Low Back Pain – What You Need to Know

Friday, October 29th, 2010 No Commented
Categorized Under: Back pain

Have you got low back pain? It’s common. Don’t fear. Don’t be afraid. You can gain mastery of your low back.

The advice you’ll get from doctors, therapists, or chiropractors can be confusing or even misleading. They’re not deliberately trying to mislead you. They might just be thinking about back pain from a limited perspective.

Before you make a commitment to a treatment program, begin by understanding some of the key facts about your pain and the low back. There’s always a lot you can do for yourself to gain control over your situation. Even if you need the extra help of a chiropractor, physical therapist, or medical doctor, your treatment will be that much more effective if you’re also doing all you can to help yourself.

I spend a lot of time explaining low back reality to my patients. You can get a head start. Here are the some of the key ideas I wish all my patients understood:

  1. Pain is an experience that takes place in the brain, not in the muscles, joints, or discs. This doesn’t mean that pain is “all in your head“. Pain has a tangible basis in the signals that are coming in from your body. Change the signals, and the experience of pain will change. Or change the way the brain processes the signals, and the experience of pain will also change.
  2. The brain creates an interpretation of pain based on all the input coming from the body – all the muscles, joints, ligaments, organs, etc. What that means is that only rarely is there a single site in the body you can point to and say “Aha! There’s the cause of the pain.”
  3. Doctors often identify the intervertebral disc as the source of low back pain. This violates principle #2 in the paragraph above. But it’s not entirely crazy, either. Discs are subject to a lot of stress, and they’re rich with nerve endings – nerve endings that can send pain signals into the brain.
  4. Nearly everyone over 30 – those with low back pain and those without – has some wear and tear of the intervertebral discs. And if you have an MRI, you’ll see it. The radiologist might call it degenerated, herniated, or bulging, or use some other term.
  5. Since nearly everyone has some disc damage, the appearance of your discs on an MRI doesn’t correlate exactly with the amount of pain you’re in. It’s a very tricky diagnostic situation. You can have really bad discs but little pain, or only slightly damaged discs and a lot of pain. You can also have pain on the opposite side of your disc bugle, or at a spinal level above or below your worst disc. The MRI shows the architecture of the disc – it isn’t really diagnostic.
  6. That means that most people are wasting their time having an MRI.
  7. There’s a lot of scientific research about the use of spinal adjustments (also known as spinal manipulation) for low back pain. In many of the research studies, it turns out that adjustments are helpful, though in other studies, adjustments don’t show much benefit. It’s a very tricky area to research since there are so many variables – the types of low back pain patients being studied; the type of adjustments given, as well as their frequency and the overall duration of treatment; if other treatment is also provided; etc., etc., etc.
  8. There’s almost no evidence that adjustments (manipulation) causes harm in patients with low back problems.
  9. Surgery for low back pain, on the other hand, has been less rigorously studied than adjustments. And like the study of adjustments, this type of research is extremely tricky to do, and shows a variety of results.
  10. Here’s some bad news: back pain can become a long-term, recurring problem. That’s not always the case – many people have an episode or two of back pain, find a method to get relief, and then stay clear of pain for the long haul. But, too commonly, once you start having a low back problem, it can linger or return at a later point.
  11. Here’s why low back pain can become a long-term problem: When you have an attack of back pain, some damage is done to the structures of the low back. Even though the pain can temporarily go away, those structures haven’t truly been healed. Then your back doesn’t quite regain its previous ability to support your body weight day-in, day-out. It’s all too easy for the pain to come back.
  12. That’s why most experts agree that the exercise you do to take care of your own back is extremely important.
  13. Unfortunately, even though there’s wide agreement that exercise is important, there’s very little agreement about the “what, when, how, and how much” of an exercise program for low back pain.
  14. Sit-ups, curl-ups, or crunches can actually do more harm than good. These frequently-prescribed abdominal exercises are suggested because strong abdominal muscles support the low back. But when you do these exercises, most often you’re exercising the wrong groups of abdominal muscles anyway. Plus, you can be putting extra pressure on the discs and other low back structures.
  15. There’s a safer, faster way to develop core support instead: the plank pose. You’re stretched out long on the floor, with your weight resting on your elbows and your toes. Use your abdominals to keep your whole trunk in a straight line from feet to your head. (You may have to find a picture of this on the internet.) It’s harder than it seems. Hold for 15 seconds. Repeat it once a day. When 15 seconds becomes easy, increase to 30 seconds per day.
  16. Don’t perform “pelvis tucking” exercises. Some examples of these exercises are: standing against a wall and flattening your back against the wall; or lying on your back and pressing the small of your back to the floor. Like sit-ups, curl-ups, or crunches, these exercises continue to be commonly prescribed for the health of the low back. They’re more likely to backfire. They put more pressure on your discs. And when you flatten your back, your spine can’t efficiently absorb vertical forces (like gravity.)
  17. A lumbosacral support belt can sometimes be helpful. This gadget cinches you in around the waist and takes the pressure off your low back. Try it – sometimes putting a support belt on relieves pain. For other people, it doesn’t alleviate pain, but it protects the back and prevents it from getting worse.
  18. A support belt can also be useful when performing challenging activities like lifting, bending, or riding in a car.
  19. Another type of mechanical stress on the low back occurs when you shift your weight side-to-side. This happens with each step when you walk. Or if you’re standing around and let your weight sag over to one side.
  20. That’s why strengthening your control of side-to-side weight-shift is an important part of protecting your low back.
  21. A good exercise to strengthen control of side-to-side weight shift:
  • Hold on to the back of a chair or a doorknob for balance.
  • Stand on your left leg and lift your right foot to the front, slightly off the floor.
  • While continuing to stand on your left leg, move the right foot slowly out to the side, then around to the back.
  • Reverse the action of the right foot, slowly moving it to the side and back to the front, and then lower it next to your left foot and stand on both feet evenly.
  • While you’re moving your right foot, pull in your stomach muscles and balance evenly over the left standing side, preventing your pelvis from sagging sideward or shifting to the front or rear.
  • Repeat the exercise on the opposite side.

Now that you’ve read this, take some time to pay attention to the pain that you’re experiencing. A lot of the pain solutions you’re looking for can be found just by paying attention to your own body and your own experience.

As you apply the knowledge contained int his article, you’ve already taken a huge first step toward mastering your low back pain.

Best wishes!