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.

Tech Neck

If you continuously suffer from neck pain, then you are certainly not alone. Harvard Medical School estimates that seven in ten people at some point experience neck pain and one in ten people are in pain at any given day. Between 50 to 85% of adults with neck pain will experience a recurrence of the pain within five years. The leading cause of neck pain remains to be weak back and neck posture, especially when we sit too long on our computers or text on our smartphones.

The solution to the neck pain problem is not a quick fix. Pain management and pain relief for neck pain involve a variety of therapies that include chiropractic care and rehabilitation therapy, medication, self-help techniques and, in some cases, surgery. Patients today play a crucial role in their recovery by participating in strengthening and stretching exercises, as well as mind and body therapy.

First, “An ounce of prevention is worth a pound of cure.” There is a significant difference in the cost of fixing a problem versus preventing it. Strengthening your neck and correcting poor postural habits could save you down the road.

The tech neck syndrome is a term that refers to a condition caused by hunching over your phone, tablet or any hand-held device for extended periods with rounded shoulders, a hunched back and forward bent neck. Medically explained, tech neck is a repetitive stress injury caused by bending your head down and forward for long periods. When you hold your head this way, a lot of tension is generated deep in the neck muscles and across the shoulders, which causes acute as well as chronic pain.

According to the Spine Hospital at the Neurological Institute of New York, bending your head 15 degrees forward is as if the head weighed 27 pounds. This is approximately 2.5 times the weight of the average adult head, which weighs 11 pounds. The problem is not simply bending the head forward, but that you bend it forward daily as you scroll on your smartphone.

Symptoms of tech neck appear in any area where pressure is applied to the muscles, nerves and joints. This leads to chronic back pain, which ranges from mild to very severe and regularly pinched nerves. After bending the neck for far too long, you can get tension headaches. A chronic joint strain may also cause an early onset of arthritis, as this stress causes inflammation.

A text neck can also lead to an increased spine curvature, or lead to an upper thoracic deformity called dowager’s hump, which results in bone structure altering of the vertebrae in this area.

Fortunately, there are simple exercises and therapies you can do to prevent or relieve the symptoms of tech neck. If you are concerned about your posture or are experiencing upper back pain, shoulder pain, neck pain and/or headaches contact a healthcare professional to discuss treatment options and therapies. Pro-Motion Chiropractic offers neck strengthening tools to help those suffering from a whiplash injury as well as those preparing to compete in MMA competitions and supplement these tools with therapies designed to relieve your headaches, muscle pain and limited neck motion, so if you need some help, don’t hesitate.

Muscle Tension and Motor Control

When treating patients I commonly find tight and painful muscles directly or indirectly associated with the major complaint the patient is being treated for. I hear “Why is that muscle tight? It’s not even near my pain.” or “I didn’t even know that muscle was so tight!”

Tightness is often a way that the body uses parking brakes in the absence of real, authentic braking systems. The braking system that the body has is called motor control and it is finely tuned to input, processing and appropriate output. When a fault is present somewhere in that system—somewhere in movement, somewhere in that coordination, timing and symmetry—a dysfunction is observable.

The body is set up to do what you ask of it, and in a situation where the strength or coordination are not present, it simply creates a parking brake system—one that tends to stay engaged, slow you down and keep you out of trouble. This parking brake is a fail-safe in the presence of fatigue, injury, protection of other structures and avoidance of pain. You may have some limited improvement in control, but you also waste energy and lose efficiency. The weakness issue remains evident. It is often deconditioning; it’s body-wide and not isolated and it’s easily fixed by getting up and moving today  . . . and then moving a little more tomorrow. However, isolated weakness is rarely just weakness.

Isolated inhibition of a single muscle or group of muscles is best diagnosed in rehabilitation as a neurological problem or impairment resulting from injury, disease or dysfunction. The subtle and background inhibition I’m speaking of is the inability for a muscle to take a command to an appropriate level of tone to execute a posture or a pattern. Our real problem here is when we simply discuss tightness or weakness of a muscle, we can go down the rabbit hole thinking it’s a muscle problem. Very often, it’s a coordination problem.

If there is tissue tightening, everything from deep fascia to superficial scarring or scar tissue from a previous injury, the muscles will be told to tighten prematurely or even maintain a significant amount of resting tone simply to protect the kink in the system. This tightness can also be preserved not from a signal from other tissues but it can be left over from a previous injury that has already been resolved. The muscles never got the memo.

Sometimes patients are confused when I prescribe exercise for a chronically tight muscle. “Isn’t the muscle too strong already?”. The simple answer is “no”. Because of a lack of strength, poor coordination, or engrained guarding from a previous injury, the brain thinks it’s only option is to contract that muscle as hard as possible to provide the only control it can. By improving the connection of the brain to the muscle (coordination), improving strength, or retraining movement patterns the brain can finally create a new habit or movement (incorporating strength and coordination) which allows those muscle to relax to a “normal” level.

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