"I Started to Feel Like a Fraud." When Pain Disappears the Moment You See a Healthcare Professional.
Topic: Why pain comes and goes, fluctuating pain, mechanical low back pain, back instability
This story is inspired by the many people we've cared for over the years. Names and details have been changed and combined to protect privacy. If you recognise yourself in this story, you're certainly not alone.
Harry’s story
Harry worked at a desk all week. Monday to Friday, he spent most of his day sitting. Come the weekend though, he was a different person. Long bike rides, a round of golf, DIY in the garden and helping friends move furniture to name a few. He squeezed a week's worth of activity into two days and, more often than not, his back would grumble for a day or two afterwards. It had been happening on and off for years and he'd learned to live with it. One Friday morning Harry woke up in severe pain.
Rolling over in bed was painful and getting his socks on felt impossible. By the time he'd reached the bottom of the stairs, he was sweating.
He called work and told them he wouldn't be coming in. "I'll rest today," he thought. "It'll probably settle." Unfortunately it didn't. By Friday afternoon, he could barely find a comfortable position. His partner finally said what he'd been avoiding all day. "You need to call someone." He gave us a ring but the only problem was that our first available emergency appointment wasn't until Monday.
You could hear the disappointment in his voice. "I don't know how I'm going to get through the weekend."
Before we hung up, we talked him through a few gentle movements to stop his back becoming even stiffer and suggested using some warmth, such as a hot water bottle, to help him stay as comfortable as possible until we could assess him properly. It wasn't treatment but it could help him get through the next couple of days.
Saturday wasn't much different and neither was Sunday. By that point, he was convinced something serious had happened.
Then Monday arrived.
When Harry got out of bed on Monday morning, he was still sore.
But...
He could stand up.
He could get dressed.
Walking wasn't quite as difficult.
The pain hadn't disappeared, but it certainly wasn't as severe as it had been when he called us.
As he sat down in the clinic, one of the first things he said was: "I feel like such a fraud, I promise it really was that bad on Friday."
We smiled because we'd heard those words many times before. It happens all the time and we believe you!
But why though?
Pain doesn’t always behave how we expect. One of the biggest misconceptions about pain is that if it starts improving, it must mean nothing was wrong in the first place but that's simply not true.
Pain isn't a direct measure of damage. It's your body's way of protecting you, and it's influenced by many different factors.
1. His nervous system had started to settle
By Monday morning, Harry knew someone was going to assess him properly. That reassurance matters because when we feel safer and more in control, our nervous system often becomes less protective. Pain can ease even though the underlying problem hasn't magically disappeared.
That doesn't mean the pain was "all in his head." It means the brain and body work together to decide how much protection is needed.
2. The initial irritation had started to settle
The first few days after a flare up are often the most uncomfortable. As the body's natural inflammatory response begins to calm, movement usually becomes a little easier. That doesn't necessarily mean the problem has resolved but it means the body has moved beyond its most sensitive phase.
3. The assessment uncovered an underlying issue
Although Harry was moving much better than he'd expected, his assessment still told us a lot. We talked through the history of his recurring back pain and carried out a thorough examination.
His assessment showed reduced control through the muscles that help support and stabilise the lower back, particularly during certain movements and positions. His back wasn't "unstable" in the sense that it was falling apart. Rather, it wasn't coping as efficiently with the demands he was placing on it. During the week, long hours of sitting left those muscles underused. At weekends, he expected them to cope with sudden bursts of heavy activity. His back had become stuck in a cycle of doing too little, then too much. Over time, that can make flare ups more likely.
Next steps for Harry
Together, we made a plan. We used hands on treatment to help Harry move more comfortably in the short term, but we both knew that wasn't the whole answer.
The real goal was helping his back become more resilient.
Over the following weeks, we worked on improving the strength, endurance and coordination of the muscles supporting his spine. We also looked at how he could spread activity more evenly throughout the week instead of asking his body to go from sitting at a desk to acting like an athlete every weekend.
The more he understood what was happening, the less frightening each flare up became.
And perhaps most importantly...
He stopped feeling like a fraud.
