What Back Pain Taught Me About Urban Design

I have a herniated disc. According to my MRI’s report, I have a “diffuse disc protrusion” that reaches the “center posterior/lateral right of the L5-S1 intervertebral disc”. L5 and S1 vertebrae are located in the lumbar section of your body. The discs are the natural cushion between the vertebrae. When a disc is damaged, it slips outside the vertebrae. This slipping pushes the infamous sciatic nerve. The pressure on the sciatic nerve makes anyone who has a herniated disc — in this tale, myself — feel constant pain extending from the lumbar area to the back of the calf, hitting the side of the knee.

Up to May 2014, I had never felt any back pain ever. At the time, I was hitting heavy weights at the gym. I was doing that thing of lifting a lot of weight and doing few repetitions. I started to feel lumbar pain and, not very intelligently, kept working out. Eventually, pain became unbearable and I had to stop. A while later, my physician asked me to undergo an MRI, but she cautioned that I probably had a slipped disc. I asked her whether anyone under 60 had ever had this issue in human history or if I was the pioneer in destroying my back in my late 20s. To my surprise, she informed me that most herniated disc patients are young. They tend to be stupider with their bodies and screw up their backs. However, she also told me no one really knows what causes the problem. Genetics, exercise, accidents — could be a number of things.

Because of that, I have physically decayed this last year. The herniated disc entails perpetual discomfort. Any position (standing, sitting, lying down) for some time is bothersome. I can’t exercise (believe me, I tried, despite all medical advice). Pain became stronger over time. Despite physical therapy, I didn’t improve much. In some weeks, though, I should be undergoing surgery to correct the problem. I’m considering moving my birthday celebrations to the surgery day — it will no doubt be the happiest day of my life.

A year in pain, however, taught me a thing or two about the city. It taught me, for instance, that we don’t give a shit about people with restricted mobility. Trivial things, which I had never paid attention to, became very important to me. For instance, having flat sidewalks that don’t put stress on my back is a dream — something that practically doesn’t exist in Brazil. This period taught me that any person that doesn’t use a car to go anywhere is a second class citizen that may be subjected to any sort of inconvenience.

Before I started feeling pain, my attitude towards urban issues could be summed up as: “Ramps for people with disabilities? Great, we should get to it some time. One of these days, huh?” Nowadays it is: “I need new sidewalks. Today. Now. Yesterday.”

Mobility Limits

First thing you start to notice when you have your mobility limited is that (Brazilian) sidewalks are not made for pedestrians. They are made for people who leave their cars and enter the buildings directly in front of the sidewalk, and vice versa. Any use outside this pattern is not viable — which leads a lot of people to walk in the street between cars. I don’t have and I’ve never had a car. Honestly, while a car has always sounded interesting, it only became a real missing part of my life with the back issues.

A report by the portal Mobilize Brasil published in 2013 gave an average 3.40 grade (on a scale from 0 to 10) to the sidewalks in 12 Brazilian state capitals. They considered parameters such as irregularities, width, obstacles, etc. For Mobilize, the lowest acceptable grade would be 8.

I have the privilege of living in the city of Recife, whose sidewalks are, according to the report, “generally (…) in awful state”.

I’ve always known that Recife’s sidewalks sucked, but it only started making a difference for me after back pain. Since then, their unevenness has become excruciating. The fact that they are generally slanted towards the street (so that cars will have an easier time crossing them to houses or buildings, or even to park on them — after all, poor cars) is noticed every single time I walk outside.

What I started to recognize is that there might be 3 or 4 sidewalks in Brazil that aren’t absolutely thrashed, wasted, uneven, irregular, varying in width, or littered with obstacles.

Municipalities claim that it is the private owners’ responsibility to care for the sidewalks in front of their property, and that’s why they’re so bad. I actually once cared about this silly game of shifting responsibilities. Not anymore. I only care that nobody cares about the stupid sidewalks, and that they keep being trash.

Sidewalks are always where any modification in the public space are supposed to occur, never trespassing the space of motor vehicles. Sidewalks are supposed to house posts, flowerbeds, trees, phone booths, commercial tables and chairs, residential trash bags, news stands, police cars (obviously). If bicycle paths are to be built, they must cut through the sidewalk.

Trees, even weighing the fact that they make this warm town a little less hostile, are something I try to do everything in my power to evade. Fatally, the tree takes over the sidewalk. The roots break the pavement and force me to do my best impression of a crippled Tarzan, slowly jumping over them. Often trees are too dense and the leaves force me to crouch to be able to go on. My back weeps.

In Recife and in a few other places in Brazil, we also have the good fortune of having sidewalks that are lower than the street. The asphalt has been layered over and over so many times that we generally have to step up to the street instead of stepping down. In rainy months, this causes the water to flow down to the sidewalk. We can’t have the cars being wet!

Actually, sidewalks are so bad that I often wonder why don’t pedestrians walk on the asphalt. As far as I can tell, I’m not equipped with an engine. It should be easier for a machine to navigate on damaged ground. We are bombarded by advertisements of off-road cars and yet the rally racing takes place on the sidewalk. Why?

We Hate People on the Street

Caos Planejado’s Anthony Ling has observed that the verticalization that takes place in Brazilian cities is the worst in the world. He observes that, here, urban regulations force buildings to leave an ever larger space depending on the height of the building. If buildings are high, there’s a huge gap between them. Sidewalks go dead, because relatively short movements become a chore. There are other factors, sure. There’s also our obsession with car spots in buildings and the ban on ground floor constructions. And so social life becomes ever more distant and far away from sidewalks.

The Direitos Urbanos group has also observed the advantages in dense urban settlements, and has also criticized the fact that people aren’t being given proper incentives to occupy the streets.

Everyone notices that in Brazil (and, relevant to me, in Recife), pedestrian life is full of obstacles. Everything is far away. Even if it’s in walking distance, the sidewalks are obstacle courses that remind me that I unfortunately don’t have morphine handy to stop the pain.

Still, even if I don’t want to, even if my back asks pretty-please and for-the-love-of-God-stay-home, I’ve got to get out. And, outside all other impediments, it’s still a karmic punishment.

Because streets weren’t made for people who are just there, standing still. They predict that people will always be moving. Moving to or from home. Moving to or from work. Moving to or from a business establishment. Never static. Never sitting down.

Since I now feel the need to occasionally alleviate lumbar stress, I found out that cities don’t have sitting spots. Not anymore. Bus stops are mostly signs. A few have seats, but they are either individual or slanted, to keep homeless people from sleeping there — something that obviously makes life a little more miserable for people who need a little rest like me.

In fact, most places that could serve as sitting spaces are blocked off in some way or another. Planters are fenced off or have pointy walls; benches are slanted or have armrests that keep people from lying down; spikes and fenced walls block off sitting or leaning spots to avoid “loitering”. Generally, all this is done to keep the homeless from polluting our streets. After all, no one should be on the street — if you want to sit or lie down, go home. If you don’t have a home, have you thought about getting one?

But I need to sit down. Sometimes lie down. These obstacles hardly registered before, but they’ve become the first fault I notice in any environment. People not only hate the homeless. They hate people with back pain — which happens to be the leading cause of disability worldwide. They also hate pregnant women. Or old folks. They probably should never leave home, if they even have a home. It’s what’s been called “defensive architecture” — pretty much landscaping when I was healthy, but something that sticks out like a sore thumb anywhere I am.

Even malls — refugees for Recifeans, with their air conditioning and flat surfaces, where they can walk undisturbed — avoid spreading benches around outside their food courts. If you are not buying anything, you probably shouldn’t be standing there.

Surviving in the Bus

I got used to the fact that buses are painful. It’s not like they will be dropping the wheelchair elevator for the apparently healthy guy. Buses are tall. To get inside, I usually cling to the door and hurl myself in. A swift yet painful movement.

Buses are uncomfortable. Seats are stiff. Shock absorption is almost nil. Every time the bus shakes due to street damage, my L5-S1 intervertebral disc yells, “I exist and I control your life, fool!”

Besides, buses are packed full all the time. Catching a bus in Brazil means submitting to the transit cartels. These cartels were little by little established by the municipalities all over the country. In São Paulo, it’s likely that even the criminal mafia First Command of the Capital controls a fraction of the bus fleets. So, buses are a transportation modal whose least priority is passenger comfort. The less of them on the streets, the better.

If you’re sensitive to it because you have to catch a bus to work everyday, imagine being the dude who has to change his posture all the time so that he doesn’t sweat in pain.

And imagine jumping down the bus when your back can’t even handle the pressure of regular walking.

Brazilians Love Cars

We’re often told that Brazil has the most expensive car in the world, even relative to similar developing countries like Mexico. Many reasons are given for that: high taxes, few economies of scale due to low production. Indeed, the cost of capital in Brazil is shocking. Besides, Brazil has also built itself a car manufacturers cartel and overtaxes imported vehicles. This drives the price even higher.

Some say the blame for the high prices of cars in Brazil is the extraordinary profit of the manufacturers — the so called “Brazil profit”, as opposed to the “Brazil cost” frequently referred to. And yes, protected cartels profiting awesomely is very common.

However, after a year of discomfort, painful walks, and physical therapy sessions, I believe the real reason is that car demand is very inelastic. Why would anyone submit to life without a car in Brazil? Walking is awful. Public transit is horrendous. The car is the only option for a rational human being.

If before I was able to ignore any urban issues because, well, I was agile, could run for an hour and lifted weights in the gym, my L5-S1 intervertebral disc demanded that I looked around.

It’s when I noticed the city didn’t want me around. I shouldn’t be in the street, the city wasn’t made for me — at least not in my current state. I don’t fit the profile of the citizen the city wants. Not anymore.

Due to my natural selfishness and good health, I wasn’t able to notice that the city was driving me away from the street. And it must’ve been the first time I noticed how urgent accessibility issues are.

You may think this has nothing to do with you. Your back doesn’t hurt.

But it doesn’t need to. The city drives you inside your home and to the driver’s wheel all the time. You just haven’t noticed yet.

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