10 myths about back pain and how to cope when it strikes



10 myths about back pain and how to cope when it strikes

With 84pc of us worldwide feeling back strain at some point, Dr Mary O'Keeffe looks at the popular myths, ways to avoid pain, and how to cope when it strikes

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Irish Independent - Published 03/01/2017 | 02:30

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We really need to change the thinking around back pain.Dr Mary O'Keeffe holds a model of the spine and pelvis. Photo: Liam Burke Press 22

Disc bulges, weak cores, joints out of place; if you suffer from back pain, you may have heard these words as the reason for your discomfort. Moving when your back is locked is sore, and you will do anything to avoid it. However, not moving feels worse. Back pain can be managed sensibly enough without resorting to drastic measures. Here five back experts offer their solutions for pain.

Back pain is common

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Attention Yvonne Hogan. Editor, Health & Living magazine. Photographed is Dr Mary O'Keeffe, Physiotherapist, Clinical Therapies Dept., UL. The Irish Research Council funded Mar's PHd in low back pain treatment. Photograph Liam Burke Press 22

While back pain can be very painful and worrying, it is very common and rarely dangerous. A total of 84pc of people worldwide will experience back pain during their lifetime. It is equally common across all age groups; from young to old and doesn't get worse with age. Therefore, it should not be seen as a result of ageing or "wear and tear". Mostly people recover reasonably quickly, and many recover without the need for treatment. Some people experience repeated episodes of back pain which can be distressing, but again these are rarely dangerous.

Scans for back pain are rarely needed and can be harmful

Most people believe that a scan (for example an X-ray, MRI) will identify the cause of their back pain. However, the scientific research shows that scans are only needed when a serious condition is suspected (cancer, fracture/broken bone, infection). Luckily, these serious conditions are rare and account for approximately 1pc of all back pain worldwide.

The problem with having a scan is that it will almost always show something and much of this 'stuff' is poorly linked with back pain. Research has shown that people who don't have back pain have disc bulges (30pc of 20-year-olds, increasing to 84pc of those 80 years of age), disc degeneration (37pc of 20-year-olds increasing to 96pc of 80-year-olds), disc protrusions (29pc of 20-year-olds increasing to 43pc of those 80 years of age) and facet joint degeneration or arthritis (4pc of 20-year-olds increasing to 83pc of 80-year-olds).

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Back pain now affects one in 10 people

The scientific research is now suggesting that these are normal findings that increase with age, are not dangerous and often not painful. So think twice about getting a scan; and if you do get a scan and receive a long radiology report with scary terms, be clear that many of these things are common in people without pain.

The back is NOT that vulnerable to damage

Most people think the spine is something that needs to be protected. This is incorrect and has led to the provision of information and treatments that promote fear, protective guarding, avoidance and disability. Common examples include: "Your joint/pelvis/disc is slipped/out of place."

People often move differently when in pain, giving the impression that something has gone out of place. However, scientific research has clearly shown that these structures do not go 'out of place' or 'slip'. Some health professionals tell people that they are putting their structures back into place through treatments like manipulation. While many will experience short-term relief after these treatments, any benefit is due to changes in the nervous system and muscle relaxation - not due to realigning of discs and joints.

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Exercise is recommended for those suffering from lower back pain

While exercising the core (planks, sit-ups, Pilates) has become very popular, core- stability programmes are not more effective than other types of exercise for back pain (for example walking). In fact, research has shown that many people with back pain over-work their core muscles. This is a bit like clenching a fist with a sore wrist, which in fact can put more pressure on the back when it is sore.

The 'weak core' or 'your back/pelvis is unstable' theory has not been supported by science, and can create a lot of unnecessary fear and needlessly complicates exercise treatment of back pain. Instead, moving in a relaxed, confident manner is more efficient.

Contrary to popular belief, there is no evidence that an ideal posture exists. While slouching is often blamed, there is no scientific evidence to support this as a cause of back pain. In fact, many people with back pain adopt very rigid upright postures and can't relax. The next time someone suggests to you that back pain is caused by slouching, look around and observe all the people without any back pain that can sit in a wide range of relaxed postures, in contrast to people with back pain who often sit in very rigid, uncomfortable looking postures.

Inactivity results in discomfort, so taking breaks from sitting is very important.

The back is designed for bending and lifting

Like other body parts (for example the knee), the back is designed to move and adapt to many activities. It is important to be conditioned to lift; and shown how to lift heavy things correctly and safely. The back is designed to move and adapt to many activities. In the same way that a person can get a sore knee after doing an unaccustomed activity, people can get back pain when they lift something awkwardly or something that they aren't used to.

People will use different techniques to lift that they find more comfortable and efficient; like people will have a different running technique. The key thing is practice and letting your body get used to different loads and weights. A coach/trainer may be helpful.

You can have back pain without back damage or injury

The traditional view is that pain is a sign of injury or damage. While some back pain may be related to a sudden, repeated or heavy-loading event, we now know that the volume switch for back pain can be turned up by many other factors also. These include physical (minding/guarding the back, avoiding movements), psychological (fear of damage/pain or not getting better, low mood/depression, stress), health (being tired and run down, low energy), lifestyle (sleep problems, low levels of physical activity, being overweight), and social (poor relationships at work or home, work satisfaction, stressful life events like a death or illness) factors.

This means that you may feel more pain when you move or try to do something, even though you are not damaging your back. Ever have a headache when you are stressed, sad, tired or run down? Back pain is no different. For many people, back pain can occur from just a minor mechanical trigger, like picking something up from the ground or rolling over. In this situation it is due to the spinal structures being sensitised due to other factors such as sleeping position or stress.

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Back Pain

Crucially, all back pain is 100pc real. It is unique to each person and it is not 'all in the head' or imaginary, even if things like stress, mood or poor sleep are a part of the problem. Being aware of all the different factors can give you a better understanding of your pain and what things need to be addressed to turn down the volume switch for back pain.

Don't take back pain lying down and don't rush for surgery

Since people often think they have done damage when they get back pain, it is common for people to go to bed and rest until all pain is gone. However, there is very strong evidence that keeping active and returning to all usual activities gradually, including work and hobbies, is important in aiding recovery. While you may feel relief from rest initially, prolonged rest is unhelpful, and is associated with higher levels of pain, greater disability, and longer absence from work.

Surgery is rarely an option for back pain. There are some uncommon back conditions where there is pressure on the nerves that supply the leg and the patient gets leg symptoms such as pain, pins and needles or numbness. For these conditions surgery can help the leg symptoms but it is important to understand that surgery is not always required.

Unfortunately, many people are sent too quickly for surgery such as lumbar fusions and these are very expensive. You also need to know that on average, the results for back surgery are no better in the medium and long-term than non-surgical interventions, such as exercise. So a non-surgical option, which includes activity/exercise, should always come first.

Exercise is good for back pain but people are often afraid

Contrary to popular belief, exercise is helpful for back pain, and the best is the type you enjoy. For example, walking, running, cycling, swimming, yoga and pilates all have similar effects for back pain.

Unfortunately, many people are given frightening information about exercise. People are often told to avoid running on the road, avoid swimming the breast-stroke, and to stick with low-impact activities like walking. Scientific research does not show that any of these activities are bad for your back, or wear out your joints. Like the sprained ankle example, these activities may be sore initially but they are not damaging to your back. Doing them in a relaxed manner (moving normally, not bracing and not breath-holding) and progressing gradually is more important.

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Back pain is now one of the major causes of people being out of work for long periods

It is emerging that the amount of exercise you do is more important than the type of exercise. More than 30 minutes per day has the greatest health benefits but any amount you can manage will result in benefit. The benefits of exercise even include reducing the risk of developing back pain.

Most importantly, you should do an exercise that you enjoy, that is affordable and easy to access.

Feeling stiff and sore after exercise does not indicate damage to your body - it simply reflects your body not being used to the activity. You can start with gentle activity and then increase your levels.

Strong meds do not have strong benefits for back pain

Many people think strong pain needs a strong painkiller. This is not true. If you have a new episode of back pain, you should start with a simple over-the-counter painkiller and not rush for prescription medications. Scientific research has shown that strong painkillers such as those containing an opioid do not provide greater pain relief over simpler options, and actually have greater potential for harm. Harms associated with opioids include dependence, overdose, falls, fractures, depression, and sexual dysfunction. If you do start on a painkiller, start with a small dose and make an agreement with your GP about when to review/stop taking the painkillers.

Buyer beware: internet, fads, fashions and bandwagons

Be wary of commercial sites that are selling a product. We hear daily claims about miracle cures and best treatments for back pain in the media and on the internet. These include electrical devices, magnets, needles, fancy exercise machines, colourful tapes, cupping therapy, herbal supplements, fancy shoes/insoles, stem cell injections and many other potions and lotions. A lot of these things have not yet been tested so you are potentially just wasting your money, and when they have been tested the results are very unimpressive.

Back pain can be cured

We really need to change the thinking around back pain. The thinking around the spine is distorted and infused with panic. Of course you can injure the back - but be confident that it will get better. It is common for people to be told that they cannot change their pain and they have to live with it. The evidence doesn't bear this out. The back can also recover.

Think of it like an ankle sprain. It is incredibly painful at the start but it gets better with graduated activation. Avoiding movement would not help an ankle sprain, and the same goes for a back injury or back pain. The pain experience is unique to you and can involve an interplay of many different factors. It therefore makes sense that all of these factors must be considered in addressing your back pain. This could explain why many different treatments for pain fail in the long term as they only look at one piece of the puzzle.

Setting personal goals, addressing your relevant factors (lifestyle, health) and engaging in activities you enjoy like exercise, relaxation, socialising with friends and family, are all important for improvement and recovery. If a flare-up happens, do not panic. It is time for a change in the management of back pain.

* Information provided by Dr Mary O'Keeffe (University of Limerick), Dr Derek Griffin (Tralee Physiotherapy Clinic), Dr Kieran O'Sullivan (Aspetar Orthopaedic and Sports Hospital, Doha, Qatar), Professor Peter O'Sullivan (Curtin University, Australia), Professor Chris Maher (The George Institute for Global Health, University of Sydney, Australia)

Health & Living

15 ways to manage back pain

After suffering from back pain since childhood, Arlene Harris tried and tested fellow sufferer Steve Timm's self-styled methods. Now 'pain-free', she shares his, and other experts' tips on reducing those niggling aches

Arlene Harris

Irish Independent - Published 21/06/2016 | 02:30

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Woman with back pain

Like most of the adult population, I suffer from a bad back - the result of a childhood injury. Having tried several forms of treatment over the years, I happened upon the Chilean-born, Australian-native, Steve Timm, a fellow sufferer, who devised a series of yogic exercises in a bid to cure his own back pain.

Like most of the adult population, I suffer from a bad back - the result of a childhood injury. Having tried several forms of treatment over the years, I happened upon the Chilean-born, Australian-native, Steve Timm, a fellow sufferer, who devised a series of yogic exercises in a bid to cure his own back pain.

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Not only did he succeed but he also developed a short programme of daily exercises which he eventually chronicled in a book entitled Mind Your Own Back (MYOB).

"My back began to fall apart in 1974 when an accident at work, while carrying a heavy piece of equipment, left me frozen with pain and flat on my back in bed, unable to move for a whole month," says the 76-year-old. "After numerous treatments by osteopaths, chiropractors and physical therapists, I was told nothing more could be done. I would have to live in pain for the rest of my life."

But Timm decided to work on a cure himself and combining his skills as an engineer and a new-found knowledge of yoga, he devised the simple plan which, in recent years, has brought relief to countless sufferers. Since meeting with Timm in 2010, I am now pain-free. With a new edition of his book available this summer, Timm, along with other experts, offers numerous ways to minimise back pain and deal with symptoms when they arise.

1 EDUCATE YOURSELF

Timm, often dubbed 'Miracle Man', says the most important step to managing back pain is to learn how it works. "Education is crucial and ignorance is dangerous," he says. "Everyone should understand the human spine and its needs. Learn how to move and use your spine and body safely - this is more important than learning to drive. People also need to learn how to lift heavy weights safely and know the limitations of how much weight they can safely lift."

2 KEEP MOVING

The retired IBM engineer says it's equally important to move as much as possible as this will benefit your spine and ultimately, your back. "Avoid long hours sitting crunched down in front of a computer," he says. "Also avoid long hours in a sinking position on a sofa watching TV. And do your best to not spend too much time in enclosed rooms devoid of fresh air."

3 STRETCH YOURSELF

"After nine months in a foetal position, we are born and the spine opens up and stretches out like a flower in spring," says Timm. "The proper opening and balance of the base of the spine is fundamental to the whole structure. So it's important to create balance which, when properly set, makes many stretches and exercises really beneficial. Due to stress or psychological problems, some people go back to partial foetal position, as if looking for emotional refuge, and back problems may occur, so it is important to stretch it out and also do some gentle aerobics and muscle building exercises."

4 BOTTOM TO HEEL STRETCH

Joey Boland, clinic director at Sports Physio Ireland, agrees and says stretching from bottom to heels will help strengthen your back and upper legs muscles.

"The bottom to heels stretch should be a part of your warm-up and morning routine," he advises. "Get on the floor on your hands and knees, making sure that your hands are a little behind your shoulders and the knees behind your hips. Slowly fold down your lower body, until your buttocks touch your heels. Do not take your hands off the floor, but extend them as your body moves towards the back. Hold the position for 20-30 seconds and repeat eight to 10 times. Make sure to use a sports mat with a smooth surface to avoid bruising your knees."

5 GO BACKWARDS

Dr Anne Reicherter, professor of Physical Therapy at the University of Maryland, says walking about is also essential to prevent back pain. "Don't sit slumped in your desk chair all day," she advises. "Get up every 20 minutes or so and stretch the other way. Because most of us spend a lot of time bending forward in our jobs, it's important to stand up and stretch backward throughout the day."

6 DITCH THE HEELS

Compulsory wearing of high heels has been a contentious issue of late, but back guru Timm says we should exchange our four-inch pumps for flats or low heels (less than one inch) because high heels "may create a more unstable posture" and increase pressure on your lower spine. "Unnatural shoes like high heels are not good and can be very damaging," he says.

7 DON'T FORCE POSTURE

Timm says his technique is designed to create balance and a healthy spine from the bottom up. "It begins by resetting the angle and position of the pelvis in the most effective way," he explains. "By restoring balance at the very foundation of the spine, it naturally corrects the distortions and deviations that ageing, muscle weakness and other causes, (high shoes) have created throughout the vertebral column. Gentle exercise is good, provided that there is no imbalance at the base of the spine but I am against forcing a 'good posture' as it should come naturally when you do your MYOB routine as you can't help but stand tall and proud."

8 LEARN TO RELAX

Richard Brennan of the Alexander Technique Centre in Galway says the key to minimising the chance of getting back pain is to learn how to relax properly.

"The Alexander Technique is a method of personal education which involves self-awareness and releasing muscular tension," he says. "This excessive tension slowly accumulates over many years of stressful living and often starts in childhood. And if left unchecked, can give rise later in life to common ailments such as back pain.

"Through the Alexander Technique you will discover ways of sitting, standing and walking which will put less strain on the bones, joints and muscles, making your body work more efficiently."

9 SILENCE

Steve Timm agrees: "Learn to manage stress and emotional tension as this will help you to feel better," he says. "I have also found it beneficial to learn how to promote structured inner silence every day. Also try to learn and practice a scientifically proven good meditation, as it will be like having a shower on the inside every day."

10 BE POSITIVE

Negativity can have a profound effect on how we feel physically and Timm says it's important to develop a positive frame of mind and try to ensure you feel emotionally strong and secure. He says while this isn't always easy to achieve, there are a few steps you can take towards positivity.

"Try to have clear good purpose in your life," he advises. "And do something to help your fellow beings. Also make sure to eat healthy fresh food, avoid overeating and drink plenty of water."

11 CREATE A PERSONALISED ROUTINE

"MYOB is completely natural and is also a form of therapy so is not suitable to be passed on in a class or group situation," says Timm. "Every session needs to be adjusted to the individual needs of each person so for this reason giving everyone a fixed version of MYOB could be damaging. So I would advise people to check out my website and book for more information. Also I will be in Dublin on August 6 and may be able to see a few people personally."

12 ROLL YOUR KNEES

For those who won't get to see Steve Timm on his Irish visit, Sports Physio Ireland director Joey Boland, says a knee roll is a very simple exercise that aims to improve the strength and mobility of your spine. "Place a mat on the floor and lie down on your back," he advises. "Lift up your knees, until both your feet sit firmly on the floor. Without moving your upper body, roll both your knees to the right until your right knee touches the floor. Hold the position for four to five seconds, and repeat in the opposite direction. It is recommended to do eight to 10 knee rolls for each side, but do not attempt to stretch your back muscles further beyond comfort."

13 KEEP IT CHILLED

Despite all our best efforts at trying to prevent back pain, sometimes injury gets the better of us. Dr Anne Reicherter of the University of Maryland says the first port of call for pain relief should be ice. "Ice is best in the first 24 to 48 hours after injury because it reduces inflammation," she says. "Even though something warm feels good because it helps cover up the pain and relax the muscles, the heat actually inflames the inflammatory processes. But after 48 hours, you can switch from ice to heat if you prefer. However, whether you use heat or ice, remove after about 20 minutes to give your skin a rest and if pain persists, talk to a doctor."

14 GET A GOOD NIGHT'S SLEEP

Sleep disturbances are common among back pain sufferers, but rest helps repair strained muscles and soothe inflamed joints, according to the HSE. "Start with a good bed and experiment with different sleeping positions - try sleeping on your side and on a firm surface," advises a spokesperson. This helps to prevent any curvature of the spine which could lead to or worsen back pain.

15 GENTLE EXERCISE

It's not always the best idea to simply rest and wait for back pain to subside as resting can cause certain types of pain to worsen and decrease muscle strength, according to the HSE.

"Instead of lying down, start with gentle stretches and try experimenting to see what ways you can move without pain," says a spokesperson. She also advises going for a slow, easy walk, and picking up the pace if it feels good. "Regular gentle exercise is also a good idea as strengthening and stretching muscles can reduce many types of back pain," she adds. "However, it's best to discuss your current routine and any changes with your doctor."

* For more on Steve Timm, see . Also, see Pat Henry's tips on strengthening your back.

Health & Living

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