It was 10 years ago when I remember hobbling down the stairs to collect my next client. I was holding my back upright and rigid, almost afraid to move in fear that I might further strain what I suspected at the time was painfully ‘unstable’ sacroiliac or pelvic joint. I had also been assessed by an experienced clinician who had told me I was ‘misaligned’.
Roll on ten years and I now understand, based on current research and expert opinion that the pelvic joints really don’t move very much, hardly at all in fact. When reflecting on my injury and considering my age, gender and how I injured myself (pulling a suitcase awkwardly form under a bed), it became clear that my strained lower back and pelvis wasn't likely to have been left unstable. But at the time I did not have this knowledge and so felt very threatened by this part of my body. It felt weak and I lacked the confidence to move freely as well as run and exercise in the gym. The pain I felt added to this sense of threat.
The primitive parts of my brain were on red alert, primed as we are to respond strongly to negative experience. I ended up feeling very frustrated even anxious about the whole issue. I suppose it did not help that working as a physiotherapist and treating clients had me thinking and talking about pain all day long. Also I should have been able to ‘heal thyself’ right?
The end result was that a simple strain to my lower back and pelvic joint region became a problem firmly entrenched within my central nervous system. The way I was feeling and thinking about my painful low back and pelvic region had contributed to a state of central sensitisation, a well-known term in pain science nowadays. In other words a ‘pain memory’ had developed long after any tissue damage I may have sustained had healed. Part of central sensitisation often involves allodynia, which is when sensations such as pressure, touch and even the sensation of movement can be misinterpreted by the brain as being painful.
It took almost eighteen months for my low back pain to settle, and in the end it happened quite quickly, within a few weeks. In my case it was the shift in perspective that came after deciding not to let my back and pelvis get in the way of a good hike while on honeymoon in New Zealand. I decided to put up with some discomfort and get on with it. When we got to the top of the climb I was a bit sore but my back had supported me. For many hours we had pumped our legs, breathed heavily and eventually marvelled at an incredible view.
It was this simple act of moving and exercising which made me realise that my pain was nothing more than an annoying sensation, not an indication that my back was damaged. I also realised I could trust my back again and use it to get me to amazing places. It was this simple yet profound shift in how I thought about my back which had me almost pain free within the next few weeks as I continued to move more, do more while thinking and worrying less about my back.
So for all the treatments we have for low back and pelvic pain, sometimes it can simply be getting moving and allowing oneself to think differently which can make all the difference.