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Is Low Back Pain Fake?


Man's low back getting treated by a physical therapist

Key takeaways:

  • Low back pain (LBP) is a multidimensional issue that occurs in nearly half the population of the United States

  • There are main factors that play a role in the chronicity of LBP. These factors include psychological, physical, socioeconomic, lifestyle, and modifiable/non-modifiable comorbidities.

  • Cortical re-organization in the brain can create a protection response against non-dangerous stimuli such as bending forward, lifting light loads, and twisting.

  • Low back pain may be completely in your control and there are ways to improve quality of movement, reduce fear avoidance, and return to normal life activities.

Have you ever lifted up a weight and felt some achy pain in your low back either immediately or the day after.


Yup! I have been there a handful of times.


Sometimes this is something you can shake off, rinse and repeat. But sometimes this can develop into a chronic issue and limit people from doing simple daily activities. In fact, as a Physical Therapist, nearly 50% of my patient case load consist of people with low back pain.


We hear it all the time. “Oh I threw out my back years ago” or “I have a bad back with bulging discs”.


But what if I told you that LBP is not what most people think it is. That it's all in your head. I know, this sounds ridiculous already. But let me explain...


The epidemic of LBP is so multi-factorial that it is impossible to say that someone is feeling pain due to an anatomical cause alone. We have to take in consideration all the factors that play a role in LBP.


- psychological: emotional stability and perception of fear

- physical: local tissue damage

- socioeconomic: work and financial stress

- lifestyle: sleep quality, diet, activity levels, and socialization

- modifiable co morbidities: smoking, BMI, mental stress

- non modifiable co morbidities: age (40-65) and height (taller increases chances of higher acute stress on low back according to research)


When we are injured due to lifting or twisting an excessive amount of weight with improper mechanics, our brain remembers this. The brain takes note and creates various networks in the motor cortex. The prior organization of these networks gets lost and results in altered perception of various stimuli.


In other words, your brain is telling you that an activity that is safe 99.9% of the time is now dangerous. When this happens a pain response is generated to the area when approaching the movements that may have caused the initial issue. Yet, there probably isn't local tissue damage causing the pain.


Within a few weeks to months a lumbar strain can repair itself, depending on the grade of the strain. A disc herniation can regress around 6 weeks depending on the severity. Pain from a pinched nerve can be managed and reduced within a year. So why does my back still hurt when I dead lift?


Well one of the reasons is the way you look at pain. Take a second and ask yourself, is pain an input from the external world (i.e. that thorn I poked hurt!)? Or, is it an output from your brain (i.e. if you touch that thorn it's going to hurt)?


If you said output, congrats you're one step closer to recovery. If you said input you're still one step closer and you learned something.


Picture this: you're 5 years old hanging around the stovetop that your mom is cooking spaghetti on. As you're reaching to touch the pot you feel an unbelievable amount of pain in the tips of your finger. I'm going to assume you learned a quick lesson to never touch a hot stove again.

Flash forward 25 years and as you're maxing out on deadlift you feel a sharp pain in your back. Do you now compare a dead lift to the same degree of harm as a hot stove? I would argue people would rather attempt a dead lift versus burning their finger on a steaming hot stovetop. But your brain doesn't can't differentiate between the two instances.


Its time to get rid of your old thoughts on pain and say thank you to your brain for protecting you. I am also going to require that you tell your brain to knock it off and let you live your life. So how do we allow our brain and body to work together to reduce pain with lifting?


Give this a try:


Although I can't make your final decision on how you live your life, I would encourage you to pick up healthy habits that fight against the risk factors of developing chronicity in LBP.


- Reduce the amount of inflammatory food and beverages you consume. Take a look here for what foods to avoid.


- Eliminate any and all tobacco smoking. It's not worth it.


- Find a way to develop a consistent sleep schedule and work on finding constructive coping mechanisms that reduce mental stress.


Return to the Barbell:


It's time you get back to enjoying the pleasure of testing your strength and lifting without pain. Let's start slow and build up from the basics.


Step 1: Quality Over Quantity


Your rehabilitation journey starts with figuring out what movements hurt. Start with a PVC pipe or broom stick. Watch yourself in front of a mirror or video tape yourself from the side and front performing the lift that hurts. Do not push through pain right now. Focus on quality movement and notice any and all deficits i.e. lateral shift in the hips, lack of core bracing, hips rising excessively before the chest.


Step 2: Form Critique


Work on the deficits you've noticed above by slowing down movement with lowered weight, only moving in a pain free range of motion. Make sure that you are adequately engaging your transverse abdominus muscle and performing a solid hip hinge before diving into a full dead lift or squat.


Step 3: Strengthen the Perimeter


A full body movement like the dead lift or squat requires more than just a strong back or quads. Even if back pain is lingering, it is completely safe to work on strengthening muscles that compliment these movements like the hip extensors, abductor, flexors, core stabilizers, posterior chain, etc. You get the point.


Step 4: Exposure


It only makes sense that we convince our brain it is ok to move through these motions. But you will want to slowly progress to forward bending and deeper squats to replicate the dead lift and squat. Start with no weight and slowly progress the range of motion when bending forward and increase weights as pain reduces. You're safe to move as long as sinister causes have been ruled out.


So is low back pain fake? Absolutely not. But, I want you to reconsider the way you look at pain and know that it is ok to move your body as you heal. Pain is your brain just trying to protect you.


We hope this information has provided some value to your life and motivated you to get back in the gym and perform the lifts you love!


My company focuses on rehabilitating the injured weightlifter. If you find yourself struggling and want a free consultation to work with me personally, check us out at the link below. Thank you!



Writer:


Dr. Jacob Lohr specializes in orthopedics and can help you reduce your low back pain

Dr. Jacob Lohr PT, DPT, OCS, USAW


Jake is a Doctor of Physical Therapy specialized in orthopedics and Olympic weightlifting. His passion is helping weightlifters return to the platform without fear of reinjury and confidence in their skillset. Jake and his wife Mariah founded Nomadic Physical Therapy with a goal of providing you with a rehabilitation program that allows you to optimize your time and return to life's activities without limitation.





References:


1) PW;, T. H. L. (2011, October 1). ISSLS prize winner: Smudging the Motor Brain in young adults with recurrent low back pain. Spine. https://pubmed.ncbi.nlm.nih.gov/21508892/


2) O’Sullivan, P. (2016). Unraveling the complexity of low back pain | Journal of orthopaedic ... Unraveling the Complexityof Low Back Pain. https://www.jospt.org/doi/10.2519/jospt.2016.0609


3) Gatchel, R. J. (2016, September 8). Home - PMC - NCBI. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/


4) Koes, B. W. (2007, June 23). Diagnosis and treatment of sciatica - PMC - national center for ... Diagnosis and treatment of sciatica. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895638/




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