Back Pain – There is Good News

relieve-back-pain

The bad news is you may have or know someone that is experiencing chronic or persistent back pain. The good news is, there is a way forward.

Yesterday, three important papers about back pain published in the Lancet (one of the world’s oldest and best known general medical journals) were referenced in the The Guardian, The Telegraph, the BBC News and the Daily Mail . So current evidence-based information, at last, making its way to the public domain.

In briefly reviewing the papers (published March 21, 2018), the key points for me are these:

Low back pain is now the leading cause of disability worldwide.

“Prevention of the onset and persistence of disability associated with low back pain requires recognition that the disability is inseparable from the social and economic context of people’s lives and is entwined with personal and cultural beliefs about back pain.”

“Most low back pain is unrelated to specific identifiable spinal abnormalities,”

Globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences.”

“Recommendations include use of a biopsychosocial framework to guide management with initial nonpharmacological treatment, including education that supports self-management and resumption of normal activities and exercise,…”

Thank goodness this is getting the attention it deserves so it can help people who need it most. And that’s a LOT OF PEOPLE.

Why now, finally? I think it’s gaining traction due to spiraling health care costs along with the opioid crisis that is so prevalent.

Over the next while I’m going to break down and comment upon some of the points and principles presented in the papers, as many form the basis of my work.  In the meantime, if you care to read the papers yourself they can be found here.

Lorimer Moseley, one of the world’s top researchers on pain continues to make the related point that people need an understanding of what pain is and what it isn’t, as he does with a touch of humor in his TEDx Talk in 2011.  Professor Moseley is most known, however, for publishing 260+ papers on pain science and his continued work as Professor of Clinical Neurosciences and Chair of Physiotherapy at the University of South Australia. And one of many leading the charge globally in what he calls a Pain Revolution.

A huge paradigm shift is required as understandably, information about what works to treat back pain and what doesn’t is confusing.  It seems counter-intuitive to ask people who are in pain to ‘just move more”. As the latest interviews I’ve listened in to with Lorimer, he states that with what we’ve learned ‘recovery is, back on the table’.  There is hope. As I mentioned earlier, there is a way forward.

I talk about this all the time with family and friends … who often have a hard time believing what I describe as it is a change from what we have believed for most of our lifetime. 

But, if we really truly want to get people out of this pain cycle (and I will say most any pain cycle) we need to help with the understanding of what the evidence shows and how to best work with it. This will also require huge shifts in our public policy, etc. as stated in the Lancet papers.

“These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.”

So come along for the ride if you or anyone you know is experiencing chronic or persistent low back pain (or any pain, really).  With 1 in 5 experiencing chronic pain of some kind, unfortunately, you won’t have to look too far.

 

 

What might be useful skills?

Funniest thing I read the other day.

Being flexible ain’t all it’s cracked up to be

Doing the splits is not exactly a useful skill.

– Painscience.com

I’ve written about this before, here. But I think it’s important to talk about again.

People associate yoga with flexibility.

I do associate the word flexibility with yoga, but it’s in how we apply flexibility to our life.

That is, we have lots of choices available to us.

People often get stuck and then their choices become smaller, and smaller, and smaller… until they feel something a little like this; boxed in.

stuck

What I’m really looking for is this:

Freedom.

Do you have freedom, to do what you want in your life?

Do you have the freedom to BE you?

Skills that may aid in this might be strength. Physical strength if you want to move around in the world. Be able to go jogging, walking, cycling. Even to simply pick up and play with your kids/grandkids.

Maybe you are an office worker or writer and need to sit a lot of the day. What skills might be useful to do that?

A skill may be the ability to voice your opinions at work?

Or the skills required to get a good night’s sleep, so you have the energy for the coming day.

A useful skill may be noticing what creates tension in your body.

Try sitting in a dentist chair for any length of time and notice how you feel?  A sore jaw, perhaps, makes sense. But what might your shoulders feel like? Or your leg muscles? Imagine doing this, unknowingly creating tension throughout the day, and what it might create? Pain, fatigue, stiff or sore muscles.

Yoga, is all about the noticing.

Which helps guide our life, …

out of the box, and toward spaciousness and freedom.

 

 

 

 

Change the brain, the nervous system, the body

neuroplasticity-and-technology-4-728The changing of our brain …

One of the most important changes in the last 14 years or so is the field of neuroplasticity.

Scientists once thought that the brain stopped developing after the first few years of life.  Since then, we’ve come to understand this isn’t true of the brain. Research shows our brain is capable of learning, adapting and changing throughout our life.

The changing of our body …

Our white blood cells die after 3-4 days, red blood cells after about 120 days, the dermis of our skin renews every 2-4 weeks. Research shows that changes in the relative level of physical stress cause a predictable adaptive response in all biological tissue.  In other words, changes take place and what’s exciting to me is how we can take measures to influence what happens in our body.

stretchingI’ve also learned it seems we may have been ‘wrong about stretching‘ insofar as we’re not really stretching or lengthening muscles. At least not as much as we once believed. Rather, we’re changing our response to a stimulus via the nervous system.

“your ability to stretch at any range is determined by your nervous system’s tolerance to that range.” – Jules Mitchell

The changing of our nervous system …

Our brain is naturally going to respond in a protective manner to anything it perceives as dangerous.  If we are trying to re-train flexibility or just movement in the body and do so with strong, forceful pressure or stimulus … the brain/body will react by saying … stop! No! Don’t go there. It will send a (pain) signal to safeguard our movement.

stretchHowever, if we move in small incremental ways within a safe and pain-free range of motion, the nervous system will react by saying … this feels okay. Safe. I’m happy to explore this.

This is a somewhat simplified way to explain all that’s going on, but it’s a starting point we can work from. We can even begin by just imagining movement and still create changes in the brain and our nervous system. So we can, really, start anywhere.

By learning to pay attention, moving in a way that allows your nervous system to adapt and create new patterns while it feels safe, you will make progress. 

Change. Big Change. Lasting Change.

It turns out – we are adaptable!

We are adaptable

Tissue can change. Your brain can change.

brain

This provides HOPE to anyone living with pain, chronic pain, limitation to mobility or perhaps psychological pain (or unease) from the stress, anxiety, depression, insomnia that often accompany physical pain. All of which are common problems affecting a large proportion of our 21st Century population.

Pain science

The experience of pain doesn’t necessarily correlate with the state of our tissue.

You may see some awful looking images on an x-ray and yet not experience pain. You may experience pain, though not even have the limb that pains you (phantom limb pain).

Which doesn’t mean it’s all in your head but that pain is indeed, very complex

Neuroplasticity

Contrary to our understanding up to about the year 2002, our brain can change

This is revolutionary in terms of we can keep learning, and also how we can change behavior and adapt.  Most important, how your pain can change.

What does this have to do with how well you can or cannot move? The fact that you have persistent pain or not? Why it flares up?

Explore this (somewhat new) information and learn simple things you can use throughout your day that are most likely to help, according to the latest research.

What I Know For Sure

What I continue to learn is we really can’t be absolutely sure, about any of this. But, stay with me …

uncertainty-is-an-uncomfortable-position-but-certainty-is-an-absurd-one-quote-1

As soon as I discover something to share or write about on a blog post, it may soon be out of date. Though research leads us in the most reliable way we know at any one time, it’s only as good as the next study. Knowledge changes, books get re-written.

There is the constant discovery of what we thought we knew, what we’re now learning and what’s yet to come. As in life itself.

As I stated before, pain is indeed very complex. I’m not sure anyone knows with certainty what causes and therefore eliminates back pain, for instance. But I have seen it dissipate almost immediately and over time for those who once believed it cannot, or never will.

For me personally? Today’s x-rays and ultrasounds will likely show arthritis and chronic inflammation / plantar fasciitis still exist in my feet. I do know, however, that my feet (legs and hips) have dramatically changed by working with awareness, changing movements and therefore re-patterning my nervous system over a relatively short period of time. That, and a whole host of other changes to sacroiliac (SI) joint pain which no longer exists, shoulder impingement being resolved and hip bursitis… almost there on it as well.

So where does this lead me, or you, or anyone else?

Are you resigned to thinking it ‘just has to be’ this way?

What is it you REALLY want to be able to do?

Many people I speak with and work alongside are/were just like me and don’t know what information or skills they can learn and use to help them move better, sleep better, feel better.

We’ll explore these together.