Ok, so let’s look at why your lower back pain is not healing in detail. In this blog, I’m going to outline the following:
- Reasons your low back pain is not healing
- How the way you breath can be causing your back pain
- Understanding your Body is key to overcoming low back pain
- Why does my lower back pain keep coming back
Reasons Why Your Lower Back Is Not Healing
1. You are not doing anything to help your back heal:
Let’s face it, sometimes, when we have low back pain, we get up and get on with it. We might have a night out, or the house needs cleaning, or you are tired of minding it, and you think playing a game of golf or soccer might help “loosen it up”. The truth is that this approach rarely works. Trying to push through pain tends to make your nervous system more sensitive to smaller movements, thus making your pain worse. While you may even get through the activity fine but then afterwards, the pain comes back with a vengeance, hell-bent on screwing up your week. So you get even more frustrated with your body and try to take some pain killers to get through the days and maintain some level of activity. Does this sound familiar?
2. Your activities are aggravating your lower back:
As mentioned in the previous section, yes, you might think your back can do a lot more than it can do and irritate it. But aside from activities, things like sitting for too long, driving, walking for too long, walking uphill, walking downhill. These are all activities that seem very innocuous, but it comes down to what length of time you are doing these activities and then at what point your back gets sore, and you keep on pushing through the pain. Going for a walk is entirely normal, but expecting to be able to go for a 3-hour hike up and downhill when you can’t sit for 20 mins or stand for 5 mins without pain is asking a bit much. You need to be aware that while your lower back can withstand these activities typically, right now, when you are in pain, it cannot tolerate this type of load for a significant length of time.
Why, because you are compensating, and when you compensate, you fatigue quicker.
We all have periods of stress, but if you have a very busy/hectic lifestyle, this can cause your body to go into fight or flight mode, which means that your Cortisol (stress hormone) levels are high. When cortisol levels are high, your body is on high alert, and your muscles are tense. You find it difficult to relax and unwind. You forget to breathe and find yourself taking a sizeable deep breath during the day. All of these symptoms of stress are screaming out protection. Our Fight or flight system is our danger system which we can rely on to get us out of a dangerous situation 3000 years ago if a tiger was chasing us. It would give us a short burst of adrenaline, increase our breathing rate and heart rate. It would also increase our reaction speed to get away from the said tiger. The system would turn on and turn off very quickly. Nowadays, our Fight or flight system doesn’t give a large burst of adrenaline, and it trickle feeds small amounts so that when we have a lousy night sleep because our kids were sick during the night, and then you have to go to work for 9 hours, come home cook dinner, wash kids clean the house the fight or flight system helps you do this. But it also needs some downtime, time to relax and unwind. It is so important to look after yourself when you have a hectic lifestyle. You are going to crash at some point if you keep going at 60mile an hour every day.
What has this got to do with my low back pain? Adrenaline increases muscle tension, heightens senses, and increases pain sensitivity. An increase in pain sensitivity is not good when trying to recover from a bout of low back pain.
4. Reduced Sleep:
Having reduced sleep also links with fight or flight as you are tired and fatigued begin your day. When we sleep, it is our body’s time to repair itself. Getting into 60 to 120 mins of deep sleep every night allows our body to regenerate cells and damaged muscles. A lack of sleep causes our body to be catching up on recovery, replacing old damaged cells with new cells ready to take on the stress and strains of your day.
If you have a busy life and sleep well, feel refreshed, and you are doing great. If you are not getting enough sleep and feel wrecked in the morning, you need to look at your rest and how you can improve this.
How The Way You Breath Can Affect Your Lower Back Pain
How breathing affects your pain might seem alien to you, but I want to link breathing back to your nervous system here.
- What do people say when they are trying to get you to relax? Take a deep breath and relax.
- What do you do when you meditate? You breathe and relax.
You see, breathing stimulates your parasympathetic nervous system (PS). This system works in conjunction with your sympathetic nervous system (SS). When you get stressed, your SS increases and your PS system decreases. The opposite occurs when you destress or relax.
When you concentrate on your body, focus on breathing deeply and slowly, try relaxing your muscles, taking your mind off your day’s stress and focus on your body. Then your PS starts to increase. This increases in your PS reduces your heart rate, respiration rate, blood pressure and muscle tension, and your body begins to relax.
Breathe and stress are like your yin and yang. We must balance them.
Understanding Your Body Is Key To Overcoming Your Back Pain
Some people tend to ignore their back pain until it gets to a point where they have had enough and want to get it sorted for good. When we first meet our patients, we go through a series of questions to find clues about the problem. Questions like:
- When is your back most painful?
- How sore does your pain get out of 10?
- What makes your back more painful?
- What makes your pain easier?
- What other injuries have you had?
- Does your back prevent you from doing activities?
- Are you afraid of your back pain?
I’m going to give you an example of a person listening to their body and a person who is ignoring their body:
1. Listening to their body
- My back pain is 6/10 in the morning first thing but then settles down after 30 mins.
- When I sit for more than 40 mins, my pain gets worse.
- Once I stand up, the pain resolves.
- I find when I stretch my quads, the back pain reduces but comes back the next day.
- I’m not afraid of my pain, but I feel I cannot resolve it on my own and need direction.
2. Not Listening to their body:
- My lower back is sore all the time. It never goes away.
- I don’t know when it’s better. It is just painful.
- I’m never any good at scaling my pain, so I can’t give you a number.
- I sit all day for work and don’t move even when it is sore.
- Right now, I’m getting scared that I’ve done something to my back and I will need surgery.
Can you see the difference between the two?
For the second person, if I asked a few more questions, I find that the pain goes away when she is walking, but they don’t recognise that they are not really in touch with what is going on with their pain ignoring it.
Getting people to take ownership of their pain and realising they are in control of their body is key to overcoming their pain. If you don’t do anything to help your back yourself, your recovery will take longer.
Finally, Why Does My Back Pain Keep Coming Back?
There is a straightforward answer to this:
“You have not strengthened your body to withstand the activities you want to complete.”
But I was given exercises by my physio? You may well have been but these were probably only exercised to encourage you to move correctly and reduce your pain. Strengthening exercise requires weights to create an adaptation in the muscles fibres and gain strength. They are very different exercises. For example, recurring injuries in athletes are not due to injured joints, muscles or ligaments. The tissues have healed, but the muscles, joints, tendons, and ligaments are not conditioned to cope with their sport’s stresses and strains.
The only difference between strengthening an athlete and a non-athlete is the starting point.
Back Pain Physio Services
We listen to you, understand exactly where you are at and exactly where you want or need to be. Give us a call now +35316855181 or schedule an appointment and we’d be happy to get you back in sync!
This Article was written by Diarmuid Hegarty, Clinical Director Resync Physiotherapy, MICP MSc Physi, MSc Sports Med, NSCA.