Tag Archives: back pain

So I screwed my back again

I always like re -injuring my back, as it really helps me cut through the academic and medical bullshit.

Its very common for us to over sympathise with  and “forgive” back pain sufferers .

We should not.

Every single bit of “normal”  back pain  is self inflicted. (m not talking about the weird obscure stuff that effects  a teeny proportion of back sufferers). Im talking about our old friend , the non specific back pain stuff that is now costing the NHS loads of money.

Anyway , today  I pulled my back in gymnastics. Obviously i could go on a campaign: one that bans gymnastics, and  stops gymnasts from holding high office. Gymnasts should be rounded up and shot. Certainly banned from schools,

You will find lots of campaigns like this: Ban Crossfit, ban strength training, Olympic weightlifting . If you come across someone  trying to ban something, look at their personal involvement and see if their conclusion is reasonable. Being knocked down by a car, does not justify a ban on cars: iI may justify a lower speed limit, more education for pedestrians etc.

So, I screwed my back doing gymnastics? Well, actually yes and no. Here is the whole story.

1) over the last month, my focus has slipped. I found myself more and more in my slumping place, slumping. I have done no “good core” enhancing exercise. My hip and shoulder flexibility regimes have wobbled.

2) On wednesday I booked  myself quite a tough day: 3 hours driving ( I rarely drive) and 8 hours standing about ( i was an extra in film set)

3) On thursday, apart from one gymnastic training session ( 1 hour) i slopped around the flat. I slumped and hunched.

4) On thursday night, i had a terrible night: I got up late on Friday, and  after skipping breakfast I went to gymnastics. I did my normal 1 hour session 10  to 11), but as warm up and  planned to start my coached session straight after. I had felt my 1st back twinge at 10.50, but continued  after a quick rest.  At 11.10m, my  coached session began and at 11.20 a slightly wrong back flick, brought the pain flashing up. While I could still move. I stopped.

So here was the story. Id stopped all my recommended exercises and began slumping. In short, i wasn’t building up my back balance as Stuart McGill tells us to do, and I was “spending” back capacity like water. That said, I had still got through my basic “back buck spending” sport. and then, at the end of a terrible week, i thought i should push my luck by adding an extra hour.

I’m a pratt and  I deserve every scrap of pain!!

Get rid of your “slumping place”

Everyone has a happy place: part of your mind that you can go to when you are happy.

Some naughty children have a naughty step: where they are sent to “reflect” after being naughty.

Smokers have  a smoking place.

As someone with repeating back pain ( assuming its not a red flag or something more serious) I can pretty much guarantee that you have a “slumping place”

Its where you sneak off to and slump. The (normally) soft  cushions allow you to collapse your back, for hours as you watch TV or read or surf the internet.  In many cases the cushions have become moulded to  the  flexion based spinal curve that will make your back ache.

You feel it as you lie there ( slump/sit there). You know its bad for you, but, it feels so good.

Here is a picture of my slump place. I try to avoid it like the plague. I try and sit   on my wooden seat if i can , or if I want a nap or a lie down, the hard floor with appropriate lumbar support, but, BUT, if I want to guarantee to make my back hurt, this is where I will slump.

my slumping space
My Slumping Place

 

It used to be one of those reclining seats…. now its this sofa type thing

Maybe like me, you cannot actually throw it out: so be it, Learn to avoid it.

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Do you slump?

I fix the backs of sedentary people and of several elite athletes, also middle range  Crossfit athletes.

One thing Ive notice about those with bad backs is their ability to push themselves beyond the call of duty.  In fact they have the reputation of being hard workers, motivated and always on the go!

The reality is , once the doors are closed, they  can head for the settee and slump. For hours!!!! They can happily stay in bed if allowed, and they can be very , very lazy.

Hard ( some would say obsessive) work can sometimes be matched by back destroying  activity elsewhere.

Specific Causes of Back pain

Specific causes of back pain: some ideas from European Guidelines for the management of Chronic non specific back pain (2004)

There is  little relationship  between  low back pain symptoms, pathology  and radiological findings.

In 85% of people (Deyo 1988), pain has no relationship  to any time of physical abnormality.

*4% of people seen with low back pain in primary care have compression fractures

*1% have a neoplasm (Deyo et al 1992).

*5% develop at least one vertebral fracture in 4 years (Kado et al 2003).

Spondylarthropathies have been reported to occur at a rate of 0.8 to 1.9% of the general population (Saraux et al 1999).

Spinal infections are rare, and chronic spinal infections are particularly rare. Infectious diseases of the spine should be considered if the patient has fever, has had previous surgery, has a compromised immune system, or is a drug addict.

Spondylolysis and spondylolisthesis are often classified as non-specific low back pain because a considerable proportion of patients with such anatomic abnormalities are asymptomatic (Soler and Calderon 2000)

Back and leg pain after surgery represent a major problem addressed at specific conferences for failed back surgery.

Failure rates range from 5-50%. Based on a failure rate of 15%, it was estimated that 37500 new patients with failed back surgery syndrome would be generated annually in the US (Follet and Dirks 1993).

One of the causes that is consistently reported in the literature includes poor patient selection (Goupille 1996, Van Goethem et al 1997).

“This means that patients with non-specific back pain are operated on for radiologically diagnosed disc bulging, herniation or degeneration, which turn out not to be responsible for their pain.”

  • References
    1. Andersson HI, Ejlertsson G, Leden I, Rosenberg C (1993) Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain, 9(3): 174-82.
    2. Balague F, Troussier B, Salminen JJ (1999) Non-specific low back pain in children and adolescents: risk factors. Eur Spine J, 8(6): 429-38.
    3. Barash HL, Galante JO, Lambert CN, Ray RD (1970) Spondylolisthesis and tight hamstrings. J Bone Joint Surg Am, 52(7): 1319-28.
    4. Bressler HB, Keyes WJ, Rochon PA, Badley E (1999) The prevalence of low back pain in the elderly. A systematic review of the literature. Spine, 24(17): 1813-9.
    5. Cassidy JD, Carroll LJ, Cote P (1998) The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine, 23(17): 1860-6; discussion 7.
    6. Deyo RA (1988) Measuring the functional status of patients with low back pain. Arch Phys Med Rehabil, 69(12): 1044-53.
    7. Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain? Jama, 268(6): 760-5.
    8. Dickson RA, Stamper P, Sharp AM, Harker P (1980) School screening for scoliosis: cohort study of clinical course. Br Med J, 281(6235): 265-7.
    9. Ebbehoj NE, Hansen FR, Harreby MS, Lassen CF (2002) [Low back pain in children and adolescents. Prevalence, risk factors and prevention]. Ugeskr Laeger, 164(6): 755-8.
    10. Follet KA, Dirks BA (1993) Etiology and evaluation of the failed back surgery syndrome. Neurosurgery Quarterly, 3: 40-59.
    11. Goupille P (1996) Causes of failed back surgery syndrome. Rev Rhum Engl Ed, 63(4): 235-9.
    12. Hestbaek L, Leboeuf-Yde C, Manniche C (2003) Low back pain: what is the long- term course? A review of studies of general patient populations. Eur Spine J, 12(2): 149-65.

Experiment with Bracing?

One of the biggest confusions in “back pain” is the role of  abdominal muscles.

For years hard working doctors and researchers have attempted to assess the role and value and ideal type of abdominal engagement and training methodology. At the same time fraudsters and  charlatans have always sought to promote  and mystify the actions of an obscure muscle

There are 3 things you can do with your abs if you are standing up in a neutral position ( we need to talk about this concept too!)

1) You  can suck them in
2) You can “tighten” them where they are
3) You can “bear out”

Ill discuss these ideas in painful depth else where.

and now the research begins

Im actually very good at fixing backs. I look at them as a back pain sufferer, a fitness instructor, a massage therapist, a sports person , a hypnotist and an avid student of the many techniques and idea  published  both  in hard copies and on the internet.

However, when ever I fall in love with a theorist, like other practitioners, I go wrong. Of course all practitioners will claim that they assess what they see. I doubt this. We tend to view the world through lenses, and sometimes assume that identifying a problem, precludes the existence of other problems.Otherwise what the point of having a belief. Which Fan of Stuart McGill doesn’t go looking for a flexion based problem?

So, anyway, I was working with a client,and we began the process of fixing by looking at his life style , what he was doing, etc, and basically concluded that his issue was a flexion issue: certainly be benefitted from evaluating his squat form,  developing his hip and shoulder flexibility , grinding out some scare tissue , and building up his core strength and endurance, and realising how much he used his back.

Nevertheless as we came to the 3rd session we realised there was another factor at play. Strangely, like me,  he accepted that he stooped, but we traced his actual injury down to an over extension fault in the squat: he had attempted a squat with his torso bolt up right,  and obtained the extra flexibility the position demanded by over extending, and collapsing at his lumbar curve at the bottom:

so a couple of extra observation, based on his feed back and mine.

1) if you have back issues, the chances are that your perception of your back position if wrong: you simply dont know what the feedback means

2) Is it  possible to tweak your back by over extending and  flexing at the bottom. Yep, you can have both.

So, I started photographing lumbar curves in a toes touching position and noted that quite a lot of people have immobile lumbar areas in flexion: they  flatten, they don”t collapse ( see the montage).  is there a relation hip between the depth and quality of an overhead squat and the position of the lumbar curve in the toe touching position? If you don’t flex your lumbar spin, isn’t coaching you to make a big chest running the risk of an over extension injury. Do we now have a potential easy to do screen.

Im off to photograph lots of overhead squats and toe touches to see if there is some sort of correlation

Breathing:

if you have back pain you need to learn how to stabilise your spine . One of the hall marks of good stabilisation is the ability to both contract the abdominal wall and breath at the same time. Poor spine stabilisers, in effect, switch between bracing their spines or breathing. In short can you brace your abs ( not suck in!!) and continue to breath?

If not,  train yourself to breath freely while maintaining an isometric  contraction in the abdominal wall.

RED FLAG: Is your back pain “serious”

In many cases, careful management deals with back pain. There is however a species of back pain that  I’ll flag up to you now. The items listed below are “RED FLAG” symptoms which means see your doctor or A & E NOW;  go in and say , “I have back pain symptoms that I think are Red Flag symptoms”

  • fever of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • swelling in the back
  • constant back pain from which there is no position of  ease
  • Chest pain
  • leg pain
  •  a change in toilet patterns
  • numbness or tingling  around your bottom and privates.
  • pain that is worse at night

These are known as ‘red flag symptoms’ and could be a sign of something more serious.

That said, I was checking the NHS  website today (23/7/2020) and it made this  distinction

SEE YOUR GP if

  • your painkillers are not helping
  • the pain is no better after a month
  • a very high temperature or you feel hot and shivery
  • unexplained weight loss
  • a swelling in your back
  • the pain is worse at night

Go to  A & E or call 999

  • numbness around your bottom or genitals
  • cannot pee
  • lose feeling in 1 or both legs
  • cannot control when you pee or poo
  • got it after a serious accident, such as a car accident