I Was Tired of Feeling Broken

Shortly after starting nursing school in 2004, I started experiencing severe pain in my SI Joint region, and I would get random finger and toe joints becoming very inflamed. Then my rib joints, then my neck. It took a long time for any doctor to take a serious look at me because from the outside I was just a normal girl stressing out over nothing. (Girls and women are often taken less seriously than males and this creates a deficit in care).

I felt like nobody believed me, and I started to question my own sense on reality. Was I making this up? Am I making it worse? I even had one doctor tell me "it can't be that bad if you can sit that way" (sideways because it was the only comfortable way). 

[Let me expand: This doctor told me this while I was in the emergency department awaiting for an OGD (stomach scope) to see what was causing some bleeding. What was causing the bleeding was long-term excessive use of NSAID because I was in so much pain from my back and hips. I asked if they could X-Ray my back because I was taking all these medications for severe pain. They fobbed me off - because, in their opinion, I sat like I was fine - and never gave me that X-Ray.]

At this point I was tired of feeling both physically and mentally broken. Nobody was taking me seriously so I referred myself to a private rheumatologist (I'm from N. Ireland, which has public health, so going private is was a big deal).

Finally, someone took me seriously! Dr. Wright had me admitted to (public) hospital for a week of investigations: MRI, X-Rays (which, btw, showed severe bilateral erosive inflammation of my SI Joints), bloods, physical therapy in a soothing warm pool. At the end of that week I had a diagnosis and treatment plan.

They said I had some kind of Ankylosing Spondylitis, an autoimmune inflammatory arthritis. I was placed on oral disease-modifying medication to prevent further damage. It didn't do much for my pain, but I felt validated and safer that I at least knew what was going on, and no longer felt like it was some kind of illusion. I got some injections for my hands and feet and to this day I have never had any small joint pain (but that wasn't the end of my pain story).

My rheumatologist also told me to start exercising. He explained that movement would help prevent my spine fusing o_O  So I signed up right away for the university gym and there began my fitness journey. 

Movement certainly did help, but I was still in a lot of pain. I think in my mind I pictured the joints "trying to fuse" and exercise was fighting it back, breaking down whatever was happening. I remember wondering if I'd have to live with this pain forever.

[If you've never been in constant pain, it is exhausting. Your body and mind end up so drained from always planning how to do even the most basic tasks without it hurting too much.]

For a year or two, I exercised despite some (and sometime more) pain. I was afraid of my joints fusing, but on some level I was also afraid that this pain during exercising would damage me more. All I wanted was a normal life, without pain getting in the way of everything. Simply walking or rolling over in bed was agony at times. Surely there had to be a way to fix my pain!

Finally, a new drug became available to me on the NHS. My doctor prescribed anti-TNF/biologics (Enbrel) which almost took my pain away completely. I still had some low grade pain, but for the first time in years, it didn't interfere with my life, unless I was having a random flare-up. 

It was around this time I was introduced to strength training. And this is when things begin to take a strange twist...

While getting stronger did seem to help my pain, I also remember being was very focused and worried that I'd flare my pain condition, making something worse. I was always looking for ways to "bulletproof" my body. I'd read blog after blog about good form, posture, making sure all my workouts were perfectly balanced, that my spinal alignment was always neutral, and soft tissue work to "break down" that fascia.

But, in the "health and fitness" bubble, it seemed like every week there was a new thing to be concerned about. 

First: glute amnesia was the bad thing so everyone had to glute train;

Then it was shoulder "packing";

Then neck "packing";

Then 360 breathing;

Then core alignment;

Mobility etc etc.

Each of these things was framed through the lens of injury/damage prevention, corrective exercise, and even some kind of weird proof of your true fitness (if you put videos of you doing exercises online, you soon realize you need it to be flawless technique so people take you seriously as a trainer).

Exhausting!!

[Now, granted, my personality also played a big role here. I am a bit of a perfectionist AND am a recovering people-pleaser. The thought of "being wrong" or "doing it wrong" gave me so much anxiety, I became very rigid in my movement technique... that + pain = robot-Marianne.]

It wasn't until years later - around the time I met my husband (who's a Physical Therapist, and pain expert) - that I actually asked myself "are we really this frail?!". And now I can see it as clear as day...

People aren't frail; we've been taught to believe we are. And, the fitness industry continues to perpetuate the belief. Why? Well, turns out, this idea is pretty ingrained in society, and may be as old as ancient Rome. 

The history of organized fitness was a way of pursuing nobility and godliness. It's been viewed in many cultures as a way to become a more superior human. And in the modern West, it is commercialized and marketed in a way to exploit the social narrative that fat is bad and leanness is good and desirable.

Now, tie all this together with the medical world treating the body like it's a machine, totally separate from the mind. When something feels sore, we go to the doctor to see what could be wrong with the body. Sometimes, if there's nothing physical that can be found, we're treating like it's all in our head. And we all know how mental health issues are treated :-/

What we're left with is fear and shame about the body, fear of pain, and a feeling of not being/looking good enough if we can't attain the perfect body. 

It was around 2013 when I first learned about the Bio-Psycho-Social pain model. At first, I was curious, but it was hard to really understand it. It sounded like "it's all in your head". And it kind of is, but not in the made up sense.

Actually, everything is governed by our brain, even what we see. Our eyes don't see, they are a portal for light sensations and information to get to our brain to interpret. When things hurt, it's our body sensors taking information to the brain and the brain deciding whether that information is worth responding to. Sometimes it responds with pain. Sometimes it doesn't. It depends on many factors whether the brain decides an injury needs pain at that moment. Running from a lion? Pain won't help, so it's dialed down. Stressed about making something worse? The brain will often dial it up.

So, I learned that human beings aren't machines, and you can't separate the body from the mind. And even more than that, you also need to take into consideration the way we have been socialized. Rather than things afflicting the body, they afflict a person, which means our experiences of pain, injury are similar to the experiences of loneliness and emotional pain. The brain governs all of these experiences. Pain and suffering EMERGE from and loop back into the person's life experiences, beliefs, genetics, up-bringing, stress, activity levels, recovery levels, and many more factors.

Now let's circle back to my experience with pain. 

I was exercising out of fear of my back fusing. I was worried that I'd damage my body. I was worried I didn't move or breathe right. I thought I just needed a stronger core or glutes. And I had zero awareness of how beliefs and fear were actually impacting my body and mind. 

All this did was make me more stiff, more guarded and more fearful when I did get pain. In my attempt to pre-empt and protect, I created a different kind of pain cycle. My body was under-recovered from being tense, my mind was exhausted from being hyper-vigilant and always thinking about "moving properly", and I had no faith in my body after a years of feeling like it had let me down.

Where's the freedom in that? Where's the well-being in that?

Along with all this pain/injury-avoidance behavior, I also wanted to look a certain way. Lean, fit... IDEAL. 

Do you see the problem? I have always held a belief that I was broken, less-than, or dysfunctional, and fitness would fix me. I lost all sense of agency and self-efficacy.  Everything I was trying to avoid became a self-fulfilling prophesy. 

The point of this is not to scare you in the opposite direction. Nor is it to claim that these details never matter, they do matter sometimes. And sometimes they matter more than others. Sometimes "correcting" or modifying something does help, but that doesn't mean the lack of it was the cause (post-hoc fallacy). It just means, you changed something and it helped. 

What I do hope you'll take away from this is to ask why you want what you want. When you're doing fitness primarily to fix something or avoid something bad, in some ways you've already accepted that you're broken, frail, and not enough somehow. 

I want you to know that when you become health-seeking and look for what feels good - not what doesn't feel bad or what might feel bad (especially when coaches imply something is "bad") - you're embracing the premise that you come equipped - physically and mentally - for your next step. And if something hurts, it can heal, because our bodies are alive and don't wear out parts like a car.

In other words: I wish we'd stop trying to fix what ain't broke.

I realize this won't resonate with everyone. Many will disagree with my conclusions, and that's okay. All I know is I'd rather not let every ache and pain cause me to spiral into countless rabbit-holes, trying to find "what I did wrong" or how to "fix" it. 

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