Where
Does It
Hurt?

Terry O’Brien, www.backtrouble.co.uk

The Book “Where Does It Hurt?” empowers the Back Pain sufferer with information that will enable them to confidently manage their Back Pain, Treatment and Rehabilitation.

Contents

 

1. Introduction – Understanding Your Pain
2. Assessing Your Pain
3. What’s It All About?
4. What Causes The Pain?
5. What Can I Do?
6. Do Drugs Really Work?
7. Should I Take To My Bed?
8. What About Physical Therapy?
9. What Are The Surgical Options?
10. Any New Treatments?
11. Other Treatment Alternatives
12. What To Do If You Are In Pain
13. Prognosis For Back Pain
14. Prevention Is Better Than Cure
15. Getting Help
16. A Pain In The Neck
17. What Is Scoliosis?
18. Coping With Sciatica
19. Exercise Is Good For You
20. Its Not A Mystery
21. Laughing Improves Health

 

1. Introduction:

They say that laughter is the best medicine, research shows that a spell of laughter can help relieve pain. It increases Blood flow, boosts the metabolism and stimulates the release of endorphins, the body’s natural painkiller.

However Back Pain is not a laughing matter and
by understanding more about your Back Pain,
you can work together with your practitioner to
find ways you can best treat it or at the very
least get it under control.

The vast majority of skeletal muscular pain is
felt in the joints or the point where a muscle
attaches to the bone. With the back for
example, it is the lower joints that seem to be
much more susceptible to pain than the ones
higher up, although the upper back is by no
means excluded.

The joints are the one place where an
imbalance can manifest because they can be
tilted or twisted. What happens to the nerve,
ligament or disc as a result of that joint moving
is the pain you normally feel.

What I have learnt is that there are usually only
one or two main groups of muscles, setting up the imbalances and causing the joint to move or the pressure to build up on a muscle making it stiff or tight and painful to move.

If the muscles that set up this twist (usually structural muscles) are worked on correctly, the pressure that causes the twist, tilt or tightness is released, along with the pain.

Using a “hands on” form of bodywork is the most effective way of identifying and correcting these problem muscles but finding someone who can do a good job quickly and effectively, and without it costing to much can be the most difficult part.

When a back develops problems it is not normally something that has just happened but rather a build up of imbalances over time. It tends to involve the whole body in some way and therefore requires a holistic approach to get a lasting cure.
In my opinion there are not enough skilled hands on therapists these days that can recognise the problem muscles, and then know how to restore their length and function and put the body back into balance again as is required.

Too many therapists want to use machines or stretching and exercise to fix back pain and these methods are flawed in many ways.

Lets be honest, if all current treatments worked I wouldn’t need to be writing this book as people would get over their problems just as quickly as they came along. Without using the hands on approach and the fact that most causes of back pain don’t show up on x-rays or scans. Physicians and therapists are guessing as to what the problem may be the majority of the time. Unless they are skilled at working on the body using their hands they can’t monitor progress or feel compensations that need to be removed, but just as importantly they can’t recognise when the problem does not involve the muscles and may require a totally different approach. Any specialist in Back related disorders could never have learnt what they have, without putting hands on the body.

Due to the repetitive nature of bodywork and the fact that the basic anatomy of the body never changes, one is constantly learning how every different type of body feels, strong, healthy, weak, stressed, young or old. Any therapist who doesn’t get their hands on the body regularly such as a doctor, chiropractor, physiotherapist or acupuncturist, is severely handicapped right from the start when it comes to treating back pain. There is no way, without the vital information you can get from the feel of the body, they would be able to devise the best way of approaching an individuals particular back problem.

Why? Because the critical information they are missing can dramatically change the treatment regime from one person to the next.

 

2. Assessing Your Pain

Faced with a patient in chronic pain the Physician has several important tasks. The first is obviously the assessment of the pain and its various causes, including physical and psychological components. Realising that pain is a bio-psycho-social phenomenon, (biological, psychological, and social) all of these aspects have to be addressed in the history and evaluation of the patient.

Only when a proper evaluation has been made can the appropriate treatment be carried out. Only the most naive of Physicians would take a simplistic mechanistic approach, or indeed go the other way and dismiss pain as “being perhaps all in the mind”. Such assessment is complex and
beyond the scope of this book, however, this has to be
methodically undertaken, and undertaken well. Not only does the pain have to be evaluated, so does the distress that it causes the sufferer and whether this feeds back to have a major part of the pain itself. Finally disability has to

be considered; is it appropriate for the known nociceptive (causing pain) disease, or inappropriate? Is the disability that has developed a major factor in the chronicity? (A chronic condition is one that has lasted for three months or more. In some conditions, chronic is defined as six months or longer. Chronic conditions often progress slowly and last for the remainder of a person’s life.)

Once this assessment has been made, management can be developed along appropriate lines. The distress should be minimised and disability should be reduced. Sometimes this can be done with great effect (e.g., through Pain Management Programmes) without altering the actual amount of pain. On the other hand, sometimes relief of the pain (for instance appropriate intervention) will alleviate distress and reverse the disability.
In most cases it is impossible to completely alleviate pain and thus a management plan has to be agreed with the patient. This may involve a rehabilitation approach, including increased mobility, perhaps in conjunction with a Chiropractic Practitioner, or the patient’s own exercise programme. These will be facilitated by appropriate analgesic techniques.

Pain is your body’s way of communicating to your mind. You do not have pain because your body was poorly designed. You have pain because you were ingeniously designed. Every pain, every symptom you experience is a part of this ingenious design.

3. What’s It All About?

It’s that dull ache, shooting pain, agonising spasm, or unbearable burning sensation that goes all the way down the leg. As many as 8 out of 10 people suffer from back pain at some time in their life.

It may limit movement, prevent standing, and it can mean days off work (it is the biggest single cause of work absence). It can be a sudden acute attack, or it can be a chronic pain that last for more than three
months, or it can come and go, triggered simply by lifting a shopping bag, or changing position in a chair.

The pain is usually linked to changes in the way that the network of bones, ligaments and muscles of the back work together, and it stems mostly from strained muscles and ligaments.

Low back pain is a major health problem in the United Kingdom and each year seven percent of the population goes to the doctor because of it.

“In many patients, this back pain gets better within three months of this initial visit. However, up to 50 percent of patients continue to have pain and disability after this time.”

 

4. What Causes The Pain?

Back pain is a symptom not a diagnosis. In most cases, the exact cause of the problem is never tracked down. Causes of simple back pain include poor posture, lifting and carrying, lack of fitness, sleeping on soft mattresses, standing for long periods, sitting in chairs that lack back support, and repetitive jobs.

Twisting or lifting improperly can cause tears in the ligaments that support the spine. Pregnancy is a common trigger for back pain, due to softening of the ligaments and changes in posture due to the growing “little person”.

Other Common Causes Of Back Pain Include But Are Not Limited To:

 

Spondylosis: Type of arthritis caused by degenerative changes in the spine that come with age.
Spondylitis: Chronic back pain and stiffness caused by a severe infection or inflammation of the spinal joints.
Sciatica: Burning, stabbing pain that can go down the leg as far as the foot. It’s usually caused by a protruding disc squeezing the sciatic nerve. Sciatica is discussed in more detail later in this book.
Herniated disc: Pain caused when disc material bulges and puts pressure on a nerve.

Most protruding or bulging discs occur in the lumbar region, and in severe cases can lead to permanent nerve damage, and rarely, loss of bowel or bladder control.

Spinal stenosis: Often due to arthritis, it’s a narrowing of the space around the spinal cord that can result in the nerve getting squeezed.
Osteoporosis: Loss of bone density and strength can lead to weak bones and fractures of the vertebrae in the spine.
Stress: Stress can cause back muscles to become tense and painful. Other causes include kidney stones, endometriosis, cancer and other diseases.

 

5. What Can I Do?

 

It is estimated that only one in seven cases of back pain are seen by a doctor, with most pain
disappearing, or being treated with self-medication or other therapies. It is a good idea to see a doctor if there is numbness or tingling, or if the pain is severe and doesn’t improve with medication and rest, or if the pain starts after an injury. It’s important to seek medical help when there is also trouble urinating; and a weakness, pain, or numbness in the legs.

Most attacks of back pain last only a few days and heal themselves. The GP is usually the first stop, but there’s a wide range of therapists who specialise in backs, including Chiropractic Doctors and other alternative practitioners.

6. Do Drugs Really Work?

Drugs can work for acute and
chronic pain, and are the mainstay
of treatments for millions. For mild
to moderate pain, over-the-counter
painkillers are usually enough.
Muscle relaxants are sometimes
used, as are steroid back
injections, while morphine can be
effective for short periods for more

severe back pain

7. Should I Take To My Bed?

 

As I will point out later in this book, long bed rest was once a main treatment but research shows that it does not help simple back pain
A study in Scandinavia found that people with low back pain who carried on as normal appeared to have better back flexibility than those who rested in bed for a week.

 

8. What About Physical Therapy?

For many people, getting joints moving properly again with physical therapy is a must, as it does help. Chiropractic Doctors are trained to diagnose problems in the joints and soft tissues of the body, and will carry out a comprehensive assessment and treatment plan. Chiropractic provides a wide range of treatments to relieve pain, promote relaxation and restore movement. Chiropractic manipulation involves the adjustments of the spine, as well as other joints and muscles.

Chiropractic care is generally safe, but it’s not appropriate for everyone. However a Chiropractor is experienced enough and skilled enough to make individual assessments on treatment suitability.

Numerous research studies conducted in Europe the United States, and Asia have documented that far beyond simply “feeling good”, massage therapy has an impressive range of physical, mental, and emotional benefits.

Benefits of Massage

 

• Stimulates the release of endorphins - (the body’s natural painkiller)
• Calms the nervous system
• Improves sleep
• Strengthens the immune system
• Aids in the removal of toxins from the body
• Reduces muscular tension
• Improves circulation of blood & lymph
• Increases the flow of oxygen and nutrients to cells and tissues
• Calms the nervous system
• Improves posture
• Increases flexibility & improves joint range of motion
• Enhances overall performance
• Relieves mental & physical stress
• Overall feeling of well-being

 

9. What Are The Surgical Options?

While most people will not need surgery, anyone whose chronic pain isn’t helped by manipulation, exercise or medication, or who has a damaged disc, will. In some cases the problem disc may be removed and the bones fused together. The problem with fusion is that it permanently immobilises that part of the back. Surgeons are increasingly using artificial discs instead of fusion. Bulging disc material can also be dealt with by use of a laser. In osteoporosis, compression fractures of a vertebra, where one bone collapses on top of another, these can be treated with a balloon, and injections of cement-like mixtures that keep the bones apart and ease pain.

10. Any New Treatments?

Many clinical trials of new treatments are well under way around the world. Therapies being tested include drugs, new surgical techniques and a wide a range of alternative treatments including the new exercise Nordic walking (with sticks), glucosamine sulphate and ginger.

11. Other Treatment Alternatives

Herbs: Two trials examining the effects of herbal medicine have found that Harpagophytum procumbens (devil’s claw) is better than placebos. Devils Claw contains the active compounds, harpagosides, which have natural anti-inflammatory and pain killing actions. While a third found it had similar effects to the drug Rofecoxib. Salix Alba (white willow bark) has also been found to be effective, while research also suggests that rubbing local preparations of cayenne can ease pain. Alexander technique: A process of psychophysical re-education, it may work for back pain, according to a review of research at Exeter and Plymouth universities: “Results imply that it is effective in improving pain behaviour in patients with back pain. It does deserve to be studied in more detail.”

Traction: According to a review of therapies by the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIMSD): “There is no scientific evidence that traction provides any long-term benefits for people with back pain.”

Nerve root blocks: “Whether the procedure helps or not depends on finding and injecting precisely the right nerve.”

Facet joint injections: Again according to the United States NIMSD: “The effectiveness of these injections is questionable. One study suggests that this treatment is overused and ineffective.”

Trigger point injections: “Although the injections are commonly used, researchers have found that injecting anaesthetics and/or steroids into trigger points provides no more relief than just inserting a needle.”

Transcutaneous Electrical
Nerve Stimulation (TENS): Involves sending mild electrical impulses to nerves. “Studies of its effectiveness have produced mixed results,” says the NIMSD report.

Acupuncture: May encourage the production of natural painkillers, such as endorphins.
Hot and cold: There’s some evidence that cold and hot compresses do help with pain. Certainly a warm bath has the effect of relaxing muscles.

 

12. What To Do If You Are In Pain

Most low back pain can be treated without surgery. Treatment involves using over-thecounter pain relievers to reduce discomfort and anti-inflammatory drugs to reduce inflammation. The goal of treatment is to restore proper function and strength to the back, and prevent recurrence of the injury. Medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and overthe-counter remedies.

Although the use of cold and hot compresses has never been
scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals.

*Its fair to say that you should resume activities as soon as possible.

While people with back pain need to be careful about the type and amount of exercise they do, experts agree that some activity is better than none at all.

For many years the advice for back pain was bed rest, but in 1996 the Royal College of General Practitioners in UK changed its guidelines and patients are now meant to
be encouraged to keep active - using pain relief if necessary. However, the new guidelines
remain unheeded by many in the medical profession.

A lot of people are still told to lie down until they feel a little better, despite the fact that movement or active management is known to be far more effective. An in-depth study on non-surgical treatments for back pain found that patients obtain as much benefit from an intense programme of exercise therapy as from spinal surgery.

Those who followed a tailored two-hour daily exercise regime, which included activities such as step-ups, walking on a treadmill, and cycling, made huge progress over just three weeks.

 

If you have back pain and want to start an exercise regime, first consult a Doctor of Chiropractic or Physiotherapist.

 

13. Prognosis For Back Pain

Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. Recurring back pain resulting from improper body mechanics or other non-traumatic causes is often preventable.

Engaging in exercises that don’t jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture.

Applying ergonomic principles – designing furniture and tools to protect the body from injury – at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.

14. Prevention Is Better Than Cure

Watch your posture, be vigilant during all activities. Take particular care when you’re lifting heavy weights. Always bend at the knees when lifting. If you sit down for most of the day, avoid slouching and crossing your legs.

Keep it even when carrying bags, try to keep the weight even on either side. As unbalanced strain on your back can lead to problems. Children should be discouraged from carrying books in shoulder bags – backpacks will distribute the weight more evenly.

Take plenty of exercise the fitter you are, the less likely you are to suffer back pain. Take regular exercise such as walking. Exercise to maintain general fitness is more effective at preventing back pain than specific exercises aimed at back muscles.

It is common sense; anything that puts pressure on your back muscles and nerves can cause pain. Bad posture continual stress and strain, weak abdominal muscles,

and extra weight commonly cause back pain. In many cases, back pain may result from degenerative changes in the back that occurs over the years. Back pain can also be caused by medical conditions affecting the spine, bones, muscles, or joints.

15. Getting Help

Establishing the cause of your back pain is essential in obtaining effective treatment. You should consult with your GP or with a qualified back specialist such as a chiropractor before starting any treatment. You will need to tell your doctor about your symptoms (what kind of pain are you experiencing), the site of the pain (where it hurts), the duration of the pain (how long you have been suffering from this problem).

Your doctor needs to know if your back pain is the result of an accident or injury. It’s important to mention other health problems you might be experiencing since some back pain is related to illnesses elsewhere in the body (referred pain). Be sure to mention if you are under unusual stress or pressure too.

A physical examination may be sufficient to identify the source of your back pain; however, in some cases, your doctor may recommend you undergo
additional tests to help pinpoint the problem.

16. A Pain In The Neck

 

Headaches & Neck Pain

Common types of headache include
tension, vascular, muscular, or
neurogenic.
Headaches can originate from the
nerves, soft tissue, and joints in the
cervical spine.
Certain types of headaches will arise
from the upper neck at the base of
the skull, and radiate from the
occiput (rear) to the front of the
head or temple(s).

Trigger points in certain areas of the neck can cause headaches.

 

Trigger points are “knotty” areas or bands in muscle tissue, and can commonly be seen in Myofacia.

Cervical facet- joint -mediated headaches are common after whiplash injuries. In this type of headache, a nerve surrounding the inflamed joint in the neck can cause severe pain. These types of headaches usually respond to physical therapy, traction, stretching, antiinflammatory medications & muscle relaxants. Facet joints can also be injected when therapies have not helped. Typically a low dose of anaesthetic and cortisone is injected into the joint(s) under fluoroscopy (x-ray). When followed by a well-designed physical therapy regimen, these injections can give excellent long-term relief from headache and neck pain.

There are other causes of neck pain, including traumatic injuries, degenerative conditions, tumours, infections and disc involvement.

Degenerative diseases in the neck are usually due to ageing and the natural progression of the spine. Repetitive trauma can account for acceleration of these injuries. Patients often complain of neck pain, numbness and tingling down into the arms and hands, and a “cracking” or “popping” sound in their neck.

Carpal Tunnel Syndrome

Carpal tunnel syndrome refers to the compression of the median nerve in the wrist. The median nerve passes through a small tunnel in the wrist that can become inflamed and irritated, thus resulting in the numbness and tingling into the hand and fingers. The severity of the symptoms can be determined by performing a nerve conduction test in the office. The treatments are generally non-surgical, using non-steroidal medications, wrist splints, therapy, and occasional injections into the carpal canal.

One of the most common causes of carpal tunnel syndrome is the repetitive use of the wrists or hands, such as when using a computer keyboard. Often, the repetitive nature of a job cannot be avoided; however, applying appropriate ergonomics can certainly help to reduce the risk of developing carpal tunnel syndrome.

One of the most common complaints of patients with carpal tunnel syndrome is numbness and/or tingling in the wrists and hands, usually into the thumb and index fingers.

Often there is pain that sometimes radiates into the elbow or shoulder. X-rays of the wrists are usually normal, so the diagnosis can depend more on a clinical presentation and electro-diagnostic testing.

A thorough examination also needs to eliminate the cervical spine as the cause of the symptoms. A disc lesion in the neck can compress one of the nerve roots and cause numbness and tingling into the fingers. Sometimes, an MRI may reveal a cervical lesion, which is contributing to the symptoms.

Once the diagnosis of carpal tunnel syndrome is made, the treatment is usually nonsurgical. Physicians may prescribe non-steroidal anti-inflammatory medication, carpal tunnel splints, wrist exercises, and occasionally injections usually will suffice. If pain persists, surgery may be the ultimate treatment.

Myofascial Pain Syndrome

 

Myofascial pain is usually associated with muscle spasm and is most often seen in the regions of the neck or low back.

Myofascial pain refers to soft tissue pain usually arising from trauma, repetitive activities, or poor posture. It is usually associated with muscle spasm and is most often seen in the region of the neck. Patients may complain of neck pain, pain across the top of the shoulders, sleep difficulties and, occasionally, headaches.

The treatment consists of stretching exercises, mild medications, ice, massage, and physicians may sometimes use, trigger point injections into the superficial muscle belly. The soft tissue pain can persist, but will usually improve with aggressive treatment and the passage of time. Since this process involving soft tissue does not usually effect the bones or joints, the initial treatment is conservative and does not involve surgery.
Successful treatment employs limited medications and specific physical therapy, utilising such modalities as cryotherapy, myofascial release, muscle stretching, and progressive strengthening exercises.

Although this is a non-surgical problem, it can be aggravated by stress and be difficult to treat. Trigger point injections or additional methods such as relaxation and biofeedback techniques are sometimes used with excellent results.Protocols for the treatment of myofascial pain are useful in guiding treatment and in tracking outcomes.

Specialist physicians have designed specific protocols for