The low down on Lower Back Pain: Part 2

The Low Down on Low Back Pain: Part 2

Why does my Back "Hurt"?

If you have not read my first blog in this series then head back and check it out HERE!

The blog covers three really important things:

  1. What is Low Back Pain?
  2. Who gets Low Back Pain?
  3. How does back pain happen?
If you don’t like reading then CLICK HERE where Dean and myself sit down to chat about Low Back Pain.
 
In this blog we will dive into where we left off in that last blog and cover why our back “hurts” and start to understand of the experience of pain in our low back. 
 
Following on from my previous blog around some potential mechanisms when we injure our lower back.
 
I want to touch on and educate you around the experience of pain.
 
This might at times be confusing to read and challenge your beliefs on what pain is and that’s ok.
 
Keep an open mind and keep working through it.
 
Now…
  1. I want YOU to understand that pain is complex
  2. I want YOU to understand that pain is an interpretation of information received by the brain

To do that I need to lay some very basic descriptive groundwork.

1. Nociception

Nociception is a signal of information that gets sent from an injured tissue along spinal pathways to the brain for processing.
 
Below is a basic picture to help with the concept of nociception.

Basically we hurt our tissues, a nociceptor picks up on it and sends a small electrical signal along the pathway up to the brain. 

2. Pain Processing

When nociception travels to the brain, the signal bounces around like a pinball between various area’s in the:

  • The Limbic system: This is the part of the brain that deals with fight or flight, emotion, motivation, learning and memory (good and bad memories)
  • The frontal cortex: where planning, decision making and behaviour occurs relative to the information received and the situation we are involved in
  • The motor and somatosensory cortex: These areas deal with localising the nociception to a part of your body and is responsible for the immediate withdrawal of what the body believes is a threat (eg hand pulling away after the hammer strikes it)

Above is a picture of the area’s of the brain responsible for pain processing and modulating.

Did you know the brain is one of the most powerful pain relievers we have? It releases it’s own opioids!!

Now lets put it all together!

The nociceptive system passes information from the injured part of the body up the spinal cord and into the brain.

That information bounces around like an INPUT to the brain and is influenced by our current situation, perception of what just happened, past experiences of self and others, sleep status, mood at the time, stress levels at the time, a pain memory, thoughts and behaviours or “am I threatened and in danger”.

ALL that information is processed by the brain and the output is PAIN felt by you in the area of injury ie the back.

Remember the body is very good at protecting itself think of pain like an alarm system going off to warn you of danger or the potential for danger/injury. 

 “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” International Association for the study of Pain (IASP 1979)

What's this got to do with my Back?

When we experience tissue failure like the model in my previous blog (eg lifting something too heavy for us once or rearranging the garage spontaneously).

We will experience local inflammation and sensitisation within and around one or more of the structures the low back, these maybe the intervertebral disks the muscles surrounding your spine the facet joints, ligaments, or the nerves themselves.

The nociceptors in and even around our back will pick up this information from the tissues and send the signal to the brain that something is up.

Brain will interpret this nociceptive information and we will feel lower back pain.

Over time many other complex interactions occur in our pain processing pathways and this is where the best management results in the best outcomes with back pain!

Here is what do we do when acute back pain strikes?

  1. Rest is ok, but movement is also important!
  2. Move enough to not overly aggravate and stimulate more pain, a low and comfortable level is enough to get tissues moving and healing.
  3. Schedule and allow rest periods or breaks with regular movement, we call this RELATIVE REST.
  4. Avoid listening to conversations that start with “I know someone with that exact same thing and they…” or end in “it worked for really me”, no two backs are the same just like no two people are!
  5. Seek advice & reassurance if in doubt from “real health professionals” on treatment and avoid quackery!
  6. Treatment reduces the time to return to normal function, eases & modulates pain but will not speed up healing time or provide magic fixes. 

Here is some EXTRA simple steps to reducing your Pain Intensity!

  1. Quit smoking as this reduces pain experienced by up to 10%

  2. Improve your sleep hygiene as this will result in a reduction of pain intensity the following day

  3. Alter diet away from inflammatory foods such as high fat, processed, starchy & high sugar

  4. Reduce caffeine intake reduces pain experienced by 10% as caffeine is a nervous system stimulant. The pain experience lies within our nervous system!

When should I see someone when I have Back Pain?

In our professional opinion it is straight away!

By doing so we can tell you:

  1. What is going on,
  2. Ease fears, concerns and worries,
  3. Provide techniques designed to ease pain and
  4. Begin you on a plan to returning normal function again following injury. 
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