Back pain is a common experience across society. Millions are spent each year on treatment yet we do not seem to be making any significant progress in tackling this vast problem. Undoubtedly footballers are also subject to spinal aches and pains, either from a direct injury or insidiously. Most people whom I see fall into the latter category, when the pain comes on gradually, the individual seeking help when the pain reaches a troubling level.
Frequently back pain is blamed upon a disc injury, a facet joint problem, arthritis or a ligament sprain. In the acute stages the muscles often tighten or spasm making it very difficult to move. The pain can be extremely intense and worrying, but in fact this is a normal body response to the problem, even if there is no significant damage to the tissues. It can sometimes take a few days for this to subside, with any movement triggering pain–when we move our arms and legs, because the trunk muscles are also being used it means that they can tighten and be painful.
Acute pain – seek help if you are unsure
The general advice with acute back pain is to remain active as possible. Usually your GP will suggest pain relief or anti-inflammatory medication to help ease the symptoms. Gentle and tolerable exercise maintains the tissue mobility meaning that movement becomes easier and easier. Typically the back will stiffen when we do not move, being painful and tight when we have to change position. Sometimes our posture is altered and we tilt forward or to one side, the muscles pulling the spine into a position of protection. Arguably pushing or pulling (manipulation) this into a straightened position is to force the body into a position and work against the natural protective mechanisms. It does seem that spinal manipulation can ease pain in the short term but does not necessarily offer a better long-term outcome. Consistent movement and positional change is a sensible option.
A study completed some years ago demonstrated that the best predictor of back pain was the ability to hold the back isometrically. With the individual lying face down on a table, his hips at the edge with the trunk being held straight out over the edge, they tested the endurance factor, i.e./ how long they could hold the position. Those with the ability to maintain the position were less likely to experience back pain over the next year.
Core stability encompasses a range of exercises that supposedly create a strong ‘middle’, thereby reducing the risk of back pain. This is based on research that was undertaken in Australia some years ago. Subsequent studies have found that to truly optimise the trunk muscles they need to be working as part of an overall movement strategy controlled by the brain. This requires subtle yet focused training with a strong cognitive element to ensure that the deeper muscles are working at the right level (very low) and with the right timing. This does not mean pulling the low abdomen in as tightly as possible. In fact, many whom I see who have practiced this end up with greater tension and pain as a result.
We simply cannot dissociate lifestyle factors from back pain. Our habits at home, work and during physical activity will have an effect upon the spinal tissues. At this point we have to consider the way in which we feel as stress plays a huge role in pain and how we use our body. The physiology of stress affects every system in the body including the musculoskeletal system where our movements and posturing are manifestations of our thinking. For example, many will tense their shoulders or clench their jaws on becoming stressed. Our thought processes therefore, have an enormous role to play in how we hold ourselves and move. In essence, movement is an expression of what we do and think about. When a pain has persisted for some time, dealing with stressors and emotions must be part of a comprehensive treatment programme. In the acute stage of back pain when fear and anxiety play a role in the protection, having a reassuring explanation is key to starting the process of recovery.
Many people with back pain demonstrate a fear of movement and avoid certain activities. The fear usually develops during the acute episode and is reinforced by further bouts of pain. This is one of the clearest demonstrations of how thinking affects our movement. Interestingly, the amygdala in the brain that deals with fear is connected with the motor centres thereby exerting an effect upon the planning and execution of movement. One of the primary roles of the healthcare professional is to thoroughly assess the patient and fully explain the symptoms and provide a meaning so as to reduce the fear factor and encourage positive engagement in tackling the problem proactively with physical and cognitive measures.
Spinal health in my view cannot be separated from our general health and lifestyle. Considering our physical activity levels, posturing, state of mind, life circumstances, past experiences, our beliefs about pain and injury, culture and the implications of injury are just some of the factors we must think about. No injury or pain happens in isolation. There is always a background to the initiation of pain whether it be acute or gradually building over a period of time. Our job is to look at the individual and their circumstances around the problem in order to find a route forward to recovery and health.
Many sports people will complain of back pain as it is such a common problem. With the right knowledge and strategies over a realistic timeline, the pain can change and we can adapt positively to lead fulfilling and active lives.