Translator: Parvathi Pappu Reviewer: Rhonda Jacobs
Alright.
This Egyptian papyrus describes a medical problem
which has affected us for more than 4,000 years.
The odds are that the doctor who wrote this
was likely 90% accurate in his treatment prescription.
Astonishing, isn't it?
Welcome to the world of low back pain.
My name is Sid, and I'm a physical therapist.
It's no secret that we have had great advancements
in the field of health care since then.
But there seems to be a problem.
Since the late 1990s, the disability rates associated with low back pain
have been consistently increasing.
Back pain continues to place a serious financial strain in North America,
exceeding hundred billion dollars.
Canada is the second highest consumer of prescription opioids in the world.
Opioid abuse is now among the leading causes of death.
One in five British Columbians live with back pain and chronic pain.
So things have gone wrong somewhere.
The truth is, back pain has become a pain in the neck.
It's been mismanaged, and it's time to stop the madness.
In other words, it's time to reboot our understanding of low back pain.
Control-Alt-Delete.
Separating the facts from fiction will give us clarity in this path.
This is a fact.
Sooner or later, eight out of ten of us would be affected by back pain.
It is the fifth most common reason for visiting a physician.
So here is the good news, folks.
If you suffer from an acute episode of back pain,
there's a 90% chance that you will recover from it with no treatment
in about three to four months' time.
Only a small number of people develop long-standing problems.
So experiencing back pain is like catching a cold
or feeling tired or exhausted.
You may not like it,
but it occurs to most of us at some point of time in our lives.
This is a myth:
The longer you stay in bed, the worse your back pain becomes.
Just like any other injury such as a wrist sprain or an ankle sprain,
avoiding the aggravating activity for the first few days might help with pain.
But there's a large body of research
which shows that returning to your daily levels of activity -
work, hobbies, pleasure - is critical in aiding recovery.
It's crucial that the increase in these activity levels
are done in a graded and gradual manner.
Even though it may be painful for your back,
it is better than prolonged bed rest.
Scans such as CTs, MRIs, X-Rays,
not only have a poor correlation with back pain,
but also people without low back pain have changes such as disc bulges,
disc prolapses, disc herniations, degenerative changes
which do not cause any symptoms at all.
In pain-free individuals, about 50 to 66% have disc bulges,
about 30% have disc herniations and up to 90% have degenerative changes.
So all these changes which you see in your scans
are something like your hair becoming white or your skin wrinkling
or your worst nightmare - going bald.
So all these are normal aging changes
which do not have to be necessarily painful.
Avoid becoming a victim of medical imaging technology.
The truth is that the majority of back pain, almost 85% is nonspecific,
where no specific cause of pathology can be attributed to the pain experience.
What it means is after all these years of research,
we can't pinpoint the exact structure which is causing the pain,
and we can't reliably tell where the pain is coming from.
Hence, scans need to be interpreted with caution
as the amount of changes seen in them may not necessarily correlate with pain.
Only a small population, a tiny minority, less than 5%, require scans,
where most signs of a serious problem are present.
So consult with your doctor or your physical therapist
and they would usually be able to tell you if scans are required.
Remember, more is not necessarily better.
Discs do not slip.
What happens is they herniate, and even when they herniate
it does not mean that they slip out of a spine.
Our spine is one of the most strongest structures in the human body
with muscles, ligaments, bones supporting them.
And, as mentioned before, disc herniations can occur in pain-free individuals.
And even if you have a disc herniation, there's a spontaneous regression,
or resorption, in the majority, up to 80% of us.
What it means is that the herniated disc shrinks on its own over time.
It is the body healing itself.
All you need is actually a simple clinical exam
to know if referral to a surgeon is necessary.
Most specialists agree
that conservative treatment is the first line of defense.
Only 10% are good candidates for surgery,
and out of that only 2% are likely to benefit from surgery.
Think about the time you had a small cut or a bruise
that you do not remember getting.
You had tissue damage but no pain.
Pain is interpreted and processed in our brain,
and it has the ability to reduce the volume and the intensity of pain.
Pain acts like an alarm system.
Danger, danger, tring, tring.
It tells us that something is wrong with the body
but it is not an accurate indicator of tissue injury.
And people with similar injuries have varying levels of pain.
And this is dependent on many factors
like the context or the environment in which the pain occurs,
like having a small cut or a bruise while playing hockey
vs. slipping on a banana peel and falling down,
or previous pain experiences, memories of pain, stress, anxiety,
depression, fear, avoidance of activities, helplessness, hopelessness,
all of which can ramp up and increase the signals sent to the brain,
resulting in more pain regardless of how much tissue damage there is.
So it's like a radio.
When you increase the volume,
it does not mean that the announcer is speaking louder,
you're just amplifying the sound.
Our body has more than 400 individual nerves,
which when combined, extend more than 45 miles.
So there's a tremendous amount of information processing happening
at a particular time.
And when you have pain for a longer period of time,
the more sensitive these nerves get at processing them.
It is like learning to play a musical instrument such as a piano.
Initially you may struggle, but with practice you get better.
Practice makes perfect.
And when you experience emotional pain, the same areas in our brain are activated
as when you would experience physical pain.
So one can feed into the loop of the other,
and they may be connected.
And remember things which fire together, wire together.
How often have you noticed that when you think of food,
your mouth starts drooling or watering?
There's no food, but yet there is a response from the body.
It is a conditioned response, and the same thing is possible with pain.
So whenever you experience back pain, and say if you feel stressed or anxious,
the same areas of the brain get good at activating or firing together,
and it is possible to experience pain without danger signals
sent from the tissue.
Thankfully, there are a number of strategies to manage this,
like education, knowing that hurt may not equal harm;
exercises, graded activities, graded exposure;
cognitive behavioral therapy; mindfulness.
Our brain has the most powerful drug cabinet of pain relieving chemicals,
which is 24/7, prescription free, and for us to make use of with exercises.
Yes, exercise is medicine too.
Motion is lotion for your spine.
(Laughter)
If you run for six miles, our brain produces opioids
which are equivalent to 10 milligrams of morphine.
So exercise is a powerful drug but one which is most underutilized.
Core exercises such as planks, crunches, abdominal bracing,
have gained widespread acceptance in the fitness industry
for preventing as well as treating pain.
Small benefits are found in a very tiny population,
but the truth is, no differences have been shown
between core exercises and other forms of exercise
in acute as well as chronic low back pain.
In fact, when you suck your belly in, when you pretense your back muscles,
you're increasing the compressive loads on the spine,
and it is one of the potential mechanisms which can lead to chronic pain.
So I want all of you to try this.
Can I have your wrist up like that?
So imagine this is your spine.
Can I have you bend it down?
That looks easy.
Now, make a tight fist and try bending down.
Do you notice it's more stiffer?
Well, the same thing happens with the spine.
All forms of exercises are good with no major differences between them,
like walking, jogging, cycling, swimming,
or even other forms like yoga or Tai Chi.
So consult with your physical therapist
and choose an exercise which is affordable,
which is convenient,
which is enjoyable,
and something which you can adhere over a period of time.
I know this is information overload, and I see some of you sleeping over here,
so shake your body, okay?
And sit upright and listen carefully, okay?
Bending, twisting and lifting are not dangerous for your spine.
There is no evidence of back pain caused by your joints
or bones being out of place.
In fact, when you get your back cracked or manipulated,
you're not putting anything back in place as there was nothing out of place.
But you may feel better, and that is due to reduced
nervous system sensitivity and improved activity of muscles.
Thanks for sitting upright, but the so called perfect sitting posture
may not exist.
Different postures suit different people.
Slouching gets a bad press,
but there is no evidence linking it to back pain.
What is important is our ability to vary our posture
and move in a confident, fluid and relaxed manner.
There is no universal agreement in the management of back pain.
That's why we have so many passive interventions
like acupuncture, injections, massage, medications.
They all have limited effectiveness as a stand-alone treatment
as they address only one factor and not other issues
like your sleep, diet, fitness levels or even management of your stress levels.
But there is a broad consensus in approaching back pain
and that is have your doctor or physical therapist
rule out serious causes for your back.
Once that's done, avoid bed rest
and gradually return to your daily activity levels.
Back pain is complex, and the management varies with each of us.
If you have higher levels of disability,
you may need to work with multiple disciplines.
But for the majority of us with lower levels of disability,
a large body of treatment is not needed,
and following a simple activity or an exercise program is sufficient.
Our body is plastic
and changes continuously throughout our life
called neuroplasticity.
Hence by identifying the contributing factors for pain
and by addressing them, pain can be changed, pain can be reduced,
and people can lead a happy and healthier life.
Thank you.
(Applause)