Back Pain

CLIENT REVIEW

At Pain and Performance Clinic we have treated many patients with back pain. Back pain can be very frustrating as it impacts our day to day lives more than other injuries. Patients with back pain often come to us and along with their pain they are confused about why they have back pain. 

We have seen it all form acute back pain to people who have been suffering with their backs for years. Whether their back pain has been bothering them for weeks, months or even years, often the first thing people ask us is “am I damaging my back more?”  

The answer to that is no!

Our backs are more robust than we give them credit for. And, often our beliefs on how strong our backs are is part of what drives your back pain. These beliefs we get from past experiences, from doctors and physios and even from family members. 

“mind your back”

How many times have you been told that? People saying things like “mind your back” or “be careful” or “don’t lift anything too heavy” to people with low back pain is what takes away their confidence in their own back to do the job it’s supposed to. Our backs are supposed to twist, bend and move just like any other joint in the body.

How do I know my back pain isn’t a sign of serious damage?

Most back pain is not caused by serious or sinister damage. You only need to worry about sinister damage to your back if your back pain is not your only symptom. You should however consult your GP if your back pain is accompanied by;

  • A fever
  • Unexplained weight loss
  • A loss of bladder or bowel control
  • You’re unable to pass urine
  • You have numbness in your genitals, buttocks and back passage.

 

Why do I have back pain?

Unfortunately, the answer to this question is the last thing a patient wants to hear. It depends. Back pain is very individualised and in order to fully understand your back pain we would have to hear your story. 

Also unfortunate is the fact that there are many physios and doctors out there that want to give you one single reason for your back pain. They want to give you a “diagnosis” so to speak. But the reality is that back pain is more complex than that. These healthcare professionals like to see things as black and white, but, when it comes to back pain (and pain in general) we live in the grey bit!

Good news though, very few people who back pain have sinister pathologies. More than 90% of the time back pain is categorised as “non-specific” this means that no structure in the back itself is damaged. This kind of back pain is very manageable with the right approach. 

What contributes to my back pain?

There are many things which contribute to our back pain. Our beliefs about back pain as we’ve said can make our pain feel worse or better depending on the outlook we have. Our past experiences can drive our pain. If you have hurt your back before, gone to a physio and found it not very useful. This can make your back pain worse. 

If you aren’t sleeping, if you are working longer hours, if you’re anxious or depressed. These can all drive our pain even more. Change of routine can make or backs sorer also. Whether it’s going from doing nothing to doing loads or vice versa.

Another contributor to negative beliefs of back pain is the word chronic. Chronis is a word that is often associated with back pain. Most people associate this with the word bad. Sure, in some parts of Ireland people use chronic and bad interchangeably. Having a negative word like this associated with back pain drives these negative beliefs that make our back pain worse. Chronic though does not necessarily mean bad. Chronic just means it’s been there for a long time but if you do the right things that can change. 

What is sciatica?

Often associated with back pain is sciatica. Sciatica is the name given to the pain that you get along the back of your leg and sometimes all the way down into your heel. It’s called this after the sciatic nerve that originates in your lower spine and travels down to your foot winding in and out of different muscles on its way down your leg. Sciatica will usually get better within 4 to 6 weeks. Sometimes though it can last longer.

What should you do if you have sciatica? First and foremost, you need to know that despite the painful feeling in your back or legs you are not causing damage by moving. Being active will hell to reduce the pain, whereas sitting for long periods may aggravate it. You will also need to have specific exercises to help you depending on your assessment. There are no generic sciatic exercise plans. Your exercise plan from your physio should always be specific to your needs. 

Should I rest to let me back pain settle?

Rest alone will not solve your back pain. Resting may initially reduce your pain but unless you gradually expose your back to movement in the right way then once you start exercising or being active again your back will hurt. 

Keeping active and carrying on with your usual activities can help to produce natural pain killers called endorphins. It is also important to remain optimistic, back pain is a manageable injury and with the right support and guidance you can reduce and get rid of your back pain

What are the best treatments for back pain?

There are many treatments for back pain and most of them are useless. A lot of people out there will have tried or had treatments suggested for them such as dry needling cupping or any other of the passive treatments as we call them. Some “passive” treatments have their place in your journey to being pain free. But, if passive treatments are the bulk of your treatment then your back pain is going to stick around for a lot longer.

At pain and performance clinic we pride ourselves on having an evidence-based practice. What does this mean? It means that we follow the best practice guidelines for treatment. We try to stay away from the latest gimmick or fad. We don’t ignore new treatments, instead we investigate these and if they’re proven useful we add them to our repertoire but if not then we won’t be using them!

Why do we pride ourselves on using evidence-based practice? We pride ourselves on using evidence-based practice, especially for back pain because it is the right thing to do. When it comes to back pain, the research shows that if a patient gets one treatment that is not evidence based in their first appointment they are more likely to have longer lasting back pain. 

So what kind of treatments are bets for back pain then? Exercise therapy is without a shadow of a doubt the best treatment for back pain. Exercise therapy should be the core part of any rehabilitation plan for back pain. The back is a series of joints and muscles. Anywhere else in the body we would move and strengthen these after an injury as part of the rehab process, and, the back is no different! Some passive treatment along with this exercise therapy can be useful to help you feel better, but, once you feel better from these treatments you need to move more and take advantage of that good feeling to get you going again.

What can I do for my back pain?

The good thing about back pain is you have all the tools to fix it yourself!

The bad thing about back pain is that you have all the tool to fix it, which means you’ll have to put in some work. 

A good physio should enable you and facilitate your recovery while also building your resilience. A bad physio will make you dependent upon them. No physio should be claiming to “fix” your back pain. They shouldn’t be “releasing your hip flexors” or “working out your knots” and they sure as hell should not be telling you that they’re “realigning your spine”

All of those phrases are part of the “treatments” that are not evidence based, if a physio has used one of those lines in your first appointment it is going to add weeks to your recovery time, if they’ve used two of them it may add months.

We at pain and performance clinic don’t just label your back pain as black or white. Back pain is much more complex than that. We will figure out as many of the reasons for your back pain and the things that may be driving your pain. We want you to be aware of the potential issues that may make your pain flare. We want to give you the tools to deal with these flares, minimise them and become resilient enough to keep going even on tougher days.

 

Simple answer here is no. The idea that a “weak core” can cause back pain is way too simplistic. Some healthcare professionals will tell you this because they like to tell a convenient lie rather than discuss more uncomfortable truths. 

First problem with this idea is that the “core testing” physios do is very non-specific and performance in this can be determined by other muscle groups. 

Secondly, more athletes have low back pain than your average joe. Do you really think an athlete with a high-performance team really neglected the athletes core training and that’s why their back is sore? If a weak core meant a sore back then the opposite too would be true, a strong core would mean no pain. Lots of strong cores have sore backs and lots of weak cores have no back pain. **hyperlink to study about back pain and weak core?

NO! 

There is no ‘good’ or ‘bad’ posture. We all sit and stand in our own unique way. The only time posture will contribute to your back is if you spend too much time in one position. Standing up fully straight with “perfect” does not mean you won’t have pain. In fact, a lot of people that stand straight all day have back pain as the muscles in their lower back are always switched on and get overworked. 

Don’t want to take my word for it? Here’s a study done in 2016  that showed there was no link between posture and low back pain. **hyperlink to 2016 study where there is no link between posture and pain

Sit in a chair that you find comfortable. Save your money and don’t waste it buying an ‘ergonomic’ or ‘orthopaedic’ chair. Ergonomics have been shown to have no link to reduced pain and yet still manual handling and “proper desk set ups” are peddled in all big offices throughout the country. 

To paraphrase Dr. Greg Lehman…

If ergonomics worked so well then using the right chairs and desks in offices would have eradicated back and neck pain a long time ago!

Here’s another one of the myths we hate. 90% of the world have two legs that are different lengths and it doesn’t mean they have back pain. In fact, you’ve probably had a leg length discrepancy your entire life, but you haven’t had back pain all your life… what does this tell you? It tells me anyway that the length of your legs is not the root cause of your back pain. 

If your leg length discrepancy is more than 2cm then it may be something you need addressed. But, this can only be measured accurately with a scan, there is too much room for error if your healthcare professional is eyeballing it or even if they’re using a tape measure.

A slipped or bulging disc is where the disc (the bit between the bones in your spine) has swollen slightly beyond its normal space and may now be pushing on a nerve or another structure within the body. The wording of “slipped” or “bulging” is probably a bit misleading. They do not mean that the disc has moved and won’t go back in. They don’t mean that your spine is damaged. 

A better way to describe the disc would be swollen. Much like if you sprain your ankle there will be swelling, the area will get bigger and if it pushes on a nerve it may cause pain. Just like the ankle though, when the swelling subsides we need to move the area, strengthen the area and get used to being stressed again before we jump straight back into our normal activity.

It is impossible to say whether or not you need surgery on your back without seeing you in person. Generally, back pain can be treated without surgery. Surgery is often unnecessary, expensive and a time-consuming way to deal with a back injury. Following back surgery, you will still need to attend a physio in order to rehab fully and rebuild your mobility and strength.

MRIs are just one part of the diagnosis process when it comes to back pain. In fact, they are often not particularly useful. Back scans are a snapshot in time and many people with no back pain have the same changes on their MRIs as people with back pain. 

MRIs often show:

  • ‘degenerative changes’ or 
  • ‘bulging discs’ or 
  • ‘narrowing of the joint space’ 

Many of these changes are normal. And these changes are often different depending on the time of day. For example, later in the day there is usually less fluid in the discs and therefore they look narrower than in the morning time. Our MRIs are a bit like photos. You wouldn’t expect to look the same in a photo now as you did in a photo 20 years ago. You should think of these changes on your spine as wrinkles on the inside. Your skin has wrinkles but it doesn’t mean your wrinkles cause you pain. 

Where MRIs are useful is for ruling out red flags. A physiotherapist may ask you to get one if during your assessment we think that there may be sinister damage in your spine. Sinister damage in your spine should manifest as more than back pain alone. It may be accompanied by a fever, unexplained weight loss, losing control of your bladder or a loss of sensation around your genitals and back passage. 

 

If you have none of these symptoms and you have back pain alone then a scan may not be necessary for you.

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