S E27: Ep 27 – Understanding Lower Back Pain — What You Really Need to Know

Hello everyone and welcome to the Pain Free Living podcast.

My name's Bob Allen.

And this is Louise Gordon, my co host.

And I'm not an osteopath, so I'm a change coach and consultant working with businesses and individuals.

But I'm here to ask all the questions because I'm inquisitive and curious.

She's very inquisitive, very curious, and hopefully she'll be asking the kind of questions that you, our listeners, will be asking as well.

This podcast is all about low back pain.

As an osteopath, I see a lot of low back pain.

If you go on the Internet, Google low back pain, you will find over 100 million responses.

Some good, some not so good, some quite dangerous.

So the idea of the podcast today is to give you some ideas about what low back pain is, why you get it and when you should be concerned.

So, and it like you said, so many people have low back pain.

I've suffered with it in the past.

I think it's like 8 in 10 people will get low back pain.

So I guess you know, you're an osteopath.

Bob, have you ever had low back pain?

Interestingly, yes, I have.

Yeah, I don't even despite my profession, I don't escape from the joys of low back pain.

Luckily it was pretty low level and it lasted about a week or two.

I did some exercises wrongly using too much weight and that's what caused a problem.

But luckily I knew that and I knew what to do about getting out of it and I could treat that myself.

Yeah, but it's good to know that you're only human as well.

I am only human.

I try and keep that secret, but actually I am only human.

Back pain is one of those things.

I did a presentation to a networking group a few months ago, about 15 people in the room and I said, everyone have had low back pain.

Put your hands up.

And funnily enough, everybody in the room put their hands up to say they have had it at some point.

So it's a very common problem.

So yeah, let's talk about low back pain.

A thing I've noticed around low back pain is a lot of people put up with low back pain.

So they will just work around it rather than actually investigate it or find out what's going on.

I don't know if you see that.

I know that from people I know.

I see that all the time.

And typically people get low back pain three or Four times a year.

The reason they go through that cycle is pretty much what you said.

So what will happen is they will have a habit, whether it's sitting at the desk for too long, whether it's trying to lift too much weight, or there'll be a reason for why they get the low back pain.

And then.

And it will be a case of I was just bending down to tie my shoelace and my back went.

Actually, it wasn't that, that was a sprawl that broke the camel's back.

It was all the things you were doing leading up to that point where you're back when.

So what happens then is they change their habits, rest, change position because it's really uncomfortable.

So they'll change their habits.

Back pain goes away, they get back into the old habit, back pain comes back and we go through that cycle.

And I've met people that have been in that cycle.

Back pain three, four times a year for years.

And it is some very often, as you just said, it's something really unconnected and small that makes the back go.

The shoelace sneezing.

Yeah, lots of different things.

But, you know, but it's never that one thing that's done it.

Sometimes it's traumatic.

So sometimes it will be lifting heavy weights.

Somebody recently, they'd lifted a heavy suitcase, but while they were twisting at the same time, that can cause a problem.

That's more of a traumatic issue.

And you can relate that to the pain.

But a lot of the time it is just a simple act of doing something, picking up a newspaper, something like that that causes a problem.

I remember this from when I was young and my dad used to hurt his back and he used to have to lay on the floor for however long for his back.

So there is this kind of.

I don't know whether it's a myth, it's assumption around you hurt your back, you need to rest it, not do anything.

What's your response to that?

My response to that is it's the worst piece of advice you can give someone.

In the 60s and 70s, the view was that if you'd injured a part of your body, rest it, it will get better.

Yeah, yeah.

And then you go back to normal.

Well, actually, what they've since found and the recommendation now is what we call active rest.

So it's certainly lying down is.

Or taking to your bed is the worst thing you could do.

Keeping mobile is better, keeping as mobile as you can.

So what I say to people who say, yeah, I can't move.

You can move a Little bit move within your pain tolerance.

Don't try and push through the pain, but if you can, but just manage the pain, but keep moving as much as possible.

So if you find a comfortable position to sit in, great, but don't sit in it for too long.

So maybe you want to sit for half an hour, 45 minutes, but then get up and move around, even if it's only to get up off the sofa, walk around the kitchen, and come and sit back down again.

Because it's that change in position that makes a difference.

So, yeah, the advice to rest, that's.

That's old school.

Now, you've mentioned a term a few times in other podcasts.

What is this one around?

Active rest.

What exactly is active rest?

Active rest is where you.

It's basically where you keep mobile.

So as I was saying earlier, when you move gets the heart rate pumping, increases blood flow.

So if you've got an injury, whether it's your back, your knee, or your ankle, if you've got an injury, what you want to do is you want to get fresh blood to that injury.

Because if you've got an injury, there's a good chance there'll be inflammation there.

If you don't move, then that inflammation kind of collects around the joint.

You also get.

You'll get buildup of CO2, you'll get buildup of waste products because the damaged cells will be broken down as part of the healing process.

And if you're not, if the blood flow gets a little bit stagnant, then that will collate around the area.

So, you know, the more you move, the better.

Again, always within pain tolerance.

So you don't want to be moving around and make the pain worse, but you want to move to a point where, okay, that's sore, but I can do it.

So the distinction I always make is discomfort and pain.

We all know when something is a bit uncomfortable, but pain is a whole different world of issues.

So one of the things that a lot of therapists do is they'll use a pain schedule from 0 to 10, where 0 is no pain.

10.

The most excruciating pain I've ever felt.

I tend not to do that.

I just ask, so if you move that, is that painful?

Yeah.

Yeah.

And if it's uncomfortable, that's okay.

If it's painful, don't I do it?

Yeah, yeah, yeah.

And what you said, I can relate to that.

In terms of knowing when I have had a bad back, the natural inclination is to try and do less because it's.

It hurts.

And it's uncomfortable, but actually even moving around more, going for walk, whatever, you do find that it.

The pain, it does ease slightly.

I mean, that's only my personal experience, so I know that everybody's.

It will be individual.

So I guess in terms of.

If we have.

And when we do have that back pain, we've got to keep mobile.

But in terms of, should you still be lifting weight?

You know, do you need to restrict things that you're lifting?

Yes, you do, to a point, but your body will tell you.

It's like I said, it's that thing about discomfort and pain.

So if you can lift weight, fine.

Most people can't.

Yeah, that's kind of like the extreme it.

But keeping mobile, keeping moving, that's.

That's the key thing.

So, yeah, exercise can be a good thing.

Yeah, yeah.

And generally is.

Yeah.

But like I said, it's all.

But you've got to listen to your body and if you have a very high pain tolerance, which means you're going to start trying to push through pain, don't do that because generally it can make the pain worse.

The big fear that people have is that by moving more, they're going to cause more damage.

And the reality is that they're not, you know, sorry, like I said, so it's just casualties body.

Yeah, yeah, yeah.

And in terms of the diagnostics for low back pain, you know, is it.

Is it only.

Is it a scam that's going to find out what's wrong with the lower back?

No.

What people tend to think is that a scan will give them the answer to their question, you know, how much damage have I done?

What's going on here?

And when I'm talking scan, what type of scan?

There's different types.

So typically for bats, you're looking at an MRI scan.

The problem with scans is that they can be people.

Some people will try and use them diagnostically.

So rather than looking at the problem and getting an understanding of what's causing the pain, they will go straight to, I need a scans, because that will tell me what the problem is.

I do occasionally refer people for an MRI scan, but I've always got my diagnosis that I've made first.

So you can use a scan to confirm a diagnosis, but you can't diagnose something from a scan to break that down.

What that means is that a scan is an image of how your back looks at that particular moment in time.

Now, there are scans where you can sit or stand, but they're few and far between, particularly in the nhs.

Most MRI scanners in the nhs, you're lying flat.

So that doesn't actually give you a great image of what's going on in the back because you're not, there's no, you're not weight bearing.

So scans are okay to confirm diagnosis.

What that means is that if you just take a scan of somebody's back or knee or ankle.

Yeah, it's a snapshot for what's going, going on at that time.

People, there are people walking around with herniated discs or slit discs, as they are commonly called.

But discs don't slip.

But that's a whole nother story for another podcast.

So people walking around with herniated discs, various things that look like injuries and issues on a scan, but in reality they are not getting any pain from them at all.

So that's what I'm saying about you can use a scan to confirm a diagnosis.

But if you just take 100 people image, the hundred people, you'd find 20 of them have got herniated discs, disc bulges everywhere, and they're in absolutely no pain at all.

You'll find five or 10 people who will have the perfect MRI scan result and they're in agony.

So scans have some value.

So if, for example, you're getting raging scientific pain down your left leg and you do an image of that and you see there's a disc bulge on the left side compressing the sciatic nerve, then you can go, okay, those are related.

But that's, like I said, that's using the scan to confirm a diagnosis.

If I took an image of your, of your back and you had a disc bulb and it was pressing on the sciatic nerve, but you had no pain at all, that's.

They have that.

They have some value, but not as much as the people think.

Okay, interesting.

So in terms of when, and we've talked about pain in a, in a previous podcast, but in terms of the back, you've got pain, lower back, is it a signal that you've done some damage to your back?

Does that, does that necessarily equate pain equals damage to your back?

No, it doesn't.

Again, it's one of those things that, well, like I said, just going back to the previous point about MRI scans, an MRI scan can show that you've got loads of bulging discs and you've got no pain at all.

Now, you would assume that if you've got a herniated disc, bulging disc, that pressing on the nerve is going to cause pain.

Sometimes it does, sometimes it doesn't.

So the level of pain very well, very rarely relates to what looks like damage to the tissues.

A good example of that is paper cut.

So paper cut on a finger, very little damage to the actual, to the finger.

But because there are so many nerves in the finger, it hurts, it stings.

Yes, it does.

But actually the level of damage is minimal.

So pain does not always equate to damage.

The reason that the brain kind of goes into generally goes into overload if you have an irritated nerve in your back is because the back is the highway for taking information from the limbs and body to the brain.

Brain sending signals back down to the limb to take appropriate action.

Now an injury, the body doesn't know how serious that injury is.

It just the alarm bells go particularly to the spine.

The alarm bells go off.

You can potentially be in a significant amount of pain from a very, very small problem.

There's a condition called a facet joint.

Again, I don't want to go into, I won't go into the anatomy, but it's a condition where you just get a little bit of joint irritation which then can irritate the nerve and that could not paralyze you.

But you can almost not want to move because of the level of pain that you're in.

That, that actually is a very, very small injury.

So yeah, the simple answer to the question is that pain does not equate to injury or tissue damage.

How interesting.

All of us spend a certain number of hours sleeping.

We need to important, but there's a whole load of stomach.

You need to have the right mattress, particularly if you've got low back pain.

Should we, you know, should we be going for a firm mattress?

Is there any recommendation, you know, in terms of looking after our backs?

Yeah.

I mean in terms of sleep.

Yes, you're right.

You know, you spend seven, eight hours a night in bed.

Now again, it's one of those things where firm mattresses were always the solution to a problem and in reality get a comfortable one if it's.

It sounds ridiculous, but it's actually it is that simple.

It's what's come to all for you.

So most people want a medium firm mattress to give back little gift back some support.

But it doesn't have to be rock hard.

Right.

Some people like a rock hard mattress.

They're just weird.

Us normal people, we want some.

We want something that's got a little bit of give in it.

Yeah.

But not too much.

So you got the extreme, which is a firm mattress.

You also got the extreme, which is a soft Mattress.

Again, some people like a really soft mattress, but the majority always again need a little bit more support than people have preferences.

At the end of the day, do not buy a rock hard mattress because you think it's better for you.

Do not buy a soft mattress because you think it's better for you.

A lot of companies these days allow you to, to try mattress for up to 100 days and if you, if it doesn't suit you, then you can return it.

So I would say go to showroom, try, try a few different ones out.

You know, you're probably going to be allowed to lie in it for an hour or two.

But buy what works for you rather than buying what you think you should, you should have.

And we are, we're all individual, aren't we?

We are.

Because Anetta questions pillows, I get a lot of questions about pillows as well.

Similar sort of thing.

I went through a number of pillows before I found one that worked for me.

I think everybody must go through that.

Yeah, pretty much.

And again.

But again, it's just finding one that you like, finding one that works for you, that you know, give gives you natural support.

One of the issues that complicates pillow buying is the fact that people who sleep on the front side or their back.

So depending on if you sleep on your front, you want a minimum pillow sort of nice or flat that puts less pressure on your neck.

If you're a side sleeper, you want a pillow that's got just a reasonable height, so basically keeps your head in a neutral position.

So it's the pillows here, you're not leaning too much that way and it's not pushing your head up so you too much that way because again, that puts a little bit of stress to that.

If you're a back sleeper, bit more of a challenge.

But yeah, work on what is comfortable for you.

And the main reason I don't get too hung up about pillows is because nobody ever stays in the same position all night.

You move.

Good point.

So it doesn't really matter which pillow you buy.

It's the one that's most comfortable for you when you're going to sleep.

I like that.

So true.

So in terms of we talked about back pain, are there any reasons to be concerned, really concerned if we get.

Back pain, 99% of back pain is benign and it will resolve over time.

There are not many conditions where it's an emergency, but there are some that need further investigation.

So for example, if it's cancer or if you've got a cyst, which is pressing it on nerve, then it needs investigation.

The one medical condition with the spine, which is an A and E job straight away, is a condition called cauda requira.

I'll put a lick in the show.

Notes to some useful information on what corda equina is.

It's rare.

Corda equina.

Corder equina.

Yeah, it's Latin.

I can give you the explanation for that, but, yeah, it's a medical emergency.

If you've had an injury and you're having problems going to the toilet, so you're having problems going for a wee, you're having problems going for a poo, you're getting pins and needles or tingling around the groin and around the bun when you're going to wipe yourself, anything like that that's affecting around.

Around the groin area, around the waist, then it's a medical emergency.

So you can ring your gp.

I would recommend going to ae.

I'll put a list, a more detailed list of the one.

Watch out, Mellie.

This is the one to watch out for.

I'll put a list of the symptoms to watch out for.

The show notes again, it's an A and E emergency.

What's happening is you're getting compression of the nerves in the lower part of the spine, but if it doesn't get resolved, what will happen is they'll take them to hospitals, they'll do an MRI scan immediately.

If there's compression of the nerves around the caudal equina area, then they will operate to decompress and take that pressure off the nerves.

Because if it's there for too long, it can have permanent effects.

So if.

If you do get any of these symptoms, you can call your gp, but you can go straight to AE and they.

And if.

Once you explain what symptoms are, they will take you in, they will scan you and they will make a judgment.

If you're wrong, if you panicked for no, for no reason at all, if you're presenting with those symptoms, they'll just go, okay, we checked, you're fine.

But it's not one of those ones where you do not be embarrassed about going.

It's not worth to mess around.

If you've got those symptoms, you spoke to your gp, they will send you to Del Sage Hospital.

And if it's wrong, fine.

If it's right, they will offer it.

It's one of those.

But like I said, it's very rare.

Nothing to panic about.

But if you get any of these symptoms, treat it seriously.

Great.

Thank you, Bob.

There's lots there around lower back pain.

Welcome.

Yeah, so again, if you've got any questions about anything we've talked about today, if you want any more information, then, yeah, drop us an email, please get in touch and I will get around to answering your questions.

I will put some links in the show notes to some of the stuff we've talked about today.

And yeah, if you've got any value from this at all, please go away, tell all your friends, leave us a review on wherever you listen to podcasts on YouTube, whatever, whatever it is.

And so until the next one, thanks for listening.