Pain, Pain go away, don’t come back another day…..
80% of us get back pain, and 80% of those go on to develop recurring or ongoing back pain, so why are we in so much pain when there are effective management strategies we could be using?
In my 25+ years as a physio, there is one thing that hasn’t really changed. People continue to get pain, people continue to get injured, and people continue to try and manage themselves.
Back Pain is one of the big causes of immobility and what we do about it and how it is managed can have a massive impact on the outcome and ongoing management that people employ.
Let’s look at what happens when we have ‘insidious onset’ low back pain (LBP) – this means – no direct cause, no direct injury, its just ‘happened’ or there has been a gradual build up ‘for no real apparent reason’.
The pain itself will usually cause us to stop doing things, whether it be local to the back, referred to the bum or legs, it may get to the point that we limit what we do, or we start to be careful about how we sit, and how we move.
We may pop some painkillers, or use a hot pack, or rest and wait for it to settle, and then gradually start getting back to normal. Then we forget about it, life goes on, and normality returns.
The next episode occurs, but this time it hurts a bit more, limits us a bit more, and takes that bit longer to settle. It may be more ‘irritable’ than before in that it limits what we can do more. Again , no real reason for it to come about, it just ‘happened’.
Idiopathic or back pain for no apparent reason is quite common. and recurrent incidences are quite common.
What actually happens though?
Think about shin splints and when they occur – we are either pushing the body too far, or too quickly, or we have new shoes that change how we move, or we change our routine or work out.
The same can happen to cause back pain. We up our activity level, change jobs and what we do day to day, take up a new activity or we just demand too much of out bodies and they give up.
The other main cause can be poor posture and poor muscle strength and muscle balance. Over time we fatigue out the body, over use some muscles that work too hard, under use others so we become ‘imbalanced’ and eventually that leads to postural issues and dysfunction leading to pain.
I know I am generalising A LOT here – but you get the gist.
Pain happens, we don’t know why, and we then have to deal with it.
Rest from aggravating activity is good but only SHORT TERM. Long gone are the days when you took to bed rest until you were pain free. We now know that pain sets up a cycle whereby we create some local muscles spasm as we try to use the muscles to “splint’ our backs and stop the painful area from moving.
This muscle spasm is in itself painful – hence why we like heat packs, massage and the like – it helps relax the muscles so they don’t feel painful, but it doesn’t solve what caused it in the first place.
Pain means we don’t want to move. It hurts to use muscles that hurt and move the back. So we become ‘stiff and static’. This leads to the joints themselves becoming ‘stuck’ and we lose the ability to actually bend and stretch and move at a JOINT LEVEL. These are those people that say – oh my back is as stiff as a board – the joints can themselves lack movement, and ironically we then have to rely on those poor muscles to do even more to compensate!
Msucles should stretch and move, they were made to move us by contracting and relaxing, working against their opposing partner ( think biceps and triceps or quads and hamstrings). The back is exactly the same.
We need the back muscles to work with our stomach and core muscles, our glutes, hip flexors, lats, or diaphragm and our rib cage to name a few so that we can stay upright, function and move.
When we have pain, pain inhibits the muscles ability to function. Our ‘core’ switches off, as the big ‘mover’ muscles such as the erector spinae, quadratus lumborum (QL) and lats start to over work and cause compression and a loading force on our spines, unopposed by the weaker muscles, we end up in even more pain.
Compressive forces occur in the lower back causing more pressure on our joints producing pain.
Big muscles that should move us, now also work as stabilisers, and can become over active and cause pain – EG. hip flexors, QL, piriformis, erector spinae
The small stabiliser muscles such as the tranversus abdominis, pelvic floor, and multifidi can’t work effectively and may become inactive completely, and ‘switched off’ – how often do you hear – my core doesn’t work, I don’t know how to (or can’t) get my core working…? This is where the muscles has become inhibited completely and needs specific re-training at LOW LEVEL – ( not bootcamp style!) to stimulate it again and get it to start working.It will never function against the big muscles that are doing the work for it until it relearns what to do.
Can cause pain in itself. When joints and soft tissue and muscle shorten or lengthen due to postural stresses, we can end up with pain or ‘postural dysfunction’. Think how many of us now work in a chair all day long, we drive home, and then we go sit on the couch or at the computer yet again.
Be honest – how many of us are actually making a concerted effort to undo or exercise against that flexed posture?
We can say we go to the gym, we are doing exercise regularly – but are we “exercising with intent”?
So….getting back on track – how on earth do you know what to tackle?
Massage will help, you will feel better but you are not addressing the real cause which is why you keep needing to go back every week / fortnight / month
Gym work will help – you will get stronger – but are you just strengthening stuff that is already strong? Do you know what is weak and not working and ineffective, or are you just having a wild stab in the dark and hoping for the best.
Do you know for sure you QL is fine, your hip flexors are tight and you need glutes? which glutes?
Which bit of your core doesn’t function?
Which muscles are strong and function well, or are they just bracing you and holding youup and together – you may think they are tight and just need rolling out – but then you get worse – that may have just been your support system you took away.
Passive treatment to loosen stiff joints and release tight tissue will work wonders, and you’ll feel better, but what about do the targeted work to strengthen it all back up so you can STAY THERE?!
If you have had back pain you will know the rule – it hurts so you do stuff to make it better, it stops hurting so you give up and go back to normal and wonder and complain when you get it back again.
The body is ageing daily, we are constantly putting our bodies under stress by not moving them, and then we complain when our bodies tell us we have had enough.
Doing 1 hour once or twice a week, is NOT ENOUGH to undo what we do the other 23 hours every day.
Think crash diets. They work for short while, we give up and we put the weight back on.
The back is the same, as is health and fitness – you need to be consistent and to make it stay improved.
You need to make a lifestyle change to stay better and get the body and pain free life you want.
Sitting and wondering about it will not make it happen.
Find what works for you and stick with it.
And if you are serious about wanting to get some consistent improvement going – then you need to be serious about getting the right thing happening.
A shot gun effect, or a splattering of different things may make you find one that works, and if you are persistent then it can have a gradual slow result.
If however you want results and you want results quickly, then you need to pull out the big guns. Spend the time and invest in your health. Get the answers you need to be able to get a realistic plan in situ.
Find out what your problem is…. joint…muscle imbalance…muscle weakness…. over activity…. inactive core…. poor posture….and then have a targeted plan to address it.
That’s our niche – that’s what we are really good at. We have heaps of clients that come to us as a last resort becasue they have been everywhere else to no avail.
Come to us first. Get results that will help you first – not when you have exhausted all other possibilities and “given up”.
read our article here on getting results –