GIVING BACK PAIN A QUICK EXIT
Nearly everyone has had back pain episodes. I certainly have. Like when I’ve been in a hurry and lifted a heavy object the wrong way or twisted awkwardly. And often when I first get up in the morning. I’m pretty sure you’ve had similar experiences or perhaps worse—chronic back pain that just doesn’t go away.
I’ve been scanning through back-pain articles the last few days and want to share two that I think are the most informative. The first gives a general overview of back pain; the second concerns the psychology of back pain. The first is from the Mayo Clinic staff August 4, 2018 article Back Pain, from which I give these excerpts:
Overview
Back pain is one of the most common reasons people go to the doctor or miss work, and it is a leading cause of disability worldwide. Most people have back pain at least once.
Fortunately, you can take measures to prevent or relieve most back pain episodes. If prevention fails, simple home treatment and proper body mechanics often will heal your back within a few weeks and keep it functional. Surgery is rarely needed to treat back pain.
Most back pain gradually improves with home treatment and self-care, usually within a few weeks. If yours doesn’t improve in that time, see your doctor.
Causes
Back pain that comes on suddenly and lasts no more than six weeks (acute) can be caused by a fall or heavy lifting. Back pain that lasts more than three months (chronic) is less common than acute pain.
Back pain often develops without a cause that your doctor can identify with a test or an imaging study. Conditions commonly linked to back pain include:
- Muscle or ligament strain. Repeated heavy lifting or a sudden awkward movement can strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back can cause painful muscle spasms.
- Bulging or ruptured disks. Disks act as cushions between the bones (vertebrae) in your spine. The soft material inside a disk can bulge or rupture and press on a nerve. However, you can have a bulging or ruptured disk without back pain.
- Arthritis. Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
- Skeletal irregularities. A condition in which your spine curves to the side (scoliosis) also can lead to back pain, but generally not until middle age.
- Osteoporosis. Your spine’s vertebrae can develop compression fractures if your bones become porous and brittle.
Prevention
You might avoid back pain or prevent its recurrence by improving your physical condition and learning and practicing proper body mechanics.
To keep your back healthy and strong:
- Exercise. Regular low-impact aerobic activities — those that don’t strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices.
- Build muscle strength and flexibility. Abdominal and back muscle exercises, which strengthen your core, help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.
- Maintain a healthy weight. Being overweight strains back muscles. If you’re overweight, trimming down can prevent back pa
- Stand smart. Don’t slouch. Maintain a neutral pelvic position. If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back. Alternate feet.
- Sit smart. Choose a seat with good lower back support, armrests and a swivel base. Keep your knees and hips level. Change your position frequently, at least every half-hour.
- Lift smart. Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight — no twisting — and bend only at the knees. Hold the load close to your body.
Buyer beware
Because back pain is so common, numerous products promise prevention or relief. But there’s no definitive evidence that special shoes, shoe inserts, back supports, specially designed furniture or stress management programs can help. In addition, there doesn’t appear to be one type of mattress that’s best for people with back pain. It’s probably a matter of what feels most comfortable to yo
Diagnosis
Your doctor will examine your back and assess your ability to sit, stand, walk and lift your legs.
These assessments help determine where the pain comes from, how much you can move before pain forces you to stop and whether you have muscle spasms. They can also help rule out more-serious causes of back pain.
If there is reason to suspect that a specific condition is causing your back pain, your doctor might order one or more tests:
- X-ray.
- MRI or CT scans
- Blood tests. These can help determine whether you have an infection or other condition that might be causing your pain.
- Nerve studies. Electromyography (EMG) measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).
Treatment
For acute back pain, over-the-counter pain relievers and the use of heat might be all you need.
Continue your activities as much as you can tolerate. Try light activity, such as walking and activities of daily living. Stop activity that increases pain, but don’t avoid activity out of fear of pain. If home treatments aren’t working after several weeks, your doctor might suggest stronger medications or other therapies.
Physical therapy and exercise
A physical therapist can apply a variety of treatments, such as heat, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain.
As pain improves, the therapist can teach you exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques can help keep pain from returning.
Surgery
Few people need surgery for back pain. Surgery usually is reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disk, that hasn’t responded to other therapy.
Alternative medicine
A number of alternative treatments might ease symptoms of back pain. Always discuss the benefits and risks with your doctor before starting a new alternative therapy.
- Chiropractic care
- Acupuncture
- Massage
- Yoga
The second item I’d like to share with you is from a Harvard Health Blog by Srini Pillay, MD on April 25, 2016 titled The psychology of low back pain. Here are excerpts:
Even though back pain is incredibly common, not all people respond in the same way to this often-disabling condition. In fact, even if two people have the same level of pain, their responses to that pain can be very different. These differing responses are due in part to different people’s psychological attitudes and outlooks.
Why chronic back pain is connected to “your head”
When your physical movement is limited, this can cause psychological distress, and the psychological distress can, in return, worsen the pain. Your personal health beliefs and coping strategies can influence both your level of distress and course of the pain. For instance, if you are anxiety-prone, expect the worst, and have catastrophic thinking, this can make the pain worse. That’s because those psychological vulnerabilities can change your brain and intensify the pain.
But it’s not just pre-existing attitudes that worsen back pain. The pain itself can rewire your brain. When pain first occurs, it impacts your pain-sensitivity brain circuits. But when pain lasts, the related brain activity switches away from the “pain” circuits to circuits that process emotions. That’s why emotions like anxiety often take center stage in chronic back pain. And it’s why emotional control becomes that much more difficult.
What you can do to tame chronic back pain
The treatment with the greatest supporting evidence (for all chronic pain syndromes, not just back pain) is mindfulness. A recent study demonstrated that a technique called mindfulness-based stress reduction (MBSR) can help to reduce back pain and also improve emotional control by increasing brain blood flow to the frontal lobe. A full eight-week course in this technique may even improve anxiety and depressive symptoms as well. Practicing mindfulness involves activating a brain relaxation pathway by deliberately ignoring mental “chatter” and focusing on your breathing. When you do this, an “unfocus” circuit, called the default mode network, is activated.
Depending on the cause, low back pain can be treated with progressive muscle relaxation too. This is a technique in which you learn how to decrease your anxiety by becoming more aware of how you can tense and then relax your body.
But it’s not simply “mind over matter”
So while it’s clear that low back pain can be “in your head,” that doesn’t mean that you have to trivialize it. “Mind” includes “matter,” especially when you consider that the physical “matter” of the brain plays a major role in mindset changes. This is especially true when it comes to the brain-based changes related to low back pain. To that extent, changing your mindset and brain biology can help your brain — and lessen your pain.
Hopefully, this post has been beneficial to you. And the next time you have back pains you’ll have a little more information to help lessen the pain and to give it a quick exit.