Back Pain Myth Busting Part 5

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

And the final part of this Lower back pain blog is regarding factors in our life that we wouldn’t think influence our pain. Also, there is hope for people dealing with persistent back pain.

 

9 Sleep deprivation, stress, low mood and worry influence back pain

Some people feel that pain can only be mechanical, but there are a few other factors that affect our pain perception when we have lower back pain. Life events that cause increased levels of stress or depression can enhance the pain we feel. Understanding these factors and trying to take control of them will help. Studies have shown that with a cognitive approach dealing with stress’, fears relating to the injury and of movement will help lower pain scores and result in good outcomes (1)

 

10 Persistent back pain can get better

As previously noted in the last point and the other parts of this blog, there are many factors influencing back pain and not every individual is the same, requiring a tailored treatment plan to match their needs. Most people with persistent back pain will likely need to address non-physical factors as mentioned in the last point (2).

It is very common as most treatments only address one factor, if someone goes for a massage for their sore muscles, but fails to address their stress at work or fitness levels. You can understand why problems likes this become an “on + off” issue throughout life.

Identifying the different contributing factors for each individual and trying to address them, pain can be greatly reduced and people can live a happier and healthier life.

 

1.     O’Keeffe et al, (2015) Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial, BMJ Open

2.     O’Sullivan, P. (2012) ‘It’s time for change with the management of non-specific chronic low back pain‘, British Journal of Sports Medicine, 46(4), 224-227.

Back Pain Myth Busting Part 4

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

Next up are two biggies. How should I sit and can I lift with a spinal injury? Posture is an important factor with both positions but it’s understanding how it can be effective while recovering.

 

7 The perfect sitting posture may not exist

The body is designed to move. If we sustain a position for too long, we end up loading an area more than it’s designed for. This can either be in a slouched position or even sitting erect. It’s important to alternate our sitting positions to avoid pain and adaptations (1). This can be done with changing sitting positions, getting up regularly and doing tasks in standing that you would normally do sitting (i.e. taking phone calls). Try to change position every 20minutes.

Knowing that movement through range in sitting is necessary to gain confidence in your spine instead of being rigid/protective. (2)

 

8 Exercise and resistance training

Lower back pain can cause people to fear and avoid certain activities that involve bending, lifting and twisting (3). However, it is important that we encourage this within a safe environment, to gain confidence and reach better outcomes.

Initially it may be sore practising these movements, but as mentioned previously it’s about understanding the type of pain you feel. This will help strengthen the spine and supporting structures, getting you back to lifting, running and jumping.

Studies have shown great benefits and long-term safety of various types of exercises (4) including high load resistance training (5).

 

1.     Zemp et al, (2013) In vivo spinal posture during upright and reclined sitting in an office chair. BioMed Research International.

2.     Baumgartner et al, (2012) The spinal curvature of three different sitting positions analysed in an open MRI scanner. The Scientific World Journal.

3.     Thomas et al, (2008) The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain. Eur Spine J.

4.     Steele et al (2015) A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain; American Academy of Physical Medicine and Rehabilitation

5.     Pieber et al (2014) Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain; Eur Spine J

Back Pain Myth Busting Part 3

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

You may have heard of the phrase, Pain doesn’t hurt. In some cases, it doesn’t. Also, the urgency for having spinal surgery may want to be reconsidered based on the research.

 

5 More pain does not mean more damage

As mentioned previously the spine is a complexed structure with many different factors effecting it from a physical, mental and environmental perspective. You could have two individuals with the same injury, but can feel different sensitivities of pain (1).

Our nervous system has an influence on the pain we feel and can sometimes get stuck in a loop if the injury is poorly managed. So, even once it has healed we can still experience discomfort.

Our coping strategies vary depending on different types of pain. Once we understand that some pains are not causing damage, our quality of life can be drastically improved. (2,3)

 

6 Surgery is rarely needed

There are only a small proportion of people with back pain that need surgery. Following clear guidance from your physio or Dr by staying active with exercise, manual therapy when needed, positive reinforcement of movement, understanding your injury and good pain management we see excellent results.

The statistics for successful outcomes following surgery vary from one country to another and between surgeons. But there is evidence showing that the outcomes after having surgery are similar to non-surgical treatments over a span of 1-2 years (4,5).

 

1.   Vernon H, (2010) Historical review and update on subluxation theories. J Chiropr Humanit.

2.   Taylor et al (2014) Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis: The Spine Journal October

3.   George et al, (2012) Predictors of Occurrence and Severity of First Time Low Back Pain Episodes: Findings from a Military Inception Cohort. PLoS ONE 7(2): e30597

4.   Brox et al, (2010) Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain Annals of the Rheumatic Diseases

5.   Wynne-Jones et al, (2014) Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine

Back Pain Myth Busting Part 2

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

Moving on from part 1 are some misunderstandings of an old medical phrase and some advice that should only be left to the most severe of cases.

 

3 Back pain is not caused by something being “out of place”

There is literally no evidence of joint subluxations of the spine when under X-ray, MRI or any other type of imaging (1). Yet the phrase of the spine being “out of place” is still used and that it needs to be realigned like pieces of Lego.

As humans, we are not symmetrical and there are slight discrepancies, more so with scoliosis, Scheunemann’s etc. But we adapt to these changes throughout life.

It is worth noting a popular treatment for being “out of place” are joint manipulations. This is not relocating the joint, but causing cavitation (the formation of gas bubbles within the joint causing an audible sound). This is however effective in providing short term improvements to pain, muscle tone/tension and lowering fear.

 

4 Bed rest is not helpful

If we were to take a trip back to the 80’s you’d likely get told by the Dr to have a few weeks of bed rest and if you’re lucky be prescribed a corset.

We now know with strong evidence that gentle movement and trying to maintain normal activities as comfortably as possible will improve the rate of recovery (2,3).

 

  1. Vernon H, (2010) Historical review and update on subluxation theories. J Chiropr Humanit.
  2. Wynne-Jones, G. et al., 2014. Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine
  3. Malmivaara et al, (1995) Treatment of acute low back pain: bed rest, exercises, or ordinary activity? N Engl J Med

Back Pain Myth Busting Part 1

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

This week I wanted to pull out some facts regarding back pain and the public perception of the most prevalent musculoskeletal injury. The idea is to give you more confidence in using your back during injury but also trying to clear the stigma associated with this condition.

 

1 Back Pain is normal factor in life

Up to 84% of people will have some form of back pain in their lifetime (1). It has become inevitable that this will happen at some point unless you’re a hermit. The good news is that only a small percentage that don’t fully recover.

Most acute back injuries are the result of a simple strain or sprain and expected recovery is excellent. Within the first two weeks of an acute episode of pain, most people will report a significant improvement in their symptoms with up to 90% full recovery within 6 weeks. Only 2-7% of people develop chronic, disabling problems (2).

2 Scans are rarely needed – be careful what you wish for

This one is great, if you put the people of Newmarket through an MRI scan about 60% will have some abnormality even if they don’t have pain. (3, this wasn’t a study of the Newmarket population) (4)

Wait, so if an MRI scan can show a disc prolapse without pain, could that mean the pain may not be associated to the disc identified? Some of us need a “label”, once being diagnosed with a disc prolapse it becomes easy fall back into the “what can I do? I’ve got a disc prolapse”. This can cause a heightened fear of moving normally and exercising, which happens to be the opposite approach to rehabbing this condition. (5)

Consider this, only 5% of lower back strains are the direct result of a disc herniation (6). It’s not to say they can’t be the cause of pain but there are many other structures and factors involved with lower back pain.

  1. Balagué et al, (2012) Non-specific low back pain. Lancet.
  2. Kinkade, (2007) Evaluation and treatment of acute low back pain. Am Ac of Family Phys
  3. Jensen et al, (1994) Resonance Imaging of the Lumbar Spine in People without Back Pain, N Engl J Med
  4. Teraguchi et al, (2013) Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study.
  5. Shnayderman et al, (2013) An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial. Clin Rehabil.
  6. Lateef et al, (2009): What is the role of imaging in acute low back pain? Curr Rev Musculoskelet Med