The symptoms of low back pain vary a great deal. Your pain might be dull, burning, or sharp. You might feel it at a single point or over a broad area. It might be accompanied by muscle spasms or stiffness. Sometimes, it might spread into one or both legs.
So why do we experience pain? Scroll down to first learn how pain is created in the body and gain a better understanding of its connection with Low Back Pain.
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Cause and Effect? Not So Fast!
Most of us think of pain as arising from an injury somewhere in the body. Think of a light and a switch. The switch turns on, which causes the light to illuminate. However, newer research suggests the story is not that simple. First, the pain experience involves more than simply “feeling” pain. It affects our attention, mood, ability to think clearly, and anxiety level. It even affects how the body functions as a whole, right down to the cellular level. It is important we understand how pain is created by the body and brain. That is right—pain is created and not merely felt by the body.
Pain, the Useful Output
Recent research into the pain process shows that pain is actually only sensed if the brain perceives a great enough danger signal that it decides action is necessary. This view stresses that pain is necessary and useful as a powerful learning and protection tool for the body. However, that danger signal does not need to originate in a specific tissue. The brain only knows the end message, not necessarily where the pain originated from. Think of a light attached to multiple switches. The light illuminates regardless of which switch is flipped.
When the brain receives an input, it is analyzed relative to past experiences and the current environment to answer the question, “How dangerous is this really?”, and sends an appropriate output. This process is dynamic and is able to both increase and decrease the output. For example, everyone knows bee stings hurt. However, if your house is on fire and your family is trapped inside with only you able to save them, and you are stung by a bee, the body cannot let you focus on that input because there are more pressing matters. Thus, you do not feel any pain from that sting.
The Connection to Low Back Pain
The back is composed of thousands of moving structures that must all work in harmony to produce functional movement. Any one of those structures can become irritated and start a pain response. For the same injury, some people can push through the symptoms while others cannot. The origin of the symptoms may be the same, but how the body perceives the threat is very individualized. For example, high-level athletes are notorious for limiting their focus on pain, which often results in injuries that are more serious. Pain is often useful and must not be ignored, but at the same time it should not receive excessive focus.
The most productive responses to back pain are to increase the body’s awareness of the potentially damaged area, modify activity level slightly to allow for healing, and then return to normal activities as the healing process resolves. However, the amount of pain you experience does not always reflect the amount of tissue damage, leaving some people stuck in the pain cycle even after the healing process has completed. This is likely why many people with chronic pain have “normal” imaging studies. The pain is still very real but the original damaged tissue is healed.
For these individuals, the pain pathway remains turned on even though the cause of the original pain has been mitigated. In other words, the brain continues to create a danger response even though the original cause of the pain has been corrected. When this occurs, therapy must focus less on the tissues originally damaged and more on decreasing the threat signal the brain receives. This therapy will focus more on increasing function and educating the individual on a series of tools to assist in successful self-management. These tools may include activity pacing, stress management, relaxation techniques, and fitness exercises.
Most low back pain rests somewhere in the middle, between useful and non-useful pain. Your therapist is trained to evaluate your condition and develop a rehabilitation program that will get to the root of the condition with a goal of improving function, not just reducing pain. Often this process is straightforward and can resolve very quickly, but occasionally it takes more time because the body must learn a new way of processing information. Each pain response is unique, and as such, each rehabilitation program must be tailored to your specific needs.
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