21 May Back Pain – Part 1

Back pain and movement

For many years health professionals have been educating people to be careful about how they move, especially with regard to their back. This has inferred that the back is weak and has a poor tolerance to activity. We now know that this advice is not necessarily correct. 

Your back is a very strong structure, and it is designed to move and be used. However, our lifestyles have tended to mean that many of us are generally weaker that we should be. This affects the ability to take load through all parts of our body, including our spine. Indeed it is the lack of moving, and the maintaining of prolonged static positions that is more likely to result in problems.

How many people have back pain?

Research tells us that up to 80% of the adult population is likely to have an episode of back pain over their life. This usually settles quickly, like many other aches and pains that we get from time to time. This is normal. However, in a small percentage of the population this becomes more chronic or repetitive in nature.

What should I believe?

Current thinking tells us that what we are told makes a large difference to our recovery. When our back becomes sore we are told to look after it and not stress it. We have in the past been told that something is ‘out’ or we have slipped a disc. All these things lead to the belief that something is wrong, we need treatment, and we have to protect and look after our back. However in the vast majority of circumstances there is no specific physical damage, and there are no torn ligaments or muscles, or joints out of place.

What has happened is that something has been overloaded and it has not coped, so it has reacted to the situation. This often creates muscle spasm, which can result in muscle pain. This is the bodies way of trying to protect itself. There may also be some inflammatory changes locally. All this results in the small nerves getting irritable which send messages to the brain, and we respond accordingly.

Our bodies response is strongly influenced by what we are told or understand. If we believe we need to protect ourselves the muscles stay tense for longer. The ongoing muscle tension may then lead to changes in how our body perceives the back. The nerves become more sensitive, resulting in small amounts of input creating excessive responses. Things like normal movement can then become painful. This all reinforces the process. The longer this happens, the harder it is for the cycle to be broken, and even when it is, it can leave behind memories which become active again next time something happens.

On the contrary, if we believe or are told that there is minimal damage and it will settle well, just like any other minor injury, and we keep moving, in a sensible way, our body keeps getting normal input and reacts accordingly. The muscle will relax and any inflammation settle, and we will feel better. This is not to say there will be no pain, but means the likelihood of everything winding up and getting over excited is much less likely to occur. The result is a much quicker recovery, and better long term results.

Key messages

1. Back pain is common but in most cases not harmful.
2. Poor education on back function can make your episodes of back pain worse and increase the likelihood of chronicity
3. You back is supposed to move. Static and repetitive postures are more likely to cause problems.