Why Do I Hurt?
This question has guided the better part of my life. It has taken me from the dance floor to physical therapists to massage therapists to ROLFers to energetic healers to yoga to meditation to acupuncture to podcast to books to … it is exhausting even to write this list. Ultimately, it has taken me to physical therapy school where I continue to ask this question.
I first had low back pain at the age of 16. I was a dancer, dancing every day for at least three hours. I was diagnosed with SI Joint dysfunction, told to hold a permanent Kegel (drawing in of your pelvic floor musculature, or the classic “hold your pee” cue), told to do abdominal exercises, and told to get rid of my low back sway and flatten my back. I did as I was told for five years.
At the end of this five years, I was in more pain than when I started. I had problems with frequency and urgency of urination (ie. I would pee my pants sometimes, involuntarily). And I no longer danced.
Why? Why did I hurt? What was wrong with me? I became obsessed with finding out this answer.
I became a slave to the narrative that I had back pain, I was failing to fix it, and it was stopping me from doing what I loved — dance.
More than that, I was getting told this narrative by healthcare professionals. So I came to believe I was broken.
That was the story I believed. That was the story that trapped me. That is the story I no longer tell myself.
This is the story of my freedom.
It takes a lot to question healthcare professionals, yoga teachers, and the mainstream cultural view of pain. Even when the writing is on the wall, it is hard to breakthrough our inherited notions of pain and healing. There were several key moments and realizations that helped me to do this.
1. There is Space
One day, in a yoga class, I had a teacher ask me, “Does your back really hurt, or do you just expect it to?”
On a reactionary level, I was offended. How dare they question my years of pain! However, I took a breath and I listened. And that day, at that moment, it was exactly what I was ready to hear.
Wow… do I hurt? Or do I expect to hurt? This notion hit me hard, and opened a door that continues to free me. I realized that day, in that pose, that I could entertain the notion of my back not hurting. I suddenly felt a space— a space where something new could be, maybe just maybe, possible. There were moments where my back did not hurt. And if there were moments, there could be more moments. And it was in my power to cultivate them. I wondered where else I could find space.
2. Your Body is your Teacher
At age 21, I went to a pelvic floor physical therapist in San Francisco who told me to cut the Kegels. Let me remind you, being in a permanent Kegel (or pelvic floor muscular contraction) was touted to me by a past PT as my way of fighting my back pain. Leave it to San Francisco to challenge the status quo!
As a little 21-year-old, this was the first time I saw health care professionals question each others’ modalities. She asked me if I had been getting better. I responded, “No, actually, worse. I’m even peeing my pants.”
She responded, “Then why do you continue to do things the way you are doing?”
I had no answer. Because I respected healthcare professionals? Because I trusted other people’s opinions over the obvious answers I was getting from my own body? Because I just hadn’t done enough exercise repetitions yet after five years of continuous Kegels?
In this moment, I realized that doctors aren’t always right. Don’t get me wrong, doctors have incredible training, are not all created equal, and positively impact lives every day. But every life is different. And the advice you’ve been given might just not be right for you. This may seem obvious, but at the time, it was an important milestone for me.
This was the first moment that I could hear, “Your body is trying to tell you something, trying to teach you something. Can you learn to listen?” This was a lesson I carried into my journey with chronic illness years later.
I learned that my body is my teacher, not my enemy.
3. You Are Not Broken, The Dogma is Broken
For years, and many bills, I saw a physical therapist who would, literally, pull my leg to “put my SI Joint back into place”. He taught me that certain movements would “pop” my SI joint out of place. He’s not the only one. This is a popular statement said in PT clinics across the US.
The message was clear to me: I had a faulty part. It needed to be protected and placed back in its spot.
Yet I could never quite find that spot. I paid more and more, reliant upon outside help, anyone, who could put me back together. But the problem was, I didn’t have a faulty part.
In physical therapy school, I am learning the reality of the biomechanics behind the SI Joint. I will expand upon this in a future post, but for a quick intro, whether SI Joint dysfunction actually exists is up for debate! (REF) The SI Joint can really only move about 2-3 mm and is actually quite a stable joint. It is perfectly situated between the sacrum and the ilium (sacro-iliac … duh). The sacrum then is perfectly situated between the two innominate bones (your hips) of the pelvis, and serves to transmit forces from the ground and the lower body up to the upper body. Why would this joint ever evolve to be unstable? It is a beautiful keystone in the body ready to support us.
So while pulling someone’s leg when they have an SI Joint issue may be pain relieving for a time, the underlying mechanism behind why there is pain in this area is not necessarily being addressed. It could be biomechanical, but I’ve found that pain in this area is not usually. This is likely due to the fact that pain is a complex phenomenon that does not always have a physiological explanation. More on this in a future post, but if you’re really curious, pick up a copy of Explain Pain by Lorimer & Moseley. Or watch my quickie educational video below.
In summary, the current dogma states that our body is a mechanical machine made of parts. When these parts are broken, we are broken. So we adjust them, we replace them, and we should be better… right?
The problem is that our pain is not necessarily linked with tissue damage. In fact, it’s usually not. (REF, REF)
Pain is much more complex than this, and our language needs to evolve to reflect this complexity.
When patients hear from physical therapists or yoga teachers that their parts are out of place, it changes the way they view their bodies. We start to fear movement, afraid that it we will knock our parts “out of place” again. We freak out when we feel pain because we think it means we immediately need an adjustment from a PT or chiropractor. I lived life through this lens for 10 years and I continue to see this fearful, mechanical, don’t break me view of the body all the time in the clinic. We are afraid to move, don’t trust our bodies, and will do anything to avoid pain.
This can lead us into further cycles of pain, and in fact is a key driver of a chronic pain cycle.
So what do we do? What did I do?
I went back to dance.
4. Find a New Dance
One Saturday, I went to an improvisational dance class. I missed dance. I missed wild movement. I missed not feeling broken and hurt.
The teacher encouraged us to throw away the movements we are used to and to find new ways of being in our body. She herself had broken her back doing ballet. She had to re-learn how to dance, but in a way that healed her. She said that if you keep moving the same way, expecting different results, isn’t that what they define as insanity?
I began to explore my body on the dance floor. How did it want to move? How did it avoid moving? Did it have to avoid moving that way? I realized all the rules I had placed on my body— all the movements that were OK or dangerous. And I abandoned them.
What if I tried to go there? What if I… oh and I… and on and on I danced on this dance floor, breathing, finding my edges, letting my mind take a back seat, and letting my body’s wisdom pour out of me.
On this day, I realized my body was to be explored— not restricted, not fixed. I realized the box of protection I had trapped myself in and my fear avoidance model of my body. I realized the infinite movements possible in my body, just waiting for me to enjoy them. I questioned my go-to patterns of movement and found new ones. And in this exploration, I realized one very important thing: I was not broken.
I even made a dance about this journey recently, here:
5. “The Belief that You’re Broken is What is Broken.”
My yoga teacher Eddie at Yoga Soup in Santa Barbara, CA once said, “The Belief that You’re Broken is What is Broken.”
No sentence better sums up my journey with chronic pain. What was broken was the information I had been told about my body and pain. What was broken was the story I had come to believe about my body. A diagnosis ceased to matter to me.
What mattered to me was how I got there. How did I come to believe this story about my body? And how did this story about my body lead me into even more pain? And how did I end up so distrusting of my own body?
When we explore these questions, we can begin to uncover the triggers in our life that lead to our perception of pain and work with them instead of against them.
6. FIND YOUR Here Now Body
I have moved from a fix my body mindset to an explore and enjoy my body mindset. Instead of coming to my yoga mat and expecting to find the same patterns, avoid certain movements, and protect certain parts of my body, I come to my yoga mat to explore my Here Now Body — or my body in the present moment. (I love it so much I’ve renamed my blog after it :) )
My Here Now Body is the book I read every day when I wake up, every time I choose to move, and every night before I go to bed. It is the story of my body, here, now, today. How does it want to move? How can it move differently?
When we can move past stories of how we expect our body to be, and instead learn to investigate our body HERE and NOW in this very moment, we can begin to find space to heal.
Some days I feel back pain in my Here Now Body. Others I feel neck pain. But the pain no longer controls me. It is just information, and there is other information present as well. I simply greet my pain and say, “Oh, that’s interesting,” and keep going. I try to move in a different way. I try to breathe in a different way. And I work with it, all of it, rather than against it, rather than trying to fix it or protect it.
I know now I am resilient. I am not broken. I know now that my body is a wonder.
This is what I bring into the room as a yoga teacher. And this is what I will take into my time as a physical therapist.