Being an athlete (a term I use loosely) I have sustained my fair share of injuries. Like most of you, I give them some time and assume they will heal on their own. In the biz, we call this “Regression to the Mean”. Injuries are a part of being active and while we can reduce our risk for injury through a variety of ways such as managing workload, improving technical proficiency with a movement before progressing weight/distance etc., improving awareness of psychosocial contributors such as stress, nutrition, poor sleep, and a variety of other risk factors that we can modify, sometimes injuries happen. Maybe it’s just a momentary distraction at the wrong time, a misplaced step on a trail or in my case, poor positioning due to fatigue. Before I get into my injury story, it’s important to take a moment to address a few things (thoughts I had to reiterate often to myself). An injury is very rarely a permanent condition even though it may be stubborn, persistent and easily reproduced. Pain and discomfort do not always equal tissue pathology especially if the pain is persisting many months after the original insult occurred. Even the best athletes in the world get hurt. Steph Curry has ankles that might be better suited for swimming. Layne Norton is a national champion bodybuilder and powerlifter who has struggled with injuries over the last year, Serena Williams, arguably the greatest athlete in history, has an entire wikepedia section on her “injuries and comeback”, Dan Green is one of the best powerlifters on Earth and is currently rehabbing a bicep tendon tear, the list goes on. Like these great athletes, I too found myself in the injury cave with only darkness, webMD, and my thoughts to guide me.
WebMD? Ok, maybe it wasn’t THAT bad. But what was incredible to me was how a physical therapist who managed athletes and recreational patients suffering from injuries all day long in the clinic could be so poor at guarding his own psychosocial sequelae when injured himself. It happened 1 year ago almost to the day. I was doing some heavy overhead pressing. Not one of my favorite lifts due to an old nagging shoulder injury that likes to peek up every now and again but as they say “working out is doing what you want to do, training is doing what you need to do.” So I was getting the work done. I really had no warning signs or concerns leading up this lift but during my 3rd rep of my heaviest set overhead a felt a “criiiick” in my upper back. Some moderate pain began but this is powerlifting, no big deal right? So I did what every physical therapist does, kept going. Nope, pain worsened significantly. Ok, let’s just drop weight and do the rest of the set. Also a hard no by my spine. Ok, how’s benching? Seems alright, let’s finish the workout, rub some dirt on it and get back to work. Over the next hour my pain progressed to the point where I had a searing headache and couldn’t turn my neck or flex my cervical spine. Mild concern, but hey, let’s give it a few days. Went home, threw some ice on it and took some (a lot of) ibuprofen and tried to sleep it off. The next few days were some of the most painful of my life.
Something a lot of people don’t tell you about pain is that it’s not just pain you’re dealing with. It’s an emotional drain. My patience was lowered, I was irritable, couldn’t sleep, couldn’t train, and as I’m sure my wife would confirm, I was unpleasant to be around. But I couldn’t do anything about it, I couldn’t get the pain to stop (that’s right, nothing I tried was helping). A few days in and I could see the light. Things were improving, I was able to do some light training and by one week from the injury, I was feeling up to pressing again. Let’s do the same workout! Felt a little discomfort moving through my warm-ups and then BAM on my 4th rep, same pain. Coooool. I was excited because I got one more rep in than last week however my excitement waned as the cycle repeated for the next several days. Brutal pain, impatience, irritability and now the seeds of concern slowly taking root. Gave it a week. Felt better, tried it again. Not happening. Now my seeds of concern were transforming into an overgrown corn field of discontent and worry. Did I fracture something? Thoracic disc injuries are rare but did I herniate a disc? Is the headache a sign of a tear in the dura?? Is this the end of my training days? So I got some imaging done to rule out a fracture or something serious and guess what?? I have scoliosis!!!!
The exclamation points are sarcastic. I had likely always had scoliosis. I set 2 Nevada State Bench records with scoliosis. I never once had thoracic pain prior to this and yet I likely always had scoliosis. But here I was, googling normative values for scoliosis, progression rates, long term effects and wondering if I was going to end up ringing a bell in a church somewhere in France for the rest of my days. It took a few conversations with Michael Ray, D.C. to talk me off the ledge. Figured a chiropractor who is an up and coming expert in pain science and an evidence-based clinician could answer my questions! I sent him my imaging and asked him what he thought. In typical Michael Ray fashion his answer was “you need to change the chemicals in your machine and the angle is all wrong”. Um? But what about the curve? Is this bad? Do those disc heights look concerning? I won’t repeat here what he called me but safe to say, I left that conversation feeling less concerned about my impending doom. The reality was, I likely was fatigued from a variety of things including a 9-month-old baby who hated sleep, had poor bracing and thoracic positioning and overextended in my press injuring some soft tissue in my thoracic spine or rib attachment. The curve, discs and general fear of seeing my spine on X-ray gave me no information; any of the findings that were there had been present long before my injury and I needed to calm down.
I had another chiropractor buddy work on me (ohmagerrrd, a PT got manipulated by a chiro!!!) once a week which helped a lot. I had a perception of feeling “stuck” and while it’s not the focus on this blog post (put the torches and pitchforks away for now) on the effects of manual therapy, spinal manipulation, nervous system modulation and patient/clinician expectations with outcomes…but that perception was real for me, difficult to manage within my skillset and knowledge and that perception was decreased with manipulation. Would it have got better with time? Almost certainly. But I have problems with narratives, not treatment options with some exceptions and alas, I have already digressed enough.
So my rehab? I modified my training to minimize aggravation which included floor bench press, single arm landmine pressing, assisted pull-ups, KB rows, etc. Deadlifting felt great thankfully, squatting less great. I added in some work to desensitize extension and found the heaviest, wel-tolerated load I could do overhead that didn’t aggravate my symptoms and most importantly, calmed down and gave it time.
So what’s the point of this blog? I don’t know if there is one but I felt compelled to share my story about how even a professional, someone who explains pain science and injuries all day, someone who has to help patients understand imaging when pertinent and understand what is normal (sidebar: abnormal findings are often normal, see our imaging blog!), and someone whose main job is to be a guide for an athlete or client navigating the waters of injury and misinformation can sometimes find themselves in the same place as you. I was shocked at how easily depression could creep in; how quickly I could move to a worst-case scenario. It was through talking it out with people I trust that truly helped. That is what you can expect at our clinic. We will listen, we will educate, we will guide you and we will be empathetic to the experience our patients and athletes are enduring because, well, we’ve been there. A special thank you to Dr. Michael Ray, DC, Derek Miles, DPT, Dr. Tony Islas, MD, and Dr. Joe Day, DC for being soundboards and lighthouses during the Great Back Injury of 2017. You’ll be happy to know I am pressing heavy and pain free and am a proud scoliosis survivor. If you have questions about an injury, contact us today and we will be happy to do a free phone consult and answer any questions you may have.
The Logic Of Rehab- Pain Science
Pain Science PodCast by Jason Silvernail
The Logic Of Rehab- Imaging
Barbell Medicine Podcast- Training around Injuries
Barbell Medicine Podcast- Injuries with Derek Miles, DPT
Nick was so attentive to my needs and he structured his schedule to fit mine. My therapy was focused on my strengths and weaknesses; therefore, my recovery time was much shorter than expected. I highly recommend Nevada Physical Therapy for any lingering pain you may be experiencing.Read More Reviews
I cannot say enough positive things about this place. Came in with an ACL injury. I spent a few weeks working with jonathan. His evidence-based approach and motivational ability was really really inspiring. He helped me get back to normal and then some!Read More Reviews
DAKOTA EZELL is at the top of MY list as a highly skilled, intuitive, present professional who values and treats me as a whole person, not just someone to fill a time slotRead More Reviews
The best Physical Therapy place I have ever visited. Rare to see an emphasis on finding the best method to improve injury instead of giving everyone the same plan. But the best part about this place is it's approach to well being during and after PT.Read More Reviews
I was referred to Brian Fearnley by someone with significant credibility. I consider working with Brian a huge stroke of luck. This specific 'PT' is increasing my recovery potential a hundred fold. Brian knows his stuff. He is well versed in PT. He has athletic history at UNR and is active in our local community. He is clearly in this profession to help people recover and get under their own power.Read More Reviews
After two plus years of hip pain, three other physical therapists, quarterly injections and no relief, Crista made the pain go away! If I could give her and this practice 10 stars I'd do it!Read More Reviews
As a professional athlete, injuries can make or break a career. Luckily, in my case, I had Nevada Physical Therapy on my side. Not only did they physically help me recover from a meniscus surgery, but they provided the best emotional support you could ask for in such a difficult time.Read More Reviews
Phenomenal. I had some brutal injuries that resulted in four surgeries and seriously disrupted my life. There can be no doubt that the quality of life I enjoy today was a direct result of working with Nevada Physical Therapy.Read More Reviews
I attended Nevada Physical Therapy for my post surgery physical therapy and have nothing but great things to say. For any of you reading this, this place is by far the best physical therapy place I have ever attended with exceptional staff. I had the pleasure to work with Dakota who is extremely knowledgeable, patient and would go above and beyond to make sure you're taken care of.Read More Reviews