Tuesday, August 3, 2010

The Dreaded Back Pain

According to Stats Canada, four out of five adults will experience at least one episode of back pain at some point in their lives. Sometimes solace can be found in statistics, but that just unnerves me. Although four out of five adults is a huge number, there are even more alarming statistics about back pain. In Britain, an estimated 4.9 million work days are lost per year due to back pain, which translates to monetary loses of approximately £5 billion a year, or roughly $8 billion (CDN). Interestingly, Stats Canada offers some reasons that we might 'get' lower back pain, including poor muscle tone, sedentary lifestyle, obesity, smoking, poor posture and psychosocial factors (chronic stress and depression). As an Osteopath, it seems to me, that that some crucial factors have been missed, namely; muscle imbalance, postural control, sacroiliac dysfunction and digestive problems.

So how can we ensure that we are not just another 'statistic'? Well, first thing's first - let's look at what Stats Canada suggests may contribute to back pain:

1. Poor muscle tone and sedentary lifestyle.

Well, that should be pretty easy to change by joining a gym, walking more and stretching during the work-day, so why aren't more people doing it? In my practice, common excuses I hear for avoiding these simple activities are, "I work too hard to exercise" and, "I don't have enough time." Time is always a challenge, and if there genuinely isn't enough time to exercise, there are small things you can do. Rather than spending 3 hours straight at the computer, you can get up and stretch every 45 minutes or so. This will keep your joints and muscles more subtle, allow better blood flow though your body and, hopefully, make you feel like doing more. Rather than driving to the supermarket and seeing how close you can get to the entrance, make a conscious decision to park a little further away to lengthen your walk. These seemingly little efforts do add up and contribute to a better quality of life.


In a few rare cases there are clinical explanations for obesity, but the vast majority of people are eating the wrong stuff at the wrong time in the wrong place. There are plenty of fantastic nutritionists out there, qualified in helping people tackle obesity. Why aren't we utilizing such invaluable resources and supports? Even a few simple changes can make a huge difference. Obesity prevention and reduction involves understanding the importance of walking at least 20 minutes per day, and recognizing that breakfast truly is important daily meal (for metabolic function), that a sugary drink is not a substitute for water, and that white bread raises blood sugar levels as quickly as eating sugar itself.

3. Smoking

Enough said.

4. Poor posture and psychosocial factors.

It is interesting that Stats Canada put these factors next to each other, as sometimes they do go hand in hand. We have all had the experience of seeing an old friend and, without exchanging words, been able to infer their emotional state. Posture and body language are reflective of the psyche. There are many psychosocial factors that can lead to a person developing back pain and many of them are under appreciated. In the western world, we are taught that the body is similar to a machine and immune to psycho-emotional influence. Many of my patients have had little or no findings on MRI or X-ray, and so the 'unspoken' conclusion by their Doctors is there is nothing wrong with them and they shouldn't have any pain. Well...they do have pain, so it must be coming from somewhere! A classical, well-accepted example of pain's psychosocial connection involves the phenomenon of phantom limbs. Many individuals with amputations have reported feeling pain in the missing limbs. Doctors accept these symptoms as real and visceral experiences, as phantom limb pain has been documented for centuries and it is understood that the pain is being generated in the brain. Through these studies of phantom limb pain, modern medicine is beginning to map the connection between back pain and psychosocial factors. (Schielp 2008)

Further Osteopathic Insights into Back Pain

There are many more reasons for back pain that Stats Canada does not list. I have highlighted 4 massive reasons for back pain that I routinely see in my clinic:

1. Muscle Imbalances

Research has shown that imbalance in hip flexor muscle length, strength, and endurance can play a role in back pain (1). Range of motion differences, in which one hip moves more than the other, have also been proven to affect the lower back. As long ago as 1964, a Czech researcher, Valadmir Janda, observed that weak gluteal muscles are significant in lower back pain (2). All these factors are reasonably easy to screen for and, unless there are multiple predisposing reasons for these imbalances, they are fairly simple to correct.

2. Postural Control and coordination

The spinal muscles should be able to contract in coordination with the other muscles of the trunk, namely the abdominals. To ensure correct muscle firing and contraction, the body relies on clear input from the eyes, ears and joints. All the information collected from these sites is processed by the brain, which enables correct muscle response to be executed. For example, if a person bumps into your shoulder while you are walking down the street (perturbation), your body should reflexively bring your trunk back to an upright, balanced position. Your ears, eyes and joint receptors provide instant feedback to your brain, which, in turn, sends out signals to the muscles in your trunk to contract and stop you from falling over. Researchers have also determined that people with chronic back pain have poor postural control. In instances of poor postural control, people may use their hips to correct movements instead of their ankles, leading to an overuse of the lower back. Also people with lower back pain showed delayed or altered muscle-firing times to perturbation.

3. Sacroiliac Dysfunction

In our clinic we have lots of people complaining about SI joint pain, a form of pain felt at the top of the buttocks on one side. Before treating for SI dysfunction, it is important to insure the pain actually originates from the SI joints, as the hip and surrounding muscles and ligaments can refer pain to that area. Fortunately, there are some simple tests we use to differentiate between these structures. Valadmir Janda worked out that the big gluteus maximus muscle can be 'switched off' if the SI joint isn't working properly. In addition to that effect, the SI joint can cause inhibition of one of the supporting muscles on the other side, the gluteus medius. He also found that this could happen in the absence of pain, so your SI joint doesn't even have to be painful for the inhibition of the muscles to happen. In addition, it has been discovered that the latissimus dorsi (the big back muscle) and the gluteus maximus work together to stabilize the SI joint. The latissimus dorsi is attached from the lower back, via the lower ribs and scapular, to the arm, so its proper function is affected by the mobility of the upper back. Since the average individual spends hours hunched over their computer, their upper back rounded and shoulders raised, it may be inferred the latissimus dorsi is negatively impacted and at the root of any SI dysfunction or pain.

4. Visceral (abdominal) Problems.

The contents of the abdomen, stomach, liver, intestines etc, are all attached to the spine. In fact, the spine acts as a bony scaffold that gives support to all those structures. As the back moves, the abdominal contents must also move. If the structures are not mobile, whether due to surgical scarring or internal adhesions, they can prevent the back from moving optimally. This leads to areas of stiffness in the spine and concomitant areas of hyper-mobility. The hyper-mobile areas of the spine are prone to overuse and injury and are commonly at the heart of complaints brought to Osteopaths. Clients will experience the pain as originating from their backs, which is true to an extent, but an Osteopath will recognize that the source of their discomfort lies in the abdomen. These abdominal adhesions can be helped with gentle visceral manipulation, freeing up the organs and reducing the load carried by hyper-mobile spine areas. Once visceral problems have been addressed, the body will be capable of repairing any damage to the back/spine and the associated pain will dissipate.

Treating Back Pain Through A Whole-Body Approach

Popular medicine addresses and successfully treats many causes of back pain, but, as reflected by Statistics Canada's areas of focus, other crucial sources are frequently overlooked. An Osteopath will not only consider the usual suspects, namely poor muscle tone, sedentary lifestyle, obesity, smoking, poor posture and psychosocial factors, but will approach the symptoms of back pain from a more holistic perspective. Back pain may be intimately connected to any of the above conditions, but, often, such broad diagnoses fail to recognize the intricacies of the body's systems. Through acknowledging the interconnection between muscles, connective tissue, the nervous system, viscera (organs), and the structural skeleton, an Osteopath is able to thoroughly comprehend and successfully treat the various elements that inform and contribute to back pain.

(1)Nourbakhsh, M.R, and Arab, A.M. (2002) Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther 32 (9): 447-60.

(2)Janda, V. (1964) Movement patterns in pelvic and thigh region with special reference to pathogenesis of vertebrogenic disturbances. Thesis, Charles University.

(3) Byl, N and Sinnot, P.L. (1991) Variations in balance and body sway in middle aged adults: Subjects with healthy backs compared with subjects with low back dysfunction. Spine 16:325-30
Ed Paget is an Osteopathic Therapist, writer, presenter, and director of The English Osteopaths, a unique health clinic dedicated to helping people find permanent relief from pain and injury by always searching for the root cause of their problems. Visit his website at http://www.theenglishosteopaths.com to learn more. While there, sign up for the free 8 Hidden Causes of Injury and Illness, a short, yet informative review of the reasons some people struggle to heal. Get in touch with Ed at 403-229-9214 or by email at ed@theenglishosteopaths.com

Article Source: http://EzineArticles.com/?expert=Ed_Paget

Monday, July 19, 2010

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