Background of low back pain
From 1990 to the present day, low back pain has been the most incapacitating symptom, negatively affecting both people's everyday chores and going to work (1). In the long run, low back pain causes more disability than migraines, depression and diabetes (1). In the short term, only illnesses such as the flu cause more days off work than low back pain (2). Globally, the incidence of low back pain has increased significantly in recent years, and currently 540 million people experience low back pain at the same time, regardless of age group, gender or socioeconomic status (3). In addition to this, it has a huge impact on the cost of health care (4, 5).
What causes low back pain?
Low back pain is rarely caused by a clear physical factor/cause that would only explain the cause of the pain. In many cases, the pain may be associated, for example, with certain postures or movements, such as lifting, which may cause pain, for example, in the form of a witch's arrow, which in itself is a strong muscle spasm. However, it is not a specific "poorly done" movement, such as lifting with a round back, but a movement for which the body has not been ready (6). Similarly, structural differences such as posture have not been found to correlate with pain (7). A movement or event may trigger pain, but the pain experience itself is always the sum of many factors. Contributing factors include stress, fatigue, sleep deprivation, worries, intense physical exertion, psychological factors such as thoughts of the danger of movement, and previous pain experiences (8). It is also not a serious tissue damage (more on this below), but the pain experience itself is the body's way of signalling potential danger (9, 10) and that there has been too much physical and/or mental strain (11). This can be illustrated according to the glass model:
The glass in the photo depicts your body's capacity to tolerate a load that is always filled with water according to the stress on the body. Work, physical activity, and all the normal everyday chores, from washing dishes to mowing grass, put more or less strain on the body. However, this is in no way harmful to the body, and the body does not respond to such normal physical exertion with pain. Not much water has accumulated in the glass yet and the more space there is in the glass, the more things can be done.
However, if we experience more load, the glass will begin to fill accordingly. Extra workload can be caused by, for example, overtime, strenuous physical performance, or long-term illness. However, the load is not always only physical, but also a mental load such as stress, sleep deprivation, depression, a negative event in life, money worries, social conflict, etc. acts, complementing the glass. The more these things pile up on top of each other, the fuller the glass becomes.
At some point, the sum of all the load may be too much for the body, causing the glass to become full and the water to splash over. For the body, this manifests itself as pain, which is the nervous system's way of signaling that there is more load at that moment than it can be absorbed. So when you think about why your back started to show symptoms, it's usually the sum of many things, and it can't be targeted at one factor, such as a specific movement. Low back pain is therefore a multifaceted symptom and in order to determine the possible cause of which it is necessary to look at the whole person and take into account both physical, mental/psychological and social factors (8).
Then What is low back pain?
Alaselkäkivun syytä ei voida todeta kliinisesti tehtyjen testien perusteella, jotka kertoisivat tarkasti että mitkä kudokset aiheuttavat kipua (12, 13). Poikkeuksena ovat hermoperäiset kivut kuten mm. issiasvaiva johon liittyy selkäkivun lisäksi myös jalkakipua, joka ylittää polven yhdessä hermoperäisten oireiden kanssa kuten tuntomuutokset (nipistelyt tai puutuminen) ja voimattomuus. (3). Nämä ovat kuitenkin harvinaisempia tapauksia (<5%), ja valtaosa alaselkäkivusta on epäspesifiä tarkoittaen että kivun syy ei ole täysin tiedossa (12).
A three-part research series published in the internationally well-known journal The Lancet describes low back pain as a symptom whose experience and the inability it causes are associated with numerous different influencers together. These include biophysical (e.g. tissue damage), psychological (negative attitudes and beliefs towards back pain e.g. the idea that pain signals something serious to watch out for) and social (work-related dissatisfaction and belief in the negative impact of work on pain), as well as nervous hypersensitivity to pain perception, which, especially in prolonged pain experience, has often been found to be an important factor (3, 14, 15). The above describes well how multidimensional the pain experience can be, and there is often no single explanation for prolonged pain, such as a bulge or wear of the intervertebral disc. This is evidenced, for example, by the fact that, for example, disc bulges or degenerations are often found in completely asymptomatic people on X-rays and MRI scans (16, 17). Indeed, such changes can be completely normal age-appropriate imaging findings (see table below).
Psychosocial factors may well predispose the nervous system to hypersensitivity and, consequently, to the experience of pain. Among these, in particular, the ideas that pain is serious and a sign of tissue damage associated with avoiding movement or exercise out of fear have been found to play a large role (18). A low level of confidence in being able to cope with everyday challenges despite pain has also been shown to correlate with prolonged pain (19).
Lifestyles also play an important role. Sleep deprivation, physical inactivity/immobility, overweight, smoking, and excessive alcohol intake, among others, can contribute to the pain experience (3). Sleep deprivation, as well as poor night's sleep, have been shown to lower the pain threshold, and thus sensitize to experience pain (20, 21, 22, 23). Smoking, on the other hand, has been shown to be associated with pain in all parts of the body, and at its highest with back pain (24).
What should everyone know about prolonged low back pain?
Pain is a protective mechanism that warns of a possible danger, and does not tell exactly what is happening in the tissue. Below are a couple of examples that illustrate this situation:
"The man arrived at the emergency room in severe pain. At the construction site, he had stepped on a 15cm nail that had gone through the sole of the shoe. Since even the slightest movement of the foot caused severe pain, he was given strong pain medication, after which the nail was pulled off the sole of the shoe. After the shoe was removed, it was noticed that the nail had gone between the toes, and no real damage had been done to the foot." (25)
"A group of people did a shoulder strength training workout. Those who had a fear of sore shoulders after a workout actually experienced more and longer pain after a workout than people who had no fear of pain." (26)
We have also heard of cases where a person experiences a serious injury, for example in sports or war, but does not experience any pain at the moment of the incident (27). In these situations, it may be more important to get out of that situation so that nothing worse happens or some other more important thing is achieved (e.g. a goal or a victory in sports), and thus this need for the so-called "win". overwhelms the pain experience. Thus, the experience of pain is related to the context, and what pain means to a person, for example. whether it is a danger or not.
It is good to know that 99% of low back pain is not severe and the pain usually goes away on its own within 4-6 weeks (28). However, some people still experience pain after this, and it has been found that up to 60-70% experience low back pain one year after the first symptoms (29). It has been noticed that for most people low back pain is often recurrent, in which case there may be episodes when there are pains and episodes when symptoms are not known (30, 31). If the pain comes back, this does not mean that something has happened, it is a new symptom or that the previous treatment did not help, but is completely normal for many people who experience low back pain. In this case, low back pain can be compared to migraines, for example, and although the cause of this recurrence is not always found, it is known that it is not about anything serious. So there is no need to worry if you experience low back pain again in the future. In some cases, low back pain can become prolonged and even persistent, which often suggests that the pain protection mechanism of the nervous system is the so-called pain protection mechanism. overprotective. As mentioned above, a large role in this is played by, among other things, low confidence in one's own abilities, fear of pain, as well as being careful and avoiding movement, but also negative beliefs about pain and its poor prognosis (32, 33). Prolonged pain, on the other hand, can cause changes in the central nervous system, in which case nerve endings sensing potential danger and communication to the brain can be sensitized, so that even signals that normally cause no pain can signal danger and thus the brain interprets the signals as pain, although there is no real danger. This refers to the hypersensitivity of the nervous system and the way of protecting, which in turn is influenced by many factors that we have already talked about before.
The remaining 1% of cases include accident-related fractures, inflammatory diseases such as ankylosing spondylitis, infections and cancers (34). So, these are very rare, and always require an accurate medical treatment plan. Almost all cases are so-called . nonspecific, in which case the exact cause of the pain is not known and cannot be found, for example, on an X-ray or magnetic resonance imaging. This is often a good thing, as there is a generally good prognosis for this type of back pain and there is strong scientific evidence on how best to treat this type of low back pain with drug-free means, which means that chiropractic, among other things, can be very cost-effective and profitable.
We will go through the treatment of low back pain based on the latest scientific evidence and international treatment guidelines in our next article.
Nearby:
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