Back pain 1: Introduction to managing back pain
An introduction to managing back pain
Recently a friend emailed me to ask for my assistance. Her lower back was hurting her and she was miserable. I fired off a series of questions to her. What was the pain like? Had she been doing anything unusual, such as moving house, recently? Etc.
Once my interrogation was over, I made my diagnosis. She was afflicted with an ailment that is epidemic in our sedentary culture: Desk Jockey Syndrome. Not to be confused with Disc Jockey Syndrome, which usually involves a predilection for dumb crank calls, playing the same annoying hit three times an hour, and what is generously termed “a face for radio”, Desk Jockey Syndrome (DJS) affects a majority of people in North America at one time or another. It’s characterized by back and neck pain, as well as frequent shoulder pain and repetitive strain injuries. In this section I’m going to address the issue of lower back pain, or LBP to those of us in the know.
Predisposing conditions for DJS include sedentary living and working, excess bodyfat, especially concentrated around the midsection (which exerts a downward and forward pull on the low back), and a lack of regular physical activity. To be candid, a lot of us spend a lot of our jobs wearing an ass groove into a desk chair or car seat. Often, the head is carried forward like E.T., the shoulders are rounded forward and hunched, and the spine is rounded. See the photos at the end of this article for examples. As a result, the neck, upper- and midback are tight, and the shoulders are in excessive internal rotation. The pecs are shortened, and the shoulder blades pulled forwards. If we do lifting as part of our job or daily life, we don’t squat; rather, we round the back, curling forward from the waist.
This creates what is called shearing force across the spine. Think of shearing force like a sideways force applied to a stack of books. If you push the top book sideways, eventually it’ll fall off the stack. Now imagine that you’ve put a rubber band around the book stack, connecting them together. If you push that top book, it won’t move as easily, and the strain will be borne by the band. Eventually if you push the book hard enough, the band will snap.
The spine is rather like that stack of books stuck together with a rubber band. It’s a chain of vertebrae linked by connective tissue and muscles. The deepest layer of musculature supports the spine intersegmentally. In other words, there are little tiny muscles that run along the spine, holding together a few vertebrae at a time (I mean this figuratively; I don’t mean that they actually run along the spine, scrambling madly to grab spine pieces).
There are several layers of torso musculature, and normally they coordinate their jobs nicely to both stabilize and move the spine. When we sit or lift improperly for long periods, and combine this with a lack of overall activity and back strengthening, then we are not providing the conditions for these muscles to do their job. For example, each time we round the back to pick something up, we are silencing most of the supporting spinal musculature. The load is borne entirely by the connective tissues of the spine: the ligaments and tendons that hold everything together. Eventually their union steward is going to file a grievance against you as management, and that means a world of hurtin’ as the muscles set up little picket lines with burning oil drums, and chant “No justice, no peace”.
The spine provides a framework that houses the network of nerves that allow sensation and movement. Nerves branch away from the spinal cord and run to the extremities. This structure means that pain that is felt in one place may actually be originating elsewhere closer to the spine, or in the region of the spine itself. For example, pain felt in the arm or shoulder may actually be originating from the upper or midback. The condition known as “sciatica” is an irritation of the sciatic nerve that runs down through the hip and along the leg. People with this condition may experience tingling and burning all the way down to their foot.
Whenever I see a client with extremity pain, I try to address what may be the root cause or origin of the irritation. This means that I look at the length of the back to see what the client may be doing, how they may be moving habitually, how they may be holding their body (are they standing with one shoulder hunched up? Are they slumping forward? Etc.), and so forth. Then, in my exercise prescription, I don’t just target the immediate area but also any other area that might be related. Sometimes the practice of bodybuilding suggests that the body is a jumble of parts, to be trained individually. Never forget: the body is a system. The foot bone is connected to the ankle bone, and so forth. So think about how all the parts are related.
referred pain sites:
Pain felt in foot, leg, and hip: tends to originate in low back
Pain felt in hand, arm, shoulder: tends to originate in neck, upper and midback
Pain felt in head and neck, esp. at base of skull: tends to originate in neck and upper back
Ok, all that is great, but you’re in pain so you want results now! The best place to start if you experience a first episode of low back pain is with a visit to your doctor. This isn’t to say that they’ll always be helpful. My doctor wrote “myofascial strain” on my diagnosis slip when I arrived with my back injury. Basically that means “unspecific soft tissue injury”. Gee, thanks. But a doctor can ask good questions, and often give you an accurate diagnosis. If they are worried that it’s more than a run of the mill muscular owchie, they may send you for X-Rays and MRI. They might treat you to some tasty painkillers or muscle relaxants, to help you deal with the immediate pain. If in any doubt, see your doctor first! Especially run, don’t walk, to see the doctor if the pain results in any loss of bladder or bowel control (hey, I think unexpectedly peeing your pants is a good reason to see the doc in any case, unless you’re three years old), or is accompanied by other un-back-related symptoms such as fever, nausea/vomiting, etc.
In the rest of this series, I am assuming a few things. I’m assuming that your back pain is a general DJS type of injury, that has not resulted from an acute event such as an accident, and does not involve any damage to or degeneration of the vertebrae itself. The type of everyday back pain I am discussing is usually a result of a muscular spasm and/or inflammation. It can be excruciatingly painful if the inflammation impinges on a nerve. You can be convinced that your spine is trying to tunnel out of your colon using its fingernails to dig a path.
The advice I am going to give can apply to both regular DJS as well as more serious disk herniations, but again, with a disk herniation, be sure to see your doctor first. A disk herniation can range in severity and symptoms. Many people with severe disk herniation can be entirely pain-free, while people with mild herniation can be in agony. It often depends on where the disk has herniated, and if it’s irritating a nerve.
In this type of everyday low back pain (LBP), pain can be felt in a variety of ways and locations. Generally it’s a dull ache without an exact location, but it can often be a sharp, localized pain. Again, if the inflammation and spasm is in a spot near a nerve, it can result in the characteristic tingling and burning sensation of nerve injury. It can be felt in the spot of the injury, or it can be felt elsewhere, perhaps in the hip. It can move from location to location.
Here’s one piece of good news. About 80% of spontaneous LBP incidents resolve themselves. Chances are good that your back pain will get better without any intervention from you. But now the bad news. Once you’ve experienced back pain once, it’s much more likely to recur. I like to think that one is never really cured of LBP, but rather, one learns to manage it and engage in preventive maintenance so that it does not recur.
In Part 2, I’ll give some concrete suggestions about how to deal with LBP. In Part 3, I show some exercises and discuss how to find and maintain neutral spine, an important part of good movement technique.