to me at the time was that even if he was wrong (i.e that stress had nothing to do with my pain), I would have been the first person he had ever came across whereby feelings of stress, frustration and anxiety helped!
- Trust the process!
This journey will take time and will require patience. Kieran had initially estimated a 3-month recovery for me, the reality was that it took over double this. Although it only required one face-to-face appointment and zero ‘hands-on’ treatment, it did require multiple email/telephone conversations for Kieran to fully educate me as to what was going on. Three months into the process, I recall being in as much pain as I had ever been and looking back on it, I nearly gave up on it all. However, email exchanges with Kieran around this time were smeared with signs of frustration and stress, as I explained how it was “killing me to be away from sport” and how I was “willing to try anything” – in hindsight, these are indications that my levels of relaxation weren’t where they needed to be just yet! And yet, despite all the low points along the way, I eventually got better! Again, with the benefit of hindsight it all makes sense: I had been living with pain for over three years, it wasn’t going to resolve overnight! The body might have to experience normal, relaxed, unguarded movement hundreds of times before it realises that movement is no longer a threat. It will also take time to fully understand and appreciate the role of stress on the entire system. It was probably only when I started to experience less pain several months down the line that I began to truly believe in this approach – but it almost has a snowball effect this way because once you begin to see that it’s working, you begin to get much better at really controlling it. It takes a lot of courage to buy into this and make such drastic changes to your life and your outlook. But if you’re someone in pain, trust the process and you will reap the benefits!
Summary
I hope that some of you have gained something from reading my story. My experiences with pain have played a big part in my decision to change career paths into physiotherapy, and if my experience has brought a sense of optimism to just one person out there I’ll have considered this worthwhile! I also encourage you to have a look throughout this fantastic website; if my story doesn’t resonate with you then perhaps those of others will, as they did for me. Hopefully my story provides evidence that as low as it can feel at times, there is an answer and with the right approach you can and will get better.
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