Lumbago / Low back pain

Placebo Effect

You’ve probably heard of the placebo effect? Believing that an action or treatment works for you is a high predictor of positive outcomes. If you can find ways of changing your mindset and working with an approach that you believe in, your pain may lessen.

It’s time for action. Thankfully, even very little can go a long way, so long as you stay consistent and keep your eyes on the overall trend. There may be dips along the way. Think of each exercise, however small, as a step on your journey. Sometimes you may sidestep or even move back a little. The overall trajectory is clear: living a pain-free, healthy and active life.

Mindfulness Exercises

Start your way to recovery with simple exercises, complemented perhaps by learning new mindfulness techniques, as experts believe those to be a powerful tool, too. The combination of exercises and mental focus techniques can give you greater body awareness, the ability to recognise when you are falling into the pain trap. (Those are also a part of the potential negative spiral. You’ll also build your option and coping skills for possible setbacks and flare-ups. We encourage you to take responsibility for your rehab - wherever and however you can.

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The back and its functions

To safely do your exercises, it helps to know what it is you are moving and why. This can also help you tune in on the right way to move and avoid triggering the wrong muscles (or looking like a lopsided banana, as you strengthen your core).

For the back to function optimally, there has to be a good balance of muscles and nice alignment of your bones and joints. All parts of the spine have to be in good working order. As we get older, develop postural habits, suffer injuries and so on, all our “parts” deteriorate slightly. We’ll tell you about those parts in a moment but be aware that exercising should become part of your weekly routine. It doesn’t have to take long, but it will help you treat and prevent lower back pain. We promise you’ll get to enjoy a more active, pain-free life in the long run.

The Spine

Your spine essentially looks like a string of pearls, consisting of boney bricks spaced with spongey, fluid-filled discs. These are not just genetically different from the start, they are also subject to postural habits - like slouching or carrying heavy bags -, pulls from tight muscles or too much movement due to weak muscles. In some of the worst scenarios, the discs can become deformed due to pressure or even rupture due to a sudden force, like a high fall. The vertebrae are also not bulletproof and can have slow degenerative diseases or break under sudden impact.

Alongside and through this structure, run nerves like a high-speed information highway. Nerves also branch out and connect smaller areas with all of them bundling up to quickly relay feedback back to your brain. It is important that the nerves can glide well and freely in their sheath and are free from pressure. You may have heard the term a pinched nerve?

Muscles, ligaments and tendons stabilise and move this complex piece of your body, which consists of a large number of joints. Some very long and large muscles run alongside your spine and stabilise around and in front of the torso, allowing you to bend or twist as well as lift and run - they connect your upper part of your body to your lower body and are crucial pieces creating pain-free movement patterns if you would like to keep playing or return to a sport. Muscles can strain or sprain, causing discomfort or pain.

As we are focusing on lower back pain (rather than upper back pain), the connecting pieces of your spine to the hips and its parts, such as the sacroiliac joint at the back of your pelvis become very important. The exact shape of bones in your pelvis and the way the soft tissue sits between them can be a big factor in stabilising your lower back. If any part moves out of its designated space, tension on the remainder of your finely tuned body parts may ensue, causing the wrong muscles to take over and also potentially pressing on delicate nerves or enervated tissue. The tricky part here can be that nerves can become sensitised, especially in the case of chronic pain cases.

Good Vs Bad Pain

The functions of the back are so complex and vary from activity to activity, which means you may be pain-free in one exercise but suddenly experience a sudden jolt in the next. For the sake of your exercise routine and long term recovery, it is crucial that you start listening closely to those symptoms. Learning to interpret whether the pain is simply “good” fatigue or an important warning signal can help you feel safer and more confident again in your body.

The muscles we want to particularly target to give you greater control in your exercises are the stabiliser muscles. These can sometimes be “switched off” when you are in a pain loop, leading to the global movers to take over and causing stronger pulls and tension in your already sensitised body.This means we need to focus and work slowly as you start your physical exercises. We want to make sure you get it right. This is Phase One, the “walking” phase of your rehab. We’ll slowly build you to Phase 3, where you are closer to “running” in your exercises.

Before you move on, it is important to know that muscular strength and range of motion across joints are both important for optimal functioning of your body. This doesn’t mean you should be a mix of a bodybuilder and a ballerina but able to go about your daily life without hitting limits in either wherever possible. We want you to be able to confidently hit life in your stride.

Symptoms & Causes

Finding a diagnosis and path to recovery starts with your symptoms. The type of pain you are experiencing, its duration, site and intensity help medical professionals, such as your GP, physiotherapist and sports doctor, to look for potential causes. It is important you note down exactly where and when you are experiencing the pain. Does it come and go, change, move around or is it constant?

Even just knowing whether you experience pain in the morning or the evening, i.e. after activity, can help the doctor determine the severity of your condition. Perhaps changes to your posture, a targeted exercise routine and cultivating new daily habits may be able to help alleviate the problem without further intervention.

As described above, the interplay of the parts of your back and hips is finely orchestrated and even just one little part being out of tune could cause problems radiating or referring elsewhere. In simple terms, just imagine what happens when we sit for prolonged periods and muscles fatigue or we slump into our posture. Sudden changes in load, such as carrying kids on your hips or dragging suitcases off the conveyor belt can cause underlying conditions or imbalances in the body to flare up. Asymmetrical movements, impacts and awkward loading can cause already overworn pressure points to crack or rupture. The source of the problems can be the skeleton, the muscles, the nerves or even your brain to a degree when we are talking about chronic pain.

Finding Causes Through Pain

There are ways in which your doctor can start to determine potential causes. Generally, the sensations you are feeling and how you describe them will inform where to look.

• If you are suffering pain that comes and goes, is dull or sometimes sharp but generally in the same area and an ache with more or less intensity, often brought on or worsened by motion, you may have what is called axial pain, also known as mechanical pain. The underlying cause could very likely be in your muscles.
  Treatments could include stabilising the area and gaining relief by taping. This also helps give the body positional feedback and ensures you do not cause further strain by limiting you to a safe range of motion. This type of pain is likely going to respond relatively well to exercises improving your control over the movement patterns in the area and strengthening the right muscles as well as mobilising any that are too tight.

• If your pain is a deeper and maybe more searing or punctuated pain, this may be classed as radicular or radiating pain. The problem here is generally at the spinal nerve root, which may have become compressed, inflamed or injured. You may also be experiencing numbness or weakness of the leg the nerve runs into. One of the most common terms you may encounter is sciatica, i.e. pain running down your leg along the sciatic nerve (see sciatica article). The problem can lie with bones pressing on the nerve and commonly also a bulging/protruding or herniated disc.

• If your pain moves around, there can be several reasons. You may be suffering referred pain that is a dull ache and changes in intensity and exact spot or is away from the site of the actual injury or problem. You might also be compensating for the original problem by guarding and moving more asymmetrically. Your body is splinting muscles to immobilise certain areas and you are compensating, making another spot in your body very tight or disrupting your body’s alignment and balance further.

No One Size Fits All - A Tailored Approach

Pain is not an exact science and, unfortunately, it can lead to a downward spiral, if not addressed. Don’t delay seeing a medical professional and taking safe steps towards your recovery.

Be aware that lower back pain symptoms can vary from person to person based on your level of activity, genetic factors like anatomy as well as tolerance to pain. The same diagnosis can have dramatically different effects on different people. Some people may go for years with the same medical diagnosis or similar MRI scan result and live free from pain, whereas others may be toppled over and unable to function.

There is no one-size-fits-all approach to back problems. A doctor may have two patients with the same Xray or MRI Scan but different symptoms. Also, not only does your skeletal structure determine how your bones and joints look and sit but your muscles and ligaments may also start at slightly different points. The neat anatomical drawings and images we so often see are just an approximate representation of a more or less typical body.

Of course, you may also have a different pain threshold or pain barrier. This can be partially due to changes in your nervous system as much as your experiences in childhood, hormone levels etc. For example, middle-aged women can experience a sudden change in pain threshold as estrogen levels drop in their bodies as a result of menopause or even just at different times of their cycle.

Different groups are more prone to different types of back pain conditions. Read more here about lower back pain women often experience. If you are a runner, click here. Age can also be a factor, as you are more likely to suffer from a degenerative disease, such as osteoarthritis.

So, every person’s experience of lower back pain can vary quite dramatically and without an immediately obvious reason. Take control back by learning more about your body and taking it one step at a time. Eliminate different factors. Exercise is one of the most promising approaches as mentioned above, so get cracking!

Lastly, your movement patterns and habits have been forming over several decades by the time you are an adult. If you developed imbalances due to carrying heavy bags in school playing an asymmetrical sport, such as tennis, or got used to picking up heavy objects in a suboptimal way, this may be harming your chances of becoming pain-free.

While somebody else may go through life without problems, a combination of factors may be causing your body to send you warning signals in the form of pain and perhaps may be trying to prevent you from causing further damage by splinting the area, which means it stiffens muscles and tries to immobilise joints. This protective response is, in essence, good. It only becomes a problem, if you stop moving, start guarding the area and develop different compensatory movement patterns.

The underlying causes of a problematic lower back put simply include:

• Stress or strain of the muscles or ligaments holding the spine, perhaps related to chronic overload or injury - such as changes in exercise load or sudden awkward lifting, especially in a twisted or bent over position. This is also known as facet joint (little bony protrusions sitting left and right on the links of the spine that can look quite different in different people) and sacroiliac dysfunction. (The sacroiliac joint is in the back of your hip on both sides, about a hand with up from the base of the spine.) In these cases, pain can often appear one-sided. Sometimes patients experience pain near the top of one or both buttocks.

• Degeneration, bulging or bursting of discs. Often due to“wear and tear” of the fluid-filled connective tissue sitting between the vertebrae of your spine, acting as a fibrous cushion. You may have also been told you have a protruding, ruptured or herniated disc. It sounds as bad as it gets and, in some cases required surgery, strong painkillers and further treatment but you can reduce your risk of suffering further damage by strengthening your core.
  This injury can be related to age, profession, genetic predisposition, injury and other factors.

• Nerve injury or disease which could be caused by a bulging (also known as protruding) disc pressing onto the spinal cord. Also, misalignment of the vertebrae in your spine can create pressure and problems. Furthermore, chronic pain leads to inflammation of the nerves and sometimes even pain once the structural problem is resolved. Downregulating the response of your nervous system and learning safe and pain-free movement patterns again can be what is required.

• Perhaps your physician may have told you you have a spinal cord sprain in the back. Deterioration of the protective cartilage that encases the individual vertebrae of your spine. This is known as osteoarthritis and is just one of the inflammatory conditions that can cause lower back pain. You can also develop little bony growths known as bone spurs.

Remember, a definite diagnosis can only be reached in approximately 1 out of 5 cases. This doesn’t mean you are powerless. Interestingly, a patient with no pain may show the same findings in an MRI and Xray. Being idle and worrying is possibly the worst choice you can make. So long as your doctor has told you it is okay to continue to do your daily activities, do exactly that: stay active and add specific exercises designed to strengthen your problem back.

SUMMARY

The optimal treatment will take time and likely include several approaches: from strengthening over mobilising to mindset and pain control work. You may need to rest briefly and may have flare-ups. In the long run, rehabilitating the back means improving its functionality. You will want to improve its ability to carry out your work or engage in leisure activities.

This can be achieved with a combination of stability, strength and functionality exercises as well as some gentle to moderate cardiovascular system training such as walking or swimming.There is a common misconception that you shouldn’t feel any pain in rehab but that’s incorrect. The “training soreness” should just be minor and disappear quickly after the training. Similarly to how stretching exercises are unpleasant and challenge you, but ultimately stimulate healing. Just steer clear of sharp and strong pain!

Use the Injurymap screening tool above to find out if you are ready to treat your lower back pain with rehabilitative exercises.

In general, exercise and fitness training are the best-documented treatment for lower back pain and lumbago. Stay in good shape. It is especially important that you have strong core muscles, i.e. stomach and back, as this will safeguard you against relapses.

Setbacks can happen. If you experience an acute case of back pain or a worsening of your chronic pain, try to identify the cause, then reduce the training load that first set off the pain.As your training progresses and your pain level drops, you’ll gain confidence. This is when you should slowly increase the load of your everyday activities. You’re now ready to return to a normal level of activity. Expect this to take between three to six months. Your recovery speed will depend on your specific preconditions and everyday needs - perhaps you are aiming to run a marathon once you have been pain-free for a year or more?

The team at Injurymap are here to assist you and wish you all the best on your journey back to full health and pain-free movement!