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  • David Robertson

It’s back pain Jim…. But not as we know it!

Firstly- hello and thank you for taking time to read my 1st blog!  I hope you find it interesting….. or amusing….. or at least not too time consuming.  Annoyingly because it’s an online blog, if it’s rubbish you can’t even use it for bog paper after 😦

I had an interesting although not too unusual experience with a patient this week which hopefully highlights some of the commonly held beliefs amongst the public (and many healthcare workers) around lower back pain.  Below are some snippets from our session.

“I have noticed recently that my episodes of back pain happen around times that I feel more anxious.”    As our understanding of pain has improved it has become clearer that tissue injury and pain are not directly linked.  It is now known that if you are more stressed or anxious any pain from a tissue injury can be amplified and that you can have a painful experience even without tissue injury.  The evidence also suggests that a strong predictor of whether your pain may become more chronic is whether you are more stressed or worried.  Understandably this can sometimes become a vicious circle.

To give this some context- it would probably not sound too strange for someone to say “I have a headache…” or “I feel tense in my shoulders… because I’m stressed”.  It perhaps would be less easily accepted for someone to say “I have back pain because I am stressed” but this is just as possible.  Understanding this relationship and then taking steps to manage stress levels or worries should have a positive affect on lower back pain.

“I try and keep my core tense as I’ve been told this is good for my back”.  Resting positions and movement should not feel laboured.  They should be effortless.  Would you walk around holding your fist tensed or clenching your jaw even if you had injured it in the past?  No, because this is not a normal way of resting or moving and may eventually become painful.  “I need to protect my back.”  The evidence actually suggests that people with persistent lower back pain struggle to let their trunk or “core” muscles relax, not the other way round.  In other words they brace or tense too much!

I do pilates to strengthen my core as this is good for my back.”  “I’m worried about running as this may hurt may back.”  Is it sore when you run? “No.”  Then run!!!  The most evidence based treatment for lower back pain is regular exercise…… of any kind.  There is no evidence that one type is better than another.  Anything that gets you sweating, breathless, and works your muscles is good, especially if you feel good doing it.  A really common misconception even amongst healthcare workers is that running is bad for back pain, however the evidence does not support this, in fact the opposite is true.  If it feels goes then do it!  Pilates is good too, however sometimes with pilates habitually bracing or tightening your trunk is encouraged as good for your back, which as was discussed before is not helpful.  Having strong muscles and bracing all the time are not the same thing!  Who’s the stronger guy in the gym-  The guy walking round tensing his guns or the guy lifting some weight?    If you are keen to do exercise specifically to strengthen your trunk muscle (which is a great thing to do!) the evidence actually suggests that resisted/weight training is best (and good for back pain).

“I shouldn’t slouch.”  Why not?  Plenty of people slouch and don’t get back pain, just as plenty sit really upright and don’t.  Sitting postures are not a predictor of lower back pain, but not moving regularly may be. What does this mean?  Sit however you’re comfortable, which again should feel effortless (no bracing or pulling in!), and change position regularly, every 40 mins or so.  Motion is lotion is the (pretty cheesy) physio catchphrase doing the rounds at the moment (if anyone has a less naff sounding alternative please let me know).

So what are the take home messages- anxiety or stress can affect back pain, bracing/tensing is not helpful, exercising regularly and having a strong conditioned body can help, don’t worry too much about your posture, move regularly.  The professional body for UK physios has recently published some “myth busters” for lower back pain.  These can be found at http://www.csp.org.uk/your-health/healthy-living/public-information-leaflets/back-pain-myth-busters.

I hope you’ve not found this too painful.  Until next time……