Back Pain

INTRODUCTION

Here at painPRO we don’t just treat back pain…we truly understand it. We have prepared this section to help highlight the complexity of back pain. We’d like to think that because we understand the many nuances of musculo-skeletal pain we are better able to treat it…thus the name painPRO.

Myofascial pain is a major cause of back pain that can affect bones, muscles, ligaments, tendons, vertebral discs, connective tissue, and nerves. It can be acute (having a rapid onset with severe symptoms) or chronic (lasting more than 6 months). Myofascial pain can be localized in one area, radiate in specific patterns, or be felt throughout the body.

Lower back pain is the most common type of musculoskeletal pain while other common types include tendonitis, myalgia (muscle pain), nerve compressions, and stress fractures. Although the principles in this area of our website can be applied to all areas of musculoskeletal pain we will be focusing our attention on back pain given that large percentage of our patients seek help for this growing problem. In fact we have found that musculoskeletal pain in other areas of the body can be a result of referral pain patterns from back, hip, or neck muscles.

Musculoskeletal pain is a fast growing phenomenon and reflects a significant cost to society. Let’s take a look at the leading type of musculoskeletal pain…low back pain. Here are some industry statistics that may surprise you about low back pain:

1. The National Pain Foundation states that less than 15% of back pain can be attributed to a specific cause. That leaves more than 85% of back pain sufferers with no specific identifiable reasons for their pain.
2. Represents 25% of all work related compensation claims and 33% of compensation costs.
3. Work related sick days due to back pain, is second only to the common cold. It is estimated that 40% of sick days are related to back pain. Over 100 million work days lost due to low back pain.
4. Leading cause of disability in people under 45 years old.
5. Second leading surgical procedure with over 500,000 annually in the U.S.
6. Surgery is generally only required in 3-5% of back pain cases.
7. Four out of five people will experience low back pain at some point in their lives.
8. Happens with equal frequency between men and women

After years of working directly with thousands of back pain sufferers we’ve observed that many people resolve their pain quickly while others find partial or intermittent relief. Although two people may present with the same pain symptoms in the low back their recovery times were remarkably different. It was for this very reason we’ve embarked on a search for solutions that were not part of mainstream thinking.

The current system of healthcare, both conventional and alternative, focuses on the physical elements of pain. As you will see the physical elements of back pain may merely be the tip of the iceberg. Each therapy has its merits and for some people they will find a solution through any one or a combination of approaches. The problem has been that patients jump from one modality to the next in the hopes that it will be the magic pill to eliminate their pain.

The truth is that each healthcare modality deals with specific aspects of pain. The medical doctor generally deals with symptomatic relief through pharmaceutical drugs, the surgeon deals with physical trauma, the Chiropractor bone misalignment and nerve impingement, the Physiotherapist with structural and joint issues, the Acupuncturist with Chi or energy blockages, and on and on we go with one or a combination of therapies being effective for many but not comprehensive enough for some.

Massage Therapy done properly will effectively deal with many of the root causes of physical back pain.

Let’s first look at some factors known to cause musculo-skeletal back pain.

• Physical Trauma
• Bone Misalignments
• Postural Imbalances
• Emotional Unrest
• Dehydration
• Nutritional Deficiencies
• Toxins
• Myofascial Problems
• Poor Fitness
• Infections (viral/ bacterial)
• Prescription Drugs
• Stress
• Numerous Diseases

There may be a few things on the list that may be a surprise to you, but we can assure you many chronic musculo-skeletal pain sufferers have one or more of these issues occurring at any one time.

Has anybody checked your hydration (water) levels? How about your nutritional status? We understand that most people are a little unnerved to think that they may have some repressed emotional issue affecting them. Of course we all have stress at some level, but do you know how resilient you are in handling stress?

This area of our website was written so you could discover other potential causative factors that are contributing to your pain. Only when you fully understand the complex nature of your back pain can you go about resolving it.

PAIN IS A SIGNAL

Pain is your body’s way of telling you … “There is something wrong. Please DO something!”

If you break your leg, the pain is letting you know that something is seriously wrong. If you cut yourself, you get a “fix-it” message depending on how serious the cut is. If you have a tooth ache, your body is signalling a visit to the dentist. Back pain is no different. Your body is telling you that something is out of balance and needs to be fixed. The question is “what”?

Instead of finding out “what” is the problem we mask our back pain with pain killers, treatment regimes, and even surgery … all without finding out the root cause of the pain.If you don’t listen when the pain is mild, it keeps on getting worse until you are practically crippled by it. Your body will keep on screaming at you (pain) until you find a solution to the actual problem. Your body is smart and will not allow you to delude yourself into thinking that a bottle of aspirin will solve the problem. It won’t.  However the good news is that in most cases you CAN solve the problem, and get rid of your pain.

TWO TYPES OF BACK PAIN

No matter what your diagnosis is –herniated disc, sciatica, scoliosis, tight muscles– all back pain can be divided into two categories:

• nerve based pain
• tissue based pain

You may suffer from one or both types of back pain.

Nerve based back pain is caused by a nerve that is pinched, pressurized, compressed, or injured. There are multiple issues that can cause this nerve aggravation including disc degeneration, disc herniation, disc slippage, spinal stenosis, muscle imbalances, bone misalignments, or physical trauma.

Tissue based back pain usually originates in the muscles or surrounding connective tissue. The problem area starts knotting up until it is hard and rigid. For simplicity we will call this a “knotted muscle” but the issue tends to be more complex and involves an integrated system of connective tissue called fascia. The origins of the knotted muscle could be stress, muscle imbalances, vertebral disc problems, excess toxins, dehydration, poor tissue oxygenation, improper diet, or actual physical injury. Knotted muscles in one part of the body can cause pain in other parts of your body. This is called “referred pain.”

COMMON MISCONCEPTIONS ABOUT BACK PAIN

Many people, including physicians, surgeons and health practitioners tend to make four big mistakes about back pain.

1. I threw my back out
2. I have pain in my back, therefore something is wrong with my back
3. I had an episode six months ago, this is something new!
4. Medical technology can identify the source of back pain

Let’s take a look at each of these misconceptions:

1. I threw my back out:
Many people associate the start of a back “condition” with a specific physical activity. They think that getting out of bed on the wrong side caused the back condition to start. That’s when the pain started, so therefore that’s when the back condition started. This is very simplistic logic for what is a more complex problem. The back is a marvellous strong and resilient instrument. Bending over or sneezing may have triggered your back pain but it is not the cause of it.  The underlying causes that were triggered by the physical action were probably in place and building over weeks, months or even years.

In the parable about the “Straw That Broke the Camel’s Back” … there were an awful lot of other straw being piled on that camel before the final straw got all the blame!

2. I have pain in my back, therefore something is wrong with my back:

In the chapters to come we will discuss some of the “other” factors that cause back pain. Your back pain could be physical, but it could also be caused by what you are eating, how you think, or by excess stress.  We will also talk about how much of the medical and health community focuses only on the possibility of physical causes for back pain.

3. I had an episode six months ago, this is something new!

We assume that the current bout of pain is new and unrelated to other episodes. For example … last time I had back pain it was because I played tennis too vigorously. This time I am having back pain because I lifted that heavy box of books. Once again we are blaming the “triggering action” and failing to consider an underlying condition that is probably getting worse with time.

4.  Medical technology can identify the source of back pain:

The wonders of modern science and technology allow us to peer into the body. From CAT Scans, to MRI’s, X-Ray’s, Ultrasound, and other amazing diagnostic tools, we have the ability to see physical abnormalities that appear to be the cause of your back pain.

But just because you can “see” something doesn’t mean that you understand what you are seeing or what caused the condition in the first place.

Current research is now bringing to light a problem with these advanced forms of technology. Researchers are finding that 50-80% of people who show some form of physical malformation or problem; do not actually experience any pain. Only 3-5% of those who are experiencing some form of back pain actually require surgical intervention.

In other words, the technology does not necessarily tell the whole story.  There are definitely other issues beyond the usual suspects of bone spurs and vertebral disc problems.

A NEW LOOK AT BACK PAIN

There are hundreds of books and research papers that deal with various factors involved in the complex issue of back pain. Taken at face value they are all part of the back pain solution.

Most mainstream research deals with the physical aspects of pain and if that were the root problem of back pain then modern science would have eradicated our current back pain epidemic. We have advanced technology that can peer deep into the body like never before in history. We have medications and surgical interventions that are jaw dropping yet back pain remains an epidemic. We agree there is a physical element to back pain but there is much more to the story.

In treating thousand of clients with back pain there is one key factor that stands out as the primary culprit…STRESS. Stress is described as any stimulus or demand that forces an organism to respond or adapt. Stress is a common unavoidable aspect of being alive. Life on earth is possible because the organisms which have thrived have been able to find a balanced relationship with the stresses of their external environment. In fact our stress response mechanisms are still tied to our “fight or flight” approach to survival but our external environment has radically changed.

We now live in a much different world than our ancestors and our stress response systems have not yet adapted to the new paradigm. As a species we are now forced to adapt to stresses being created in our internal environment. This includes more complex social interactions, longer working hours, less physical movement, time pressures, unnatural foods, and a reduced connection to our natural state of being. To maintain a state of harmony we need to find a balance between our internal and external stressors.

Stress as we see it is the tipping point for the four key elements associated with back pain. First let’s look at what we consider to be the Four Elements of Back Pain:

• Physical
• Nutritional
• Emotional
• Spiritual

Stress as described above can be any stimulus or demand that requires a response in any of the above four key elements behind pain. In other words if there is too much stress in any one element, or a combination of elements, you have an increased probability of becoming unbalanced. This imbalance whether it is physical, nutritional, emotional, or spiritual can set up a cascade of events resulting in chronic or intermittent back pain.

Let’s take a closer look at a possible real life stress scenario:

You may be facing a particular job stress situation. Perhaps you are under extra pressure because of deadlines you have to meet, or your company is facing job cuts and you think you may be in the line of fire, or you have been promoted and have to work extra hard. In any of these situations, you are facing situations that force you to adapt to these stressors.

In order to adapt to your changing work environment you work longer hours, sit longer, eat irregularly, exercise infrequently, have less of a social life, and find no time for yourself. For most of us this is our way of life. For short spurts of time we can cope with these added changes. However, over extended periods of time, it can become difficult for the body and mind to adjust and this can result in more chronic problems.

Slowly over time you can create physical imbalances, nutritional deficiencies, emotional unrest, and spiritually disconnection. The end result is an increased risk for physical pain.

The connection may not be crystal clear at this point but over the next few chapters we will put all of the pieces of the puzzle together. We will give you the information and tools you need to analyze YOUR situation and figure out what is happening in YOUR life. You may not be able to do it all yourself, but you will be on the path to reducing your back pain.

THE FOUR ELEMENTS OF BACK PAIN

Back pain can be complex and can have one or multiple causes. In this chapter we will discuss the most common issues involved in back pain.

Physical

The most obvious for the majority of people is some physical problem in the back. This could have occurred due to trauma, muscle imbalances, muscle degenerative disease, or poor posture over a prolonged period of time. The net result is that your body shifts thus causing problems in the following three areas:

1. Bone Misalignments/ Changes – bones can be pulled or forced out of their optimum position placing strain on surrounding nerves, tendons, ligaments, or muscle. In addition changes in bone structure due to arthritic conditions or bone spurs can have the same result.  A secondary result of bone misalignments can be inflammation.
2. Nerve Impingement – this occurs when bones or soft tissue press against a nerve. The result will be various sensations that could include pain, tingling, muscle weakness, and a feeling of heaviness. Depending on the structures pressing on the nerve these sensations can radiate into different areas of the body.
3. Connective Tissue – this includes muscles, tendons, ligaments, and fascia.  They can become stretched, compressed, or trigger points can form due to postural imbalances or bone misalignments. When connective tissue is either compressed or stretched it can set up an inflammatory response.

Nutritional

A lot of people are surprised to find out that what they eat can cause or impact the level of back pain they have. It is not part of mainstream thinking to link nutrition with back pain. But we have found a direct link between the two. There are three key areas that impact us when it comes to nutrition:

1. Foods –  for most people this is a surprising insight into the power of the food we eat. Since we are all biochemically individual, food impacts each of us differently. The basis of food is to provide the energy and building blocks for sustaining health and vitality. The essential problem is that we can eat foods that are toxic to our biological processes and this has a cascade effect on inflammation, hormone production, and chemical metabolites. The result is pain in areas of the body already out of balance.Another key fact regarding food involves eating too much of it. The excess weight that results puts added pressure and strain on joints and muscles which can result in back pain.
2. Hydration – water is critical to maintaining health and vitality. Given that the average person is 60% water it stands to reason that it’s significant to our health is critical. Without the required level of water in your body:

• The inner core of the disc’s between your vertebrae become compressed. Since the inner core of the disc is designed to carry about 75% of the weight load of the spine dehydration can lead to back pain.
• The body has a reduced ability to carry away toxins. These toxins tend to set up inflammatory responses in the body that can lead to back pain.
• Muscles and joints lack the ability to function properly. Much like a grape turns into a raison as it dries the same effect is evident in your muscles and joints. The result is poor function, imbalance, and pain.
• Mental function and emotional state become inconsistent. This is due to the fact that the brain has higher water content than the rest of the body. With less water in the brain you are less able to cope with everyday stresses and emotions and as you will see these can result in back pain.

1. Digestion – we have found that a great number of people with back pain have poor digestion. With compromised digestive function the body’s ability to assimilate the necessary amino acids, essential fatty acids, enzymes, vitamins and minerals is impaired. Without these key building blocks the body is not able to repair damage effectively and this results in poor cellular function and inflammation. Over time this will lead to connective tissue degradation which in turn can lead to back pain.

Emotional/ Psychological

We do not want you to think that your back pain is all in your head but there may be some truth to it. Current research is uncovering links between your thoughts and the way you think  –  and back pain.

Pain to most people represents a physical sensation caused by a direct injury/ trauma to soft tissue or muscle tension caused by stress. But what about prolonged lingering chronic pain? Why is it that some people struggle with constant neck or back pain and others don’t? We all suffer from some form of stress don’t we?

You may be interested to know it may all be in the mind. The sensation of chronic pain in many cases is caused by reduced oxygenation in the soft tissues of the body.  Let’s explain this a little more.

The standard models of pain are being challenged by the findings of Dr John Sarno who for the past 30 years has uncovered the origins of lingering unexplained pain. The answer … repressed emotions in the subconscious mind. This may be a radical concept but Sarno’s clinical results are irrefutable. The term used to describe this condition is Tension Myositis Syndrome. (TMS)

According to Dr. Sarno the primary emotion we repress is anger. This primitive emotion was critical for our evolutionary survival as a species but could you imagine what life would be like today if everyone freely expressed their displeasure. In our current society the free expression of anger is not socially acceptable and usually results in a backlash of negativity from those around you.

In order to maintain our socially accepted norms, our mind bundles up all our little frustrations and stuffs them into our subconscious mind. Over time this builds up like a pressure cooker. Our rational conscious mind understands that the free expression of this pent up frustration may do more harm than good in our social network. The mind solves this problem with … Distraction!

The area in the brain where anger resides is the limbic system. This is also the area where our autonomic nervous system intersects. One of the things our autonomic nervous system does is control our fight or flight response. Over the eons this has served us well. When danger is present it helps shunt blood to and from specific muscles to assist us in physically dealing with a threat. Today we encounter very few physical threats … but we have a lot of repressed emotions that if let out would be extremely disruptive to our daily activities. In order to keep from blowing the lid off the pressure cooker (repressed emotions), the mind creates physical distractions in the body by reducing blood flow in specific areas. The result … PAIN!

Spiritual Disconnection

This topic can create a host of reactions and it is important for us to define our view of the spiritual aspect of life. We understand that each of us has our own belief system that surrounds the topic of spirituality. At its core we view spirituality as our personal connection to something that is more powerful than us yet unites us in a union that involves an inner exploration to seek love, emotional connection, and understanding through non-judgement of our internal and external world.

Some find this journey through religion or religious practices like prayer, others find it though a connection to nature, and many find it through meditation. In the end it is a deeply personal journey that only you know is right for you. What we are referring to here is the topping-up of joy, happiness, tranquility, peace, emotional “connection” and emotional balance in your life. Spiritual renewal is very personal and can take place in an inspired instant, or as part of a regular practice. Many of us are so immersed in our busy, stressful lives that we don’t take time to renew the inner part of us that some people call our “soul.”

When we become disconnected from the source or our spiritual essence we set up a disharmony in our energy production at a cellular level. When our energy levels become depleted we set ourselves up for physical and emotional imbalances that can result in pain.

You could get spiritual renewal from prayer or meditation, or you could get it from fly fishing or a picnic lunch beside a fountain or a stream. Spiritual renewal is different from letting go of the stress and relaxing. It is another layer on top of that … adding to, rather than letting go.

Here is an example of an activity that can have one or more layers:

In yoga, there is a series of flowing yoga movements called the Salutation to the Sun.  It is a morning routine that potentially has three layers of meaning.

1. The Salutation to the Sun can be seen as a strictly physical exercise series that stretches and awakens the muscles of the entire body. It enhances your flexibility, gets the circulation going and oxygenates the entire body. A great way to start your day!
2. The Salutation to the Sun can also be used as a stress buster. At the same time as it is waking the body up, it is also relaxing the body and mind. You are letting go of stress physically and emotionally.
3. The third layer is the spiritual aspect of the Salutation to the Sun, in which the physical poses and mantras are intended to induce a balanced state of mind, intellect and emotions. In other words a connectedness.

THE PHYSICAL ELEMENTS OF BACK PAIN

Sedentary Lifestyle

Physical dysfunction is an inevitable result of neglect. This is an increasing problem today with many of us sitting at desks or in front of computers for 8 hours or more a day. To add to this many people have become intoxicated by the lure of the mindless entertainment provided by TV, video games, or the internet. The result is further inactivity and impaired physical vibrancy.

A sedentary lifestyle can leave you with weak shortened muscles, poor health, and poor posture. Bad posture places an additional strain on the entire body, but especially on the back, and worse, it leads to a further muscular compensation and impaired movement function.

The most significant effect of having a sedentary lifestyle is the bodies reduced capacity for energy production. This lower energy production has a direct effect on reducing your ability to handle stress, oxygenating your tissues, and compromising brain function. The onset of anyone of these situations can lead to pain.

Postural Imbalances

If your body is in an unnatural position or posture, virtually every part of your anatomy may be forced to move in ways that it simply was not designed for. When your posture is not balanced you are forced to use certain muscles either more or less to complete the action. Each movement can cause muscles to be recruited to that are not specifically designed for the task. This can result in short term pain and if the imbalances are not addressed it can lead to long term chronic pain.

Many people are especially susceptible to pain from an incorrect posture if they spend a great deal of time sitting. Not only do shortened muscles cause the pelvis to tilt, it places a severe strain on the back. To compound the problem, many people do not sit with correct posture. They sit skewed over to one side or the other, or twist themselves into unnatural positions for hours at a time.

Sales people who stand a lot, either on the sales floor or behind the counter may become habitual hip cockers.  They throw their weight over onto one hip and stand like that for hours on end.  Mothers with little ones under the age of three tend to be the largest group who suffer from this dilemma. They will carry their child on one hip or another with the result over time being low back pain.

Your shoes can make a big difference in your posture. Women’s high heels may look attractive but it doesn’t take a brain surgeon or even an orthopeadic surgeon to see that being forced onto your toes for hours every day is profoundly affecting your posture.  And it is not just women … many men wear heels too. Cowboy boots were designed to make it safer to ride a horse … not as normal walkabout footwear.

Weight Distribution

Many of us consistently carry objects which throw off how the body is balanced. If you carry a, purse, laptop, brief case, or a gym bag you are creating a strain on the body. Even if you are constantly talking on a cell phone, you can slightly pull your body to one side. Consistently carrying a weight on one side of the body may start a chain reaction in which the strain and incorrect posture lead to more serious problems.

Next time you are walking down a street, observe women with their purses and men carrying gym bags or brief cases. You will see some people shrugging their shoulder upwards, while others let the weight pull their shoulders down. Watch people kinking their neck to one side when talking on their cell phones. Now imagine years of that!

The result is back pain, but the back pain is typically only a small symptom of a larger problem. Pain is just the body’s way of telling you that you’re doing something wrong. When you misuse the body with imbalanced weight and incorrect posture, the muscles, joints and ligaments are weakened and damaged over time. It may take months or it may take years. Then one day you sneeze, get out of bed on the wrong side, lift a weight that is slightly too heavy, and suddenly you find yourself in pain with a serious back problem.

The injury would not have happened had you taken better care of yourself over the years.  Don’t ignore minor aches and pains … they are the early-warning-signal telling you that something is not right. If you ignore the minor pains now, you will end up with major and chronic pain in the future.

Pain in your back is a danger signal. Pay attention and start making corrections and adjustments right away.

Muscle Flexibility

As you exercise a muscle, even in the course of your daily life, scar tissue (called fibrin) is formed within it. This is a completely normal part of the muscle growth and repair cycle. Fibrin provides a sort of lattice upon which the body can rebuild healthy tissue. When the repair process is completed, the fibrin is normally removed by proteolytic enzymes secreted by the body.

As you grow older, the process of breaking down fibrin from damaged tissue becomes slower and slower. Fibrin which is a still and inflexible material, builds up in the muscles, causing your body to get stiffer and less flexible. The degraded muscles not only feel stiffer, they also provide less support to the joints. This in turn affects your spine.

We will discuss a program of diet and stretching exercises that will help you retain flexible muscle functions well into your older years.

Muscle Trauma

Muscle strains, tears and trauma can occur because of accidents, sports injuries, and moments of inattention. If the muscle is not allowed to heal properly this could lead to further complications including trigger points.

Myofascial Restrictions/ Trigger Points

First we should explain what the term ‘myofascia’ means. As much as we like to sound smart it is more important that you understand what is happening in your body. ‘Myo’ simply means muscle and ‘fascia’ is a connective tissue that forms a matrix or web that interpenetrates the extra cellular matrix that surrounds muscles, bones, organs, nerves, blood vessels, and other body structures. Fascia is an uninterrupted, three-dimensional web of connective tissue that extends from head to toe, front to back, and interior to exterior.

In fact this fascial matrix is a communication system between each and every cell in your body. The communication takes place through the free flow of electrons or electricity. Energy flows and is transferred through 12 myofascial meridians in the body. These myofascial meridians are linked to the energy meridians used in Acupuncture.

Through stress, injury, poor nutrition, postural imbalances, overworked muscles, and repetitive activities your fascial matrix can become contracted or stretched, thicken, become congested and inflamed, and adhere to surrounding structures such as muscles, bones, nerves, and organs. The result for you is pain and irritation due to the development of trigger points and their resulting pain referral patterns. In fact your fascial matrix is so interconnected that problems in your foot can actually result in back, neck, or shoulder pain along with digestive disturbances.

The body’s fascial matrix is now one of the most researched areas of medicine and therapy. In fact, our entire system of understanding anatomy in terms of muscles, bones, organs, and nerves is being rewritten because of this new area of research. Science is now proving that a healthy fascial matrix is critical to overall health.

The release of myofascial adhesions and trigger points through gentle stretching or compression of the tissue is the starting point for effective long term pain relief.

Our painPRO Registered Massage Therapists are all trained in myofascial release and trigger point therapy.