Your Guide to managing recurring neck pain and stiffness

PROVIDING YOU WITH A PERMANENT SOLUTION TO YOUR BACK PAIN

Index

• Chapter 1 : Introductions
• Chapter 2: Common Misconceptions
• Chapter 3: What causes Back Pain and why does is reoccur?
• Chapter 4: What causes your Back Pain to persist and return?
• Chapter 5: The solution - the process
• • Stage 1: Initial assessment and Acute treatment
  • Stage 2: Improving global strength and mobility
  • Stage 3: Functional strength and general health - The Key to Prevention

To see exercises and Treatments for your lower back pain Click Here to see our blogs

Chapter 1. Introduction

Across the world back pain is the second most common condition presenting to General Practitioners, and 80% of people will experience severe low back pain. One of the most common findings in Physiotherapy Private Practice is the “recurrent nature” of back pain. People recover from their pain episode, but, up to 84% of patients report a further back pain episode within a year (Hides 2001). Cirencester Physiotherapy Centre sees many patients who have tried many approaches to “SOLVE” their back pain but continue to suffer from back pain or recurrent back pain, despite intervention.

Our Approach at Cirencester Physiotherapy Centre is to team our treatment with education as it is paramount that in order to “SOLVE” lower back pain we must work as a team to improve your current episode of Back Pain. Once this has happened, we work on your knowledge and strength so that you can stop any painful episode before it even occurs. In essence making you your own physio.

IMAGE

Chapter 2. Common Misconceptions

To start your journey into Solving your Back pain let's clear up some common misconceptions that friends, family or social media may have told you that may be doing more harm than good:

1. If an exercise hurts it must be causing me harm

This is not the case, exercise itself is one of the most common ways of improving Back Pain. It is actually far more common, as high as 99.5% (University of Iowa,2019), to present with Back Pain but have no significant damage, disease or structural irregularities, with the most common cause of the pain being stiffness of joints and weakness of muscles. To which exercises are an essential part of therapy.

By understanding that “hurt” does not always mean “harm,” you can slowly train your brain to not over-respond to the pain associated with these physical activities. Even though these exercises may cause more pain, this doesn’t represent damage or harm to your spine.

2. Bulging/slipped discs cause a majority of my back pain

Actually, no.

Many have been told their pain is coming from disc bulges or tears that look abnormal on their MRIs. Research shows that chronic back pain frequently does not correlate with the structural abnormalities that may appear on MRIs. In fact, if analysing the general population, it is estimated 60-70% of people have a form of disk issue right this second, but only 5% of people are actually experiencing pain.

Disc degeneration is a normal process. In fact, the blood supply to our discs was the best when we were teenagers. Every year afterward, the blood supply to the disc decreases. By the time we turn 40, many of us without back pain will have radiographic evidence of disc degeneration. This process is completely normal. Our spines have the ability to adapt to new environments and activities. Studies have shown the disc actually benefits from increased physical loading and gradually adapts as joints, bones, muscles, tendons, and ligaments do.

3. My back pain is caused by being out of align or having a leg length discrepancy

This is not the case

When you consider the fact that, when comparing each side of your face you will see differences in eye position, cheek shape, etc. Why do we believe that our bodies need to be perfectly straight and symmetrical to be pain free? It is utterly normal to have one leg longer than the other or a slight twist/curve to your spine as your body has learnt to adapt to these positions that you have had throughout your life and have got strong within them. One of my favourite examples of how the human body can thrive under what we would consider “broken” and in need of ‘’fixing” is the fact that Usain Bolt was born with a scoliosis of around 30 degrees resulting in a leg length discrepancy and has become the fastest man on earth.

4. My chronic back pain must have begun with an injury

Consider this:

Unless you undergo significant trauma to your spine, like being thrown out of a moving vehicle, the human spine is capable of absorbing a lot of energy without being damaged. By the time we develop chronic pain, our bodies have usually had several decades of wear before the first sign of back pain occurs. If one has neglected routine maintenance for many years, (such as maintaining a healthy weight, diet, and exercise habits) it makes the occurrence of problems like chronic back pain more likely.

5. I need to severely restrict my activity because I have back pain

Let’s rethink that conclusion.

We lose muscle strength and endurance much faster than we can regain it. Being off work or stopping our exercise deprives our bodies of physical activity for all of our muscles. Being able to take it a little easier while your muscle rebuilds itself is advisable, but long leaves from work or exercise deprive these deep muscles of the regular exercise they need in order to repair themselves. This is why keeping our muscles at their best flexibility, strength, and endurance is so critical. Regular exercise may actually have a preventive effect in terms of frequency of back pain and recurrence.

Chapter 3. Why does back pain reoccur?

This problem has been looked at from a research perspective for many years, and findings from MRI, EMG and Real Time Ultrasound studies have shown that even one episode of low back pain can dramatically impact the strength of the muscles surrounding the spine.

The key spinal muscles involved are often inhibited or “switched off” when pain persists. The result of this reduction in muscle contraction is that your body slowly reduces the strength of surrounding muscles decreasing structural support given to the spine. The body will always try to compensate by over-activating more superficial muscle groups. After the loss in strength the spine can commonly get stiff because of a lack of movement. This is why people reinjure their spine and get recurrence of pain, because they are not stabilising efficiently and losing muscle as they reduce their movement. Subsequently a simple movement like bending and twisting can reinjure your spine and it’s simply due to poor muscle strength and coordination meaning the muscles can't help stabilise the movement. Over time this may accelerate degenerative changes (wear and tear around the discs and joints) and result in further episodes of back pain.

IMAGE

Chapter 4. Why does back pain "persist" once it's reoccured?

To understand this phenomenon, you need to understand some of the physiology behind pain. When explaining pain, I like to refer to it as your protection reaction but because our minds can be overprotective the brain can perceive the incoming electrical impulses as pain even though no true damage has been done.

In a normal response to an acute back injury, you will have pain and inflammation that will most likely settle in time. The healing process takes place and your pain goes away. In some instances, your nervous system which produces pain, can become “sensitised” during the healing process. That means increased sensitivity within the nervous system and the brain registers more pain signals and starts to register pain from signals that previously were not painful, like light touch!

If your “reoccurring pain” becomes “persistent”, this neural sensitivity is often a feature and your brain has set up a system of being overprotective. The important thing to realise is, to you, THIS IS REAL PAIN, but it is not a response to damage to your back or discs. The difficult thing to understand is that you can work into this pain a little and not have further injury or damage.

This Neural sensitivity can also be further amplified by an area of the brain called your limbic system which can control the level of pain dependent on your mood and memory of painful experiences. In essence this means that if you're under large amounts of pressure causing stress etc this can increase the pain you feel from the same strength of electrical impulse. This can then lead to a simple action like hoovering or gardening for example to become a trigger for your pain purely because your brain remembers that this action was painful the last time you completed it.

 

This reaction is why it is so important to see a Physiotherapist as soon as possible as it stops you getting to the point where your body can no longer regulate its pain making it harder to get rid of.

Being reassured that you are not causing further damage is often what is needed to improve your pain and get you moving again. Remember we are designed to move! It is common with persisting or chronic pain to feel like your pain is an indicator of further damage to your spine and to reduce your activity. Often, by the time people come to us with persisting recurrent back pain, they have de-trained, become unfit, put on weight and walk differently.

What we find on assessment is, they have developed muscle weakness and poor firing patterns. This loss of deep core stability is worsened by the fact that every time you move, you get pain, so you tend to stop moving and increase back stiffness and tightness. If we know that a sensitised nervous system is being overprotective and is signalling pain when non-damaging activities are occurring, we can start to confidently move our backs again.

As we start to progress you through our BACK PAIN SOLUTIONS program you will begin to understand nervous system sensitivity. You will be able to cope more effectively with a pain response during exercise that you know won’t hurt you, but previously had stopped you from exercising! As you can see, we are really linking your body to your mind and you really can’t recover from persistent back pain until you understand this connection. Now it’s time to FIND A SOLUTION and deal with some of these barriers that have stopped you progressing in the past and get you out of the pain cycle.

Chapter 5. The Solution

BACK PAIN SOLUTIONS are one of our specialties at Cirencester Physiotherapy Centre. The solution will involve a Pathway to Recovery. The solution to recurrent back pain involves three stages.

1. Personalised assessment, acute treatment to address joint stiffness, muscle tightness and basic muscle strengthening. Vitally this is teamed with education on how you can not only understand but own your back pain.

2. Improving global strength and mobility, by providing exercises that actually build muscle while addressing other underlying joint issues that may trigger your pain (e.g. your hips)

3. Improving your spinal strength with Functional Rehabilitation and Conditioning, teamed with personal support to improve your general health.

This is often the most important stage as it will prevent you falling back into the pain cycle with recurrence. Each stage is very important in the “solution” as each stage sets you up for the next stage.

We often hear of people with recurrence of their lower back pain once they feel they have recovered. In these instances, they had been PAIN FREE but not recovered. For these people there is still the possibility for their back pain to return, as they had not been taught the relevant tools to stop lower back pain before it starts, and have not “conditioned” their back or spine to cope with the stresses of everyday life and loads like lifting and twisting without triggering a pain response.

Stage 1: Initial assessment, Acute treatment and Understanding

In order to personalise your treatment plan, as a team, we must highlight the pattern your back pain follows. This is done by one of our trained Physiotherapists through a detailed assessment of both the history of your back pain and how it currently responds to your lifestyle. We think of this as a timeline and we try to track changes in your pain and link them to possible activities that have exacerbated your pain. This allows us to personalise your treatment so that it is as effective as possible. As a team, we then move to controlling and stopping your Back pain, this is done through a mix of hands on treatment including; massage, mobilisation and stretching to name a few. Which are unparalleled at reducing pain and assisting healing. And hand off treatment including; gentle strengthening and control exercises such as Pilates combined with education on what may be causing your pain.

I cannot stress the importance of this enough as if you think of chapter 4 above, the confusion you feel around your back pain can literally dial up the strength of the pain you are feeling. So, providing this understanding early in your treatment can rapidly reduce the pain you feel, while pulling you out of the cycle of pain. In this stage it is vital that treatment be administered regularly and consistently to accelerate healing and reduce pain. Which is why we are one of the only clinics that teach you and your family how to recreate the hands on treatment at home. In essence, think of this stage as trying to heal any irritated structures, while achieving consistent short term pain relief which allows you to move more naturally while building strength and flexibility.

Stage 2: Improving global strength and mobility

As you may expect this section heavily overlaps with the previous section. This is the first vital step on the road to “curing” your back pain and is the area many patients as well as therapists neglect. The goal of this stage is to achieve two things: one, improve the strength of your muscles so that when placing your spine under load your muscles are strong enough to support the structure without the activity triggering your pain. The most common fault patients make is not training at an appropriate level of load. In order to gain muscle for fitness or rehabilitation the human body must work at a minimum of 70% of its maximum to change and adapt its structures. Unfortunately, most treatment plans do not include this element so fail to improve your strength leaving you vulnerable to re-injury.

Secondly, we work on reducing stiffness and tension from other joints like the hips, so they don’t reduce your movement so prevents them from contributing to your pain. For example, this commonly occurs while gardening. We see multiple patients that get stiff and painful backs caused by stooping forward for several hours instead of adopting less fatiguing positions.

In essence this stage strengthens you against your environment and looks to minimise possible situations that may cause your pain by allowing you to move freely so those muscles can function in their best positions when they are at their strongest.

By the end of stage 2 you are often pain free and have a real understanding of applying the changes needed to “stay feeling better” and remain pain free with movement. You have now gone from “just feeling better” to really understanding and applying the changes needed to “stay feeling better”. You will be given a PERSONALISED VIDEO PROGRAMME to maintain the changes you are learning and be able to apply to everyday activities. We will then advise you on how you are travelling along your “PATHWAY” to recovery and achieving your goals.

We will refer back to your goals to help you stay motivated to achieve these goals, whether it is playing with your grandchildren or standing at work without pain. At the end of Stage 2 you are well on your way to your Back Pain Solution. This is when you need to really apply it to all parts of your life and get STRONGER.

Stage 3: Functional rehabilitation and improving your health

In this stage you will be pain free and we really focus on prevention of your pain. We do this by training you to be strong and comfortable in every position life throws at you, as we can’t always predict when we might be called to load our spines in peculiar ways. So essentially this stage trains you for the unexpected. We do this by carefully teaching you exercises at home or in the gym using our GUIDE TO THE GYM class that loads your spine in those positions that you may previously been afraid of. This works so exceptionally well because it allows you to build spinal strength and stability through every inch of your movement and creates an impenetrable confidence that your back is the healthiest and strongest it has ever been reducing the chance of neural sensitivity. Meaning whether it's picking up a bag of cement or catching a toddler you will always be prepared for whatever the world throws at you.

To maintain this mentality, we recommend occasional catch up sessions to refocus and continue your goals, during this time we take a broader look at your lifestyle and try to create realistic ways of bettering your quality of life. Such as stress relief tactics as well as weight management advice as the only true way of living a pain free life is by adapting your lifestyle.

RULES FOR A HEALTHY SPINE

• Get up and move – change your sitting position regularly.
• Maintain cardio fitness – walk regularly (at least 3 to 4 times per week).
• Maintain flexibility in back and hips – stretch your back and hips.
• Keep your spine “neutral and stable” when bending and lifting weight.
• Maintain healthy weight (avoid a protruding tummy or reduce it)
• Expend as much effort caring about your mental health as your physical health

If you are struggling with Lower Back pain, please don’t hesitate to get in touch on 01285 238240 or 07427 442103.

Or drop us a message on any of our social media channels…

Facebook / Instagram / LinkedIn.

You can book an appointment or speak to a physio here get in touch

Let us help you to prevent, recover, re-gain your movement and be pain-free!

Why not check out our What Hurts? page. We have advice for each part of the body and free guides to help you to be pain-free – simply Click here.

Thanks for reading…
George