• Julia Trollip

“I’ve got a bad back!”

This is a statement I hear so often, and I must be honest, on assessment I regularly find that you appear to have a very resilient, but probably, fatigued back.


“Why is it so sore then?”, you ask.

“Because you’ve been using your back more than your hamstrings (or glutes, or calves, or abs … you get the drift) or due to a lack of mobility elsewhere, or even the legacy left from an old injury and the belief around that.”


“But I’ve been told my back is out or my Sacroiliac Joint is unstable!” Or “The MRI showed I have degeneration of my spine and I’ve been advised to stop doing ‘X’!” (As examples.)


Your back bones or vertebrae can’t just pop out. Many studies have shown people with no symptoms were found to have conditions such as degeneration or disc bulges when they had an MRI.


It's time to change the narrative


We really need to change the narrative we use when it comes to pain and injuries. Being told one has a bad back can lead to caution or apprehension, fear whenever it tweaks and an avoidance of activity to prevent any further damage. Often the way a diagnosis or a medical report is explained can cause a person to fear their condition or lead them to believe they are in danger, or that they have to adapt their lives and live with this new sentence. This can lead to feelings of concern, hopelessness, anxiety and the like, and can have a massive impact on quality of life, activities, work and relationships.


Finding the root cause


We also need to make sure we are treating the root cause and not just the symptoms. I recently saw someone share on social media that they have found a brilliant therapist and they now only need to have their back treated every few months. Previously they were going monthly and have done so for the past decade. Yes, you read that correctly… 10 years! I really must question whether the root cause had been identified or whether they were treating the symptoms and keeping pain at bay.


As Gabor Mate says, ‘Diagnosis describes things, it doesn’t explain things.’ This links in with treating the symptoms or ‘the bad back’. Two people may present with exactly the same symptoms of a sore back but one may have had an ankle injury in the past whereas the other could have had an ACL reconstruction. Two totally different injuries but both have resulted in a ‘bad back’.


In both the ankle and knee example, the people were likely protecting the tissues around the ankle and knee and therefore their backs were working harder to pick up the slack. Ultimately, each part of the body should do its portion of work but when an injury occurs, one often compensates to protect the area of injury and this can then lead to disparities in load. Our bodies have an amazing ability to compensate but once they have exhausted all the options for compensations, even a small stress can then cause a severe reaction.


Identifying pain triggers


By understanding the root cause of your back pain and by identifying your triggers, as well as what it is you would ultimately like to be doing but cannot currently because of your pain, you can work towards having a ‘good back’. Important to also realise though, is that when someone has an old injury (root cause) which has led to a compensation which has then led to a ‘new’ injury, which has perhaps been rehabbed to some degree to then develop another niggle and so the cycle repeats itself, the picture can become blurry. Therefore, I feel it’s important to look at the body the way it moves, as a whole and to ensure that all the bones, joints, ligaments, tendons and soft tissues are working together as they should to ensure that the person can function as optimally as possible.


For some people, emotions (sadness, loneliness, stress) can trigger pain. For these people, it is important to make this connection and put in place strategies to help. So many people use words such as terrified, scared, anxious, stressed out, hopeless when they describe how their pain makes them feel. They tend to catastrophise pain and this keeps them in a negative loop. By putting strategies into place such as, for example, doing nasal breathing during an exercise they may perceive as dangerous, this can help shift their focus and also allow them to make progress with the exercise. Hopefully they will then begin to reprogram their beliefs around the movement and be able to progress with their rehab.


Back in action


It’s also important to know exactly what it is you want to get back to doing and to then have a plan unique to you that will get you back to that. For example, if you would like to get back to playing tennis without your back kicking off, it’s important to make sure your rehab includes rotational movements and movements that your body will be exposed to on the court so that you learn how to move.


Pain is a very real experience, but I think it is so important to change that narrative and understanding around pain. Chronic pain is often linked to complex systems. It’s also important to realize that complex systems are not linear and therefore their behaviour is likely to be irregular. Several factors can increase or decrease pain and some days may be better then suddenly worse before being fine again. By understanding what your triggers are, what your beliefs attached to your pain are and by challenging them, you can empower yourself and work towards overcoming your pain and removing the label ‘I have a bad back’.


If you are suffering from chronic pain or problems with mobility, contact us today.

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