This was by far the most challenging post I’ve ever written. I’d like to preface it by admitting that I have no medical certifications and I certainly don’t possess an expert understanding of the healthcare system. This is merely my experience as a patient.
Anyone who knows me well knows that I suffer from chronic pain.
At first (like...for more than 2 years!), I denied the facts staring me in the face. I always told others that I just had acute pain and felt confident that I could solve it with a simple fix, either via self-treatment or with the help of a health care practitioner.
Now, more than four years since the initial incident that spurred this condition, I’ve come a long way into understanding my situation, but I also still have a long way to go.
Below is a chart outlining the initial journey I took through America’s health system attempting to address my pain, which took place from October 31st, 2010 and culminated with back surgery on January 10th, 2012.
What follows is by no means a comprehensive report on everything that happened along the way. It’s just a breakdown of some of the key events.
1. A Sprained Ankle?
On halloween of my junior year at college, I sprained my ankle while running and limped around campus for a few weeks. Little did I know at the time, this led to an overcompensation in my hip. The pain started on the outer portion of my left hip and thigh, but eventually spread below the knee down to the ankle and down the right outer leg as well.
For the dynamic, connected system that is my muscular-skeletal body, this was the butterfly flapping its wings from the chaos theory: "the small change in the initial condition of the system, which causes a chain of events leading to large-scale phenomena."
It certainly didn’t seem like a big problem at the time, so I started out by trying to treat myself.
It’s a mantra almost as old as sports itself: "experiencing muscular pain or tightness? Stretch it out!” Conventional wisdom is full of articles and youtube videos providing stretching techniques to ease pain.
I dove headfirst into daily stretching routines and experienced brief improvement.There was even a time when my personal twitter description was “Just Stretching!” because I was so often asked by others what I was doing. Little did I know at the time, this may have actually been worsening my condition.
Either way, it was only treating the symptoms, not the actual cause of my pain. This will become a recurring theme.
3. Massage Therapy
I still remember the first time I was alerted that the problem might be larger than my initial self-diagnosis. I went to a massage therapist at Cornell University, where I was currently a student, and asked for a medical massage focusing on my left thigh. As I was paying, the therapist said to me: “The pain is in your legs. But the problem is in your hips and back.”
If only I had engaged with her and asked more follow up questions, this journey may have followed a different track.
4. Primary Care Physician
Upon returning home for summer vacation, I admitted utter defeat at self-care and decided it was time to see a doctor. My primary care physician (PCP) conducted a brief movement and pain screen, then diagnosed ice packs and advil to reduce the inflammation in my outer hip and thigh.
Using online research, I also discovered the benefits of foam rolling on reducing tension in my fascia, the thin connective tissue that attach to and stabilize muscles. I foam rolled religiously for years, before and after workouts and often at both the beginning and the end of the day.
All summer and through the fall semester at school, I iced my hip on a daily basis, developed a slight addiction to acetaminophen, and spent hours on the foam roller. I also began to see a physical therapist twice a week, who worked me through a progression of treatments, including strengthening and stability exercises, massage, and electrode nerve stimulation.
Each of these treatments helped….temporarily. Sadly, I was again treating the symptoms instead of eliminating the cause.
At the end of the semester, stressed by a mounting load of work and upcoming final exams, my condition deteriorated. I distinctly remember experiencing debilitating pain after standing for more than 20 minutes at a time, and my energy was constantly sapped. It was a difficult time and I although I never would have admitted it, my physical pain had also triggered emotional suffering. By this point, I was ready for any potential solution.
5. “Of course the surgeon wants to perform surgery”
During winter break, I went back to my physician and was referred to a back specialist. Although the pain was primarily in my legs, the hypothesis was that a bulging disc may have been the culprit.
I had an MRI performed and the resulting images were disturbing; one of the discs in my lower back was protruding into the spinal nerve and causing spinal stenosis, otherwise known as a narrowing of the spinal column. Honestly, as someone who spent the vast majority of my time hunched over a desk, it’s not even that surprising in hindsight.
This was a crossroads: continue with the existing remedies or go under the knife for back surgery?
While discussing the decision with my parents, I distinctly remember what my Dad, who is well-versed in America’s health system, said: “of course the surgeon wants to perform surgery.” A fact that remains baffling to me is that operating under America's "fee-for-service" payment model, hospitals and medical practitioners generate revenue based on the quantity and cost of the services they perform, not the outcomes of their patients.
This is what excites me so much about the potential value in reimagining the healthcare system. The vast majority of time and energy is focused on treating people who are already sick, but spurred by an "outcomes-based" payment model, an ounce of prevention is worth a pound of cure.
Regardless of anyone else’s better judgement, I was fed up and physically debilitated. I didn’t feel like any of the treatments were sustaining improvement and was convinced that we had finally found the culprit. In hindsight, was the surgery necessary? I’m honestly still not sure.
6. Prescription Pain Killers
After surgery, I was still in a significant amount of pain and received a prescription for Vicodin. This is still my least favorite segment of the entire journey. I hated the way the pain killers made me feel: like I was constantly devoid of energy and unable to operate at peak mental performance.
In the spring of 2012, things began to feel better. I made improvements. I could walk again. I stopped taking the drugs. I went to a physical therapist for 8 weeks and we quantified my improvement at the end, which was a great feeling.
But at some point over the next few months, as I migrated back to my old movement patterns, focused less on stability and rehabilitation, then eventually settled into a desk-laden job in corporate America, the symptoms returned.
About 2 years have now passed since my surgery, and although I have gotten significantly better at managing and understanding my chronic pain, I cannot yet say that I have solved it. Pain still radiates from my hips down my hamstrings, glutes, and quadriceps, and I am often subject to intense foot and calf cramping. My hips, knees and ankles have been known to make some frightening noises.
Although the story doesn’t have a happy ending, along this journey I have accumulated an incredible amount of knowledge about the human body and discovered an entire community of individuals dedicated to restoring functional movement in patients with similar conditions. I’ve never been more confident in my ability to make progress and live a pain free life.