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newsletters
Back Pain – All in the Mind? (July 2008) Welcome to the 3D PTS Edge July 2008 newsletter. There’s little doubt that today the Western World is in the midst of a back-pain epidemic. The numbers are staggering: there’s an 80% chance that at some point in your life you’ll suffer from severe back pain, and treating back pain costs about $26 billion annually in the US alone.(1) You’ve probably heard the same story a number of times from friends, relatives or colleagues, they just bent over to pick something up, they weren’t even straining, but something ‘just went’. About 90% of those injuries will clear up in a relatively short period of time, causing some discomfort but no lasting pain. It’s the 10% of back pain that doesn’t go away, turning into a chronic, debilitating, and often life ruining condition, which poses a major problem for human beings today. It is also a fact that the medical establishment has largely failed to develop any significant understanding or treatment of the condition to date and in this vacuum it has largely resorted to possibly unnecessary pharmaceutical and surgical intervention.
So what’s going wrong with our backs? Is it all down to poor lifting technique and posture? Poor lifting technique certainly plays its part, along with poorly maintained core musculature, bad posture and limited flexibility. A body showing muscular and postural imbalances is primed for back pain even when moved properly. So what can we do? “A strong back knows no pain” is a phrase used by Keiser Training, a large multinational gym company. Keiser promote the use of machines that isolate and strengthen individual muscles, thus ‘protecting’ the joints and spine. We think they’re dead wrong, and here’s why: This type of 1 dimensional machine training does exactly what it says on the tin, isolating and working each muscle individually. This makes your core musculature (which stabilises you when moving and lifting) almost completely redundant, further reducing your flexibility. It creates a series of muscle imbalances – a leading cause of back pain.
A balanced body knows no pain The key to avoiding and relieving back pain is a balanced body, achieved through functional training, strong core musculature and regular stretching. This is the difference between working out 3 dimensionally: pushing, pulling, lunging, twisting using your whole body, and working out 1 dimensionally, isolating everything. Working out 3 dimensionally develops a balanced body which provides a solid base for the spine and promotes flexibility. Allowing one muscle to become too short and tight or too long and loose directly affects the other muscles around it, creating an imbalance in your body. Many leading physical therapists have reported significant success in relieving back pain by working on muscles that are not located in the back. According to leading physical therapist and soft tissue release innovator
In his experience the spinal erectors and abdominals are least involved in causing back pain.(2) Simply chasing the effects of pain such as tight back muscles and pinched nerves does not bring long term relief. We need to look beyond the effects and locate the root cause of back pain, which is probably not in your back. Today we tend to spend all our time attempting to ‘fix’ the effects of the problem rather than the problem itself. When we fix the cause, the rest follows.
Physical solutions for back pain A sedentary lifestyle, hunched over a computer or the latest games console, never mind many an inert hour sat ogling the television is definitely going to lead to the muscle imbalances described above. You need to move your body. Bad posture is also a factor in back pain, so make an effort to sit properly! If you suffer from back pain, try to find a personal trainer who specialises in functional and corrective exercise and stretching (like we do at 3D PTS). A postural and movement assessment is essential as part of your first session. Manual therapy and deep tissue massage can also help. One technique practiced at 3D PTS is Dorn Spinal Method which works on correcting various spinal misalignments like scoliosis. Also recommended and used here at 3D PTS are techniques to remove soft tissue restrictions: Soft Tissue Release pioneered by Sports Therapist, Stuart Taws, and Raynor Style massage therapy. For strengthening of the core musculature, Pilates can also be very beneficial, but be sure your instructor is aware of any existing conditions.
Nutritional stress and your back What you eat can also contribute to back pain. Food intolerances, for instance to gluten and dairy, compromise the integrity of the core muscles which provide stability for your spine. Because intolerances cause irritation and inflammation in the intestines, your brain ‘switches off’ certain nerve impulses emanating from your spine which usually keep your core muscles engaged and provide essential lower back stability. Taking on adequate amounts of water is important too: 75 percent of the weight of the upper body is supported by the water volume stored in the disc core of our vertebrae. Sufficient water will help ease back pain.(4) In terms of supplements, the respected doctor, nutritionist and health writer Dr John Briffa suggests 1500 – 2000mg of vitamin C helps in collagen formation – an essential component of the intervertebral discs in your spine. Dr Briffa also recommends 500mg of glucosamine sulphate 3 times daily, as this building block can help stimulate healing and repair in damaged discs.(5)
So why is back pain still such a big problem? What we’ve discussed so far are techniques to prevent and eliminate the pain signal being generated at the site of physical stress or injury. Traditionally this is how we see pain – we have an injury that triggers a pain response and we experience pain. Therefore to deal with the pain we must investigate the physical stimulus behind it and fix the injury, often meaning a range of scans, appointments with consultants, epidurals and painkillers with accompanying side effects, and when all else fails, surgery. But is it all necessary? “After undergoing a full range of diagnostic tests, 85 percent of patients suffering from lower-back pain still don’t receive a precise diagnosis. Instead, their pain is parceled into a vague category, such as lumber strain or spinal instability. A 1994 study published in the New England Journal of Medicine imaged the spinal regions of 98 people with no back pain or back-related problems. The pictures were then sent to doctors who didn’t know that the patients were not in pain. The end result was disturbing: Eighty percent of the pain-free patients exhibited “serious problems” such as bulging, protruding, or herniated discs. In 38 percent of patients, the MRI’s revealed multiple damaged discs. These structural spinal abnormalities are often used to justify expensive treatments like surgery, and yet nobody would advocate surgery for people without pain.”(1) The problem is that although techniques such as manual therapy outlined above do achieve considerable success both in preventing and relieving chronic pain signals, it’s not enough just to treat the physical aspects of pain. Treating the problem 3 dimensionally means looking at the whole human response, and at what happens in your mind when pain signals are received there.
The psychological paradigm – is back pain a disease of the nervous system? New research into chronic back pain suggests that it’s our emotional, negative experience and perception of pain that determines what level of discomfort we feel. Chronic pain is felt predominantly by your mind, not by your back. It works like this: our nerves tell us we are experiencing pain by sending electrical messages to the brain, saying ‘hey, we have something wrong here!’. The part of your brain dealing with pain messages decides what level of priority to give it by passing the message on to the area that creates emotions. Your brain needs to do this because at the same time it’s also receiving millions of competing messages from your mouth, nose, eyes and of course the rest of the nervous system, plus other parts of your brain. For instance, if you have chronic back pain and you see a bus heading straight for you at considerable speed, your brain will prioritise the visual and nervous signals telling it that you’re about to be flattened, above the nervous system telling it that you’ve got back pain, and if only for a few seconds, you don’t have back pain anymore, simply because your brain chose not to feel it. The pain signal didn’t change. Your mind did. Chronic back pain exists because your mind can’t distract itself from the pain signal – it becomes locked into a vicious cycle. Now, if you can train your mind to prioritise other messages over the pain signals, you’ll still know that there is a pain signal, but your brain won’t lock in and assign any negative emotional status to it and the pain just doesn’t seem painful anymore. The message itself doesn’t hurt that much. Our minds are acting to amplify the pain signal because of the importance our emotions and psychology place on it. Sean Mackey, MD, PhD, an associate professor at Stanford University and director of the pain management division says “We’re now beginning to recognize that you can’t talk about chronic pain without talking about its psychological aspects. It’s a condition in which signals from the body are literally distorted by the brain.”(1) A number of scientists and psychologists have developed therapies to train the mind not to assign negative emotions to chronic pain, such as cognitive behavioral therapy and self-regulatory therapies, which appear to be successful.
Chronic back pain and depression If chronic back pain is a condition of the nervous system, does depression cause the pain signal to be amplified even further? A team from the Department of Psychiatry at Manchester University in England certainly thinks so: “Considerable previous research has investigated the impact of depression on pain experience. Depression increases the risk of first onset pain and increases the risk of the development of chronic pain complaints over time. Among pain sufferers, depression is associated with greater pain intensity and unpleasantness, more bodily pain sites, and a higher degree of pain related disability. Overall, the weight of evidence seems to indicate that depressed subjects are more vulnerable to developing pain and, once pain has developed, have a broader spectrum of more negative experiences and outcomes… Chronic pain results in reorganization of pain pathways so that both central and peripheral nociceptive processing is enhanced. This process might be further enhanced by the presence of depressed mood.”(6) Overall, there seems to be little doubt that although the pain message is real enough, it’s our minds that decide how we perceive and experience it, and that depression feeds and enhances our experience of chronic back pain.
3D PTS back pain relief strategy At 3D PTS we believe that treating chronic pain holistically means a greater chance of reducing and eradicating it. It seems clear that there are at least two known factors in our perceptions of chronic back pain, the nervous system creating and transmitting the pain impulse, and our minds interpreting it. By engaging in manual therapy, corrective exercise and functional nutrition, we can treat the cause of pain, by training the mind to perceive and experience the pain impulse differently, we can decide for ourselves what role it plays in our lives. Wishing you all the best in health and fitness, Craig, Matt and the 3D PTS team
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