30 Oct Guide to Chronic Low Back Pain Rehabilitation
Low back pain is something that most people will experience in their life, with many experiencing more long term chronic symptoms. This type of back pain can last anywhere from a couple of months, to years, depending on the individual and circumstances surrounding it’s onset. For the purpose of this article we will talk specifically talk about chronic low back pain, what may cause it, and some things you should be aware of if trying to improve your own situation.
Causes
Often times low back pain can start with something innocuous and become chronic simply because the root cause has never been addressed. In some cases it can start with an accident or incident, but with most of the long term back pain issues we see in our facility, things start with a simple enough niggle that progresses over time. We often hear clients explain its progression in this way: “My back used to go once a year for a few days, then it started to happen every few months and take much longer to recover from, now it’s constantly there”.
Unfortunately, this story has become all too common and people generally have no idea how they have ended up in constant pain. They have tried exercises to strengthen their “core”, been to physios or chiropractors but the issue still persists. The reason why is that there is likely an underlying biomechanical issue that has never been addressed. Most people have poor posture and a poor ability to move with balance and symmetry. Add load this over time and the body starts to bite back.
The Biopsychosocial Model
This model is often used to explain complex pain symptoms, and as it relates to low back pain, it’s often asked how impactful things like psychological and social factors might be. If someone has been suffering for an extended amount of time they may come to have certain beliefs about their pain, limiting or not. They may also come to identify as someone with chronic low back pain as a condition and this can have a direct relationship to things they feel in their body.
This is something traditional therapies will lean into when a solution physically cannot be found, and while is some rare circumstances it can be relevant, our experience has taught us that there is always an associated movement issue. The question is will it be uncovered, and more importantly has a practitioner the skill to actually solve for it. The mind and body are most definitely linked but people can be very quick to blame the mind for feelings in the body, rather than the body for feelings in the mind.
Wrong Place at The Wrong Time
This is a concept that we use to explain to clients mechanically why they might find themselves in pain for often that not. Imagine our body like a complex set of gears. When we stand, sit, walk or run, those gears have to synchronize relative to the others so that we have no excessive friction.
Let’s think about a car for a second. When driving 100km/hour what sound does the engine make if we are in 1st or 2nd gear? Or have you ever found yourself changing gears only to hear the clutch screech because the change wasn’t smooth? Similarly, if you’ve ever tried to pull out of your driveway in 3rd gear you’ll notice the engine will stall and cut out. The point is that there is an appropriate gear for each scenario, and the sound the car makes indicates whether or not you are in the correct gear.
The gears in the example above can be thought of as different positions in the body. A pelvic rotation or tilt in the wrong direction can be like finding yourself in the wrong gear. Unlike the car which will simply make a noise letting us know there is too much friction, our bodies way of telling us we are in the wrong place is to create a pain and trigger nervous system reaction. Overstimulation of the nervous system over time can create a cycle of hypersensitization that can also contribute to chronic low back pain.
Now obviously the body is a complex living system and not metal parts like a car, but the same concepts pf physics in terms of friction apply. Have more friction if your car engine and slowly cause more wear an tear. Have more friction in your body when you move and have more pain. Most people are operating from the wrong gears constantly, and as a result feel the effects of it day to day. If you find yourself in the wrong gear, or in the wrong place more times than not, you will eventually feel pain.
The Solution: Learning to Drive
Unfortunately nobody has the ability to change your gears other than you yourself. That’s why the benefits of hands on treatment like message, dry needling, or chiropractic adjustments can be short lived and not very long lasting. What is needed to help someone out of chronic low back pain is an education on how to position themselves in space to reduce friction in their body. Over time this is then loaded using precise strength training to build around these positions.
Loading the wrong positions will ultimately just cause more grinding of gears and more friction. To use our analogy above, people need to learn how to drive and seamlessly change between gears as they move day to day. At Functional Patterns this is exactly what we do. We are specialists in pain, posture and movement and use our expertise to help people understand the complex gear system that is the body. By focusing of putting our body in the right places more often than the wrong places we can retrain it’s natural tendencies and help people out of chronic pain.
Conclusion
When it comes to chronic low back pain people often lose hope and resign themselves to the fact that like a chronic disease, it is something that they may have to deal with for the rest of their lives. Interventions we currently have don’t get near enough to the root cause and fail to inspire hope. What is needed is a proper education on positioning of the body and how it can create or release excessive friction. Like learning to drive, learning to change the gears in your body correctly can make it feel dramatically different. There is no quick fix or magic bullet, but a soon as this starts to click with someone they can get huge relief very fast. Get in touch with us today if you are suffering and want help.