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Never-ending Back Pain?

    Physiotherapy and back

    Ever experienced low back pain that seemed to just linger longer than it should have?

    Let’s talk about that nagging low back pain that is unrelenting. This seems to be an area of contention for many clinicians and researchers. We still do not have all the answers or understand all the underlying reasons for why back pain happens. But, there are things we do know about and I want to share these things with you.

    First, I would like to provide an explanation about my preference in terminology. I was recently asked why I refer to things as dysfunctions rather than the biomedical term. One of the main reasons is because there may not be a structural or tissue injury component to your pain. Now, that isn’t to say your pain isn’t real. Your pain is REAL. But the source of the pain may be different than what you initially thought. Typically, people experience pain related from tissue damage with injuries such as an ankle sprain. This pain usually resolves within 12 weeks. This is what we refer to as acute or sub-acute pain. When pain persists longer than this, we need to consider the whole body, including the nervous system, and not just blame the tissues.

    I find dysfunction to be a more accurate descriptor of what is happening in your body, where your musculoskeletal, neurological and immune systems may not be functioning optimally to meet the demands being placed on it. This doesn’t mean that you’ll be like this for the rest of your life. As I’ve mentioned in previous posts, your body is adaptable and can make changes when guided appropriately.

    But, I’ve been diagnosed with degenerative disk disease and have multiple disc herniations? Does where does that leave me?

    This is likely one of the most common diagnoses I see with patients experiencing low back pain. There are a few things that need to be addressed here. The first is the effectiveness of imaging and its relation to low back pain. Have you ever read your MRI results and felt like you were practically falling apart? Multiple studies have shown people without any low back pain or symptoms having degeneration. Another study actually found having multiple MRIs could potentially increase the occurrence or severity of low back pain. These studies demonstrate the limitations of imaging in accurately identifying and potentially worsening low back pain based solely on MRI findings.

    Next is tissue healing or spontaneous resolution. Have you ever waited months for your results only to find out that everything is normal? For many, there may have been an initial injury (acute injury) that may have caused your disc to herniate and can be painful. However, did you know that disc herniations can heal on their own? And it can take anywhere from 6-12 weeks to heal. So, if your scan doesn’t show anything, this could be a sign that your tissue healed.

    Please note that if your back pain is accompanied by neurological symptoms or other symptoms such as unexplained weight loss, or changes in bowel or bladder function, consult with your healthcare provider or family physician to assess your symptoms further.

    But then why do I still have pain?

    And this is where things can be a little tricky. What the most recent pain science research is telling us is that it is multifactorial. But the underlying issue is hypersensitive nerves. Depending on a few factors, your body may have primed itself to be more protective than usual. Whether your stress is elevated, increased anxiety, minimal sleep, dissatisfied in your work or relationship, or experiencing poor gut health. All of these factors affect your nervous system. So, treating your severe pain without addressing the hypersensitivity of these nerves may not result in long-lasting effects. And what we know now, is that the longer you’ve been dealing with this pain, the more sensitive multiple areas in your central nervous system are, including the brain. And it is important that your treatment addresses all of these areas.

    Now what does my pelvic floor have anything to do with all of this?

    How do we know the pelvic floor is involved with low back pain? A recent study has shown increased association between pelvic floor dysfunction and low back pain in women. More specifically, people with chronic low back pain were more likely to experience urinary incontinence, chronic constipation and painful intercourse. How can this all be related? What is interesting about your pelvic floor is that it is a part of your inner core and working together with your abdominal wall and diaphragm to provide a solid foundation for movement. If this system isn’t synchronized well, it will rely on compensatory strategies to gain this sense of foundation. These are not ideal for the long-term. The other important aspect is that the nerves that supply the pelvic floor come from the low back. For individuals who have dealt with chronic pelvic pain, whether it be tailbone pain or period pain, this can contribute to increased sensitivity. This increased sensitivity can also manifest through a tense or tight pelvic floor, making the inner core even more dysfunctional. The good thing is, this can be easily addressed by having a thorough internal assessment to see what state your pelvic floor is in.

    Well, I think that may be more than enough information to digest in one sitting! Stay tuned for a future post about how to reduce your pain through your pelvic floor!

    Until next time,

    Grecia