Hello Back Pain!
Back pain is considered the modern day affliction.You may have heard the statistics that back pain costs us up to a 100 billion dollars annually in health care, disability and lost productivity. All the more reason why we are all so eager to find relief. Are you one of the sufferers? Then you are definitely not alone.
My first episode of back pain happened when I was 19 year Swedish high school graduate, an active athlete living as an Au pair with a family in Vienna, Austria. Leaning over to unpack their dishwasher, I suddenly froze and couldn't stand up straight. My host family was in disbelief of how such a young person could get so crippled with a condition often associated with old age. I hobbled around the streets of Vienna for a week in great pain and then it disappeared. I had no idea why or how.
The world is filled with misconceptions about back pain, that it is a sign of aging or that you must have "done something" bring on the back pain.
Here are some facts:
80% of the American population will suffer some level of back pain in their lives.
Most spinal disc injuries occur between the ages of 20-40. Signs and symptoms may appear during or after this event.
Degenerative disc disease, arthritis and spinal stenosis are often the end results of a back condition that may be congenital or has been going on for decades.
Some mild back conditions result in excruciating pain, some severe back injuries yield limited pain.
Some scientists theorize that we are doomed to lower back pain due to evolution. We stood up from 4 to 2 legs and the forces bearing down on our lumbar spine and pelvis are too great to handle.
All of this is small comfort when you are a sleep deprived parent roaming around the bedroom floor trying to find relief from a back spasm, or a frustrated runner stretching your piriformis (angry butt muscle) to relieve the sciatica radiating down your leg, or a perplexed Pilates instructor trying to explain to your students how you can suffer from this debilitating condition.
So, what to do? Is this unavoidable or curable? Who holds the answer? The physical therapist, the back specialist, the trainer, the massage therapist, the chiropractor, or the makers of ibuprofen?
The answer is yes. As frustrating and exhausting as it can be to find a cure to YOUR back pain, you will benefit from trying many avenues, being well informed and from having a great team of supporters and experts to help you find relief.
First, what is going on?
Getting a good diagnosis of your back pain is important. If your back pain has been going on for some time and rest, stretch and Advil is not cutting it, it may be time for the next step. Ask your primary doctor for a referral to a back surgeon, osteopath, or an orthopedic specialist, or check with your chiropractor. They may order different tests such as Xrays and MRIs to get a closer look at skeletal structure and soft tissue.
Fun fact: Most MRIs of patients 40 and up come back with signs of some disc and spine degeneration of various degrees with or without any symptoms present. In other words, you may hit the lottery and never suffer back pain even though your spine is imperfect, or you may be like the other 80% of us and feel even the slightest impact of compressed nerves.
Onward and upward
So, once a diagnosis of back pain has been established, a treatment plan can be laid out.
You may be prescribed physical therapy, a steroid injection, get an adjustment of several from the chiropractor, be put on a decompression table or in worse cases be recommended to have surgery.
Apart from the more drastic measures, there are things you can do to improve and prevent further pain and here is where we can add Pilates to the plan. Everyone has heard the tales of how Pilates is good for strengthening the core and in fact, many doctors will recommend Pilates to their patients as part of recovery and prevention of back pain. However, not all Pilates training is created equal. Finding a good, knowledgeable Pilates trainer is key and so is a customized and well integrated approach to your recovery.
Neutral Spine, a pain free state?
What, then can we expect to achieve from taking Pilates?
Ideally, what Pilates aims to do is to help you get to know your body and to establish your neutral spine. For many, finding a neutral spine and pelvis and being able to sustain it with a strong, deep core is the path towards a pain free state of being.
However, focusing on deep core stabilizers and maintaining good neutral posture often goes ignored by most of us, be it athletes, gym buffs and even Pilates trainers with busy schedules.
How many of you have thought of connecting your pelvic floor while reading this blog?
How many of you have thought of connecting your pelvic floor while reading this blog?
This does not come naturally and unfortunately not quickly, either. It takes training and retraining of muscles and of the nervous system.
Furthermore, due to modern life we sit for many hours every day, forget to stretch and take breaks and end up with inactive core musculature and terribly tight and weak hip, glute and back muscles.
And perhaps worse of all, anytime the nervous system detects sign of injury to the back, whether perceived or real, it turns off the multifidus and other deep core muscles, during the one time when you need them the most. So, there we are with an inactivated core and in even worse pain!
What goes on in the Pilates Studio?
In short, Pilates training involves training and retraining the deep core muscles using special equipment in the Pilates studio. When we do footwork on the reformer for example (what looks like a series of leg presses to the layman eye) we are in fact positioning the body in neutral spine, applying gentle resistance and asking the deep stabilizers to fire. Clients often say it feels good to do the footwork and putting the feet in straps (where the legs are suspended) is considered heaven for back pain sufferers.
By training the body in different plains (on the back, sitting, standing, etc) with different resistance, the deep core musculature is gradually turned (back) on, muscles that have may gone dormant due to the injury wake up again and the client feels better.
The key to proper muscle firing of the core is focusing on breath work. A good Pilates instructor will queue and queue again on when to inhale and exhale and will often use imagery to encourage a solid connection between movement and breath.
Do I really have to pay money to take a Pilates studio class? What about the gym? I saw this great clip on uTube....
There are things we can do on our own. As mentioned, if you are sitting all day long, schedule stretching breaks. Walk more, breathe deeper, etc. Definitely do your Physical Therapy exercises if you were given any. However, you don't want to experiment on your own with Pilates training while still being a tender state due to injury.
You may also be tempted to duck into the traditional Pilates group mat class offered at most health clubs. Group exercise Pilates is great for general core training and it can teach us the true principles of Pilates, however, the mat repertoire involves a long series of exercises with forward bending and rotations. This can be disastrous for a client with a herniated disc or an arthritic spine. And even the most conscientious Pilates instructor may have a hard time knowing all the different conditions of a group of 20 students and how to manage them all, accordingly.
Pilates - the bridge between the Physical Therapy clinic and the gym
Instead, Pilates training for back pain should be done one on one at first and then in small groups where the trainer knows your body and your limitations. Ideally, all training should start with an evaluation including exercise history, medical history and a postural analysis. Remember, your Pilates instructor is part of your team. He or she needs to know specifically what is going on with your back. Don't hesitate to bring in a copy of your MRI and your PT exercises, if any. Connect your Pilates trainer with your PT or chiropractor and have them work out a plan together. Consider Pilates the bridge between the Physical Therapy clinic and the gym. Besides, I have never met a Pilates instructor who doesn't love pouring over the details of spine anatomy, muscle imbalances and figuring out a plan. It's what we do!
Living with Pain
One overlooked aspect of back pain is the emotional toll it may bring.
I went in for an MRI and a nerve test to determine whether the herniated disc in my back had caused any damage to the motor nerves in my legs. I had recently developed a nasty habit of falling while running, often injuring myself in the process. Turns out that I had permanent nerve damage and onset of paralysis in my legs. The fear of loosing my ability to do my work, being active or perhaps even just being able to walk was very real.
Other clients have described their lives changing due to back pain. Athletic careers coming to an end, parents not being able to pick up their kids, successful professionals who cannot sit or stand and have to blow off important meetings, business travel that has become hell, etc.
This can cause great stress and lead to feelings of anger and hopelessness. Constant back pain itself may lead to depression.
Are we under too much stress?
As a grad student of Psychology I was drawn to the field of Psychosomatic medicine and the study of how stress and inactivity of modern day life may result in some form of illness. Stress is a very broad term, but negative stress can manifest in tension and pain. Think of a stressful situation where it may not be possible, appropriate or even safe to find an immediate outlet, (dealing with road rage, for example) and where we end up holding it in and "dumping our feelings" into our muscles and joints.
We also noted that back pain itself can cause drastic life changes and lead to stress and depression which in turn may exacerbate the back pain sending us into a downward spiral! Managing our stress and even changing negative thought patterns can have a real impact on our pain perception. Mindfulness training, meditation or a gentle yoga practice can be invaluable tools we may want explore as part of our recovery from pain.
I have noticed that while sitting usually sends my back into a tight knot I can sit by the piano for hours and play and sing without discomfort. Music and the vibrations of singing have become part of my therapy.
Your relief from back pain may be found in places far from the surgeon's table or even the Pilates studio, but I hope you give yourself the time and patience to find it.
Next up: Neutral Posture and why you should wag your tail!
Therese TC Brewitz, MS Psychology, STOTT PILATES Instructor
http://www.livescience.com/27189-human-evolution-pains.html
Injuries and Special Populations, STOTT PILATES, Merrithew Health and Fitness materials
Injuries and Special Populations, STOTT PILATES, Merrithew Health and Fitness materials
