Why does your back hurt?June 6, 2019
People who suffer with back pain generally describe the same signs and symptoms as to why their back hurts. while the cause may be different, how it presents is often the same for people. Common signs and symptoms of back pain is pain in standing, pain with doing the dishes, raking, vacuuming or anything in the bending position. There can be pain when you get up in the morning, pain that wakes you up at night, pain with driving or sitting too long, pain with activities like running or exercising, pain with sneezing, pain with going from sitting to standing and many more those are just some common ones. The bottom line is that back pain can present in many different ways.
An important thing to understand is pain that is reproducible is reducible.
What that means is that pain, that you can cause, sit too long, stand too long anything that we described above, that pain that we can cause that we can reproduce, pain like that is reducible, meaning it can be fixed. If your pain gets better or worse depending on the hour of the day, then that is pain that is fixable. You may always have pain but if that pain gets better and worse with activities, then that pain is reducible.
This gives a lot of people hope, to know that not only is their back pain fixable but it is fixable without medications, drugs or injections.
There are 3 different categories on how people chose to handle back pain or any kind of pain.
- You ignore it
- You alter it or
- You handle it.
Most people fall on category 1 when the pain starts they just ignore it. Oh, this is just a spasm it will go away. I’m getting older I’m getting back pain. My dad had back pain so I’m going to have back pain so I’m just going to ignore it. Many of you may have said some variation of these things to yourself at any given time.
My rule is 2 weeks, if the pain doesn’t go away in 2 weeks then you see a doctor immediately to get it worked on, 2 weeks is enough time for something to resolve on it’s own. And if the pain is not occurring on a daily basis but you notice that now instead of spasms once every couple months, you have spasms every other week. This is a sign of a problem that is not going to go away on its own.
The second way people handle it is to alter it. Altering it means taking drugs, whether if it’s an epidural shot, or an over the counter medication like Advil or some heavier prescription drugs you are altering it, you’re not handling it, you’re not ignoring it. Now in altering it, you actually make everything much worse, because instead of ignoring it or handling it, you are changing the game. Your back will begin to come up with new movement patterns that will cause even more pain because it is trying to alter the pain. So the pain that was just in one spot, now grows to involved many other spots.
There are 4 main causes of back pain:
- Herniated disc
- Sacro Iliac joint or SI joint/ Pelvic pain and
Let’s first look at the Herniated Disc. So a herniated disc is also a bulging disc or a slipped disc, this can also indicate sciatica but sciatica is usually a catch all term for just pain going down the leg but could be from any cause. If there’s pain in your back, in your leg, pain in your butt, this is not a herniated disc. A herniated disc doesn’t cause pain, a herniated disc causes numbness and tingling. If I were to examine you and I touch spots on your back you won’t be able to feel anything, it wouldn’t irritate you if I was touching, it won’t bother you but you will still feel pain going down your leg.
This is common in the 40 year old category, who bends and picks up their kids the majority of the time. Bending and picking things up off the floor is some of the highest pressure you could put your discs.
70% of people who get an MRI get herniated disc have a herniated disc show up on the MRI. It doesn’t mean they have back pain, I have herniated discs I don’t have any back pain. So don’t be so quick to think that just because you have a herniated disc that is causing your pain.
Stenosis, is a narrowing of the spinal canal. The common sign of this is when you see someone who has to bend over the shopping cart or who has to bend over to walk because they relief. They will get immediate relief if they bend over the shopping cart or they sit down. I’m not talking about pain that gradually eases up the longer you sit or the more hunched over you are, I’m talking about instantaneous relief that occurs with sitting or bending over a shopping cart.
Stenosis usually involves pain that is going to shoot down both legs and it’s going to be pretty unrelenting so it will constantly be there unless you are sitting or hunched over a shopping cart.
SI joint or Pelvic Pain is one of the most common diagnosis people walk into my office with. “I have a pain right here” is most often what is said and described. This is not to be confused with “I have a pain in the butt” because a pain in a butt is different diagnosis. There may be pain all over the back pain but there’s one point right on the lower back that really bothers them. This is the SI joint.
With pain in the SI joint, nothing’s going to show up on an Xray or MRI or any blood test or any type of work up that you could do it’s going to diagnose this. This has to be diagnosed by a physical therapist who knows exactly what they’re doing because it’s not a definitive test, it is several different tests that need to be done.
Compensation. Compensation is not a direct reason that you have back pain it is not an actual diagnosis like stenosis or herniated disc but this is the number 1 people seek treatment for back pain and that’s because they’ve ignored it, altered it and now they’ve decided to handle it and by the time they’ve decided to handle it, the muscles have compensated for everything and now do not know how to function.
Compensation is when you allow your muscles to work differently. When your body feels pain, some muscles are going to work harder and some muscles are going to work a little less, which is how your body is designed to work, for a little bit. If it can stop you from feeling pain, then it will. The problem is, is that if the body uses the muscles differently for too long, it thinks this is how the muscles are supposed to work.
They start recruiting other muscles to help them out and this is a snow ball and it keeps going and going until your muscles finally exhaust themselves, and say ‘hey we can’t compensate anymore we’re all done here’ and then the pain can no longer be hid or compensated for an the pain goes from just being every few months to every week to every day. This is a very long process to get here and unfortunately a long process to reverse. In order to treat compensation, you have to get the knots out of the muscles, you have to then retrain the muscles on how they’re supposed to work.
The Number 1 way to fix back pain is posture.
Some people hear that and sit up as straight as they can and jam their shoulders back. And that lasts for about a minute and then it goes away until some random times a couple days later when something reminds them they should jam their shoulders back. But this sitting up as straight as you can is incorrect also.
Most people don’t have correct posture because their environment doesn’t allow them to have correct posture. If you have a desk at work and your monitors are off to the side and it’s not on eye level or you work off a laptop, you can’t have good posture. You have an environment that forces you to have poor posture.
If you work on a laptop you don’t have a way to have good posture, if you work on your smart phone for more that 15 minutes at a time, there’s no way you’ll have good posture, if you sit on your couch with your laptop at night and do your work, you can’t have good posture. In all of these situations you’re herniating your disc, you’re causing yourself back pain.
Posture is not just standing up straight, posture is not just jamming your shoulder back as far as you can. It is making your environment force you to have good posture. You want to make sure your low back has support and you should roll your shoulders up, back and drop them down. This is where your shoulders should sit. If you have compensation going on, maintaining your shoulder posture will be difficult. Within a minute or two of you intentionally dropping your shoulders you will find them creeping up towards your ears. You need to constantly set a reminder either on your computer or on your phone, to drop your shoulders until your muscles relearn not to be up near your ears.