On Working Through The Pain

Physical therapy, breakthroughs, and how it can all go to hell when you get sucked into your next Thing.

I wrote the bulk of this essay in a mad rush one night, about a month ago. I was so excited to have written a whole first draft in one session–this being the first time in years that I’d drafted anything in one session, because my chronic wrist pain made that impossible starting in 2018. Happy to have a first draft in hand, I naturally procrastinated on revising. And then Putin invaded Ukraine, and this very personal essay about my chronic pain journey seemed unimportant and trivial.

It still seems unimportant to me when I compare it to the overwhelming terror of current national and world events. But my body, and how my relationship to it has changed, is not at all trivial to my life, and I appreciate my past self (that guy from February already seems like a version of me from ten years ago) for articulating the most crucial of those changes. I am giving those words space here. 

My 2022 kicked off with severe mental health turbulence, veering from high highs to low lows, and as has been the case for much of the past three years, the trigger for my depressive periods was the chronic pain in my arms. This pain started with my wrist tendons in summer 2018, then traveled up both forearms to my elbows, upper arms and shoulders. The pain is exacerbated primarily by texting and typing, but also by household chores, holding a paperback book, and almost anything else that requires using my hands. Last year I had surgery on both wrists to repair the tendons, but despite the 12 weeks of medical leave that the surgeries required, the pain persisted. My surgeon and my occupational and physical therapists were perplexed. No one could give me any answers.

Once I recovered from the second wrist surgery and was sent back to work full-time, only to realize that I still couldn’t type for more than 20 minutes without hurting (let alone texting or scrolling social media, activities that brought on the pain even faster), I was plunged into a pit of mental despair. I felt that I was wrestling with myself, with the medical establishment and the American healthcare system, with capitalism itself. 

And then in February, I experienced some kind of eureka moment in my understanding of how my muscles worked together. This moment arrived in the aftermath of my impulsive, depressive decision to quit going to physical therapy. Between October 2020 and December 2021, I was going to physical and/or occupational therapy three times a week, in addition to appointments with my surgeon, appointments for trans-related healthcare, appointments for expensive medical tests, etc. When 2022 began I was desperate for a break from all the medical appointments, a desperation that outweighed any belief I had left in western medicine’s ability to help me. When I came back home after visiting family over the holidays, I put off going back to physical therapy, at first telling myself that I just didn’t have the wherewithal to make a scheduling phone call that day but that I’d do it soon, and then eventually I stopped lying to myself about having ghosted my physical therapists. 

I had lost hope that the pain would ever get better, though this phrasing is not quite right. It’s more that I traveled past a place of lost hope and to a place of acceptance. Instead of struggling constantly with my arms and their fragility, my thoughts turned to how I might plan for a life with a permanent disability. I faced the possibility that I might never be able to work a full-time office job without being in great pain as a result, and frankly fuck that trade-off. I resolved that if my arms did not fully heal in the near future, my next job would not be a salaried office job, even if that meant taking a pay cut.

Then I had some kind of epiphany while working on my posture. I had tried to attack my tendinitis via improving my posture before, as an MRI had confirmed that some of my arm pain was likely originating from my cervical spine, traveling from my neck through my shoulders and down to my elbows and forearms. Terrible posture while working and texting had exacerbated this, but I’d quickly given up on my previous attempts to correct my posture when they made my neck and back incredibly sore–the opposite of what I thought needed to happen.

The same thing happened this time around. On a Monday I began paying sustained attention to my posture while working, and I found myself too sore to turn my head or sit up straight by Wednesday. I assumed I was doing it wrong but that ‘fuck it’ zen attitude that can sometimes accompany depression made me keep going; some of the habits had become compulsions, and I began obsessing over the ergonomics of my desk setup and how it affected my posture. 

Of course these were all things that I had tried before, but this time something clicked in how I understood what my muscles were doing, how my neck and shoulders and spine and arms all worked together, and what they needed in order to stop hurting me. While much of my idle time in the past three years had been spent, in vain, trying to convince my arms to stop hurting (I’ve developed habits of massaging my forearms, wrists, etc, any time I have nothing to do with my hands), suddenly that obsessive focus turned to my benefit: when I got distracted from work (or writing, or household chores, or showering, etc) by trying to stretch or massage pain and stiffness out of my limbs, I saw results, and my body responded by gaining strength, flexibility, and showing me that it could respond to my desperate desire for alignment if I gave it the proper attention.

I cannot overstate the distance between this new progress and the stagnation that preceded it. Both before and after the surgeries on each of my wrists, when I would try to massage the huge knots of tension out of my forearms, the knots would persist despite my best efforts, and I would be left with arms covered in bruises and no pain relief. The only thing that helped was ice and heat, and even when those modalities successfully relaxed my muscles, the knots would reform as soon as I continued to work. All this while going to physical therapy, resenting how much time I had to spend at physical therapy appointments, while also berating myself for failing to do my physical and occupational therapy exercises at home. Why couldn’t I muster the self-discipline to do these simple exercises every day at home? Did I not want to escape this pain badly enough? Why couldn’t I pull myself up by my TheraBand bootstraps?

***

Experiencing a real and sustained decrease in pain kicked my enthusiasm for exercise and stretching into high gear. In particular I became so obsessed with posture, ergonomics and alignment-in-general that my wife has occasionally teased me about the bizarre contorted shapes she would occasionally catch me in while trying to work the kinks out of my back. 

This obsession paid off. Fixating on my posture was difficult at first, when my muscles were so stiff and my shoulders so rounded that it hurt to get anywhere close to correct posture, let alone keeping the form for hours as I typed all day. But after an initial painful few days, I found that muscle memory had become my friend. Imagine! Aside from walking my dog, my life since the pandemic began has for the most part been wretchedly sedentary, and I have no idea when was the last time my muscles remembered to do something positive and good. 

But there’s a reason that “just like riding a bike” works as a simile for so many people: muscle memory can send us back through time or anchor us to the present. It can be a superpower, a crucial piece of the dazzling puzzle that is humanity’s adaptability. Reconnecting with my physical intelligence has been tremendously empowering, the kind of rush that unlocked my motivation to not only schedule extra time in my day to work on my stretches and exercises, but tempted me to blow off all other responsibilities and pastimes in favor of working on my own strength. I  found a YouTube channel run by physical therapists (aimed squarely at the senior citizen demographic) that satisfied my obsessive desire to learn everything I could about how my muscles functioned. It would not be far off-base to say that for a while there, I had joined the at-home physical therapy fandom.

This enthusiasm hasn’t been a miracle cure, but every day I have been getting noticeably stronger and more limber. If I keep getting better at this pace, then an actual full recovery could be around the corner. It is unbearable to let myself hope for a light at the end of this tunnel, but I have to admit that the scenery around me seems to be getting brighter.

***

That preceding paragraph was written by the most hopeful version of Past Me, who didn’t want to believe that my enthusiasm would peter out and leave me with the same time management difficulties (how the hell do I find the time for physical therapy and writing and work and and and and) as I had before. The original draft of this essay ended with an impassioned screed against the entire concept of “working through the pain,” whether you are working at your own art, working in an office, or working in a factory. 

But as I said up top, that first draft was written pre-Russian invasion, and as soon as that happened my focus on my own physical strength flew right out the window. I am particularly fond of these two paragraphs from Past Me, Pre-Doomscrolling-War-Twitter Me:

I wish that I could take enough time away from my desk job to apply my newfound physical therapy knowledge without having to also do daily damage control to heal from working at a computer 40+ hours a week. I wish that capitalism in America did not force so many of us to work through pain, to distort our limbs over time in order to meet the demands of productivity, to chip away at our body’s miraculous capacity to recover both because we have to and because we have been indoctrinated with the lie that working through pain is an admirable thing to do. I am one of the comparatively lucky ones in this country, with a salaried white-collar office job and good health insurance, and I was able to work from home during the worst of the pandemic. Yet still the dominant struggle of my third decade has been the fight to not let my body be destroyed by my job.

You want to know the single biggest change that I have made in the past few weeks, the actual magic secret to getting better? I’m hiding it here, at the end, because I have irrational paranoias about employers reading anything in which I admit to not being a perfect worker. Here’s my magic secret: I no longer work through pain. Ever. If I’m working, too bad. If I’m writing, too bad. I refuse to work through so much as a god damn headache, not for myself and sure as hell not for anyone else. I’m done.

I have such affection for this version of myself, this naive lad who thought it was possible to stay so fully present in my body that I could stop whatever I was doing and address pain when I felt it. But then the invasion of Ukraine happened, and that became the only thing I could focus on for weeks. (You can imagine the toll that took on my mental health.) I dissociated through my work days, and I sure as hell was not taking breaks from twitter or the news to do my stretches or physical therapy exercises. I ignored my body’s pain signals over and over, as if they were happening to someone else. And I could not blame all this working (“working”) through the pain on my employer or on toxic internalized capitalistic ideals. It was coming from me. It’s just something I do, sometimes, when I’m sufficiently driven. I suspect I’ll be catching myself doing it for the rest of my life.

However, I am ecstatic to report that the pain in my neck and arms remains vastly decreased since the beginning of the year, and those weeks I spent determinedly focused on recovering my strength and posture continue to pay dividends. Enthusiasm fades, but the body remembers.