A Painful Yarn part one

I was riding my bike on my normal route to work. Then it happened, like a blink. A jeep that was not supposed to be there was there, coming at me. No time to change course or apply brakes, just brace for impact.

I was headed west bound on a two lane road. Entering a light controlled intersection on a green light.  A Jeep Cherokee in the opposing left-hand turn lane crossed traffic and met me.

We hit in an instant. I recall my first instinct being to tuck, get on the hood, and drop my head (to roll over). Truthfully, I don’t know if those cognitions came during or after the fact. I do remember a sense of hardness; a hardness that meets you and tests your entire will to stay in one piece. In all my years playing football (American), I have never felt something so strong that it threatened to tear me limb from limb. Next came the weightlessness and spinning. I remember thinking, “well this is good”. Between the twisting on multiple axes, I was senseless to right myself. Then, the fall, as I hit the ground all the worldly sensations came rushing back into me.

Pain entered hard through the legs, and left side of my spine; I instantly felt my entire left side recoiling. Knowing, I was somewhere in the middle of the street, where more traffic could meet me I rolled left, saw the car that hit me turn around, rolled right and attempted some primitive crawling motion, unsuccessful. I succumbed to the sensations, put my head on the pavement and breathed. I told myself the damage was done, and in time my body and mind would heal—I just had to breathe through this.

At my awareness of the first responder standing above me, I started groaning and screaming, nothing intelligible, he looked scared. I told him to give me his hand, he was reluctant. I said, “Just hold my hand!”  Moments later the paramedics were there, my spine was cleared and it appeared that none of my extremities were grossly out of alignment—a relief.

I have a vague sense of coming down in a crumple, with my left knee coming down underneath me, pinned into internal rotation, valgus and flexion—“that does not look right”, I can remember thinking.

Ambulance, more groaning, all I want to do is groan and move. Not stand up, but just escape the onslaught of sensations that were bombarding me.  A short ambulance ride and I was in the emergency department. It took an absurd amount of time to get me off the stretcher and out of the neck collar. I knew my neck and lumbar spine were fine, even though my pelvis and spine were locked in spasms that were progressively crawling up my back; I laid there for 30 min or so. They tried to keep my legs straight—which once the spine was cleared makes absolutely no sense. The only thing my body wanted to do was curl up into a ball, a ball so tight that I could appease the rapidly building tension in my abdominals, psoas, and hip muscles.

The medical interns performed the standard procedures, they asked me to rate my pain, I said, “1”. Which is strange, clearly the magnitude of collision would deem a higher level. I just hit a car head on going probably 20mph, while the opposing vehicle went at least 15 mph; I flew maybe 10 to 15 feet; my bike was crumpled, the windshield shattered. The cross bar of my bike that was next to my left knee was bent at least 10 degrees. Was I trying to just, “be a man”, I don’t know, but I knew that what I was feeling at this point was largely alright. Most of my extremities were fine. I was mildly concerned about a tibial plateau fracture and or fibula fracture. My discomforts were telling me to move, and keep moving so to register this as pain did not seem correct.

X-rays negated fractures in my legs, and I continued to wait in the ED. I turned down taking pain meds, because I wanted to do an n=1 experiment. That experiment being: first, I wanted to really feel, clearly, moment-to-moment what my body was going through; second, I also wanted to understand this idea of ideomotion—holding the intention that movement is “okay” despite pain and that doing this will lead to an instinctive motoric response which will guide me towards the resolution of pain (read: William James); third, I wanted to experience what it was like to have “counseling” and how that affected my pain symptoms.

With regards to counseling, a little background is necessary. I am part of a community of people whom meet regularly to counsel each other. We are not professionals, but more like friends, we do not offer advice, but serve as partners for listening. How this works: each person trades time listening to the other. Trading time means that one person gets the undivided attention of the other while that person talks, laughs, cries and shares whatever they have going on with them. The goal is to give undivided and nonjudgmental attention to the other (read: gestalt acceptance theory for a near equivalent). So when I refer to counseling that is what it is….

Click here for Part Two of Erik’s Painful Yarn

About Eric Kruger

grey A Painful Yarn part oneErik is a blogger (The Physio Manifesto) and staff physio at Denver Health—the Rocky Mountain Region trauma hospital and community health safety net for Denver, Colorado.   Eric works with, the gamut of neurological, trauma, sports orthopedic, persistent pain and medically intensive patients.  When not working Eric enjoys a sophomoric interest most things adventuresome and recreational while constantly being embroiled in the question of: “What is next?”

You can follow my recovery at Soma Simple

 

 

Comments

  1. After what I’ve been through I’m not so sure about this: “holding the intention that movement is “okay” despite pain and that doing this will lead to an instinctive motoric response which will guide me towards the resolution of pain (read: William James)”.
    I did that too after a fitball I was sitting on burst and I felt the ‘hardness’ of the concrete to my pelvis. After the shock and initial freeze was over I crawled to concrete and actually laughed at myself. it hurt… After the investigations I kept going thinking it was all fine, it’d be over in 8 weeks. I pushed through pain, it was only pain… I stood up and sat til i could’t and then would lie down in the middle of the office until the pain became tolerable and I resumed… on and on….
    I’m at the 6 year mark now. I have pudendal Neuralgia and i wonder most days if I had rested and listened to the pain would I have recovered better? would I have not taught that pain tune… did something need rest?…
    I hope you’re ok. What a terrifying experience.

    Eric Kruger Reply:

    Hi Soula,
    Thank you for sharing your experience as well. Rest assured I have questioned my own advice. I think every injury is different and amount of physical trauma does not correlate with pain. Additionally, underlying mechanisms of pain may be drastically different and ‘simplistic’ advice such as mine may be wholly insufficient to resolve complex pain.
    I have worked with patients with different neuralgias and CRPS to find that too often my advice and interventions can be completely ineffective. Despite this, I think humbly imparting early (acute) education, knowledge and the permission to move can be a catalyst for resolution in some but not all cases.
    To help clarify: my experience with patients in pain (persistent/acute) is not a philosophy of “push through the pain” but one of listen to the changes that movement may play in changing your sensory/pain output. To pick up on leads/directions that signifies ease/comfort and move toward them. Often these types of directions are not focused on a functional output but an inward sense of movement/position/interoception. As pain (hopefully) abates we transition awareness from inward domain to the outward (functional) output.
    Your comments expertly highlight the tricky tight rope we as therapists are required to walk with our patients every day. I wrestle with this question at every day: encourage movement, encourage rest, is there an actual threat I should seek more qualified information to answer what that threat is–by no means can be definitively answered.
    I see patients that I know need to move, orthopedically speaking, yet they are struggling to manage their pain. Encourage them to move so they protect themselves from long-term functionally limiting contractures? Or push through the pain so they are more comfortable in the moment? Do I risk creating central sensitization of their pain if I apply vigorous joint mobilizations/stretches? The best answer I can provide is: the more the patient thinks like me (through imparting knowledge) and me feeling like them (through using my own mirror neurons) all the while empowering the patient’s locus of control, we can figure out a way forward together.
    I am okay, as I hope that you are doing well too. Thanks again.
    Eric

    Eric Kruger Reply:

    This line should state: “Or dial down the movement stimulus so they are more comfortable in the moment?”

  2. Fascinating read, Eric, and it’s serving as the impetus to reflect on my own recent experience of being hit by a motorbike in India. In the midst of the shock I took myself through the same observation and listening-to-my body approaches that I lead my chronic pain patients through in yoga-based movement classes.

    The hospital offered sedation and feed me pain killers, which I declined for two reasons: firstly, I wanted to tell the difference between drug-related dullness and the side effects of being hit on the head! The second reason I think is much like your n=1 experiment (love the terminology, by the way) to let me be my own body’s barometer for what was going on.

    Agree with the discussion above that there is a big difference between pushing through the pain and attuning yourself to work with it. Perhaps shows the importance of the work happening in this field to enhance our own proprioception so that when something happens, it’s a much more natural thing to do.

    Looking forward to part 2.