My back has never felt stronger – it has rarely been symptomless for more than 6 months at a time in 25 years, but I’m more confident now than ever before that I can remain pain-free. I had lower back pain in my early 20’s – lots of it, and have had many episodes since. It was eventually diagnosed in my twenties as an L4L5 disc herniation. Given I’m an osteopath, and you might hope that I wouldn’t suffer lower back pain, I sort of feel like I imagine someone does at an AA meeting – and so – in a pointless attempt at anonymity I’ve used an image of a strong back that isn’t mine (incase you were wondering about my weekend activities, and were surprised by what I look like under my tunic coat, and where I keep my long hair when at work). However, if you’ve read my blogs before, my history of back pain won’t be news to you – nor my sense of humour.
Why is it so much better now? Essentially because I have finally accepted that so much of what I do is bad for my back AND I consistently work to avoid these things and undertake activities that keep my back strong – and the same could probably apply to you.
It’s worth remembering that the primary function of pain is as an alarm system. Pain isn’t there to make you suffer, it’s there to warn you that something is wrong and if you persist with your current course of action, the alarm bell will keep ringing. (Please note though that the alarm system can “break”, leading to on-going pain even when there’s no mechanical reason for it – this is more likely the longer you’ve had pain. However, this doesn’t seem to be the case for me – fortunately – and I hope it isn’t the case for you.)
Here are the lessons I’ve learned about back pain…
It’s all about loading
All tissues (muscles, ligaments, tendons, bones etc.) have a limit to the load that they can tolerate. Exceed the load and the alarm system will start to ring – often even before you’ve damaged something. This load can be “peak”, “sustained”, or “cumulative”. Peak is lifting something really heavy. Sustained is staying in one position for a prolonged period of time; and cumulative is doing the same thing again and again. If you combine two or more of these, the combined load can lead to damage e.g. if you’ve sat in a car for two hours in one position, that’s sustained load (if you do it frequently that’s cumulative); when you then lean forward to lift something out of the boot, or a child out of a car seat, that’s peak load… wham! The last-straw-on-the-camel’s-back effect.
Some backs don’t tolerate loading when sitting, others when standing and others when walking or lying in bed. You need to work out which of these applies to you and then minimise that kind of load before gradually re-introducing it. For me as a student it was sitting. I’d sit for 10 minutes at the back of a lecture room and then have to stand up for the rest of the lecture due to severe pain; now I’d know just not to sit at all! By avoiding the painful loading, my back would have been able to start to heal and then I could have slowly built up the sitting again. Instead – by trying to blend in with the other students who were all sitting – I just couldn’t get over it.
Pain is a warning
Pain does not equal damage. It’s purpose is to warn you. You can have pain and damage, but you can also have damage without pain (think rugby player who doesn’t notice the hole in his head), and pain without damage (think phantom limb pain, or headache). If you ignore the warning, the bell often continues to ring. Taking painkillers just numbs your ability to feel the warning; there’s a time and a place for them, but remember that’s what they’re doing.
Movement is essential
Moving around frequently is good for you in so many ways. But from a loading perspective it’s vital in avoiding the sustained load problem. Moving helps to remove old blood and tissue fluid, thereby allowing fresh blood loaded with nutrients to get them to where they’re needed. If you don’t move, this process slows down so that your tissues become stagnant, slow to heal and unhealthy.
All types of movement are not all good for you
Movement exerts load on your tissues, so we need to be sure which movements are good for your back and which are not. This is not always easy to work out yourself, given that it’s possible to have damage without pain, and pain without damage.
Pain is not all bad
Pain has taught me a lot of life lessons. I know this is hard to read if you’ve got long-term severe pain, and I apologise if it offends you. But it has taught me some useful things.
If you’d like help working out which loads are bad for your back, and in creating a rehab program, just email me or give us a ring.