As a Registered Osteopath in Doha, I frequently encounter people who are suffering from either persistent or recurring lower back pain. Many have undergone months and even years of passive manual therapy treatment such as massage and manipulation, but have not managed to reduce their discomfort to a level that allows them to live a normal life, without the need for regular treatment. Patients often describe their treatments as a ‘short term fix’ as opposed to a long-term solution.
Your lower back doesn’t need realigning
It is very common for people with ongoing lower back pain to believe that there is something wrong with their spine, or that something is out of place. Pain can make things feel really weird and patients often use various descriptions to try to characterize what they are feeling in their body, such as misaligned, out of place, restricted, etc.
In addition, many medical professionals still look at ongoing aches and pains from an anatomical perspective and blame lower back pain on anatomical variations such as spinal curves, pelvic misalignment, posture and core weakness. It is important to be reassured that our bodies are highly adaptable organisms that do not have an objective reference point for the ideal spinal curve, posture or amount of core strength. Neither does our body need to be symmetrical to function properly or be pain free.
Let’s take tennis players or athletes such as javelin or discuss throwers as an example: They will have visible and functional imbalances in their shoulders and arms due to the nature of their sport, this doesn’t mean that anything needs fixing.
Have you ever tried writing or brushing your teeth with your other hand? This highlights the lack of symmetry in our bodies, and why we shouldn’t be so obsessed with one side of the body looking and functioning the same as the other. Differing spinal curves, asymmetric limbs and different postures are all normal variants that should not be held responsible for ongoing lower back pain.
Quick fixes don’t really work for ongoing lower back pain
Unfortunately, we can be led to believe that these normal variations need ‘fixing’ to get rid of discomfort, but this frequently ends up being an expensive journey of ongoing treatment that only provides transient relief at best. These ‘quick fix’ and predominantly ‘passive’ treatments also create a dependency that leads people to believe that they cannot function without their regular ‘fix’.
If I am to use an analogy, this is kind of like getting rid of the smoke, but not putting out the fire, and if we want to get rid of pain for good we need to become more of an active participant in our healthcare and not just a passive recipient of healthcare.
Looking at the bigger picture to beat lower back pain
In the case of ongoing lower back pain, it’s time to stop blaming our bodies and start building our tolerance. Sensitivity of the nervous system is now being widely accepted as a major factor in ongoing lower back pain. This can be analogized as a protective mechanism, that is trying to keep us from harm, but, for some reason, is over-reacting to even non-harmful activities and movements. Kind of like an alarm system on a car that goes off even when the car has not even been touched or disturbed!
From a very simplified perspective, there are really only 2 directions to go with persistent pain and it is analogized perfectly by Dr Greg Lehamn who talks about calming things down and building them up. The first step is to zoom out from the lower back pain and look at the person, which allows us to take into account all of the lifestyle factors that are contributing to the pain experience. This may include:
- Sleep (poor sleep hygiene, irregular sleep patterns etc)
- Stress (work, home, physical, environmental)
- Diet (are we promoting an inflammatory state by gaining weight, eating poor quality foods etc)
- Movement (are we moving enough, too much, or in the wrong way)
- Mindset (how we are interpreting our body, our day to day life, and all of its demands and challenges)
The alarm signal of pain is often triggered or produced when we have been exposed to an excess of stress from any of the above-mentioned inputs. A lack of sleep, over eating, excessive unhelpful thoughts and feelings, lack of or too much movement etc. Therefore, it makes sense to start with an appraisal of the circumstances in our lives that may be amplifying our discomfort.
Then we need to activate our own healing mechanisms by firstly calming things down and reducing the prevalence of any lifestyle inputs- trying to improve our sleep, diet, increase or decrease our movement, engage in some stress resilience activities and generally improve poor habits. Now this may not provide an immediate difference to our aches and pains, but it will provide the platform for the body to feel less threatened, become more tolerant, and also respond better to any treatment that we may choose to have.
Back to basics to beat the back pain
If we are not getting our day to day basics right and reducing provocative lifestyle factors, how is someone else’s treatment going to ‘fix’ us? It’s like putting new wheels on a bicycle that has a broken chain! It doesn’t matter what wheels (treatment) we buy, our bicycle won’t function as we want it to unless we fix our chain (improve lifestyle factors).
A few treatments a week isn’t going to combat sitting hunched over a desk for 8 hours a day, 5 days per week, in a highly stressed state, eating rubbish food. However, if we apply a few basic tweaks to our day by getting out of our chair every 30 mins for 5 mins, clearing rubbish food from our work environment, and practising some abdominal breathing throughout the day, those treatments may seem far more beneficial!
On the subject of sitting, the Pomodoro Principle states that we are more productive by taking a short break after 25 mins of working, so break up your sitting every 25 mins with a 5 min walk or stretch, and become more productive at the same time! Now that’s a win win for your lower back and your boss 😉
Build things up to beat back pain
When we have made the lifestyle related adjustments to reduce any provocative inputs to our discomfort, we then have a platform to start building things back up (increasing our tolerance to pain).
Exposing the lower back to gradually more intense activities and exercise can help the sensitive nervous system become accustomed to a greater variety and intensity of movement. This may help reduce the fear of using our back normally and also improve endurance, flexibility and strength in the area. Stretching, strengthening, playing, any movements that are novel and gradually more intense than what we are used to. Even nudging into the movements that may provoke more discomfort can help us increase our threshold and tolerance of discomfort. Pain relies on context, so if we have a new context of being able to do more with our lower back, previously aggravating movements can become less threatening and painful.
Lower Back Pain is our ‘Call To Action’
As mentioned in my article- ‘Movement is Medicine for Lower Back Pain’, it is helpful to perceive chronic pain as a call to action. To take a look at the bigger picture and do something different with our body, as opposed to hand it over to someone else to try and ‘fix’.
This whole approach really embodies the concept of being an active participant in treatment as opposed to a passive recipient of treatment. Tending to the basics so that we give the body the optimal environment to feel better, and also probably respond better to any treatment we decide to have. Building our confidence and faith in our body so that we don’t fear normal movement and become less and less tolerant as a result.
20% effort for 80% improvement
Things may feel out of wack, you may have been told that things need adjusting and realigning, and you may feel as though you’ve done all you can to resolve your discomfort, but in the case of persistent lower back pain the most effective ‘fixes’ are administered by ourselves and everything else is complementary.
If you want to build a strong foundation of good health and create the environment for your body to feel better, the 31 Day Health Transformation will provide you with practical and effective steps to improve your nutrition, resilience to stress, exercise, sleep and mind set. It is often the first 20% of change that creates 80% of the results, so by making small sustainable changes, you can experience significant results.
As an Osteopath in Doha, I specialize in helping people address the causes of aches and pains, not just the symptoms, so for more help and advice on how to resolve your aches and pains, as well as improve your overall health, lifestyle and performance, get in touch, and in the meantime- Get Active!