If you're also had significant lower back pain, you'll benefit from the treatment decision tree on how to choose surgery over non-surgical options. I have had five significant back injuries and recurrent, acute and chronic back pain, at times associated with severe sciatica, numbness in my left foot, weakness in my left leg and difficulty walking upright, all caused by repeated herniation of lumbar discs 3.4 and 5 after an initial "hip check" injury at work worsened a congenital spinal stenosis (narrowing of the spinal column), created a spondylolisthesis (sharpened curvature of lumbar spine due to compressed discs) and worsened the natural deterioration of bone (degenerative disc disease).
Over a dozen years I developed a management routine that typically worked to get me functional and relatively pain-free using physical therapy, aquatic therapy, muscle relaxers, anti-inflammatories,epidurals, yoga, walking, strengthening, swimming, massage and rest. The sacroiliac joint on my left side was typically wrapped in an inflamed knot of muscle so I'd often need my husband to kneed it before I could sleep. Since it's located in my ass he didn't typically mind but what he said it felt closest to is when I was in back labor with our first child and he had to press as hard on the outside of my spine as Cait's head was pushing on the inside to regulate the pain. That's what it felt like for me too. I've always needed the "deeper, harder" kind of pressure in physical therapy and massage to alleviate muscle pain and was a big fan of the Theracane to reach those areas myself.
But over time it took longer to recover from each episode and the work in the meantime was exhausting, as was pain. One day the orthopedic surgeon's PA who I liked and trusted said "maybe we should just do this," this being a spinal fusion with the stabilizing cage (summarized by Dr. Hanscom here). During a consult with the doctor--who I also liked and who knew me well--he said yeah, the surgery probably could stop the rolling tides of shifting discs, compressed nerves and spasming muscles but so could possibly doing less. Not a less invasive procedure, but less activity and treatment overall.
He wasn't suggesting I turn myself into a bowl of jelly, but the yoga, the stretching and strengthening, the daily swim laps in a cold pool, the sitting on a stabilizer ball at my desk, the hour walks with sun salutations on the beach--all good in theory for building my core but with my instinct for pushing myself, I often injured myself in the pursuit of some sort of physical immunity to back injury. What would happen if I just stuck to walking and a few upper-body stretches with a therapy band hooked over my bedroom door handle? Maybe took some extra fish oil because that seems to help him with similar issues (he had not, BTW, had the surgery himself) and spent more downtime doing things I actually enjoyed?
Well, what happened is I went from reinjuries 3-4 times a year to now about 1, I stopped feeling so responsible for my own injuries and rehab and I started writing more in the time I wasn't at work, which has become an expressive godsend during my recovery from PCS. I've written a bunch of stories, taken classes, and imagined a much different life for myself than when I was always fighting against the specter of impending pain and decreased mobility.
So, the DOCC framework worked for me even before I read about it. I'd say the source of my back pain was all three--structural, soft tissue and perfectionism fueled by a high-stress job that I hated to abandon with time off for injuries. But the harder I worked to prevent recurrent injuries, the more I inadvertently caused them, and the less I enjoyed my life.
This is the Back in Control graphic that sums this cycle up nicely:
This paradox has been repeated with my PCS recovery, though it took my neurologist writing "stop trying so hard" on an Rx pad this past spring for me to make the connection.
But I'm blaming the concussions. If I wasn't muddled I definitely could have figured this out myself :)