Everything you need to know about back pain
As physiotherapists we all have our specialist interests (mine is back pain!) – some more socially acceptable than others – personally (Tim@advancephysio here) I’ve never been keen on respiratory physio where you have to encourage sputum clearance by getting people to cough, needless to say people always seemed to turn their head towards me and cough in my face! Not something I’m keen on at all!
The point is we get interested in something we can help or have personally experienced, and then we read and read and explore the topic until all avenues have been learnt and mastered to some extent (we’ll never fully master anything physio related as there’s always more to learn but you get my drift). That then turns into this specialist interest.
You have people like the Running physio (Tom Goom – specialist interest = running!), the Sports Physio (Adam Meekins – specialist interest = the shoulder complex), Peter O’sullivan, Mary O’Keefe or even the Neuro Orthopaedic Institute (David Butler and Colleagues – authors of Explain Pain – specialist interest = Pain!) that take this specialist interest to another level – they have thousands of people following them on various social media outlets because of their specialist interests.
For me, my specialist interest, is back pain. I find it fascinating. Especially the severe acute back pain and the long term chronic back pain. How on earth can someone experience pain years after an injury? Surely the body has healed? Surely the damage has gone after so many years of healing? Why do people describe the severe back pain as worse than child birth?? It’s fascinating. It affects so many people – 4 out of 5 of us – at least once in our lifetime. And when you’ve had back pain of any sort (I’ll explain later the different types you might experience), you can understand how debilitating it can become.
As someone who has experienced chronic back pain myself (from an accident – perhaps I’ll explain at some point) and as someone who has family members who have chronic pain (Fibromyalgia) and as someone who has friends with chronic back pain and as a physio who helps people manage back pain – it’s probably the single largest problem that I’ve experienced as a physiotherapist.
This has led me to explore back pain more and more. So as a way of sharing some of the wisdom that we learn as physiotherapists and as a way of sharing some of the personal experiences I thought I’d give you my top 5 bits of back pain pub quiz winning snippets of information.
1. Back pain is not all the same
Back pain can be a dull ache, throbbing and stiff. It can feel like a catching and jarring. It can feel like the muscles are ripping apart, like a massive muscle spasm or cramp. Your back can feel like you’re being pulled to one side so that your hips are off center. It can come in waves of sharp shock like pain. It can radiate like a dull ache or it can radiate like a deadening, numbing or prickling sensation. It can pop and crack. It can simply feel tight. It can feel weak and tired. Or it can feel indescribable.
Back pain is most definitely not all the same. So if someone tells you to wise up and stop complaining and you’ve just had a severe episode of back pain, then point them to me and I’ll gladly explain the different types of back pain.
2. Back pain is rarely something to worry about
Only 1 person in every 100,000 people will get severe symptoms that are a medical emergency*. Only 1-3% of people will get a symptomatic intervertebral disc herniation*. So what does this mean practically – well in clinic if we were to see 500 people a year, 5 people in a whole year will have a disc herniation.
3. Leg pain is not always leg pain
It’s a brain teaser I know and it can sometimes be quite confusing for people. But it’s true. Leg pain does not always come directly from the leg. Most people have heard of sciatica pain. Well you can have calf pain without having back pain but the cause is an irritated nerve in the back. MIND BLOWN! It depends on what part of the lumbar spine is effected and at what point the nerve is irritated. It also depends what part of the nerve is effected. Imagine a piece of rope and only one side of it is irritated. The part that is irritated is in the low back and is the part that supplies sensation to the calf. The back still works normally but the sensation to the calf has been effected causing pain and a tightening sensation.
4. Back pain is best helped by movement
This is my favourite piece of advice ever. Back pain is helped by movement. It’s knowing what the best types of movements are that is the clincher. There are certain movements that, if repeated, will decrease the ache like pain. There are other movements that if sustained will provide you with a position of ease from the radiating leg pain. There are other movements that look ridiculous but help to open up the joints to relieve pressure from the stiff back. These movements are safe and don’t cause further damage. Rest is ok initially for like one day – maximum. And avoiding the aggravating high load activities like running just make sense initially. But keep moving even if it’s just small controlled movements for the first day and then increase it as able.
5. More Back pain does not always equal more damage
We are a chartered profession. That means we are held to certain standards of care and if we don’t meet them we are struck off. The society that helps us meet these standards is called the Chartered Society of Physiotherapy (CSP). They recently ran a myth busters campaign to help educate people about back pain. One of their messages that I thought was exactly on cue was their one about more pain equaling more damage.
There is so much that contributes to your pain experience, more so than simply the physical damage that was experienced. If you hammer your thumb you have a physical reaction to pull the thumb away. But what else do you do? You will also have an emotional experience – some will cry – some will shout – others will swear. So with every pain there is an emotional experience. What else do you then want to do? You want to share that experience with someone. You either need to tell them to help you or you want to share socially with some about your anguish of hitting your thumb. So with every pain there is a social response. These emotional and social and physical responses are remembered by our brains and bodies to try to make your life easier. Next time you hit your thumb you might shout louder if the damage the first time caused you to break your thumb. Otherwise you might get use to the pain and not shout at all.
With back pain it’s the sum of these different past experiences that can have an impact on how you experience your pain.
Everything you really need to know about back pain?
So really the heading of this post was probably massively misleading in that there is a whole lot that I’ve not covered about back pain. But hopefully there’s been enough food for thought and perhaps in the future when I’ve just climbed a mountain looking out over the horizon contemplating my specialist interest there will be more posts about back pain.
There are a number of excellent resources out there that can help you manage your back pain. Here are a few for further thought:
- The Pain toolkit: https://www.paintoolkit.org/tools
- The Neuro Orthopaedic Institute: http://www.noigroup.com/en/Home
- Check out their explain pain book – it’s class!
*Cauda equina syndrome: a review of the current clinical and medico-legal position. Gardener, Gardener and Morley (2011).
Herniated lumbar disc. Jo-Jordan et al. 2009/ 2011.
Disclaimer: Please seek professional medical advice before starting any self help programs.