The Low Down on Low Back Pain: Part 3
Why does my back keep hurting?
This blog follows from my previous blogs around some potential mechanisms of low back pain and the how nociception becomes pain.
You can read them here:
Today, we are going to explore persisting low back pain, or back pain which lasting longer than 3 months.
“Persistent pain affects over 20% of the population and is a result of many factors and is a very complex condition”
However I am going to simplify it for you.
It’s important to note that this can happen anywhere in the body, not just the back.
Our blog will also help people suffering other areas of persistent pain.
Let’s get into it.
When we experience an injury and musculoskeletal pain such as a sore back, and this experience of pain lasts for many months or even years and decades.
Many of us may attribute it to “tissue damage”; a structure in the back that has worn out, is broken, bulged, failed to heel or shows an abnormal finding on scans.
But did you know that the longer pain hangs around for, the more likely it is not a result of “tissue damage” or structural cause.
Give me a few of your precious minutes and I will explain how this can occur.
When we have an acute injury, it is the first time that this has occurred.
There is a mechanism to it which results in tissue damage and “acute pain” occurs.
Depending on the trauma to the tissue this pain can lasts anywhere from a few days up to 3 months.
3 months is generally the maximum time it takes for a tissue to heal.
Eg bones fracture and heal completely within 6 weeks, ligaments take 6-12 weeks, muscles 3 days for a sprain up to 6 weeks in more severe cases. Tendons, well that’s for a different blog.
There are a few exceptions to these general rules, but they are rare.
Most of the time, the body does an absolutely amazing job for itself heal. You have to remember we are designed to heal, adapt to our environment, survive and thrive after all.
Below is a simple representation of what occurs with tissue healing.
Lets break it down a bit more, when a tissue is injured it will:
- Bleed; which brings in important healing factors and last hours to a few days (creating redness)
- Become Inflamed; (resulting in swelling) will be the next step that can last hours to days. Inflammation initiates tissue repair through bringing it a natural tissue healing response. This is normal and a very important part, so don’t race to jump on those anti-inflammories to quickly. Certain chemicals in it will create a response from our body which kicks off the next phase.
- Proliferation (think a scab) begins and lasts up to many weeks where cells arise within the wound creating a bed or frame work for new tissue to grow
- Once that finishes, remodelling occurs. This will begin in varying stages/weeks lasting up to 3 months. Here the new tissue reorganises and matures to increase its strength and resilience, restoring homeostasis and normality to the tissue and it’s function.
“Our body is designed to heal itself so we survive and does an amazing job of it!”
As our body is healing it naturally protects us from further harm during these stages.
It wants to best repair the injured tissue, so it has a fighting chance of survival.
If your confused, put your primal, cave dwelling brain to use here and think “If we broke, we need to fix, so man can hunt for food and survive” Simple hey?
So how does it protect, guard and allow us to heal?
Sensitisation is the term used to describe how our nervous system reacts to protect us when we are hurt or injured. Bleeding and the inflammatory response kick this phenomena off.
During sensitisation the nervous system is heightened and will react quicker than normal and result in increased feelings of cold, hot, pressure, touch, movement and pain. (See Part 2 of our series as it explains pain)
The sensitisation process occurs rapidly after an acute injury to create a heightened level of perceived danger or threat.
It quickly warns us that we need to stop, rest, avoid what we are doing to allow the tissue healing response to occur and the body can rebuild the injured area.
Sensitisation happens within both the the perepherial nervous and central nervous systems (see below).
Read on as I break it down further if you are interested!
The peripheral nervous system is where the small nerve fibres in our tissues temporarily become hypersensitive to nociception (remember last blog? the information sent to the brain). This happens so they can scream information quicker and stronger to our central nervous system.
When these signals go from the PNS to the CNS, they first reach the spinal cord where they arrive at a junction.
Normally it will take a lot of input to pass this junction, but when we are injured and acutely sensitised the signal is stronger which scream at the brain to slow us down and heal.
Once we have begun a healing process, inflammation (the bodies information) slows to the PNS, CNS and the brain . The threat to our survival is now going away and as a result our pain will gradually decrease over the next few days to weeks.
Now for persistent pain (last months to years)
If pain lasts beyond the time expected for healing following injury, trauma, surgery or other conditions then it will be considered as chronic or persistent pain.
What’s happening? Why would it still hurt
Acute pain can transition into chronic pain if it is untreated or poorly treated.
If an injury or pain is untreated, poorly treated or mismanaged, then the brain has been inundated with misinformation and signals for a very long time.
“Sometimes the cause of chronic pain is an injury or is hard to identify. This can be frustrating for the person experiencing the pain.”
Persistent or chronic pain is when the body maladapts, learns and develops an unhelpful pain processing cycle.
This results in changes within the nervous system, which make the body more sensitive to pain and can create sensations of pain even without external stimuli (ie no nociception from an injured tissue)
For example, people can feel intense pain from normal touch or ongoing pain in an amputated limb (phantom limb pain)
Here is why and what happens
The central nervous system changes!
For many reasons and factors people experience chronic pain due to changes in the way the nerves, spinal cord and brain talk to each other and work together.
The changes mean that incorrect, heightened or random messages travel from spinal cord to the brain.
As a result, the brain processes the information and reacts with a pain experience and associated emotions, reactions, behaviours and movements as if there is a threat of harm even when there isn’t.
Sounds crazy? Well you’re not, and neither am I!
The CNS, and at times parts of the brain, have re-wired itself, can misinterpret, or now can even produce the same information as the part of the body that was originally injured despite ALL tissue being healed.
When it comes to Chronic Pain; the brain has been inundated with information and signals interpreted as pain for greater than 3 months, even to years and decades.
As a result the CNS and brain continue an unhelpful pain processing cycle long beyond tissue healing.
This results in:
- Fear of further damage, hurt and harm
- Worry it is going to happen again
- Avoidance of anything that may cause you pain
- A lack of confidence in your bodies ability to do what you need or want to do
- Stress of not being able to work, play with kids or enjoy life
- Anxiety on whether it will strike again unknowingly
- A sense of disability
- Depressed mood
All from prolonged pain experiences!! Seams complex.
But there is hope!
You can manage and even beat your pain, reduce your worries and fears of re-injury, and stop avoiding things you love doing. You can ease your stress and anxiety about pain hitting you unexpectedly or when you try to get back to what you want to do.
You just need a plan, a step by step proven framework to get you back on track, functioning again like your old self. One that we can provide you at Fighting Fit.
Like my previous Client, let’s call him “Tom”.
He is a young man, only 31 years of age. Unable to work for 10months, unable to move and enjoy his life.
He was in pain 24 hours a day, 7 days a week when we first saw him in October 2019.
Tom had experienced low back pain since October 2015 recalling in detail how and when his pain stared.
He had many scans, neurosurgical opinions, even tried physio (clearly not with us) and was destined to surgery. But he had to wait another 11 months before they could operate.
Tom found us on Google hoping there was something he could do to ease his pain even just a bit before surgery. He even come in for a chat before he even booked a consult just to ask “is there anything I can do for my back?”
Fast forward to 2020, he is back at work (more than) full time, has little to no pain and loving life again doing what he wants to do, not what his pain or anyone else tells him to do.
He got one of our chronic pain management plans and turned a complex problem into a simple solution.
So if your like Tom, feel free to drop in for a chat so we can help you.
Kyle Wells is a Physiotherapist at Fighting Fit Physio.
He has a special interest in arthritis, neck pain and tendinopathy. Just to name a few.
Kyle loves cross fit and has an exceptional eye for technique and performing exercise correctly.
He use exercise to improve patient results and get them moving better for the long term.