What if it’s not your back’s fault?
Do you have a ‘weak’ back? Given that up to 80 percent of people in the developed world will suffer with back pain at some stage, most of us have at least experienced back pain. And plenty of people have relatively frequent recurrences, thus their belief, reinforced by experience that they have a ‘weak’ back. But here’s a question to ponder: what if it’s not your back’s fault? Many workplaces these days require staff to attend manual-handling courses, where over the course of a day, participants are reminded that their backs are inherently weak, unstable structures that needed to be minded at every turn. To be sure to be safe, we have to learn how to lift – ‘bend your knees, not your back’ and ‘lift in teams if possible’. Heck, I’ve even worked on hospital wards that have ‘no lift’ policies to protect staff. When you do have an episode of back pain, often it feels like something could go wrong at any moment, reinforcing the belief that the back is weak. Chances are you end up with a physiotherapist, osteopath or chiropractor and the notion that your core muscles aren’t doing their job to stabilise the spine gets suggested. So now you have a weak back and a weak tummy. Crikey, if you were a sensitive soul you’d be in tears by now. But you’re not. You’re resilient and proactive, so you go to Pilates, yoga or the gym and work to get your core and your back stronger. Good for you. Except for one thing. Plenty of patients do all of those things, and despite their best efforts and the best intentions of health-care professionals, yoga and Pilates teachers and personal trainers, the pain still manages to recur. So, what are we all, both patients and therapists, doing wrong? Could it be that we are ignoring the multitude of other factors that contribute to back pain specifically and the pain experience in general? Let’s consider back pain as a purely mechanical concept. First, let’s break the body into three segments: the lower limbs and pelvis, the upper limbs and rib cage, and, in the middle, the poor weak back and core. Consider that this three-segmented man is lifting a box from the floor. It’s heavy, so he bends his knees, braces his abdominals and bends his elbows slightly before lifting, just like he was taught. But then his back goes; because it’s weak, obviously. Consider though, that each of those segments has to put in one-third of the effort, and that the man has a slightly dodgy shoulder from playing rugby and that he tore his ACL years ago, oh, and his ankles have been sprained a few times and he doesn’t fully trust them. If each of the three segments of this man’s body were supposed to contribute one-third of the effort each, but the dodgy shoulder, knee and ankles just couldn’t quite achieve that, the missing proportion of the effort has to go somewhere. The poor old ‘weak’ back takes the load and suffers. Or maybe, just maybe, the back has had enough of doing the extra work and decides it has had enough. Maybe it’s not weak, it’s tired. Which brings us to the non-physical factors that contribute to our friend’s pain, what we call the psychosocial elements. Consider how his tolerance to pain might be affected by a lack of sleep, or frustration at being the one having to lift the box because all of his colleagues have disappeared at the precise moment there’s hard work to be done. Consider too, that perhaps the man is nervous about lifting the box because of his back-pain history, and he is almost expecting it to hurt. In such circumstances the tolerance to pain is lower and the expectation of pain is almost a self-fulfilling prophecy. The sudden twinge of back pain that comes when doing something simple seems easily explained. In reality, it’s anything but a simple process with different factors contributing to a different extent for every individual who experiences pain; those factors even vary for every episode for a single individual. The main thing to remember in all of this, is that your ‘weak’ back probably isn’t that weak, and, without wanting to give you other things to worry about, there’s every chance it’s not your only problem.
Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.