If you’ve ever suffered from lower back pain I’m sure you are familiar with the fearful thought of ”something is terribly damaged in my back!” You make a movement, like bending forward to pick something up off the floor and boom! It snapped, or broke, or torned apart. You cannot imagine that kind of sharp, distinct pain being something other than a serious injury. So you limp over to the couch, lay down, and remain there. Desperately trying to protect the area from any more damage you spend the following days walking around like a stick, carefully making sure not move the lower back in any way. A corset seems like a good idea. Preferably a metal one, moulded in one piece.
And there. You create a perfect foundation for a prolonged cycle of pain that is very hard to break free from. Thankfully, Ive got your back on this one. Pun intended.
Here are 3 things (and a bonus one) you have to know about lower back pain in order to begin your own journey towards high quality lower back pain management:
Let’s start with the bonus thing:
did you know that lower back pain can be caused by a tumour in the spine? Yes, in rare cases this is the case. Or, you may have kidney stones and that pain shows up like lower back pain. In other words, if non of the things you try helps and/or you have any other reason to suspect this to be the case, then do check with your health provider! Okay, so that was my word of caution. Now for the real stuff.
Here are the 3 things you absolutely have to know about lower back pain:
Thing no 1 you just have to know about lower back pain: The sensation of pain is created in the brain. Not in the paining tissue.
Yes, you have pain receptors in the lower back, sending information to the central nervous system about potentially harmful stimuli. This is not, however, the only input that makes you go OUCH!these nervous impulses travel to the central nervous system where they are being processed within a network of neurons that consists of loops between the thalamus and various parts of the cortex, as well as between the cortex and the limbic system. The sensation that you experience as pain is created in this network. Neural impulses travel in a specific pattern, which is known as your own, individual neurosignature. It is influenced by large numbers of both internal and external input. These can be things like stress, anxiety, or ongoing infections, they can be emotions, like anger, or excitement, they can be memories of painful experiences, or your own perception of back pain and everything that has formed it. If you have been living with lower back pain for a long time Im sure you have sometimes noticed that he pain may vanish when your caught up in doing something you love, and maybe that it gets worse when you are stressed or sleep deprived. Fear is a highly influential factor for the pain experience. Fear of provoking the sharp pain, or fear of damaging the back by making movements that cause a sharp pain, but also fear in general.
Hence, thing no 2 you have to know about lower back pain: Lower back pain does not equal damage to the back.
The most common structural problems that can be found in the lower back are herniated or bulging discs, and structural degeneration of the bone of the vertabreas. Bulging discs may press on nerves causing pain centrally, or in one or both legs. Yes, so much is true. But, there is not a straight correlation between damage and pain. Having some degree of degeneration in the lower back is common, even normal, and the prevalence increases with age, but in most people its asymptomatic. Yes exactly, most people have som ”damage” in their lower backs, but for most people it doesn’t cause pain. So thinking your back has to be fixed, (or fixated) for your pain to vanish just doesn’t hold up.
Sometimes you will get an x-ray or MR scan at the beginning of your treatment for back pain. Often this show that there is some structural damage, and this in turn can make you overly conscious about not injuring your back further. While it is mostly good to get a better picture of the state of the body, sometimes having this knowledge is detrimental. On the other hand, you may be lucky enough to meet a health professional who is really good in the area of back pain, and wise enough not to tell you that your back is broken, but rather that it looks perfectly normal and that you should just be going on with your life, movement and exercises like any pain free person would.
Knowledge about lower back pain, and specifically of one’s own lower back, has been shown to improve lower back pain. Fascinating, isn’t it? Like I mentioned earlier, fear is a big component in the pain experience, and we tend to fear the unknown. Increasing our knowledge can serve to gain us control of an area that appeared frightening and unsafe.
While pain does not mean that something is broken, it can still be an indicator of tense, sore muscles and tendons. Part of the pain cycle is that when you experience back pain, you will avoid movement, making the muscles tense, which can lead to even more pain. Not just from the tense muscles themselves, but they may also press on nerves, causing more tension, etc. and the whole areas of the lower back will become rather sore, sensitive, and paining. Yet not seriously injured or damaged.
Then of course, you could also break your back, as in having actual fractures on the bones of the vertebras, and now we’re talking very serious injuries. And very uncommon. Extremely unlikely to be caused by mundane movements such as putting on your socks. More likely caused by car accidents or falls from heights.
Thing no. 3 you have to know about back pain: You can manage your back pain by altering your perception towards it = it’s a mind-body thing.
Knowing that you back pain is created in your brain and does not mean your back is injured might lead you to think that it may be possible to improve it simply by thinking the rights thoughts or having the right mindset. Its not, however, that easy. Man, if we were to just think ”my back is strong and healthy and pain free” all the time and our backs would become exactly that, wouldn’t it be something?
The point is that exercises are not enough, neither is thinking, or meditating your way to a pain free back, but both aspects have to be present. The change in perception has to occur on the level of the nervous system. Not in your conscious mind. That’s the tricky part. You now know that the pain you experience in your lower back is created in your brain, and that it doesn’t mean that the back is damaged or seriously injured. How do you get that information into the neural network in your brain responsible for the pain you experience?
”Dear brain, my back is fine, please stop hurting” Well. Say that, but say it with movements instead.
In my program on Body Intelligence and lower back pain I work a lot with techniques that support a changed perception on the level of the nervous system. What I have found is that the best way to approach back pain is to make small, slow movements that give you time to adjust before the sharp pain hits. These kinds of movements will provide feedback into the nervous system that moving is safe. Also, trying to gently release the muscles of the back can feel great, and also help in such a way that it changes the brain’s processing of the inputs that leads to the pain experience.
I work a lot with somatic awareness as a way to raise our interoception, or knowledge of our own backs. We always make sure to start moving from a state of relaxed alertness, of awareness and with acceptance of your body the way it is functioning right here right how. Easier said than done if deep down you’re angry with your body for not behaving the way you want it to. Working with lower back pain thus becomes a broader endeavour as we have to face deep seated emotions and reactions, a journey that is truly developing and valuable far beyond the back itself.