Back pain is very common and most people will experience it. Many reasons are given for back pain, usually blaming the discs (they are not discs but rather amazing structures that work with the vertebrae to allow movement and force transduction — they are also very robust), joints, muscles and posture.
The simple fact is that the pain we feel in our body is not because of a structure. It is because our brain thinks we are in danger, or the tissues in the area of pain are in danger or potential danger, a warning. Pain is an output from the brain that is detected in the body, driving and motivating protective behaviours. This can be helpful in the acute stages of pain, but as time moves forward and the tissues heal (if they have been injured), these learned strategies become part of the problem. The pain persists, the alarm bells go off during normal activities (e.g. sitting, standing, walking) and we continue to behave as if we need to protect healing tissue. This on-going guarding, change in movement and adapted activities causes many problems including pain and fear.
Breaking the habits of protection and guarding are essential. The increased and inappropriate use of muscles in the back means that they work hard, too hard. Similar to a challenging workout, there is post-exercise soreness and pain, except this is happening on a day to day basis. Re-training the way the brain is activating muscles is vital but to do this, firstly you must understand that you are safe. The movements that re-educate normal movement are simple and can be done at home, at work, in the garden, in the park, anywhere that promotes safe and varied actions. This safety comes from an individual’s understanding of pain. So, this is the first step, making sure that pain is understood in the context of the patient’s narrative.
Understanding pain plus simple movements to develop body sense, nourishment for tissues (‘motion is lotion’) on a consistent basis (again very simple moves with feedback and a sense of safety) and skills to calm systems that are on alert to protect such as mindfulness or relaxed breathing. A basic movement can be primed and used in many different ways to represent the variance we experience every day. The brain loves variety and if it feels safe, you will be able to gradually build your activities back up to recover and get back to having fun.
Here are my formulae:
Understand pain + simple movements + confidence + feedback = reduced threat
Reduced threat + gradual increase in activities + mindfulness = pain relief and resolution of normal activities
Contributed by Richmond Stace, The Specialist Pain Physio