The story of my back pain (the hardest blog I’ve ever written)

Ok, so this post has been one YEAR in the making. Yep, a whole year to get myself together to write this.

Every time I have sat down to write about how I recovered from back pain, I have stopped myself.

You see, when you have experienced agonising pain that has affected your job, lifestyle, mood (well, everything)… you never really feel like you’re cured/healed/recovered. There’s always this little part of your brain that tells you “pfff, you aren’t better. It will only take one bad movement and bam…that pain is back”.

You live in fear. Fear of that pain. Fear of that disability.

So I couldn’t bring myself to write about it for such a long time…because I felt that somehow the Universe would say “who the hell do you think you are?” and curse me with another acute episode. Yep, I know how crazy that sounds, but this is what happens to your brain when you have experienced significant pain. It re-wires itself – and not in a helpful way.

But yet here I am. So how did I get to this point? How did I get confidence in my body again? Why do I finally feel like I can write about it now?

I want to tell my story (and it is a long one!) so that perhaps it might help others who are experiencing something similar. Even as a physiotherapist, working with people in pain and knowing something about the science of pain and how the brain works…I still found it really challenging to experience it myself.

But I did get through it and here is my story…

The back story

Marika Corporate

Me in my professional gear ;)

I have been working as a physiotherapist for a fair few years now – mostly in private practice, treating back, neck and knee pain – so it is fair to say that the concept of back pain is not new to me. I had a few acute episodes of low back pain in my younger days (20s!) but never lasting for longer than a few days and usually requiring minimal treatment.

Fast forward a few years (and a couple of pregnancies and births later!) and I had my first episode of severe back pain. Given that my current job is teaching pre and postnatal exercise (it wasn’t back then), I can kind of shake my head at my stupidity in retrospect.

Hitting the slopes with family and friends in Colorado

So, I was about 8 months postnatal…I had been doing some basic postnatal pilates and gentle gym work. We went on holiday to Colorado and I desperately wanted to go snowboarding. Never one to take things lightly, I went hard core – off piste, moguls, you name it.

I was so friggin excited to be boarding again – nothing was going to hold me back! Unfortunately my body didn’t react so well from this workout and I couldn’t move for about 3 days. Literally couldn’t walk (challenging looking after a little baby, but luckily I had lots of family with me at the time!).

Things settled with time, gentle exercise and movement…and I felt pretty normal again within a few weeks.

After we moved to Melbourne, I decided that I missed my old Taekwondo life and found an amazing school that enabled me to jump back into it (about 18 months after number 2!).

With Master Spiridon Cariotis – USMA Melbourne– achieving my Second Dan in ITF TaeKwonDo

I found it challenging physically, as I had taken 11 years off martial arts and had had a couple of babies – my flexibility was poor and my core strength was…well, not great. Even though I taught pilates at a sports medicine clinic at the time, I found it hard to find time to do much for myself. I worked part-time, had two small children, no family nearby and a husband who worked away a lot. It was difficult to prioritise myself (something I hear from my clients all the time!).

But I LOVED TaeKwonDo – I loved the movement, the intensity, the people, the philosophy. I worked hard, I sweated, I burned and I smiled.

Bit too far away ;)

I somehow found myself competing in some tournaments. Even though I didn’t know the rules and perhaps lost a few points on penalties (you aren’t allowed to grab people’s legs and sweep them…I must have watched too much Karate Kid!), I managed to win the sparring in my first ever tournament! It was the Victorian championships and most of my competitors were at least 10-15 years younger than me (and much fitter), so I was stoked to come away with the gold … (plus some bruised ribs).

 

The Big One

As with many people with back pain, I had one episode that eclipsed all others. One that dropped me to the floor. One that stopped me sleeping, had me taking strong medication…one that made me cry.

Selling a house while still living in it with two small children = stressful!

In retrospect, of course I can see how all the pieces of the puzzle slotted together to create the perfect storm. We had just auctioned our house in Melbourne (HUGE amount of stress getting everything perfect for that) and we had purchased a house in Perth and were moving our life there. The Dockers had just lost the Grand Final of the AFL (ok, not so relevant but may have added to my mental state!).

I had made the Australian team for the World Championships in ITF TaeKwonDo! I had booked my flights to Rome and had chosen a club in Perth to train with. I had enrolled my daughter into her new school and started to settle into life here. Oh..and I decided to start a new business teaching pre and postnatal pilates.

Yeah…to say that it was a stressful six months is an understatement.

So one weekend I did a myofascial release half -day course. We foam rolled and stretched – my back went into positions that it hadn’t for a long time. It felt a bit sore, but wasn’t too bad.

I drove straight to a three-hour training session after that. We did heavy kicking on bags – I basically tried to kick a 100kg male from one end of the gym to the other. I felt sore, I stopped. That night my back felt pretty darn achy.

The next day I tried to ride my bike. As I went to push down on my pedal with my right leg, something went “clunk” and I couldn’t move. I was stuck straddling my bike by the side of the road, trying to yell at my husband to come and help. I literally couldn’t lift my leg over the cross bar.

I went home and cried. Took some anti-inflammatories, rested and did some gentle movement. I was devastated. I felt that Rome was out of the picture. I worried that I wasn’t going to be able to teach pilates in my new business. I was also doing a locum for a sports physio clinic – would I be able to work? How was I going to get the kids to and from school. I felt sick with the stress and the pain. My physio thought I had a stress fracture and wanted scans. I didn’t want scans as I knew that I would have degenerative changes (because pretty much everyone does!) and I thought they would impact negatively on my recovery. Long and short of it – I had scans, there was no fracture and of course there were degenerative changes.

I had treatment on my back over the next few months – I had manipulation, acupuncture, massage and craniosacral treatment. All helped a small amount. I felt better bit by bit and week by week…but it was slow going. Every day I would have a few episodes where I would move and an electric shock would shoot through me. It would take my breath away and kept me on edge. I pulled out of the World Champs…and cried some more.

Perth has so many beautiful places to walk!

I could sense that my anxiety about the pain was really ramping up my nervous system and I needed to do something to calm it down. So here’s what I did:

I started walking mindfully. Sounds weird I know, but I just put my headphones on and walked down to the river.I focused on my arm swing first – and I noticed it was completely asymmetrical. My right arm pretty much didn’t move! So I got my swagger on (as Robin Kerr – physio extraordinaire calls it!) and felt my thoracic spine start to move again.

I learnt to breathe again. Yes of course I was breathing …but I was so tense through my abdominals that my belly didn’t move! I learnt to relax my abs and get my lower ribs to expand. This style of breathing helped calm my mind and my body (and I’m sure I got better oxygenation as a result!)

I danced. I had a friend’s wedding during this time. I remember

At a friend’s wedding, I found that dancing really helped my pain.

going out to buy some flatter shoes as I knew that I wasn’t going to be able to manage heels! At the wedding I felt consumed by thoughts of my back. I worried that I wouldn’t be able to sit down. I couldn’t concentrate on the conversations around me. Then the music came on…

Once a started dancing, I felt things start to ease. The rhythmical movements soothed my nerves. The pelvic tilting and weight shifting eased my spine. The endorphins released by having such a great time with my friends and moving with the music calmed my soul.

I started dancing more at home with the kids. We put on funky tunes and just grooved away in our living room (yes, we still do!).

With two of my buddies from TKD

I got back into TaeKwonDo. This was a big challenge. I was really nervous about starting up again, but I have wonderful instructors at Platinum TaeKwonDo who supported me and encouraged me to come along and just do whatever I could. They knew that it was important for me to build my confidence again, but to also be surrounded by my friends in the club. Those who have experienced pain, know all too well how isolating it is to be removed from the social circles that are linked to physical activity.

So I started up again really slowly (it was many months after the “big one”) and realised that I was ok. Sure some days I ached afterwards, but I didn’t get crippling pain. Yes I couldn’t sprint or kick high, but that was ok. I was there. I was moving. I found ways to move that weren’t painful….and I did more of them.

One of the great things about martial arts, yoga, qi-gong and tai-chi are the sequences of movement. In TaeKwonDo we call them patterns. In Karate they are called katas. They can be almost meditative in nature, depending on speed and focus, and I certainly found them helpful in my recovery.

I challenged myself. When we were putting our new pool in, we had to move wheelbarrow loads of cement from the front to the back of the house (via a ramp that went down a few steps). My first thought was “I can’t do that, it will hurt”. I took a few minutes to think about it and realised that I was completely capable of the task and I gave it a crack. I was tired, but fine. I learnt so much about my body that day – I was NOT broken!

Beautiful trails in Dwellingup, Western Australia.

So we tried hiking. I just carried a smaller pack (poor hubby carried the big one!) and just did about 20km in 2 days. Sleeping on a hard surface was pretty uncomfortable and I woke up stiff and sore. But guess what? I was fine!

I went mountainbiking  – well, no real mountains in Western Australia, so let’s just call it cross-country cycling! I was a bit nervous about the bumps and how it might jarr my spine. I reminded myself that if I tensed up, I was not going to be a good shock absorber, so I chilled out and had a brilliant time.

I started to lift. I really felt that if I wanted to continue doing TKD (and certainly if I wanted to get back into competing), then I needed to be a LOT stronger. I contacted an exercise physiologist (Tristan Hellings) and started doing weights at home. At first, I was kinda shitting myself (technical term) at the thought of deadlifting…especially off the floor. But I started with light weights and soon afterwards could easily pull 40kg off the floor. The knowledge of that achievement gave me great confidence. If I can lift 40kg easily off the floor, then I certainly can lift the laundry basket without too much difficulty!

The snow in Japan is so forgiving… very different to the icy roads in France that I learnt on!

I asked Tristan for a snowboarding program around 12 weeks out from a trip to Japan. Believe you me, I was focused on being in great condition for that trip! I worked hard in my home gym and managed to snowboard 10 days in our 14 day holiday (I still can’t believe it – really grateful that our kids loved the snow!). Again, my back was great. I had so much more strength through my whole body and I felt relaxed. It was amazing!!

I did a course with the amazing Antony Lo (Physio Detective) who further not only challenged my thinking, but taught me some strategies for how to use alignment, deep muscle activation and breath in lifting (#spreadtheload).

Do you notice a theme here?

Do you see that for every new thing I tried, I had to overcome my own fear and limiting beliefs? I had to try the movement and prove to myself that I wasn’t broken. With every new thing that I tried, my confidence in my body grew and grew.

So where am I at now?

Well, it’s now three years since the “big one” and I continue on. I do TaeKwonDo and I have my sights set on the World Cup in Queensland in 2018. My plan is to build up my muscle strength and power so that I can increase my kicking speed.

I’m keen to try CrossFit and have been working on my lifting technique in order to be able to do so safely.

I no longer live in constant fear of pain. I can play soccer in the backyard with my son without discomfort. If the kids want to go for a ride on their bikes around the river, I am happy to jump on mine without thinking twice.

We are planning a hike in New Zealand at the end of the year, plus another ski trip to Japan (I need to work my butt off this year to earn some money for these holidays haha!).

I have to continue to work on my breathing and relaxation techniques every day. I try and make sure that every week I do something for myself that is enjoyable, whether it is coffee with friends, reading my book outside or going for a walk.

And I use this experience to help my physiotherapy clients. I see women every week who have pain during pregnancy or the postnatal period and I can truly empathise with what they are going through. I help them manage their pain and find ways of moving comfortably.  I have just started working in a personal training studio in Perth and I love seeing people achieve goals that they never believed were possible – whether it is just moving without pain or running a marathon.

I can’t say that I am never going to experience pain again. I probably will, because I am alive! But I no longer live in fear everyday, and I now feel that I have the tools to manage the pain if it does return.

 

Do we need strong abdominal muscles for birth?

dsc_0050Recently I wrote a brief blog about side planks in pregnancy. This topic came up because a client of mine had signed on to an app which gave her specific exercises for each week in her pregnancy. At the 20 week mark her app told her to start doing side planks as they “can be a great way to strengthen your abdominals and core for delivery.”

This isn’t the first time that I’ve heard fitness and health professionals recommend abdominal strengthening exercises for birth. It really puzzled me – why do we need strong abdominal muscles for birth?

I reflected on my own birth – at the start of second stage labour, my body pushed all by itself. I certainly wasn’t making it happen – I was just going along for the ride!

Now those that know me know that I am a HUGE advocate of exercise in pregnancy. Basically I think it is essential and is a magic bullet for helping just about everything – from reducing risks of blood clots and gestational diabetes, to helping manage anxiety and depression, reducing back and pelvic pain, improving sleep quality…the list goes on and on.

We definitely want to maintain (and improve if we can!) our muscle strength and fitness in pregnancy for all of the above reasons. But do we really need strong abs for birth itself? What is the role of the abdominal muscles in labour?

I asked a few experts for their opinion. A HUGE thank you to the following:

tracy

Tracy Donegan (TD) – Midwife, author and founder of the Gentle Birth Program

sami

Sami Cattach (SM) – Pelvic Floor Physiotherapist and Restorative Exercise Specialist – Body and Birth Physio

pip_wynn_owen

Pip Wynn Owen (PWO) – Midwife, Birth Educator – Birth Savvy, Instructor Hypnobirthing Australia – Perth Hypnobirthing.

In a normal physiological birth, how does the baby move down through the birth canal?

TD “ It’s often surprising for mums to hear that the 2nd stage is a reflex  – just like a sneeze, or the way you blink when something comes towards your eye.  You were never taught these reflexes – they just happen.

As your baby descends deep into the pelvis your baby’s head triggers Fergusons reflex (also known as the fetal ejection reflex) and your body automatically starts to nudge your baby down with or without you. The top of the uterus (fundus) gets thicker and thicker and moves down behind your baby – like a tube of toothpaste. When you think of how our body works when you vomit. Your body throws up….so in labour it’s like your body is throwing ‘down’. You’d never say oh I had a dodgy curry last night and was pushing up vomit all night….you’d say you were throwing up….it’s the same with the 2nd stage….your body does all the work for you.  

itty-bitty-birth-photography-2

(Image: Itty Bitty Photography Tasmania)

It’s an irresistible urge that you can’t ignore. Think of how the bowel works – pushing when you don’t have the urge to push is like me instructing you now to go and have a bowel movement immediately when you don’t feel the need to go! Think of a time when you really really needed to go….did you need someone to coach you? Did you need to do anything else other than find a bathroom, sit down and relax? Whether you sit on the toilet and do Olympic pushing or bring a book (men are great at this) the poop still comes out!!! When you think of it how did humans get born for the thousands of years before Midwives and Doctors came on the scene? Who is coaching the cows and sheep in the fields or the women who have accidental homebirths or give birth in the car? When a baby is born unexpectedly at home or in the car those mums were literally sucking those babies back in but the body has other plans.  

The good news is that you don’t need strong abs for labor – the uterus does so much of the work for you (even with an epidural) and there’s no exercise you can do to make your uterus work more efficiently.  Some small studies do suggest that Raspberry Leaf Tea can act as a uterine toner and some women experience a shorter pushing stage after consuming RLT in the 3rd trimester.  However having a strong core in pregnancy can help avoid back pain in pregnancy and after.”

PWO –“During a physiological birth your body and baby really work together. When your hormones are triggered in the right way, you use gravity and you work with your baby, there really is no need to do anything else.

Your hormones will trigger the right responses and the muscles of the uterus will work together to help move the baby out. This is known as the Ferguson reflex, however it is a shy reflex and we need to make sure it is not interrupted at this stage.

breastcrawl-scientific2

(Image: breastcrawl.org)

Most people don’t realise that their baby is not passive in all this either, he/she is wriggling and finding the easiest way out. I always recommend clients watch a breast crawl, of a baby straight after birth, so they can sees just how active and capable their baby is.”

 

What happens if you push too hard?

TD: In recent years women have been led to believe that they need to be taught how to push – that there is some magical secret technique that only an ‘expert’ can instruct you in. What most mums to be don’t realize that these expert ‘techniques’  that include holding your breath for long periods of time puts her baby at risk. Nobody told her that ‘purple pushing’ could damage not only her baby, but her bladder, her pelvic floor and perineum. In fact many hospital classes encourage it and other women tell these mums to ‘listen to your Midwife – she’ll show you how to push’.

There are a number of studies comparing coached vs spontaneous pushing. In 2003 the WHO recommended removing coached pushing from practice. Mother led pushing is protective for your baby.  When you hold your breath for sustained periods of time the oxygen to your baby, uterus and perineum is turned off, cardiac output is affected as well as your blood pressure.  

Research from 1957 describes the damage to the muscles of the vagina and support ligaments after coached pushing so the new research is reaffirming what we already knew to be the case – that ‘purple pushing’ is harmful for women and their babies and the more Mums can educate themselves about local maternity practices the better.”

heiditvbirth

(Image: Katherine Heigl. Knocked Up. Universal Pictures)

SC: “Bearing down can occur when someone holds their breath while pushing which creates a much more generalised downward pressure caused by the diaphragm. This means instead of the uterus and deep abdominal core muscles (TrA) helping to push only your baby out, there is more pushing down onto pelvic organs (including the bladder and bowel) and stretching of the ligaments that hold up these organs. In some cases, this can contribute to pelvic organ prolapse.

Also, under pressure or load, the reflexive response of the pelvic floor muscles is to contract and lift up, though this is the opposite of what we want those muscles to do during childbirth. Optimally, we want the pelvic floor muscles to be as relaxed or as supple as possible to allow for less resistance to baby’s descent.

PWO – “Pushing too hard is not good for mum or baby. It puts way too much strain on both of them. I really don’t understand why there are still care givers who will instruct mums to do the “Valsava Pushing Technique when the evidence is quite clear on this. Babies have better APGAR scores when Mums works with her body rather than forcibly pushes their babies out.”

Is this different when an epidural is insitu?

epidural

(Image: Healthwise Inc)

 

TD:  “One of the tradeoffs of having an epidural is that you lose mobility and it can be more challenging to birth upright.  Often times it’s the staff who find it challenging rather than mom.  I’ve worked with moms who have been facilitated to birth on all fours even with an epidural.  With an epidural in place the uterus still nudges your baby through the pelvis and by giving moms more time (3-4 hours of passive descent) especially first time moms we can improve the odds of mom having a normal vaginal birth.  Be sure to include in your birth preferences that you would like extra time for passive descent or laboring down as it’s also commonly known as.”

SC: “An epidural will affect the mother’s ability to move around and help baby descend into the birth canal, and may limit what positions she can the be in to deliver. It can also affect the ability of a woman to sense when and how to push, which can sometimes lead to more generalised bearing down or more forced pushing as if for a bowel movement. Clinically, this seems to correlate with a higher likelihood of postpartum rectocele.”

Do you recommend abdominal muscle training in pregnancy to specifically to help with birth?

SC: As baby grows during your pregnancy, the muscles lining the uterus get bigger and increase in number to prepare for the big event of pushing baby out. Your uterus really is the main ‘pushing’ muscle during delivery, as opposed to your diaphragm or abdominal muscles. I don’t specifically recommend abdominal core training for birthing, though functional core strength and whole body strength is essential to help support the rest of the body and increasing weight of baby, and then to support you during labour and delivery.

What can women do to optimise the second stage labour?

PWO: “To optimize second stage I recommend:

– Trust your body and your baby: if you are over thinking the process you can dull the hormonal triggers that are meant to happen at this point

– Learn some relaxation techniques so you can really relax your body and allow it to open as it should.

If you are doing perineal massage, make sure you are doing it for the right reason. Perineal massage is not about making yourself more stretchy, it is about teaching yourself to relax to that sensation

Use gravity. If you think about the physics of what is happening the downward energy of the uterine muscles is massively weakened if you are lying on your back. You are also making it hard for your baby to do all the turning and negotiation of the birth path that he/she is trying to do.

Make sure no one tells you to “PUUUUUUSSSSSHHHHH”. It is like going to the loo for a poo, if people stood outside the door yelling “Push. Push, Push” you would most likely get “stage fright” and lose the urge. Exactly the same thing happens in birth, you will lose the shy Ferguson Reflex.

Make sure that you write in your birth plan that no one is to direct you to push then get your birth partner to ensure everyone respects your wishes once you are birthing your baby.

– Don’t announce when you feel 2nd stage has started. You will feel a change and possibly like you want to poo, just keep it to yourself. If you announce it, lights might go on , VEs might be performed, trolleys might be wheeled in and the clock will start. 2nd stage can take a while as there are actually 3 phases of second stage and there is no need for heightened activity at this time. Remember the Ferguson Reflex is shy.

Do an Hypnobirthing course. This really will give you the edge as not only will you understand what your body and baby are doing, you will have some excellent tools and techniques to use.”

SC: “Optimising the second stage of labour cannot be separated from preparing the whole body for pregnancy and childbirth. You need healthy, supple pelvic floor muscles, a strong and functional core and good support from all of the surrounding muscles of the hips and pelvis which come from moving and exercising well throughout your pregnancy. Learning how to relax your pelvic floor, breathe with your diaphragm is key.

More specifically, here things I would recommend…

Prenatally:

– Perineal massage

Hands and knees squat prep (from my eBook/video series/youtube video “Drop it like a Squat”)

During second stage:

– Positioning that allows some assistance from gravity and no resistance to the mobility of the sacrum and coccyx (i.e. not lying on your back)

– Exhaling during big pushes which will help recruit your TrA and avoid bearing down with your diaphragm”

Some useful articles:

Effects of pushing techniques in birth on mother and fetus: a randomized study.

When and How to Push: Providing the Most Current Information About Second-Stage Labor to Women During Childbirth Education

SPONTANEOUS PUSHING DURING BIRTH: Relationship To Perineal Outcomes

World Health Organisation – Care in Normal Birth: A Practical Guide

To learn more about health and wellness in pregnancy, as well as some tips that you can use to prepare for YOUR birth, head to our pregnancy club page.

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