The role our beliefs play in our experience of pain is pivotal.
Lower back pain is something that affects most of us at some time during our lives.
For a lot of us it will pass and we may never experience it again. For some of us it may pop up every now and again, and for the unfortunate among us, it may become a permanent pain in our lives (excuse the pun!) So why do we all have different experiences?
First of all it is important to distinguish between two types of lower back pain, namely ‘specific’ and ‘non-specific’. Now of those who experience back pain, only 5% will have what we call ‘specific back pain’. That is to say they have back pain because a specific structure in their backs (a disc for example) is responsible for their pain. This type of back pain is very rare despite a lot of us naturally assuming this is why we experience back pain.
Conversely the second and far more common type of back pain is called ‘non-specific’. This pain is not the result of a problem with a specific spinal structure but instead can be caused by a variety of factors. These include our posture, our movement patterns, our level of conditioning, our stress levels, our mood, our sleep quality and lastly our beliefs.
The beliefs we hold about why we experience back pain will significantly influence our pain experience.
Let’s look at two different scenarios to illustrate this:
Firstly a lady with non-specific back pain believes that her pain is a result of her disc ‘slipping out’. Every time she moves she visualises her disc pushing further and further outwards. So what does she do? She stops moving naturally. When she does move she does it in a very different way. She holds her breath, braces herself for every movement and always keeps her back straight. Her fear levels are sky high, as she worries about how she will cope financially, if she has to stop working.
Now take someone with exactly the same spine. However when this person experiences pain it does not concern them. Instead, rather than attributing it to a structural cause they attribute it to the high work load they have taken on recently, their poor posture or general lack of conditioning. They imagine their pain will go soon, the pain does not pose any threat to them and as such they might take it a bit easier for a few days but on the most part they continue to move and function in the same way perhaps with some over the counter pain relief to take the edge off.
Of these two people (who structurally have exactly the same spine), one may have a week long experience of back pain and the other may well have ongoing pain for the rest of their lives. Why? Because how we understand our pain will affect how much of a threat we perceive our pain offers us and therefore how our body responds.
Now it is important to understand that this does not mean the first lady’s pain was all in her mind! On the contrary all pain is 100% real. However the threat level we associate with our pain will in turn influence not only the amount we move and the way we move (both of which can work to prolong pain) but also the chemicals that are released in our brains resulting in more pain messages being sent. Interesting isn’t it?
So how do we manage this pain?
Physiotherapists are skilled in the diagnosis and treatment of non-specific lower back pain. We look at your posture and movement patterns, plus your level of abdominal activation when you move (did you know contracting your abs when you move increases back pain? That’s a topic for another article!)
We will also explore the less tangible elements (as previously mentioned) which can influence your pain and which are personal to you. No one person with back pain is exactly the same so we diagnose your individual pain drivers and then tailor your treatment to address them. The results can be life changing!