1. BACK PAIN IS COMMON AND NORMAL
According to various epidemiological studies from around the world, anywhere from 60%-80% of people will experience back pain at least once in their lifetime. 1 As someone explained quite well, experiencing back pain “is like getting tired or becoming sad - we don't necessarily like it” 2, but it occurs to almost everybody at some point. What is not normal about these common occurrences of back pain is when someone doesn’t recover.
2. SCANS ARE RARELY NEEDED AND MAY ACTUALLY LEAD TO MORE PROBLEMS
Conventional medical wisdom used to dictate that taking a good picture of the spine would help us solve back pain. However, good science shows us that this is most often not true.
A systematic review of scientific research projects about this issue done in 2014 3 found that what we think of as possible causes for people’s back pain – degenerated discs, arthritic changes, bulging discs, herniated discs – are actually found in large percentages of people with NO pain.
For example, 37% of 20-yr old people showed disc degeneration on their scans. As age increased (decade by decade), the number of people with disc degeneration increased as well. At age 80, about 96% of people showed disc degeneration. Another 30% of 20-yr old people showed at least one bulging disc. That percentage increased to 97% by the age of 80. Facet degeneration (arthritic changes in the spinal joints between vertebrae) was found in 4% of 20-yr old people, 50% in 60-yr old people and 84% in 80-yr old people. Now, remember, NONE of the people in these studies that formed part of the review had ANY back pain!
What is more, we actually have good scientific evidence that shows that when we have our backs (and necks) pictured, and then hear from a well-meaning healthcare provider that our back is “damaged”, this can backfire. Fear, anxiety and avoidance of activity actually increased in many cases.
In reality, many of the things that show up on scans are more like “wrinkles on the inside” - an indication of getting older that does not have to be painful.
3. MOVEMENT AND EXERCISE ARE GOOD AND SAFE
Many people with pain are afraid of movement and exercise when they hurt. They tend to avoid it because they think it may cause them to get worse. Unfortunately, not moving is the thing that actually causes more problems. The saying “motion is lotion” is true. Movement is like squirting oil into the joints. It improves circulation which brings nutrients to the area to get the healing process moving. It also can move the swelling out of the area.
Here’s the good news: pretty much any type of exercise is good for back pain. The latest guidelines indicate that a combination of aerobic (walking, swimming, for example) combined with some strengthening and stretching works very well.
When you are in pain, starting an exercise program can sometimes be difficult or scary. How can you be sure you won’t do too much and then experience more pain? Check out the helpful tip in one a previous posts (http://www.vtsphysicaltherapy.com/blog/breaking-bad).
4. STRESS, POOR SLEEP, LOW MOOD AND WORRIES SHAPE BACK PAIN
How we feel emotionally can influence our experience of back pain (or any pain, for that matter).
Stress, mood and anxiety levels, poor sleep patterns are all factors that are not only linked to health conditions such as cold sores, irritable bowel syndrome and tiredness, for example, but they also strongly affect back pain. Not surprisingly then, it is important to find ways that allow us to relax.
5. MORE BACK PAIN DOES NOT MEAN MORE DAMAGE
Different people with the same injury can experience different amounts of pain. As mentioned above, different factors can affect how much pain we feel. Have you ever had the experience of looking down at your arm or hand, for example, and wondered when and where you got that scratch that is bleeding? Or witnessed the child who fell down but was fine until his over-reactive mommy jumped up and flew to the rescue only to cause the child to start crying well after the fact of the supposed “injury”?
Our nervous system has the ability to control how much pain we feel at any given time. If a person has back pain, his/her nervous system may sometimes become hypersensitive, causing the person to experience pain, even though the initial injury (a strain, sprain, etc.) has healed. This can mean the person feels more pain when they move or try to do something that does not cause any damage to the spine.
6. PERSISTENT BACK PAIN CAN GET BETTER
It is not uncommon for people to experience much frustration – even hopelessness at times – when they fail to achieve pain relief in spite of having undergone many different treatments. Generally this happens because most treatments only address one factor. Someone gets a muscle relaxer for the spasm in their back muscles, for example, but their sleep or posture patterns are not addressed.
Pain can be significantly reduced and people can return to an overall healthier life when the different factors for each person are identified and addressed simultaneously.
And this is precisely what physical therapists strive to do – to tackle back pain comprehensively. If you have lost hope that you will get better, it may be time to seek out a PT that will spend concentrated time with you looking at ALL the factors that may influence your experience with persistent back pain.
If back pain is keeping you from doing and enjoying the things you like to do, you may want to give a PT a call.
1. Available at: http://www.who.int/medicines/areas/priority_medicines/Ch6_24LBP. Accessed October 26, 2015.
2. Available at: http://www.independent.ie/life/health-wellbeing/15-things-you-didnt-know-about-back-pain-31367264.html. Accessed October 26, 2015.
3. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-6.