Car­la Rauseo

If you think you are go­ing to find a mir­a­cle cure for low back pain, maybe you should go to Mars or some oth­er galaxy and find an alien with a mag­ic fin­ger. How­ev­er, I am afraid you will be dis­ap­point­ed. The an­swer ac­tu­al­ly lies in you. Acute back pain usu­al­ly sub­sides spon­ta­neous­ly with­in a few days and most, if not all of us, for­get about it and con­tin­ue our usu­al lifestyle, lift­ing, bend­ing, slouch­ing and sit­ting for pro­longed pe­ri­ods, stress­ing the back. With re­cur­rence rates av­er­ag­ing about 80-85%, that acute back pain is very like­ly to rear its ug­ly head again, and again, and again, with each re­mis­sion be­ing short­er than the pre­vi­ous one. Of­ten this can de­vel­op in­to chron­ic low back pain. It is on­ly then that we de­cide to do some­thing about it, a true self-in­flict­ed in­jus­tice, for it can be­come very ex­pen­sive, not on­ly in terms of fi­nances, but in terms of time and qual­i­ty of life. Re­search has shown that if those with a first acute episode of low back pain seek prop­er treat­ment in the form of spe­cial­ized ex­er­cise for the back, the re­cur­rence rate is on­ly 30% com­pared to 84 % in those who do noth­ing about their first episode. So ear­ly at­ten­tion and treat­ment of low back pain is crit­i­cal, and it is up to you to take ac­tion ear­ly.

How­ev­er, for chron­ic low back pain suf­fer­ers, it is too late for ear­ly at­ten­tion, so their ap­proach be­comes one of man­ag­ing their low back pain. Once one has chron­ic low back pain, one is like­ly to suf­fer pe­ri­ods of ex­ac­er­ba­tion through­out the lifes­pan. Man­age­ment is aimed at lim­it­ing the lev­els of pain so that one can func­tion nor­mal­ly through­out the day, and de­crease the num­ber of ex­ac­er­ba­tions that may oc­cur.

There are many ways to man­age chron­ic low back pain. A mul­ti-dis­ci­pli­nary ap­proach tar­get­ing the di­men­sions of well­ness is need­ed in or­der to be suc­cess­ful. The first is the phys­i­o­log­i­cal di­men­sion, the in­ner work­ings of the body at the lev­els of the lit­tle cells that are our build­ing blocks. Prop­er eat­ing habits, avoid­ance of smok­ing, and los­ing weight to re­duce the stress on the spine are fun­da­men­tal first steps to im­prov­ing gen­er­al health. Good in­ter­nal health is vi­tal for if we do not feel well, the back can­not heal, nor can we fo­cus on the oth­er di­men­sions of well­ness that are so im­por­tant to man­ag­ing low back pain.

The psy­cho­log­i­cal di­men­sion of well­ness in­volves de­vel­op­ing good and ef­fec­tive cop­ing skills to deal with the stress of chron­ic low back pain. For any­one who has this con­di­tion, feel­ings of de­pres­sion, fa­tigue and a lack of mo­ti­va­tion are all too fa­mil­iar. Dif­fi­cul­ty sleep­ing at night fur­ther ex­ac­er­bates the fa­tigue and pain, and can lead to the use of mul­ti­ple med­ica­tions and their un­pleas­ant side ef­fects. A com­mon fea­ture of chron­ic low back pain is a phe­nom­e­non known as "fear avoid­ance be­hav­iour." This refers to the eva­sion of ac­tiv­i­ties be­cause the per­son fears that they may cause back pain, de­spite the fact that they may not. Fear avoid­ance is a night­mare for those try­ing to re­ha­bil­i­tate from chron­ic low back pain be­cause it pre­vents them from be­ing ac­tive and from func­tion­ing in their home and com­mu­ni­ty...from liv­ing their lives. This can have fur­ther psy­cho­log­i­cal con­se­quences, per­pet­u­at­ing a vi­cious cy­cle. Of­ten, the low back pain suf­fer­er ben­e­fits from the pro­fes­sion­al help of a psy­chol­o­gist who can teach cop­ing mech­a­nisms and help them de­crease their fear avoid­ance be­hav­iour. This fear avoid­ance can have se­ri­ous reper­cus­sions on the progress of a pa­tient with low back pain be­cause it af­fects the psy­chomo­tor di­men­sion of well­ness or the phys­i­cal ac­tiv­i­ty of the pa­tient.

Pro­fes­sion­al­ly guid­ed ex­er­cise is one of the most vi­tal com­po­nents of a low back re­ha­bil­i­ta­tion pro­gramme, There are end­less stud­ies that have shown the tremen­dous pos­i­tive im­pact of spe­cif­ic ex­er­cis­es on chron­ic low back pain. Through MRI stud­ies, cer­tain mus­cles that sta­bi­lize the spine have been found to be at­ro­phied in pa­tients with this con­di­tion. Spe­cif­ic ex­er­cis­es tar­get­ing these mus­cles have been shown to in­crease the size and strength of these mus­cles. The im­por­tant mes­sage here is that the ex­er­cise pro­gramme must be de­signed and ex­e­cut­ed by a qual­i­fied phys­i­cal ther­a­pist. Tech­nique and con­cepts per­ti­nent to suc­cess­ful progress are taught and prac­ticed so that the pa­tient can be ed­u­cat­ed on low back pain ex­er­cise philoso­phies and equipped to safe­ly progress in­to a gym set­ting. It is high­ly risky to en­ter in­to a gym pro­gramme with a train­er who is not versed in low back re­ha­bil­i­ta­tion con­cepts as this can cause fur­ther in­jury.

The oth­er as­pect of the psy­chomo­tor di­men­sion of well­ness in pa­tients with low back pain is ac­tiv­i­ty mod­i­fi­ca­tion. Un­der­stand that it is ac­tiv­i­ty mod­i­fi­ca­tion and not nec­es­sar­i­ly ac­tiv­i­ty re­stric­tion. For ex­am­ple, many of my pa­tients love to gar­den, but the repet­i­tive bend­ing over to weed, dig and plant wreak hav­oc on their backs. They do not have to stop gar­den­ing al­to­geth­er, but sim­ply change the pos­ture in which they weed by as­sum­ing an all-fours po­si­tion in which the back is sup­port­ed. Prop­er er­gonom­ics is key for desk work­ers, and lift­ing tech­niques are in­valu­able to every­one, as we all lift any­thing from gro­cery bags, to chil­dren, to a hose in the yard. Back pain need not rule your life. It is both a phys­i­cal and psy­cho­log­i­cal chal­lenge re­quir­ing pro­fes­sion­al as­sis­tance. But you have to take the first step and make the de­ci­sion to beat the back pain. The pro­fes­sion­als will guide you, but you must have the dis­ci­pline, the de­ter­mi­na­tion and a pos­i­tive out­look in or­der to stick to your ex­er­cise pro­grammes, mod­i­fy the way you do things, and live a gen­er­al­ly healthy life. Time and time again, those who fail in man­ag­ing their back pain are of­ten not com­pli­ant with their ex­er­cise or ac­tiv­i­ty mod­i­fi­ca­tions, or have dif­fi­cul­ty cop­ing with their sit­u­a­tion. It is not an easy task by any means. No doc­tor or ther­a­pist can wave a mag­ic wand and in a big, black cloud of smoke mirac­u­lous­ly cure you from your tor­ment. Suc­cess lies with you. Af­ter all, it is your back.