Oh no, here it comes again! You read the 5 tips to avoid low back pain during the Spring yard work season from the last iMove PT blog…but your low back pain is rearing its ugly head again. As part of our treatment approach, the physical therapists at iMove PT passionately educate our patients as to the why behind their pain.
Pain is very complex and not easily described in a short blog. But let’s move forward with trying to describe some key points about pain so you can begin to understand why you have low back pain after planting those flowers and spreading that mulch.
I now present to the amazing iMove PT community the why behind low back pain.
Those pesky discs!
The bones of the spine are called vertebrae. Did you know that an adult has 24 vertebrae? 7 in your neck, 12 in your mid back, 5 in your low back. Ok, but what about those discs?
In-between two vertebrae is the intervertebral disc (less just simplify things and call it a disc!). The discs in your spine are made of cartilage. Cartilage helps to cushion joints. Sounds good so far…but two things you should know about cartilage: it can break down as we age and it has no blood supply.
The fact that cartilage breaks down as we age is easy to understand. Many orthopedic surgeons have made a career out of performing total knee replacements because the cartilage in the knee breaks down. Well, the same thing happens in the low back. The nice thick disc breaks down and your low back tolerates less physical stress. Let say for example a healthy disc can tolerate 2 hours of yard work. Well, it would be safe to say that a disc that is broken down would tolerate substantially less yard work, perhaps only 30 minutes.
The blood supply issue to the disc is much less discussed but oh so important! Blood supply to an injured area is what helps to heal the injury. Injury causes inflammation. Ugly chemicals then get produced in the area of injury. Don’t worry, the best looking person in the world has the same ugly chemicals (feeble attempt at humor from a blog writer!).
The injured site counts on blood flow to clean up the injury and promote healing. But alas, no blood flows to the disc. OK, so how does cartilage heal? Cartilage depends on physical movement of the area to push out those ugly chemicals. But how much do you really move when your low back hurts? Probably not very much.
Now you begin to understand how a disc injury in your low back can evolve into chronic pain. Enter the physical therapist to help your body to move again and push those ugly chemicals out of your disc!
Why does my brain get involved?
In the last iMove PT blog I talked about bending through your knees and hips in order to use the large leg muscles to lift instead of the tiny (but very important!) muscles right next to the spine in your low back.
Let’s say you bent down to pick up the 20# bag of mulch. The bag was too far away from your body, but you were in a hurry and forgot what I wrote in my last blog! As you went to pick up the bag you had a sharp jolting pain in your low back. Congratulations, you just applied too much stress to those tiny muscles in the low back and that beautiful brain of yours now has woken up!
Most people function day in and day out without their brain on high alert because of pain. However, when an injury occurs in a body your brain wakes up and pays attention! If the inflammation from the injury stays active and doesn’t go away, which happens to millions of Americans every single day, the brain stays on high alert. In some cases your brain overreacts to an injury where inflammation no longer exists. This is called “central sensitization” and will be left to discuss in a future blog!
Pain is your body’s way of telling your brain “Hey, pay attention to this area, there is something going on.”. However, the brain being as complex as it is, sometimes overreacts to an injury, further causing you to stop moving which causes you to lose mobility, strength, and function of that area.
I can get arthritis in my low back?
Did you know that you have joints made of bone that run up and down your entire spine? These joints, just like any other joint in your body (especially weight bearing joints) can develop osteoarthritis.
Billions and billions of dollars are spent daily to combat pain from arthritis. Please understand there is no cure for osteoarthritis. The physical therapist’s job is to preserve movement of a joint and to increase strength surrounding the joint.
As pain develops from the arthritis the common reaction is to stop moving because of the pain. Well, if we stop moving the health of the muscles, tendons, ligaments of our low back starts to spiral downward.
And not to make this more complex, but the arthritis in the low back can start to narrow the area in your low back where nerves exit the spine. This condition, called spinal stenosis, is very common. In fact, if you have low back or leg pain when walking but when you sit the pain totally goes away I am going to bet the farm (if I had one of course!) you have some degree of spinal stenosis.
I do hope you now have a better understanding of why you are having low back pain. Physical therapists spend a large part of their education learning about the why behind pain. In order to find out what to do about your pain, it is so important to understand the why behind the pain. Hmmm, now that sounds like a great idea for the next iMove PT blog…what to do about your low back pain!
If you have any questions about the why behind your low back pain please reach out to iMove PT at info@imovephysicaltherapy.com. A mission of iMove PT, a mission we live every day, is to make the world healthier, a world where fewer people are living with low back pain and where all can achieve the physical activity level they desire, whatever that level of physical activity may be! Thank you for reading!