1. Surgery isn’t for everyone. Build your muscles to create a functional body
2. Exercise. The magic pill to get the body strong
3. How does the brain dictate chronic pain? What differentiates the mental versus the physical?
4. Find a trainer you can trust and push you. Be comfortable with being uncomfortable in the healing process.
Back pain was an everyday staple for author and investigative journalist Cathryn Jakobson Ramin since she was a teenager. Growing up, she would have flare ups and occasionally have moments where she was writhing around the floor trying to straighten her back out. When she was pregnant with her sons, her condition got considerably worse.
In her book, Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery, she breaks down how she took steps to heal herself. Ramin speaks to DTS Fitness Education Director of Education Ben McDonald about how her book aims to help others (listen to the podcast here).
**#1) Surgery isn’t for everyone. **
Ramin was on a book tour after writing her first novel Carved in Sand: When Attention Fails and Memory Fades in Midlife, when she realized something needed to change if she wanted to keep working the way she liked to.
“I was standing there gripping the podium in pain and wondering how I would ever write another book,” she recalls. “I was just like everybody else at this point. I decided that I would go again to see my primary care doctor who suggested back physical therapy but I had already seen many people to no luck. So he suggested I get an MRI.”
One surgeon’s office, followed by several more, followed with a diagnosis of unending number of problems that resulted in a small decompression surgery.
“The only thing about (the surgery) that was helpful was that I realized that I would have to “rehab” from surgery. This was a far cry from physical therapy,” says Ramin. “There’s always this inclination to do the quick and dirty decompression and that can be helpful. But, if you do not rehab like a maniac, it will not be helpful.”
An issue, however, that may occur with decompression surgery is the development of instability as a result of removing parts of ligaments, bone or muscle from its original location. Ramin notes repeatedly she is an investigative journalist and not a healthcare professional. All information obtained is based on scientific literature or her own experience in an exercise atmosphere.
“If you do end up with instability, you may end up with a spinal fusion. There seems to be a trend towards doing the decompression, because insurance will pay for that and then when the patient becomes unstable then that’s an indication of spinal fusion,” adds Ramin.
When considering alternatives or surgery, Ramin points out that someone with chronic pain should not be offered a laundry list of interventions and asked to choose the one they want. A large number of people who don’t have any back pain show exactly the same abnormalities in the back as the people who do when given an MRI.
“You should not assume that there is anyone out there who can fix you. You, will be fixing you. Assuming no serious pathology otherwise, you are the only one who will fix you,” she states firmly. “The truth is there’s about 80% of herniated discs on all MRIs for people your age. The trouble is it got there for a reason. Very likely because you are not using or recruiting the proper muscles, you don’t have glute strength or proper glutes at all. I see men all the time who are completely missing a butt and they have back pain. You have to have glutes. I didn’t particularly want them, but you need them. How? By doing an enormous amount of squats with weights.
When people tell Ramin they're in too much pain, she notes, unfortunately the only way out of it is through it.
#2) Exercise. The magic pill to get the body strong.
Before one even contemplates about surgery, they should find a really good trainer and get training once the doctor gives you the all clear.
One of the first things she was told by the trainer was that she was weak and didn’t have any muscles.
“I remember telling Diana, my trainer, that I was in pretty good shape,” recalls Ramin. “She basically covered her mouth with her hand to laugh. She and I have now worked together for six-seven years now. She has turned me around. She said we have to build you a functional body, and she has really done that.”
Ramin points out how her trainer forced her to exercises she wouldn’t have done on her own, or ever thought she could do.
“I now believe strongly that exercise and being respectful of your body through lifestyle has turned my back pain around. I’m now rarely incapacitated by back pain,” she says, adding everyone will be hit with back pain at some point in their life. “Those of us who have had big trouble, if we even have a little bit of back pain we get a little panicky, ‘Oh, here it comes again, I’ll be out x number of months. Well, no, that’s not how it works. The trick is to know how to intervene on it and how to be consistent with exercise and your lifestyle so it doesn’t clobber you.”
Her lifestyle in particular as a journalist required copious amounts of sitting for long periods of time. Chair after chair was purchased to no avail until she was interviewing David Call (sp) owner of Fully, who explained active furniture and the need to move. Ramin now owns her own sit-stand work-station with two different stools and shifts around throughout the day.
“Because I’ve stopped sitting (so much) my back pain is basically non-existent. It didn’t matter how strong I got, as long as I kept sitting eight hours a day, it wasn’t going to leave,” she says.
#3) How does the brain dictate chronic pain? What differentiates the mental versus the physical?
Physical benefits of exercise aside, the neurological and emotional aspect of the injury and pain also needs to be addressed. Through research and her own experience, Ramin says there is a heavy duty neurological aspect to chronic pain because it’s not where one would think it is.
“You think it’s in your right hip, no it’s in your brain. Chronic pain is the brain saying, I have lost track of what is going on here but I think there’s an emergency,” she says. “That can only be dealt with by intensive rehab because the brain needs to be convinced otherwise. The brain is so protective, and rightly so, that the brain will need to hear the news that I just lifted 20lb weights for 20 reps and apparently I’m not dying. So calm down now, everything is ok. We have no problem getting the groceries out of the car.”
When the body understands there is no pain through the movement, the emergency signals stop. Confidence in a person goes up when they realize they can lift weights and move their body without pain.
“It’s not just the psychological confidence, but the brain getting the message that this person is no longer in trouble, we can back off now. There’s no real difference between the psychological, neurological and the physical,” says Ramin. “To ignore what is going on and what has gone on in a person’s life that has had chronic pain, is a gigantic mistake because the brain has gotten the message and the brain is taking it out somewhere on the body. Until you can really acknowledge what is really going on, you’re never going to get better.”
Ramin includes herself in the many people who have allowed the emotional aspects of life to hinder her recovery from back pain. In part the fear of additional pain makes one guard their movements and not allow for proper healing through movement.
“If you don’t address it or believe it, and you keep guarding your hip and won’t do anything, you won’t get better. That’s the problem,” she claims. “There is a major reason for people to have back pain. It’s a huge excuse for not being an active member of the family, it’s an excuse for not having sex, and it’s an excuse for many things, so some people need that back pain.”
#4) Find a trainer you can trust and push you. Be comfortable with being uncomfortable in the healing process.
From there, one would find their own personal back whisperer.
“You’re going to look for someone who gives you confidence, does not go easy on you, has an eagle eye on you for your every move and tells you things like, your left toe needs to move two inches to the left. That kind of attention is what you’re looking for,” says Ramin. “Do not take yourself and your back pain to a gym and start screwing around on your own because the thing is, people with back pain cheat.”
By thinking they can do it by themselves they do the movements or exercises wrong, and ultimately cause more injury to themselves as they avoid the pain.
“You’re not getting any benefits and you may actually be doing more damage. You really do need someone with eyes on,” she adds. “In order to succeed, you have to find someone who is willing to push you and someone you trust to not kill you. Now you’ll think you’re dying, but you’re not.”
She recalls her time with her trainer Vinny in New York who told her she needed to strengthen this tiny muscle in the back of her shoulder. He gave her small weights and had her do an exercise that looked innocuous.
“By four reps in, I’m like, ‘Vinny, this is hurting me.’ He laughs and says, ‘Yes, because you’ve never activated these muscles before in your life and you’re going to be hunched over lady if you don’t activate them,” she says.
When she went back three days later and told him she couldn’t move her arms for two days after, he asked her how it was at that moment, and gave her the weights again.
“It’s never hurt again,” she says. “But you have to live through that process.”
People tend to chicken out, back out or have a lot of excuses. That’s why they need someone who can be trusted and who can push, concludes Ramin.
Resources and References from the Podcast
Website - https://www.cathrynjakobsonramin.com/
Book - Crooked on Amazon.com
Book - Crooked on Amazon.ca