October 23, 2013

The Pain Puzzle - My Two Year Chronic Pain Journey

I did something absolutely incredible earlier this month, I completed a gym workout, a full body gym workout.

Notice I said complete and not that I simply went to the gym for the first time in very a long time. You see it's been well over two full years since I've been able to engage my upper body in any way shape or form that involved lifting, contorting, or even just sustained support of my own body weight, such as sitting and working long hours on a computer. I have carried with me a significant secondary injury from the eight and a half months I spent on crutches, which itself spanned throughout late 2010 and most of 2011.

Some people may remember that during my time on crutches I was still working hard with a strength and conditioning coach and completing workouts such as this one at least a few times a week. During my time on crutches I had greatly increased my upper body strength and was approaching my pre-running days, which at one time saw me regularly in the gym with the upper body strength to bench press over 200lbs and do at least 50 consecutive push-ups. This was many years back but the point being that the muscle memory had already been established which always makes the task of regaining that strength that much easier if you stay dedicated.

In May of 2011 I course directed the Burnaby MOMAR race. I had just returned from Hawaii where I'd managed this, my second break, and was back on the all too familiar metallic sticks. I had progressed through my first break and the resulting four months on crutches without any secondary issues, in fact I even 'ran' 10k on them on Jan 1st. I had progressed enough in my crutching experience to challenge myself on a continual basis to not use either leg at all. This is to say I had the balancing ability to hop around on nothing but the two skinny sticks for up to a few minutes at a time. At one point during the first break I was at a party where a friend was DJ'ing and without even questioning it I single legged jumped off the stage, which was a meter high, onto the dance floor, landing tripod style before hopping up onto my sticks to dance without legs for the next sixty seconds. I called this 'embracing' the crutching experience though certainly in hindsight it could be seen as rather reckless.

Once I ended up back on crutches for the second time I continued and even upped my antics. After course directing the MOMAR on crutches I spent many hours on the dance floor that night, continuing to stress my upper neck and back, though at the time being blissfully unaware of the forthcoming consequences of my actions. The following week while at Curb's gym doing a standard workout things felt a little off. There was tension and sensitivity in my neck where none had presented itself before. I cut my workout short and called it a day. One week further on would prove to be my final time in a gym for the next 27 months. I had aggravated something in my neck / upper back region that rest and stretching was not helping to resolve. Each day become slightly more painful as the ability to fully rest this new injury was in fact impossible since my only means of getting around was to load the exact muscles / region that were in protest. I had acquired a chronic injury and it was about to plague my life.

Initial attempts to treat the injury were met with worsening symptoms. My upper back and neck were effectively responding like a smoldering fire. The pain was ever present, a shooting sensation predominantly on the right side of my neck and a tension right across my upper shoulders. It was akin to whiplash. Anytime treatment was sought it reacted like high winds on embers and would send me into hours and even days of an increased pain cycle. Eventually the theory that was settled on was 'wait till you're off crutches and this'll fix itself'. This made sense of course, so instead of seeking treatments that only seemed to make things worse I rested and stretched the area as much as possible. To use my crutches only seemed to aggravate things further so I became very good at hopping around on one leg. My crutches were only used when I would leave my apartment and I became very good at hopping around since my injury was of the 100% non-weight bearing kind.

Eventually September rolled around and I found myself in walking boot for the back half of the month. In October I was free of any hindrance to my bipedal ways, and the waiting began. A week passed, a month passed, a few months passed and before I knew it it was 2012. Nothing had changed. The pain was just as prevalent as ever, even after removing the most likely variable in the equation which of course was the crutches themselves.

In this time frame arose the reason that this has never been publicly broached before, I expressed my pain and frustrations to my mother in a phone call after a road ride which itself also set off an increased pain response. One week later I was informed that my mother had lost five pounds. My mother has eternally stated that she 'just needs to lose five pounds' even though she's stayed at a consistent weight for seemingly her entire adult life. She did not discover a new fad diet, she was literally worried sick about me. My mother and father are balanced people and this response was beyond out of character for her. After living the whole twice over broken foot thing right along with me this was the apparent breaking point for her. Of course parents worry about their kids but after seeing me in some form of pain for a calendar year at that point she seemingly couldn't stand the thought of me not just being happy and healthy again, so I gave her that guise she so desperately needed and I went about quietly working my way through one of the most complex puzzles of my life.

Break a bone = 6 weeks
A more complex break = a few months
Most standard injuries = a set time frame to recovery

Even while in jones fracture hell I knew there would be an end to it all. Whether I could get back to competitive running or not was then up for debate, but I knew I'd get off of crutches around a set date and then be able to go back to normal day to day living. Some injuries last longer than others, but land yourself in chronic injury pain territory and it's a whole other ball game.

2012 included

A month on Lyrica
A yoga therapy assessment
A.R.T. treatments
A chiropractic adjustment
Electrostatic treatments via a device called the Hivamat 200

The Hivamat 200
I was exhausting any and all options at my disposal, and in doing so I was working with some of the absolute best people within their fields. Each Doctor had their own incredible resume including working for the Olympics directly, working on and with Olympic athletes, working solely for professional sports teams such as the Toronto Blue Jays, the actual person who opened the MRI lab at my local hospital, etc, etc. There wasn't a single person I met with who wasn't the rock star in their respective field, and yet my issues managed to confound each and every one of them. It had gotten to the point where my wife Linda was reading textbooks on how to work your way out of a chronic pain cycle. If no one and nothing is able to diagnose an actual root cause of the pain than it must in fact be psychosomatic, and as such I had to accept that to get better was to continue pushing through the pain and effectively ignore the pain response my body was producing. This of course proved to be one of the more painful and disheartening months throughout the entire process.

Now I must clarify at this point that throughout all of this my running was fairly immune to these secondary issues I was dealing with, in fact the more time I spent upright the better I did feel. The main triggers throughout 2012 were time spent on my computer, driving, stress, and any upper body movements that weren't specific to forward movement. I had my work space around my computer addressed and then purchased a tablet so that I could effectively work while laying on my back. Laying supine and sometimes in the fetal position were the only effective resolutions of a spike in pain on many occasions. Running helped things, although seemingly simple additions to my running such as wearing a pack and using trekking poles did not. I was racing UTMB in 2012 and I was doing so with a backpack (of course) and trekking poles. Some workouts hurt more than others, though nothing from the waist down was ever compromised so I continued to regain much of my lost fitness.

2012 bled into 2013 and nothing but my level of frustration with the process had altered. When you feel like you've exhausted every possible option, what do you do beyond living with your circumstances as though they are your new normal. Pain cycles increased around stress levels and work loads since my work is now predominantly online. The funny thing about making your living off of events is that from the outside looking in it appears that all work is done out in the wilds and on trails while loving every second of it. In fact I spend more time staring at a bright screen now than I ever have in my life, usually answering questions like "What will the weather be like on race day in eight week's time?" or "How do I find this piece of super important information that is conveniently hidden on your home page" or "Will I encounter squirrels during your race?"

Joking of course but there is a lot of online work involved in what I do and I have never, in my entire life, ever once had a job that involved sitting down. I believe this is one element that allowed me to successfully start ultra running from complete scratch in my late twenties and to have a modicum of success, but that's another blog posting entirely.

Computer time = pain. Sitting = pain. Stress = pain. Not running = pain. The most painful week of 2013 for me was immediately following my run at the Diez Vista 50k (1st CR) and just prior to flying to Japan for UTMF (4th). I had been training hard and staying upright, but in the week following DV I had an absolute boat load of online work to tackle and I didn't run a step for five straight days. It had been just shy of two years since this whole neck debacle / pain issue had begun and this was one of the absolute lowest points in the entire journey.

As I revisited the previous two years and all the failed attempts at a resolution to this problem that truly affected my day to day life, I could not help but to be enveloped in a fit of depression. This had somehow become my new reality. I was going to be living in pain for the foreseeable future. My body was seriously damaged and there was no ready solution, no sensible answer. This is what chronic pain is like. You feel completely helpless and at ends with your own physical being.

"Tell me what's wrong so I can fix it body. Work with me here dammit! WORK WITH ME!"

Little did I know that all was about to change, the answer was about to find me and though I'd slowly but surely given up all hope it would take take one person's conviction to convince me otherwise.

A successful race in Japan was followed by three weeks of downtime. Early in the year one of the more experienced chiropractors in town had given a presentation at a run clinic I was then overseeing for our local run shop. He was renowned, hence his selection as a presenter, though we had never officially met. He said I should swing in sometime just to get an assessment. I had finally decided to take him up on his offer now that I found myself with so much free time following my second 100 mile race of the year. The interesting part about this first assessment is that I recall him asking what issues I had and I responded with none. My running was going great and outside of the standard post 100 soreness that was present I felt fine. He talked further, asked more questions and as an after thought I said,

"Well there is this neck thing, but I've already exhausted all avenues in search of that answer."

His face lit up. It was a mix of 'you've got to be kidding me' and 'this sounds like a fun problem to fix.'

I of course stated that the answer was not to be found in modern medicine, I would likely require a complete neck and back transplant that would not be covered by Canadian health care for at least another thirty years, and we'd likely need to shut down government to figure it all out. He poked and prodded my spine and was somehow convinced he could help.

"But I've had an adjustment and it just seemed to make things worse. I was in pain for two full days afterwards."

"But did you have multiple adjustments? Did you stick with it for an extended period of time?"

"No. It was incredibly painful and very early on in the process. It was easy to write it off back then, nearly two years ago. I haven't had an adjustment since."

"Commit to coming to see me for a month, twice a week. Recognize there will be increased pain throughout this process but trust me when I say that I believe we can fix this."

So to be completely honest here's where my feathers go up. I don't have much in the way of disposable income as it's usually invested in adventures and travel. Chiropractic care is not covered under our health care system, nor was the A.R.T, the acupuncture, the Lyrica, the yoga assessment or the Hivamat treatments. I had basically invested equally into each of these theories, giving them one month to procure results. I was a few thousand dollars into exploring solutions and was none the better for it. Now I was staring at another $400 - $500 investment into a treatment theory that was no greater than any other and in fact something I had attempted, though very briefly, very early on in the process.

"I'll think about it."

I had a lengthy conversation with Linda and we basically came to terms with the blatantly obvious 'this has been going on for far too long and isn't going to resolve itself. If we don't invest in this now I'm going to be living with it indefinitely and I'll have completely discounted someone who is rather confident in his findings.'

"Let's do it."

I started in on twice weekly adjustments throughout late May and early June. It was not a whole lot of fun and through the first few weeks I would often find myself in an elevated pain cycle for the entire three days between adjustments. It felt like regression instead of progression but my Doctor was convinced he was getting results. I wanted to cut my losses and save my money. I am incredibly thankful that he did not allow me to do so for in the third week I finally felt like we had gotten somewhere.

Cautiously Optimistic

Week four saw further noticeable improvements, primarily the ability to work on my computer for extended periods without needing a supine break and some tablet time. Week five saw me attempt a few push-ups, just to specifically strain my upper body a bit. There was still a pain reflex, but it was fleeting. I was finally convinced we were getting somewhere.

After about seven weeks of treatments I became overwhelmed with my racing and race directing schedule and before I knew it I found myself directing the Squamish 50, which much like the first year did not allow me to sit down whatsoever for the better part of forty hours, then I flew to France, then I got married, then we had a honeymoon, then I had an out of town event contract and then it was October.

"How's your neck doing honey?" asks my now wife


"You're neck? You know, that constant source of pain and aggravation for the duration of our relationship."

"My neck? My neck feels really good actually. I've hardly thought about it, save a few high stress days, since? Since July maybe!"

"Do you think you could handle a gym workout?"

"Yeah, I'm going to take it super easy but yeah, let's test this thing out."

Three weeks and six gym sessions later, here I sit, finally, finally confident enough to complete this blog posting.

I am very nearly back to 100% for the very first time since I first snapped my foot, which happened on October 25th, 2010. Holy f#@king shit. I am only now myself realizing that that is nearly three years ago to the day.

Here's to health and well being. Don't ever take it for granted when you're fortunate enough to have it, and fight like hell to get it back when it's somehow taken from you.

What did I learn from this process?
That the answer is always there. There is a solution to any given problem. The bigger problem is finding the person or people who are most likely to have the answers to your specific problem. The more questions you ask, the more open you are about your process, the more likely you are to solve it in the shortest possible time frame.

How could I have solved this sooner?
Having never experienced anything like this before I spent far too much time in between exploring different types of treatment simply buried in a negative "I'll never solve this" head space. Pain has a funny way of getting the best of you sometimes. Financial stress incurred due to sourcing different treatment methods doesn't help either of course, but if I were to start all over again I'd simply attack this problem relentlessly and likely have found an answer in half the time or less.

Does this change anything in terms of my training and running fitness?
I'm simply excited to get back to an all body fitness for the first time in far too long. My running fitness came a long ways this year but I'm now excited to be able to add in more in the way of cross-training and core strength training programs. I feel very fortunate that throughout all of this my running seemed immune to the pain and in fact was more of a relief than anything, though I firmly believe that an all body fitness and training approach will always trump a singular, repetitive style of training.

I'm excited to be back, almost all the way back to pre-injury all body fitness. What a crazy ride it's been.


Doctor's Notes
On your intake form you said you had no specific problems! Just "high mileage" issues...however, as we talked you then began to tell me about the chronic upper back pain that had been nagging for some time, the MVA in 2012, crutches from stress fractures and acceptance of your life with pain.

Anyway, your upper thoracic spine was significantly 'kyphotic' - a rounded upper back, the mobility was very limited in extension - backward bending motion - as well as loss of rib joint motion, and moderate to severe tightness of the neck and shoulder muscles.

We began a course of spinal manipulation to restore normal vertebral and rib joint mobility. You were sore and a little wary after the second visit, a normal flare-up, but felt committed to get better and your pain diminished significantly after 5 treatments. On the 7th visit you had logged 400 miles and worked 4 events in 3 weeks, then a little relapse, then voila you won Knee Knacker with no flare-ups! You told me that on July 18th and then I didn't see you until the other day Oct 19 and you had run the gauntlet of racing, travel, marriage etc...you now realized something had changed very significantly. Great story for us both!


Ray said...

Hi Gary, very interesting story. I've been following you for 3 years now on the successes and the lows. You are a great writer and have sage advice. Good luck with your future runs.

garobbins said...

Thanks so much Ray, always nice to hear such supportive comments.

All the best,

Dan said...

Hey Gary,

Great to read that you finally have gotten rid of that pain! You are a great inspiration when it comes to never giving up and keep pushing through the hard times.

And now that this "handicap" is gone, and you're able to train your core, you're going to fly even higher next season!
2014 is gonna be epic for you my friend; mark my words ;)


garobbins said...

Hey Dan, thanks for the kind words!

The hope is certainly to continue to get stronger and faster year after year. If nothing else I can finally add back in an element of my training that I've been 'sorely missing' for a few years now.


Ken Michal said...

Wow! Hard to believe the original break was 3 years ago already!! I'm really glad to hear that you're finally whole again after all that!! Hope your training is going well for HURT!!!

All Day!

garobbins said...

Thanks Ken! See you in January!


Dave James said...

Glad you are pain free Gary!

garobbins said...

Thanks Dude! I'm looking forward to seeing you rip it up in Squamish in August!