Low back pain
is one of the most common complaints I hear about as a physical therapist. On the positives, 80-90% of episodes of low back pain resolve within 2 -3 months (Hides et al. 1996). Of the 5-10% that do develop chronic low back pain, 85% are classified as “non specific low back pain” (Dillingham 1995). This infers that there is no specific entity that anyone can point to, and say this is causing your pain.
So Why Am I In Pain?
Current research suggests that there are a variety of factors working together to evoke the feeling of pain. Note I said “evoke” pain. Pain is a response to a stimulus as opposed to being caused by something. Say you quickly bend down to pick something off the floor and immediately feel a twinge in your back. What just transpired is, you bent over quicker than your body anticipated, small receptors in the soft tissue/joints in your back sent a signal to the spinal cord and said, something is not right here, I don’t usually have to move this quick. The spinal cord then relays this message to the central nervous system in your brain which then decides if this is a threat or not. If it decides its a threat it will tell the spinal cord, yea don’t like this, send this pain signal along to the tissues in the back and also tell them to spasm so this guy doesn’t move his back for a while. What results is a stiff and painful back!
The Brains’ Evaluation
What researchers believe happens in cases of chronic low back pain is, how the brain perceives a threat is influenced by attitudes/beliefs, previous experiences, psychological distress, cultural factors, social/work environment sensory input from body and expectations/consequences about pain or danger of pain, (Moseley 2003).
So in the above example it seems fairly harmless, you’d expect the pain to settle in a day or two. However, what if this is an 80 year old man, who had worked as a manual labourer for most of his adult life, lived alone and had a fear of losing his independence. Added to this is his belief that (common misconception) if something is sore you shouldn’t move it or it will get worse. This is a very different scenario in which the brain has to process input from all these different factors. Now a few days later and the muscle has calmed down and is back to normal, but due to the other factors previously mentioned pain signal are still being sent to the tissues. In this man’s brain a connection between his back injury and all these factors have occurred which are now driving his perception of pain.
What’s really Happening
In this example this man is experiencing real pain even though the tissue has healed. What he thinks is causing his pain and what is actually causing his pain is more complex . Therefore if he or his therapist doesn’t know what is causing his pain how is he going to become pain free. Hence it is very important for therapist and clients to be aware of other factors that might be contributing to the experience of pain.
Things to keep in mind the next time you have a twinge: it will probably settle in a few days, keep moving, pain doesn’t mean damage, worrying about it will only increase your pain, your back is very strong and is very rare to cause permanent damage.
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