Back pain is one of the most common complaints seen in the health sector. In New Zealand 75% suffer back pain at some point in their lives. The UK quotes this rate as 80%. No matter how you slice it, the incident of back pain is very high.
With lower back pain many people will also experience limited use of limbs and other co-conditions such as depression, neck tension, and headaches. Changes in posture or gait will also create compensatory patterns in the body, and you can even find that things like ankle, knee and shoulder pain can occur through imbalances in posture by trying to avoid aggravating your sore lower back.
It’s a big minefield. This pain can lead us to anti-depressants, overuse of pain medication and for some people as sad as it sounds, will even resort to taking their own life.
Back pain is not nice. As a chronic back pain sufferer for 13 years I have been through the complete lows of where this debilitating condition can take us. Over time and through experience, education, research, trial, error and success and talking to every professional I could get my hands on I have become a bit of expert in this area and I’m going to share with you this holistic guide to lower back pain.
Your back pain is not the same as your friends back pain.
This is the first thing to know. The pathology of lower back pain (LBP) is complex due to its central position in the body and the nerve supply to and from the back and surrounding organs and muscles. You may have a bulging disc…your friend may be constipated, yet you can both have LBP.
A quick note about discs
Discs don’t “slip”, so the terminology of a slipped disc is incorrect. Think of your disc like a starburst lolly. Jellified on the outside (this is called the annulus) and soft and gooey in the centre (the nucleus). When we have disc problems, the interior of the solid jelly begins to rupture and the acidic goo starts to seep towards the outside of the outside. As this partial rupture happens it presses on the nerves of the spine, causing pain around the spine, but also referred pain to any thing else that shares that nerve pathway. When the jelly ruptures completely the goo seeps right out and the acidity irritates the nerve supply in quite a big way, this is very very painful.
The outer casing of the disc is connected to the vertebrae, so if by some chance you actually did “slip” the entire disc, chances are you’ve broken your back – This article is not about broken spines.
There are a few conditions that can affect the discs, this article doesn’t go into them – we are looking largely at idiopathic back pain.
Back pain and your lower digestive tract
You don’t have to be completely not going number 2′s to be constipated. If you have incomplete elimination, pellets, every second or third day or anything that isn’t daily and well formed and healthy, then you could be constipated. Constipation puts a huge strain on the large intestine, and anything that affects an organ will most certainly affect it’s nerve supply. You may be feeling your constipation in your lower back.
TIP: Eat a meal containing either corn or beetroot to assess your transit time. Beetroot will make your #2 red and corn will come out as undigested bits. See how long it takes for that meal to pass through you, and take note whether the same meal is still popping out the next time you go #2′s. You may also like to try a natural laxative remedy for no longer than a week to see if complete elimination improves your back pain. DO NOT use laxatives long term, this technique is simply to see if a clear colon makes your back feel better. If you are suffering from poor elimination function, then you need to seek sensible assistance with it.
Poor abdominal function and back pain.
The Inner Unit is made up of 4 key muscles; transverse abdominis, pelvic floor, diaphragm, multifidus and assisted by fibres of the internal obliques. This “box” of muscles tightens under load and acts as a natural weight belt. If any of these muscles aren’t firing well then other muscles have to compensate. This can pull the spine out of neutral alignment and cause…. you guessed it, pain.
This pain can come from a number of places: an over worked, over compensating muscle or it can come from torsion or shearing on the spine itself encouraging nerve compression and referred pain to muscles.
The best thing to do here is to get a proper postural assessment along with core function testing.
Poor Glute function
Squatting is man’s best friend when it comes to a healthy spine. But only if you can do it properly. A good primal squat (ass to grass) AND the ability to fire the glutes and abs to get you back up again is a great sign that you may not have too much in the way of back issues related to muscle control.
When we fail to use our glutes properly, just like our abdominals, other muscles have to compensate for the load and to quote a very old ad campaign here in NZ – “Don’t use your back like a crane”. Now, there’s nothing wrong with bending at the spine, after all, it’s quite capable of doing so, but if you lift entire loads with your back and absolutely no glutes then more than likely you are going to have back strain and pain. And you seriously increase your chances of actually damaging your discs.
I’m not going to get into the mechanics of lifting here, as it can get pretty complex looking at things like ankle mobility, lordosis vs kyphosis in lifting etc. But basically, if your back aches when you are doing something that should be using your glutes, then that’s a pretty good sign your glutes are weak. Try a pilates class. Some lifters may think this is girly stuff, but trust me, there are a lot of lifters out there who are ruining their backs thanks to a large ego that won’t let them lower the weight and go back to remedial Glute training 101.
In some cases a food intolerance will affect the lower back and it does this through a couple of ways. Firstly, an inflamed intestine caused by a not so happy food will affect the nerve pathways to the spine, just like in the case of constipation. Secondly, an inflamed digestive tract has the ability to shut down full function of the abdominal wall, and will affect the back as per the information on abdominal weakness.
Emotional stress and your spine
Stress is a physiological state that affects the nervous system amongst other things. When we become stressed, we get tense (whether we’re aware of it or not) and these tensions cause muscle tightness and also tightness in the brain and along the spinal cord. You may feel this tension in the lower back directly, or it can start somewhere like the neck or jaw and as your body compensates to stay in balanced alignment, the information feeds down the spine and can end up in the lower back…not to mention the hips, knees, ankles…anywhere! That lower back pain you have, may have originated a few years ago from a stressful situation and you may not know it.
It’s not just the organs that share the nerve supply with the lower back that can cause us back pain. Just like stress can start in the head, neck or jaw similarly organs higher up in the spine can cause imbalances and throw the posture or balance of the spine out.
Scarring, tight fascia and old injuries
An old acute injury can later present as chronic pain as part of the healing process. Let’s say we have an accident and fall on our tailbone 10 years ago, the initial injury causes inflammation which is the first stage in the healing process. As things heal they can develop scar tissue and thickening of the fascia. This tissue becomes rigid and has the ability to cause pain through many different mechanisms. This pain may not present for 12 months, and by that time we’ve completely forgotten about the original injury. It’s good to look at fascial release techniques, massage and spinal mobility exercises.
Excessive curvature in the lower back (lordosis), excessive curvature in the thoracic (kyphosis), forward head posture, sway back, spinal twists or side bends, valgus or varus knees internal shoulder rotations, scoliosis, crooked jaws, elevated or depressed scapulas…etc are all postural deficits (and these are only some of them) and can create further postural issues. Just like a game of Jenga, if its not balanced or stable, then it’s not going to hold itself straight.
Postural deficits create unequal loading on the spine, organs and muscles. I don’t think I need to explain any further that if a muscle, organ or spine is under stress then there is going to be pain. If you missed it, read the entire blog again.
Don’t isolate yourself
It is possible to have all of these things going on, or some of them. Very rarely will it be a simple case of one thing. Lower back pain is not a deficiency in painkillers or anti-inflammatories, so using these as a long term solution is counter productive to your health.
If you have chronic lower back pain, there is usually a way through it – if you’re prepared to think holistically and embark on the journey.
My top 3 recommended action steps to take are:
- Postural assessment, with glute and core function assessed
- Nervous system assessment (chiropractor or osteopath) and a good hard look at yourself and your stress
- Gut and digestive health
And from there, it’s up to you whether you will apply the key recommendations made to you. Your back pain is now in your control.