There is a lot to be said about low back pain, enough to write a whole book. So this article is going to cover some essentials that can be overlooked. Back pain can come out of nowhere and disappear just as fast, or linger for months or years on end. From the injury itself, the rehab process, and everything else, low back pain can be complicated and needs to be treated as such.
The Injury
Immediate pain after a specific movement is common — at the gym, playing with kids, housework. But low back pain can also develop (and change) over time. A nagging ache that happens once in awhile may become persistent pain, and then go away for months at a time before seeming to randomly appear again. An important thing to remember is that because of this constant state of change, no two back injuries are identical. So when your colleague tells you that he/she ‘threw out their back too’ and gives advice, please remember that you are not your colleague, and your back can’t actually be ‘thrown’ anywhere anyways. As a living being, your body is constantly adapting based on the environment and changing demands placed on your body. This constant state of flux requires that movement, and managing it, will always be a part of your life. It’s actually one of the things I find most interesting about being human; we are constantly moving and changing and everything we do impacts our future self.
Then what is causing your pain? The million dollar question. It might be muscle tension, weakness, joint dysfunction, a ligament strain, disc irritation or nerve sensitization. More likely, it could be a mixture of all of these things to varying degrees, and the inflammation and tissue adaptation send signals via the nervous system to your brain, creating the sensation of pain. What makes it even more confusing is that the physical ‘source’ of pain may not actually be the cause of the problem at all. The painful location may just be the resultant end point from a chain of dysfunction. It is very possible that the way your foot, knee, hip..etc..are moving (or moved in one particular instance) has modified the way load is distributed through your body and therefore your low back. Over time or in one quick movement, this unevenly distributed load increased in your low back can lead to inflammation and pain.
Following injury, the need for imaging (XRay, MRI) should be considered carefully. Imaging of any kind can be beneficial in determining structural anomalies sometimes, but unfortunately it will not provide the holy grail to solve all your back pain problems. Structural changes do NOT always correlate to pain, and this is normal. I’ll say it again: your imaging may not explain your pain. While it can provide insight, it is not a definitive understanding. Pain can be present, and severe, without any findings on imaging, or vice versa. And neither of these findings mean you’re crazy for feeling/not feeling pain. It is just another piece of the puzzle.
The Rehab
If you are experiencing acute or chronic low back pain, please do yourself a favour and seek some help from an expert (physiotherapist, chiropractor, massage therapist, osteopath — whoever you choose). The goal of rehab is not only to get you out of pain, but to make your body more resilient so that it doesn’t recur. Invest the time and energy, because it takes your dedicated effort for the body to truly improve. Passive treatments can help alleviate some of the pain, but they won’t fix the root problem. Even after the time it takes for tissue to repair and inflammation to settle following an injury, your body is constantly modifying past this. And if you were moving inefficiently before, the retraining of your motor patterns (how you move) is integral to preventing your low back pain from returning.
Unfortunately, it is not a one exercise fits all approach. Your low back must be able to bend and extend as well as side bend and rotate left to right to certain degrees, all in a controlled manner. Further, you have to be able to create stability in this area while moving your limbs (legs/arms) for lifting or moving heavy objects. Those are both very general statements, but are what need to be addressed in your rehab on a broad scale. Your back needs to be strong for whatever YOU want to be able to do with it. And whatever you need to be able to do in life. Society has us sitting for such a large part of our day that the stability muscles aren’t needed. One of the most frustrating things I hear is “I’ve tried physio before, it doesn’t work.” Don’t get me wrong I entirely agree it can be frustrating when a treatment approach is unsuccessful — but it takes time and dedication to improve — on both your and your therapists part. Everyone is different, so make sure you find a therapist that works for you and is dedicated to progressing movement patterns, limitations and muscle strength towards your goals. Past medical history, injuries, lifestyle, etc. will all be important information in creating a personal rehab plan, one which must be adaptable to changes in your body and your goals as time passes. Other factors in life can, and will, influence these plans as you progress.
Everything Else
The overall health of your body will affect your recovery. I can tell you based off of experiences personally, and with the many patients I’ve seen with low back pain that this is true. The more you learn, and the more research that comes out, the better you’ll realize it is truly all connected.
Your diet. What you put in your body is literally your fuel. It is the building blocks for your tissue and who you are as a human. If you’re not providing your system with good nutrients, how can you expect your body to be healthy and tissues strong. The newly (kind of) discovered gut-brain axis — look it up. Research has shown a bi-directional link between how your gut behaves and your brain. Simplified, this means that inflammation in your gut directly impacts your brain — which not only sends signals to all the other parts of your body (ahem..the muscles/ligaments/joints/etc of your low back) — but also determines your perception of pain and your emotional and cognitive response to it.
Your mental health. You all know this by now, so start actually taking care of your mental health. First, when you are stressed your breathing patterns change. This [unconsciously] throws off your breath and stability system that support your low back, torso and pelvis, and can create tension in the surrounding muscles. The stress hormone cortisol can actually lead to muscle loss and fat accumulation, which won’t help this support system to say the least. Any form of chronic stress (physical or mental) can sensitize the nervous system — meaning that your nerves send signals with a lower threshold. Essentially, something that may not seem painful typically can become a painful stimulus when in a constant state of stress. Pain and stress often go hand in hand; perceptions of how long pain will last, wondering if it ever get better, and the time-frame for recovery can be frustrating, scary, and contribute to the chronic state of stress for your body. People with depression, stress, and other mental health concerns experience more pain than those without. Start taking control of your mental health with meditation, counselling, breathing techniques, or whatever works for you to help conquer your back pain.
Your sleep. Sleep is when our bodies recover. Growing research is showing just how important sleep is to our immune system, brain power, and health overall. Not getting adequate sleep means you’re not allowing the tissues in your body to recover from the demands of the day and become stronger for tomorrow. Your quality and quantity of sleep can’t be made up for with caffeine, and the lack of sleep often fits into a downward spiral with mental health problems and chronic pain. It’s another piece of the low back pain puzzle you can try to tackle to help yourself heal.
When you think it will just go away with time, please remember this — the longer you have pain, the longer this dysfunction is lasting in your body. Your body is smart. It compensates, and adapts to get you from point A to point B as easily as possible. The adaptations become your new normal, and your body doesn’t remember what moving well and pain-free really feels like. So the longer you let these adaptations go one, the longer it will take to change your patterns. It’s not a straight road for recovery, and to be honest it never really starts or ends, but it’s an important one. So start now; get the help your back and body deserve.
