There are a lot of frustrated back pain sufferers looking for answers when it comes to back pain, in order to figure out a solution you need to know what the problem is. Pain can be quite complex, 90% of back pain is categorised as non-specific pain, meaning back pain that can’t be attributed to a particular cause or origin. Despite this, a chiropractor will claim the underlying cause is misalignments, even though we know misalignments are not related to back pain. A physio will claim back pain is a result of a weak core or glutes that aren’t activating, a massage therapist will claim your back pain is coming from tight hip flexors causing your lower back too curve excessively, I have to admit, I was once guilty of this in the past.
This article may be a bit long, but it has some very important information and I highly recommend you read the entire article. If you can understand and appreciate the information in this article you will potentially have a much greater understanding of your own pain and a better understanding than many of the “experts” claiming to fix the “underlying cause of pain”.
Nociceptive Pain
We have pain receptors (nociceptors) throughout all of our body, specifically when it comes to the low back, the structures or tissues that are important which contain pain receptors are the muscles, fascia, joints, tendons and ligaments. The spine is an integrated structure working as a unit, rather than a sum of parts, for many back pain sufferers several of these structures may be involved, this is why I treat up to 45 minutes, using multidisciplinary approach to ensure the best outcomes.
This type of pain occurs more in the initial onset of pain, acute pain; first month and subacute pain; up to 3 months and involves mainly tissue/nociceptive pain. Most people with acute/subacute back pain (under 3 months) will have episodes of back pain, on and off for up to a year, but unlike chronic pain (below) is not continuous and persistent over that time frame and wouldn’t necessarily be described as pain but a tension, ache or tightness, this is the vast majority of back pain that I treat, and I generally treat them as mixed back pain, subacute and chronic/nocioplastic.
Nocioplastic pain
This tends to be more prevalent in the chronic phase from 3 months onwards, Studies suggest 20% of back pain sufferers will have persistent/ongoing pain. Just like when you sprain your ankle or even a break a bone, the body will typically heal these effected structures, this is no different to the structures of the low back. However, this is where chronic pain gets complicated, most of the latest research around chronic pain is showing there may be an issue with pain processing within the nervous system, meaning the nervous system sends out pain signals more easily, i.e. has become sensitised to pain. Chronic back pain sufferers will continue to use unhelpful pain avoidance strategies such as constantly tensing and bracing their spine by contracting the muscles, especially movements that provoked pain in the original onset such as bending forward or sitting with a relaxed spine, it’s no wonder why when I treat chronic back pain sufferers their spinal muscles feel like cables!
This becomes a vicious cycle of pain which leads to unhelpful pain avoidance strategies such as severely limiting movement of the spine by contacting and bracing the muscles on top of an already pain sensitised nervous system. This is why many who get treatment that just target the tissues such as chiropractic, physiotherapy, massage therapy, cortisone injections etc… at best get temporary relief as shown by most, if not all research when it comes to back pain and why research shows people who believe their pain is a result of damage, misalignments, degeneration etc… suffer much worse outcomes as this only adds to the fear, uncertainty and helplessness of many chronic back pain sufferers.
There was a study that had two groups of back pain sufferers who had MRI’s done of their low back. One group had findings which showed things like disc degeneration, herniations, joint arthritis and the second group had findings showing similar things. However, group two had their findings put in to context and were told they were normal wear and tear and there is a high prevalence of people with no back pain with very similar findings. This group experienced less pain, higher quality of life and spent less money spent on treatment and medication compared to the first group who believed their spine was damaged and needed protection.
This study demonstrates the importance of how we perceive pain can greatly influence how we experience pain. There are many other factors such lifestyle, emotional wellbeing, genetics, diet etc… which potentially add to the overall picture of chronic back pain.
How to use this information
If you’re in the early stages of pain (acute/subacute), get a wholistic treatment that is multimodal or multidisciplinary, someone that can assess and treat all the potential painful structures of your low back, muscles, fascia, joints, tendons and ligaments. If you find yourself in the chronic or persistent phase, especially if you’re very fearful and protective of your spine it’s vital you see a professional who has training and expertise in being able to identify and treat this type of pain in a more evidence based, and patient centered approach that doesn’t reinforce the idea your spine is damaged or misaligned.
In part two of this article, I will describe a very recent study done by Australian researchers that compared standard treatment (chiropractic/physiotherapy) and a treatment using a holistic and integrated approach based off modern pain science described in this article.