Back Pain

It is estimated that 80% of people experience back pain at some point in their lives.

Back pain can be managed and future suffering can be reduced or avoided by using specific physical activity and lifestyle strategies.

At BeMoore Pilates, Yoga & Personal Training we offer the following services to help empower you to manage your symptoms and reduce future episodes:

Classes

Once a week is recommended as a minimum requirement (which can be combined as part of  home exercise program). 2-3 times a week is highly recommended.  If your back pain has been diagnosed as non-specific- it is most likely you will be able to go straight into classes. Private coaching may be recommended on a case by case basis.

Private coaching

If a pathology or nerve damage has been diagnosed we would highly recommend at least one private session before starting exercise. Some positions can exacerbate back pain, therefore it is imperative for us to examine you closely and offer alternatives if necessary.

Back pain can be defined as:  muscle tension or stiffness with or without leg pain (sciatica).

Low back pain is very common; it is estimated 4 out of 5 adults will suffer low back pain at some pain in their lives. 94% will have non-specific back pain where there is no underlying disease or pathology.

The number of people with back pain increases with age, starting in school and peaking in adults of 35 – 55 years; back pain is also common in adolescence as well as adults.

After an initial episode of low back pain, 44 – 78% of people have relapse symptoms. While 26 – 37% relapse in the form of absence from work. High-pressure sedentary management roles increase risk, as do jobs involving heavy manual labour- especially those involving repetitive lifting and twisting.

Evidence suggested that low back pain should not be considered temporary and consequently neglected since the condition presents with a period of attacks and temporary remissions.

Evidence also shows that 90% of people with low back pain stop consulting health care professional within 3 months. Yet, most will still be suffering one year after their initial consultations.

It is more common in women (the risk for a woman increases with each pregnancy) than men.

At BeMoore Pilates, Yoga & Personal Training we provide you with the tools you need to manage your back pain long term.

The cause may vary between spinal ligaments, strained muscles, muscle spasm, facet joint or disk irritation-  the origin is mechanical and practically unidentifiable.

This is the most common, accounting for 94% of cases.

This includes sciatica and other pain where the nerve is impinged, typically as it exits the intervertebral foramen-  potentially by a herniated intervertebral disk or the piriformis muscle as it passes through the pelvis.

These are fairly uncommon and account for around 5% of low back pain cases.

There are a number of different forms of spinal pathology including:

  • Osteoarthritis
  • Rheumatoid Arthritis
  • Ankylosing Spondylitis
  • bone disorders
  • fractures
  • infections
  • tumours that can all cause low back pain

These causes are low and account for less than 1% of low back pain cases.

We have a multidisciplinary approach to back pain and we assist with behavioural, lifestyle, physical, nutritional and physiological factors to help reduce your chance of further damage and future episodes.

Three of the below risks are non-modifiable but the rest can be changed or managed:

  • lack of physical fitness /physical inactivity
  • smoking
  • obesity
  • psychosocial stress
  • physical trauma
  • awkward positions at work
  • frequent bending and twisting
  • heavy or repetitive lifting
  • jarring, gripping, vibration or repetitive actions
  • prolonged sitting and or standing
  • mechanical loading (ie children that carry a bag more than 20% of their body weight have high LPB rates)
  • functional movement and alignment
  • number of children
  • major scoliosis
  • increased age

A perceived inability to cope with stress

Stress over a long period of time suppresses the immune system function, creates endocrine (hormonal imbalances) and can increase musculoskeletal tension. Body positions that are associated with fear include spinal flexion (hunched shoulders or curling into a ball) remove the lordotic curve of the spine.

In addition, whilst the body experiences stress it diverts blood away to the muscles and away from the gut which increases muscle tone as part of the flight or fight response. This is advantageous as far as physical activity is concerned. However, in many modern situations, the body is sitting inactive- so the additional blood flow and tension can lead to spasms and tightness.

Avoidance of normal activities out of fear for worsening pain

This is the natural instinct to protect a body part.

A better understanding of pain means we now know that pain is a function of the central nervous system.  Although initially triggered by peripheral nociceptors, after this acute incidence the pain exists in the nervous system and is not being caused by trauma to tissues. Understanding this and gently beginning to move in a normal way, helps the body to realise that it is safe to move and stop sending the pain signals.

If movement is avoided out of fear this prevents the body from relearning natural movement and reinforces the pain pathways, which can make recovery much slower.

Catastrophising about worst-case scenarios 

Associated with the all or nothing way of thinking. Some people are more prone to thinking this way and making generalisations. They may think of the worst-case scenarios and limit their activities to what they think a person with back pain ‘should’ and shouldn’t do.  Often this is based on inaccurate beliefs and involve them protecting themselves from pain by avoiding certain movement, a belief that their back pain is due to a serious pathology may also develop.

Holding negative expectations and beliefs about pain and recovery 

Having a pessimistic or negative outlook often occurs alongside catastrophising and is known to reduce the impact of treatment interventions. The relationship between body and mind is so strong that emotions and beliefs have a physiological influence on the body. The reverse is also true.

This is one of the reasons that psychological therapies including Cognitive Behavioural Therapy are used as a second line treatment for those whose LBP persist for longer than 6 weeks.

Psychological factors including anxiety, depression, stressful responsibility, mental stress at work and poor body image are linked to low back pain. Some of the issues (such as anxiety and depression) can be secondary, an indication they are brought on as a result. The other factors appear to precede the incidence of low back pain, indicating they may be causative.

Stress is known to cause multiple symptoms in the body, affecting all systems from the heart and CV system, the endocrine system, the nervous systems and the digestive system to the Musculoskeletal Systems.

Chronically increased stress can lead to ischaemia in the muscles, which changes their function and can lead to spasm. Inflammation of joints, degradation of connective tissues and alterations in motor control and posture can also occur as a result of chronic stress, to predispose an individual to an episode of low back pain.

Safe movement has been proven to reduce pain levels.

By strengthening the areas that have become weak and stretching (lengthening) the areas that have become tight we can reduce the pressure on the lumbar, reducing pain and chance of further damage and future episodes.

We also work on bringing the posture back into balance. All of this will help to prevent further injury.

When we become inactive, some muscles become tight and some become weak. This means that the body can not support itself as it should and our posture begins to change. Pressure on the body can create, discomfort, and injury.

Inactivity can also be linked to feeling down, or even depression. The more inactive we are, the more down we feel and then it becomes a vicious circle. We have to work hard to break the cycle. Committing ourselves to regular classes or sessions can help to break this cycle.

We have a multidisciplinary approach to back pain. We assist with behavioural, lifestyle, physical, nutritional and physiological factors to help manage your current condition, and reduce your chance of further damage and future episodes.

Many approaches are recommended such as massage, osteopathy and physiotherapy, these may also be necessary but they are short term fixes. Lifestyle changes such as adapting work environments, exercise and diet are long term changes we need to make to manage back pain for life.

Providing that pathologies and nerve damage have been ruled out the risks of participating in exercise is low.

One should be mindful of the side effects of any medication and keep an eye out for any red flags.

If pathologies or nerve damage exist, we would highly recommend at least one private session before starting classes, some people may need 6 -12 sessions, everyone is different. We will make this decision with you, to suit your situation and your budget.

We always make sure you are exercising in a safe environment to the level that is suitable for you.

Please always feedback to your teacher if something does not feel right for you so we can advise as required or give you an alternative.

Varied movements in multiple directions are favourable with back pain patients.

Any exercise prescription should include many exercises that will develop fitness without undue pressure on the spine such as Pilates, Yoga, walking and cycling.

Core stability training and flexibility exercises will strengthen and lengthen the area surrounding the damage or irritated discs and help prevent further damage.

High Impact activity should not be performed on any patient who is recovering, or being treated for lower back disorders.

A general aim of exercise for patients who are suffering from lower back pain is to increase exercise tolerance and prevent debilitation which is often caused by inactivity.

When patients described their symptoms as severe, exercises challenging the lower back and hips should be delayed for a period of two weeks, or until symptoms reducing severity. When symptoms are present, patients are encouraged to focus on abdominal hollowing exercises that promote the activation of the TV transverse abdominals and increase the blood flow to the stabilizing tissues.

Generally, those with back pain should:

  • Avoid high impact activities
  • Refrain from heavy lifting jerking and jarring movements
  • Not perform double leg raises or straight leg setups
  • Refrain from repeated twisting rotating and bending
  • Avoid exercises that load or compress the axial skeleton
  • Avoid sustained or prolonged static postures
  • Rehearse engaging the abdominals regularly
  • Seek opportunities to improve posture

These red flags would indicate an emergency referral (if not already diagnosed):

  • The difficulty with the discharge of urine
  • Loss of anal sphincter tone or faecal incontinence
  • Saddle anaesthesia around anus, perineum or genitals
  • Widespread (>nerve root) or progressive motor weakness in legs
  • Gait disturbance

We keep an eye out for red flags for serious spinal pathology if you have:

  • Age of onset of less than 20 or more than 55
  • A recent history of violent trauma
  • Constant progressive, non-mechanical pain (no relief at bed rest, night pain that causes difficulty sleeping)
  • Thoracic pain
  • Past medical history of malignant tumour
  • Prolonged use of corticosteroids
  • Drug abuse, immunosuppression, HIV
  • Unexplained weight loss
  • Persisting severe restriction of lumbar flexion
  • Widespread neurological symptoms – paraesthesia, numbness, loss of muscle strength, significant muscle atrophy (including cauda equine)

The person should also not exercise if they:

  • Cannot lift their arms above their head due to a structural problem and or pain in back or neck
  • Experiencing an episode of pain
  • Are taking strong pain killers

They should stop exercising if:

They can no longer perform the exercise with good technique and correct posture (due to fatigue).