How I Finally "Fixed" My Low Back Pain- Part I

By Martha Theirl, PT, DPT

“You’ll be in a wheelchair by the time you’re 30.”

That sentence was spoken to me by an ER doc in Buffalo, NY in 2004. I showed up after a lacrosse game I had to leave because I couldn’t move my back. I was a sophomore in college and playing club lacrosse where we were competing to be invited to nationals (we made it the following year, BTW). This wasn’t my first run in with a doctor who told me to stop playing lacrosse, or run, or basically move because of my back. I’m going to give a little back story here (yup, still on that strong pun game). If you want to just get to the meat and potatoes, scroll down.

I initially injured my back throwing the shot put in highschool. I wanted to lift weight on the track team and the only way to do that at the time was to do a field event, so I chose shot put. Through a combination of overtraining and under fueling, I ended up injuring my back and landing in Physical Therapy.

This PT was three weeks of three times a week hot packs and E-stim to my back. Not surprisingly, after three weeks I wasn’t feeling better and when I asked when I could lift weights in their gym, the PT told me “When you don’t have back pain anymore”. I stopped going there immediately and rehabbed myself, feeling better as I moved more. This worked for a time but I couldn’t stop injuring myself. I’d be OK for 6 months, then injured for 3 months, then OK, then injured again. It’s a story I’ve now heard from so many people over the years.

Surf and Turf Champions 2009

That day in the ER, after receiving a cortisone injection into my glutes, the doctor told me I’ll never get better if I keep playing lacrosse. My discs were so bulged and he wouldn’t be surprised if I was in a wheelchair by age 30; I was 19. Not surprisingly, the cortisone and the pain pills they gave me did nothing. I graduated having two more bouts of pain but never again went to seek help for it. Why bother? I was being told the same thing and never given any real help.

After college I moved to Boston, got a grown up job in a lab, played lots of post-collegiate lacrosse, and got into the best shape. I trained Crossfit, played lacrosse 3 days per week, and was training for my half marathon. I thought my back pain was behind me. Fast forward to 2013 when I moved to California to go to Physical Therapy school.

Dr. Kane and myself a few months after he helped me initially calm down my back symptoms.

At this point, it had been 13 years since my initial back injury. I’d been feeling pretty good for several years and decided to play some lacrosse with the women on a club team. One night, my first semester of grad school, I took a shot like I was 18, you know the one, in the air… twisting…. and got hit while I was airborne. I fell to the ground on my back. Duh. I knew it wouldn’t be good. I felt it immediately. I continued to play and when I got in the car threw the seat heater on.

The next day I couldn’t get out of bed. It took me 15 minutes. It took me another 15 to dress, I drove to school instead of biked. My anatomy professor after the second day called me up and asked me what was wrong with me. I quickly told him and he listened. He tested. He did what felt like voo-doo magic at the time. I immediately went from 8/10 pain searing down my right leg to 2/10 pain in just my back. WAIT WHAT? PT can do that!? I get to do that? Yup, I was bought in.

The following 2.5 years of grad school was my mission to get better. To finally heal. To learn how to never let what I had gone through be another young persons journey. Upon graduation in 2015, I was able to run more than 4 steps without searing pain, lift with reckless abandon, and play lacrosse no longer feeling terrified I’d break myself. Oh, and I was 30, and definitely NOT in a wheelchair.

So what did I do? While each journey is unique, they all have some parallels. This is the part where I say I haven’t assessed you and I don’t know your history. This isn’t medical advice. It’s trends I’ve seen from the clinical evidence and the scientific research. It’s principles to build a great Physical Therapy plan of care on. Seek out a great medical professional that can help you do this! Ask me about this in 20 years and see how much it’s changed!

Step One: Calm it down

This is the second most important step to me, but it’s the first one that needs to be addressed. When symptoms are super high, it’s hard for our nervous system to cope. We shut down a bit and everything feels hard and painful. There’s a lot to assess here. Have pain down your legs? May be nerve related, may be muscles sending pain signals elsewhere. Numbness and tingling? Make sure you check the nerves. Any red flags? GET THEE TO THE ED! Pain in the low low low back? Check the SI Joint (sacroiliac) and maybe a manipulation is warranted. Pain in the low back but above the hips? soft tissue and pelvic movement may be helpful here. The treatment is always less important than the assessment. Which leads to step two.

Step Two: Find the root cause

THIS is the most important step. This is where the magic is. Being able to listen as you talk through what’s been going on so I can make my little mental list of hypotheses of what is going on. As Joe Lavacca says, “Listen and people will tell you what’s wrong. Listen long enough and they’ll tell you how to fix it.”. Someone needs to hear about what’s going on. All of it, not just a little, to ask the right questions, and come to the right conclusion.

Dr. Smith and myself at PT school graduation

This happened for me with another professor of mine, Kayla Smith. After getting out of initial pain, she was kind enough to meet with me with a fellow she was training. We chatted, she and her fellow tested, we chatted more. Then I had to do the hardest thing I’ve ever done in my life. I had to try to use muscles that had spent the last 13 years atrophying. She was very honest with me, and told me it would take about 18 months to really solve this problem. Honestly, what’s 18 months in the span of 13 years? I was in.

She gave me homework. It was lumbar multifidi activation, transversus abdominus holds (core bracing), bird dogs and dead bugs. It took me 6 months to be able to do 3x10 bird dogs and keep a moderate level brace and back engagement. She was honest, and that gave me hope. It allowed me to set my goals appropriately. Then, I was ready to move into step three.

What’s step three? Tune in next time. It’s my favorite step and it’s why I haven’t had back pain in 7 years and counting. I’m not even afraid to jinx myself by saying that out loud!

Be resilient to the finish.

Have questions? Ask! Post in the comments or email me at martha@q4pt.com