Losing My Identity, Self-Confidence, and Developing Chronic Pain and Inflammation
I was 30 years old the first time I experienced severe back pain that rendered me immobile for 3 days in my bed. I decided to join a competitive women’s tennis league and had not competed in any sport for years. The last event I competed in was the Nike Women’s San Francisco Marathon when I was 26. As a child and teenager I played sports at a highly competitive level for years. I practiced gymnastics 3 hours a day, 6 days a week. On holiday breaks we would practice twice a day and during the summers I’d be waking up at 5:30 in the morning to hit the gym first thing with my teammates. In between working out at the gym you could find me on Bayou Texar in Pensacola, FL, throwing trick after trick behind our family boat. I grew up wakeboarding, skiing, barefoot skiing, knee boarding, tubing and anything else you could do behind a boat. Needless to say, my body had taken quite the beating before I reached the age of 15. There were quite a few falls in the gym and on the water that I can recall left me with severe whiplash and back pain. I think that chronic pain was just part of my life. I remember lying in bed at the end of the night and having to breathe deep for 10 minutes because my entire spine hurt. It was almost as if the compression of all the high impact activities was all I knew and at night the act of lying down would allow my spine to somewhat decompress. It’s strange now as an adult to look back and recall this feeling not as “pain” but more as just a way of life. In an article published in Sports Health titled “Low Back Pain in Young Athletes”, it is estimated that back pain occurs in 10% to 15% of young athletes, but the prevalence of back pain may be higher in certain sports. Studies show that back pain occurs frequently in college football players (27%), artistic gymnasts (50%), and rhythmic gymnasts (86%). 1
Despite my chronic falls and overuse injuries gymnastics made me strong, extremely coordinated, flexible and mentally tough. I made the agonizingly tough decision to stop gymnastics in high school. It was truly one of the hardest decisions I made as a teenager. However, it was the best decision, because it opened up my life to other possibilities for movement, gave me a more well-rounded social experience in high school and gave my body a reprieve from the constant overloading of my spine. The athletic base I built in gymnastics allowed me to excel in four varsity sports in high school: soccer, volleyball, diving, and tennis. I continued to move and use my body all through high school and into college, running and working out at the gym. I cannot imagine my life without sports and movement and I have no regrets about my decisions to stick with gymnastics as long as I did, despite my chronic spinal issues. My love of movement led me to a career as a strength coach and personal trainer that I have enjoyed for 18 years. Unfortunately, as so many athletes have experienced, the things we do as children in sports will always come back to us at some point. For me, my body decided to hold out until I was 30 before giving me a huge lesson in pain!
As a certified strength coach / personal trainer, and former athlete, I couldn’t imagine picking up a tennis racket and joining a 4.0 tennis league at the age of 30 would ever be the straw that broke the camel’s back. I wasn’t the greatest player on the team, but I was quick and fast and I could run the court so my team immediately nominated me to be one of two singles players, which meant I was going to be pounding the pavement a bit more. I had so much fun in that league because it brought back a competitive spirit I loved. I would literally dive to return a shot. Unfortunately, my competitive spirit led to my downfall. I was near the end of a three set match. I was so determined to win. We were playing on clay courts and my opponent had a great shot deep in the left corner. I slid on the clay as I reached as far as possible to return the shot with my back hand. As I slid right foot front and pulled my racket over my right shoulder, rotating my torso to the right I heard a literal “pop, pop” sound. It felt like an electric shock went through my body. I immediately stopped. I knew it was bad. Somehow I managed to sit on the bleachers until my teammates had completed their matches and drove myself home. I spent the next three days unable to move in my bed on pain medications and scared out of my mind. I had gone from athlete to back patient in a split second. Everything changed.
Up until this day, I had never truly felt what it was like to be debilitated by pain. I was scared and worse, I felt like I should have been able to prevent this injury. After all, this was my field and I had been studying the body for 10 years. Luckily enough I was married to a physical therapy student at the time so I was able to be seen by one of the greatest physical therapists in the country, Dr. David Morrisette. He greatly reduced my pain. Unfortunately, I didn’t know my limits and I wanted to jump back into working out, because I had always relied on it for my emotional well-being and I didn’t know how to cope without it. This led to three years of off and on chronic back “flare-ups”. I often times had to call in sick to work because my back or neck had flared up and I could barely walk or turn my head. I couldn’t pinpoint my triggers and exercise was such an important part of my mental state that I pushed through pain that I should not have pushed through. In an article published on PubMed the author describes the psychological impacts on athletes after injury. “Injury is often accompanied by depression, tension, anger and low self-esteem, particularly in competitive, seriously injured athletes. Mood disturbance seems to relate to the athlete’s perceived progress in rehabilitation and has been shown to negatively relate to attendance at rehabilitation sessions.”3
My husband, Dr. Jason St.Clair, would often tell me to lay off this or that and give me advice, which I often, stubbornly, did not listen to. Each time I would have a flare up he would treat me and my body would feel much better until I pushed it to its limit another time. I am truly married to the most patient, well-educated, phenomenal physical therapist that I know. I am so grateful to him! If you live in the Charleston, SC area and need therapy, please look him up! I promise I am not biased. RISE Rehabilitation (More on Jason and his services in an upcoming blog post!)
In January of 2011, Jason and I discovered that we had fertility issues and would be unable to have a child naturally. We had tried for a long time and were ready to do whatever it took, which, for us, meant IVF. We went through two rounds of IVF to have our son, Quincy. It was a very difficult time and the stress of the procedures and medications only made my chronic pain worse. I obviously knew there was a connection between stress and pain but in the midst of my sorrow and anxiety it was so difficult for me to find moments of peace to allow my body to recover. I was like a massive ball of inflammation and I felt powerless over my body. (Below are some pictures of me after my first failed round of IVF. I developed ovarian hyperstimulation. Hardly the picture of health at this point.)
Once an injury has occurred the body responds with a cascade of biochemical reactions that prime the nervous system to get ready for pain. To make things worse, long-term inflammation causes adaptive changes to the nervous system that cause the sensations of pain to become magnified. 2 It was as if my chronic stress and pain had taken over my body and the athlete that once inhabited my body had disappeared and I could barely remember who she was. I have to say that this was probably the lowest point for me in terms of health. I was a wreck physically and mentally. There were so many days that I would wake up at 4:30am to get to the gym at 6:00am to train my clients and I would literally sit in my car and have to stop myself from crying before going in. I often tell friends and family that it was my clients and my chosen profession that got me through that time. Having to get out of my own head and stop dwelling on my pain so that I could put my game face on and be there as a coach for my clients was so difficult but so therapeutic at the same time. Luckily for me I have some amazing clients that understood when I needed to cancel because of the IVF treatments or my back issues. I truly cannot say enough about everyone single one of them, most of whom I have trained for over 10 years and are still training with me today. Goodness! I am one lucky trainer! For all my clients reading this, I truly cannot thank you enough!
I was in the worst shape of my life and yet I still looked fit and trim and totally healthy. Well, let me tell you from a first hand perspective, what a person looks like has nothing to do with how healthy they are! I am living proof! At 125lbs with ripped abs and muscular thighs and 34 years old I was not the picture of health. I couldn’t move or function the way I wanted to and my body was an inflammatory mess. My back hurt and my emotional state was a wreck. I wasn’t sleeping well and I was tired all of the time. Finally, the day before Thanksgiving we got the best news of our lives. We found out we were pregnant and the second round of IVF had worked. To say we were overjoyed is the biggest understatement of my life. We were ecstatic! Unfortunately, the wonderful news carried with it a sense of anxiety that I would live with for the next 8 months because I knew just how precious this pregnancy was. An anxious reaction is common, says Amy Blanchard, Ph.D., a psychologist in Cupertino, CA., who specializes in infertility. “Women who become pregnant after infertility treatments face more complex challenges than those with a natural pregnancy,” explains Blanchard. “They can’t relax; there’s incredible fear and anxiety over miscarriage or birth defects. They’ve usually spent years in infertility treatment, and are used to things not working out.” This excerpt is taken from an article on Fitpregnancy.com for anyone wishing to read the entire article. Needless to say it hits the nail on the head in terms of addressing just how much stress I was adding to my already over-stressed hyper-inflamed body.
Pregnancy as a trainer who stood on her feet all day definitely posed a new set of problems. The bigger I got the harder it was on my back.
I slowly learned how to tone my workouts down. By the last trimester I limited myself to low impact exercises like the stepper or walking. I did very little strength training and any strength work I did really focused more on seated free motion machines. This was a major change in my normal routine as I usually focused on calisthenics, balance, plyotmetrics and full body complex exercises. I can’t say I loved the physical aspect of pregnancy but I can say that it did teach me to slow down and listen to my body. At 35 weeks I had preterm contractions, likely from all of the standing and moving I did at work. I was put on modified bed rest which for me meant an opportunity to clean out every closet and drawer in my house. I can now look back and say pregnancy was probably the best thing for me. It taught me to listen, to slow down and to appreciate the amazing ability of a woman’s body to create a human being. It taught me that despite chronic back pain, amazing amounts of stress, and constant anxiety, I was still strong enough to create a human life inside of me. Pregnancy and the birth of my son Quincy was the most courageous, most athletic, most humbling experience of my life.
I will be forever grateful to the universe, to our doctors, Dr. George Koulianos, and Dr. Bridget Williamson, to our therapist, Lynne Galbally (I will never be able to say in words how much she helped me), to my family and to my husband, Dr. Jason St.Clair, for helping me get through. Most importantly I am thankful for my strong will and determination that I learned years ago as a gymnast for pushing me through when I felt I could give up at any moment. My athletic background, my back injury, my IVF journey, pregnancy and reaching a point of pure hopelessness were the greatest gifts of my life because they taught me about who I really am. I no longer wanted to be the athlete I pictured myself for all of those years. I wanted to be a strong self-confident mother to a beautiful baby and I wanted to feel amazing. I stopped obsessing over staying lean or trim or being able to do the hardest exercises I could find. I had to start from square one. I had to learn how to rebuild a body with cervical and lumbar disc injuries, a huge three finger diastasis (a separation along the linea alba of the abdomen, basically a split in my abdominal wall), and a C-section. On top of all of this, Quincy had horrible acid reflux and colic and cried all the time for the first 4 months of his life. Wow! I had my work cut out for me!
Coming back from Injury, Chronic Pain, and Pregnancy
The beginning of Quincy’s life was tough. For anyone who has ever had a baby with colic or acid reflux, I know that you can relate. The constant crying and my inability to soothe him took its toll on me. Remarkably, motherhood provided me with an ability to push through with very little sleep and still get through the days. Jason was a huge help and stayed calm when I really needed to breath. In the beginning my exercise consisted of walking and light jogging. I bought an online program for diastasis recovery, which, to this day, I have never taken out of the box. I can’t even imagine having time to lie on the floor and rehabilitate my body with a screaming baby. So I didn’t. Instead I trusted my body and myself. Around 6 weeks after my C-Section I went back to the gym and began working out again. I had to take things so slow! I had a hard time even holding a plank for 30 seconds and had to start on my knees. I knew enough to know that sit ups and russian twists and anything that created too much abdominal pressure or shearing of the spine were never good for anyone so I stuck with basics. I focused primarily on stabilizing through my entire body and maintaining a neutral spine while performing simple exercises. Pre pregnancy I could knock out 10 unassisted pullups and post pregnancy I could barely do a 50lb lat pull down. It was humbling to say the least. Keep a look out for a future post on post natal strength training and dealing with a diastasis. For now I will refer you to my friend and former coworker, Dr. Sarah Ellis , who has an amazing online resource for anyone currently dealing with rehabilitating the body after pregnancy.
The road to rebuilding was slow and long. I would estimate that I started to feel like I could add functional exercises and more advanced calisthenics back into my workouts a year postpartum. Quincy was on a schedule and sleeping through the night and I could find time each day to exercise and get a mental reprieve. I cannot express how important it is for new mothers to find at least 30 minutes a day for themselves. The number one reason I believe exercise is important for new mothers is stress relief. Motherhood is stressful and exercise releases endorphins that keep you focused, happier and clear-headed. Endorphins act as analgesics by reducing your perception of pain, and trigger a positive feeling in the body, similar to Morphine without the negative side effects of medications. 4
As a trainer, I have always emphasized posture and form with my clients. Any one of them can tell you how nit picky and meticulous I can be. I do this because I know it is so important. If something hurts then I need to tweak their biomechanics or give them an alternative exercise to work the same muscle. I don’t believe they should ever push through joint pain, and it was finally time for me to take my own advice. I realize now, as I look back on my life, that I had always endured such a high level of activity that I didn’t even realize how often I was pushing through pain. Pregnancy humbled me and taught me to truly listen to my body. I made a conscious decision to make sure I was never pushing through my own pain. It was this decision that got me on the road to becoming a new, healthier version of my athletic self. I didn’t have time to not be able to walk or hold my baby or help support my family. I had to make sure I stayed healthy and healthy meant avoiding injury and working on my weakest links.
If I was in an exercise class and the instructor had me do an exercise I knew was bad for my body, I did something else instead. If I tried a new exercise and was unable to stabilize or protect my fragile abdominal wall, I didn’t do it. I started small and built on the basics: squats, lunges, pushing, pulling and low impact cardio for my mental health. I gradually began adding in single arm or single leg stability exercises, cable rotations, and even some very gentle plyometrics. If anything ever hurt or didn’t feel right then I didn’t do it.
The past two years have been the healthiest my body has ever felt. I am 10lbs heavier, I have more muscle, I enjoy my workouts more, and I’m challenging my body to do things I couldn’t do at 25. I eat healthy but I enjoy food and don’t put restrictions on what I can have. In addition, I have made educating myself on how to realign the body my top priority so that I can be an even more effective trainer. I have taken multiple courses on body alignment and am committed to continuing and furthering my education. My most recent course was through Postural Restoration Institute. Their non-manual techniques for aligning the body are incredible and have given me a new-found respect for taking control of my body. I now have the tools and comprehension to help my clients take control of their own bodies. For more on Postural Restoration check out this article on my blog. I have fewer set backs, I have less pain and I take steps everyday to keep my inflammation and stress in check. And I’m even back up to 8 pull ups in a row!
There are still moments where my back or neck will be irritated but I now have the tools to properly handle the anxiety and stress of pain, to re-position my alignment through non-manual techniques I can do anywhere, and to trust and know exactly when I am feeling a pain that is not good for me to push through. I believe athletes and everyone dealing with chronic pain, injury, or inflammation can develop these life skills.
Here is a small slideshow of highlights from this year. I’m living life happy, healthy, and mostly pain free, and enjoying every moment!
A Guide to Reclaiming Your Body and Becoming Healthy After Chronic Pain, Inflammation and Injury
Step 1 – Recognize good and bad pain and respect your body. So often my clients will say to me, “that hurts” and I am always trying to distinguish if they are feeling good pain (muscular fatigue) or bad pain (tension and pain in joints). I actually loathe the saying “no pain, no gain” because it can encourage people to push through pain they shouldn’t push through. When you stress a muscle through exercise you will experience delayed onset muscle soreness (DOMS) a day or two after your workout. The belly of the muscle will be tender and it may feel fatigued. With this type of soreness the muscles actually remodel and become stronger. Having said that, I am not a fan of trying to make someone as sore as possible by repetitively stressing a specific muscle. In the long run I don’t believe you should be so sore from your workouts that you can barely move. My ideal level of soreness for my clients is always just a little sore but overall energized and ready for another workout the next day. I want them to leave me feeling better than when they walked in. Bad pain is considerably different. Bad pain usually involves joint pain. Feeling pain in your knee, hips, back, elbow or any joint in your body is your body telling you that something is not right. It is important to take a step back and adjust your form or to seek the help of a professional to make sure the alignment of your joints and your bio-mechanics are optimal. Performing repetitive movements with misaligned joints is a recipe for disaster. Another type of bad pain is “radicular” or nerve pain. This type of pain causes a shooting sensation down your extremities, usually as a result of inflammation or irritation of the nerve root. 5 If you are experiencing any “bad” pain it is critical that you seek the help of a professional to prevent further damage.
Step 2 – Seek help from an amazing Physical Therapist, Athletic Trainer, Strength Coach, Personal Trainer, or other health professional to help guide you on how to prevent and treat your own pain. This is a very important aspect of preventing reoccurring pain or injury. Most of us will get a check up by our primary care doctor once a year, see a dentist twice a year, and an OB/GYN once a year. It’s interesting that we do not seek the help of a physical therapist once a year to do a musculo-skeletal check up. I hope that one day this will be part of our overall health care. It is important to note that not every PT, ATC, Strength Coach or Trainer is the same. Ask for references, check their education and understand their philosophy on therapy or training. There are personal trainers who studied for a few weekends and got a certification online and there are trainers who have a bachelors or masters in an exercise related field. Look for certifications and then question their continuing education. The same goes with physical therapists. Research is always evolving along with techniques that can enhance your experience. Look for a physical therapist who is committed to staying current in their education. If you live in the Charleston, SC area and need a good therapist or trainer please let me know. I have a handful of each that I can confidently recommend.
Step 3 – Take steps to reduce stress. Meditation, yoga if your body can handle it, gentle cardiovascular exercise, deep breathing or seeing a licensed therapist are all options. I cannot stress enough the importance of learning to breathe correctly! It’s amazing what 5 diaphragmatic breaths will do for your body. Here is a great introductory video from the Institute of Health and Human Performance. https://www.youtube.com/watch?v=kgTL5G1ibIo Shallow breathing often accompanies stress, anxiety, and other psychological difficulties. This is typically a result of sympathetic over-arousal, commonly referred to as the “fight or flight response.” With practice, diaphragmatic breathing leads to a reversal of fight or flight, to a quieting response modulated by the parasympathetic nervous system. Studies suggest that slow, paced breathing can be a useful self-regulatory tool for the management of pain. 6 In addition, breathing is free and it gives you a tool that you can do anywhere to improve your pain. It puts you in charge of your own health, which is extremely empowering.
Step 4 – Eat a healthy-ish diet. Incorporate lots of fruits and vegetables and limit inflammatory foods, especially during times of high stress. Don’t eliminate foods you love. Learn to enjoy them in moderation. I’ve always been of the mindset that moderation is key when it comes to food. I’m a foodie myself, I love to cook and I love great food. If you try to take something away from me or tell me I can’t have it, it feels like deprivation and I don’t believe that is good for your mental state. Having said that, certain foods that are known to be inflammatory like sugar, white flours, processed snacks, dairy and meat can add up and increase inflammation, leading to more chronic pain. During times of pain and high stress I find it helpful to eat as many vegetables, fruits, and whole grains as possible. Focus on what you are adding to your diet and not what you are taking away. Inflammation is the body’s immune response to toxins in the body. In an article from the Cleveland Clinic, Dr. William Welches, DO says, “Research shows that diet should be an integral part of a pain management program — especially as patients age. A vegan or Mediterranean diet — or healthier eating inspired by these diets — can control insulin and cholesterol levels and reduce inflammation — which is the pain culprit. 7
Step 5 – Focus your workouts on gaining mental and postural strength and when you have extra time, if your body is ready for it, you can add in higher level more intense exercises that get you excited about what your body can do. I cannot stress enough how important it is to focus on the cornerstones of a healthy body, mental well-being and postural alignment. A body is only as strong as its weakest link. This is true in so many regards. If you are carrying around a body full of anxiety and you are constantly in a fight or flight mode then your workouts will suffer. You will not be able to move forward to the next level and gain strength because you will constantly feel overworked and exhausted. Similarly, if you are exercising without proper spinal or pelvic alignment, it will make it 10 times harder to perform an exercise. It is amazing what a body in ideal postural alignment can do! If you have nagging hip pain (“piriformis”, SI dysfunction, etc.), knee pain, low back pain (chronic low back tightness, radicular pain down the legs, inability to feel your abdominals working…), neck pain or shoulder pain (impingement, muscle tears, rediculopathy, tendonitis…) it is likely that one or more of the joints in your body is not in its optimal alignment. Don’t keep pushing through! Seek the guidance of a professional to help restore your posture and to give you tools for improving your body’s ability to stay in proper alignment while doing all of the exercises you love. Sometimes the biggest strength gains come from taking a step back and finding the smallest parts of you that aren’t working the way they should, reestablishing a new movement pattern, and building your way back up.
Step 6 – Check in with your primary doctor for a full physical that includes blood work to rule out any underlying health issues that could potentially be adding to chronic pain. Just because your injury or pain is localized to one area does not mean that it is not affected by the entire body. Our bodies are complicated machines and one part is always affected by another. If you have been dealing with chronic pain or a nagging injury for a long time, it is always good to check hormone levels and basic markers for inflammation. Dealing with the big picture can help you heal and get better from a whole body perspective. Here is a great article on common tests that can be ordered by your doctor to help you determine if you have any underlying issues. Top 5 Blood Tests for Inflammation
Step 7 – Expect slow changes and embrace the time it takes. Stay committed to the big picture of a truly healthy body. Often times, the slower changes become the changes that last. It is easy to get caught up in wanting a quick fix but usually the quick fix is not the best solution. Likely it will take a well-rounded plan to decrease pain and heal an injury. Don’t expect that a few visits to a chiropractor will do the trick. Just putting joints into alignment through manipulation doesn’t keep them there. Likely the body has been functioning in a misaligned state for a long time and it is going to take a lot of neurological reprogramming to get certain muscles turned on and to shut other muscles off. I cannot express how important the neurological component is. You have to make a concerted effort to teach your brain how to move in a new pattern. This takes time, dedication, and knowledge. Once again, you will likely need to reach out to a professional.
Step 8 – Be very cautious before going down the rabbit hole of surgery. Make this your absolute last resort once you have exhausted all of the steps above. I see commercials on television all the time touting minimally invasive surgeries that can be done in an outpatient setting and leave you feeling amazing. If you are seeking the help of a doctor that tells you this, question his credibility. There is NO surgery that is without consequences! Different surgeries have different outcomes. It is important to know which areas of the body have good outcomes and which ones do not. Ask what the consequences post surgery will be and ask for researched based information. Randomized double-blind placebo studies are the gold standard. Get a second, third, and fourth opinion. Also, recognize that post surgery you will still need to do the work to deal with changes in the body due to surgery. When you fix one area of the body it will affect the entire body and how it functions. For example, a spinal fusion of L4-L5 (lower back) means that there is no longer movement in that area that was once there. Your body will begin to compensate by moving above or below and likely consequences will develop up or down the kinetic chain. Eventually you will have to deal with those consequences. Do your homework and make sure you have exhausted all other areas before having surgery. There are no quick fixes without consequences.
1 Purcell, Laura and Micheli,Lyle. “Low Back Pain in Young Athletes”. Sports Health, May 2009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445254/
2. Ji RR, Xu ZZ, Strichartz G, Serhan CN. Emerging roles of resolvins in the resolution of inflammation and pain. Trends Neurosci. 2011;34(11):599-609. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200462/
3. Smith AM. Sports Med. “Psychological Impact of Injuries in Athletes” 1996 Dec;22(6):391-405. Review. PMID: 8969016. https://www.ncbi.nlm.nih.gov/pubmed/8969016
6. Mehling WE, Hamel KA, Acree M, Byl N, Hecht FM. Randomized, controlled trial of breath therapy for patients with chronic low-back pain. Altern Ther Health Med.
7. Welches, W. “How and Anti-Inflammatory Diet Can Ease Pain As You Age”. https://health.clevelandclinic.org/2015/11/anti-inflammatory-diet-can-relieve-pain-age/
8. Jockers, D. “Top 5 Blood Tests for Inflammation”. https://drjockers.com/top-5-blood-tests-inflammation/