Steve Kerr’s Dilemma: Understanding his pain, how he got here, and what it means for his future

Coach Kerr recently came into the news, not for succinctly slamming Trump as he’s been like to do, but for taking a medical leave of absence and indefinitely handing the reigns of the Warrior’s head coaching responsibilities to lead assistant Mike Brown; for game 3 of the Blazers series and onwards.

The news was originally reported as “an illness” but it was soon revealed that Coach Kerr was still suffering residual affects from back surgery, a tale that began over 2 years ago. 

His Medical Trials and Tribulations

Coach Kerr’s low back pain began when he, as he said, “threw out his back” and couldn’t take 30 steps without pain. 

He was diagnosed with a herniated lumbar disc.  The protrusion was large enough to impinge into his spinal canal and irritate nerve roots while increasing his sensitivity to pain.

Here’s an illustration showing the spinal canal and what happens when a disc herniates:

Many people, very likely including myself, have some level of disc herniation.  It's a natural part of aging and only becomes a concern if symptoms appear. If you want to read a more detailed account of disc herniation and understanding why it happens, stay tuned for a future post.

Coach Kerr did have symptoms and decided to have surgery in order to alleviate the herniation.  During the surgery, the surgeon, without realizing it and thus not correcting it, nicked the outermost protective layer of the spinal cord called the “dura mater”, or “dura” for short.

The dura is a thin, tissue-paper like membrane that envelops the nerves, blood supply, and cerebrospinal fluid (CSF) in the spine.  A cut in the dura can expose these aspects and in Coach Kerr’s case, led to CSF leaking out. Here’s an illustration: 

 

This leak in the CSF caused the pressure in his brain and spine to decrease, resulting in severe headaches, nausea, and constant fatigue.  2 months later, Kerr underwent another surgery to repair the dura.

However, as he confirmed with his recent leave of absence, he has still been suffering through similar symptoms.

When addressing his leave with the media, Kerr said:  "I can tell you if you are listening out there: If you have back problems, stay away from surgery," he said. "I can say that from the bottom of my heart. Rehab, rehab, rehab."

He is not medically trained but in general, I’d agree.  The research continues to mount in favor of conservative therapy being as effective as surgery for many low back conditions, especially in the case of physical therapy for lumbar (low back) stenosis, aka narrowing of the spinal canal.

That being said, there are still low back conditions that are immediately indicated for surgery.  Changes in bowel/bladder control (also known as “central cord symptoms) or severe muscular weakness (“severe neurogenic symptoms”) very often indicate a need for immediate surgery.

Whether he should or shouldn’t have gotten surgery is a beyond the scope of this piece.  What we do know is that his trials and tribulations have now created a significantly complicating factor for his recovery:  chronic pain.

The Complicated Reality of Chronic Pain

To attempt to understand chronic pain and the challenge of treating individuals with chronic pain, you have to accept the following:

For individuals suffering from chronic pain, pain is not just tied to the actual injury.  It becomes tied to multiple inputs.  Therefore, healing of the injury itself will not result in the elimination of pain or symptoms.

Chronic pain is a constantly reinforcing cycle that is tied to many spheres of that person’s life. This diagram is a simplified but valuable representation:

 

Does Coach Kerr fit into the chronic pain profile?  I would say more than likely yes. He had his disc herniation removed and had the dura repaired yet 2 years later still continues to suffer from debilitating symptoms. 

Additionally - and I'd argue far more telling - his recent quotes about his surgeries and the ongoing process give further insight into his frustration and anger; key emotional stressors reinforcing the chronic pain cycle.

In sum, there are more factors at play than just his anatomy. This reality makes his pain and symptoms exponentially more difficult to alleviate.  In order to do so, the triggers that reinforce them must be mitigated. This includes, and is certainly not limited to:

-       reducing emotional and physical stress

-       implementing graded and gradual physical activity

-       constantly working on breaking mental fixation and mood patterns

-       decreasing negative perceptions

-       normalizing sleep patterns

-       consistent nutrition .

Even when addressing these factors well and with rigor, it’s still a very challenging process.

What This Means for Coach Kerr’s Future

If you are at all familiar with the life of a professional head coach, let alone of one leading an NBA team vying for championships, you have probably realized it may not be the best situation for an individual with chronic pain.

It’s a position and environment that causes health problems in the first place, let alone allows you to heal from existing ones.

So what does this all mean for his coaching career? 

If I had to guess, I think he coaches the Warriors through their peak, 2-3 more years, and then retires.  He has openly and often repeated how much he enjoys coaching this iteration of the team so I think he will stay through their apex. 

When the team goes on the decline, I think he realizes - I had a helluva run but I'll never get over these chronic issues unless I remove myself from this role.  

Update 5/14/17:  Coach Kerr underwent another "spinal leak procedure" - details are very sparse - at Duke on May 5th.  He remains out indefinitely but yesterday he attended his first practice since leaving.  Although this is a positive sign, there remains a long and rough road ahead - as tends to be the case when suffering from chronic pain.

Thanks for reading. A bit heavy but hopefully it provided some additional insight, particularly into the chronic pain aspect. 

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