“Bad back? There’s a back-pain epidemic – Most treatments make things worse – Here’s why and what you can do” (All of which I’ve happened to have been through myself). My comment on an article in New Scientist, all references where not otherwise stated to the author Helen Thomson who’s article presents important research and great actionable advice for us all.

The main article cover text reads:  “Bad back? There’s a back-pain epidemic - Most treatments make things worse – Here’s why and what you can do”
The Cover of ‘New Scientist’ August 31st.

Expertise already in action

 Luckily, for me and many others, there is a lot of expertise in the UK who are already very aware of all of this and the good and the best medical practice has already changed.

 For instance, my consultant was part of a leading group of researchers looking into potential harmful impact to do with chronic pain of seeing your MRI scan on of your back, as “once you start to look for abnormalities, you will find them”. Doctors are then more likely to prescribe painkillers, steroid injections or surgery. Most of us over our life develop minor issues in the spine.

 I’m aware of lots of people who’ve dramatically improved their lifestyles again from necessary interventions, but for the vast majority, the above may not help and may make things worse.

“People say they can tell you what is wrong from a scan. They can’t. It’s not possible”

 There is an interesting point made about evolution and variation in our vertebrae which I won’t go into here.
New Scientist website link below:
https://www.newscientist.com/article/mg24332450-600-the-back-pain-epidemic-why-popular-treatments-are-making-it-worse/

 There is also a lot in the article about lifestyle factors which now “cost the US $635 billion per year in medical bills and productivity”.

 “Backache can also be caused by accidents, sports injuries or a congenital disorder, but lifestyle factors such as obesity and smoking are the biggest problem as a society…being overweight places greater mechanical strain on the back and decreases mobility, a precursor to disc deterioration. Smoking probably increases risk due to the clogging of arteries and reduced blood supply to the spine.”

 “Most people fall under the category of ‘non-specific back pain’ which usually improves in a matter of days or weeks”

The graph title reads: Disability related to lower back pain has increased dramatically around the world in the past few decades.
A graph showing ‘Disability-adjusted life years’ with Age group.  
The biggest aspect I believe the article points to is the increase in hours seated and office work culture, along with obesity and smoking.

 Dr. McGill (I’ve read and apply things daily from his book) talks about there being no such thing as non-specific as there is always a mechanical reason. He explains superbly all the notions of back-hygiene.


Back pain Research and advice

 Pain is discussed in detail, specifically the signals and messages sent from the brain.

 “Not all pain is bad – It is key to our survival… But chronic pain serves no purpose and can seriously harm our health”

 Often there is no identifiable mechanical explanation.

 “It isn’t necessary to stimulate these cells to feel pain, nor is their activity always directly related to our experience of discomfort.”

 I’ll jump in here with some personal examples:

 I overcame a L4/5 nerve end compression due to a tiny disc fragment, the instance of which could have been an aggressive surfing wipeout in hyperextension, but was likely set up from an accumulation of ‘niggles’ in that area over time, from rowing competing nationally over 12 years total, surfing and my time Pro-Windsurfing (with not enough S&C at that time!!) On one day I’d warm-up and then get on the rowing machine, with an anticipation that I might not be in the best place that day and I’ll feel pain.

 On another day I’d do the same warm-up and rowing machine session and feel no pain, or very different things. Perhaps this is because even just warming up, I might be worried about the possible effects of not being able to do what I love due to back pain. Sometimes there has been the common psychological side of anticipating pain having overcome a significant injury – the site is healed but the movement pattern may not be back in full, natural, efficient.

  On the other hand, on another day when I only had the positive side to things in mind or had some great positive interactions, the same warm-up does its job and I feel ready and better and without pain.

 Perhaps the reasons why post-rehab, going windsurfing, surfing, snowboarding again, and also when I’m weightlifting or doing other focused gym or athletic work, these are challenging activities which I enjoy, I just get in the zone and focus on that, there is no space to worry about my back. This is the sort of thing my chiropractor, osteopath, physio, consultant, all wanted me to embrace. Their advice has been invaluable to me in dealing with my chronic back pain. Bit by I sorted the mental side of it.

In the gym with clients

 Working with clients in the gym post-rehab, to increase their robustness, mobility, basic strength & stability, finding the right level of challenge for them and building back up their physical literacy, it’s up there with the most satisfying things I could ever imagine doing, seeing someone’s confidence come back to move well again in every plane and lift load again and enjoy their sports or activities again.

You have to consider the whole body – it’s a complex system. A lot of the time the back pain is the result of other stuff going on elsewhere.

For more insight into my coaching work, background and client stories, check out
https://ndmcoaching.co.uk/about/

“All the circuits can be triggered or suppressed”

 Therefore, there are examples of studies of the effects of images, music or film altering brain activity, subduing or increasing pain.

Back pain – research and advice

 Other studies show that it matters that clinicians acknowledge our pain.

Buchbinder suggests ‘The best way to prevent long term disability from back pain is to ditch the drugs and promote wider international adoption of a mix of increasing physical activity plus mental retraining’.

 So, other top tips of my own and from the article include NOT taking bed rest – which has been the typical outdated advice.  “When young healthy male volunteers spent eight weeks in bed their lumbar multifidus muscles, which keep our lower vertebrae in place, had wasted and become inactive”. None of this, of course, is a surprise to an S&C coach.

  • Walking regularly
  •  Moving regularly
  •  Standing desk – don’t sit all day, which reduces mobility and can accumulate one setup of load in one position on discs.
  •  Ergonomic chairs “don’t work”.
  •  Pilates
  •  Standing still for some can be as hard as sitting still, so being able to vary positions is key.
  •  Loaded work keeps muscles, ligaments, and tendons strong, and keeps up bone density. There is no substitute for some loaded work, for everyone, ie. resistance training.

 “Nobody expects to get through life without a cold, and they don’t visit the doctor when they do”

 I guess with all of this, the trick must be understanding for works for you, but there are certainly some common themes and there is evidence that the above can help the majority of back pain.

That list seems straight-forward but chances are high that most of us dont do enough of some of these activities, and therefore doing more of that or better improves back pain!

If you deal with back pain drop me a line – i’d love to hear your thoughts about all this – what works for you and what challenges you face.

13 replies
  1. 마사지잘하는업체
    마사지잘하는업체 says:

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    • Nick Moffatt
      Nick Moffatt says:

      I had no prior experience – I hired a professional, who I also went back to to update things, and learnt as I went a long.

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  3. Barbara
    Barbara says:

    great post, very informative. I wonder why the opposite specialists of this sector don’t notice this.
    You must continue your writing. I’m confident, you have a huge readers’ base already!

    Reply
    • Nick Moffatt
      Nick Moffatt says:

      Thanks so much. I think most practitioners are far more aware of all this now as understanding has increased, and it’s great that New Scientist magazine opened things up and challenged areas!

      Reply

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