Hurt Doesn't Always Equal Harm

Hurt doesn’t always mean harm. “Hurt” is a protective mechanism produced by the brain to warn us when we are in danger. “Harm” we will define as disease or bodily tissue damage. We typically assume if we experience pain we have injured our bodies and, vice versa, if we see an injury we expect to feel some pain. However, this is often not the case. For instance, the lifetime prevalence of lower back pain (LBP) is reported to be as high as 84% (1). That means that as much as 84% of the population will experience lower back pain at one point in their life. Imaging findings are weakly related to LBP symptoms. In one cross-sectional study of asymptomatic persons aged 60 years or older, 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc (2) .

Pain is normal and is what your brain judges to be threatening. Even in the presence of tissue damage, if your brain doesn’t determine it to be threatening you will not experience pain. In the exact same way, in the absence of any tissue damage, the brain may protect you (with pain) from what it judges to be dangerous. Non-specific lower back pain (NSLBP), back pain that has no identifiable pain generator, is a common example of this. Recurrent pain (say, months after an injury) doesn’t demand that there has been a reinjury of the tissue. It is often your brain recognizing familiar cues and signals from your body that it then judges to be threatening.

There are four “essential pain facts”. 1.) Pain protects us and promotes healing. It provides a “safety buffer” from going beyond tissue tolerance (i.e., burning yourself, getting a cut, tearing a ligaments or tendon) As soon as you have an injury, the “safety buffer” becomes much larger and so you experience pain with, perhaps, any movement. 2.) Persistent pain overprotects us and prevents recovery. Your brain and spinal cord “learn” to be more protective or hypersensitive so that the “safety buffer” remains very large. This must be treated very differently from an acute injury. The aim of treatment and therapy is to return the safety buffer towards normal 3.) Many factors influence pain. Pain can be influenced by psychological factors, such as stress, depression, and/or anxiety (3). Life circumstances (living situation, socio-economic status, etc) can affect your ability to deal with and treat pain upstream of an injury 4.) There are many ways to reduce pain and promote recovery. One effective way to reduce pain is to understand your pain and can help you identify how you can influence your own system.

If you suffer from pain, acute or chronic, and need help, please find a therapist who can help guide you through recovery. Also, enjoy the video below about pain and injury. Take care and be well.

1. Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012 Feb 4;379(9814):482-91. doi: 10.1016/S0140-6736(11)60610-7. Epub 2011 Oct 6. PMID: 21982256.

2. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990 Mar;72(3):403-8. PMID: 2312537.

3. Besen E, Young AE, Shaw WS. Returning to work following low back pain: towards a model of individual psychosocial factors. J Occup Rehabil. 2015 Mar;25(1):25-37. doi: 10.1007/s10926-014-9522-9. PMID: 24846078; PMCID: PMC4333236.

The Lost Art Of Bending Over

One of my favorite clinical terms is “lumbopelvic dissociation”. What this basically describes is when an individual is unable to move their hips without moving their lumbar spine. For instance, bending forward (flexing) at the hips while maintaining a neutral lower back. That movement is called is a “hip-hinge” and I teach it often when rehabilitating lower back pain.

There was recently a story on NPR titled “Lost Art Of Bending Over: How Other Cultures Spare Their Spines” (February 26, Morning Edition) which talked about how (in general) western cultures bend over versus how those in other parts of the world tend to bend over. More specifically, how these differences can lead to, or avoid, lower back pain. What the observer found when traveling to other countries was that people working in rice fields or working in their gardens bent over in a way that made their back like a table, i.e. their backs were flat and their hips were bent. More often than not, an American performing the same task would round their back to create a “C” with their hips and lumbar spine. This is one of the mechanisms that can lead to lower back pain.

In the story, Dr. Stuart McGill, PhD, likens the mechanism to woven cloth which is repeatedly pulled and stretched in one direction. Eventually the fibers start to loosen and unravel. Similarly, the outer layers of an intervertebral disc, when continually pulled in a certain direction, start to “delaminate”, or pull apart, making disc bulges and herniations more likely. By learning the correct mechanics of a hip hinge many people can avoid an episode of low back pain or recurrent episodes of low back pain and people who spend their days working in gardens can do so without suffering from lower back pain.

The hip hinge is a necessary skill for everyone from weight lifters to pregnant mothers. If you are having trouble with lower back pain, sciatica or back and hip strength, please call Pro-Motion Chiropractic and Rehabilitation or seek treatment from a knowledgeable doctor, clinician or therapist.

https://www.npr.org/sections/health-shots/2018/02/26/587735283/lost-art-of-bending-over-how-other-cultures-spare-their-spines

Central Sensitisation

I often have people come into my office who have been dealing with pain for a long time. These people suffering from chronic pain are often frustrated, depressed and anxious. Anything they do may set off their pain, they’ve tried “everything” and sometimes they feel there is no hope and that they just have to “live with it”. In the article “Where pain lives” the author discusses how science is learning that chronic pain isn’t just “acute pain that goes on and on”.

There are several possible mechanisms of how chronic pain starts, propagates and persists, but they all take into account that pain doesn’t equal tissue damage. Meaning that patients with chronic pain no longer have injured or damaged tissue (muscles, ligaments, discs, nerves) that might’ve have long ago been a mechanism for pain, but suffer from the brain creating “circuits” that constant re-live the pain or becoming hypersensitive to any form of stimuli, known as “central sensitisation”.

It is important for people living with chronic pain to understand what they are going through and the specific brain changes that have allowed their pain to continue and then take steps to rehab and strengthen their body knowing that “hurt does not typically mean harm”. There are no pharmaceutical means to treat this type of pain yet but there has been a lot of success using “Cognitive Behavioral Therapy” and graded “non-pain contingent” exercises. I have always said that my “ideal” practice includes a pain psychologist for this reason.

This article contains a lot more detailed information and deserves a read. I hope you will take the time and learn something from it and if you have more questions please feel free to contact me at Pro-Motion Chiropractic.

https://aeon.co/essays/to-treat-back-pain-look-to-the-brain-not-the-spine

Whiplash

Now that the snow is starting to fall, soon the roads will become a bit more dangerous. There’s nothing like the helpless feeling of sliding towards the car in front of you as your anti-lock brakes shutter and try to gain a grip on the ice beneath you. Whiplash is the most common injury following a car accident and can occur even at very low speeds. Here are some interesting statistics about whiplash that may surprise you.

Whiplash Statistics

• Most injuries occur when traveling less than 12 mph
• A read-end collision generally causes more damage to the cervical spine than side or frontal collisions do
• Whiplash injuries are more severe in women and children because their necks are smaller
• Whiplash injuries occur 5 times more often in women than men
• Symptoms of whiplash can often appear weeks or months after an accident
• In 75% of patients, symptoms of whiplash can last 6 months or longer
• Victims of whiplash lose approximately 8 weeks of work
• Whiplash injuries occur more often in people 30 to 50 years of age
• A whiplash injury can increase your chances of chronic shoulder and neck pain
• People suffering from chronic pain due to whiplash injuries often have abnormal psychological profiles
• More than 60% of people who have whiplash injuries require long-term medical follow-up
• More than 50% of those who have whiplash injuries will still have chronic pain 20 years after the injury
• Pre-existing health conditions such as arthritis will lead to greater severity of injury and greater pain

Signs of a Whiplash Injury

After an accident, you are likely to feel some pain and limited ranges of motion. Even if the pain is minimal, it could worsen hours after the crash. Some signs of whiplash can include:

• Pain when moving your head side to side
• Tenderness
• Headaches at the base of the skull
• Fatigue
• Dizziness
• Difficulty sleeping
• Memory problems
• Tingling or numbness in the arms

Signs and symptoms of whiplash usually develop within 24 hours of the accident, which is why it is crucial to seek medical treatment immediately. If you’ve had an accident please let a professional make sure you are ok. You don’t want to be one of the 50% who has chronic pain 20 years after the injury.

The "Big 3", with Stuart McGill

 I just read a great q & a about the "Big 3" core stability exercises according to Stuart McGill. I have studied his books and followed his research for years and am excited to hear more and more about him in the media. It's a good read and you'll learn about some causes of lower back pain and how the "Big 3" help to alleviate it. Have a good one!

https://www.lifetimedaily.com/leading-back-pain-expert-reveals-fix-back-pain/

The Brain and Pain

I found a couple studies that I wanted to share with you. I often discuss the brains role in pain processing and changes that occur in the brain as a result of pain. The psychological effect pain has on us is immense and is just starting to be recognized and understood. Here are the studies that, I think, help shed some light on how we, as health care providers and manual therapists, can help our patients.

• Bunzli, S., Smith, A., Schutze, R., Lind, I., & O’Sullivan, P. (2017). Making sense of low back pain and pain related fear. Journal of Orthopaedic & Sports Physical Therapy.

This narrative (not a study per se) is especially interesting to me because I deal with it all the time. The authors conclude that the Common Sense Model (CSM) can be used to cope with “fear-avoidance behaviors”. In the “Fear Avoidance Model”, patients foresee extremely negative outcomes of their pain and so they avoid any and all activity that might exacerbate the pain, which leads to disuse atrophy, depression and chronic pain. By using the CSM patients can 1.) identify the pain, 2.) know what causes the pain, 3.) understand the consequences of the pain, 4.) learn how to control it, and 5.) know how long it will last. With this knowledge the patient is able to better cope with and treat their pain.

• Kregel, J., Coppieters, I., De Pauw, R., Malfliet, A., Danneels, L., Nijs, J. & Meeus, M. (2017) Does Conservative Treatment Change the Brain in Patients with Chronic Musculoskeletal Pain? ASystematic Review. Pain Physician, 20(3), 139-154

This study reviewed 9 different studies which used MRI to determine if functional and/or structural changes occurred in the brain of patients suffering with chronic musculoskeletal pain after a course of conservative care. They found that conservative care seemed to produce both functional and structural changes in the brain and also that these changes were associated with positive clinical outcomes (decreased pain, increased function).