Back Pain – Part I: Clues into the why’s and how’s of Back Pain

Back pain royally sucks, no doubt (I speak from personal experience). It will strike most of us at some point in our lives- some people earlier than others, some more intensely and debilitating than others, some recover quickly while others it becomes a chronic condition. Why? The first answer is: genetics. You got what you’re given, like it or not. Just like your height, eye color, condition of your heart, or how flexible you are, genetics plays a huge role. Many of the primary structural contributors to back pain like Osteoarthritis, Degenerative Disc / Joint Disease, and spinal Stenosis are determined by your genetic parents. Many people develop these conditions early on in life, while some not until much later. Identical twin studies have helped prove this, whereby identical siblings will be tracked over their life span. One may have a very physical job / lifestyle, the other more sedentary, and most of the time they will develop the same back pain causing conditions at about the same time. There’s not much you can do about this except minimize environmental conditions & lifestyle choices that exacerbate these conditions. Things like being overweight, smoking, not exercising, having a poor diet – they all can contribute to earlier onset and/or worse symptoms when these conditions are present.

But what about when these conditions are not present? Why do so many people (in fact, the majority of acute back pain sufferers) get back pain when none of these conditions are present? The short answer is: those same environmental & lifestyle conditions that have a huge effect on the physical state of your soft tissues. Things like stress, certain movements / postures, poor muscle strength or endurance, and poor body mechanics can bring on back pain. Humans are upright beings with long, relatively thin back muscles, which are NOT designed to do a lot of heavy work or lift / move heavy loads. Yet go to any construction site and see the heavy loads being lifted / moved / carried w/ bent backs and straight legs – OUCH! That’s a back spasm waiting to happen. Not to mention the load that intervertebral discs are subjected to when one bends over to lift even just a 20# object with a rounded back (discs can bear 5-10x more lbs / sq. in. than the load itself). This causes OVERLOAD. And just like when you overload an electrical outlet in your home, your brain acts as the breaker box and “trips the breaker. ” Only instead of cutting off the electricity, it supplies your back with an involuntary, uncontrollable, and often unending blast of electricity, commonly called a spasm. This can last for a few hours or a few weeks, depending on many various factors, things such as: is it a repetitive stress / movement that has accumulated trauma to the tissue over time or is it a single action that overloaded it? What state was the tissue is in to begin with – were the tissues healthy, fit, and in good condition prior to the event or were they stiff, dehydrated, weak / fatigued? How much rest and healing time is the sufferer able to allow the overloaded tissues before subjecting them to loads again? These all play into how intense, frequent, and long lasting back pain can be. Plenty of research is out there, even in popular magazines like Consumer Reports, saying that the most common cause of acute back pain is muscle / tendon / ligament injury. A host of medical experts and studies in the past 5-7 years have proven that the typical ways of evaluating and treating back pain (X-Rays & MRIs followed by invasive treatments & opioid medications) have failed to show any significant reduction in either pain or disability. That’s partly because it’s been proven that the structures that most commonly show up as “positive findings” on X-Rays and MRIs (bulging or deteriorated discs, facet arthritis) are not typically what’s causing the back pain. So getting these tests can lead a person to receiving all kinds of unnecessary treatments without getting to the source of the problem.

So, what can we do about it – both before an acute back pain eruption and after it’s already happened? The best things to do to prevent, or at least minimize the likelihood, of back pain is to stay fit and be smart. Being fit means maintaining an equal amount of mobility / flexibility as well as strength. A person can be super strong but have very little flexibility (picture the stereotypical logging crew guy that can pick up a tree and sling it over his shoulder but can’t get to his kneecaps in a forward bend). Conversely, one can be the best Yogi in the class, so flexible she can lay her forearms on the floor, but her core muscles can’t stabilizer her pelvis carrying a laundry basket up a flight of stairs. Both of these individuals are more likely to get a back spasm due to overload of those long, thin back muscles –  the guy from over-stretching, the gal from over-working. Once an overload has occurred, it depends on how severe the brain perceives the overload to be that determines how severe the “trip of the breaker” is. It could be as mild as a little bit of tightness in certain motions or difficulty bending all the way over to tie a shoe lace, or so severe the person can’t stand up or even roll over in bed. NOTE: Pain in these situations, even what feels like nerve type pain or pain radiating down into the legs, is most often normal, and should be thought of as a sign that the signaling system is working as it should, not that there is something structurally wrong that needs to be “fixed.” There are a few “red flags,” however, that do warrant an urgent exam by a doctor or other practitioner experienced in back pain: bilateral and/or unrelenting radiating pain into an unchanging region of the body or leg(s), loss of function or control of any part of the body (bowel / bladder or other organ, legs, or feet). Once those red flags are ruled out, the biggest healers are: avoidance of exacerbating movements / activities / postures, getting professional help to speed recovery (Physical Therapy is obviously my first recommendation), and time. Medications and pain blocks can mask the signals the injured tissues are sending the brain, thereby allowing you to go on business as usual and that can further injure already injured tissues. Rest and recovery are what the brain is trying to force when it causes “spasms,” so listen to it! 

Besides MDs & Physical Therapists there are lots of other practitioners out there that say they treat back pain: Chiropractors, Massage Therapists, Acupuncturists, even a dozen or two YouTube gurus who claim everything from “solve your back pain in 5 minutes or less” to “never have back pain again.” Who’s telling the TRUTH?

The truth is: they’re all right…sort of. Watch for Part II of this post….

 

 

Written by Damon

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