The Roman philosopher Seneca cheerily said that pain is either bearable or brief. Either way it is unpleasant and chronic pain can also affect your mental health. With psychological as well as physical implications, bad backs are bad news.
Back pain can also be a sign of an underlying issue. You should seek immediate medical attention if your back pain is characterised by any of the following:
- •Back pain that has lasted longer than 6 weeks
- •If the pain is unremitting or if it is progressively worsening
- •Pain that is worse at night or at rest
- •Constipation or loss of bladder/ bowel control
- •Severe stomach pain
- •Nausea, fever, chills or shakes
- •Pain down both legs
- •Weight loss or loss of appetite
- •You’re over 55 years old
- •A history of cancer
Low back pain (LBP) affects over 80% of people at some time in their life. The source of this pain is only determined in 15% of cases. The rest are dismissed as ’nonspecific’ or ‘simple mechanical back pain’, but neither are apt description. In reality, the cause is specific albeit mysterious and clearly not simple.
What’s the mystery?
No one likes ambiguous ailments, so a scan is often used to identify a cause. These rarely give sufferers the answer they are seeking. An MRI may well reveal disk degeneration – in fact it’s quite likely to. Some degree of wear and tear will be present in 30% of people under 30 years old, 60% of those between 30-60 and essentially everyone over 60. However, this deterioration is not usually the cause of any pain or discomfort (except of course, when it is).
Pain and injury do not always go hand in hand. Something can hurt and not be injured and not every injury will cause you pain. Around half of us right now will be merrily reading this with a bulging disk, a torn meniscus or a rotator cuff tear and not even know it. This common and asymptomatic wear and tear is just part of the joys of later life.
So if it is not always a direct injury, what causes LBP? There is no shortage of pet theories: a lack of flexibility, weak core, bad posture and so on. Do enough prodding and poking with self-fulfilling tests and whatever you wanted the problem to be can soon be proven. If you go on a wild goose chase you are guaranteed a chase, not a goose.
Usually examinations are used only to justify the next step, which is rectifying the so-called issue with whatever the preconceived solution was. Often stretching, strengthening the core and corrective exercises are prescribed. Sometimes this works, sometimes not. Perhaps it was the wrong treatment or done incorrectly, but quite often the problem found wasn’t really the irritant or even a real problem.
Just as a victim complaining loudly is far easier to spot than the culprit who is hiding quietly, prominent symptoms are easily pointed out by charlatans trying to relieve you of your money while the underlying cause lurks unseen beneath the surface. We would all assume that being weak, twisted and inflexible will not do you any favours, but we must recognise that this is just an assumption. Are these ailments more likely to cause a bad back or be the result of one? If it is the latter, then what is the point of even testing?
Managing your back and your expectations
Stretches, exercises and treatments will not cure or heal anything. The most we should hope for is that they restore pain free movement and then the rest is up to your body. Just as a light bulb doesn’t cure night time, it does allow you to operate effectively whilst it’s there.
Once upon a time bed rest was recommended. This has been replaced with cutting back on anything too strenuous but to keep active. With a bad back this is easier said than done! Painkillers are part of the current recommendations but not everyone likes to take a pill for everything. This has given rise to the plethora of stretches, exercises and treatments. All of them in one way or another try to promote pain free movement.
Bad backs are a complicated problem to untangle – anyone telling you otherwise is trying to sell you something. We all like simple sounding solutions or thinking we ‘know our own body’, but there is no one size fits all approach. If all you have is a hammer then everything will look like a nail. Getting fixated with just one method will blind you to alternatives and limit your chances of success.
A multidisciplinary approach is best, but don’t try everything at once. Be ready to try combinations of different options, layer treatments. Ultimately, see what needs to get you moving and being out of pain. To do this, here are just a few of your options.
Inflexibility will only injure you if you exceed your limited range. Conversely, trying to develop your mobility into a superpower will not guarantee you protection from damage. However, flexibility is trainable and stretching does sometimes help relieve back pain.
A little yoga can work wonders (there are many type and standards vary, so don’t rule it until you’ve tried more than one or two classes or teachers). A few well-chosen stretches can be just as effective. Do not excessively stretch the lower back or the hip flexors. Instead focus on the glutes, hamstrings and the seldom mentioned QL’s (quadratus lumborum).
Improve core stability
Core stability and core strength are very different things (as explained here). Stability exercises don’t feel difficult and some dismiss them as ‘child’s play’. However, children don’t generally suffer from bad backs and perhaps you might be one of the lucky few who relieved their agony by the judicious application of these techniques. Remember, the quality of the movement or ability to resist unwanted movements is far more important than the quantity of reps or difficulty of exercise selected. These exercises are to challenge control not test strength.
Reduce sacroiliac pain
The sacroiliac joint is involved in a third of all cases of back pain. Squeezing your fist between the knees can cause an audible pop and offer some relief (as could a joint manipulation). These won’t alter the position of the joint but nor should they.
The only thing you’re looking to change is the pain you’re in. If you are suffering with pain or discomfort just above the tailbone then there are many exercises and stretches that may help.
Manage sciatic symptoms
The lack of precision in back pain has led to ‘shotgun’ strategies that overlap techniques. Conversely, with sciatica the advice can be narrow – you may need to rest or walk more. I recommend flexion-based exercises or do more extension, all depending on what is causing the condition.
This is because sciatica is a symptom, not a diagnosis. It usually includes shooting pain or a burning sensation down your leg or pain in the buttock or back (but not always).
Trigger point stuff
Very little is understood about myofascial trigger points, adhesions, knots, whatever you want to call those sore little spots that sometimes only seem to hurt when pressed. However this lack of consensus in their exact nature doesn’t mean they don’t exist and poking and prodding them does seem to help.
Some may want a more rigorous explanation before accepting this but as Umar Khayyam roughly said ‘Sober or drunk in ignorance we stand’.
Typically these areas get pressed or jabbed by a thumb, a hard ball or an unenthusiastic partner’s elbow until they feel better. Professionals may go a step further with their tactical poking and use instrument assisted techniques with either a thing that looks a bit like the batarang or acupuncture.
Usually when it comes to lower back pain, the knots can be in and around the lower back but also pain may be referred from the top outer portion of the glutes too so do fish around, just avoid the spine itself.
See a professional
If by following the instructions above you haven’t sorted your back pain out yourself, it doesn’t mean it can’t be done. A fresh set of eyes or more experienced pair of hands may be needed.
We all have preferences and biases when it comes to looking for an expert. Some swear by massage therapy, osteopathy, chiropractors, physios or muscle fluffers. I think the discipline is less important than the person.
It would also be lovely to think that every time a practitioner has rid their client of their back pain, it was because they accurately identified the cause, carefully selected the correct course of action and then expertly performed the treatment. In the real world, even the superstars will not win every encounter and occasionally the worst therapist will get a result.
Just be wary of very long chains of reasoning and trying to correct something in order to create some sort of domino effect to the target area. It is nice to think how everything is connected and the further or less obvious the cause is from the pain the cleverer the therapist appears and the more special the patient feels but it is usually nonsense. Back pain can be very complicated but in truth we are lucky if we can identify even the most obvious sources let alone the obscure ones.
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LBP exit interview
Sometimes what ‘worked’ may be down to nothing more than a novel stimulus and a bit of luck or just sufficient time passing in which the pain would have passed anyway. This is why we need an open mind – don’t rely on a single technique and you can expect some trial and error.
Not everything will ‘feel’ like the right thing. Occasionally your back will get worse before it gets better or the treatment will take a few days to have an effect. However, if something isn’t working don’t kid yourself. You shouldn’t have to think too long and hard to judge if that fleeting relief you may or may not have felt counts as an improvement.
Anything less than a long-lasting, significant improvement is not a successful outcome. Once a winning formula has been found, it shouldn’t need to be continued for long. Ignore those knowing looks you get when you tell someone you stopped the treatment and now the problem has returned. You shouldn’t have to make permanent changes for future prevention.
This is hard for many to grasp, but the principle is obvious in other contexts. Think of a building’s fire sprinklers. They are triggered by a fire breaking out. They do not routinely kick in each day to prevent them. That is because what causes the fire has nothing to do with the way you’d tackle the current blaze or prevent future infernos.
Recurring back pain may not be indicative of the way you manage the condition. It could be down to you not doing a job in preventing them in the first place.
Genetics probably play a big part of this, but it’s too late to pick better parents. What we can do is not mistreat our spines and always train properly. Either accept your limitations or the consequences of exceeding them.
It doesn’t matter whether your back pain is from carelessness, misfortune or it is the price you pay for doing what you want. Managing the pain is possible and you shouldn’t have to suffer needlessly.