More than 70% of you who read this article will have already experienced acute back pain at some point in your lives. The main causes of back pain can be sitting at a desk for prolonged periods of time, poor posture, grinding your teeth, lack of exercise and poor choice of shoes. Back pain is a theme that many people can relate to. This is the story about how I broke my back and dealing with back-related pain.
I broke my back after falling from a two story building. My L1 bone, one of the central bones in the back, shattered into small fragments. Within 48 hours after being admitted to hospital I had already undergone both CT and MRI scans, which showed an urgent situation: some of the pieces of bone were actually resting on the spinal cord, which meant there was a high probability I would be paralysed. When you break your back you are typically given two options that each have their pros and cons. The first option is that you can remain bed-bound in a brace until the bone heals well enough to support physical movement again, which is approximately six months. The advantage of this is you avoid any surgical complications, however you will likely suffer bed sores, extreme constipation and muscles wastage, and someone will need to feed, clean and care for you 24 hours a day. The second option is that you can go for surgery, whereby they insert titanium rods around the broken bone to stabilise and strengthen the area. The rods are strong enough to support your physical movement and the broken bone can mend without affecting your mobility. The risks related to this option are typical surgical complications such as infection, nerve damage, or your body might simply reject the titanium rods.
I wanted to go for surgery however with my touch-and-go situation there were few doctor’s that would dare to operate on me. With the fragments of bone so delicately resting on the spine, just one wrong manoeuvre would mean I could never walk again. Fortunately Dr Arun Ranganathan, one of the best spinal surgeons in Europe, decided to take a chance on me. He led a team of 3 surgeons to perform a 10 hour surgery at the Royal London Hospital, in the hope that I would be able to live a full and normal life. They cut 40cm lengthways into my back and inserted two long titanium rods with four screws to keep them in place.
I can remember when I first woke up from the surgery. My husband was standing by my bed in anticipation to find out if I could feel any sensation in my legs. My body was extremely heavy, I could barely move and my right leg was completely numb. The nurse came and attached a self-service morphine drip to me so that anytime I felt too much pain I could press a button attached to my wrist to administer the pain relief. She made me drink a big glass of water and take two paracetamol tablets and recommended I try and eat something. I was very concerned that I could not move much. A few hours later a physiotherapist came by to assess me. First he tickled my feet to see if I could feel anything and then he moved his hands up and down my shins and thighs to check the level of sensation. It was very good news that I could feel something and my left leg responded normally to touch. However my right leg was numb. He then encouraged me to try and get out of bed. At this point I had been lying flat on my back for almost 7 days and my muscles had wasted away considerably. Furthermore, during the operation the doctors had to cut into all the muscles in my lower back so they could operate and they were now extremely weak. I essentially had no strength. The best I could do was slowly sit up in bed, which took quite some time and effort, and then go back to sleep again.
Without the morphine I would not have been able to sleep because I was in a lot of pain. When you lie in the same position for a long time you become very stiff and uncomfortable and I did not have the strength to shift about or turn on to my side. I was also located in the trauma ward, and the other patients around me were also in a lot of pain. Every night there was the constant sound of people crying and screaming. From observing the other patients, I was able to guess the reason why they were in hospital as well. There was an elderly lady next to me who seemed to be suffering from a severe type of cancer. She could not move much and she never had any visitors, so she was very angry. She would shout and swear at the nurses and throw her food drinks on the floor, and in the evening she would scream obscenities. There was another elderly lady admitted because she was blind. She had been suffering from many earaches before suddenly losing her sight. The doctor’s were very interested in her case and some students came to interview her for a study they were doing. This lady was almost 100 years old so all the nurses respected her a lot and called her “mama”. She was not a very aggressive person, but she was very sad that she couldn’t see anymore and she was always sobbing and telling anyone who would listen that she was blind. Then there was another youngish lady with lots of make-up who had admitted herself because she had some hip problems. One day when she was leaving the pub she slipped and fell on the pavement outside, breaking her hip. She has had hip problems ever since and has sued the pub for a lot of money. She was always talking loudly on her phone and complaining rudely to the nurses for being so slow. Then there was the sweet lady in her 50s, who very carefully put her make-up on each morning before the nurses served breakfast. She experienced chronic pain in her legs and she had major surgery to correct it. She sometimes talked to her husband on the phone, but he never came to visit her because he was busy with work. She always tried to make lots of conversation with the nurses because she felt lonely.
On the third day after the operation the surgeons came to visit me to see how I was recovering. At this point I had only managed the strength to sit up in bed occasionally but I still hadn’t walked. Dr Ranganathan was angry and said that if I didn’t start walking right now I would never walk again. Muscles start to waste away after approximately 8 hours of inertia, so it was crucial I began exercising. I was so scared because I barely had the strength to lift my head, but the two doctor’s physically dragged me out of bed and forced me to walk. There was a big strong male nurse working on the ward that day and they called him over to assist. I had three people holding on to me as I tried to make my first steps. Because I had been on so much morphine, after about 5 steps I had the urge to throw up and started to scream. The nurse was very quick to react and he quickly grabbed a bin just in time. I then asked them to please remove the morphine drip from me because it was making me feel sick.
After their visit, the doctor’s instructed the nurses not to assist me anymore because I needed to start walking again. Up until now, I had been completely cared for. I had been hooked up to a catheter, which collected all my urine, and in the morning the nurses would wet my limbs with a soapy sponge to clean me. They would then change my sheets, which was a huge drama involving five nurses rolling me from side to side as they put the clean sheets on. There was a very witchy nurse on the ward, with pointy glasses and big bob hair. She unhooked my catheter, gave me a towel, and told me to go to the bathroom and clean up now that I could walk. I was very sad because so far I had only managed to walk 5 steps, and carrying a towel felt like carrying a heavy suitcase.
For the first few days after the surgery, walking to the bathroom was my main form of exercise. It was very physically exhausting and I would always need a nap afterwards. Gradually I began to gain more strength and by the 5th day I was able to go for a short warlk around the hospital. I suffered a great deal of pain, which was mostly due to muscle fatigue, but I had stopped taking any pain relief besides paracetamol and diclofenic, which is similar to Nurofen. By the 10th day the doctor’s decided I was well enough to go home.
My husband picked me up from the hospital with a big bouquet of flowers, a bottle of champagne and a platter of my favourite cheeses, and we went home to have a mini celebration. Although my muscles ached and I had difficulty walking, I believed the worse was over. Little did I know that my nightmare had just begun. However that night I enjoyed one glass of bubbly and had a great sleep finally in my own bed.
As I settled back into normal life, it was just a few minor issues at first that posed any difficultly, such as going to the bathroom. I still had a large plaster covering my back and I was not allowed to get any moisture on it until it was removed. I was also unable to balance on my own or lift my legs, which completely ruled out having a shower. At first I would fill the hand basin with warm soapy water and use a wet hand cloth to clean myself. Eventually I gained enough strength in my lower back to be able to lift my legs high enough to get into the bath, which was much more convenient for bathing. If I wanted to wash my hair my husband would have to do it for me as I could not bend my neck or reach my arms up. Another little issue I faced was my inability to bend. This made it difficult for me to do almost any kind of household chore. If ever I clumsily dropped something on the floor, which happened very often, I would need to wait for my husband to pick it up.
Three weeks after the surgery I began hydro-therapy. These are special exercises done in the water with a personal therapist to increase muscle strength. The water is very warm and in the pool you felt as light as a feather, which made it easier to move about. Around this time I also returned to work part-time. I felt like things were going in the right direction as my walking improved rapidly day by day. The numbness I felt in my right leg was also going away, but in its place came a sharp pain. Initially the pain would only start around 7pm at night, radiating from my hip down my right leg. It was bearable at first so I didn’t worry too much about it, however each day it slowly became more and more painful. I consulted my hydro-therapist but she was unable to diagnose the cause and put it down to the fact I was not walking correctly.
After 5 weeks of hydro-therapy I then moved on to land-based therapy. My physiotherapist was a young man called Adam who was the best therapist available at the Royal London Hospital. We did lots of exercises that strengthened the core muscle group as well as some acupuncture. Around this time the pain in my right leg had gotten considerably worse. Now the pain would begin at around 2pm in the afternoon and would gradually get more and more severe as the day went on. The only relief from the pain was to lie down. I asked my physiotherapist what it could be, and he suggested it was possible nerve pain caused from inflammation and that extra exercise would help. As the pain became worse and worse, Adam became more of a psychiatrist to me, as I would often cry in our sessions about the unexplained pain I was feeling. I also consulted one of the surgeons at the Whitechapel hospital who mentioned some other possible medical complaints that could be causing the pain and he gave me some paracetamol and tramadol to help manage the pain. Tramadol can be a dangerous and addictive drug, and I tried not to use it at first to manage the pain. However as each day passed the onset of pain would begin earlier and earlier and the intensity would also increase.
Months passed, with numerous doctor’s visits, MRI scans and X-rays. Nobody was able to explain the cause of the pain. I had tried the nerve pain medication Gabapentin which had little effect on my situation but my local GP kept insisting I persist with it. My only source of relief was Tramadol and without it I was no longer able to walk or put any pressure whatsoever on my leg due to the level of pain I was experiencing. I became desperate for some answers to my problem so I decided to explore other solutions on the internet. I came across a chiropractic website that advertised the activator method to treat nerve pain so I decided to give it a go. The owner of the clinic was a friendly blonde woman who treated me. Over the course of several weeks she tried many different techniques on my back including acupuncture, the activator gun, back manipulations, block techniques, stretching and even cracking my neck. Nothing worked and in fact my back now started to feel very painful, which I hadn’t experienced since my recovery from surgery. The lady said that in all her career she never had a patient she was unable to heal and she became desperate in her attempt to fix me, so much so that she even started to hurt me.
After a very long wait, I was finally able to get an appointment with the surgeon at Whitechapel hospital who had performed the surgery on me, Dr Ranganathan. After spending a very long time studying all of my x-rays and MRI scans he finally said that according the scans, there should be no problems. The bone looked like it was healing nicely and the metal rods appeared to be in exactly the right place. He said the only way to see precisely what was wrong would be to have a CT scan, which produces images with a lot more detail. However as CT scans expose the patient to 20 times more radiation than a regular x-ray, I would not be able to have children for several years afterwards as there would be a high risk of an abnormal birth. Dr Ranganathan understood that a CT scan was not ideal, and he even persuaded me not to have it. Instead he made a diagnosis based on my symptoms along with a physical examination of myself. He concluded that the metal rods on the right hand side of my spine were either trapping or rubbing against a nerve. This produced the severe nerve pain throughout my right leg and explained why the pain was aggravated by any type of movement such as walking, turning, or sitting. The only solution would be to remove the metal rods once the bone has healed.
It takes approximately 18 months for the broken bones in your back to heal. Damaged nerves repair at a standard rate of 1mm per week. It will be a long time before I can experience a normal life without pain. However, despite the long road to recovery, I was very relieved to hear Dr Ranganathan’s diagnosis as it finally provided me with some clarity. Up until that point I had been suffering for months without any idea of what was causing the pain or if it would ever go away. When I told people that my leg was sore, they thought I was exaggerating and told me to just take some paracetamol and “get on with it “. I don’t think that regular people can understand what it really means to have a painful leg. Nerve pain is one of the severest types of pain and for me it feels like someone is constantly stabbing my knee with a thick metal pole, whilst also twisting it. At the same time there is a constant sharp ache in my hip that radiates down the top of my thigh, making the leg feel very tight. Overall the whole leg feels like it is burning and freezing cold and it is throbbing with pain. When I step down on my leg, all of the pain intensifies by twenty. In addition to the nerve pain I do experience some very minor back pain, which is mostly muscle ache and bruising caused by the protruding metal rods in my back.
I have developed a good program for dealing with the pain and I am able to live a very normal and happy life. Exercise has made the greatest improvement to my quality of life. When I don’t exercise, I experience more muscle pain in my back and my nerve pain really flares up. I go to my local gym every second day and I use the cardio machines that target the core muscle group: stomach, buttocks and thighs. By strengthening this area it relieves the pressure on my lower back, which is currently carrying all the weight that normally would have been managed by the broken bones.
For more detailed information about living with pain, read my blog on living with chronic pain here.