Pain is the reason why most of us seek the help of a physical therapist in relation to back pain or any other condition that falls under physical therapist’s practice. Recent findings show that low back pain has become a significant global health burden nagging millions of people worldwide.

It is common for one to experience back pain at some point in their lives. But not all people respond in the same way to this often-disabling condition. In fact, if two people have back pain, the level of pain and their responses to that pain is very different even though they are suffering from the same thing. This simply means, back pain with everyone is not, is never and will never be the same. This is because people present different dysfunctions as much as their complaints are the same.

How one responds to back pain is due to different people’s psychological attitudes and outlooks or interpretation of pain. This can be due to inflicted fear by health professionals interpretation of how one’s back looks bad e.g.  MRI or X-rays describing how off everything is. It could be, but in most cases it isn’t. For instance everyone has a bulged or slipped disc on the back if imaging is done country wide today. But everyone is up and about, why then should such a thing compromise your perception about pain and your injury yet you are lucky to have discs! When you have back pain, its interpretation of how severe it is, shouldn’t limit you from bending or going to work or create fear of whatever is happening in your back. Such outlooks encrypted in patients’ minds has led to poor response towards healing from back pain.

Many patients know little or nothing of whatever is happening which is even more dangerous than knowing and being filled with fear.  Neither case helps. It is therefore important for the doctor to carry out investigations through MRI or X-rays for assessment in reference to your back and it is also crucial to get a thorough assessment by an experienced and skilled physical therapist that would do a thorough physical examination and other clinical tests to help you understand more and manage your back pain.


When one has back pain and is being medically treated, it helps if one understands the psychological factors that impact pain – in one’s brain rather than “cautious unreasonable events” happening in one’s back. The latter creates fear among patients that would implicate the amount of pain equals the injury to be “so real and severe”, yet the amount of pain doesn’t correspond to the injury or tissue damage.

Back pain loop to “your head”

In case of serious injury on the cause of your pain e.g. a slipped disc(s) with complaints of shooting pain or numbness on your leg as described by your health practitioner, one will tend to condition themselves to less mobility and work. They may even have extreme fear of their back, “if this happens that will happen? My back!!” forgetting that the pain doesn’t equal the extent of injury on your back. A good physical therapist would advise that when your physical movement is limited, this can cause psychological distress and psychological distress can in turn worsen the pain and that mobility and exercises is important in recovery. 

Depending on how you cope with a disease in terms of stigma about your condition and its treatment, the same applies to your health beliefs. Fear avoidance mechanism and coping strategies can influence your level of distress and pain. If you are always anxious, pessimistic and expect the worst in terms of thoughts and imaginations; your pain will become worse and worse. Why? Just because the  fear, distress and anxiety has changed your brain perception and intensified your pain.

When pain first occurs, signals are sent to your brain and interpreted as pain. But when pain lasts, the related signal switches away from “pain signal” to circuits that process emotions which intensifies the pain even more.

What else…

Depression as a result of long term management of back pain is one aspect that is known in psychology. Back pain in such a state impacts how we perform our activities in our day to day life. This would result into inadequacy at work, economic constraints and strained relationships at home and even work. Psychological stress,  negative social interaction and the injury in terms of your body ‘damage’ causing pain (biological aspect) all influence your response to back pain recovery.  Therefore as much as we are this far in terms of psychological therapies a good physical therapist would always note that and upon understanding the three aspects it becomes easier to manage and get good response however much your pain is.

So while it is clear that low back pain can be “in your head”; that does not mean that you have to see things as very complex. To avoid instances of fear, distress and hopelessness in back pain it is important to know that your back is robust and stronger than you think. A few facts on back pain will help you to get rid of negative perceptions about you back, because it is always important to know than not to know.


What you need to know about back pain

  • Your back is robust, stronger than you can imagine

Your back is strong and is held by strong short to gross fleshy muscles and ligaments as well as orientation and support of strong bones. Almost everyone experiences back pain which can be disabling and worrying but it is common and rarely dangerous. As much as one experiences repeat episodes which are distressing, it is rarely dangerous.

  • You can have back pain without any damage or injury

Many physical and psychological factors cause back pain and often a combination of these are involved:

  • Physical factors, such as ‘protecting’ the back and avoiding movements or a simple strain
  • Psychological factors, including fear of damage or not getting better, feeling down or getting stressed.
  • General health and lifestyle factors, like being tired and rundown, not getting enough quality sleep, being overweight, or not getting enough physical activity.
  • Social triggers, such as difficult relationship at work and home, job dissatisfaction or stressful life events, like death or illness.

It’s however important to know that all pain is real and never ‘all in your head’ even when factors like stress and mood are involved.

Each of the above factors can turn the volume on your pain and gaining a greater understanding of when that can happen puts you in a stronger position to recognize them and learn how to turn down the dial.

You should not fear bending or lifting

Bending and lifting are always portrayed as causes of back pain and while an injury can occur if something is picked up from an awkward position, it is most likely to be a sprain or strain.
The most important thing is to practice and get your body used to carrying different loads and weights in a way you find comfortable and efficient.We all run differently, and it is perfectly okay for us to find our own technique of lifting.

  • Painkillers will not speed up your recovery

Pain medications should only be used in conjunction with other measures, such as physical therapy, evenas a short-term option they can induce side effects.
Exercises, which is safer and cheaper is the best option.

  • Surgery is rarely needed

In some uncommon cases of back pain, e.g. one having severe numbness in the legs with associated pins and needles, surgery can help the leg symptoms but it is important to know that it is not always required.
You also need to know that on average, the results for back pain surgeries are no better than non-surgical interventions such as physical therapy and chiropractic medicine.

  • If it does not clear up, seek help but do not worry

If your back pain doesn’t clear up within 6 – 8 weeks make an appointment to see a physical therapist. Physical therapists will provide expert advice, guidance and treatment for back pain. This will help to prevent future back pain episodes.
          
                                 *Courtesy of the Chartered Society of Physiotherapy

Always consult a skilled and experienced physical therapist for your back as its management is now gross and dynamic in physical therapy practice. Worry less about your pain and be more aggressive in terms of seeking proper treatment for faster rate of recovery.
Thanks to Eunice Kabana DPT, OMPT, Certified Dry Needling Specialist, Fascia Therapist and Nancy Gachohi DPT,OMPT, Certified Dry Needling Specialist atChiropractic and Physiotherapy Health Centre.

Written by:
Moses Katasi
Physical Therapist

Back Pain in the Back of your Mind

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