Low Back Pain: We are all different. You need tailored care.
Approximately 80% of us will have back pain at some point in our lives, and a significant proportion will develop an ongoing problem. What keeps the pain going? Is it the disc bulge? Is it arthritis? Highly unlikely. X-ray or scan findings don’t tie closely with what you feel. In people with no pain at all approximately 20% of 20 year olds, 30% of 30 year olds etc., up to 90% of 90 year olds have disc bulges or arthritis despite being perfectly comfortable.
So, what does keep the pain going? To have pain, you have to have a brain: it decides if we feel pain or not. When US President Ronald Reagan was shot (in real life, not in a role as a silver screen cowboy) he felt no pain, because at the time it was more important for him to get out of trouble. Pain wasn’t helpful to that scenario, so his brain didn’t register any.
Receptors in our body respond to stimuli perceived as being potentially dangerous, like pressure when you shut your finger in the cupboard, heat when you put your hand on a boiling kettle, or inflammation if you sprain your ankle. The receptors send messages to our brain. Before they reach the brain those messages are not pain, just a message that your finger is squashed or your hand is too hot. Then your brain decides if it’s the right time to translate the “danger” message into pain or not. Usually it would be appropriate for your brain to perceive the danger messages from the hot kettle as pain, so you put it down and don’t get burnt. However, if you’ve just been shot, it’s more important to escape, so despite danger messages from your receptors, it doesn’t hurt, and you keep running.
What have Reagan and kettles got to do with back pain? You might have a disc bulge, but that doesn’t mean you must have pain. Lots of things can be perceived as danger messages by our brain, which can then influence whether we feel pain: whether we feel down, have had stressful events in our lifetime, or believe pain indicates we are damaging our spines all tie closely with pain because they can be seen by our brain as a potential danger. Other potential dangers include how you move, other illnesses, being overweight, poor sleep, feeling that your back has changed shape etc. etc.. Recent research tells us that there is so much flexibility in our complex brains, that each individual has their own set of dangers stimulating their brain, and maintaining their back pain.
So what is the role of your therapist? Firstly it’s to delve into the danger and safety factors for your brain. That’s why they’ll ask about why you think you have pain, your medical history, and have a close look at how you move. Then they tease out the most important factors to change. The counterbalance to those “dangers” are to offer the brain safety. Your therapist can do this by helping you understand how your pain comes about, why moving in a certain way may be a problem and how to change that, how your thoughts and feelings influence your pain and how to manage them better, give you relevant broader lifestyle tips, and liaise with other healthcare professionals where other illnesses have an impact on your pain. More safety, tailored to your brain, means less back pain (or neck pain, or knee pain etc. etc.)
Martin Rabey
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