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Two Types of Back Pain

The idea that we don't understand something about ourselves can put some people off. You hear the story of the cinderalla story character that learns to understand themselves and that's what drives them to greatness, but that's not very relatable. What did they need to understand?

If your issue is back pain, then what you need to understand is why it is occurring in the first place. There are two reasons why your back will hurt. 1) Your back is injured. 2) Your back is not injured.

To be clear, why it hurts and what is making it hurt are not the exact same thing. What makes it hurt is nerve conduction signals, but that really doesn't help much, unless we are going to start removing nerves (they do that, it's called a rhizotomy). What is making the nerve signals tell your brain to feel pain is not why you are in pain. Inflammation, pressure, tissue damage can all generate pain signals to the brain (the what), but they also don't have to. In fact, they don't generate pain signals most of the time. This is getting confusing, so let's take a closer look at these two concepts of why you're feeling pain and clear this up.

1) Your back is injured.

Something happened. You sneezed and a disc herniation pressed on your back nerves. You lifted something heavy and your back got strained. You lifted something light a bunch of times and your back got strained. You did something new that involved your back muscles and now they are injured and inflamed because of it.

In this situation it is best to rest for 1-2 days. After that you need to gradually increase movement toward the activities you were performing previously for the next 2-8 weeks (depending on the severity of your tissue damage).

As a medical provider, I find this scenario to be the easiest one to describe to patients. There is a tissue insult we know of, we can identify movements that hurt and need to be modified or avoided while the tissue heals, and after a predictable amount of time it is healed/you are back to normal. If this is you, you should only need a minimal amount of guidance. Why? Because you are going to get better.

2) Your back is not injured.

You're probably thinking so why the heck does it hurt? If you remember from the paragraph above, pain is nothing more than nerve signals. Your brain is amazing because it does two things automatically and there is nothing you can do about it. 1) It runs your vital organs. 2) It uses thousands of reflexes to keep you safe from harm. Both of these are survival mechanisms. Pain coming from your back that is not tissue damage, is coming from your reflex mechanisms aimed at keep your body safe from harm.

This potential "harm" can come from a ton of different places. Stress, posture, weakness, confidence with movement, are just a few of many examples of why your back will feel pain. None of these variables are guaranteed to cause pain, and that can be very frustrating for someone who doesn't recognize that. Also, more often than not it's not just one thing causing you to feel pain. The only way to get to the bottom of why you are in pain is to speak to someone who has a Doctoral level of knowledge in why people are in pain. The more time you spend with them being evaluated, the more likely you are to catch all contributing factors. The worst thing you can do is nothing, but the second worst thing you can do is get an incomplete explanation and become discouraged.

If something didn't happen recently and you are in pain, you need to find out why. In order to find out why you are in pain precisely, you won't get your answer from a blog or internet search. If you are under the impression that the MRI findings you received years ago are the cause for your continued back pain, you have been misled. MRI findings fit in the first category. If something happened, it will heal. If it is a normal degenerative process, yes I said NORMAL, then it won't continue to cause pain. You need to find the true reason you are in pain. Degenerative disc disease, early stages of arthritis, bulging discs, labral tears, rotator cuff tears, all of that stuff happens to people who never even know it. In fact, the statistics behind people who have these "injuries" but have no pain is staggering. In a recent study, 1211 people without neck pain received an MRI. 87.6% of them had a disc bulge. 3110 people received an MRI of their low backs, 80% had disc degeneration. None of them had pain. These may hurt when they first occur, but the pain goes down as the function returns to normal. If you need help getting your body back to normal, get it.

Performance Physical Therapists utilize a patient first model that allows you to understand why you're in pain, how you can get out of it, and most importantly, they provide you with the tools to help yourself. There's no twice weekly for the rest of your life treatment plans. No random exercises written on a piece of paper all dosed at 3x10. No injections, no surgeries, no pills. There is only assessment guided movement based treatment that you can do largely on your own at home or at the gym. If you are ready to find out why you are in pain, schedule a free consultation. We want you to know how we can help before you commit to anything. If we can't help you, we will find you someone who can.


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