Search for back pain relief on the Internet, and you will find a common theme: back pain is self–limiting, meaning it will resolve on its own, typically within 2-8 weeks. Most standards use pain as the indicator of how well you are doing. You’re not doing so well if you feel pain. On the other hand, you’re “healed” if you don’t feel pain. Pain itself is a terrible indicator of how well you are recovering following an injury. When it comes to the most common injuries affecting the back, pain is usually the last thing to show up, and the first thing to go away.

So, why it is more common for low back pain to stick around than it is to just go away?

1. Changes to the nervous system or neuroplasticity.

Neuroplasticity is so important. It forms the basis for how our nervous system learns, and it is involved with everything from learning how to play a musical instrument to playing a new sport. Neuroplasticity is also involved when it comes to injuries that have resulted in chronic pain. Our nervous system changes when we are injured. In some cases, our brains stop “seeing” the area that was injured, leaving parts of the neural circuitry to wither and die. Studies conducted by Tsao et al, have revealed that patients experiencing low back pain have reduced neural drive from the brain to the muscles around the low back. The importance of this is that it means that your back muscles become weaker and unable to support your spine regardless of whether you feel pain or not. Consequently, the link between the neural signal and muscle contraction is altered following injury.

2. Deconditioning.

Low back pain can result from many different things and damage can occur in many different structures in the low back area. The good thing about treating back pain is you don’t need to know the exact area of damage to properly target a solution. This is the benefit of using movement to heal an injury. You can’t move without engaging and nourishing all of the different areas of the back. Targeted bodyweight training provides one of the best stimuli for getting the back and the muscles supporting it back in action and working together as a team.

Unfortunately one of the common myths surrounding back pain is that you need to rest for it to get better. This simply isn’t the case and can often lead to increased likelihood of having your back pain last longer. Deconditioning, or lack of activity, is also a key reason for the breakdown in the body’s ability to control and withstand the stresses imposed on it. Preventing deconditioning in key muscles tasked with supporting our posture and stabilizing our joints is fundamental to preventing injuries from occurring in the first place. Evidence has shown that poor endurance (deconditioning) in the back muscles is a risk factor for developing low back pain as well as a consistent finding in those currently suffering low back pain.

Exercising and keeping our weight down with a healthy diet are two obvious ways of addressing some of the common underlying reasons for knee pain but are our lifestyles themselves partly to blame — and should we be looking at this issue more seriously?

Modern Lifestyles

There is very little debate: these days we eat more processed food and sit more than we used to.

Whether it is one of these factors in particular or a combination of both, that are the leading cause for the growing numbers of chronic health problems we are seeing everywhere in the world today (in industrialized and developing countries), depends on who you ask. But most will agree there is some connection.

The Lancet journal recently named physical inactivity as responsible for a similar amount of deaths around the world per year as smoking. Chronic diseases we are all familiar with like heart disease, diabetes and certain cancers have all been conclusively linked to physical inactivity.

Chronic lower back, neck, knee and shoulder pain are all on the rise too, as evidenced by the sharply growing amounts of over-the-counter and prescription pain medications purchased in developed countries.

I believe the connection between lifestyle and chronic health conditions is stark and it is actually of pandemic proportions – being the single most serious health problem that affects us today, and one that crosses international borders without prejudice. The growing middle classes of India and China, for example, are suffering from similar chronic problems to those on the rise in the US, the UK and Australia.

Sedentary Office Jobs — The Changing Nature of Work

Most people aged between 18 and 65, in developed countries, spend 35 to 40 hours per week at work.

“Work”, for many, increasingly means an office as opposed to a place of manual labor — as it is for farmers, some factory workers, outdoor labourers, tradesmen, etc. It stands to reason, therefore, that workplace activity levels have fallen correspondingly.

Offices are still seen as places that need to support our presence for eight or nine hours per day, even though communication has become increasingly mobile and we no longer need to sit by a filing cabinet to access the papers we need. Offices are not designed to include the necessary physical activity in our daily lives.

To deny that this would have an effect on our bodies after a while, is naïve and disregards the biology of human movement. In short our bodies have evolved to move and it is only in the past forty or fifty years that they have become increasingly sedentary.

At a time when diets have also changed from natural–based foods to mass-produced and processed foods, this is a double whammy for our bodies — and it is being played out before our eyes in declining health.

“Office Knee”

To put the focus back on knee pain, there is evidence to suggest that too much sitting in itself can contribute to knee pain — so much so that there is a condition popularly referred to as “office knee.”

A recent study by Nuffield Health in the UK found that more than a quarter of the UK workforce between the ages of 16 and 65 suffers from knee pain, with people over the age of 55 suffering the most. One in ten questioned said they are in constant pain.

This means that a quarter of the population is prevented from living a normal, active life, doing all the things they want to do. It may not be life threatening but they are restricted by their pain and one in ten severely restricted, even in basic mobility.

The obesity epidemic places extra strain on the knee joints which can lead to osteoarthritis. In addition to this, without the necessary strengthening activity and a nutritious diet, people are dragged into the cycle of pain because of deconditioning, which weakens the support mechanisms of the knee.

It seems we need to fight a little bit harder to stay active these days, and to reap all the benefits that our body gets from a more active lifestyle. Just some small changes can make a lot of difference though — it doesn’t require 10-mile road runs, which can put their own strain on knees and ankles.

Sitting less, walking more and strengthening your knee may seem like hard work for many to fit in to an already hectic lifestyle, but what’s the alternative? Be the next patient waiting in line for a knee replacement operation? Or worse?

What are you doing to try and get more activity into your life?

A study by researchers at Northwest University in Seattle found that people have a strong influence on the duration and intensity of their pain depending on the way they perceive it.

Over the period of a year, they used brain imaging technology to examine 39 patients with back pain; they were able to predict, with 85 percent accuracy, who would be pain-free and who would still be experiencing pain.

How is this possible?

Where the scans indicated a powerful connection between the nucleus accumbens and the prefrontal cortex, suggested a strong emotional attachment to the injury. This is often the case when patients have a particularly negative or fearful attitude towards their pain. We actually don’t perceive pain until it reaches our brain, the signal carrying the painful stimuli are spread across the brain to different areas. The more we worry about our pain, the more likely it is that the pain will last and possibly get worse.

In this study it was predicted that patients who worried more about their pain, would still be feeling pain at the end of the study period – and in most cases this was what happened: acute pain turned to chronic pain.

It was also found that depression and anxiety could contribute to acute pain becoming a chronic condition. It has long been known that these conditions can be very debilitating, but a direct link to the chronicity of pain is a breakthrough. This was the first study to provide clear, scientific insight into why different patients, who experience the same type of pain, either make a full recovery or end up suffering with chronic pain.

In practice I’ve seen this a lot. I can have two people with the same complaint and one patient is in agonizing pain while the other is only slightly bothered by their condition. I think this study may shed light on why athletes can often subject themselves to high levels of physical stress, that results in pain, but will often work through it without consequence. Athletes are highly motivated to move forward and overcome their injury. This study provides evidence of how important it is for people to stay positive when experiencing an injury.

The leader of the study, A. Vania Apkarian, Ph.D. said:

‘The injury by itself is not enough to explain the ongoing pain. It has to do with the injury combined with the state of the brain.’

The chief of the pain management division at Stanford University added this:

‘Those who had more fear during an acute low back pain episode were much more likely to ultimately over-predict the amount of pain they had, which ultimately led to significant increase in fear-avoidance behaviors, with subsequent worsening of symptoms, increase in duration of pain, and increase in disability.’

Our perception of what the pain means to us can be more important than the actual level of damage in determining if you will get chronic pain.

Henry Ford once said “whether you think you can or you think you can’t – you’re right.”

This seems to apply to overcoming pain as much as it does to achieving goals in life, and forms the basis for why I have many of my chronic pain patients write a pain-free journal. A pain-free journal is about identifying the things you would do if you were not in pain. It is also about making “pain-free” a goal and breaking it down into small tasks, like you would other goals. Let’s take going on vacation as an example, you wouldn’t just say, “I’m going on vacation” and not do any planning to actually make that happen. Yet often we fail to do such planning for our health.

If you are optimistic about overcoming your pain something happens in your body that seems to help you along – and you will also take the necessary health steps to get there, like starting an appropriate exercise program and getting on to a healthier diet or losing some weight. If you are defeated in your mind before you set out, the reverse seems to happen, your temporary pain may turn into something more permanent.

As many of you know, I am a huge advocate of exercise and movement for helping people overcome their pain and prevent injuries. If you are injured you need to have a plan in place to help with recovery. Combining a great body weight program with some aerobic exercise will benefit you in several ways, it will help you get in shape, it can help break the cycle of ongoing pain and improve your mood.

If you are suffering with chronic aches and pain, try writing a pain-free journal everyday where you visualize and then write down how you would be living your life if you were pain-free. Then try to take one new habit, like daily walks or better nutrition, and see if you can stick to it for 21 days. Let me know how it goes and if there is any way I can help.

What is the difference between rehabilitation and conditioning? This is a question I am commonly asked in clinical practice. With the popularity of things like “functional training,” the defining differences between rehabilitation and conditioning can become blurred. Traditionally, rehabilitation is used to help you restore function that has been lost due to an injury. Conditioning is about improving function beyond your current level. The key differentiation is restore (rehabilitation) vs. improve (conditioning), which opens up a lot of interpretation by both the rehabilitative and conditioning community. Both rehabilitation and conditioning have certain “rules” they have to follow in order to achieve the intended outcomes. There are two rules that I feel are the most important when it comes to achieving results with fitness or rehabilitation programs, specificity and frequency. If you have stalled in your progress it might be worthwhile for you to look at both specificity and frequency to see where you have gone wrong.

Specificity

Specificity means you have to target what you are trying to achieve and then provide the right stimulus to the body that matches that objective. For example, if you wish to improve your conditioning to do something for a long time, like ride a bike for multiple hours, you would need to focus on endurance training. More specifically, if you wanted to become a better runner, your conditioning program would have to include running. If you wanted to get better at chin-ups, you would have to include chin-ups in your program.

This is where people often get confused, and sometimes end up having to do a rehabilitative program because they get an injury by not understanding the rule of specificity. Any time we try something new we run the risk of getting injured. If you are a great cyclist and you are super fit, you can’t just jump into running full blast without risking injury. You may be a great runner while running on pavement, but you can’t just go and run the same distances on the beach during your vacation without increasing your chances of getting hurt. This all comes down to specificity. Our bodies adapt to what we are subjected too.

When it comes to rehabilitation, specificity is about identifying what exactly is not working or is in a state of dysfunction and then doing the right types of exercise to help stimulate improvement. It also becomes about being specific in targeting the area that needs to be rehabilitated. For example, if someone was experiencing chronic knee pain  and they were just given exercises for the muscles crossing the knee joint, they may end up frustrated by a lack of progress. This is because the muscles surrounding the hips, as well as the muscles controlling core stability influence the knee. If you ignore these important muscles groups, knee pain will not resolve. So in this case, rehabilitation is about reinstating function and then conditioning would follow which would be about improving function.

Frequency

With respect to conditioning, if you are the type of person that constantly changes your workouts, you may be limiting your overall chances at reaching your fitness goals. The body needs a certain amount of repetition in order to stimulate lasting change. If you are trying to become a better runner or cyclist, the always-changing training sessions you are doing may reduce your boredom, but are not helping you strengthen your body in a meaningful way. One the positive side, you end up with an exertion effect, like burning calories, but you don’t spark adaptation in which your body would undergo changes in performance.

We have to do something often enough to evoke a change.  The often-cited guidelines for physical activity miss the mark with their recommendation of strength training 2 days a week. I know anything is better than nothing, with only around 20 percent of people meeting the minimum guidelines for physical activity these days.  But if you want to create a change in your body, you will need to stimulate your body towards that change at least 3 times a week. This is what the evidence supports and this means if you are doing some sort of strength training, you really do need to make it happen at least 3 times a week.

So as you can see, specificity and repetition are very important for both rehabilitation and conditioning.  Let’s look at an example to highlight the importance.  Let’s say you wanted to train for a marathon and I told you I had the perfect program for you. My program is state of the art, because it doesn’t involve any running. Instead we are only going to swim. Swimming is cardiovascular in nature and so is running and you get to avoid all of the impacts associated with running. Would you have a good marathon following this type of program? Of course not and the reason is because of the lack of specificity. What happens if I then tell you that I have revised the program and beg you for a second chance and you agree? This time we are going to run, only we are going to run once this week, and then maybe again next week, then a couple more times a couple of weeks after that. Would you have a good marathon? Once again you would fail to reach your goal. This time we were specific but we lacked enough repetition to stimulate the right adaptations for improvement to occur. I see this a lot in both conditioning and rehabilitation programs. In fact it may be the reason behind why are not reaching your goals. Whether your goals are to restore function or improve performance, specificity and repetition are crucial components to a well-designed plan.  Take a look at how your current plan is structured and ask yourself, “am I providing the specific stimulus, frequently enough, to tell my body to adapt in order to achieve the results I’m hoping for?”

Pain is a very complex issue and one that we still do not fully understand. Over the past few years, with advancements in science, we have been able to learn more about pain than all of the previous years combined throughout history. What we are learning is amazing and will hopefully help millions in their battle against chronic pain conditions. We now know that pain is not just a subjective “feeling.” To better understand pain and why you may have it, we should first understand how it is generated. Pain has 5 main components that contribute to you ultimately experiencing it.

1. Trauma

Acute pain processing begins when potential or real injury from thermal, chemical, or physical sources stimulates special nervous system cells called nociceptors. Nociceptors convert the initial stimulus into an electrical signal that, if strong enough, provokes a response in the nerve endings that ultimately begins your journey toward pain. Trauma also triggers damaged cells to release inflammatory substances that increase sensitivity to pain.

2. Conduction

Once the initial stimulus is converted into an electrical signal, that signal is then conducted to the spinal cord on very specialized neural pathways that only carry the signals that will eventually become “pain.”

3. Transmission

As the signal is conducted from the spinal cord to higher brain centers, it must pass certain junctions along the way. At each of the junctions, the electric impulse is transmitted to the next chain of neural highways to allow the journey to continue.

4. Modulation

Modulation is the process by which the body tries to filter or dampen the level of electric signal reaching the higher brain centers. The less impulse making it to the brain, the less pain you will feel.

5. Perception

When those electric signals finally reach the brain, they are spread to various areas of the brain leading to the perception of pain. For this reason, pain is experienced differently for each person, even if the injury is exactly the same. This demonstrates that the perception of pain literally is in your head, but that in no way diminishes the reality of how debilitating pain can be to the individual experiencing it.

Understanding that the perception of pain is in the head will help build pain management treatment plans that require a combination of behavioral and mental techniques. Both health care providers and chronic pain patients need to be aware of the complex mechanisms involved and a successful treatment requires an active partnership between the person in pain and the medical staff guiding his or her recovery.

Our brains control our bodies, but our movements can reshape our brains.

I remember sitting in a psychology class just a few years ago (give or take a decade) and being taught that the adult brain was fixed. Meaning it could not generate new cells or change, so if you have an area of the brain that ends up with damage or injury you can pretty much kiss it goodbye. Amazingly enough over the last few years we know that the brain has tremendous capacity for change. Thanks to the efforts of educators like Dr. Norman Doidge, people are beginning to understand how our environment, thoughts, food and physical activity can change our brains.

“Neuroplasticity” – The Good and the Bad

The human brain is incredibly adaptive. Although we have yet to unlock it’s true power, our mental capacity alone is apparently limitless. The brain’s ability to change in response to the different stimuli is known, in the scientific community, as “neuroplasticity.” This special characteristic allows the brain to constantly adapt or learn by creating new pathways for neural communication and to rearrange existing ones throughout life. This ability allows humans to memorize new facts, master new skills and form new memories.  Because of the brain’s neuroplasticity, we are able to overcome brain injuries and cognitive disorders.

The gift of neuroplasticity is not all-positive news, the brain is just as vulnerable to negative external influence as it is to positive ones. The experience of chronic pain is a process that occurs due to neuroplasticity.  Not unlike learning how to play the guitar, the learning involved with experiencing chronic pain allows the nervous system to perceive the sensations of pain on an ongoing basis and with more efficiency meaning that it will sense pain at lower thresholds.  This complex phenomenon occurs via an orchestrated effort of many different structures and types of cells within the nervous system.

Low Back Pain – Movement as Medicine

The good news is that neuroplasticity is also bidirectional meaning it can work in two directions.  Neuroplasticity is involved with deleting old connections, if you don’t use it you lose it, as well as enabling creation of new ones.  When it comes to such things as chronic aches and pain, neuroplasticity is helping guide new and innovative exercise and rehabilitative programs.

With “directed movements,” the scientists and clinicians behind the FPR programs can deliver calculated sequences of input, and specific repetitive patterns of stimulation through movement, to cause desirable and specific changes in the muscles that have been traumatized as well as the brain itself. The concept of training the brain and the body simultaneously helps turn movement into medicine for many individuals suffering common ailments such as low back pain.

The notion of movement being a foundational component of human health is evolutionary, not revolutionary.  We have evolved with the basic human biological need to be active.  We are now learning that activity, and more specifically, movements that simulate learning a new skill can help reinstate health to damaged tissues as well as promote positive changes in the brain.

2 Exercises to Try at Home

An example of an exercise that simultaneously trains your brain as well as targets the key muscles involved with low back pain is the Quadruped Kick back.  This is considered a foundational exercise that will strengthen your core and low back muscles. It provides the basic foundation for other more complicated Quadruped movement patterns.

Another great strategy to train your brain using movement, that super easy to add to your daily routine, is standing on one foot while brushing your teeth.  This helps to stimulate the pathways involved with maintaining your balance as well as working key muscles involved with maintaining your posture and the support of your spine.

The key to each of these exercises is where they are structured within your overall plan and how often you are doing them. Change only occurs in response to frequent stimulation so we typically advocate performing such moves at least 5 days a week.

Nobody argues about how important a good night’s sleep is; though that can be more of a distant hope than a realistic expectation for many sufferers of low back pain.

It is a condition that troubles most people at some point in their life and is one of the leading reasons for days off work in North America – many cases actually caused by job-related tasks. Yet few people appreciate how acute or chronic low back pain can permeate into many other areas of our lives, if not addressed.

What is Low Back Pain?

Lower back pain can result from a number of causes:

1. Aging – as bone strength and muscles weaken, the backbone discs can lose strength and their capacity to cushion the vertebrae decreases
2. Injury – for example, when people lift heavy objects without due care, the resulting overstretching can cause sprains, spasms, ligament damage or bone problems.
3. Nerve Problems – serious injury like ruptures or extreme strain can create pressure on nerves leading to serious pain
4. Disease – especially arthritis, osteoporosis, other bone diseases or diabetes
5. Lifestyle – extreme weight gain, smoking, stress, poor posture or lack of exercise can induce or worsen back pain

What’s a Lost Night’s Sleep?

For many ailments, rest and sleep is a great comfort and helps the healing process. Many people experiencing back pain will only have to suffer a night or two of lost sleep before the pain dissipates.

For other sufferers the problem can be more serious and can lead to other issues.

If someone is not able to get to sleep because of back pain or has their sleep interrupted by it, they do not achieve the therapeutic rest that we all cherish; and, in turn, this can make the waking hours at work or at home a misery too; lack of rest can lead to lethargy, lack of energy, lack of mental clarity, depression and anxiety – all of which have complications of their own.

As sleep gets altered, pain increases, which further affects sleeping patterns creating a vicious cycle.

At least if we can sleep we have some break from the pain we are suffering.

Getting Better Rest

Typical approaches to improving sleep, when experiencing low back pain, range from addressing the sleeping environment to more serious measures that address the actual back pain. These include:

• Improving sleep posture
• Updating your mattress
• Using corrective exercises to alleviate sore and achy muscles and joints before going to bed
• Engaging in meditative and breathing related exercises

The method you choose will probably depend upon the severity of the pain you are experiencing, as well as which other measures you are taking with your healthcare provider, according to your diagnosis.

We will talk more about this in future articles. Meanwhile if you have any experiences about low back pain and how you have alleviated it, please leave a comment below and share it with us.

Injuries are common in the lower back area.  Most of these injured back cases are from attempting to lift something with poorly conditioned core muscles and bad posture.  Back injuries can also occur from uncontrolled movements due to weak spinal stability and control. Back strain is a general term that is often used when one or more of the back muscles that are involved with moving the spine are injured. There are three classifications of a strained back; first degree, second degree, and third degree.

1. First-degree strains are the most common and come from minor tearing and over-stretching.
2. Second-degree strains are partial tears of one or more of the back muscles.
3. Third-degree strains have complete tears and can include swelling and spasms.

Symptoms of a “strained” back include stiffness, cramping, or spasms in the area of the strained muscle. In significant cases there can even be nerve damage issues that can lead to leg pain, numbness or weakness in the extremities. The pain can be dull or sharp. The pain can come from inflammation, which can be a result of the injury, or it may come from small muscle tears.

There are many natural ways to treat back pain. The use of ice, heat, and corrective exercises that reinforce specific movements will help you build stability and control in your back. Corrective exercises are effective at both getting you out of pain, and keeping you out of pain.

These natural solutions for back pain are good for those who are trying to reduce their reliance on medication or for those who are unable to take pain medication due to allergy, liver or kidney problems. Lifestyle changes including trying to improve your posture, taking microbreaks at work and eating a balanced diet with an increase intake of omega 3 fatty acids all aid in reducing your discomfort associated with low back pain.