Dr Victoria Chambers (Osteopath)
Has this happened to you? Maybe you were brushing your teeth, maybe doing some washing or just getting something out of the boot of your car. It was a small movement, a nothing movement really, but now, you can’t move and you have intense pain in your low back.
Why! I didn’t even do anything! You ask yourself what it could have been. Was it the gardening on the weekend? Was it standing around at that party all afternoon? Or maybe that long car ride? You rack your brain for what you could have done to cause this pain.
The likelihood is that it was none of those things. Or it was a combination of all of them. When there’s no clear mechanism of injury, the explanation tends to come down to all the things you’ve done as opposed to just one. Bending over to get the washing from the machine is not enough to cause any strain or damage to your back, that’s clear. Instead, we need to look at all of the small amounts of load placed on your body in the weeks, months or even years preceding this episode.
The role of your brain in pain
It’s your brain’s job to protect your body, keep you fueled, rested and away from anything that may harm your tissues. Pain is a necessary and positive protective mechanism, which is designed to change our behavior before tissue damage occurs.
We have sensory receptors all around our body which are designed to respond to stimuli (temperature, mechanical/load or chemical). When they detect such stimuli, they send a message to the brain via the spinal cord and the brain decides whether the stimuli is a threat that requires action.
The brain assesses how dangerous the situation is based on current and past experiences and the current situation i.e. how we’re feeling, what we’re seeing or if we’ve had this experience before. If the threat is deemed to be serious, the brain sends pain signals to stop your behavior. This is an easy task when the threat of tissue damage is imminent i.e. your hand accidentally touches a hot stove. The temperature is high and could immediately result in a burn and so your brain needs to get your hand away from the threat ASAP!
This is a good example of your brain protecting you from immediate danger. Your brain also protects you from more subtle dangers which can build up over time. A good example of this is the muscle soreness you experience after a big workout at the gym. This is your brain telling you that your muscles have worked hard and are fatigued. If you repeated this same workout every day for a week, it could result in a muscle strain. Your fatigued muscles wouldn’t operate as well and would be vulnerable to damage because they couldn’t stand up to the load. So, your brain sends down subtle pain signals, which register as discomfort to prevent you from repeating the behavior.
In the second scenario, you don’t need to feel acute pain, because the threat of tissue damage is not as high as in the example of the hot stove, but it’s enough that you feel soreness for a couple of days after your exercise.
What does this have to do with my back?
Remember earlier when I talked about load? Load isn’t just about squats or weights at the gym. Load can be any force or pressure which is applied on your body. Load can be active or passive.
Squats at the gym is a good example of active load. If you only did one type of squat and only that as your lower body exercise, then one set of muscles would become very strong and the muscles not being worked wouldn’t fire as easily. The result would be an unequal muscle load, which could, over time, be perceived as a threat to your brain because if the unequal load continued, it could result in tissue damage.
An example of passive load is prolonged sitting. When you sit for a long time in one position, it can result in unequal forces being applied on structures in your back. If you sit in the same way every day for months on end, you could end up with a lot of force being applied to these structures which your brain perceives as a danger.
These little bits of load individually aren’t enough to register as a danger, but when you add them all up over time, it becomes a potential threat to your brain. You may have had some warning signs, for example discomfort after sitting on the couch for too long, or excessive stiffness when you first wake up, but it’s likely these settled fast when your brain became distracted. More often than not, you didn’t notice anything preceding the big pain flare and instead you’re left wondering why you’re in pain after just brushing your teeth.
Once the big pain happens, you may not have any tissue damage, but your brain is protecting your back as though the threat of it is as imminent as your hand accidentally touching a hot stove.
So what’s next?
It’s important to say here that every case is individual and any time you experience serious pain you should consult a health professional. As a general rule though, if the action which resulted in the pain is as small as the ones described above, then you have very likely not done any major tissue damage, but the pain will be as real as though you have. It’s important to try to stay calm because any excessive stress or anxiety can make the pain you are experiencing worse.
Find a comfortable position and try to take some deep breaths. You can also try a heat pack on the area where the pain is at the worst and try some small, gentle, well controlled movements, such as dropping your knees from side to side, or a gentle pelvic tilt. At the end of this article are some links to these two exercises for your reference. If the movements shown are too painful, reduce the range to a manageable one.
You can also speak to your pharmacist or GP about anti-inflammatory medication which may help with the acute phase of the pain.
Finally, you can see your osteopath. Osteopathic treatment can help to settle the initial acute pain symptoms and you will be provided with exercises and advice to help manage the pain yourself. In the long term, your osteopath can help to identify some of the habits or biomechanical factors which could be contributing unequal loads on your body which could have played a role in the painful episode you are experiencing.
That’s a wordy way of saying that your osteo can help to make it feel better and hopefully, prevent it from happening again!
Here are a couple of exercises we love to give our patients who come in with this type of pain!