Got a bad back?
You are not alone.
What is Chronic Back Pain?
If you have it, you know darn well what it is.
Not being able to reach down and tie your shoes
Taking about 10 minutes to get your pants on.
Lowering yourself slowly into the driver’s seat.
Fear of rolling over in bed once your shoulder has fallen asleep.
Moving slowly and deliberately from one support post to the next.
Being pissed about your loss of mobility and freedom.
Hoping the kids don’t sneak up on you and jump on your back.
Muscle relaxers and pain pills that only provide temporary relief.
Another crappy day in your miserable life.?
Back problems, back pain and getting old
Back problems (and specifically back pain) are one of the the most common ailments of the aging.?
That’s you and me. You are either aging or dead.?
So ?it?s better to be aging even though there are some complications to deal with.?
A bad back can make your simple tasks seem impossible. And working on getting fit is simply out of the question.
Is there anything you can do about persistent back pain?
Yes there is. But first you should gather some facts.?
Know what you are really up against.
There is some potentially bad stuff you probably have not heard about. And there are some things you think you know, that sounds pretty bad, that really are not true.?
Let?s separate fact from fiction. First the bad.?
A study in Sweden showed that chronic back pain not only ruins your life every day you have it, it actually can shorten your life expectancy as well. This was a large study of 4.7 million people and looked at those who missed work due to musculoskeletal pain (back pain being a subcategory) and showed nearly a 1.5 times risk of premature death over those without muscle pain induced work absence (meaning the pain was bad enough to be the primary cause for their loss time at work).?
Low back pain can drive you crazy
In addition, increased mortality risks were seen for tumors, cardiovascular disease, suicide and mental disorders for those suffering with chronic pain.?
I felt myself going crazy at times when I struggled through a severe bout of lower back pain but now a clinically significant finding in a trial proves it happens to others as well.
Always good to know you are not in it alone.?
But all joking aside, this is serious stuff. If you do not solve your chronic back pain (or any chronic pain you suffer from) you may incur consequences far beyond those being inflicted in your low back.?
Your lifespan can be shortened by chronic pain.
This is something I never even considered through all my years of intermittent lower back pain.?
What about chronic back pain can be?considered?good news??
The good stuff is that what you have likely heard about the cause of your lower back pain is probably not true.?
The mechanical symmetry and anatomical?perfection?myth
All the mechanical problems of spinal misalignment and crookedness or your legs being different lengths or your discs being herniated are very likely just illusions of the experts who are specifically trained to imagine these problems.?
What is chronic back pain conventional wisdom?
What are some of the theories we always hear about that are causing our bouts of severe lower back pain??
One of the biggest misconceptions out there is the idea that your spine is a fragile structure and you are just overdoing it.?
If you believe in evolution, this just?doesn’t?pass the smell test. How could 2.5 million years of evolution, a process that continually improves the host to ensure that continuation of the species is guaranteed, produce a naturally weak spine??
The very structure that protects the nerves carrying vital signals to and from your brain for all body and life functions is inherently weak??I don’t think so.
You have to be careful bending over because the primary mechanical element of your body is easy to damage??I am not buying it.
In fact, this is crap. It makes no sense at all.?
Intelligent design. Whomever designed the human body, knew what they were doing
The spine and entire skeletal system is a marvelous design of built in strength with added mobility through a full range of bending, twisting, flexing and rotational movement.?
You don?t have a bad back because mother nature screwed up the design process.?
You have more than likely self inflicted your chronic lower back pain with poor lifestyle choices. Did you know that increased stress levels and chronic lower back pain are highly correlated? This means that stress is almost certainly a contributing factor to your back pain.
Do you realize that muscle pain or knots in your muscles is more than likely the?cause?of your debilitating condition? Yes trigger points or just nasty muscle knots have brought you to your knees.
OK so what do you do about it??
You should follow two parallel courses of action.
Any good problem solver will tell you:
Stop the bleeding first (this is acute back pain corrective action) and
Implement true preventive action. This is what prevents recurrence of the problem.?
How to stop the bleeding? What can you do right now to alleviate the symptoms of your bad back??
Stop being a Bad Back?Believer
Get over your belief that there is something terribly wrong with your lower back. Belief is a powerful thing. Believing you feel like crap and are damaged for life actually intensifies the pain.?
I know you think you have a “Bad Back.” I thought this way for years myself.?Read about my 35 years as a guy with chronic lower back pain.
I injured my back when I was 19 and had periodic recurring incidents throughout my life where I “threw out” my back.? Or so I thought.
And I also thought I’d always have a bad back.?
Until I discovered that this was all BS. This was merely a story I told myself to justify my whining when my lower back pain returned.?
Stop whining and find out the truth about your back. You may be pleasantly surprised to discover your bad back can be fixed.?
Sure it is possible you really do have a serious problem requiring professional diagnosis and intervention.?Read this post about how to remedy lower back pain once and for all. It provides step by step instructions for assessing the root cause of your lower back pain.?
OK so back to the corrective action for your acute low back pain?
And effective corrective action for back pain (or any pain for that matter) is:?
Mitigate the pain
Loosen the spasm or knot in your muscle to help improve mobility
Allow your spine to realign itself and restore normal posture and function
So how do you do it?
Pain relief options are:?
Ice and/or heat
Massage and perhaps other manipulation therapies like acupuncture or chiropractic
Ultrasound or Nerve Stimulation?
Drugs are up to you
From simple aspirin and Tylenol to prescription painkillers, anti-inflammatories and muscle relaxers, drugs do work for temporary relief and may be needed just to get some sleep in your first days of injury. Anti-inflammatory drugs are not very effective for low back pain because there typically is little inflammation associated with low back pain. The low back does not swell up like a sprained ankle, for example.?
Hot or Cold therapy?
The conventional wisdom (CW) on how and when to ice or heat has been a moving target over the years. It used to be ice for the first 48 hours to limit swelling and inflammation. Then heat to promote blood flow to the area and speed healing.?
I think you have heard me talk about CW before. Conventional Wisdom is often wrong.?
Now there are mixed reviews on this hot and cold protocol.?Some say keep icing to limit inflammation. Makes sense. Except the low back, as stated earlier, really?doesn’t?swell up very much from injury.
Others advocate ice for the initial period (24 to 48 hours) and then use both ice and heat to create a flushing effect. Warmth increases blood flow which flushes toxins and cold keeps the inflammation in check.?This kinda makes sense as well. And it is what I normally do for all injuries except the lower back.?
There is a belief by some ?that low back injuries can be exacerbated with additional movement and stress so icing is a bad idea because it may mask your perception of pain.?Sounds possible. But this would only be true if indeed there was a true mechanical injury.?
Since it is far more likely your back pain is caused by muscle pain (yes just knots in your back), you probably don?t have to worry about exacerbating your injury from excessive movement.?
Icing is actually hard to do. It hurts to keep cold packs in contact with the skin for long periods.?But it does work on inflammation.?And you will notice that it is standard practice for elite athletes to immerse themselves in full ice baths after performing to limit swelling and speed their recovery. But again, the low back may be a bit different.
I prefer the heating sessions to icing. Heat feels good and definitely promotes loosening of the muscles for me.
Just tell me what to do
So the bottom line after all this back and forth. Heat is your best bet for lower?back pain. It both feels good and promotes loosening of the muscle spasm.
What about Hands on Therapies?
Live and learn. I have come full?circle?over the years with what I believe?to be effective therapies for chronic lower back pain.
Massage?definitely?works however sometimes it is too painful to even get onto the massage table when you are really in acute pain. But massage is hands down (a pun?) the most effective therapy for releasing trigger points and knots in your low back.
A chiropractic session is also very difficult to do when in acute pain. Some people swear by their?chiropractor’s skill and ability to relieve pain.?Personally?I never liked the idea of forcing my spine back into alignment when I was knotted up and painful to the touch. But I did use it many times over the years of my recurring low back episodes.
When you are in excruciating pain, you will try almost anything. But now I don’t even believe the?whole?theory about spinal mis-alignment being the source of the problem in the first place.
So I am a thumbs down on?chiropractic?adjustment even though a very good friend of mine is a successful practitioner of chiropractic and serves a large audience of clients?regularly? Some folks like it and swear by it. I simply do not buy the spinal subluxation theory which not only points to mechanical alignment issues as the root cause but also purports to being able to correct these imbalances with fairly rough and crude body adjustments.
Acupuncture is another area I have changed my opinion.
I first went to a Korean acupuncturist in my early twenties and was?absolutely?convinced he made me feel better. I used other acupuncturists over the ensuing years as I moved?around?and some were?clearly?better than others. This is likely to be the case?for?any?manual?treatment. They are businesses based on personal skill after all.
But I can clearly remember?believing?that acupuncture was the best treatment I had found for the acute phase of lower back pain and recommended it to others routinely.
I changed my mind primarily because I have read clinical studies that seem to?prove?otherwise. I talked about it in this post about treatment for chronic back pain. One study in particular?showed?that there is no difference between acupuncture and sham acupuncture for treating lower back pain. Sham acupuncture is pretending to stick needles into your back. And a clinical trial concludes there is no difference in the outcome whether you use the needles or not?
Not exactly a huge endorsement for acupuncture.
How can this be you may ask? Well pain, after all, is created by the brain. It is?simply?a way for the brain to get a desired response from you after evaluating all the incoming signals it is getting.
For example, you pull your hand away from a flame because your brain tells you it hurts to leave it in the flame. The intended result of this action is to save you from really getting hurt by?burning because your brain knows fire will burn your skin.
Similarly, pain in the lower back is your brain signaling?you?to stop doing something to prevent or limit real damage to your back. Maybe you are trying to lift something too heavy or are?just?sitting in an awkward position for too long.
The thing to?remember?is that pain isn’t a physical thing like blood from a cut. It is a manufactured signal from the brain created to get a certain response from you.?Your brain is talking to you; stop doing that or do it a little differently or if you don’t modify your behavior, something bad may happen.
So you can see how pain can be perceived differently from person to person. This is?why?it is often said that someone has a high or low threshold for pain.
And?this?also may give us insight into how placebo works. If you?believe?something will work like chiropractic or acupuncture for example, you probably feel better afterwards.
Both pain and placebo are fascinating?subjects.
What about electronic?devices?
The two most common stimulating devices used for muscle pain are ultrasound and nerve stimulation machines. You may encounter these?devices?while in physical?therapy?(PT) or in the chiropractors office. They are?typically?used as a “loosening up” session prior to the main event.
- Ultrasound?devices?pass ultrasonic energy or sound waves into the?tissue?through a hand-held?transducer. Heat is generated by the vibration created in the tissue as the sound waves pass through.
- Nerve stimulation or TENS devices (trans-cutaneous?electrical nerve stimulation) send electrical?impulses?into the tissue though?electrode?pads attached to the skin. Pain is thought to alleviated by two methods.
- The electrical pulses cause the tissue to twitch and jump around inducing minor mechanical stimulation. It is like a mini massage.
- Companies promoting TENS therapy theorize something called The Pain Gate Effect which says there are two?independent?sets of nerve pathways to the brain from?anywhere?in the body. One?path?is like a super highway while the other?is?more like a country road. Pain signals travel along the country road exclusively which is a slower going path. All other signals,?including?those induced by the TENS device travel on the speedy?superhighway. The result is the TENS device sends signals to the brain that arrive before the pain signal from the same location in the body and the pain signal is somehow canceled out.
- I don’t know. As FOX news says, I report, you decide.
Now for full disclosure. I have a TENS device courtesy of my mother who?gave it?to me for Christmas. I have used it many times on my low back, neck and shoulder areas and tried to provide an honest, unbiased review of its performance.
I thought it worked, more or less. I didn’t think it was useful as a stand-alone therapy meaning it was not going to solve your muscle?pain?problems by its use alone. But I thought it was?effective?as a warm up to other things like massage or mobility work.
But I have changed my mind and am no longer?recommending?the TENS as a viable option for muscle pain?after?doing more research on it.
Once I discovered trigger points and how they are likely to be the primary reason for most chronic back pain, I did some additional testing with the TENS device.
- I have an obvious walnut-sized trigger point on the back of my neck. It is in a common trigger point area on the occipital muscles of the upper neck just below the base of the skull. And it is a tough SOB. I?have?been?manually trying to break it up for over a month now.
- But I had an idea on how to better analyze the effectiveness?of the TENS device. One of the big challenges with?pain management?and?particularly?back and neck pain, is that quite often the source of the pain and the location of where the pain is felt are not the same.
- This is called?referred?pain. The pain radiates out from the?actual?source making it very difficult to address the cause of the pain. It doesn’t?matter?what therapy you are using, from?massage?to TENS to ultrasound to chiropractic. If it?hurts at point A but the source?of?the pain is point B, you will have difficulty getting reliable results.
Back to my upper neck trigger point.
I knew exactly where it was since it was so obvious. I decided to place the electrodes of the TENS unit parallel to one another on each size of my muscle knot. I performed?therapy?like this for?several?days using?different?programs and?wave form frequencies.
The electrical pulses had to be?traveling?right?through?the middle of my trigger point. But no relief. ?Not the?slightest?change at all. I considered that this particular knot is very stubborn. I have been unable to get it to release for an extended period after many self-massage sessions. So it is a tough nut to crack.
But I do get some?relief?after?massage. My neck mobility is better and the knot feels dispersed a bit after a?massage?session?but it seems?to reform?again by the next day.
The TENS?session?did none of this. So I no longer believe the electrical nerve stimulation therapy is a great option for muscle pain. If you have a?device, there is no harm in using it. However I do not advocate going out and spending money on one.
What about ultrasound devices?
There is little true?evidence?for ultrasound even though it is widely practiced and sold as a muscle loosening and pain mitigating therapy. This paper??summarizes?the review of 38 studies on the clinical effectiveness of ultrasound.
It unequivocally concludes that ultrasound does not work. Pretty straightforward.
So the next time you are at the PT or chiropractor and she is wasting 10 minutes on ultrasound, you may suggest she just give you a massage instead.
How to become bullet proof to chronic back pain
- Learn about trigger points, myofascial therapy and how to keep your primary back pain?aggravation?from forming in the first place. Read about how to remedy lower back pain here.
- Build a stronger back. You don’t have a bad back, you have a weak back. Learn the?secrets?to lose back pain once and for all.
What is chronic back pain and how do you know if you have it?
- You have chronic back pain if you have seen a?professional?for any nagging, debilitating pain from your neck to your hips in the last year.
- You whine like a baby.
- And in your mind, even if you don’t say it out load, you are certain there is something really wrong (F’d Up) inside your back
What do you do about it?
- Be thoughtful before following conventional wisdom
- Pick your experts carefully
- Get the facts about back pain
- Try some trigger point therapy
- Build a stronger back
Know anyone with back pain or other chronic pain? Share this post and you may just prove to be an angel.