The X-ray factor revolutionising the way dancers deal with back pain
The herniated disc pressed down on a nerve in his spine. The pain started in his back and ran down his foot, and was with him for what felt like every second of the day. He feared he would lose everything he had worked so hard for.
For Ty King-Wall, a principal dancer at the Australian Ballet, to beat his back pain, he had to rebuild his body - but also his mind.
Ty King-Wall.CREDIT:KATE LONGLEY / AUSTRALIAN BALLET
“Initially I was quite stubborn about the mental side of things. I thought: I have an injury, that’s why I feel pain. And once the injury is fixed, the pain will go away,” he says.
“And it took me a little while to get the idea into my head that I could be increasing my experience of the pain through where my head was at.”
King-Wall is an elite athlete in an art form that makes extreme demands of the back. Female dancers need to hyper-extend the spine; men are tasked with lofting their partners above their heads.
Ty Wall-King and Amber Scott in Sleeping Beauty.CREDIT:KATE LONGLEY / AUSTRALIAN BALLET
So back injuries make up about a third of all injuries to dancers, and historically have been a major reason for early retirement.
Yet, through a focus on the mental rather than physical causes of back pain – and strong discouragement of dancers looking at their X-rays – the Australian Ballet has not had a single back-injury-related retirement in 15 years.
"And we have never operated on a back, which I think is really important," says Dr Sue Mayes, the company’s director of artistic health and a world leader in injury rehab who installed the new regime.
“We try to help them overcome any fear about back pain. And we educate them on the fact that pain does not mean damage,” she says.
“We hear about disc prolapses, disc bulging – we are fearful that is going to happen to us. And a lot of that fear can drive dysfunction.”
Dr Sue Mayes (centre) is the Australian Ballet's director of artistic health.CREDIT:KATE LONGLEY / AUSTRALIAN BALLET
To rebuild King-Wall’s back, he needed to move. Even though it hurt.
King-Wall spent a lot of time in the pool, keeping his back moving. He worked on his lower body, building the strength to support his back. He visualised his spine moving gracefully, like flowing water.
Then there was the mental side. Modern pain research indicates the more we think and worry about pain, the more pain we feel.
“It’s a vicious cycle. If you’re convinced pain equals damage, you get more pain, so you think you’re getting more damage, so your brain gives you more pain, so you think you’re getting even more damage,” says Professor Lorimer Moseley, a world-leading pain neuroscientist based at the University of South Australia.
To beat his pain, King-Wall, working with the company’s psychologist, learnt to separate the pain from the injury, from the pain that was coming from his brain. Slowly, the pain faded into the background.
"Once I learned how to separate and strip away that extra pain I was contributing myself, I could reassess how much pain I was really in, and whether or not I could function with it and work through it," he says.
It is a common belief that our backs are fragile, and that back pain is caused by damage to the spine or a slipped disc. So many patients expect – or demand – their doctors give them an X-ray to spot the problem they know must be there.
But many high-quality studies in fact show this is not true.
On an X-ray, many people will have what look like slipped discs, but feel no pain. And many will have perfect discs but be in chronic pain.
Counter intuitively, scientists now believe simply seeing a slipped disc on an X-ray is enough to prompt chronic back pain.
“So we don’t launch into imaging for that reason. Because we know we’re probably going to find something,” says Dr Mayes.
It is an approach scientists are trying to change. Clinical guidelines recommend against letting people with general lower-back pain have X-rays, yet about 40% still do.
And X-rays often put patients down the path of opioids, or painkilling injections which are not recommended by current guidelines. Often, it ends in surgery - despite US and UK clinical guidelines noting there is insufficient evidence to show disc surgery and spinal fusion help patients.
“If we took away all the harmful treatment, minimised imaging and surgery when it's not appropriate, injecting people, giving them crazy messages, we could halve the burden of back pain overnight,” Associate Professor Mark Hancock, a leading back pain researcher at Macquarie University, told The Age.
King-Wall is now back, performing in the company’s production of Giselle in Sydney. His body has been rebuilt, and so has his mind.
“When I was able to get on top of my headspace, that was a real turning point for me.”