Beyond the Structure of the Body
Mary Ruth Velicki MS, DPT
One of my friends, Kathy, came into my office visibly upset. For several months she had sciatica, a nervy type of pain that travelled from her lower back down her leg to her ankle. Her primary care physician had referred her to an orthopedic surgeon who specialized in the spine. During the consultation, the surgeon took a quick look at Kathy’s MRI scan and briefly explained it to her. Kathy was totally unfamiliar with MRI scans, and she felt overwhelmed as the doctor pointed out the bulging disc in her lower back and where it was putting pressure on a nerve root as it exited the spinal cord. The images scared Kathy, and she worried that she would need surgery or have to endure the pain for the rest of her life.
Through my own healing journey and my work as a physical therapist, I had acquired some knowledge that had the potential to quell Kathy’s anxiety. I shared that many of my clients have been frightened by the diagnoses they’d received and by the scans they were shown. I, too, felt stunned and afraid when I was dealing with chronic neck pain and saw the disc bulges on my MRI scans. For many people, these scans show objective proof of their level of brokenness and so increase fear and anxiety. I also explained to Kathy that it may not be so simple and that evidence suggests that the findings on MRI and Computed Tomography (CT) scans may not be directly correlated to the level of pain one experiences.
For example, in a longitudinal study published in The Spine Journal in 2005, 100 subjects with mild and persistent low-back pain (LBP) who had high risk factors for developing more serious LBP were evaluated. Each subject had an MRI scan of the lower back at the beginning of the study and again approximately five years later. During this period, they were followed every six months to determine whether their LBP subsided or worsened at certain times. It was found that the development of serious LBP was strongly predicted by psychosocial variables but weakly associated with degenerative changes pictured on MRI. In addition, no association was found between structural abnormalities on the scans and the development of disability or the need for future medical care.
Another study in The Spine Journal in 2010, found that degenerative changes in the spine were fairly common, but they did not always create low-back pain. All 187 subjects in this study had a CT scan of their lower back area as part of the Framingham Heart Study to evaluate whether the large vessel (aorta) had calcification. In this study, the scans were reviewed for evidence of degenerative changes in the spine, including narrowing between the discs, osteoarthritis of the small joints (facet joints), small stress fractures (spondylolysis), forward displacement of a vertebral bone (spondylolisthesis), and a narrowing of the canal where the spinal cord traverses (spinal stenosis). The study showed that degenerative features of the lumbar spine were extremely prevalent, but none of these findings (except spinal stenosis) was associated with LBP.
I shared with Kathy that on some level the human body is like a machine. It can definitely develop a stiff gear or misaligned part, and that can be helped with physical treatments. However, pain is transmitted by the central nervous system, and many factors determine how that information is processed and ultimately experienced. Unlike a machine, we think and feel, which may directly influence our experience of pain.
To reinforce this idea, I shared this story: About two months into healing, my urologist performed a cystoscopy to look at the interior of my bladder. He moved a flexible tube with a small camera and light at its tip up my urethra and into my bladder. Then, he looked at images that were displayed on a screen and reported that the interior of my bladder was very inflamed. This finding made sense to me because at the time, the bladder pain was intense for much of the day. However, at that time I had started attending yoga and found that the pain levels would drop during class, and sometimes I would be pain-free for the full hour. My bladder didn’t miraculously get healed during the yoga session. But the pain level I experienced significantly decreased when I was in a calm and relaxed state and focused on the sensations of my body and my breath.
Kathy shared that her pain had also lifted during yoga and meditation and that she, too, felt relief for several hours afterward. With Kathy, as with me, although these therapies didn’t fully resolve the underlying physical condition, they significantly decreased the pain. Kathy confided that she was confused and didn’t know what to do about her condition. At first, she was resigned to having surgery, because the spine surgeon had told her that a disc bulge that large would never get better without it. Instead, she decided to try several therapies before opting for surgery. Kathy received physical therapy, massage therapy, acupuncture, and holistic bodywork. She also had a helpful conversation with her doctor about her recurrent depression and discussed readjusting her medications. After a few months, she was back to cycling, and she stated that she was very happy, relieved, and grateful to be in that state of health and both pain-free and surgery-free. When Kathy considered that her condition was more than just the structural problem, she found many paths that helped her to heal.
Early in my illness, I was most aligned with my analytical mind, so I started on this journey thinking my way through the pain—but later I learned to also feel my way through it. Over time, I realized that my illness created challenges and changes for my mind and spirit as well as for my body. I came to understand that all three aspects of my person—body, mind, and spirit—are interconnected pieces of this healing puzzle. Taking this holistic approach to my illness ultimately played an integral role in my healing.