Motion Forword - Words of a Therapist - No 12
Welcome to Motion Forword - Words of a Therapist! Issue 12!
Motion Forword is about discussing the combined benefits of movement with a positive mental attitude. Using my personal/professional experiences, evidence-based research and some of your own experiences.
Bringing some hope, positivity, happiness and maybe usefulness to those, perhaps like yourself, that needs a pick me up.
A year in the life - A year of Motion Forword
12 months on from starting this little blog venture. Putting my thoughts onto black and white.
The aim was always to try and put a positive spin on the gloom that often comes with people in pain coming to see me for the first time. The functional limitation, depression, pessimism, defeatism and generally feeling like crap.
I would like to think I have curbed all that a little with my positive take. Your feedback has really given me a boost that makes writing these enjoyable. (Please feel free to keep doing so and email me at contact@nathanbullosteopathy.co.uk!)
Here are some highlights from Motion Forword over the last year: (Click for descriptions)
It has been a fun year and I’ve achieved a lot. It is good to look back to see how far we’ve come because it can feel like we are going nowhere when we only see the little changes we make day-by-day.
Zoom out.
You’ve come further than you realise.
Something for you - Back Pain Myths
I really like this article: 10 myths about back pain and how to cope when it strikes. It has been written by 5 top back pain researchers and clinicians. It is long but easy to read. But I have broken down their points here. Please note, these points are based on scientific research and not opinion.
1. Back pain is common - They quote 84% of the population will get back pain at some point in their lifetime. It is equally common in younger and older populations so we cannot blame age related ‘wear and tear’ for all back pain types. Back pain is rarely serious or dangerous.
2. Scans for back pain are rarely needed and can be harmful - scans are only necessarily in 1% of cases because of something major e.g. broken bones, infection, cancer. An Xray nor an MRI will identify a specific problem with your back. Research does not support having a scan as an immediate approach to back pain because most of the time (99% of the time), it isn’t helpful.
The reason they can be harmful is that they may identify a red herring, a coincidental finding or something that was there before your pain started. This has nothing to do with your pain but can make you more worried about it. Making the scan not only unhelpful but inhibiting.
3. The back is NOT that vulnerable to damage - Unfortunately, there is a lot of fear-mongering in the realms of back pain. ‘You have a weak core’, ‘you have a slipped disc’, ‘you have a joint out of place’. It can certainly feel that way when back pain strikes (I know, I’ve been there) but it's simply that… a ‘feeling’. No different to a ‘frog in your throat’ or ‘butterflies in your stomach’. It’s simply how we describe something as let's be honest, most of us don’t know how to describe pain beyond ‘its fricking painful’!
The main point is that our backs (and our bodies for that matter) can take a lot of punishment before we start getting pain, perhaps even more before something actually becomes damaged. It is usually more to do with a change in how our nervous system behaves than where our joints/bones/muscles reside.
Just for context of how much our body can take… consider this. It takes 3000 Newtons (305kg) per cm2 of pressure to deform our soft tissue (myo-fascia) by 1%. The biggest force a therapist has been shown to apply is 350 Newtons (35.6kg).
4. The back is designed for bending and lifting - we shouldn’t be scared of lifting/bending in general. The trick is to make sure your back is conditioned (i.e. used to) the particular thing you are bending to lift. Don’t start picking heavy things up you are not used to nor start doing a lot of bending when you haven’t done any (springtime gardening!) Build it up!
5. You can have back pain WITHOUT damage or injury - A common thing people say is ‘I usually have such a high pain threshold’. Well… have you ever thought about how that threshold might change? For example, you’re having a stressful time, you’ve had a difficult time at work, with your relationship, with your children, you’ve slept poorly, you haven’t been able to eat well and you haven’t got enough hours in the day. Then your dog gets poorly or you have to take a loved one to the doctors. (does any of this sound familiar?)
Don’t you think this might have an influence on your ‘pain threshold’? Well… it does. It brings it right down and makes your body more ‘sensitive’ to insults. Which means the insult can be as simple as sleeping awkwardly or picking up a pencil. Bam! Horrendous agonising pain. This isn’t enough of an insult to cause any physical damage (consider the Newtons needed to deform tissue as said above) but with a reduced pain threshold your body is hyper aware of anything that might.
In this sense, pain is not necessarily an outcome of injury but more like the first warning signs.
6. Don't take back pain lying down and don't rush for surgery - Complete rest can be helpful in the short-term but it is generally advisable to keep active and keep working where possible. Something I describe as ‘relative rest’. You are not doing as much as you would normally do, but you have toned it down somewhat.
This is another reason why X-Rays and MRIs are not recommended and can be harmful (point 2). The scan will find something that is unrelated to the problem (red herring) and may potentially have surgery on something that wasn’t the cause of your problem. This only causes further problems and you still have the pain. Fortunately, surgeons are wise to this now and opt for non-surgical conservative management in the majority of cases.
7. Exercise is good for back pain but people are often afraid - People are often afraid of making things worse… so they do nothing. In my experience, we do need to be a bit mindful as not all exercise is great all the time. But often it comes down to doing something that is comfortable, is easily accessible and is something you enjoy. The research doesn’t seem to find any one type of exercise as superior over another. Just get it done. They recommend 30minutes/day in this article - this can be as simple as walking.
Oh and a bit of stiffness after exercise is just your body getting used to that specific type of exercise.
8. Strong meds do not have strong benefits for back pain - I’m glad they included this one. You don’t need the strongest painkiller straight off the bat. In fact it's probably doing you more harm than good as people often find that the strong painkillers aren’t helping that much anyway. So all you get are the side effects. Great. Inevitably I have people coming into my clinic having been given stronger and stronger painkillers with little to no benefit. If you are taking these medications for longer than they are intended (weeks to months) then they probably aren’t helping. Always discuss with your Doctor about prescriptive pain management medication.
9. Buyer beware: internet, fads, fashions and bandwagons - if it is too good to be true, it probably is. If the product/service offers huge promises of a cure, you’ll probably be very disappointed and have a lighter bank balance to boot. I’ve even bought a back support in the past just to try, it wasn’t overwhelmingly effective and returning it wasn’t easy either (despite their money back guarantees).
10. Back pain can be cured - I’ve always said that ‘cure’ is a strong word (at least in the MSk world). But in most cases people can recover from back pain despite being told otherwise or how ‘nothing can be done’.
The most evidence based approach we have is treating the person, not just the problem. Considering lifestyle factors, psychological factors, social factors, exercise/training factors AND the pain we have a better chance of ‘curing’. Zooming out rather than zooming in.
I hope you enjoyed my more flippant approach to explaining the articles 10 myths about back pain. If you relate to any of these points, please get in touch. Be interesting to read about your own experiences.
Thanks for reading.
Until next month…
Motion Forword ⏩⏩
Nathan