On A Scale From 0-10, This Is Painfully Ridiculous

Pain should be described, not numbered. Pain is relative. It’s determined by individual experience.

I don’t think that some people handle pain better than others. I also don’t think that the experience of pain can be accurately measured in numerical value. This is why I hate when providers ask me to fill out a form and identify the pain on a scale from 0-10. There’s so much important context to consider.

As an analogy, let’s take a look at temperature. On a 70° day, my Floridian friends might pull out a light jacket whereas my friends in northern states might rip off their jackets and throw on shorts. It’s the same temperature, just different reactions.

No one is wrong. They are simply responding to their unique standard of normality. The experience of temperature is similar to the experience of pain. 

For 25 years, my standard of normality was different than most. I had unknowingly experienced pains and complications due to hip dysplasia my entire life. Although I’m frustrated that my pediatrician didn’t catch it (there is no record of hip assessments in my pediatric records), I met all of my milestones. Since I seemed like a normal growing infant, my parents never had reason to assume anything was wrong, either. However, as I grew up, the complications from my undiagnosed hip dysplasia evolved too. According to the Mayo Clinic, the common symptoms of hip dysplasia in teenagers and young adults are as follows:

• Activity-related groin pain (i.e.: exercising, walking, using stairs, etc.)
• Sensation of instability in the hip

*Note: Hip dysplasia can also cause osteoarthritis or a hip labral tear. 

This is normal, right?

Here’s where we get to my normal. Prior to my hip replacements, I avoided stairs because they made my thighs “sore”. I also felt “sore” in my hips, inner thighs, back, and knees when I’d walk or exercise. I use quotations because at the time I didn’t know I was experiencing pain. I assumed these feelings were the same experiences that others referred to when they said they were sore from walking across campus or after a morning in the gym. I thought these feelings just meant I was experiencing the normal consequences of an active lifestyle (LOL, joke was on me).  

I also thought that I was double jointed in my left hip because I could pop it out. Seriously, I used to brag about it. Oops. 

None of these were my biggest issues or symptoms though. The biggest problem was that my hip dysplasia caused a curvature to my spine. The curvature was so significant that it resulted in years of back issues. Throughout my teens and into my mid-twenties, I had at least one herniated disc or other back complication each year. The first one I distinctly remember was in high school after a sneeze. Yes, a sneeze. 

Nope, it’s not normal.

The grand finale of my unknown back issues occurred in December 2020 with multiple herniated and bulging discs. After reviewing my medical history, my spinal surgeon curiously took x-rays of my hips. That imaging showed the true cause of these years in agony: hip dysplasia. I would later learn that this diagnosis was only a portion of the cause to my pain.

In addition to the bilateral hip dysplasia, I was also diagnosed with avascular necrosis (AVN) to my hips. The AVN had developed idiopathically later in life. The condition of my left hip was worse than the right, though. On top of both diagnoses above, these were added to the list:

• Large osteophytes
• Narrowing of joint space
• Sclerosis
• Deformity of bone ends

Yikes. You’re probably thinking, “Courtney! How did you not realize the amount of pain you were in??” Well, the definition of pain is “physical suffering or discomfort”. Let’s focus on the term discomfort.  You can only know the feeling of discomfort when you know the feeling of comfort. Remember, my entire life I’d thought all of my pain was normal human sensations. I’d never experienced pain-free hips. Before being diagnosed with the hip problems, I would complain about radiating back pain into my hips and thighs. I never pieced together that the “hip pain” could be an entirely separate issue. In hindsight, without knowing any different, my “normal” was pretty painful – especially as the hip dysplasia worsened and the AVN began.

Well, nothing is really normal. 

As I write this, my right hip is almost fully recovered from the total hip replacement (THR) while my left hip continues to heal from the THR. I can only now grasp the full extent of pain I’ve undergone for the last 25 years because I’m not experiencing those same sensations anymore. In the 7 months prior to my hip replacements’s, my hip pain significantly worsened as my back could no longer appropriately accommodate for my hips. Those months were excruciating. Although my left hip is still experiencing post-op pains, those surgical pains are entirely different than what I’ve known and adapted to throughout my life. 

We can only gauge pain by our own standard of normal. Ultimately, remember that everyone’s levels of comfort and discomfort are different. This is why, on a scale from 0-10, I think those charts are 100% ridiculous. You can’t identify or quantify pain if you’ve unknowingly adapted to a specific threshold. It doesn’t make anyone stronger or weaker – it just proves that “normal” is different to everyone. Whatever your pain is, it’s always valid.