Back pain has many variables and returning to health can be complicated but it is not impossible.
This article is written for people with conditions of the spine who want relief. If you are looking for a quick fix for symptoms without addressing the cause, this guide is not for you! By addressing the cause(s) of back pain, engaging in active participation and connecting with your overall health you will dramatically improve your chances of long term recovery.
A new client in her thirties once told me she suffered with back and sciatic leg pain for eight years. The Advil she was taking daily wasn’t working anymore and NOW she was starting to get worried. EIGHT YEARS!
Answer these two questions.
1. How long have you had this problem?
2. Why are you seeking care now?
A wealth of information is held in the answer to these two questions. As a physician, the answers reveal the nature of a problem and the mindset of the person seeking help. Recovery comes from identifying and treating all aspects of a condition, as well as, addressing the person and their expectations.
Additionally, these two questions about back pain, neck pain or any other bothersome or concerning pain provide imperative information about the condition, and the persons relationship with their body. They reveal whether someone respects, trusts, and listens to their body and its signals. The answers to these questions also reveal insights into someones willingness to put up with (or not) things that are good or bad for them.
Noticing and responding to your body improves the odds for recovery. There is much more to treating back pain than making the symptoms go away.
There is care of the problem and there is also care for the person.
Some back pain is easier to resolve. People bend and hurt their back, they come in, treatment is rendered, advice is given and within a few days or weeks things are back to normal. However, many cases are not straightforward and getting people better takes more treatment time and more active participation by the patient in order to make back pain go away and stay away.
The best thing you can do with pain is handle it sooner than later. If it’s not improving after a few days seek help. Waiting for pain to go away is like living with the fire alarm going off in your house all day, every day. Pain means something and responding to it sooner than later improves your chances of having a complete, instead of a partial recovery. If you let the house burn half way down while you have been ignoring the alarm and the fire, well, maybe things won’t quite ever be the same.
Listening to and responding to your body and pain in a timely manner is one of the best things you can do for your health. Unfortunately, in our culture many people are taught to ignore pain or live with it instead of respond to it respectfully. The best solution is to shut off the fire alarm and put the fire out.
5 Basic Categories of Back Pain
Back pain may be mild or severe. It can range from muscle tension to severe pain as with an acute fracture or herniated disc. Proper diagnosis is important prior to any treatment or home care.
Acute: A traumatic new incident such as bending or lifting or an accident like a fall or blow.
Chronic: A back problem that has lasted three months or longer and may come and go and last for different lengths of time with each episode.
Repetitive Overuse: Pain from repetitive motions; prolonged sitting, poor posture, or motions you do over and over again like bending over to stack wood or looking up to paint a ceiling.
Pathology: A condition of the spine related to diseases like tumors, osteoporosis or other systemic diseases including auto-immune conditions.
Cause or Symptoms?
With back pain it is important to understand the cause of the problem and the contributing factors. There are some treatments and remedies that can be applied for immediate pain relief but most of those do not necessarily address the real causes of the pain. Commonly, once someone has experienced back or neck pain they will have another episode in the future. There may be no acute symptoms but over time more subtle symptoms like stiffness or slight loss of motion occur. Because the tissues were injured and potentially not completely rehabilitated they have been affected and a process of underlying degeneration is taking place. A slow wear and tear or creep is happening.
For years the body may not exhibit signs of pain and yet the injured area becomes less mobile, posture changes occur, adaptation happens and then 5, 10, 20 or even 30 years later you see the effects of old injuries on muscles, bones, nerves and the organs that those tissues are affiliated with.
This is why active prevention is the best course of treatment.
By keeping the spine supple, flexible and strong, the tissues will absorb forces better, and have less wear and tear. Not all spinal problems start with immediate or severe pain. It is not uncommon to see x-rays of a spine that has multiple areas of degenerative arthritis and absolutely no pain. Usually, there is stiffness and loss of motion until the area can’t adapt any further and then pain begins. This type of problem is unlikely to reverse.
Lack of pain does not mean well-functioning tissues, muscles or nerves. At some point symptoms will result from these old injuries. Therefore, improving as many contributing factors as possible reduces the chances of a flare up later and prevents premature degeneration.
Major Contributing Factors
These factors have a more permanent nature. They can certainly be treated and influenced with care but to a lesser degree than complicating features.
Structural or anatomical variations. Structure effects function. Any variation in normal anatomy can contribute to back pain.
- fused vertebra
- variations in bone shape or size
- muscles that are absent
- limbs missing or amputated
- changes due to fractures or surgeries
- scoliosis or curvature of the spine
- stenosis or narrowing around the spinal cord or nerves
Degenerative arthritis (wear and tear or aging of the vertebra or other joint surfaces)
Inflammatory arthritis (auto-immune conditions affecting the vertebra, gout or other joints conditions related to a systemic inflammatory response)
Bulging or herniated discs (internal disc derangement with or without spinal cord or nerve root impingement)
Neurological disorders (nerve conditions that change muscle tone or function, causing muscles to become too contracted or flaccid resulting in altered mechanics such as multiple sclerosis, post stroke syndrome, etc.)
Patients ask, “Why do I have this?”
More often than not, a combination of things cause pain to begin, cause flare ups and keep pain from going away. Therefore, treatment includes addressing a primary problem or diagnosis, (what you have) and the secondary diagnoses. Treatment must also include the things that contribute to the problem(s) that can be addressed to improve the diagnoses and provide relief (treatment options).Treatment must be inclusive of the whole body, person and lifestyle.
Things that make a primary problem worse and can often be improved with efforts by the patient or treatment with a specialist.
Poor Posture: Good posture distributes the weight of the body and gravity with minimal strain on joints. The muscles balance strength and flexibility and allow full range of motion in the spine and extremities. Poor posture strains muscles and joints and contributes to motion patterns that lead to the breakdown of tissues. Eventually, that leads to other conditions like arthritis, strains, bursitis, tendonitis, tension headaches and other repetitive overuse syndromes.
Deconditioning: Generalized poor muscle tone from lack of exercise and conditioning. Strong muscles and adequate flexibility stabilize and protect joints from imbalanced wear and tear. Weak muscles and inflexibility leads to poor posture and related conditions.
Balance: Poor balance contributes to an altered gait or stance. Steps become small or wide which puts joints in unnatural positions or a reduced range of motion which effects overall mobility.
Muscle imbalances: When the muscles that move joints are not in appropriate strength balance ratio they can effect mobility and function of a joint. An example; a person with tight pectoral muscles and rounded shoulders will likely have weak back muscles. Therefore, the shoulder joint, rotator cuff muscles and neck are at risk. Muscle imbalances are found throughout the body and there are many reasons why they exist.
Disuse: Any period of disuse may result in atrophy of surrounding tissues and contribute to muscle imbalances or strain.
Crutches, Casts, Walking Boots, Canes: All alter motion patterns or gait cycles creating unequal motion patterns for the body which alter its normal motion and function. These can be the source of new repetitive overuse conditions or loss of motion in joints as compensation occurs.
Surgery: Some surgeries cause patients to be in abnormal or sustained positions for many hours under anesthesia. The body’s normal ability to move and correct from strained positions is altered by anesthesia and therefore, on occasion, results in sprains or strains. Surgery may also change normal mobility resulting in otherwise abnormal sitting, lying, sleeping or moving positions.
Pregnancy: A change in posture and changes in ligament laxity both effect spinal joints and pelvic positioning. Pregnancy may increase strain on the lower back muscles or effect muscles and tissues in the pelvis that create pain.
Arthritis: There are two forms of arthritis, one is degenerative, and the other is inflammatory. Both leave joints with reduced joint space and changes on the boney surfaces that can prevent normal motion and cause inflammation and stiffness. Arthritis can be managed in many ways and it is best to consult with a physician to reduce inflammation and pain. There are many natural remedies, as well as, chiropractic care, and exercises and stretches that can improve the symptoms of arthritis.
Unequal leg lengths: Imbalances in the chain of motion from the foot to the skull may result in pain. Often compensation will occur in the pelvis and create lumbar and pelvic joint dysfunction. Correction with orthotics and spinal alignment may correct this. For more than 10 millimeter differences in leg lengths corrective shoes are often a solution.
Prosthetics: The use of prosthesis can cause unequal movement patterns and therefore imbalanced musculature in the upper or lower body. There may also be changes in gait that affect the lower extremity, pelvis, shoulders and even cervical spine.
Dental issues: Braces, night splints, long dental procedures, dental surgery, injury to the jaw, and dentures are all things that may affect the temporal mandibular joint (TMJ). Pain in the muscles or TMJ may also affect the muscles and joints of the neck (cervical spine).
Reading Glasses & Bifocals: If is not uncommon for people with corrective eyewear to alter their head position while working on a computer or projects. These positions of neck strain may result in pain.
Auto Immune Conditions: Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, celiac disease and other autoimmune conditions often affect joint health and cause joint pain. Auto immune conditions may be the cause of back pain and they also complicate improvement of back pain.
Organ function or distress: Organs, tissues and bones can refer to the spine and mimic back pain. It is not uncommon for the gallbladder, kidneys, ovaries, stomach, heart and other organs to refer pain to the back.
Prescription Medications: Some medications may directly affect back pain while others may minimize treatment effectiveness. Muscle relaxers, for example, will change the tone of muscles and may worsen conditions that need supportive increased tone. Statins are known to cause muscle pain as a side effect. Many medications affect digestion and those symptoms may also refer to the back. Side effects may be a contributing factor in diagnosis or recovery.
Cigarette Smoking and Tobacco Usage: Significantly alter circulation and impair healing, especially in connective tissues, including spinal discs.
Past Injuries: History of trauma, whiplash, fractures, repetitive strains, and surgeries may all be limiting factors in recovery and healing.
Foot Design: A foot that collapses at the arch, an arch that is excessively high or a history of sprained ankles may lead to altered mechanics of the foot and therefore contribute to lower back pain.
Shoe Fit: Ill-fitting shoes may cause changes in the foot or gait that alter mechanics leading to back pain.
Immediate Pain Relief
Ice or cryotherapy: Most often used for new or acute injuries. Cold is recommended for 20 minutes. Use an ice pack. Do not apply directly to the skin. Instead, put a thin layer of fabric or a towel between the ice and injured area. In order, you will experience the sensations of cold, burning, aching, numb.
Heat Therapy: Most often used for chronic joint pain to increase circulation. Heat will relax sore muscles which may make a chronically stiff joint more mobile.
Stretching: Stretching is not good for all conditions. Stretching is best utilized with a known diagnosis. In some new conditions, people may feel the urge to stretch when tissues are swollen and stretching will further aggravates injured tissues. Think of putting stretch or pull on a newly ripped tear in a piece of fabric. It would only further tear the tissues. Stay away from stretching new injuries and ask a professional for advice on rehabilitation that is condition specific.
Pain relief creams: There are many topical creams used for pain relief. They are analgesic in nature and may provide temporary relief. They increase circulation or numb an area for a period of time. Some distribute pain relief to tissues below the skin. Best used for muscle aches. There are more effective means of pain relief, depending on the cause of the problem, especially if it is related to the joint or disc.
Castor oil packs: Long used for pain relief and inflammation. Castor oil has many healing properties.
Ergonomics: How we sit and stand while working will either support good posture mechanics or strain them. Set up sitting desk work stations with forearms and thighs at 90 degrees to the floor and sit up on the sitting bones (ischial tuberosities). If you are standing it is best to not lean forward at the waist. Potentially shift your weight from foot to foot for equal amounts of time and if possible put one foot up on a stool to keep the lumbar spine in a neutral position. There are many supportive cushions that can also assist you with finding the best position for your body.
Sleep: Adequate rest promotes tissue repair. Not only do you need enough hours of sleep, you need good quality sleep. If you have poor sleeping patterns do what you can to resolve them. That may mean a sleep study, weight loss, decreasing food or alcohol prior to bedtime, adjusting lights or noise in your room or other factors that affect quality of sleep.
Sleeping positions: If you are healing an injury you may need extra support while you sleep. Your head should remain in neutral, support your natural cervical curve when lying on your back or your side. You may also need a pillow between your knees if you are sleeping on your side or under your knees if sleeping on your back. Additionally a mattress that sags or is too stiff will put undue strain on the spine.
Shoes: Shoes can cause many problems. Some bend too much, some too little and some squeeze too tight. Improper arch support can change your gait. Custom orthotics, exercise, stretches, chiropractic adjustments and mobilization may improve foot mobility and gait. A shoe should bend just behind the big toe and allow you to propel forward. Small toe boxes may alter the direction of the toes over time and deform and change proper joint mechanics. If you suspect shoe fit is contributing to your pain discuss this with your doctor or a professional.
Lifting & Bending: Proper lifting and bending can make a back condition better. Adding load with poor lifting technique strains and injures tissues. Apply proper techniques to improve back pain and prevent injuries. Bending forward and twisting is never a good idea, especially with a heavy load. It is best to bend your knees and keep your lower back in neutral or in slight extension rather than flexed. Keep loads a manageable weight and lift with your legs not your back.
Gut health: The gastrointestinal system has the power to heal or inhibit your recovery. The GI system requires a balance of good bacteria and intestinal wall integrity. Food allergies, yeast, celiac disease, medication usage, food borne illnesses all affect the GI tract. Improved GI function can be the difference between pain and recovery.
Diet: The food you eat determines the quality of your tissues. Nutrients support all of our metabolic processes, including healing. Foods that are inflammatory like red meat, dairy, alcohol, sugar and trans-fats can all aggravate pain conditions. Food sensitivities and allergies further complicate digestive health. Consult an expert on diet advise.
Supplementation: Nutrients are diminished in our food supply and you may be lacking essential nutrients and could benefit from supplementation. There are many good reasons to take good quality supplements to improve healing. It is common for people to be low in vitamin D which is involved in over 10,000 functions in the body, including healing. The test is inexpensive and improving your vitamin D levels may drastically improve your health.
Some people have poor digestive capability and therefore even the good foods they eat don’t get utilized effectively. Supplements can be helpful in maintaining adequate levels of nutrition until healing is achieved. Consult with a physician before using supplements as some interfere with medications and other health conditions. Also, use a brand that is high quality. Many over the counter supplements are not bioavailable or well absorbed or utilized.
Weight: Even ten pounds of extra weight is taxing on the back and joints of the body. Get your weight within five pounds of your ideal body weight. Diet and exercise recommendations may need to be tailored by a professional if you have movement limitations.
Stress: Conditions that move the body from parasympathetic (rest & digest) into sympathetic function (fright & flight) can slow healing. Under stressful conditions the body does not have the proper resources and chemistry to heal. Stress can be emotional, physical, and chemical. It may also be caused by food sensitivities or allergies, trauma, food poisoning, not enough rest, too much sugar, chemical addictions, or a combination of many etiologies. For best results see a professional and adopt a lifestyle of wellness practices.
Meditation: Clearing the mind of thought, slowing the breathing and reducing stress are all beneficial for the healing process. There are many types of meditation. Find one that feels right to you.
Deep Breathing: Not only is it good for stress relief, it exercises the muscles of respiration. These muscles get short with poor posture and shallow breathing. Deep breathing tones the diaphragm, gets more oxygen into the body for healthy profusion and exercises the rib cage. Deep breathing is especially important for those with asthma, COPD or other respiratory illnesses.
Exercise: Like stretching, exercising while injured may or may not be a good choice. Some things like walking may increase circulation and improve overall biochemistry for healing but an injured back may need rest. Defer to your health professional for the best timing of exercise and which specific exercises are best suited for your condition. Many studies are showing the benefits of movement in the early stages of healing. Since most back pain has an element of muscular involvement exercise is almost always a good idea for improving the overall strength and function of a joint. Therefore, if you are not doing any exercises ask an expert for guidance and if you are doing exercise and still having trouble, you may need an updated evaluation and recommendation.
Core Strengthening: As specific exercise has targeted benefits, it’s worth mentioning core strength. The core muscles support the spine more intimately. These are often the smaller forgotten muscles that need exercise as much as the larger muscles. Consider specific spinal exercises for the multifidus muscles, the pelvic floor muscles, the diaphragm and the muscles of the abdomen. These muscles ensure protection of the spine and discs as well as stabilize the body as the appendages move about.
Hamstring flexibility: One of the main contributors to lumbar strain is inflexible hamstrings. During the bending phase if the hamstrings don’t stretch the load is transferred to the muscles, ligaments and discs in the lumbar spine. Improving hamstring flexibility combined with proper lifting and bending techniques could be the difference between back pain, and a disc herniation or not.
Yoga: The general principals of yoga are strength, flexibility and balance. Yoga can be done at the level of the participant. Practicing in a way that demands poses you aren’t ready for could do harm, as with all exercises. Those that are hypermobile may need to practice for the strength benefit of yoga, not flexibility. Not all poses are for all people. Use personal comfort as your guide and seek a trained yoga teacher for instruction. Furthermore, yoga offers the benefits of meditation and principals of healthy body relationships and self-care that are supportive of a healthy back.
Pilates: The principals of pilates are concentration, control, centering, breathing, flow and precision. Core strength and flexibility improve mobility and stability of the spine. Practice with in your own limits with a trained instructor.
Endorphins: Natural pain killers are made in the brain with exercise and pleasure. Much research has confirmed that daily exercise can change brain chemistry enough to eliminate the need for narcotic pain medication. Additionally, human connection stimulates natural hormones that reduce pain.
Chiropractic Care: Treatment with a specific, controlled force applied to a joint to restore proper function and mobility that affects the nervous system and its connection to other tissues and organs. Chiropractic physicians focus on the diagnosis, prevention, and care of spine-related disorders and other joint issues. Many chiropractors also provide soft-tissue treatment, exercise, nutrition and lifestyle recommendations. Chiropractic adjustments effectively reduce pain, increase movement and improve the speed of healing of some conditions. Chiropractors do not prescribe medication. Many have advanced training in nutrition and functional medicine.
Chiropractic treatment is safe and effective for all ages, including newborns and the elderly.
Massage: Is helpful to relax, reduce stress, increase circulation and ease muscle tension. Like all physical medicine, it does have limiting factors. Massage may not be the best treatment early on in an injury or in a condition that has not been completely diagnosed. If the goal is pain reduction, be sure that massage is being targeted to a muscle problem. Otherwise, you may be treating the symptom and not the cause. Massage is often a beneficial modality when applied to address specific conditions, especially in the remodeling stages of strain/strains, whiplash, fascial disorders and postural syndromes. For injury care work with both a physician and licensed massage therapist for best results.
Acupuncture: Like any of the treatment options, treating the cause of the problems is key. Acupuncture has been used effectively for pain related conditions. Acupuncture is directed at needling the Chinese meridians and directing Qi (energy flow), sometimes utilized with massage, cupping, and other supportive therapies.
Dry needling: Similar to acupuncture but different in that dry needling is directed specifically at trigger points to reduce spasm and pain.
Physical Therapy: A well-known medical treatment for mechanical pain syndromes. There are many approaches and different types of therapists. Some are more hands on, some are more exercise oriented, some are condition specific. Find a therapist that best suits your condition for best results.
Behavior therapy: There are many forms of behavioral therapy that can affect the cause of pain syndromes. If pain is relate to physical or emotional trauma a behavior therapist may affect pain through improving esteem, posture, muscles tone and personal habits, beliefs or behaviors that are physically counter or destructive.
3 GREAT YOGA TIPS
Strength: Practice sitting in an easy seat, Sukhasana. Sit with your legs crossed and your pelvis elevated and supported with a blanket or block. Stay in this position for 5-10 minutes each day. If your hips are tight, you can move your feet forward, they do not need to be crossed tightly. As you sit, energetically lengthen your spine as you reach the crown of your head upward, pull your shoulders back and slightly elevate your sternum. Keep a natural curve in your lower back (not hyperextending and not slumping).
This is the traditional position of meditiation. This position is excellent for building spinal muscles from the lower back to the neck. It is also good practice in awareness of spinal alignment in a sitting posture.
Flexibility: Because most people sit in a slouched position with their head forward and their lower back arched, the back body is overstretched. Focus flexibility on the front body. To improve flexibility of the shoulders, midback and hips a nice position is to lie flat on your back with the arms overhead with elbows positioned at 90 degrees (goal post position) and the soles of the feet together. If the backs of the hands do not touch the floor, keep opening them out to the sides until they touch. This will stretch the pectoral muscles, bicep and front of the shoulders. If the hips are tight and uncomfortable put a pillow or block under the knees or back of the hips for support. If the midback is lifting off of the ground and placing an arch in the lower back, open the arms out to the sides until the midback can rest in a less severe stretched position. Hold this posture from 3-10 minutes. Be mindful that when you come out of this position to slowly move the arms and hips and rest in a neutral position for at least 30 seconds before moving to another position.
Balance: Practice standing on one leg at a time each day for up to one minute, 1-3 times. Start slowly and progress until the knee comes to 90 degrees and the sole of the foot is parallel to the floor. Pull in the opposite hip of the standing leg. For variation challenges move your arms to the sides or overhead, bend your standing knee or close your eyes.
Absolutely Urgent, Call a Doctor When…
- Your back pain is severe and relentless. If it does not go away after a few days, or when resting or lying down, it’s time to seek a professional.
- If you have numbness, tingling, weakness or lose control in the arms or legs seek care.
- If you lose control of your bowels or bladder seek immediate help.
These are all signs that you have a serious nerve problem or other underlying medical condition that requires immediate medical attention.
If back pain persists, seek a practitioner to help. Just as people have a dentist to manage their teeth throughout their life many people have professionals that guide them and treat them for not only acute and chronic back pain but for prevention. The nature of the spine, similar to teeth, is subject to the wear and tear of use and aging. A clear diagnosis and treatment plan for a current condition and long term management are critical. Not only to relieve back pain but to improve your mobility and function in the long term.
Whatever you do…don’t wait 8 years to seek help! Consider your life with relief. The sooner you advocate for your wellbeing the sooner you can be enjoying your body, your life and the people and things that matter most to you. It may be complicated but relief is possible.
For a complimentary chiropractic consultation or comprehensive spinal examination call 406.888.6044 or email firstname.lastname@example.org
Dr. Erika Putnam, chiropractic physician, is the owner of The Bend in Whitefish, Montana. She uses a broad and holistic approach to treat spinal and extremity conditions and other health problems with a variety of chiropractic techniques, rehabilitation, nutrition, lifestyle and functional medicine. She has over 20 years of experience in the chiropractic field and holds a 500 hour yoga instructor certification. The Bend has a private yoga studio where Dr. Putnam helps chiropractic patients recover by engaging them in yoga or exercise instruction to prevent injuries from reoccurring and to improve overall strength and flexibility. She advocates for healing in a pro-active environment that includes physical, emotional and energetic wellbeing. She teaches yoga anatomy for teacher trainings as well writes on topics of yoga, health and Montana adventures on her blog Bones & Breath. You can find her at www.thebendatwhitefish.com
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