From pain to strength, with purpose: My chronic pain story
by Anthony Berrick | August 4, 2020
In 2008, while driving to my first job as a provisional psychologist, I was injured in a car crash, which left me with PTSD symptoms and eight years of persistent shoulder pain.
My psychological ‘injury’ was treated successfully, but three years of passive physiotherapy treatments, steroid injections, pain medications and corrective exercises failed to relieve my persistent pain, and I resigned myself to living with pain as well as reduced mobility and strength.
In 2015, I was introduced to barbell-based strength training, which in turn led me to the sport of powerlifting. When I competed in my first novice powerlifting meet the following year, my shoulder was pain-free for the first time since the accident.
I didn’t fully understand the processes that had led to my recovery from chronic pain at the time, but in 2019, at a Sydney seminar with Dr Jordan Feigenbaum and Dr Austin Baraki of US-based Barbell Medicine, I finally began to see how the pieces of the pain puzzle fit together.
What I’ve learnt about chronic pain has changed my life for the better. I hope it changes yours too.
It’s funny how memories work, isn’t it? If you asked me what I ate for lunch last Friday, I wouldn’t have a clue, but I remember every detail about the accident over 12 years ago as if it had happened this morning.
I remember the feeling of shock and inevitability as an oncoming car turned in front of me across the intersection and I instinctively hit the brakes, knowing that it was too late to stop. I remember the confusing few seconds after the impact when silence replaced the sound of metal crashing into metal, and time stood still while my brain tried to process what had just happened.
I remember the pain.
At first I was winded, like I’d been punched hard in the guts, and it took me a moment to catch my breath. Then, as I shifted my body and reached my right arm down to release my seatbelt, I felt a sharp pain in my neck, which shot down through my chest and abdomen.
Fear began to set in as thoughts about whiplash and spinal injuries swirled through my mind.
I gingerly leant back into the headrest and kept my body rigid to protect it as I fumbled with my mobile phone, passing it to a kind pedestrian who offered to call for an ambulance.
I arrived at the nearby hospital barely 20 minutes after the accident, and then spent the next few hours doped up on pain medication, waiting to find out the full extent of my injuries.
Despite the neck pain, and some heavy bruising on my legs, abdomen and chest, the news was much better than I had feared: a small fracture was detected on my right collarbone, but the x-ray had found no other signs of damage.
I was discharged that afternoon with a sling to keep my right arm immobilised, a prescription for more opioids to manage the pain, a medical certificate for a few days off work, and a referral to a fracture clinic.
I walked home (my house was just a few hundred metres from the hospital) feeling upbeat. The consultant had reassured me that my injury was so minor that I’d forget which collarbone I’d fractured in six weeks.
The following morning, I was woken by my alarm in time for my fracture clinic appointment. Still half-asleep and foggy from the pain medication, I instinctively reached out my right arm to turn off the alarm on my bedside table. A big mistake.
I heard an audible cracking sound and immediately felt a sharp pain in my collarbone. I cried out and sat up clutching my right shoulder area with my left hand. I could feel a lump underneath the skin and the surrounding skin quickly turned an angry shade of pinkish-red.
The 15-minute snail-paced walk to the fracture clinic was agonising. Another hour-and-a-half sitting in the waiting room gave me plenty of time to dwell on my injury and imagine every possible worst-case scenario.
Finally, a second x-ray confirmed my fears: reaching my arm out to turn off the alarm had caused the fracture to displace. I can still clearly picture the image of the misshapen bone in the x-ray.
The orthopaedic surgeon reassured me that, despite how it looked, the fracture wasn’t too serious and the prognosis remained positive. Collarbones tend to jiggle around a bit, he explained, so the two halves of the bone should settle back into place without requiring surgery. A sling and more pain medication while waiting for it to heal would do the trick.
Physiotherapy and rehab
The next six weeks were fairly unremarkable. It was annoying as hell to have my dominant arm out of action, but the pain was managed well with over-the-counter medication and my collarbone slowly returned to a far more regular shape.
With the bone healed, I was given the all-clear by the orthopaedic surgeon to begin physiotherapy to restore strength and mobility to my right shoulder.
I dilligently attended my weekly physiotherapy consultations and performed the exercises I was prescribed, but progress was halting and I grew increasingly frustrated with the process as the weeks turned to months and my shoulder pain failed to improve.
I began to feel despondent about my shoulder, and feelings of resentment about the accident also affected my mood.
It was around this time that I started to notice physical symptoms of anxiety – racing heartbeat, ‘butterflies’ and light-headedness – when I was a passenger in a car or bus. Images of myself or loved ones being killed in a car accident started entering my mind, often in my sleep.
Fortunately, I was able to identify these experiences as symptoms of PTSD and I quickly made an appointment to see a psychologist for treatment. I experienced firsthand the effectiveness of exposure-based cognitive behavioural therapy, with my symptoms resolving after just a handful of sessions.
But my shoulder still hurt.
Over the next couple of years, I must have attended nearly a hundred physiotherapy consultations. There, I would receive ultrasound, massage and manual therapy – all of which I must admit felt quite pleasant at the time, but none of which seemed to have any more than a transient benefit.
I continued doing my at-home exercises, because I was determined to be a ‘good’ patient, but I found them incredibly boring and repetitive and, they too, did little if anything to improve my pain or shoulder function.
On several occasions, when the pain had been particularly bad for a week or longer, I was referred to a sports physician who administered steroid injections into my shoulder. Again, these provided some short-term relief, but I didn’t experience any lasting benefit, so the cycle continued.
I don’t remember the precise explanation I was given for my persistent pain at the time, but I was of the belief that there was some kind of underlying misalignment of the bones in my shoulder joint, resulting from the collarbone having been displaced, which needed to be fixed.
As far as I was concerned, I had a shoulder problem, not a pain problem. The term ‘chronic pain’ had still not entered my lexicon.
In early-2010, just over two years since the car accident, I received a call from my lawyer to inform me that the insurer had made an offer to settle my claim. I accepted without hesitation, relieved that the whole legal saga was finally over.
The first thing I did after I picked up the insurer’s cheque from my lawyer’s office was to phone the physiotherapist to cancel my next appointment. Without having to prove to anyone (myself included) that I was being a conscientious patient anymore, and having experienced virtually no benefit from the treatment I had received, I saw no point in continuing.
In hindsight of course, I realise I should have changed course much sooner than I did but, just as it can make perfect sense to someone to get their fourth spinal fusion surgery when the previous three haven’t worked, it made absolute sense to me at the time to persevere with the treatments that weren’t working for me either.
Ironically, this shift in focus – away from ‘fixing’ my shoulder, and towards getting on with my life – was probably the most beneficial thing I did for my shoulder pain.
Although feelings of frustration and resentment about my persistent pain lingered on, the less time and energy I spent focusing on the pain problem, and trying unsuccessfully to get rid of it, the less it seemed to bother me, and interfere with my life.
Starting strength training
There was still one area of my life that was significantly affected by my pain. Even though I hadn’t played competitive sport since high-school, I had always enjoyed playing sport socially, but every time I attempted to do so, the pain flared up, and I gave up.
As a result, I became far less active than I had been prior to the accident – for the next several years, a brisk walk was the closest thing to exercise that I regularly engaged in. Finally, in 2014, I bit the bullet and join my local gym.
I trained consistently and with a real sense of purpose. Becoming a father for the first time a year earlier had fundamentally changed my priorities, and I trained for my son as much as myself.
What I lacked in knowledge, I made up for in enthusiasm. I used all the weight machines the gym had to offer, but steered clear of the barbells out of fear of injuring (or making a fool of) myself. I did chest days, leg days, arm days, upper/lower-body splits, reps to failure, circuits, supersets, and everything else the internet told me to do.
I made about as much progress as could be expected from such a haphazard approach to strength training (i.e. nothing to get excited about), but the real good news was that my shoulder hurt less and less the more I trained – in fact, I often forgot about it altogether. The bad news was that my hip had started hurting instead, so I made an appointment with a physiotherapist to get some advice.
As luck would have it, the physiotherapist I saw was a powerlifter and so, rather than telling me to take a break from training, he encouraged me to start lifting with barbells and stop doing the reps-to-failure leg exercises that were probably putting more stress on my hip than it was able to recover from.
Since I had no clue how to train with barbells, I sought out the expertise of a qualified strength coach, who helped me with lifting technique as well as programming (i.e. which exercises to do, how often to do them, and how much weight to lift).
Over the following months, my hip pain resolved and I gained strength faster than I had ever imagined was possible – so much so that I even decided to take part in a local novice powerlifting meet to give myself a fun goal to work towards.
Powerlifting and coaching
Often confused with Olympic weightlifting, powerlifting is a much less technically demanding strength sport in which each competitor gets three attempts at three barbell lifts – the squat, bench press and deadlift.
That first powerlifting meet was a blast. Though my performance was no better than you would expect for someone who had only started training half a year earlier, I exceeded my expectations on all three lifts and felt more motivated than ever to keep training and getting stronger. The rest, as they say, is history.
Since that first powerlifting meet over four years ago, I’ve trained three or four times every single week without fail, making sure I find a way to train (with appropriate modifications if required) even when I’ve been sick, injured, travelling for work, or on holiday with my family.
Under the guidance of Joe Pemberton, strength coach and owner of Sydney Strength Training, I’ve since competed in several Powerlifting Australia sanctioned meets, and in 2018 I posted my first Nationals-qualifying total in the 105kg weight category.
More importantly, I’ve developed a much deeper understanding of the process of training for strength, and have come to appreciate the journey as much as the destination.
I’ve also been incredibly fortunate to have received coaching from Tom Campitelli, Dr Jordan Feigenbaum, Leah Lutz, and Dr Austin Baraki from Barbell Medicine, who are committed to helping individuals get stronger and healthier with an evidence-based approach to strength training and busting harmful unscientific myths.
In February 2019, I attended the two-day Barbell Medicine seminar in Sydney. As I listened to Dr Baraki’s lecture on pain and rehab, and reflected on my own experiences, as well as those of many of my clients, I finally began to understand how, without even realising it at the time, strength training had been the key to unlocking my recovery from chronic pain.
By focusing on getting stronger rather than ‘repairing’ my ‘damaged’ body, and by making careful adjustments to my training (courtesy of good coaching), in much the same way that the brain’s fear and anxiety system can be retrained to be less reactive to certain stimuli, my pain system gradually learned to produce less pain over time.
After that seminar, I was hungry to learn more, so I began reading journal articles and books by leading pain researchers and clinicians – in particular, Professor Lorimer Moseley, a renowned pain scientist, and Professor Lance McCracken, a psychologist specialising in pain.
Suddenly, all the pieces of the pain puzzle were starting to come together, and I knew there was no going back.
In October 2019, I completed the NCAS powerlifting coach’s accreditation to deepen my technical knowledge of the sport so that I could confidently coach others – I wanted to find a way to use my psychological expertise, as well as my strength training know-how and understanding of pain science, to help people who, like myself for all those years, were struggling with persistent pain.
Don’t get me wrong, I would never say that I’m glad I had that car accident – the psychological and physical pain it caused is an experience I wouldn’t wish on anyone – but if the end result is that I can help others who are struggling with chronic pain like I was, then I wouldn’t have it any other way.