Chronic Lower Back Pain Recovery
Treatment for the physical & psychological aspects of lower back pain.
Trauma & Chronic Pain
Trauma, and the anxiety and depression you often feel with it, reduces levels of serotonin and endorphins, the body’s natural painkillers and increases levels of Substance P, a neurotransmitter which regulates sensitivity to pain, making your body more sensitive to pain at the very moment your painkillers are reducing. Release of too much of the stress hormone cortisol, during Fight / Flight, leads to the immune system turning against the body, creating further pain. The nervous system is agitated, again increasing sensitivity to pain. Traumatic sensations, and memories of trauma, can also be stored in the body, especially the back, neck and shoulders, as pain, stiffness, and tension, and are caused by the contraction of muscles to prepare the body for action when Fight / Flight is triggered. Tension in the fascia is also a response to the release of cortisol and adds to stiffness and pain in the body.
The Neurology of Chronic Lower Back Pain
Where the spine does suffer damage, the affected area sends damage signals up the spinal nerves to the area of the brain’s pain system covering that part of the body. The signal is analysed and if the brain decides harm will occur unless something changes or help is given, it sends a signal back down the spinal cord to make you feel pain in affected areas, to draw your attention to it. Over time, as the damage signals continue, the system gets overly sensitive and carries on sending pain signals even though the damage signal gets weaker as the original issue heals. In assessing the damage signals and deciding whether to send pain signals, the brain takes account of information from the rest of the body’s sensory system, taking account of its general condition and the broader environment, being more likely to signal pain if the body is feeling stress or there is danger in the environment. Eventually, the system sends out pain signals even though the damage signals have stopped. So one part of brain holds the knowledge that the spine is fine and there is no need to feel pain, while another part thinks the issue continues and the body should be feeling pain, so the pain continues.
Physical causes of Chronic Lower Back Pain
Pain in the lumbar spine can also be caused by poor posture, structural issues including Lordosis (exaggerated curve in the lumbar spine), Kyphosis (hunched, rounded shoulders) Scoliosis (lateral curve throughout the spine) or an anterior pelvic tilt. Herniation of intervertebral discs, creating pressure on spinal nerves, weakness in the core musculature and lack of mobility in the spine can also create problems.
CONSULTATION & ASSESSMENT
Your back pain can be caused by physical causes, psychological causes (trauma, depression, anxiety, stress), or a mixture of all of these and it can be confusing trying to understand what the real issue is.
I offer a thorough assessment comprising taking an in-depth history to identify any traumatic incidents, current stressors or other psychological issues which may be causing or exacerbating the pain, alongside an in-depth physical assessment, comprising both postural and movement analysis and an evaluation of core strength and flexibility, to establish whether there are any postural, movement or structural issues which may be contributing to the pain. Sometimes, a long history of unsuccessful treatments, especially if invasive, can cause stress and trauma and this will be considered in the assessment.
The assessment informs decisions about the best combination of approaches to help you with your recovery. NICE (National Institute of Clinical Excellence), recommends exercise plus psychotherapy for the treatment of non-specific chronic lower back pain (back pain where no clear physical cause has been identified), especially where more traditional approaches have been tried unsuccessfully. I offer both these services:
EMDR : EYE MOVEMENT DESENSITISATION & REPROCESSING
Free yourself from the grip of trauma.
There is growing evidence for the effectiveness of EMDR in the treatment of chronic pain, including chronic lower back pain. Eye movement and other forms of Bi-Lateral Stimulation (BLS) allow the parts of the brain and nervous system which hold the knowledge that the body is healing and there is less and less need to feel pain, that the body is safe, with the pain system which is still sending pain signals, so that the pain system can be switched off. EMDR can also target the traumatic, stressful memories and experiences which are making the pain worse, or in some cases creating it. As trauma reduces, pain reduces. I can also teach you breathing, relaxation and visualisation techniques to help you soothe your nervous system and reduce your pain yourself when you need to.
Healing the Mind & the Body
Treatment for the physical & psychological aspects of lower back pain.
Pilates & Visualisation to relieve chronic lower back pain
Research shows that any exercise is better than no exercise for chronic lower back pain recovery and also that Pilates may be the best form of exercise. Pilates builds your core strength and control and teaches you to find and maintain the optimum posture (standing, sitting or lying) to keep your lumbar spine healthy. It builds flexibility and mobility through the spine and makes the spine stronger even while it’s moving. As you get stronger, the muscles of your deep core lift the spine and support it, enabling the vertebrae to pull away from each other, taking the pressure off the intervertebral discs, and reducing pain. You also build your confidence to move (bend forwards, sit forwards, sit back), get down on the floor and back up again), taking the anxiety out of the Activities of Daily Living, (ADLs). In a Pilates session, movement is smooth, fluid, controlled and linked to a pattern of breathing. You learn how to focus your mind on the movement. The movement and breathing calm your nervous system and the focus ensures your brain learns that the body is moving calmly and smoothly. The brain relaxes, and stress and anxiety are reduced, further reducing pain.
I run a Pilates for Lower Back Pain class on Zoom, on Monday evenings at 7 pm. You can join from home and all you need is a mat, a block or cushion and a Pilates ball (I can advise you on where to purchase if needed).
The class is 60 minutes of Pilates, focused on core and spinal mobility and a relaxation/visualisation session at the end to address the psychological elements of chronic pain.
Personal Training
I am a Level 4 Lower Back Pain Specialist Personal Trainer (PT) and can design and deliver a personalised training programme for you to help you recover from chronic lower back pain and prevent further recurrences. The programme aims to stabilise and strengthen the core and build flexibility through the spine. You will learn how to achieve a neutral pelvis and maintain this as you move and lift and then move onto a weights programme involving kettlebells and dumbbells to build further strength in the whole body and a cardio programme to improve overall fitness. I can also teach you good lifting techniques and correct any movement / postural issues which may be affecting your back.