I wake as usual in pain.
It’s not an instant pain. But it’s sudden enough.
A slow, increasing, deep ache has started worming its way through my mid back. It forces my befuddled, sleeping brain out of the cleansing peace of unconsciousness.
I roll on to my left side, trying to shift my shoulder downwards and elevate my hip. I’m trying to straighten the slight scoliosis in my lumbar spine, to alleviate the constant stretch of the left lumbar paraspinals.
They have spasmed in the night, or was it in the morning?
Predictably, it does nothing.
I crack an eyelid, glancing at my watch.
I could just get out of bed and haul my stiff and sore, tired body off my mattress. You know, go walk the pain and stiffness out.
I have done that previously of course. Painfully rising like a blind Lazarus. Stumbling around in my purple, Phantom boxers, bleary eyed on the driveway. Frightening passing, early morning joggers.
It’s the only thing that will definitely alleviate the pain.
But I’m tired, and pain has a way of sucking motivation.
Against my wiser judgment I had once again succumbed to lure of the late night smartphone, like a gambling man on a slot machine. Tumbling down the never-ending wormhole of YouTube.
I probably deserve this punishment.
“Never again I promise”.
But I want and crave more sleep.
I don’t even attempt to lie flat on my back or front. Such movements and positions are excruciating. It’s like trying to sleep on your back while balancing on a metal bollard.
A constantly protruding, pain.
Thrusting deeply and relentlessly, into my spine.
I sit up into a slumped position, using the soft bedhead to support the lower thoracic region of my spine.
This gives a mildly relieving traction to the bulging and damaged disc between the 9th and 10th thoracic vertebra.
Placing a pillow behind my neck and shifting my pelvis forward, I allow my thoracic spine to distract.
The pain drops by a few percentage points. It’s like precious water on dry cracked lips. I need and crave that blessed relief.
Yes, Its textbook bad posture.
But the slumping traction relieves my pain by half.
On a good day when the pain is mild, this technique will work. It will allow me an extra hour of upright, fitful sleep.
If it’s a bad morning, the pain will relentlessly increase till I am forced to move out of bed.
For 2 years now I have experienced these symptoms.
Why, you may ask?
I’m a chiropractor right? My back, the back of Dr Jonathan King, Chiropractor at King Chiropractic, should be perfect… right?
“He shouldn’t be suffering with back pain”.And if so why is he? Does he practice what he preaches? Surely he should be able to get out of back pain?
Everyone suffering back pain asks “Why?”
I am no different.
Why am I feeling this? Was it that snowboard accident years ago? Have I inherited a genetic weakness or some arthritic condition? Is it some heritable curse which will haunt me for years to come? Could it be a slow growing tumour?
It couldn’t…could it?
Such is the mind of man in pain.
A sensory schizophrenia that drives fear and uncertainty, washing away all rationality.
“Why am I feeling this?”
People were asking, “Why Me?” back in the time of Caesar Augustus. Governments are still asking why today.
It’s more useful to focus on the reality of the present and plan to improve the future.
Focus on the now… and the how, rather than the regrets and injuries of the past.
Pain may be inevitable, but suffering is a scale of experience that can be chosen or changed.
Unfortunately, long- term suffering is often chosen.
We are so often the authors of our own destruction.
How will you alleviate your suffering in the present and for the future?
Taking the easy option of regret and resentment may give short-term relief.
I understand that.
“Just take it easy right?” Such is the non-exertional, soft poison ideal of mediocrity and self-deception.
In actuality, actively working to improve your pain reality for the long term will alleviate your degree of suffering.
Not now probably, but in the future.
This is the comfort that I take for my pain.
I try to stay fit. I paddleboard, run, swim, surf and do bodyweight calisthenics. I endeavour to engage in good self care, and frequently, I do fail.
I don’t eat well at times, and often smash the pastries and chocolates. It takes visible and palpable effort to continually course correct and choose the better path. Trying to make things better by gradually changing habits is something that is honourable and meaningful.
Choose to be better.
And Nick treats me regularly. Chiropractically I mean.
How regularly? At least once per week.
I know what you’re thinking. “I cant afford that Jono!”
But consider my individual situation. I have multiple vertebral endplate impressions, low back degeneration and discogenic pain. Combine this with a very physical job, (ironically being a chiropractor creates huge strain for the low back).
Therefore, regular Maintenance Care for my back is essential. It keeps my pain and discomfort from spiralling out of control. It allows me respite from the pain, to reconnect with attempting to make life meaningful and to strengthen my resolve in becoming the best version of myself.
I can’t get a decent night’s sleep without regular care.
If I miss a treatment my sleeping time cuts down to 4 hours a night within 2 weeks.
So how much treatment is good for you?
To answer this question let’s take a moment to define our terms and frame the subject clearly.
Most treatments performed by chiropractors can be divided into two phases.
The initial phase of treatment attempts to bring the problem back to its pre- clinical or maximum improvement status. This is usually around 4 treatments (Senna MK, 2011).
The second phase of treatment is maintenance care, which is aimed at maintaining this status (Axen et al, 2008).
Maintenance care aims to prevent further painful events happening, or maintains an incurable condition at acceptable levels.
Symptomatic care is when patients experience pain and come in for treatment when they feel like it. They usually stop care when the pain goes away.
When my brother Nick treats me he is attempting to maintain my chronic, “incurable” spine problem at an acceptable level of function and to minimize my discomfort. He is giving me ”Maintenance care”.
If I wait 3 weeks and my spine locks up into a brutal spasm and desperately seek treatment from Nick because I can barely function, I am utilizing “Symptomatic Care”.
So which treatment option is better? How would we even measure and investigate that?
Well, we could compare the amount of days spent suffering in pain over a year period, for people receiving maintenance care in comparison to symptomatic care.
Lucky for us these questions were recently scientifically investigated with clear demonstrable results (see below for the link to the study).
Eklund et Al compared 328 patients who responded well to an initial phase of chiropractic care (around 4 treatments). They found that the patients allocated to the Maintenance Care group experienced nearly 2 weeks (12.8 days) less in pain than the symptomatic care group over a year. Interestingly the Maintenance Care group only used two (1.7) visits more than the Symptomatic Care group over the same year.
Put another way, for 2 extra treatments over a year, Maintenance Care gives an additional 2 weeks of pain free days compared with symptomatic care.
If you have a positive treatment result and get better within 4-6 visits, you should consider Maintenance care to optimize your low back health.
Potentially, you will experience less pain, move and feel better and perform at a higher level of function.
Maintenance Care may be every month; it could be 4 times a year or even once a week. It is different for different people and requires and individualized approach.
Maintenance Care enhances biomechanical joint function and neuromuscular control, while aiding psychological health.
I recommend Maintenance care as treatment option because of my personal and clinical experience both in suffering and treating low back pain. My experiences and expertise are supported by the literature.
However I must emphasize that I do not force any treatment option onto my patients. If you benefit from Maintenance Care and value it, then I will see you sometime soon. If you are happy to only see me when you feel sore, then I will treat you to the best of my ability.
Your health in the end, is in your own hands, but if you choose to put your trust in my hands then I will endeavour to improve your quality of life with all my hard learnt skills.
So what about your pain experiences?
How have they affected your life? What have you done to alleviate your suffering? Has anything cured you? Please let us know and contribute to the conversation.
Dr Jono King,
Senna MK, Machaly SA. 2011. Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976). Aug 15;36(18):1427-37.
Iben Axén et al. 2008. The Nordic maintenance care program – case management of chiropractic patients with low back pain: A survey of Swedish chiropractors. Chiropractic & Osteopathy 16:6
Andreas Eklund et al 2018. The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. Published: September 12