Back Pain- It’s Multifaceted.
Back pain is multifaceted (pun intended - a facet is a part of the spine, woohoo for anatomy jokes). Many of you also wouldn't know that I struggled over the blog post's title. When talking about occurrences of pain, it's essential to understand that it is much more multifaceted than one might think. Therefore, explanations surrounding pain and its mechanisms require delicate and deliberate thought. I will stray from using conclusive statements such as 'this is why back pain occurs.' Instead, I will ambiguously dance around the facts like a politician, implicating several different reasons for its occurrence. Because, as the title suggests… back pain is multifaceted.
When you understand how the body should move, it's easy to see changes in people's movements. When people have injured themself, I explain what movements the body doesn't have access to rather than giving a diagnosis. While some find this ambiguous, it also removes people clinging to a diagnosis and defining themselves by it. Remember, you are not your injury.
I have carefully woven some scientific evidence in with my own nonsensical ramblings as a means to encapsulate all audiences. To you, the reader, I hope this gives you a little insight into why things may or may not be working for you.
What are these multi-facets you speak of?
Great question.
Much like the never-ending question, what came first? The chicken or the egg scenario, back pain, is similar. Why does it occur? Is it repetitive use? Or is it once off injury?
I am going to explain 3 fundamental principles to keep in mind when looking at human movement. This helps understand why the body moves the way it does.
Gravity
To understand the first principle, we need to cast our minds back to grade 10 science, where we were first introduced to this principle. Gravity, it's the most constant stressor on the body, and no one can deny it. Astronauts in space are the only people who don't have gravity acting on them. We would all be floating around without it.
Gravity is good. It gives the body a chance to put weight through our joints. Bones, muscles, ligaments all like to be loaded. If our bones aren't loaded, they become softer. Weight training is good for bones as it allows us to stress bones more than we would in our everyday lives. For further reading on this subject, look up a term called 'super-compensation,' for now I digress….
As I alluded to, humans are always managing gravity. Our brain manages gravity subconsciously. The bones of our body then move into positions to keep our own centre of gravity in the middle of our body. Simply put, it's as if we (humans) end up bending backward to manage gravity.
Ribs without managing gravity
Ribs while managing gravity
Everyone has to manage gravity, so we are all in the same boat in one sense or another
As you can see, the bending backward of the ribs puts the body 'backward.' It's not that bending backward is bad; please don't think that. It's more that now being bent back means we now cant get forwards as well… which is what the back doesn't like. This could be one of the possible causes of lower back issues.
See the below section for exercises to help with back pain. These exercises are aimed at helping you bend forward and back efficiently.
Pain is not just due to physical injury
Pain is not just due to 'hurting a muscle, twisting your ankle or falling over.' This is generally the hardest thing for anyone to get their head around. Pain can be due to:
● Changes in an emotional state
● Mental stress (How we think and feel about ourselves)
● Physical stress (going to the gym, overdoing activity)
● Biological stress (Nutrition and illness)
In a simple sense, these are all aspects of stress. People generally categorise stress as a mental thing, yet this couldn't be further from the truth.
Stress cup analogy
Imagine yourself as a cup. You have 100% capacity to be filled and the liquid to fill you up is stress. Stress comes in all forms, and as you fill your cup, you have less capacity to handle other liquid stress. Your stress liquid may be taken up by physical stress (50%), mental stress (30%), and changes in emotional state (30%). You may realise that is a total (110%). Your ability to tolerate stress has a significant influence on your pain experience. The more your stress cup is metaphorically overflowing, the less likely you can handle extra stressors.
If you can relate to this, it's probably time you started cutting yourself some slack. Go and get a massage, take a walk in the sun, go to the beach, go and do your favourite hobby. You may just find this helps with your stress and or pain.
Be kind to your body. Give it what it needs to survive AND thrive. Feed it enough vegetables and protein. Give it enough sleep. Give it enough WATER. Out of the thousands of people I have now seen, ninety percent of those do not drink enough water. Nor do they eat enough vegetables and protein. Nor do they sleep enough.
If you would like to further read a research review discussing this topic, I will put the link below.
https://www.physio-pedia.com/Biopsychosocial_Model
Pre-existing injury
Pre-existing injury is the number one indicator for further injury. In a nutshell, the body will find a way to move away from old injuries. You name it, if the brain doesn't feel ok with using the site of a pre-existing injury, there will be a 'compensation' pattern. I put compensation in quotation marks because it is a word that is thrown around in rehab circles. For the sake of this text, just understand the broad concept of compensation as 'moving away from old injuries.'
If you have more injuries, generally speaking, it breeds more injuries. This doesn't mean you need to wrap yourself in bubble wrap and not do anything (as I explain below). It just means you need to move intelligently, rather than smashing out a workout just to 'feel the burn.'
Imagine that your starting point was 100% before an injury. You have now injured yourself and may be functioning at 95% of the 100% you used to operate at. Unless you completely rehab the injury (which most people never do), you may keep performing at that 95%. Because you now move away from the old injury, you may now load other parts of your body… and so on and so forth. Say you have 5 injuries, you could be operating at 25% less than your full potential (5% per injury is just an arbitrary number, rather just a way to explain what happens. The thing is, even though you are operating at 75% of your previous capacity, this is your brain's new 100%.
These numbers are arbitrary, but I use them for example:
Injury each injury = minus 5% from total
Normal rehab approach equation
(Starting point) 100% - (5 x injury) = 75%
= 75% (now new 100%) + 5% (common injury approach of rest and isolated exercise to injured area)
= 80% (new 100%)
Proper rehab
(Starting point) 100% - (5 x injury) = 75%
= 75% (now new 100%) + 75% (holistic approach to body - nutrition, hydration, sleep, exercise to injured area and exercise for entire body)
= 150% (+ 50% of old 100%)
To stay on top of injuries, do some form of movement most days of the week. Whether it is weight training, walking, riding, running, swimming, golf, tennis, martial arts…. It doesn't matter. What matters is you keep the body moving. The brain, muscles, joints, and ligaments all enjoy movement. You always have options for movement. Don't feel restricted just because your doctor has told you not to do the exercise that hurts. There are always other movement options; you just haven't explored them yet.
Secondly, get a professional who understands WHY you move away from your old injuries. Getting out of pain doesn't mean the pain is fixed, that's only part of the process. The rehab process as a whole is about getting you back to 150% of your current position. Proper rehab is also about addressing the body as a whole, not just helping your back because you have back pain.
Summary
The following 3 principles influence all pain experiences, not just back pain. Understand these principles as a way to 'globally' approach pain, rather than a traditional approach of exercising the local site of injury.
Out of the thousand-plus individuals I have now treated, 100% of these individuals benefited from getting more sleep, increasing water intake, increasing vegetable and food intake. Everyone also benefited from talking about how their pain impacted their emotions, behaviours and life. Everyone also benefited from doing some form of exercise daily, no matter what it was.
I have included some general exercises I have found useful for the majority of people I have seen. The links are included below.