Battling back from back pain

Persistent lower back pain is something a majority of people will suffer from, but help is at hand as Sophie McCandlish reports.

Back pain is a common problem, which will affect around 80 per cent of us at some point in our lives.

The vast majority of cases will be a persistent lower back pain which has no identifiable underlying disease, classed as ‘non-specific’. But there are things you can do to alleviate back pain and help recovery.

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There are a number of clinics in Leeds which specialise in treating back pain, offering physiotherapy, chiropractic and sports massage services as well as advice on exercise, while NHS Leeds has published a guidance sheet for sufferers which not only includes exercises but stresses the importance of staying active.

Staying active is a key point stressed in a new book on dealing with persistent lower back pain by two medical professionals.

In Back To Life: How To Unlock Your Pathway to Recovery, Dr Grahame Brown, a consultant in persistent musculoskeletal pain, and David Rogers, a physiotherapist who specialises in spinal pain, said we 
need to rethink our whole approach to back pain.

The authors said it can be natural for people with persistent back pain to avoid being active for fear of making things worse, but often, this can be counter-productive.

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People are commonly given very negative and unhelpful messages about their back, such as ‘your discs are crumbling’, which will naturally make them perceive their back as weak or damaged,” said Mr Rogers.

“These messages aren’t based on any reliable scientific evidence. Disc bulges or degenerating discs and many of these negative labels people are given are just as common in people without back pain.”

“It is really important to understand that the body repairs itself from injury within a few months at most.

“For a variety of reasons, the volume dial for pain in the nervous system remains set at a high level, and although it feels like the tissues are still injured, it is highly likely they are not.”

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“For a long time, health professionals have believed persistent pain is due to a long-term injury that hasn’t healed.

“People will have been told this and naturally assumed it to be correct,” said Mr Rogers.

“However, more recent evidence, particularly in the field of neuroscience, has helped us to understand that ongoing persistent pain has less to do with actual ongoing injury and more to do with the sensitivity of the nervous system.”

Many biological changes happen when back pain is experienced involving the central nervous, endocrine and immune systems, plus musculoskeletal areas.

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One example is in the sympathetic nervous system. An initial back condition or injury prompts the system to release adrenaline in response to the pain threat as part of the body’s danger-alert system, leading to muscles tensing as the body prepares to fight or flee.

While helpful in the short-term, if the response remains switched on, the continuing muscle tension can contribute to persistent pain, leading to muscle cramps, prompting more danger signals to be sent to the sympathetic nervous system, ultimately resulting in a “vicious cycle of pain”.

In addition, the endocrine system may release cortisol when the danger-alert system is switched on, diverting oxygen to the muscles so we can flee if necessary.

If cortisol levels are elevated for a prolonged period, problems including poor sleep, fatigue, depression and poorer physical performance can occur (all of which, again, contribute to chronic and greater perception of pain).

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When sensors in the back keep sending danger messages to the spinal cord, the nervous system creates more danger-alert neural pathways.

“The result of this is that your pain experience becomes stronger, and your back starts to hurt even more.”

Fear of causing further damage means people often avoid physical activities they previously enjoyed and may even stop working which can be detrimental for their mood and quality of life which can actually delay recovery.

Dr Brown and Mr Rogers, who both work at Birmingham’s Royal Orthopaedic Hospital, said when back pain persists for more than a few months and various treatments have had limited benefits, research suggests that focusing less on getting rid of the pain and more on getting back to meaningful activities leads to better functioning and quality of life, and less pain.

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Activity should be gradual and, they warn, expect to feel worse initially. Don’t overdo it, and review your plan weekly.

NHS Leeds guidance leaflet can be found at leedscommunityhealthcare.nhs.uk

If you are looking for a private physiotherapist ensure they are a qualified member of a recognised professional body such as the Chartered Society of Physiotherapy csp.org.uk and registered with the Health and Care Professions Council.

Back To Life: How To Unlock Your Pathway To Recovery is published by Vermilion, priced £12.99.

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