I was once asked an irregular question. “Does a physio ever get back pain?” The simple answer is “Of course we do”.
A similar question could be asked of other health professions. “Do doctors ever get sick? Do dentists ever need fillings?”. To which the same answer would apply.
So if all of that professional knowledge and experience cannot protect them, how can we trust that these health professionals know what they are doing?
To answer this question a greater understand how injuries occur is needed, so as to appreciate that there is more than one way to hurt your back. In fact there are two common ways in which you are most likely to hurt yourself.
“Just like that!” A cause and effect back injury.
Firstly through a high, sudden load or traumatic incident, such as tripping, lifting a very heavy box or moving furniture. In this scenario of back injury, there has been a high physical load applied to your body’s joint, muscle and disc tissues, which results in a tear and creates immediate pain. So there has been a direct cause and effect relationship in this type of back injury .
Clients will typically describe what has happened as follows..
- “I bent over to pick up the chair and felt my back go”
- “I tripped over a rock and felt a jolting pain in my back”
- “I picked up my kid and as l lifted them up into the air, there was a sharp pain in my back and my legs felt weak”
In many ways, this is the most obvious way people become injured. Sometimes it is doing something we know we shouldn’t do, such as lifting a heavy box without asking for help. Yet sometimes it is simply doing things that we know are somewhat physically difficult, but we ignore the potential consequences because there is a reward, for example in the case of lifting your child for a hug.
Do as I say, and do as I do. Using knowledge and experience.
In these ’cause and effect’ situations, l would like to think that a physio was less likely to hurt themselves in this manner compared to the non physio population. Our training provides us with knowledge of high risk and largely preventable actions or movements.
We know that lifting an object from the ground is inherently more risky than lifting the same object from a higher level. We know that combining lifting with rotation, that is twisting your back, increases the likelihood of injuring the discs in your spine, as they are not anatomically designed to withstand this type of mechanical force.
An important part of our job is to teach people how to reduce the likelihood of injury, by adopting correct posture, learning the correct lifting technique, as well as assessing and modifying the workplace.
We would love it if people stopped hurting themselves. Over 20 years, l have treated many people with varying degrees of injury and illness. Fortunately, the large majority of people do get better. However back pain does have a high incidence of returning in the first 12 months and some people continue to have back pain for the rest of their lives. For most people it will continue to come and go – but never quite go away. Other people live in constant pain. I have seen many clients lose their jobs, have their relationships placed under strain, and lose a sense of their identity through low back pain. All physios have.
This experience in itself reminds us all to respect our backs. To appreciate that it is a mechanical structure that is susceptible to strain if overloaded, that as it ages it becomes less able to withstand physical stress. That “surely it won’t happen to me” way of thinking, really means that eventually it will, the proof of which we see every day.
So if a physio hurts themselves for example by lifting a heavy object, it’s not because they didn’t understand the risk or how to modify or avoid it. Rather it’s because they chose to ignore what their head was whispering, and instead listened to the little imp on their shoulder who smiled and pronounced “Go on! It’s only this once! You’re too young / fit / smart for a back injury to happen to you!”
“It snuck up on me”. Back injury without symptoms.
The the second most common type of injury is when back pain gradually develops. There wasn’t any particular thing that you did, as life had been the same day in, day out. Just that one day you felt fine and the next day your back starting hurting. So if the cause isn’t obvious, how does this type of back injury develop?
The simplest explanation is that you can have mechanical failure without the symptoms. That is, you can have minor tears in your muscles, joints, discs ; but not experience pain. The degree of injury is not sufficient to produce any significant bleeding or swelling and consequently there is no pain. At least, not yet.
Examples of this low level load are:
- working on a project at a table that is too low, causing you to bend forwards in order to work
- work that involves lifting or moving small objects that are not particularly heavy, but frequently moved
- sitting all day in front of a computer, in a chair that is convenient, as opposed to one that provides adequate back support
With all of these load situations, there are often no pain or discomfort indicators at first. Then after a few weeks or months, your muscles start to feel a bit tight, then gradually ache. More at the mosquito nuisance level, rather than at the angry wasp about to sting stage. And then finally one day, it hurts and you suddenly think, ‘This is not right! Why am l sore?. It sneaks up on you because it has been so subtle, it has been easy to dismiss. But by this stage the pain is strong and constant, at which point you finally think ‘I need to do something now’. Pain does not like being ignored.
Another way this insidious pain appears, is as if by magic. It presents with an element of surprise. “All l did was bend over to brush my teeth and l couldn’t straighten up”. Another common presentation “I sneezed and my back went”. In both of these instances, it personifies the phrase ‘the last straw that broke the camel’s back’. In physiological terms, the mechanical stress has been gradually progressing, to the point where it finally reached the threshold of producing pain.
A physio is human too.
And yes, a physio can develop back pain this way. Like everyone else, the cause only becomes apparent in retrospect.
When you don’t feel pain at the time of doing something, you naturally believe that everything is fine and you are not doing any damage. We are all caught out by this scenario, as although we may not be experiencing pain, we are still increasing the risk of injury, with a physio having the same risk as everyone else. Hopefully though we have the benefit of knowledge, and hearing our client’s stories to recognise the warning signs a lot sooner.
So for the sneaky types of back injury, listen to the body instead of ignoring that minor tightness in a muscle here, or a slight twinge in your back over there. Stop at this point. Think about what might be causing it and make some simple changes. Sometimes that will be enough to prevent further injury and pain.
Lastly, these last two truths, I have learnt over the past 20 years.
A physio with personal experience of back pain is a good thing. Don’t think badly of your physiotherapist if they say they have had back pain. They will then know exactly what you are going through, and will most likely have many personal tips to share with you, that may help with your own journey.
Pain is a great motivator. Unfortunately it’s not until we experience pain that we realise our own limitations, and subsequently how fortunate we really are, when we live a life pain free!