Tag: Back pain

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The “Back Whisperers” — Back Pain Part 3

Like everything else, it’s better to prevent back pain than to have to treat it. But what do you do if you already have chronic non-specific back pain? The simple answer, according to several experts, is to strengthen weak back muscles and change bad habits, but this can be easier said than done…

What about surgery and steroid injections?

An estimated 38% success rate is reported for back surgeries, with some patients actually worsening after the surgery instead of improving. Steroid injections, which can give temporary reductions in pain and inflammation, can also cause side effects of bone loss and weakened muscles in the injected area. Misplaced injections have caused serious injury, including paralysis (referred to as a spinal “stroke”). Because several existing treatments have not been highly successful, new programs have been developed, some by back surgeons who were disillusioned by their inability to help their patients through surgery. Investigative reporter and author of Crooked, Cathryn Jakobson Ramin, refers to these non-surgery back experts as “Back Whisperers”.

The “Back Whisperers” – Exercise specialists

One such doctor is Brian Nelson, a former back surgeon who decided to develop a different method to heal chronic back problems, and he founded the Physicians Back and Neck Clinic. Recognizing the need to strengthen the weakened muscles of the back and that many people do exercises incorrectly (using gluteus “butt” muscles or leg muscles instead of the muscles of the back that need strengthening), he invented an exercise machine called MedX that made his patients do their exercises correctly as part of a broader rehabilitation program. The machine is now used in many high-end back rehab programs world-wide.

Canadian University of Waterloo kinesiology professor, Stuart McGill, made a career of studying the mechanics of why back muscles, bones and ligaments fail so commonly. While he recommends customizing exercise according to what is “mechanically” malfunctioning in each individual, he did design “Stuart McGill’s Big 3 Exercises” to develop core stability, supporting the back. You can view these strengthening exercises on You Tube. Ask your doctor or therapist if they are right for you. He also recommends walking, even for short periods of time, several times a day as an excellent exercise. He recommends doing this in a somewhat “military” style, swinging the arms to loosen tightened back muscles.

Movement techniques to correct posture, such as Feldenkrais, the Alexander Technique, Tai Chi (tie-chee), and Qigong (chee-gung) are designed to help you undo unconscious habits, helping you to develop “conscious control” and bring your system and posture back into balance. Some of these techniques can help you to realize which bracing, “protective” postures that you may be unconsciously holding that create pain and spasms, and can teach you how to relax and let go. And some forms incorporate an element of active meditation that can help reduce stress. Here’s a small example on YouTube of simple Qigong exercises… but ideally you would want to join a class to be instructed properly.

Yoga, while helpful for relaxation, can often tend to overwork lumbar and cervical regions of the spine with forward bends that load extra pressure on the spine that can be painful in those who are already deconditioned and weakened. Low back trauma is reported to be the most common type of yoga injury. However, two styles of yoga, Viniyoga and Iyengar, are considered more suitable for people with joint and muscle problems. A skilled instructor can help to identify and correct problems that are causing chronic pain.

Using the mind/body connection

One of the worst things for the back is to tighten and guard against painful movements. A diagnosis of “degenerative disc disease” can frighten a person into avoiding any kind of exercise, in case they further damage their “fragile” spine. However, most people benefit from exercise and learning not to fear possible pain once they have a proper diagnosis and treatment program. Some of the most effective programs include “cognitive behavioural therapy”, where patients are taught to take a positive view of their condition: that their situation is not hopeless and that they can learn to manage their pain.

Ron Seigel describes the central issue of chronic non-specific back pain as being the fear of back pain in his book, Back Sense. “Pain causes distress, which causes muscles to tighten, which causes more pain” in a downward spiral. Dr. John Sarno observed that emotions caused the unconscious mind to create painful spasms in many of the back pain patients he treated over the years, as described in his book Healing Back Pain. He claimed that many patients could make a dramatic recovery once they realized the source of their chronic pain.

Red flags

But before you would consider an exercise program for a chronically painful back, you should have your doctor assess for “red flags” — symptoms that suggest the possibility of a serious problem. These include long-standing pain that is unaltered by a change in position (possibly suggesting a tumor and a need for imaging such as an MRI), or a history of fever and chills (suggesting the need for a bone scan to rule our low-grade infection).

However, scans to diagnose back problems are generally not recommended, especially early in the course of an episode and barring any “red flags”, as changes in spine structure do not correlate well with the cause of the pain, leading to unnecessary surgery in many cases. Degeneration of discs between vertebrae is common as we age, and is often seen in images of spines of people who have no back pain. Ruptured discs are reported to heal when pressure on them is avoided for a period of time, eliminating the need for surgery to correct the problem.

In summary…

If you have chronic back pain, ask your clinician about non-surgery options and specialized back rehabilitations programs. If you are taking opioids for long-term back pain, ask your doctor how you can transition off these, perhaps to an anti-inflammatory medication if it’s safe for you to take.

The main reasons to avoid NSAID anti-inflammatory medications is existing stomach problems or kidney disease. However, because the dose needed is much lower, when anti-inflammatory creams are used , they can often be substituted for the pill version.

Be aware that these creams need to be applied to specific areas, known as the “trigger point” for your particular muscle spasm, and it may not be the most obvious painful area. Ask a therapist who is familiar with the work of Drs Travell and Simons to show you exactly where to massage the cream. A self-help book I’ve used for many years that explains these well is The Trigger Point Therapy Workbook by Clair Davies.

Acute back pain

If you have an acute (less than 1 month) or a sub-acute (less than 3 months duration) back problem, realize that most will recover from this. The worst thing you can do is stiffen and guard against painful movements, or take opioids that could cause side effects and long-term problems, and could even eventually worsen your pain. Remember from Part 1 of this blog series that anti-inflammatory medications (by mouth or as a cream) and sometimes short-term muscle relaxants can give relief. Total bed rest is no longer recommended and, instead, gentle rhythmic exercise as tolerated, such as walking, has been found to help improve the problem more quickly. Applying heat or ice can also provide some relief. A visit with a physiotherapist or skilled massage therapist can set you on the right track for a full recovery. If the pain is severe, you may benefit from an assessment by your physician. Once you’ve recovered, work with a therapist for a visit or two to strengthen muscles that support the back to prevent future episodes.

In response to my first article in this series, a reader who is an occupational therapist described to me how they recommend their patients strive for a balance in work (purposeful activity), rest and play, and in mind, body and spirit. It seems that the cure for back pain is not the same for everyone, but it’s all about strengthening without overworking, avoiding painful activities unless being supervised by a professional, addressing stress and associated muscle tension, and learning to move without fear. Several experts have stated that 90-95% of back pain sufferers can recover without surgery.

Additional reading:

Crooked by Cathryn Jakobson Ramin

Healing Back Pain by John Sarno

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Health

The “Sitting Disease” — Back Pain Part 2

If you think your latest back problem was caused by lifting a heavy object, or from twisting the wrong way, or whatever the event was that brought it on, you would likely be wrong. Most back problems don’t just happen “all of a sudden”. They are the result of things you’ve been doing (or not doing…) for many years. Here’s what the experts say…

Posture

First, your posture can set you up for back problems. How we sit and stand can set us up for pain down the road. For example, when you cross your legs knee over knee, your back twists to compensate. Since humans are creatures of habit, we tend to assume a posture we find comfortable frequently, sometimes for hours at a time. Chronically twisting the back, even if it feels comfortable at the time, eventually results in shortened muscles on one side and a back that doesn’t quite straighten out when you stand up. But you are unlikely to notice the change yourself. Other positions like slouching with the neck extended, shoulders rounded and back curved to compensate also set you up for future pain.

The Sitting Disease

Second, just sitting for long periods of time means there are muscles that aren’t being used. And these can become weak over time, setting you up for painful muscle spasms when you do try to use them to lift or twist. It isn’t really the “lift” that is the true cause of the pain, it’s the fact that your muscles have withered from lack of use. Humans were designed to move, not to sit for hours at a time at a desk!

Stress

Third, many people notice that their back “goes out” more frequently when they are stressed. And there is definitely a connection between the mind and the body… I’m sure you’ve heard the term “tension headache” — it’s a headache caused by spasm of the muscles in the scalp, usually brought on by stress or fatigue. Other muscles can spasm for the same reason, including muscles of the back and shoulders, causing back or neck pain. Back expert, Dr. John Sarno, calls this “Tension Myositis Syndrome” and cites it as a major cause of back, neck, shoulder, buttocks and limb pain in the many patients he has treated over the years of his practice. His book, Healing Back Pain written in 1991, still has valuable information for back pain sufferers.

I’m certainly “guilty” of tensing my shoulders when I’m stressed, and too frequently have a stiff neck that I blame on a car accident 40 years ago or on having spent too much time with my head turned to one side or upward the day before (or all of the above…). Like many writers, I sometimes study and write about subjects I am personally concerned about, while also helping my readers! I’ve already put some of what I learned for this article to use…

And constipation?

Fourth, constipation can make low back pain worse for some people too! The bowel is suspended from the lower spine by a web called the mesentery. When the bowel gets full and heavy because the contents aren’t moving along as they should, it tugs on the lower sections of the spine, compressing nerves and causing discomfort. Also, when you consider that opioids cause constipation, for some the “cure” could be making the pain worse! And treating the constipation may help to improve low back pain.

What can you do?

Taking a break from sitting regularly can help prevent back problems. Shifting position frequently while sitting can also help. And avoid sitting in a twisted, cross-legged position. Some researchers have suggested that the ideal chair should have a seat that slants forward, putting some weight onto the legs, and should allow you to wiggle and move around to vary your position, but I’ve never seen anything that looked like that in an office furniture store!

The conventional 90-degree office chair actually puts high pressure on the discs between the vertebrae of the back, researchers say, and can lead to tight hips and psoas (the muscles that run inside the hips and need to extend to stand up), weak gluteus (your “butt” muscle), poor circulation causing swollen ankles and varicose veins, and a strained neck. The ideal hip angle, they tell us, is about 135 degrees, halfway between sitting and lying down, which brings to mind anti-gravity patio chairs! If your chair has an adjustable back, you might be able to tilt it back for part of the day, depending on the type of work you are doing, to create the ideal hip angle for at least a little while.

Until they invent the perfect workstation, the best suggestion is to take a break and move around every hour, and to change your sitting position frequently while you’re sitting. As one expert says, “The best posture is always the next one”. (Rethinking Sitting by Peter Opsvik)

As you see in the photo above, I’m trying out a new desk configuration… with my chair back slanted close to the ideal 135 degrees and using a second elevated screen, at least for some of my work… but taking a break now will help! I may even try doing some writing on the couch where I can elevate my feet and relax in another position for variety, and using dictation to give my arms, shoulders and hands a rest is definitely on my list.

So, pay attention to what you do while reading emails or watching TV — it might make a difference in how your back feels in the future.

Next week, I’ll share what I’ve learned about how experts treat these problems if you already have them… Sign up by clicking the “Subscribe” button if you want to be sure to get Part 3 of my Back Pain series!

Suggested reading:

Healing Back Pain by John Sarno