A Strong Back - Chapter 3

This is a personal story, not medical advice. See full disclaimer at the end.

And then, we arrived at the defining disc herniation a year later amid the anxious journey of trying to conceive again after loss.

It wasn’t even something traumatic like a fall from great heights or a car accident. I was simply carrying a cheaply-made TV stand from the moving truck to our new home in Burlingame. I was clueless about how damaged my lumbar spine had been for years without symptoms (surprisingly common among those with bulging discs that aren’t putting pressure on the nerves, yet) but was just one poorly-positioned lift away from being completely broken (via disc herniation and nerve compression). Having long neglected the body meant no knowledge of proper lifting postures or the critical role of a strong core in protecting the back. And having disregarded the “minor” bouts of lower back soreness throughout the years, I had simply integrated it into my identity instead of proactively addressing the root causes.

Two weeks in, the undefined lower back pain wasn’t going away, unlike all my previous flare-ups. I started getting nervous, and scrambled to find resources in a new town, both online and off. Blindly searching for anything that could make me feel better, I had the hardest time accepting the new norm of constant pain. Navigating the medical system without a proper direction only added fuel to the fire. (First misdiagnosed with acute muscle pain by my primary care giver, I eventually had to self-refer to the spine doctor that correctly diagnosed me.) “Why am I still not getting better?!” was my daily self-talk after countless YouTube tutorials with nonspecific advice and scary prognosis, lumbar roll and back brace purchases, and physical therapy that offered merely temporary relief. Amid these futile and aimless efforts, a tugging sensation began to travel down the thighs and calves as the pain migrated and expanded its reach. Nerves were further impinged; sciatica crept in with its insidious grip.

Over the years, I’d told others and myself casually, “I’ve got chronic lower back pain,” as if it was a lesser fact inconveniencing a preferred truth, something to be dismissed. But anyone who’s endured truly chronic pain knows how all-encompassing it is, overtaking one’s life with its relentless, debilitating hold. The body’s loudest cry, it refuses to be dismissed. From the start, chronic pain invades and shifts one’s identity rapidly, causing overwhelming desperation. With growing hip and sciatica pain came fewer steps walked before legs weakened, longer time taken to move in and out of a car, and more tears cried as frequent and unpredictable shooting pain stopped me in my tracks. Sitting even for a few minutes led to the worst strain; jumping and running became unthinkable. Despite hurrying to feel better, loss of mobility trapped my restless body like a rope halter forcefully restraining a galloping horse. The more I struggled to accept and slow down, the more chronic pain’s coarse rope pulled me back.

The right specialist and procedure eventually diagnosed me with L4-L5 and L5-S1 disc herniation. The doctor and the MRI result set me straight; there was no more room for denial.

Between acupuncture sessions, physical therapy sessions, fertility clinic visits, and the omnipresent stress from my job no matter where I work, my body was finally being treated but hardly resting. My dear husband painstakingly drove me up and down the Bay Area day after day, while feeling similarly uneasy and exhausted. But with systematic treatments in place both for my back injury and family forming, we grew cautiously optimistic.

Acupuncture, even the “aggressive” kind (two or three sessions a week), is considered a conservative treatment for disc herniation. And I learned that most patients respond to conservative methods within four to six weeks. That timeline offered hope, but not so abundant that I had to be the overachiever and research what else I could do to expedite the recovery. Pain distorts one’s sense of time. To me, four to six weeks sounded tediously long. I decided to start swimming after years of not going near a pool, enticed by a few YouTube videos about aquatic therapy and spine health.

Granted, disappointing fertility clinic visits week after week contributed to my desire to speed things up. The spine doctor’s caution about back pain and pregnancy was surely alarming as well. Trying to conceive after our second-trimester loss was uniquely nervewrecking enough; I had to get better fast so we could try and hopefully conceive with one fewer source of anxiety. But that compellingly familiar desire to race toward recovery ironically added more stress than calm to the body and hindered its willingness to cooperate.

I eagerly dove into the pool after the second acupuncture session. The gentle water carried my body and lightened the load on the lumbar, a tremendous relief. I slowly paddled away from the handrails, proud of myself for not having forgotten the only swimming style I learned as a child, breaststroke.

Unbeknownst to me, breaststroke is actually one of the worst styles for alleviating back pain. The stroke and its signature frog kick require repeated arching of the lower back, putting more strain on the lumbar spine. In fact, I felt an increased pulling sensation with each kick, but dismissed it as a part of the process instead of listening to my body. Unfortunately, one slow lap in the pool aggravated my symptoms. Nerve roots were further irritated, with more intense, shock-like pain rushing down both legs. Already insidious, sciatica quickly bloomed into something far more crippling and erratic after the swim. Once again, my urge to circumvent the body’s own pace backfired.

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久病成医 (pronounced as jiǔ bìng chéng yī) is a Chinese idiom that means a patient becomes a doctor after being ill for a long time. A patient grows so familiar with their conditions that they become a self-taught medical expert. I felt that way through the entirety of my injury. For better or for worse, I grew my knowledge base about back health exponentially in the span of a few months. Pain is a more effective teacher than anything else, because the wisdom one gains through pain is internalized and long-lasting. The wisdom gained through pain has the power to change one’s life forever.

Only through pain could I possibly unearth the root causes behind my doctor’s exclamation “Your back has been messed up for years!” as he pointed at the practically flat upper spine from the MRI images. Those “minor” flare-ups that my body alerted me to but my mind ignored? They’d been warning signs about how “flattened” my spine had been and the weak core that failed to protect the already fragile lumbar. The spine’s natural S curvature was compromised and essentially straightened by prolonged flattening of the back, putting long-term pressure on the lumbar vertebrae. My long list of risk factors for lower back pain and eventually disc herniation therefore included a sedentary lifestyle with poor posture (e.g., sitting on the tailbone instead of the sit bone; slouching over for a long period of time). Another culprit was shrinking the body instead of standing and walking nice and tall. Equally complicit was the lack of specific exercises that build resilient core muscles, which the body can rely on more than the bones and ligaments when exerting strength or moving. “Don’t hunch over!” My mother’s stern command that I overlooked, along with a long list of never-addressed risk factors, now suddenly fell into place.

Like a miracle, fixing my standing and walking posture for a week brought significant relief to the lower back, hip, and sit bone areas. I could stand for a longer period of time almost pain-free! With a lumbar roll’s assistance to keep the nice-and-tall posture steady, even sitting turned more tolerable - such an peculiar but unsurprising development.

(If you’re reading this on a laptop, a gentle but firm reminder from me: Sit up nice and tall, and visualize maintaining that slight S curvature of your entire spine. Extend that same posture when you stand and walk too. Your back will thank you for years to come.)

On the other hand, sciatica was more complex to manage with posture fixes alone. The stabbing and unpredictable pain as a result of a pinched nerve was worsened by breaststroke. Lying flat turned dangerously comfortable compared to moving around, as any movements could trigger that electric-shock like pain down one or both legs.

Just two weeks into my rigorous acupuncture treatment, I found my life ground to a halt. Long hours at work chained me to my desk and demanded my attention even as I struggled with pain most of the time. Legs and lumbar still frail, I could only switch between standing and sitting so many times before laying down was the only position to get me through the rest of the workday. Trips to the kitchen, the car, and up and down the stairs were punishingly slow and often left me in tears. Anxiety swelled as yet another fertile window came and went. Optimism perished, and my mind began to spiral with the last straw: the frightening prospect of irreversibly-lost muscle strength and eventual leg paralysis if sciatica wasn’t treated timely.

Chronic pain advanced its invasion of the mind. Only this time, despair set in. I found myself drowning in the vortex of tears and hopelessness, a vicious cycle that led to more sciatica pain, and in turn, more tears and anguish. How was I ever going to carry another pregnancy if my body would be paralyzed for months if not years?

Is this it? Am I fated to be immobile and without a living child forever? Is this the price to pay for regrettably neglecting my body for years?

These are the questions you start asking after a deep dive into chronic pain. When you hit rock bottom, hope seems sorely distant and unreachable. What does hope have anything to do with it anyway? The body has been broken seemingly beyond repair, the mind in a dark and lonely place and sensibly so. Depression and anxiety seem to be the only appropriate stance.

Like a treasure chest lying at the bottom of the ocean, this is where the essence of 久病成医 - a patient becomes a doctor after a long illness - unveils itself. Granted, the medical expert in you accumulates knowledge about your broken body, but the wisdom you gain through pain inevitably goes beyond the corporeal and into the realm of the mind and spirit.

I’ve long been an advocate for recognizing and validating those feelings that are perceived as “negative”: anxiety, frustration, disappointment. “Feel the feelings” has been my mantra, as I wholeheartedly believe that living a full life requires experiencing a wide spectrum of emotions. These “negative” feelings are natural responses to often agonizing situations, like a daunting prognosis. They serve a function in life and deserve acknowledgement. If suppressed, they resurface in other unhealthy or even dangerous ways in our behaviors and relationships. “You cannot selectively numb those hard feelings,” as Brené Brown affirms. In many ways, they are also a necessary part of the grieving process, for a loss in identity, mobility, reality, and a future we picture for ourselves.

And here’s the twist, a more hidden lesson from pain. These hard feelings are not the only responses we are limited to. In the long run, they turn from being helpful and valid, to harmful and exacerbating. If untempered, they overwhelm the nerve system, flood the body with stress hormones, and heighten pain perception through a web of biochemical mechanisms. Lasting for a long time, they perpetuate a dangerous cycle of suffering and no longer serve us benevolently.

What else is left then?

Not at first, but hope reveals itself as the only (dare I say) logical and non-negotiable mindset to sustain one through a long illness, a firm conviction that the body will heal. Not today, not tomorrow, but some day. It starts out tenuous and elusive, like a dim but unwavering source of light beaming into the deep ocean floor where darkness reigns supreme. Over time, it proves to be a conscious, arduous choice, arguably the only effort in the mind that propels the body toward healing.

Hope is rarely automatic and aptly uncomfortable. Choosing hope is believing decidedly, at the body’s weakest point, that it is still strong and will be stronger. It is the doctor that reinforced the belief to Eleanor Longden, a tormented voice-hearer who was diagnosed with and ultimately overcame schizophrenia, that “recovery was not only possible but inevitable.” It is the faith in declaring to myself in spite of seemingly incurable sciatica, “I have a strong back. My back will heal. I trust my body’s ability and timeline to heal.”

The dim light, unwavering still, eventually grew brighter.

My body and mind held on tight to “I will prevail,” which gradually expanded from language to practice, complementing acupuncture, physical therapy, and the body’s intrinsic drive to rebuild over time. A domino effect, the information I sought out also began to shift and challenge my hardened, anxiety-fueled belief of “I will be like this forever.”

Initially, a herniated disc indeed sounded irreversible to me: The jelly-like substance in the center of the intervertebral disc ruptures through the damaged outer ring and moves into the spinal canal, compressing the nearby spinal nerves and causing inflammation and intense pain. I often wondered, how on earth would anyone heal from it without surgery that cuts the bulged jelly-like substance away from the nerves?

A YouTube spine doctor who championed the body’s own capacity to combat pain solved the mystery for me. Given enough time and the body’s biochemical magic, Dr. Shim explained in detail how most herniated discs heal on their own, albeit leaving scar tissue in the damaged area that’s prone to re-injury. In the comment section, heartfelt stories and outpouring gratitude abounded; so many needed that message of hope.

It turns out that “I will prevail” wasn’t a mere fantasy, a mind trick I played for my own sanity, but it truly was the body’s natural inclination.

What a stunning contrast to the deep-seated belief of “I will be like this forever.” Humans truly are, as Peter Levine captured beautifully, a unique being “endowed with an instinctual capacity to heal as well as an intellectual spirit to harness this innate capacity.” The knowledge and wisdom gained through pain has the power to change one’s life forever.

The whole person - mind and body, internal and external - finally attained congruence and progressed toward healing after three long months of acute pain. The first week with noticeable decrease in pain level and improvements in mobility eventually arrived. Then came the second week, with more pain-free movements and less burning sciatica. And the third week, the one-year anniversary of my daughter's loss, I found out that I was pregnant. In the quiet before my family cautiously embarked on another pregnancy, a visceral journey that tests the body and mind to their core, scar tissue had formed in the lumbar spine, and my back was strong.

Disclaimer: The content of this essay is based on personal experience. It is for storytelling and informational purposes only and should not be considered medical advice. I am not a medical professional, and any decisions about your specific situations, diagnosis, treatment, or health care should be made in consultation with qualified medical practitioners.