Ever have back pain so bad you think you need a miracle to fix it? I’ve been there before. Yup, a certified physiotherapist like myself. I was stuck on a dirty gym floor in pain and agony for 30 minutes after a failed squat attempt a couple years back. The culprit? Probably poor execution at the bottom of the squat movement. The paralyzing pain I felt also led to a terrible night’s sleep. Then I miraculously went to my physical job the next day. “Wait what?” you might ask.
What was the miracle? I didn’t let that paralyzing pain fool me into thinking my back was damaged and out of service. Instead, my conclusion was that I simply irritated my lower back. Self-diagnosing it beyond that would have been utterly useless. Ironically, it was my knowledge about physiotherapy for back pain that inspired me not to overthink it.
Physiotherapy for Back Pain
I have to admit that it’s easy to think the worst. Debilitating pain is a great provoker of fear and pain-avoidance. Throughout my experience providing physiotherapy for back pain, I have resolved that this arises from the unknown. The unknown for most people is a problem distinguishing hurt from harm. Hear me out.
Hurt is when something causes pain, but not necessarily any type of structural or physical damage. Harm on the other hand is structural or physical damage that can and is often accompanied by pain. Fear from experiencing back pain is typically linked to the assumption that the body is harmed, and perhaps beyond repair.
Hurt vs. Harm
To understand “hurt” a bit better, we need to figure out what pain is. Pain is a brain experience in a nutshell. Your brain needs to understand that the signals it’s receiving equate to pain. Where do these signals come from? Different types of nerves grouped into what we call “nociceptive nerve fibers”. These are found throughout our body, responsible for sensing pain-provoking stimuli.
There are multiple versions of these nerves because there are a variety of pain experiences that can occur. You can go from having a quick and sharp pain to a dull, searing, deep ache that lasts forever. These two experiences are governed by different collections of nociceptive nerve fibers. But whether you stub your toe or have long-standing low back pain, signals must always be transmitted to your brain for interpretation.
Why is this important to know? Because of a concept called the Gate Control Theory of Pain.
Gate Control Theory of Pain
Physical therapy for back pain isn’t just about treating the pain problem as it presents. It’s also about understanding how the brain experiences the pain. The magic is in taking advantage of this brain experience, and figuring out how to manipulate it. In fact, sometimes we instinctively modify the pain experience without even knowing. Let’s talk about something we’ve all done.
Do you recall the last time you stubbed your toe or finger? What’s the first thing you did after saying (or yelling) a four-letter word? My bet is that you grabbed and squeezed it. Sounds counterintuitive though considering you just hurt it. However there’s a good reason why you’re doing it, and why it works. Just like we have nerves that sense pain, we also have nerves that sense pressure.
The brain must now interpret pain and pressure at the same spot on the body. It’s a horrible multitasker though so it divides its attention between the two experiences. A decreased attention to pain must happen now to accommodate an increased attention to pressure. Because of that alone, you’ll experience less pain. That’s gate control in a nutshell. Pretty cool right?
Why Is This Important for Back Pain?
Of all the pains we experience, back pain is arguably the most complicated. Many factors tie into it including psycho-social factors like stress. So much so that one study even determined that the number one factor correlated to back pain was job satisfaction. Yes, you heard me right.
In our “physiotherapy for back pain” toolkit, an important tool we use is education. It’s our responsibility to help our patients understand what back pain really means. Ironically, that alone can help decrease the pain experience. But it also helps indirectly by promoting behaviours that were once hindered including:
- Moving regardless of fear of pain
- Positive outlook regarding the pain
- Addressing factors that are continuing the pain experience (i.e. stress, sleep, posture, lack of movement, poor nutrition, etc.)
So Where’s The Miracle I Promised?
I argued in the headline that physical therapy for back pain is the miracle you’re looking for. I chose the word “miracle” specifically because our body is just that. By understanding it more, we can miraculously overcome the debilitating pain that the low back can cause.
And as much as I hate cliches, the one that resonates most is “knowledge is power”. Knowledge about the pain experience should be the first step in healing. If we believe pain is debilitating, then it will debilitate everything else. That in itself can perpetuate pain. However, a mindset change can stop this negative cascade in its tracks.
Beyond that, a veteran physiotherapist can teach you physiotherapy exercises for low back pain. Physiotherapy for lower back pain is incomplete without a proper exercise routine. A strength and mobility program goes a long way in healing and preventing future back pain.
What’s The Next Step?
Speak to your clinician regarding physio for back pain or any pain in general. Ask them about what makes the pain experience. Get them to explain the difference between hurt and harm. Learn more about the gate control theory of pain.
It’s also important to consult a physiotherapist first before attempting to fix anything yourself. Get diagnosed and receive proper physiotherapy for back pain. Not all back pain is created equal. There are certain red flags that a therapist will also look for, and rule out. Problems can often arise from areas away from the low back.
Conclusion: No Brain, No Pain.
If your brain can’t receive or interpret the signals, you will not experience it. That’s not to say pain is a bad thing. Heck, it’s actually amazing that we can get it. Without it, we wouldn’t know what is going on with our body if something wrong occurs.
But pain can also go wrong in some ways. For example, chronic pain is a pain that has long outlasted any potential harm that may have taken place. Addressing pain starts from addressing the brain, and working down from there.