Back pain - A vicious circle

UNDERSTANDING BACK PAIN

I always find that the beginning is a good place to start telling a story. So, let’s do that and begin by asking two key questions:

WHAT DOES YOUR BACK ACTUALLY DO? AND WHAT DOES IT DO FOR YOU?

Other than protecting your spinal cord – already a very important task -, your back does the following things for you:

1. First of all, it holds you upright.

You shouldn’t underestimate how difficult a task this represents! For your body to be maintained upright, your back needs to be remarkably strong and resistant. And this is precisely why your back is made up of powerful muscles and extremely resistant bones. If I told you the composition of a vertebra is such that in a controlled testing environment (a laboratory) it can resist up to 9 tons of pressure without breaking, would you believe me? And yet, this is true. Let me just mention that a piece of cement of the exact same size would shatter under such pressure. “Not my back!”, “Not my vertebrae!”, I hear you say. Yes, your back too! Yes, your vertebrae too! This is by no means an invitation for you to put this to the test and do something silly. I simply want you to understand that your back - even if it hurts - is a very strong structure. So, next time you’re about to tell someone that you have a weak back, remember the 9 tons. Most of you who suffer from chronic or recurrent back pain do not trust your own backs anymore, as if your back had become an amazingly delicate porcelain object capable of breaking at any moment, when in fact quite the opposite is true.

Let me say it again: YOUR BACK IS A VERY STRONG AND STURDY STRUCTURE. I want you to remember this because it is essential that you begin to trust your body and your back again in order to get better.

2. Secondly, it allows you to move.

The fact of the matter is that movement can only happen if a structure (in this case: vertebrae + muscles) is flexible. Popular belief has it that flexibility erodes with age, thus making movement more difficult. In reality, this is only very partially accurate. The truth is, that the biggest enemy of flexibility, the absolute nemesis to maintaining one’s back limber for comfortable movement is NOT age but lack of movement. Yes! Not moving is the worst and yet most common mistake back sufferers make. When you overprotect your back for a prolonged period of time, its muscles weaken and its flexibility erodes. Weak muscles and poor flexibility together form a very, very bad combination.

Therefore, should you remember only one thing from this page, let it be that THE ONE AND ONLY WAY TO A BETTER AND HEALTHIER BACK IS: a) improving its flexibility by increasing the amount of physical activity and movement in your daily routine and b) strengthening its muscles. You will find more information regarding physical activity and muscle strengthening on the “Living without Pain” page of this website.

3. Thirdly, it acts as a counterweight.

Your back constantly takes on the role of counterweight to the rest of your body to keep you in balance. This prevents you from falling over whenever you move, you stand, or you sit. You may have the impression that you’re merely moving your arms or your legs but while you are doing that, your back is working hard (contracting muscles) to ensure that you are able to make the movement you want without losing your balance. Quite an amazing piece of engineering, this back of yours, don’t you think? And you can understand now how it might get tired: it’s busy all the time! That’s why it needs to be kept in good and strong shape. Not only that, but as the amazing and busy structure that it is and everything it allows you to do, it deserves a great deal of respect. The reason I mention this is because many back pain patients express feelings of hate and disgust towards their bodies and their backs. You musn’t hate your body or your back. Once the pain in your back is relieved through Reflexology (or other therapies), you can begin to give it what it needs: PHYSICAL ACTIVITY AND STRENGTH. And soon, you will feel much better. For more information on physical activity and muscle strengthening, please go to the “Living without Pain” page of this website.

In 85 to 90% of cases, back pain is NOT the result of a severe injury or a serious illness. Instead, it is bad posture and lack of exercise which are responsible for the majority of back complaints. Most of you have gone to all the doctors, undergone all the tests, tried all the treatments and nothing does it. Nothing. You’re told there is nothing seriously wrong with your back and you wonder: how is it possible, if there’s nothing seriously wrong with my back, that it hurts so much? And indeed, back pain can be both paralyzing and exhausting. Back pain can unequivocally take all the fun out of life. And, if it is such a strong structure, such a fine piece of machinery, how can bad posture and lack of exercise create such havoc? The answer is actually quite simple if you look at it from an evolutionary perspective. Humans (homo sapiens) have been busy surviving for approximately the past 300.000 years. The bodies we have today are the heritage of those 300.000 years. During all that time our ancestors needed to survive by hunting, fishing, gathering, migrating, fending off fierce animals, finding materials to build shelters, keeping warm, and later on by working the land. In essence, our ancestors worked out all day long. Our backs were designed for that lifestyle.

It is only in the past 200 years that our societies have dramatically changed with industrialization and that we have become beings who are predominantly sedentary. Most of us sit all day, whether at work, at home, or during transport. Our backs were most definitely NOT designed for day in day out sitting. SITTING IS IN FACT ONE OF THE MOST STRENUOUS POSITIONS FOR THE (WEAK) BACK. And in 200 years our bodies have not had the time to adapt. You cannot undo 300.000 years just like that. Hence the world epidemic of back pain.

SO, WHAT HAPPENS EXACTLY INSIDE YOUR BACK WHEN YOU HAVE PAIN?

Whether back pain is caused by a structural problem in the spine such as injury, degeneration, deformation, etc. - a MINORITY of cases - or manifests itself without any damage being present in the spine or surrounding tissues - a vast MAJORITY of cases -, the process that activates pain is the same. Pain comes from nerves whose function is to transmit pain when they are activated, and there is an incredible amount of these nerves in the back. Usually, for a pain nerve to start transmitting pain, it needs to be compressed. In 85 to 90% of cases this compression occurs as follows:

Prolonged or repeated bad posture and/or weak muscles force

	Muscles to work above their capacity
	These muscles get tired due to overload
	and
	As a result, begin to spasm.

The muscle spasms press on the surrounding pain nerves and are what activates the pain nerves.

If the story ended here, it could be considered a relatively simple story. Unfortunately, this is where the story about back pain turns ugly.

Once the pain nerves in the back start creating pain, it would seem that everything has been planned to keep them working, as if the factory had forgotten to deliver the “off” switch, or hidden it very well. Sometimes, when these nerves have been stimulated for a long time, they keep sending pain signals even though the initial problem may be gone. Moreover, the activation of pain nerves in the back causes in itself more contraction of the back muscles. More contraction of the back muscles activates even more the pain nerves…. And a VICIOUS CIRCLE begins:

Muscle spams in your back		Activation of pain nerves

Activation of pain nerves		More muscle spams in your back

		And so on, and so on …

And it doesn’t end here. The activation of pain nerves leads to the release of substances which greatly dilate blood vessels in the surrounding area. This process is better known as “inflammation”. The increase in blood causes the tissues to swell and their temperature to rise. Just like muscle spasms, inflammation aggravates the pain, what in turn creates more inflammation. And another VICIOUS CIRCLE begins!

To make this worse, when muscles spasm, they can press on blood vessels. This reduces blood flow. When there is less blood, muscles tend to spasm and pain nerves are activated. And yet a third VICIOUS CIRCLE!

With three vicious circles acting at the same time you can see how difficult it is to get rid of the pain. And if muscles are weak, bad postures prolonged or repeated, it is very easy for these vicious circles to become activated again and again.

THE GOOD NEWS IS: In 85 to 90% of back pain cases, there is a great deal of pain and a great deal of muscle spasm but no actual damage to the back. The level of pain is not proportional to the problem. It’s just that, pain, and nothing more. Reflexology can be extremely helpful in making the pain and muscle spasms disappear in these cases. Additionally, if there is no damage to your back, it means that you do not have to be afraid to move or to exercise, as long as the exercise does not exacerbate the pain. Rest is your worst enemy. For the 10 to 15% of cases where back pain is caused by structural damage to the spine, you too can greatly benefit from Reflexology treatments in order to reduce pain and muscle spasms. Also, as long as it is possible, as long as the pain can be managed, the more you move and the more you strengthen your back, the better you protect the parts of your spine where there is no damage, thus preventing a worsening of your condition. For you too physical INactivity is your worst enemy.

Let’s briefly summarize what we’ve learned so far:

-	Your back fulfills a number of very important functions (standing upright, flexibility, and balance) for which it needs to remain strong and flexible.
-	Your back was designed for a life of physical activity and not for sitting all day long.
-	Prolonged or repeated bad posture and weak back muscles are responsible for the vast majority of back pain.
-	Back pain is the result of a number of vicious circles activating pain nerves and, in the majority of cases, does NOT reflect the severity of the problem.
-	Overprotecting your back is the wrong way to approach the problem and will only aggravate your pain.
-	Backs are very strong and resistant structures. Treating yours like a delicate and breakable object is the wrong attitude.

As the following sections will show, first you need to reduce the level of your back pain so that you can quickly return to a higher but comfortable level of physical activity and begin strengthening the weak muscles in your back (and perhaps your abdominal muscles as well). Reflexology will be of great help in achieving a reduction of the pain. But, in the long run, the solution is in your own hands. There is no magic pill. And there is only one answer to a better and healthier back:

PHYSICAL ACTIVITY + STRENGTHENING OF BACK MUSCLES

Please read on and discover what Medical Reflexology is and how it can certainly help your back pain.