Getting to the bottom of your low back pain
Many mistakenly believe that they have to live with the pain in the lumbar region. I have rehabilitated hundreds of clients with lumbar back pain, and the success rate is almost 100%! This article will reveal the secret in depth, and describe what it will take for you to get rid of your lumbar back pain forever.
Lumbar back pain is people’s disease. It is a lifestyle disease. This article will describe which lifestyle causes it, and how to make a lasting improvement in the symptoms, and how to permanently remove them. It is fairly easy to reduce the symptoms, or make them totally disappear for a short period of time. The only problem is they come back.
The vast majority, contrary to what many believe, can actually relieve their lumbar back pain permanently, if they know the secret, make an effort, and have a qualified therapist to treat their ailment. This article will unfold how I’ve achieved an almost 100% success rate in over 10 years of treating patients with lumbar back problems.
Lumbar back pain costs the Danish society around 10 billion Danish Kroner annually. It is an enormous socio-economic cost, and, of course, a very large individual cost, which many patients can verify. It is a growing disorder. Approximately one third of the population has had a sore lower back within the last year. 80% of the population has been afflicted with discomfort in the lumbar back area at some point in their life, and 80% of them are going to live with it the rest of their lives – some in constant pain, while others in fluctuating symptoms. There are good and less good periods, and the reasons will be discussed later in this article.
Symptoms of discomfort in the lumbar back region may be local pain, rigidity in the joins, reduced movement in the lumbar region, and lower back fatigue. However, they may also be present in other areas, because the spinal nerves are connected to the nerves in the legs and the intestines. Therefore, one can experience symptoms in the form of paresthesia (tingling/pricking sensation) or pain in the legs, the feet, the knees, the thighs and the groin. I often encounter patients, who have been misdiagnosed and told that they have injuries, for example, in the foot, when the discomfort actually originates from a nerve that is trapped in the lumbar region.
Other symptoms also include difficulty in controlling leg movements, like reduced power – as if one is about to fall. One can also experience symptoms in the colon and the small intestine in the form of flatulence, abdominal pain, constipation or diarrhea.
All these can be caused by trapped nerves in the lumbar region.
Diagnosis of lumbar back pain consists of investigating the patient’s medical history, clinical testing, and at times, diagnostic imaging, where MRI provides the best overview. In some cases, blood tests and bone density tests are conducted if there is a suspicion of osteoporosis or rheumatic disorders.
If a patient with a back pain goes to a doctor, he will most probably be diagnosed with “non-specific lumbar back pain”. 70% gets this ambiguous diagnosis, which is linked to 2 factors. Firstly, a general practitioner is not a specialist in back problems. Secondly, being a good diagnostician requires thorough training and great experience. The “non-specific lumbar back pain” diagnosis is what I call a suitcase diagnosis, because it can contain an infinite number of diagnoses. This diagnosis is not a diagnosis in itself; instead, it covers many different diseases and problems such as disc herniation, disc protrusion, facet joint syndrome, Bechterew Disease, degeneration / arthrosis, osteoporosis, scoliosis, Scheuermann’s Disease, sciatica, spinal stenosis, fractures, etc.
A patient with a back pain is usually sent home by the physician with painkillers. He is also informed that if he rests his back, it will be fine again, which is also the case. After approximately 3 weeks, 50% will be cured, and after approximately 3 months, 90% will be cured. The problem with this approach, which involves a health policy, is that the symptoms recur for 80% of the out-patients mentioned. Back pain comes back. Statistically, the good periods becomes shorter and the pain becomes more intense if measured over several years.
When the pain recurs, many choose to seek the help of a physician again, and eventually they will be asked to try physiotherapy. Many also choose to go to chiropractors, and after approximately 10 treatments, the patients’ condition gets better. Such is the case in the beginning. But the challenge is, of course, the pain comes back, because the underlying cause is not resolved. Going to a physiotherapist, chiropractor, acupuncturist, reflexologist or other types of therapists, does not amend the causes of back pain.
Lumbar back pain is a lifestyle disease, and lifestyle is not altered by treatments or by doing back exercises in a period of, say, 3 months. So, let us now look at the causes to back problems.
The 6 stressors that create back problems
Lumbar back pain is a lifestyle disease, which means that there are many factors in the overall lifestyle that is in play when we talk of this disorder. Overall, the 6 stressors that create back problems are:
2. Mental / emotional
4. Physical (This is where the conventional treatment is usually applied)
The conventional treatment
The conventional treatment of lumbar back problems includes medical treatment using NSAIDs (non-steroid anti inflammatory drugs), e.g. various forms of arthritis medicine, also corticosteroids. The treatment may include physical therapy, chiropractic, and in extreme cases, surgery. It focuses almost exclusively on the physical factors that cause back problems. Since this is often only a fraction of the overall cause, there is a great chance of relapse.
It is about the temperature (hot and cold). If you have a job, where you are exposed to cold draft or where your back is exposed to cold air, there is an increased risk of developing lumbar back problems. Temperature has a great effect on one’s immune system. Imagine, for example, that one sits on a bench in the freezing weather for an hour wearing a T-shirt. The risks of developing a cold or getting the flu within a few days have clearly increased.
Psychological / emotional stress
The psyche affects, on the overall, two factors in the body. First, it affects the posture; so, if one is depressed, one will fall into a slumped and a slouching posture, leading to a greater mechanical stress on the joints of the lumbar spine etc. Second, the stress hormone cortisol, breaks down tissues and muscles, and inhibits the body’s ability to regenerate over time. If one is ill or imbalanced and at the same time is, under mental / emotional stress, then the recovery rate is slow. This stress can be anything from having too many balls in the air, being subjected to excessive workloads, a complicated relationship; procrastinations i.e. keep postponing confronting someone, whose behavior and attitude affects one negatively, financial speculations, or unhandled traumas. Some of these may be subconsciously and others, consciously.
This is linked to whether you are getting the nutrients your body needs to function optimally. Your body needs a wide range of micronutrients (vitamins and minerals) in the right quantities and qualities. Likewise, it shall have macronutrients in the form of diverse acids, proteins and carbohydrates. The challenge lies in the fact that your body is designed for survival. Therefore, it can survive on almost anything without perhaps noticing that it is bad for you. You can, for example, offer your body only alcohol in 30 years and still survive. There are examples of people who sit on a bench for 30 years, and basically just live on beer. The body can survive on it; however, they do not get good results solely on beer for 30 years, as the body needs a well-balanced diet. I have treated, rehabilitated and trained some of the country’s best athletes. In order for them to perform at the top, and allow their injuries to heal as quickly as possible, a carefully planned diet is required.
Nutritional stress also includes water intake. Each person needs approximately, the body weight (kg) times 0.033 liters of water daily. This formula is valid for a normal office job, where one does not sweat much. If one is physically active, one needs more water to operate normally. Again, one can survive with much less, but the body will not function properly. Approximately 10% of my clients do not have to do anything, but drink enough water. It is a waste of my time and their money if the cause of their back problems is due to chronic dehydration. So, I do not want to see them before I’m sure they drink enough water.
The physiology behind this is complicated, but I can highlight two points. First, the spinal discs are approximately 98% water. They absorb water, and the only way to get it is to drink it. For example, if you need 2 ½ liters, and you only consume 1 liter, the water deposits will be drained. One of the depots, from which water will be drained, is the discs. When the discs lack water, they become flatter, and the distance between the vertebrae becomes, therefore, lesser. This may result in nerve compression and entrapment in foramen intervertebrale (the place where the nerve root runs to and from the spinal cord). Ligaments of the spine will also be a bit more lax, because there isn’t the necessary distance to keep them stretched. This gives one an segmental unstable lower back. Second, chronic dehydration mainly affects the large intestine and form constipation. This can lead to pain on the spine, and affect both the back and the stomach muscles, preventing them to function optimally. It is the same neurological segments in the spine, which feeds nerves to the back and the stomach muscles as those feeding the intestines. For the body, the digestive system is more important than the musculoskeletal system (muscles, bones, tendons, joints and ligaments). If one has an imbalance in the digestive tract due to poor diet, or food intolerance eg, most of the neurological drive (nerve signals) from the central nervous system in the spine will be channeled to the intestines to restore the balance there. Thus, there is not much left for stabilizing muscles of the lower back. As a result, it becomes difficult to train these muscles, and requires enormous concentration, and a lot of will power to properly activate them. I have observed quite often that I cannot make long-lasting results with clients, who suffer from lower back pain without first correcting their intestinal imbalances. (You can read my article on food intolerance to learn more about this)
It is this factor, most people in the health sector focus on today. This is about postural distortions on the back in the form of asymmetrical or poor posture, uneven leg length, which can result to skewed back, pelvic dysfunction, tight or weak muscles, worn out tissues, etc. This is where we manipulate, mobilize, massage, do agility, stability, balance and strength training. Physical stress also includes lack of sleep or poor sleep quality as well as overtraining, as some athletes experience at times. I will describe in another article, what science says about the importance of sleep in relation to the body’s ability to heal, perform, learn, and prevent disease. For now I just want to emphasize that as a rule of the thumb, you must go to bed by 22:30, and get at least 8 hours of undisturbed sleep. You should feel rejuvenated and well-rested, when you get up in the morning. If you are struggling to get out of bed and need to use mental force on it, there’s something wrong, and you should seek help. In this case the body will have difficulty getting rid of back pain.
Chemical stress comes from all the chemicals your body must detoxify daily. The breaking down of chemicals occurs in the liver, which is your body’s detoxification center. Annually FDA (Food and Drug Administration) in the States, estimates that a normal person receives about 75 kg chemicals added to the food from his diet on a yearly basis, thus, a very large amount of chemicals to be broken down in the liver. The liver has a very large capacity, but it is overworked today not only from the daily diet, but also from the chemicals, which come from perfumes, deodorants, make-up and cleaning agents – many of the consumption articles, which more and more people gets allergic to. (You can read my article on allergy to learn more about this)
Finally, we have electro-magnetic stress. This form of stress comes from the sun’s harmful rays. The sun is just as dangerous as it is life- giving and wonderful. Overexposure is not advisable – Everything in moderation. Everything that is healthy can be exaggerated. You might also get too much carotene. If a person gets too little sun, he will lack vitamin D, which increases the risk of skin cancer. Electromagnetic stress also comes from the radiation your body gets in the form of radio waves, mobile phone and microwave radiation.
Your body’s reaction to the 6 stressors
Your body’s response to stress will always be the same. Whether you are exposed to thermal stress, insufficient diet, lack of water intake, lack of sleep, economic speculations, or chemical overload, your body’s response to stress is to increase the stress hormones. These are mainly cortisol, but also adrenaline and noradrenaline in extreme cases. This can be good in the short term, because it enables your body to survive and cope with the load it is exposed to. Eventually, the abundance of stress hormones in the body will inhibit the production of growth and repair hormones, sleep hormones and weaken the immune system. Stress wears out the system. This means, if you have too much stress in your body, it will be very difficult for it to heal some of the pain and ailments, which you may have accrued over the years, even though the physical cause has been removed. It is the total amount stress that matters. This means, if you have a demanding job and a lot of mental / emotion stress, then it is even more important that you get the nutrients and sleep you need. Conversely, if you are positive and mentally strong and not extremely occupied, you can tolerate a more erratic lifestyle with poor diet, more chemical intake, sleep deficit, and still not get injuries, imbalances and ailments that will not heal. This, together with with one’s genetic predisposition, determines why some people can smoke, drink heavily, live unhealthily, and still live to 100 years old; while others die from lung cancer at a very young age. It seems unfair, but is interplay of many factors. One thing is certain. You can never run away from your lifestyle. You may not notice it now, but it will catch up with you after 20, 30 and 40 years.
What do I need to get rid of lumbar back pain forever?
In order to make lasting improvements in patients with lumbar back pain, it is necessary to have a good overview of the 6 stressors mentioned above, as it is often interplay of several factors that affect the disorder. Of course, we will need primarily to be thoroughly grounded in all the physical factors like, correcting postural distortions, dysfunctions, muscle weakness, tightness, etc., but statistics show that it is not sufficient to create a sustainable healing and pain reduction for clients, who have pain in the lumbar region.
I became aware of this when I finished my degree in physiotherapy. I was really excited to go out and find people, with all sorts of problems in the musculoskeletal system, that I could help. I was passionate about healing their injuries and illnesses. However, I got quickly disappointed, because I realized that much of what I did was just treating the symptoms, and sometimes people did not get any better. It could be simple injuries such as an Achilles tendonitis or tennis elbow. These injuries have known and established treatment regimens. However, 10-15% did not heal as expected, and the process was very slow. Moreover, many did not recover at all. It irritated me, and I thought that something was wrong. I had to study some more.
The body is designed to heal itself and get back in balance, when it becomes sick and injured. Thus, if it does not heal, something must be wrong. It is coded in your DNA, that if you get a muscle strain or small partial rupture, it automatically heals in a few weeks. When you cut your skin, it patches up. When you fracture a bone, it heals within 6-8 weeks. When you lose ½ liter blood, the body refills it. If you catch flu, your body regains a healthy balance after a short time. Everything in the body is alive and regenerates constantly. Within a year approximately 98% of all your body’s 100 trillion cells are replaced. If you think one year back from now – it was a total other skeletal system you had. Your liver is brand new in 6 weeks etc. Thus, if you get an injury or an imbalance that does not heal, even after you’ve sought professional help, then something is wrong. You should seriously consider seeking an expert, who can assist you in relation to the framework mentioned in this article.
I started studying nutrition with the preconception, that there must be a reason we have to eat a diet consisting of many different nutrients. I asked my patients to keep a journal of what they ate and drank in a week. Sometimes there was a daily shortage of protein i.e. 20g. As soon as I prescribed a diet with extra 20g protein, the same patients began to heal and were asymptomatic after 2-4 months, despite the fact that many had had their injury for years. Other times it was omega-3 fatty acids or some important vitamin and mineral that was deficient. The bottom line is, if you do not give your body the necessary foundational factors like the nutrients it needs, you can keep getting treatments and doing back exercises for rest of your life without fully recovering from your ailment. Training, in this case, will be like building a house on sand, because the necessary conditions for your body to regenerate is absent.
Sometimes I meet athletes, who have injuries that would not heal despite all possible treatment regimens. Their training program was reasonable. They had a good diet, and were not mentally burdened by stress. But when it came to sleep, they went to bed around midnight and got up at 6:00 or 6:30. In this case, sleep had to be adjusted. Deep sleep is essential for cell regeneration and healing. You need 8-9 hours of sleep per night. The moment I prescribed the athletes to go to bed from 22:30, and sleep for at least 8 hours good per night, it took a relatively short time before their injuries and imbalances began to heal. This is how important sleep is – Summa sumarum!
When we talk about lasting improvements in lumbar back pain, you need to find a therapist, who has a holistic examination or overview of your body and lifestyle, and who is good at physical rehabilitation. She/he should conduct the necessary and relevant tests, and help you submit an action plan, that tackles all the underlying causes of your situation. This will ensure the permanent riddance of your back problems. I speak, partly, from my own experience. I endured a serious and debilitating lumbar back pain for more than 10 years. It was only when I took this approach that I got rid of it for good – and partly, from my experience with treating and rehabilitating hundreds of clients suffering from lumbar back pain and discomfort.
Our approach to treatment of lumbar back pain
In light cases we always conduct a thorough interview with our clients as well as a thorough testing of the biomechanical causes. We make various measurements of your position, the pelvic position, measurement of leg length, and perform different clinical tests for spinal discs problems, etc. in order to make a diagnosis. The diagnosis is often held up against an MRI. We test muscle strength, stability and endurance. There is quite often weakness in the deep back and abdominal muscles and hip stabilizers. There is also rigidity in some muscles, and weakness in others as well as joint imbalances. The balance may be affected. We design a tailored training and treatment plan that corrects the patient’s individual dysfunctions and optimizes the body to perform the functions of everyday life and sport, which has, otherwise, been painful.
In severe cases, where the patient has suffered from lumbar back pain for many years, the above treatment is rarely enough. Thus, we combine it with a health test. This is necessary because the patient does not respond to the training, and any concurrent treatment he gets. During the first interview at the clinic we will clarify whether the patient should start directly with a normal training / treatment or whether he needs a health test and action plan parallel to ensure healing.
How long does it take
If you have suffered from lumbar back pain for several years, you should count on 500 days of intensive workout, and follow the action plan for your new lifestyle. You can be very sure that your body will get stronger, and that you have improved your life so much that you no longer have to worry about lumbar back problems. Moreover, your stronger body and better lifestyle can prevent you from getting a wide range of other diseases.
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