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Why does your back pain and sciatica flare up?

A recent article from a research group in Australia reminded me of a patient who I will call Amanda, we were able to help out. She came to us with back pain and sciatica due to a herniated disc in her lumbar spine (low back). This poor lady had been experiencing debilitating pain for over a year by the time she ended up in our clinic. When I first met her, she was completely frustrated and depressed. She had previously led a very active lifestyle but her pain would flare up and she was forced to rest. Once it settled she would try and get active again only to be knocked back down by pain. Although her story is a common one, the cool thing for me to witness was that her mental toughness and determined effort to get better is ultimately what saved her.

Trust me, we weren’t the first place she visited for help. Despite various approaches and treatments, she continued to believe there was a solution. Her belief system about why her back and leg pain kept flaring up every time she attempted to get active was what kept her searching for help and ultimately why she got better. The ultimate success of her treatment plan was because it followed the biopyshosocial model. More on this treatment approach in a moment but the point is she is an example of what the Australian group found. Their findings also fly in the face of a lot of trending modern approaches to treating back pain and sciatica.

Modern treatments for back pain and sciatica

As a bit of background, modern approaches to back pain treatment embrace the biopsychosocial model. This means the mind, body and our social environment all contribute and play a role in recurring back problems. The challenge with that model is that the pendulum seems to have swung lately to overemphasize the psycho-social aspects. Brilliant pain researchers like Lorimer Moseley and David Butler of the NOI group have a pretty compelling approach with their Explain Pain system. I love this approach and certainly think it plays a role in helping people recover, which is why it plays such a big role in our Spine Boot Camp classes. It is certainly important to understand that the mind and the body travel as a package and recovery from back pain needs to take both into account but lets not go overboard on blaming the role the mind or the body play and contribute.

What the researcher’s found

More than 84% of people in this project believed their back pain flare ups are due to biomedical reasons rather than psycho-social reasons. They felt active movements like bending and twisting as well as static postures caused their back pain flare-ups. The insightful part of this was that they felt it was the quality of  the movement they performed rather than the movement itself that was responsible for triggering their back pain and sciatica flare-ups. The amazing thing for me to read is that only 2.3% of this group felt that their pain was caused by some sort of spinal damage (e.g. disc herniation). This is the key take home message and played a huge role in how we were able to help Amanda get on the road to recovery.

How it works

If you have had a scan (e.g. MRI) that showed you have arthritis in your spine or a bulging/herniated disc and you or your health care practitioner think that is the cause of your pain, here is a question I want you to ask yourself (or your health care practitioner):

Is the damage on my MRI because my back is the victim or the culprit? The results of this recent study suggest that people inherently think their back is a victim which I fully support and endorse. It is also supported but lots of research showing a disconnect from the amount of damage and pathology (arthritis, disc herniations) on MRI’s and the amount of pain and disability someone has. Check out this blog post that myth busts what MRI’s and CT scans can and can’t tell us about the cause of your back pain.

Take home message: The majority of people felt the quality of the movements they were performing rather than the movements themselves were responsible for their pain flare-ups. They also didn’t feel the structural damage in their spine was responsible. I can’t emphasize this enough: Often times, it isn’t the disc herniation on your MRI that is the biggest problem, it is what you keep doing that continues to re-injure that disc so it won’t heal. That is what we call a gestalt in thinking and may just make the difference to get you back on the road to recovery…

Feel free to comment below to share your experiences or thoughts. Also let me know if this doesn’t make sense to you or you want some clarification on how this may apply to your specific situation.

Reference:

What Triggers an LBP Flare? A Content Analysis of Individuals’ Perspectives

Nathalia Costa Paul W Hodges, PhD Manuela L Ferreira, PhD Joanna Makovey, PhD Jenny Setchell, PhD

Pain Medicine, pnz021, https://doi.org/10.1093/pm/pnz021

Published: 19 March 2019