Hip or knee replacement surgeries are no longer exclusively performed on older persons and are now not uncommon procedures for many patients with persistent, significant hip or knee pain. Good out ...View Article
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Posted on 09-13-2016
My wife likes to make fun of me because I am always injured. For my whole life I have played every sport you can think of — minor injuries come with the territory. From pulled hamstrings to sprained ankles and jammed fingers, I have had it all.
One day in my late thirties I was at the rock wall at the gym — bouldering, which means no ropes — and I fell. It wasn’t too far, maybe about 15 feet off the ground, and I landed on a mat. I felt a twinge in my low back but all seemed well. I played in a few soccer games that weekend, and my back felt a little funny.
A few days later I woke up in the middle of the night and I couldn't move from the waist down. Every inch sent excruciating pain and stabs of electric shock through my spine and down my right leg. I crawled like an injured soldier, dragging my dead legs behind me along the ground, to get to the bathroom. I had to manually pull up my right leg in order to urinate canine-style. The realization slowly enveloped me that I had suddenly become my own worst patient. I was terrified.
When I got up the next morning, I reassessed the situation. The pain was traveling down my low back, down the right leg all the way to the foot. I could stand on my left leg, but I couldn't put weight on the right leg. I was unable to contract the muscles in my right leg at all. I was initially unable to find any position to relieve the pain.
All I did every day at my office was preach to chronic pain patients that surgery wasn’t always necessary, that most pain could be solved with the right combination of manual therapy, exercise, and an anti-inflammatory diet. That the human body is able to heal itself. That chronic pain is not necessarily permanent and there is always hope. Suddenly, I felt like God was playing a practical joke on me.
I limped directly to the nearest MRI machine. I treat acute pain patients all day long, and suddenly I have become one. To be the one with the severe pain was pretty humbling. I fully felt the irony that I was a chiropractor with a back problem. I was supposed to be the healthy one. The strong one. The one giving other people advice. Now I needed some.
After the MRI was complete, the doctor reviewed it and shared with me that I had a 15 mm disc bulge, which is severe. He said I would likely need surgery. He said this was not going away. I felt defeated. Crushed.
I went home and talked to my wife. She was pregnant with our third baby, and our twins were 2 years old. Bad timing for a major setback. I had to figure out how to keep working and solve my back problem at the same time.
I was against getting surgery. I have many patients who chose the surgical option and still had pain. They are the hardest for me to help because many have hardware in their spines, which prevents movement. When an area can’t move, generally it loses function and deteriorates. My job is all about movement. I move people’s bodies around until the parts are back in the right place. If a patient jumps straight into surgery, they have bypassed the opportunity to heal naturally and instead have done something permanent, which can be harder to come back from.
I decided to take my own advice: start a nutrient-dense, anti-inflammatory diet to promote healing, determine what exercises would strengthen the area, and have my manual therapists work on me frequently. Hopefully my multidisciplinary approach would suck the disc back into alignment. And all the while I had to keep working — bending over patients and manually pushing and pulling their bodies around to figure out the puzzle of their pain while ignoring my own.
This was a grueling time and there were many moments when I almost gave up and had the surgery. At one point we had to fly to Minnesota. I had to manage the airport and plane with twin toddlers and a pregnant wife, all the time in agonizing pain. The trip was a nightmare. The only comfortable position for me was “tummy time.” Yes, lying on the floor on my stomach with my back deeply arched like an infant. Try that at the airport. Then explain to people that you are a chiropractor with a disc bulge.
At my lowest lows I will admit that, although I am an advocate for natural healing, I did rely on prescription medication. Our nation has a huge problem with prescription addiction, and it makes managing pain challenging for medical doctors who rely on prescribing it. I didn’t want to take medication myself, but I had to function: to work, to play with my kids, to help around the house. I do believe temporary pain medication can serve a purpose: to allow temporary relief from acute pain in order to exercise, improve posture, and eventually heal. If you are stuck in bed and you can’t move, healing will be very slow. Motion is life. Restoring proper motion and function to the area is what allows rapid healing. If temporarily taking an anti-inflammatory allows for that, so be it.
Around this time, I made an appointment with an NMD friend and colleague of mine who does natural injections to heal joints: prolotherapy and platelet-rich-plasma (PRP). Both procedures involve natural ingredients injected into the weak area, in order to strengthen the area and promote healing. I believe this treatment was a key part of my multi-disciplinary recovery. What kept me going were the minuscule improvements. Day after day, week after week, I did start to see myself recovering. It was slow and tortuous, with many peaks and valleys, but eventually my body did heal. It took two years.
My knowledge about biomechanics told me my low back had always been lacking the proper curve, making it weak and therefore susceptible to the bulge occurring. I also realized that I had not been exercising consistently enough — only playing contact sports on the weekends — another contributor to my weak low back.
I had to restore the curve into my low back and strengthen it with targeted exercises. I also strengthened my core and worked on having strong posture in everything I did. My pain would diminish if I exaggerated “correct” posture, with my chest and buttocks pushing outward. The lessened pain motivated me immensely to turn this situation around, so I could show people that it works. It is possible to heal yourself, even in an extreme situation, without surgery.
I went to the gym almost every day, figuring out which specific exercises relieved my pain. I don’t believe a pain patient should exercise into pain. Therapy shouldn’t be painful. Instead, I look for movements and postures that decrease pain and strengthen weak areas. For instance, regular squats killed my low back — so I used an exercise ball between my back and the wall, arching my low back slightly, taking the pressure off my low back and putting it into my legs. If you have bad knees this option is not for you, but my knees were strong. This is a great example of why exercise routines should be custom-tailored to individual patients.
I gradually increased my exercise routine until I was exercising vigorously. I incorporated yoga into my schedule, which focuses on posture, strength and flexibility. I had my therapists work on me often, digging deeply to release the fascia throughout my body, to improve my posture and allow healing. The whole body is connected by soft tissue called fascia, so if you release the fascia in the hamstrings, those muscles stop pulling on the low back. Eventually, the disc bulge was gone. My physiatrist friend was impressed. My MRI doctor was surprised. I was happy.
I was no longer a weekend warrior. I was listening a little more carefully to the signals my body gave, felt the power in a regular exercise routine, and had the satisfaction of achieving my goal. Now I’m 46 years old, and I still play soccer and fool around on the rock walls, but I know my limits and work hard to keep my body strong and pliable.
I learned so much from having to go through my own battle with pain — about myself personally, but also about how to heal patients. Not only do I now have unique empathy for my patients, but having my own therapy performed on me helped me refine aspects of the therapy itself and improve the process. My philosophy was strengthened; when we have advanced alternative and medical procedures, there are a multitude of options. Start with the most organic, least invasive procedures and move toward the less organic, more invasive ones. There is nothing to lose in that approach.
My largest lesson learned is this: If you are firmly dedicated to learning how to solve your own personal pain puzzle, it’s entirely possible.
Bio: Dr. Marc Bonacci is a chiropractic physician certified in physical medicine modalities and therapeutic procedures. For 18 years, his compassionate and creative approach to solving chronic pain issues has led him to develop a system in which he manually aligns nerves, muscles, connective tissue and joints to re-train the posture and allow healing. Learn more about The Bonacci Method of Regenerative Alignment at arizonapainandposture.com.
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