What Does a Chiropractor Do When They Get Back Pain?
As a chiropractor, I spend my days treating people and dispensing health advice. It's my job. Even when I'm not at my job I find myself being asked these questions by friends, family and sometimes strangers. Most of the time I happily answer and give them my 2-to 22 cents (I really get into it sometimes) about their question and then go on with normal conversation. Oddly enough, there's one question I never seem to get: "What do you do when you get back pain?" Some people view us as these superhuman beings that spend their free time performing pelvic bridges, perfecting deep squats and maintaining our overall excellent level of health. However just as many of your parents have done, we can get away from good habits and become more of a "do as I say, not as I do" authority. Its not often but we DO fall into disrepair. Here's what happened to me just this past weekend.
Last week I was invited to speak at the first class of a 4-week runner's winter maintenance course. I said a nice introduction about the class to the attendees and provided some play-by-play about how certain exercises are beneficial during the class. I talked to some nice people, answered a few questions (mostly about knee pain) and was also asked to come back next week to participate by a few of the folks at the class.
This week I decided to oblige them and arrive with my yoga mat and foam roller in-tow. There were a few more people there and one of the women brought her granddaughter for me to check out her knee that was bothering her. We started off with a warm up, and continued to do many of the same things as last week: lunges, squats, inchworms and single-leg squats. One exercise I have been trying to achieve for some time is a full pistol-squat, of which the single leg squat is a precursor. I decided to have a go with the pistol squat during this activity. For those of you who are not yet acquainted with a pistol squat, it is a single leg squat where your non-weight bearing leg is held straight out in front of you parallel to the ground, with your plant foot flat on the floor and your back as straight as possible. It requires a ton of hip mobility, core strength and balance. Although sloppy, I struggled through our assigned 10 reps with the right leg and moved on to the left. As soon as I dropped down, my hip felt significantly more unstable than my right side. Believing I just need to focus on proper muscle firing and maintaining a solid core I went down again. MISTAKE! Just as I eclipsed 90 degree flexion of my hip and knee I felt a shift in the right side of my pelvis. It wasn't an immediate shot of "pain" but it certainly was uncomfortable, causing me to coast through the rest of the day's activities that required hip strength and stability. I got through the class. made some small talk and drove over to CrossFit 100 where I had a patient scheduled. Once I got out of the car, I couldn't get back up! It made my patient visit less than pleasant and put a damper on the rest of my day.
What do you DO about it?
After seeing my patient, I got home and did a little self-assessment: checked hip range of motion bilaterally, "palpated" for fluid motion in my pelvis/sacrum/lumbar spine (silly, but I had to try) and then decided to foam roll and lacrosse ball the bejesus out of my low back. I tell my patients 5-10 minutes of foam rolling would be good for general low back pain. I was on my floor squirming and breathing heavily about for at least 20 minutes working on the singular spot. Much to my chagrin, it didn't seem to help a bit!
Not long after my mobilization marathon a couple friends invited my lovely fiancee and I to check out a movie with them. Should I go? On one shoulder was a little chiropractor saying, "You need to get up and go for a long walk to get inflammation out, followed by pelvic exercises, stretching. Take care of this!" The guy on my other shoulder had some choice words for that little chiropractor, followed by, "You really wanted to see this movie! Its just down the street at that old-school cool theater you keep hearing about! There's probably boobs in it!" Well...that logic swung my vote. I'm heading to the movie.
Once again against my better judgement, I decided to take a shower. A HOT shower. THE cardinal rule of acute low back pain like mine is if you feel the need to use ice or heat, do NOT use heat. It will make it worse by bringing in additional inflammation; to alleviate pain you should only use ice immediately after an injury until 72 hours have passed (you really don't NEED either since neither of them speed up the recovery process, just alter pain perception). I was going against more rules I set for my patients and acting how they often do to my requests: largely ignoring them.
While in the shower I decided to test something: If I injured myself doing a pistol squat on the left, could I fire my muscles enough during a pistol on the right to undo my injury? While there are no rules against performing exercises in a shower in the chiropractic realm, there are rules against it in any other realm. Pistol squatting on a wet, slippery surface while more water is pouring onto the surface is totally ridiculous, let alone the fact that I'm naked and if something serious were to happen to me my fiancee would NEVER let me live it down. Although counter intuitive, I did it. Then I did it on the other side. Then I realized something: the psoas major, the body's main hip flexor, on the right is TIGHT. Crazy, super duper tight. It wasn't really a "back" thing. The psoas was in spasm, likely from irritated nerves and overuse, compressing my lumbar spine and irritating my low back. This was a psoas thing!
When I hopped out of the shower I immediately started stretching my right psoas (pronounced SOH-ASS). I stretched for multiple 1 minute reps, focusing on relaxing and drawing out my exhalation. When I walked to that movie I had NO pain whatsoever. After sitting for 2.5 hours I had some trouble since I allowed my psoas to shorten and go back into spasm, but then I stretched quickly and bought my self enough time to walk home upright. There was hope!
Patients often thinking we are immune to the very conditions we are trying to correct is a great feeling for us health practitioners and it indicates that our patients respect our knowledge and believe us to be experts in our fields. However, as much as we try to set an example for our patients, I know that many of us can get caught up in bad habits just as our patients do. Since moving to Milwaukee I have regularly exercised, improved my hip mobility (thanks to my boys at Drench Fitness) and I'm thisclose to having a respectable front rack position (thanks to Doug and Marcela at Crossfit 100). I strive to set a good example for my patients but sometimes, these things do happen and you have to roll with it.
Today I went on a long walk with my lady and my pup, focused on left glute and hamstring strength as well as stretching my right psoas AND mobilized it with a lacrosse ball. Tomorrow I'm seeing my good chiro buddy Thom to get adjusted. We have already discussed doing a psoas release and checking L2-4 (these nerve roots innervate the psoas and they could be a major factor in its hypertonicity) as well as my L5, sacrum and right SI joint where I initially felt my discomfort. I'm going to try to be the best patient I can tomorrow. I'm going to listen to exactly what he says, knowing that if I do as I'm told, this will go away before I know it because chiropractic works!
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Labels: back pain, chiropractic, chiropractor, milwaukee