Does this story sound like you?
‘Eight years ago I had a lifting injury at work. It was terrible pain, I was worried so I went to the
doctor who ordered a scan. The doctor said I had a back of a 70 year old. He said I couldn’t surf again and or do manual work. I was devastated.
I underwent lots of treatments to stabilise my spine with exercises, spine injections and medication. Over this time the pain just got worse. I stopped work, I was spending 6 hours a day lying down and had stopped socialising. My back pain had consumed my life, I felt desperate and had nearly lost hope.’
You must not allow yourselves to think your back pain is a bigger problem than it is. You need to understand that your back isn’t damaged – you can be taught how it is that your whole nervous system can be ‘wound up’ due to fear which gives rise to more pain!
If you can learn how to relax and move normally again, you won’t fear movement – you CAN change your mindset. You can go back to exercising and you can return to work. It doesn’t mean that pain may start when you are stressed but you can be taught not to worry about it so much – the pain won’t limit your life like it did.
The person’s story above illustrates what happens when you live with fear, you lose confidence in your body and you continually protecting your back by tensing it because you believe it was damaged. You avoided things that hurt, and often just can’t relax – and you remain stressed.
What does your brain say when it sees a disc that’s slipped so far out it’s sitting on it’s own? If you’ve ever seen a disc in a cadaver, you can’t slip a disc — they’re immobile — but that’s our language, and it messes with your brain.
The good news is that disabling back pain can change for the better with proper advice and coping strategies.
A randomized Controlled Trial – a collaboration between Bergen University, Norway and Curtin University, WA, Australia was conducted by Dr Kjartan Vibe Fersum. It tested an approach to managing mechanical, persistent low back pain using a patient centred, body/mind approach to understanding and managing low back pain that has got ‘out of hand’, i.e. the person starts to ‘catastrophise’ about their pain as demonstrated in the diagram below.
As well as considering the anatomy of the problem, the research considered how the patients’ nervous systems were reacting to the pain, how lifestyle and physical factors, such as avoiding playing sport, working, even bending and twisting were affected and how muscles had often become over tight due to the fear of re-injury in an attempt to protect the spine against more damage. It acknowledged that for each individual there is a unique contribution of factors across these different domains that act to maintain a vicious cycle of pain and disability that we see above.
The study focused on the beliefs, fears and associated behaviours (both movement and lifestyle) of each person with back pain.
It studied what happened when the patients were encouraged to be mindful that pain is not a reflection of damage – but rather a process where the person is trapped in a vicious cycle of pain and disability. This is fuelled by a nervous system that is stressed and sensitized due to negative beliefs, fear, lost hope, anxiety and avoidance, linked to mal-adaptive (provocative) movement and lifestyle behaviours.
It showed how when a patient is empowered to do the very things they feared and / or avoided, but in a graduated relaxed and normal manner, they had reduced pain. It showed how they could become reconditioned if they were weak. It motivated them to engage with exercise and active living based on their preferences and goals.
This approach was shown to build self-efficacy, confidence, adaptability and provided hope and opportunity for change for the person with pain in a person centred manner.
Using this positive approach, there were greater reductions in pain, disability, fear of movement and work, improved mood, less need for ongoing treatment and less time off work. The patient satisfaction levels at 12 months were remarkably high (96%).
This approach requires a different perspective on back pain on the part of the chiropractor. It encourages the view that pain is to be respected but not feared.
It is the approach you will encounter when you visit us at the Avenue Clinic.
Many people with back pain are essentially living in an over-reactive, seized-up state — their back reacts to just about everything like that. We can train you to see that you can have a temporary setback and it does not mean that you will have pain for weeks.
Too many people with chronic back pain are essentially living in that over-reactive, seized-up state. We aim to make sure that you don’t.
There are two key differences between someone whose back reacts to everything like this, and someone who only reacts to more serious stresses and also recovers more quickly:
- The number and severity of muscular trigger points in the region.
- The confidence of the victim that they are not really fragile.
Time and time again, it is the people who buy into the idea that their back is structurally unsound who react to every challenging stimulus as though it were the end of the world — they fear and loathe their own backs.
It is those who have some confidence that their spine is basically a sturdy structure who are relatively immune to stressful incidents.
There is a “mind game” in low back pain treatment. It’s not that back pain is “all in your head” — it’s not; there absolutely is pain in your back — but it is very much affected by what’s in your head.
Pain is always worsened when you believe that there is danger … and models of slipped discs like the one below are much too persuasive. Don’t be worried and fearful if you have been told that you have a disc that is bulging, prolapsed, herniated or that you have degeneration or stenosis – these things are very common and they do not mean that you will have a lifetime of persistent back pain as a result.