Identity Crisis / Fear & Vulnerability
None of us are impervious to injury. Not a single one.
[FOREWARNING: Buckle up. This is a lengthy post but well worth the read in my biased opinion]
Life happens.
For some, it’s because we allowed ourselves to be de-conditioned or on the flip side over-worked something.
For others, it’s an out-of-the-wild-blue-yonder kind of injury. One we didn’t see coming and perhaps couldn’t stop from happening even if we tried.
Regardless of how it came to be - an injury or issue can royally mess with your psyche of identity. Who you are at your core. The social relationships, interactions, and overall lifestyle that are important to you. All of it gets altered and we lose our sense of control.
That’s a scary place.
Smart people in the realm of Pain Science Literature call this the BioPsychoSocial Approach.
Let’s use the case of someone who herniated a lumbar disc for sake of example to explain how this approach can be defined.
Biologically we incur an injury or symptom. This could be anything from pain, ache, tightness, or even decreased performance. There is a biological (think ‘physical’) stress to the system. In our example case, a Herniated L5 Disc with compression on the Right Nerve Root.
Quite often we think of this being the biggest elephant in the room. Even without fully recognizing the medical jargon above, you probably understand that this individual is dealing with a great deal of low back pain. With the nerve root compression they also have been experiencing shooting pain and weakness down their right leg causing difficulty walking, sitting, and sleeping. Unrelenting, constant, writhing pain. Not fun, eh?
But the issue doesn’t stop there. Nope. We still have two more categories that can become inundated by stress. For that matter, sometimes these next two categories are represented even larger than the Biological ‘circle’ on the ven-diagram.
It’s really these next two categories are the ones that really mess with our identity.
Psychologically after injury or onset of symptoms we become frustrated with ourselves. This is a dark place. It starts by playing the blame game trying to figure out what happened to lead to this issue. “Maybe I shouldn't have ran that marathon.” “Skipping leg day for a full summer probably wasn’t the smartest idea.” “what if I lifted with my legs and not my back..”
Furthermore, we become mentally worried or anxious about what this injury means to our lives Socially. Our abilities to participate fully at work or be the spouse/parent that we need to be at home. I don’t know about you, but to me this is the biggest identity crisis. No one wants to be the parent who says “no, no sweetheart, I can’t play that with you because daddy’s back hurts” for weeks on end. Only to see the look of confusion, concern, and disappointment wash over their little face.
If you haven’t picked up on this story by now; I’m speaking from my own experience.
All three components of the BioPsychoSocial Model are entirely filled at the moment. Unrelenting pain. Fear. Guilt. Confusion. Sleeplessness.
I know I’m not special. We’ve all felt these things before to some extent. Hopefully to a lesser level and perhaps not all at once, but that’s life. It gets scary at times.
My situation is only just beginning, but I haven’t shared the whole story of inception yet - so here it goes:
Background History:
2007 - Compression Fracture of L5 Vertebrae
2014 - Sponylolithesis and Pars Imbrication
2016 - Mild Disc Bulge and Stenosis
Three months after Compression Fracture of L5
After Spondylolithesis - Bruising concurrent with 25ft fall from snowboarding
At this point in my life I had enough. I started focusing on anti-fragility. Hours and hours of hip mobility work and exercises such as Jefferson Curls, seated Goodmornings, and Reverse Hyperextension to strengthen the lumbar spine into flexion tolerance.
From 2016 until 2023 things were remarkably great! Very few low back episodes of spasm or pain (ignoring the classic tightness from a few too many rounds of golf in a week.)
Then, in the summer of 2023 I decided to run a Marathon. If you’ve been around a while you might remember that I hate running - so of course I decided to run this marathon with a 40lb vest on. You know, might as well make it suck as much as possible so that I convince myself never to run another one again, right?
With two young kids, a growing practice, and a multitude of other hobbies and obligations that keep me busy - I barely had enough time to train for a marathon. Let alone enough time to keep up with the necessary strength training for the system. So, I did what a lot of busy people do and prioritized the biggest elephant in the room. I chased endurance over all other things (mobility and strength in particular.)
The marathon went great. No major issues and finished just ahead of my pre-set goal of time.
About a month later, I was on a golfing trip with some friends that I played football with in high school and one of them made a remark that stuck with me. “Reid. Dude you look.. frail.” I was shocked, but he was absolutely correct. Not only did I lose a few pounds from all the training and running, but my body was lacking any strength. It was basically all sinew and bone.
I made a point to jump back on the strength wagon as soon as I got back from the trip. Oh, that didn’t last long..
A couple of weeks later in mid-October, I had one of those freak sneeze + cough things. You know what I’m talking about right? Totally catches you by surprise and you do both at the same time? Yeah, well those two synergistically combined at the same time that I turned the corner with a towel around my waist, the dog ran between my legs chasing a ball thrown by the kids, and I smashed my shoulder against the wall corner. That’s a lot going on in one sentence. So please go back and read that all again. Done with the recap? Yeah. That happened. I wish I had a video of it because I’m sure it was a scene. Well anyways; through that debacle my low back tightened up a little bit. Not terrible. Just guarded.
That same evening after work, I was going about my day-to-day daddy obligations and picked up the kiddos from school. As I went to put my daughter into her car seat she did what 3 year olds do best and threw a mini-tantrum. Nothing major, just a little wiggle.
Well, from a bent and rotated position, that little extra nuance load hit me like a ton of bricks. I immediately crumbled to the ground writhing in pain. And of course, with my education and background I knew immediately what had happened. Shoot.
The initial visits with Urgent Care and follow-up MRI confirmed what I already knew to be true - just to a much larger extent than I thought was possible. A giant 9mm extrusion of the L5 disc. Woof.
NOT a screenshot from my MRI here. Just an image from literature because I somehow can’t access my MRI series. But this is almost exactly what my extrusion looked like. A big ‘ol chunk of jelly eeking out the side of the PB&J Sandwich.
Two weeks consisting of lots of rehab with the assistance of muscle relaxers and a Prednisone pack. I was feeling back to a roughly 50-75% version of myself. Deadlifting light weight, going for walks with the family, seeing patients full-hours at the clinic. Heck, I was making plans to climb up on the roof to clean gutters and hang Christmas lights!
Then on Monday, November 13th I was going about my usual get-ready-to-go routine. Jump out of the shower, throw the pants on, check the kids’ backpacks, throw on the socks…. AND BAM! Dropped to the floor. AGAIN. And boy oh boy did it come back with a vengeance.
To tell you the feelings I had immediately wash over me would take a lifetime. But let me just start with what I already mentioned.
Fear.
Guilt.
PAIN.
The feeling of helplessness and worthlessness that I felt for the next four days of cancelling patient appointments, not being able to help around the house or play with the kids, not being able to drive, and heck I was barely able to dress myself. Just atrocious.
But that’s vulnerability. Letting go. Shedding much needed tears. Asking for help. Trusting that time and repetition heals a lot of issues.
I’m beyond thankful for my wife who helped take care of not only me, but my family throughout this journey. By opening up and accepting that I can’t do everything myself, I posted my situation on social media. Within the coming hours I had well over 100 responses from friends, family, and many many people I don’t even know sending their wishes, their ideas, their experiences, and their curiosity. It was a much needed reminder that there are SO many people in the world who care about you and who want to see you succeed. You just have to be ready to accept it.
Right now, as I type this up, I’m still in a fair amount of pain (biologically) but I’m exceedingly optimistic about how the next few weeks are going to progress (psychologically and socially.)
Thanksgiving is just around the corner and man-oh-man there’s a LOT to be thankful for in life. Yes, we lose track of that sometimes for hours, days, and weeks on end. So it’s important that we remain vulnerable and open.