Have you been experiencing pain for one week, one month, or over a year? Maybe over 10 years?? Maybe you know someone in your family that has been suffering with the same injury for what seems like decades.
Have you (or they) been to countless physician appointments, taken prescription medications like it's your job, and possibly even undergone surgery?
Maybe you're afraid of that cycle because you've seen your Aunt Bessy go through it and you're afraid that you're going down that same destructive path.
First thing to note:
Our healthcare system is broken.
The days of speaking with your MD or Specialist are over. Now we have become reliant upon assistants and other practitioners. That's not to say that they don't do a fine job. However, physicians are now in charge of seeing their patients and overseeing the patients of PAs (physician assistants) and NPs (nurse practitioners).
You can see how it would be easy to overlook someone's problem or unintentionally let people slip through the cracks. I don't blame the practitioners for this.. I blame the insurance companies and greed - but that's a topic for another day.
Let's get to my point:
Low back and neck pain are key contributors with the rise in opioid use. Many will go to specialist after specialist, undergo countless imaging and testing, along with injections... without any relief in their pain. For many people, their pain actually INCREASES.
And this is where it starts.. for many, it may have started at the very beginning. Their physician gives them a prescriptions for anti-inflammatories and pain killers. When that doesn't work then they start with the injections over the course of several months which then eventually leads to surgery.
Throughout this entire process, physicians continue to prescribe pain killers because what else can be done? Might as well try to help them numb the pain until it can be "fixed" with surgery, right? And don't forget about their caseload.. alot of practitioners don't have time to think about anything other than referring a patient to a specialist or performing surgery.. when was the last time you spent more than 10 min with your physician?
After surgery, the pain still continues... then what happens?
Typically they will refer these patients to other "specialists"..
and so the cycle begins...
I have a BIG problem with this cycle..
First of all.. IT NEEDS TO END.
Secondly.. How do we do that?
We have to determine the underlying cause of the pain. Pain doesn't happen randomly and for no reason.
This is our body's way of saying.. "I'm not a big fan of what you're doing here.. something's just not right!" If not, then we would continue to do further damage without knowing it.
That's EXACTLY what our painkillers are doing..
They kill the pain. Quite literally.
You might be thinking to yourself, "Well I'd rather not be in pain so what's the harm in taking them for the time being?"
Because it's disrupting your body's normal alarm system. It's quieting it down or shutting it off completely. And just because the pain goes away (or is decreased) that doesn't mean it's getting better. Many times, you'll end up doing more harm because you can't feel what you're doing.
You won't feel the pain when sitting at your desk at work. You won't feel the pain when picking up your kiddo or grandkiddo. You won't feel the pain when picking something up off the floor.
Eventually, you will have to take more medication to have the same effects and that's when it can become scary.
The people getting addicted to opioids aren't the men and women who are living on the streets...
It's the average person trying to get by. Trying to continue working without going on disability... Trying to tackle all of the responsibilities of being a parent... Trying to live an active lifestyle... You get my point.
What needs to happen is the first line of access should be seeing a Physical Therapist
If you don't know one.. then find one! Do your research. Don't just go to the Physical Therapist that is the closest to your work or home.
Finding a true Musculoskeletal Specialist that isn't bogged down by all of the paperwork as well as being overworked and underpaid may be difficult, but it's not impossible.
But you would do this when researching a Neurosurgeon.
You wouldn't pick the first one that pops up on Google or one because they have a hospital closest to your home.. at least I hope not! :)
I understand that surgery on the spine can be very dangerous so you'll want the best! And I'm not saying Physical Therapy comes with the same precautions as surgery. However, if you see a PT that doesn't perform a thorough comprehensive assessment and establish a treatment progression based on YOUR specific needs then you will slip through the cracks unnoticed and be on the track for surgery.
And get this.. you may have surgery on something that ISN'T the primary cause of your pain. You complain of back pain and symptoms down the leg.. then go in for an MRI to show horrid things.. "oh my! I have degenerative WHHAATT? Well of course I need surgery!"
Let me break it down.. just because you have signs (or actually have) degenerative disc disease or joint disease does NOT mean that you automatically HAVE to have surgery. And just because someone says your joint is "bone on bone" doesn't mean you HAVE to have surgery!
Does it mean that you will never require surgery?? Of course not.
But why not give the conservative route (AKA Physical Therapy) a try? What harm could it do? You can ALWAYS have surgery..
And most importantly, I have helped many people return to active and healthy lifestyles without requiring surgery.. And . yes, these are people who have been told, "You have the worst spine I've ever seen" and "You're bone on bone. There's no way you'll be able to play with your grandchildren".
So there is still hope!
Musculoskeletal Specialists will provide you with a comprehensive total body assessment
This will involve a detailed history of YOUR PAIN. Each session should be 45-60 minutes long and should be heavily manual based.. meaning they work on your _____ fill in the blank by using manual techniques.
Through their assessment, they should be able to develop a plan of care that tackles the underlying cause of your pain.
Remember that children's song.. "The leg bone's connected to the knee bone, the knee bone's connected to the thigh bone..?"
Well, its true!!
Your body is a kinetic chain.. meaning that everything works TOGETHER.
When one part moves, the other part stabilizes. Therefore, if you have an injury or source of pain in one area of your body.. then you'll certainly develop aches and pains in other areas of your body.
And when you add painkillers into the mix you can see how that can be a toxic concoction.
One thing that I do want to note is that if you are currently dealing with pain and are discouraged.. DON'T LOSE HOPE!
I have seen, firsthand, how resilient the body is. Just because you've been told, "that's the worse (insert body part) I've ever seen" or "it's bone-on-bone" or even "you have degenerated discs and joints, you shouldn't do xyz.." doesn't mean it's true!
I have had MANY people overcome pain that they thought they would have to deal with the rest of their life.. Is it easy? Heck no!! Is it possible? Heck yes!!
Now depending on how long you've been dealing with the pain and how many body parts are involved, it might take longer than you like. Unfortunately there are no quick fixes in life.
If someone tells you they can fix something in one session then you might want to walk the other way. That's not real life.. However, if you are dedicated to overcoming your pain and will do anything to get back to a healthy and active lifestyle then, by golly, you can!!
Where to go from here?
Over the next few weeks I will be discussing common injuries (starting with back pain) and ways to treat them!
If you're local to the Nashville area, I provide FREE Discovery Visits and Phone Consultations. I would love to talk with you and explain how I can specifically help YOU and YOUR pain.
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
And please subscribe to my newsletter to get email reminders for my upcoming posts! I'll also send you my FREE Back Pain Guide!
I would also love to hear any questions that you may have! Please email me directly at firstname.lastname@example.org or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
KS Fitness + Co, LLC
Hey friends! So if you had told me just a few months ago that I would write a topic about being TOO fit then I would have told you that you're bonkers! This is my expertise.. there can never be too much of a good thing, right??
Okay, let's back it up before we get into the real nitty gritty..
Let me start by giving you a brief background about me :)
Sooo.. I've been active pretty much my entire life. I mean really.. I started dribbling a basketball when I was 3! I couldn't let my older brother show me out! Fast-forward 10-15 years later and I'm playing on a Nike traveling team in the summer and playing for my high school the rest of the year. It was a full-time job and I had very little down time. My entire focus was on my basketball career.
I earned a full ride scholarship to UMBC- for you March Madness fans, you might recognize that name. This past year the men's team was the first #16 seed to defeat a #1 Seed, Virginia, in the tournament! I played there for 2 years and decided I wanted to be closer to home so I transferred to Belmont University located in Nashville, TN. That's where I met the hubs and pursued obtaining a Doctor of Physical Therapy.
During Physical Therapy school, I got away from the world of basketball and started to dive head first into training for half marathons and olympic triathlons. I have always (and will always) be a competitor so I needed something to train for and compete in.
I also started researching and learning more about nutrition - even though I was just scratching the surface - because I wanted to learn how to properly fuel myself for training. I believe that proper nutrition is paramount to succeed at any sport. You can train twice as much as everyone else but if you're not adequately fueled then your body will not be able to perform at the optimal level.. That's why the things I'll discuss a bit later have been so tough on me!
Even though I had experience playing at the elite level, earned a Doctor of Physical Therapy and became a certified Strength & Conditioning Specialist, there was still a HUGE aspect of my life that I was putting on the back burner. It had become the norm to me so I didn't think too much into it.
Over the years, I had yearly check-ups and discussed this topic with specialists in that particular field with little to no avail. Each physician told me that I was completely normal and that I need not to worry..
Okay.. so you might know the direction I'm heading in or you might be thinking TELL US ALREADY...
This is a topic that most people do not talk about and to be quite honest, I'm not the most comfortable sharing either. However, I want to raise awareness because (especially in the fitness industry) I know there are other girls who struggle with this and feel as though there is no hope.. or perhaps, they have been misguided and will not realize it until later in life (like me).
What I have struggled with, every since hitting puberty, is amenorrhea- which is absent or missed periods. I started my period when I was 13 but then would only have one a year for the next 3 years. Each time I would go in for my check-up with my gynecologist, she would say not to worry and it's completely normal for someone who is active to not have a period. She would continually encourage me that I was healthy and all was well.
Now before I continue, I want to say that I highly respect the health professionals within Women's Health and that I know they are able to help MANY women all across the boards.
My main point is to raise awareness for this particular topic because it seems that it is quite often overlooked BY EVERYONE. Most healthcare professionals are being taught that the pill (birth control) is the bees knees and that's all we need to make the world go 'round.
The fact that I have seen 5 different gynecological specialists - 1 in Knoxville, 1 in Baltimore, 3 in Nashville - and they all have said the same thing over the past 10 years says a lot. I have read the literature and have seen that there is more research being done to show the negative implications of amenorrhea and that it can not simply be treated by birth control. The underlying cause NEEDS to be addressed and we need to stop putting band-aids on things crossing our fingers in hopes that they will heal on their own.
Now that's cleared up.. back to what I was saying before..
I have gone YEARS without having a regular cycle and had no clue what that was doing to my body. 10 years later - 5 years into marriage - my husband and I are in the early stages (emphasis on early) of trying to conceive and I had an appointment to see a nurse practitioner that works under my current gynecologist (I saw her because I would have had to wait 3 months to see my regular doc).
I went into the appointment excited to break the news that we were ready to have the baby talk! I'm no dummy so I knew that I had irregular periods and that could complicate things. But since I had always been told I'm healthy (and all was well in my fertility world) then I figured they would have a few magic tricks up their sleeves to help get things flowing.. pun intended :)
Welp.. needless to say, that is not how it went.
A healthcare professional that I had never even met before who has been doing this for over 20 years stated that I could NOT have a baby because I don't have periods.. therefore I don't ovulate.
I stared at her blankly... thinking, "I didn't hear her correctly. I'm healthy. I'm a fertile myrtle. This can't be right!"
She then proceeded to say that since I have a protein C deficiency (more on that later) that I can't take birth control (remember, that's the bees knees) so she's going to refer me back to my regular gynecologist and maybe I could take some medicine or something.
Oh yeah, I almost forgot.. She also said that because I don't have regular cycles that I was at risk for cervical cancer and that she thinks I may have PCOS.
For those unfamiliar with PCOS:
PCOS stands for Polycystic Ovarian Syndrome. it is a hormonal disorder causing enlarged ovaries with small cysts on the outer edges.
3 major symptoms include:
The only symptom I had was irregular menstruation. And without doing a blood work-up or ultrasound, there is no way of knowing whether you have PCOS. They typically do it based on general presentation.
This brings me to my next topic:
Hypothalamic Amenorrhea (HA)
According to Shady Grove Fertility:
"Hypothalamic amenorrhea is a condition in which menstruation stops for several months due to a problem involving the hypothalamus. The hypothalamus is in the center of the brain and controls reproduction. It produces gonadotropin-releasing hormone (GnRH). GnRH) signals the production of other hormones needed for the egg to mature and for ovulation, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) after ovulation. In turn, FSH and LH signal the ovaries to produce estrogen. Estrogen thins the cervical mucus and - along with progesterone (from LH) - prepares the uterus for a fertilized egg."
Now in English:
Hypothalamic amenorrhea is when you lose your period completely, have prolonged periods, or irregular periods due to lack of energy for the reproductive system to work properly. There are a lot of factors that play into this but it typically comes down to exercising too much and not eating enough.
So I have 4/5 symptoms listed for HA and only 1 symptom for PCOS. I have below average body fat, I tend to stress out a lot due to starting my company, and I exercise frequently. I could fall under the low body weight category but to me, 5'9" and 135-140 lbs is pretty average if not a bit higher than average due to muscle mass.
One other topic is food.. with doing further research, I realized I was not getting enough healthy fats into my diet and that is paramount for optimal reproductive health. I enjoy and eat all food groups but other than avocados, almonds and coconut oil, I was unintentionally eating a low-fat diet. I thought I was properly fueling myself and would average between 2,000-3000 calories per day. However, I was always and hungry and that should have been an indicator that something's not right.
A Few Fast Facts..
So clearly fertility issues are quite common. And if we are all generalized in the broad PCOS category without looking at other possible diagnoses then we are doing ourselves a disservice.
Also, if you have irregular periods.. THAT IS NOT NORMAL.. I repeat.. That is not normal!! No matter what anyone says! It might be convenient at the time to not have to worry about Aunt Flo but this is your body's way of communicating with you and begging for heeellllpp!
Here is an article from a nutritionist and nurse practitioner, Robyn Nohling, who struggled with HA (and overcame it, she has a precious nugget now) and was misdiagnosed for years. She underwent countless tests that further discouraged her until she decided to dig further into the research herself and go back to school to become a nurse practitioner. Her story is amazing!
She discusses the difference between PCOS and HA here
She also wrote an article specifically about why not getting your period is NOT normal
And lastly, she discusses a topic regarding your body's healthy set point.
Every person has a unique and individual personality and our body's are the same way. There are elite athletes who compete at a very low body fat (some even at 15-18%) who still have regular cycles. Other (like me) don't operate well at 17.5-18.5%. Each person is different and one key way of knowing if we're at our healthy set point is by our monthly flow!
Robyn goes on to say in her blog post:
"One thing about set point theory that is overlooked or not spoken about clearly I think, is that your "set point" isn't one certain number. Or even one number give or take a few pounds. No. Research estimates that the average person has a set point range of ten to twenty pounds. Ten to twenty pounds."
To wrap things up...
This has been one of the most difficult things for me to write about, or even talk about (just ask my bible study peeps from Monday!!). Part of me wanted to wait until I had everything figured out so I could say, "Look at what I struggled with and how I overcame it!" That way no one would know that, as of right now, I feel broken.
I'm broken and beaten down. I'm discouraged and ashamed. I'm even embarrassed.
I can't believe that with all of the knowledge and experience I've acquired over the years that I didn't realize this sooner.
How did I not realize that my body wasn't operating at a healthy set point?
Why didn't I think about eating a high fat diet?
How did I not know that something was wrong?
I continue to beat myself up over this.. and blame myself for the fact that I may not be able to bring a new life into this world.
The fact that I'm at the point of even considering have a nugget is a BIG DEAL. God had to do a mighty work within me to come to get to this point..
And this is what keeps bringing me back..
This is why I feel led to share this with you now! I want to take those who are interested through this journey. Because not all hope is lost!
I believe that I have been given a platform to raise awareness for this topic. And if I can help just one person (like Robyn helped encourage me) then feeling super awkward and vulnerable will be more than worth it!
I also highly encourage you to ask you OBGYN these questions. In one of the articles listed above, Robyn shows how to interpret blood work to differentiate between PCOS and HA. You can also get an ultrasound that will rule in or out PCOS by physically seeing if there are cysts on your ovaries (btw.. it's not uncommon to have cysts but those with PCOS have 12 or more.. don't quote me on that though!).
Once all the bloodwork and ultrasound checks out.. I recommend seeking out a Registered Dietician (like Robyn) to help you make sure that you're eating properly to achieve your healthy set point.
Lastly, if you LOVE exercising as much as I do and truly enjoy eating whole foods then you might want to reassess where you're at and what your goals are.
My two main goals are:
1) To continue to pursue what I love in life.. helping adults and athletes of all ages stay active and fit without relying on pain medications, injections or surgery. Through this experience, I understand the body even more now and that each person requires different nutritional requirements.. and that it's waaayy more than just calories in versus calories out when it comes to reproductive health.
You want to know how to lose weight and gain lean muscle mass or rehabilitate from a nagging injury.. then I'm your girl!! But hopefully through this journey I will learn how to help other women maintain a healthy set point while achieving their fitness goals!
For most people, not much will change. However, for the elite athlete or fitness enthusiast, it will look quite differently and I look forward to helping others navigate that process after going through it myself.
2) To make my reproductive health a priority! I want to be able to have a nugget or two (or three!) so that means I'm going to have to make some changes.
I'm going to incorporate more healthy fats to my diet. I am also going to back off high intensity exercise and switch to yoga and light walking. This will naturally entail that I'm going to gain some extra fluff and lose lean muscle. Once I regain a normal cycle, then I will once again reassess where I'm at.
I truly believe that I will once again be able to perform high intensity exercise but that I need to find balance in my life and establish my body's healthy set point first.
And I want to be honest with ya'll.. I'm not looking forward to it. Part of me fears that people won't listen to me if I gain weight. The other part says, gurrrr.. you gotta do what's best for you! Take care of yourself!
At the end of the day, it doesn't matter what others may think. I have to do what's best for me and my family. We are a unit. Nothing can break us unless we allow it to get in between us.
Sooo.. I'm both excited and scared to start this journey! I have another appointment to have a full blood work up done as well as an ultrasound. After that, I'll have an even better idea of how to navigate this temporary obstacle :)
For those who took the time to read this post in it's entirety.. THANK YOU!
Until next time...
Dr. Katie Spruel, PT, DPT, CSCS
KS Fitness + Co, LLC
"Be still and know that I am God." - Psalm 46:10
Dr. Katie Spruell, PT, DPT, CSCS
I am a licensed Physical Therapist and Certified Strength & Conditioning Specialist practicing in Nashville, TN. I started a small private practice - KS Fitness + Co, LLC - in April 2018. Recently I moved my practice to Knoxville, TN.