Wisdom is nothing more than healed pain.

-Robert Gary Lee

 

Do Not Fear

Back pain is so common yet so debilitating. In fact, it is one of the top reasons for people to seek out physical therapy. Sadly, there has been a 423% increase in expenditures for opioids for back pain. When you are suffering from pain, having no fear is easier said than done! Seth Godin says, “you can’t make fear go away, but you can learn to dance with it.” What if we can?

Most people who arrive in my clinic are so tired of the hamster wheel of trying to figure out a specific diagnosis for their back pain. Maybe you are on this same spinning wheel. You’ve tried injections, scans, tests, pain medication and maybe even alternative care, yet the pain still persists. You may have been told something is wrong with your disc and you fear surgery may be the only option. I want you to know something that most doctors don’t reveal,  “Positive findings, such as herniated disks, are common in asymptomatic people.”  Yes it is possible to have a herniated disc without experiencing any symptoms.

Listen to this, a study with 148 subjects, assessed the prevalence of MRI findings in the lumbar spine. This study was done on subjects  1) without current low back pain or sciatica and/or 2) those who have never had back pain.

The results showed:

  • 123 subjects (83%) had moderate to severe desiccation of one or more discs.
  • 95 (64%) had one or more bulging discs.
  • 83 (56%) had loss of disc height.
  • 48 (32%) had at least one disc protrusion.
  • 9 (6%) had one or more disc extrusions.

This is fascinating because remember these subjects had no pain, yet 83% of them had moderate to severe disc issues. Diagnostic testing can be helpful to rule out a severe lesion in the body/spine, but it’s not necessarily a helpful tool to determine your symptoms.

“Basically, looking for things wrong with people’s spines makes people fear their spines, which ironically leads to hypervigilance, sensitization, and disability.”  When you read words like disc degeneration, do not fear. Fear keeps you stuck mentally as well as physically. Here is an informative chart, by Stanley I. Innes,  to show how fear can worsen your pain level. It shows how pain, especially chronicity of pain, is not necessarily an accurate measurement of the health of your tissues.

Chiropractic & Osteopathy volume 13, Article number: 6 (2005)

 

So what is the cause of your pain? It’s not always an easy answer.  This study states that Pain includes various complex biologically driven processes (as opposed to psychologically driven). Read: your pain is not imaginary. Pain is real, but it is complex, subjective, and multi-faceted. Science is showing more and more that pain is derived in the brain. For example, in some cases the initial tissue injury (like a disc) has healed, but the nervous system is still sending a pretty powerful alarm, therefore you still feel the pain. This is due to the protective nature of your brain. The first helpful strategy is to understand that you can calm the nervous system, create a more biologically driven approach, and reduce your pain response. My approach for this, is to educate my patients on the wellness cycle.

 

The Wellness Cycle

Focusing on pain reduction is not enough. Neither is focusing solely on pain education. Pain education + movement + lifestyle factors can create incredible differences in someone’s pain and disability. As a PT, my focus is on movement dysfunction and function more than pain. Gather 10 people with the same back diagnosis and none of their symptoms or their pain level will be the exact same. This is why I am not someone who cares to give blanket statements like, “do xyz to cure your back pain.” It is much different when a patient is in front of me asking for help. I can hear their story, see their reactions, feel their mood, listen to their mindset, ask about their history and current condition, assess their movement, figure out their function, discuss their goals, etc…

These aspects tell me about the whole person. Pain is just a small part of it (although to the one in pain it feels like the only part). Many times improving movement can and will reduce the pain level, but what about when it doesn’t. This is when providing a healthy understanding of pain, the body, and the brain can make all the difference. In fact, Utilizing pain education strategies in conjunction with interventions provided by physical therapists demonstrates a moderate to large effect sizes on pain and disability.  When you have specific lifestyle tools that calm the nervous system then you are the one in control. The wellness cycle is about being proactive not reactive. See the breakdown below.

 

© Remedy PT Wellness 

Sore But Safe

In the PT profession it’s easy to point out the flaws and fixes because it’s our job to problem solve and provide solutions. But when you’re stuck in pain, being reminded daily of all that needs to be fixed can be very discouraging.  As a patient you need to be reminded more about your possibilities than your inadequacies. You need empathy for your story, hope for a brighter future, and empowerment for the journey. If you’ve been dealing with persistent back pain, you can be afraid to move and afraid of further injury. This is where excellent physical therapy is so needed. You need a guide toward learning the most beneficial movement patterns for your body. You may start physical therapy and be sore and wonder if its worth it. However you can be sore but safe! When you hurt after treatment or exercise it doesn’t always mean there is more injury. Sore but safe  is a helpful reminder. When you fear less, you move more! Finding movement that you enjoy can calm your nervous system, improve your energy and mindset and decrease pain. Movement is very powerful for the brain and body, and it is one part of the equation.

 

My wellness cycle shows other powerful factors connected to movement. I use it to empower patients to understand how they can take control over their pain response and the health of their body. This cycle can be a negative or positive feedback loop and they get to decide which one it will be. It is so empowering to learn that even though you may not know the initial cause of the pain, you can still control your response to the pain.

Here is how you break down the cycle:
  • Your breathing affects your stress levels (fight or flight system). When you breathe properly using your diaphragm, you improve the rest and digest system which means your stress response improves.
  • With a healthy stress response and a body not running on cortisol al the time, your sleep will be more sound. This means better renewal for your brain and body.
  • When you get adequate sleep, you move better.
  • When you move well, you eat well. Movement improves the health of your GI system, your body, your healthy choices, and your brain.
  • Proper nutrition affects your mindset about life and health etc.
  • Your mindset can affect whether you breathe deeply or more shallow thus signaling the nervous system to either ramp up or calm down.

By the way, the cycle can also work in the counterclockwise direction. 

What is so profound is you don’t have to change every block of this cycle to create a positive loop. Choose one! I have people start with breathing. It is the easiest and cheapest. It can down regulate the nervous system rather quickly and ask the vagus nerve to turn on the rest and digest system while turning off the fight or flight system. Yes you may be in pain, but the pain doesn’t have to control you. I know it’s hard! Your mind may be always fixated on that pain and its increasingly difficult to halt it. There is positive news from a study out of Arizona State Univ. aimed at fibromyalgia pain. They  found that slow breathing may help people cope with the emotional and physical symptoms that result from chronic, moderate pain. The subjects all reported reduced pain and less emotional stress when they practiced slow breathing as compared to the pain felt when they practiced regular breathing. Below I have included studies on sleep and pain as well as chronic stress and chronic pain. My goal as my patient’s guide is to go above and beyond symptom relief by empowering them in their own health.

Every individual is different in the amount of education and tools needed to help them take charge of their life/health/body/recovery. Everything is connected and people need to know how each area influences the other. Your goals are their own and armed with knowledge and guidance you can meet them 100% of the time.

7 Wellness Strategies

These 7 strategies include pain education and the lifestyle factors of the wellness cycle.  When you are stuck in persistent pain, you need an approach that takes into account all of you, body-mind-spirit (not just the medical or biomechanical part of you).  Here are some links to help you get started creating your own positive wellness cycle.

  1. Understand the science behind pain  – a very helpful video
  2. Gain a more connected breath – my upcoming online course
  3. Get more sound sleep – a study on sleep and pain
  4.  Eat an anti-inflammatory diet  – my book, How To Tame Your Sweet Tooth
  5. Reduce stress – a study on chronic stress and pain
  6. Focus on a healthy mindset  – a patient’s story
  7. Get help with a targeted approach to movement –  get a free discovery visit at Remedy PT

To gain more in depth knowledge of the wellness strategies, continue reading in part 2.