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Three Big Facts About Chronic Lower Back Pain

If you or anyone you know has chronic low back pain (LBP) lasting several months or recurring multiple times, then this blog is for you. That means most people should read this, since up to 58% of people at any point in time experience LBP.1 Your perception of your pain will shape your recovery. Let’s break this down for you into 3 concrete concepts:

1. Pain is not harm.

“Pain is the perception by the brain of an unpleasant sensation that is due to actual or potential tissue damage.” Actual tissue damage in this sense is acute pain – for example, when you suffer a hard fall on your bum or you deadlift beyond your capacity at the gym. This acute, protective LBP is due to traumatic incidents.

Chronic LBP is typically associated with the brain perceiving potential tissue damage. Long after your fall or your back strain at the gym, you feel this pain 6 months or even 5 years later. Physiologically, the tissue has long passed its phase of healing. But you STILL feel pain. Why is this?

Anytime we actually injure our body (e.g., muscle strain, fracture, etc.), our brain creates a strong memory about this pain. Following the incident, even the smallest discomfort in that area is interpreted as intense pain. The lasting memory of the accident, the location in which the injury was sustained, the position of the body, or the time of the incident can all resurface the feeling of pain. But pain is not always harm!pain in our back is always causing physical damage. Has someone told you that if you cough, sneeze, or bend in a weird way, your disc will slip out of place? Or has someone told you your back looks like a 90-year-old’s? Because of this, have you been fearful of certain movements or avoided moving as much? Well, the spine is a strong and stable structure. It would take a lot more than a cough to cause any serious destruction.

There is enough research out there to show that only a small portion of LBP is due to fracture, tumors, infection, aneurism, or more. For example, less than 1% of patients coming into a primary care office have a tumor, 4% have a spinal fracture, and <.01% have a spinal infection.1,3 Therefore, it is crucial to first understand that, most likely, your back pain is not due to a serious medical condition. When you feel pain, your back is not increasingly being harmed.

Red Flag Disclaimer: This is not to say that your back pain is definitely not a serious problem! If you have unexpected weight loss, pain at night that does not change with altering position, rapid fatigue, fever, reduced appetite, any trauma (accident or fall), bowel or bladder changes, or pain radiating down both legs, please see a medical doctor.1

2. Negative emotions and Pain are Interconnected

 

 

 

 

 

 

 

 

 

Have you ever noticed that if you are really busy at work or school, you “forget” your pain for a little while or you feel it less intensely? Or have you noticed that if you are relaxed and calm, sipping a corona on the beach, you have less LBP? This tells us that much of our pain comes from emotional regulation. This does not mean that your back pain is not real! However, you cannot feel pain without your brain because your emotional state at any moment in time can influence how you perceive pain. Being unhappy, negative, stressed, or anxious can be linked to your pain. In fact, there is a higher occurrence of LBP with reports of decreased job satisfaction and social support and increased workplace demands and stress. 1

If you feel less pain when distracted, then focusing on symptoms may actually increase pain. If you were to shift your focus away from constantly thinking about it and, instead, believe that you are strong and healthy, you may not experience pain as intensely. Similarly, if you feel pain less when you are relaxed, then decreasing your stress can play an important role in your path to pain relief. See our Chronic Pain blogs 1 and 2 (hyperlinks) to understand how this works

In general, while LBP can cause unhappiness, stress, and anxiety, the reverse is also true. With continued negative emotions, pain is perceived more intensely and frequently and this becomes a cyclical process. If you can connect your pain to your emotions, then you are one step closer to controlling your pain. It’s all a matter of shifting your perception of how pain works.

3. An aging back is just like your gray hairs. It’s normal.

Spinal degeneration is part of the normal aging process. As we spend more time on this earth, our spine is subject to the same effects of gravity as the wrinkles on our skin.

 It is clear through research that age is a risk factor for LBP, particularly increasing between ages 30 to 60.1,4 Your perception of a naturally aging spine can change how you feel about your lower back.

Just because your MRI says you have a disc herniation or your x-ray shows arthritis in your spine does not mean you will be doomed for life. Join the club – you are getting older! In one study, researchers took MRIs of two groups of patients with sciatica (intense nerve pain in the leg). Firstly, only 68% of those who reported disabling LBP had presence of disc herniation whereas a striking 88% of those who didn’t report disabling LBP had a herniation. This shows that disabling LBP did not correlate to a worse MRI result. Secondly, they found that reports of disabling LBP WITHOUT a disc herniation on MRI caused WORSE perception of recovery 1 year later than an ACTUAL herniation without disabling LBP.

What an interesting finding! Just being preoccupied about your MRI can be linked to more pain later on! It all boils down to perception.

The Take Away…

If you can understand that pain is not harm, that emotions can affect pain, and that an aging back is a normal human phenomenon, then you can gradually alter your perception of your back pain and be one step closer to finding a solution for it. Without the brain, you wouldn’t feel the pain because the mind and the body are not separate entities. Pain IS real… but this real physical pain comes from your brain. The brain can also send pain-relieving signals just as it induces pain-producing signals. Changing your perception of your pain can change the physical

feeling of pain. Understanding this is Step 1. Step 2 is taking massive action! If you continued to live the way you did, if you did not change a thing about your mindset or the way your body moves, then there is little to no chance that you will see improvement.

But there is hope! While back pain has been a massive enigma for centuries, with the advent of modern pain science, we understand it at a higher level. At EMH Physical Therapy, we have devised an evidence-based approach called re.lieve Solutions for Chronic Pain (hyperlink) that treats pain by targeting the brain and the body. If you or your loved one has been suffering from chronic LBP and want solutions NOW, then take a look at what re.lieve Solutions for Chronic Pain (hyperlink) has to offer for you. Visit our website or give us a call to learn more!

References:

  1. Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Practice & Research Clinical Rheumatology, 2010; 24:769–781.
  2. Tanenbaum, D.R., & Roistacher, S.L. (2012). Docto, Why Does My Face Still Ache?: Getting Relief from Persistent Jaw, Ear, Tooth, and Headache Pain. New York: Richard Altschuler & Associates, Inc.
  3. Verhagen AP, Downie A, Popali N, Maher C, Koesi BW. Red flags presented in current low back pain guidelines: a review. Eur Spine J, 2016; 25:2788-2802.
  4. Meucci RD, Fassa AG, Faria NMX. Prevalence of Chronic Low Back Pain: Systematic Review. Rev Saúde Pública, 2015; 49:73.

My Jaw Hurts!

Have you ever experienced pain with chewing gum or opening your mouth widely to yawn? Does this sometimes send pain up your temples and give you a headache or even ringing in your ears? Do you sometimes hear popping or clicking in your jaw? There may be many reasons for this but more than likely, you are experiencing some form of Temporomandibular Disorder (TMD).

Let’s break this down. The Temporomandibular joint (TMJ) is the junction between your skull bone (temporal bone) and your jaw bone (mandible). There are several muscles that control the opening, closing, forward, backward, and sideways motions of this joint. There is also a disc inside this joint that acts as a shock absorber. After all, the TMJ is the most used joint in the body! We need it to talk, eat, cough, make facial expressions, sing, and more. So this disc is very important in preventing degenerative joint disease here. Sometimes, this disc can become displaced and cause popping or clicking sounds when we open or close our mouth.

A big reason for TMDs is poor posture. Let me lead you through a quick exercise. Assume the worst posture you could ever have: round your shoulders, jut your chin forward and up, and let your trunk slump. Notice where your jaw is sitting. You might find that the bottom row of your teeth is drawn backward towards your ears and the front of your neck is long and stretched out. Now assume the best posture you could ever have: roll your shoulders back, tuck your chin in, and sit up nice and straight. You might now find that the bottom row of teeth is more in line with the upper row. Now imagine that you spend most of your time in bad posture… it makes sense that you might start to chronically stress the ligaments, muscles, and the joint in ways that they weren’t meant to be!

Another large reason for TMDs is stress. Stress can cause an array of body habits. One of them is clenching the jaw, which creates tension and constant compression at the TMJ. With this comes muscle spasm, which can then send pain upward, giving you a splitting headache.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To help alleviate symptoms, it is important to avoid poor posture, chewing gum, eating hard or large pieces of foods, biting your nails, sleeping on your stomach, and grinding your teeth. Try to stifle yawns if this worsens your symptoms. You may need to see a dentist to determine if a mouth guard is appropriate for you if your partner or loved ones have mentioned that you grind your teeth at night. Since the TMJ can be affected by stress, it is also important to relax your mind and body with breathing techniques, exercise, and mindfulness.

Severe forms of TMDs can be quite debilitation. Imagine you can’t even open your mouth or chew down to eat your favorite chocolate chip cookie! Physical Therapists at EMH specialize in the treatment of TMDs. We can help release muscles from both the outside and inside of your mouth, mobilize the jaw to decrease pain and restrictions, guide you through importance exercises to help normalize your jaw movements, and work on strengthening and stretching tissues around your face, neck, and shoulder to improve your posture and jaw control. This will ultimately set you up for success as you eat that favorite cookie of yours! Now check out two great exercises to relax your jaw below.

  1. De Rossi SS, Greenberg MS, Liu F, Steinkeler A. Temporomandibular Disorders Evaluation and Management. Med Clin N Am, 2014; 98:1353-1384.
  2. Furto ES. Move Forward. APTA. Created May27, 2011. http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=0cb5 5ce4-d260-4887-ad29-d8cb18e0b91e. Accessed Jan 31, 2018.
  3. Gauer RL, Semidey MJ. Diagnosis and Treatment of Temporomandibular Disorders. AM Fam Physician, 2015;91(6):378-386.
  4. O’Sullivan & Siegelman. National Physical Therapy Examination Review and Study Guide. TherapyEd. 21st Edition. Illinois: TherapyEd Publishing; 2018.
  5. Wieckiewicz M, Boening K, Wiland P, Shiau Y, and Paradowska-Stolarz A. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. The Journal of Headache and Pain, 2015;16:106.