There is room for improvement, however! We could, at least, not add insult to injury with pointless and expensive testing, therapies, and surgeries that are all about finding and fixing structural problems that are mostly not there, or not the real problem. This pervasive myth of spinal fragility has many unfortunate consequences, such as unnecessary fusion surgeries — a common and routinely ineffective procedure — and low back pain that lasts for years instead of months or weeks.
The seriousness of chronic low back pain is often emphasized in terms of the hair-raising economic costs of work absenteeism, but it may well be far worse than that — a recent Swedish study shows that it probably even shortens people lives. In this tutorial, you will meet those medical experts and find out what they know and believe and why. The evidence that tissue pathology does not explain chronic pain is overwhelming e. Why does the myth of mechanical back pain , the premise for so much ineffective treatment, get repeated endlessly on the Internet and in health care offices around the world?
All of these points above will be explained and substantiated in detail further along — these are just the highlights. Plus, of course, there are an almost unbelievable number of sketchier treatments for sale, easily marketed to desperate souls. Is low back pain treatment really this much of a mess? Sadly, I believe so. This tutorial explores more practical options. But not all. This tutorial is mainly for patients with unusually stubborn low back pain and sciatica, and for the doctors and therapists who want to help.
Even for these really entrenched cases, there is hope. People who believed for years that their pain was invincible have still found relief. Not always, and often not completely — but sometimes any relief is far better than nothing. How can extremely stubborn pain finally ease up? So many health professionals are poorly prepared to treat low back pain that patients can easily go for months or even years without once getting good care and advice.
Donnie Thompson is the only man to total 3, lbs 1, lb squat, lb bench, lb deadlift. He could barely walk, but he got out of bed and rehabbed himself every day. Within three months he was back to heavy squatting and setting personal records.
Symptoms of lower back pain
Got that? Setting personal records three months following an injury that herniated 3 discs! How could that be? I have never met a patient — no matter how experienced or self-educated — who could not gain at least some new insights and new hope from this tutorial. But it happens. Andy Whitfield, star of Spartacus , thought he just had back pain from his intense gladiatorial training.
In fact, he had a tumour. It killed him in The most dangerous thing about trying to reassure low back pain patients is the unnerving possibility that I might reassure someone who should not be. But reassurance is almost always appropriate. Most back injury feels worse than it is — its bark is worse than its bite. Can you recognize the early warning sign of cancer, infection, autoimmune disease, or spinal cord injury? These things often cause other distinctive signs and symptoms, and so they are usually diagnosed promptly.
If you are aware of these red flags, you can get checked out when the time is right — but please avoid excessive worry before that. The rule of thumb 19 is that you should start a more thorough medical investigation only when three conditions are met:. This free article explains in more detail including a list of red flags and is strongly recommended to anyone who feels nervous:. In all other cases, you can safely read this tutorial first. For instance, even if you have severe pain or numbness and tingling down your leg, you can safely read this first. Or, even if you have an obviously severe muscle tear from trying to lift your car or something, you can safely start here — rest and read.
Your back is not as fragile as you probably think, and understanding why is a great starting place for healing in nearly all cases of low back pain. Working at the edge is a risk. But then again, so is walking out your front door. In this section, I will challenge the mythology in just a few paragraphs, supported by dozens of references to the best scientific information available. Most people — and most health care professionals — believe that back pain is usually caused mainly by structural problems , either injury or degeneration of the spine.
This idea is not supported by the scientific evidence. When structural problems are exaggerated, you also get a plague of bogus explanations and solutions based on that. Spines do degenerate, but not for the reasons most people think they do: genetics is by far the biggest factor in degeneration, 26 not your posture, your office chair or mattress, your core stability, or anything else that low back pain sufferers have taught to blame their pain on. The idea that the spine is fragile is an unjustified but deeply held belief, based on ignorance of a complex subject and on an obsolete mechanical view of biology that has dominated medical thinking for centuries.
Continue reading this page immediately after purchase. See the complete table of contents below, plus links to other free articles about low back pain. Most content on PainScience. There are free articles on PainScience. This page is one of 8 extremely detailed guides that I sell. Book sales — over 57, since — make it possible for me to work full-time keeping all the content scientifically current, without advertising or selling coffee mugs although a salamander mug would be fun, actually.
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You will receive order confirmation and access information by email but again … check your spam folder!!! Payment unlocks access to more chapters of what is basically a huge webpage. There is no paper book — I only sell book-length online tutorials. The design and technology of the book is ideal for reading on tablets and smart phones. You can also print the book on a home printer. Feel free to lend your tutorial: I do not impose silly lending limits like with most other ebooks.
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You can also complete the set later, minus the price of any books already bought. More information and purchase options. You can also keep reading more without buying. You are allowing yourself to be led by your emotions, but you do have a choice.
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You need to decide whether you want to be a victim or a survivor, a passenger or a driver. You do have rights and even responsibilities as a health consumer and a patient. Because chronic pain is difficult to detect or measure, you need to be an informed, active participant in your treatment.
An open and trusting relationship with your doctor is essential. This means being able to tell your doctor how you feel, ask questions and feel listened to and understood. The doctor-patient relationship must be a two-way street. It is your responsibility to describe your symptoms as accurately as possible and to report back regarding treatment outcomes, even if unfavourable.
Under-reporting of pain has been identified as one of the biggest causes of mismanagement of pain. The doctor-patient relationship can be undermined by bad communication, ignorance, arrogance and fear. For example, many people are actually afraid to tell their doctor how they are feeling for fear of being labelled as weak or a complainer. You should feel that you can talk to your doctor, that he listens and respects you, and be satisfied that he is working competently and thoroughly on your behalf. You also have a right to change doctors if you are dissatisfied.
In the treatment of chronic pain it has become fashionable to recommend ignoring pain after medical investigations are complete in the belief that it is only pain and there is nothing physically wrong. This approach represents a pendulum-swing away from the old fashioned notion of prescribing bed-rest in favour of maintaining activity.
The idea is that inactivity only leads to depression and does not help the problem anyway. However, with certain types of pain, this can lead to a cycle of aggravation, sleep deprivation, exhaustion and increased pain and suffering, particularly if you are someone who typically ignores pain ignoring pain is of course, what causes most repetitive strain injuries.
These repetitive pain experiences lead to overstimulation of the nervous system and the generation of spontaneous pain signals, leading to a cycle of stress and pain.
Low Back Pain Diagnosis
There are thus sound reasons for wanting to avoid pain, but again, total inactivity is not the answer. The best approach is a balanced one with paced activity levels and avoiding undue aggravation of the pain. As we have indicated, since chronic pain is partly caused by neurological changes, avoiding activity will not stop the pain. Avoiding activity also leads to muscle wasting and a build-up of waste-products in the tissues, which can actually exacerbate pain.
At other times, you may feel frustrated and force yourself to complete relatively major tasks eg mowing the lawns knowing that it will hurt later. This may cause you to have to take two days of bed rest to recover. A breakup or divorce launches you into uncharted territory. Everything is disrupted: your routine and responsibilities, your home, your relationships with extended family and friends, and even your identity.
A breakup also brings uncertainty about the future. What will life be like without your partner? Will you find someone else?
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Will you end up alone? These unknowns can often seem worse than being in an unhappy relationship. This pain, disruption, and uncertainty means that recovering from a breakup or divorce can be difficult and take time. Grief is a natural reaction to loss, and the breakup or divorce of a love relationship involves multiple losses:.
Allowing yourself to feel the pain of these losses may be scary. Just remember that grieving is essential to the healing process. The pain of grief is precisely what helps you let go of the old relationship and move on. While these emotions will often be painful, trying to suppress or ignore them will only prolong the grieving process.
Knowing that others are aware of your feelings will make you feel less alone with your pain and will help you heal. Writing in a journal can also be a helpful outlet for your feelings. Remember that moving on is the end goal — Expressing your feelings will liberate you in a way, but it is important not to dwell on the negative feelings or to over-analyze the situation. Getting stuck in hurtful feelings like blame, anger, and resentment will rob you of valuable energy and prevent you from healing and moving forward.
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Remind yourself that you still have a future — When you commit to another person, you create many hopes and dreams for a life together. As you grieve the loss of the future you once envisioned, be encouraged by the fact that new hopes and dreams will eventually replace your old ones. Know the difference between a normal reaction to a breakup and depression — Grief can be paralyzing after a breakup, but after a while, the sadness begins to lift. Day by day, and little by little, you start moving on. When mom and dad split, a child can feel confused, angry, and uncertain as well as profoundly sad.
Support from others is critical to healing after a breakup or divorce. You might feel like being alone, but isolating yourself will only make this time more difficult. Connect face-to-face with trusted friends and family members. People who have been through painful breakups or divorces can be especially helpful.
They know what it is like and they can assure you that there is hope for healing and new relationships. Frequent face-to-face contact is also a great way to relieve the stress of a breakup and regain balance in your life. Spend time with people who support, value, and energize you.