Pain, stress and anxiety
It may seem obvious that chronic back pain will lead to stress and anxiety, being in pain is stressful! However this also works in reverse – over time there is a chance chronic stress can lead to back, neck and even shoulder pain. This is not one of those “it’s all in your head” conversations that suggests a psychological cause of pain but an explanation of how our nervous system’s response to stress affects us on a physical and anatomical level.
When we become stressed, be it from work, a difficult home situation or a significant life event, we experience a fight or flight response causing increased muscle tension (as though preparing us to fight a tiger!), an elevated heart rate and increased breathing rate. If the stress doesn’t go away we become chronically stressed and the changes in muscle tone and breathing mechanics (a shallower more rapid breath pattern) also persist.
The anatomy
The diaphragm, intercostal and accessory muscles control the movement of our ribcage when we breathe. The diaphragm also has a secondary role as a core stabilising muscle, working alongside our abdominal, pelvic floor and spinal muscles to support our body’s posture. If the diaphragm is not able to contract and lengthen through its full range of movement, as a consequence of a shallow stressed out breathing pattern, other core muscles will be affected and fatigue more easily – including our spinal muscles.
If our back muscles are already tense from the flight or fright response and overworked from a lack of diaphragm activity in our core stability ‘cylinder’ then they will become tight and painful. Similar issues can happen at the neck and shoulder (but that is beyond the scope of this blog). If you have been struggling with back pain and chronic stress for a while, and found that traditional back exercises and/or rest haven’t solved the problem, it may be worth trying another approach.
How can breathing exercises help?
So what is this approach? Put simply, breath work and relative relaxation in addition to more traditional physiotherapy. By relative relaxation I mean doing something that allows you to switch off your brain and have some down time on a daily basis to get out of ‘fight or flight’ mode – this may be walking, swimming, reading, meditating… something that you enjoy and allows your nervous system to have a break.
Daily breath work can be as simple as slow deep breathing practiced at a set time each day. Yoga breath patterns, Pilates breathing and practicing Hypopressives are all good ways to allow your diaphragm to start to move through its full range of movement. In turn allowing your core muscles to work more effectively during exercise and daily life.
I’m still working on incorporating and explaining this approach to clients in physiotherapy sessions and putting it all down in blog form allows for it to be revisited and re-read to understand why I’ve given them breathing exercises, whilst also educating others who may be interested.
How physiotherapy can help with back pain
Back pain is one of the most common medical problems worldwide, affecting about 80% of people at some point in their lives. There are many causes of back pain, ranging from muscle or ligament strains, herniated discs and arthritis to more serious conditions like spinal stenosis or fractures. Poor posture, a sedentary lifestyle and improper lifting techniques increase the risk of developing it.
Back pain can be acute, lasting from a few days to a few weeks, while chronic back pain persists for 12 weeks or longer. Many treatments exist for back pain, non-invasive treatments like physiotherapy, yoga, Pilates and acupuncture are the first line of treatment and are very effective for some individuals.
As a physiotherapist I see a lot of people with back pain, some with acute back pain which has come on after lifting heavy weights in the gym or in their garden, and others with back pain that has persisted for years and either flared up, or gotten significantly worse to the point they need to seek help. I can help with both forms of back pain and take an individualised approach to treatment, as each person will have different physical and situational factors affecting their pain and will have different preferences, needs and goals of treatment.
What to expect during an appointment
During an initial physiotherapy appointment for somebody with back pain I will start by asking some questions about their pain such as where is the pain, when did it start, what have you tried so far? As well as other specific questions to rule out anything serious that needs onward referral. Once I am clear on what might be causing or contributing to their pain I will complete a physical assessment including movement tests (asking the person to complete some movements and exercises), muscle and joint palpation and nerve and reflex testing if indicated. Once I understand what is going on physically for the person I can discuss a likely treatment plan with them involving exercise, lifestyle advice and other treatments such as massage or acupuncture if required.
How many sessions will i need?
Most people will need anywhere from 3-12 follow up sessions to progress and carry out their treatment plan, depending on their diagnosis, if their condition is acute or chronic, how long it has
been present for and their own budget and time commitments. Many people continue to see me for preventative treatments such as Pilates sessions or massage once their pain has resolved.
If you would like to learn more and/or have been struggling with persistent back pain and need some help please get in touch: info@clairegurneypilates.com
