Dancing out of pain
Well, a few months ago when I had my first medial branch block in my lumbar spine to treat my facet joint arthritis, I promised a longer, more thoughtful post about it at a later date.
I’ve just had my second rhizotomy. So, here’s that update I promised.
You might be wondering, what happened? Why do I, a twenty-something, have lumbar arthritis?
I wish I could tell you. I never injured myself. I didn’t get hit by a car. I didn’t play impact sports growing up. As far as I know, I just drew the short end of the shit stick when it came to back genetics. After all, I couldn’t be born super talented, intelligent, funny, and have a healthy spine. You can’t have everything, after all.
To contextualize this, I’m going to work backwards. Also keep in mind that I am presently lying in bed with a soupy brain from hydrocodone and exhaustion.
What fixed it?
“The nerves quieted,
no more cause for agony.
I am new again.”
The treatment that ended up working for me was directly targeting the nerves in my spine that sent the pain signals to my brain. A medial branch block, a type of injection, is diagnostic; that is, they temporarily numb the problematic nerves to see if that’s the source of the pain. After it was confirmed that it was the source, I was able to schedule a rhizotomy, which basically does the same thing, but for a much longer period of time. A block works for a few hours, whereas a rhizotomy can work for a few months or years, depending on how quickly your nerves grow back. The nerves from L4–S1 on both sides have all been burned, and will stay quiet for a while.
Dr. Google can fill in any missing information. All you need to understand is they temporarily fried my nerves in my low back so they can’t hurt me for a while. This does mean I’ll eventually need it done again, which is both uncomfortable and expensive… but I’d pay any amount of money to stay out of pain.
What didn’t fix it?
Or, more precisely, what treatments failed?
Chiropractic: As many of you may have experienced, doctors tend work from least invasive to most invasive treatments. In other words, you have to jump through a lot of hoops to get the radical health care you may need. I went to chiropractors for years who addressed my back pain under various theories, including:
Bad posture
Weak glutes
Tight psoas
Bad sleeping position
Leg length discrepancy
Walking incorrectly
Weak “core”
And many others…
It took years of going to these doctors before I was referred for an MRI in 2018, which showed the arthritic spots in my spine. However, my chiropractor didn’t call it “arthritis”. She called it “facet joint hypertrophy”, and prescribed traction for it. If you’re not familiar, lumbar traction is a moderately uncomfortable procedure where you’re strapped into a girdle and hooked up to a machine that pulls your vertebrae apart a wee bit. Theoretically, it would relieve the pressure on my facet joints. So, I did about 6 months of traction, thinking this would fix it. It did relieve some of the pain, but it always came back.
Note: At no point did she communicate to me that my pain was due to a chronic condition that would never go away. I was never informed that these treatments were temporary. I was under the impression that this would cure me. Did she intentionally misinform me in order to swipe my debit card twice a week? Maybe. She certainly made a pretty penny off my insurance and my savings for something that was never going to last longer than the time I was strapped into the machine. However, I have since learned that chiropractors do often prescribe predatory treatments in order to bankroll themselves, and many of them don’t understand modern pain science to begin with.
Physical therapy: I had a long break after this. I couldn’t afford to keep up with the traction, and I prayed that I’d had enough treatments to make dancing bearable until I could afford it again. Come 2021, after undergoing knee surgery and working with a physical therapist I really liked, I shared with him my back pain struggles, and he encouraged me to try physical therapy before going back to traction. So, he put me on a core-strengthening regimen.
Even though traction never fully fixed my pain, it was the only thing that relieved it temporarily, so after about 4 weeks of physical therapy, I sought referral for traction again. I showed them my MRI report, and they said the same thing: facet joint hypertrophy that hasn’t responded to physical therapy. Let’s try traction again.
And so twice a week I went for traction. They kept up my core-strengthening regimen that oscillated between exercises that were so easy it was boring, or so complex I wondered “How could anyone do this correctly?” (There was one exercise where I was literally standing on a BOSU ball on one leg while holding an elastic band that was hooked to the wall, doing one-legged deadlifts as the elastic band was pulling me sideways. Was it challenging? Sure, but is this insanely complex movement something that can be used as a benchmark for core strength?)
After 25 traction treatments and 3 months of core strengthening, my back pain had not improved at all.
This is when I had a come-to-Jesus meeting with my physical therapist.
I told her I was not getting better, and I cannot go on living like this.
At that point, I was needing multiple days of rest in between dance rehearsals because I would be so crippled by the end of them. It was a never-ending cycle. As I got older, my tolerance for the pain lessened. I’d been muscling through it for so many years, but my ability to do that was weakening, along with my resolve. If I didn’t find another solution for this, I would be looking at retirement.
So I asked her: “Is there a point where this is going to get better?”
“No,” she hedged. “At this point with arthritis, you can only hope to manage the symptoms. It’ll never go away.”
You can only hope to manage the symptoms.
It will never go away.
I wanted to throw up. I did cry.
This was the first time the doctor had said in so many words that you are never getting better. It was transformative—and I was mad.
But it got me to the next step: seeing a spine surgeon.
Why I ignored you
When I made my post about my branch block back in February, I had several well-intentioned people unburdening themselves in my inbox. And if you’ve ever suffered a chronic condition, I’m sure you’ve experienced similar things.
Have you tried yoga?
Have you tried these supplements?
Have you tried trigger point release?
Have you tried doing more planks?
If you said it to my face, there’s a chance I humored you to some degree, because 1) I am conflict avoidant, and 2) I know you’re only trying to be helpful. I probably listened and smiled and nodded and thanked you for the suggestion.
If you wrote it in a comment or sent me a message, I deleted it and/or ignored it.
Here is why:
I have spent the better part of 10 years dealing with doctors telling me the reason for my back pain is my fault.
I’m not:
Stretching enough
Sleeping correctly
Standing correctly
Walking correctly
Doing enough planks (seriously, physical therapists love planks)
All of these treatments were prescribed to me predicated on the assumption that I was doing something wrong, or at best inefficiently.
That guilt lived with me every time my back twinged. It kept me from seeking further help. Any time I’d go back to the chiropractor and they’d ask “Have you been stretching?” Well, obviously not enough, or I wouldn’t be in pain.
Every workshop I had to sit out,
every class I had to leave early from,
every social engagement I declined,
every event I grinned and beared through,
I felt a deep, aching guilt for not taking care of myself. I was exacerbating my own pain because I wasn’t doing ___ enough.
And it was never true.
After years of being fed medical shop talk about “facet joint hypertrophy” and “facet degeneration and ligamentum flavum thickening”—because what the fuck does that mean??—I was at the end of my rope before someone said: “You have arthritis, and it will never be cured.”
And like I said in the introduction, sometimes you just get shitty back genetics. It’s not a result of me being a side-sleeper, or having one leg that’s slightly longer than the other, or not doing planks every day.
So when you ask me if I’ve tried things like stretching, yoga, supplements, essential oils, crunches, etc, to me, you’re reiterating that idea that I am doing something wrong and perpetuating my own pain. To me, it translates as “You are in pain, and it is your fault.”
I am not sleeping, walking, dancing, or existing incorrectly. I am not cursed with this pain because I am weak.
I am in pain, and it is NOT my fault.
I’m not interested in non-radical, non-invasive solutions to this problem. Is a rhizotomy at my age considered extreme? Maybe, but what does it tell you that after almost 10 years of non-invasive therapies, I am willing to subject myself to semi-annually having my nerves fried in order to be free of it?
So, in summation, I invite you to keep your advice to yourself.
What I learned
I have lived with this pain for as long as I can remember. I didn’t seek treatment sooner because of our society’s culture around joint pain: everyone has back pain, everyone has knee pain, everyone has ___, etc.
But what I have since learned is this is not true. There’s a difference between “everyone’s back hurts sometimes” and “I have to lay in bed for a week to recover from 3 days of dance classes”. Because of these messages, I never sought treatment because I was under the impression that everyone was dealing with this, and I was just bad at handling it.
Something a lot of people have told me when they find out about this chronic pain is “I had no idea”, “You definitely didn’t show it onstage/in class/etc”, “I never would have known”. If you’ve ever met me at a dance conference or in a class or backstage, I was between a 4 and 7/10 pain and just muscling through it because I had to. I didn’t know if I would survive through Massive last month, and I nearly didn’t.
While the rhizotomy is far from a permanent cure, it’s as close as I’ve gotten to pain management outside taking heroic doses of opioid painkillers. While it sucks that I’ll likely have to have this done once a year or so, at least something works.
If I could go back to 15-year-old me, I’d tell them to complain louder.
Conclusion
After my first branch block, I had an emotional meltdown. I had never been free of back pain before, and I was so overwhelmed with emotion that I quite literally sobbed all the way home. It was a taste of what my life could be like. I think I alarmed the barista at Starbucks as Beans got me my post-surgery Americano.
Imagine how much farther I could have made it without the pain?
Imagine how much more life I could have lived without the pain?
I don’t have answers for any of this, of course. I’m not interested in dwelling on could-haves and should-haves, but rather, focus on could-bes.
What am I capable of now that my biggest barrier has been lifted?
…I guess we’ll see.
“I hope your nerves know only
how to sing
so that you can finally dance.”
