PhysioMonkey

Back from BJC and a wonderful time was had (apart from the nasty case of tonsilitis I have).

Workshops:

1 - Injury prevention and advice - I'm now quite sure that this workshop is probably not needed.  The advice can be offered as part of other workshops.  Too much talking from me and not enough to do practically.  Would work as part of a day long session.

2 - Control and stability - Ooh this was a good one.  I enjoyed it.  The Chocfest one lasted 90 minutes.  This one ended up at 2.5 hours.  The majority stayed for most of it too.  Some interesting shoulders (one in particular) and lots of time taken to show what's going wrong.  If you were at this then I'd love some feedback on how you felt it was for you.  The responses I had afterwards were all positive.  If you didn't find it useful or interesting then I'd like to know how to improve it further.

Clinic time: Met loads of folk and gave plenty of advice out to all.  One or two odd cases and some pretty basic stuff.  If you asked me anything and want more info then get in touch.

Have fun.

[Reposted as slight changes throughout.  (Thanks to Dr Helen for the info!)]

Most injuries will be minor BUT major injury can happen even from an apparently minor incident.

[Because of increasing spam comments on this particular article I have now closed the comments section on this article only.  Sorry but if you have comments then please send me an email.  If relevant then I'll publish them on here.  Cheers.  Alan 29/5/06]

The first of the big controversies. 

Warming up is, as we all know, vital to prevent injury and prepare us for action.

Actually; no.  It's bollocks if you excuse my vernacular usage. 

I'll be more specific:  there is NO evidence to show that warming-up reduces your risk of injury.  In fact there is far more evidence to show that it's a complete waste of your time if injury avoidance is the main reason you are doing it.  But it's something that has always been done and everyone still learns and teaches it.

I've seen any number of workshops in tumbling, acro-balance, trapeze and even 3 ball juggling that have included up to 20 minutes of warming up, usually in the form of stretching everything out.  A waste of time for 90% of the participants and it's usually done incorrectly to help the remaining 10%.

Now I'll drop the real bombshell for many of you:

Stretching as a warm-up actually reduces your muscles' ability to respond as well as it could if you hadn't stretched it out.  This means that, not only does this NOT reduce your injury risk, it also drops yours performance level.  It's about a 6% loss of ballistic power.  This doesn't seem a lot but, if you're performing at the far limit of your ability, doing your hardest stuff, it can easily be the difference between success and failure.  It has been described as "the difference between winning a gold medal and not getting onto the podium".

So: so far we have:

• Warm-ups do not reduce your risk of injury.
• Stretching as a warm-up reduces your ability.

So why the hell do we do it?

There ARE benefits to a dynamic (ie not passive stretching) warming up:

• It raises your heart and breathing rates and increases core temperature.
• It gets you "in the zone".
• A set routine is more likely to get you mentally ready.

Therefore a dynamic warm-up is grand for performers.

So how do we reduce our risk of injury?

• Taking care (IE don't be stupid - follow the rules of play).
• General fitness.
• Specific fitness.

I'll talk more about specific fitness.  Sports Scientists and trainers witter on about something called "Specificity of training".  What this basically means is "to get good at something you must practice that thing".  In other words you get fit to run long distances by running a long way a lot of times.  Of course you'll start with a couple of miles only and build up as your body adapts to the new stresses that you're putting it through. Spending hours on a bike (or uni) will not really help you get good at running.  Doing both will make you more generally "fit" but the one doesn't help the other.

Relating that to us:  if you're habitually not going on a trapeze you're likely to hurt something if you try and copy a trained trapeze artist doing something quite difficult.  However much you stretch stuff out before going on the trapeze is immaterial; your body will not be fit enough to deal. 

Think about juggling; when we start to learn 5 balls we are crap at it so we practice more. We don't practise 5 balls as a whim or by accident, we practice it because we know that it's the best way to get better at it.  Getting good at diabolo will not help our 5 ball patterns.

So back to warm-ups

If all you need is injury prevention - get yourself fit to do the task you are aiming for.  The warm-up won't help you suddenly be able to manage something that is novel to you.

If you are performing then you need a dynamic warm-up.

Dynamic warm-up

• Will be different for different skills/purposes and for different people.
• Generally involves getting "geared up" to do the job.
• Increases heart-rate.
• Use a set pattern to get you mentally prepared as well as physically ready.

Examples:

Jugglers

Just crack on with what you want to do.  Many folk feel that starting with easier stuff is preferable to trying your outer-limits stuff.  It's up to you.  Stretching will not stop any injuries.  Not doing stuff for too long or well beyond your physical capability will stop you injuring yourself in the normal course of things. 

For performances try practicing your basic stuff.  Make sure your body will at least manage the more physical parts of the act (eg the contortionist).  Work towards one or two runs of some hard stuff then get yourself out on that stage.

Trapezists

Make sure all your joints are managing everything they'll need to do today.  So do brief shoulder stretches just to see that the range needed is there.  Do some running on the spot or around the gym, star jumps anything to get your blood going and your heart-rate up.  Don't wear yourself out before starting to perform though.

One more thing about warming up

This is an observation after seeing something once or twice at conventions.  The most notable occurance was an acro-balance workshop.  The participants spent 20 minutes doing a wonderful series of stretches as their warm-up.  We now know that this reduced their power and didn't help prevent injury but anyway.  They then sat around (most of them) as the 2 tutors spent 15 minutes talking through and demonstrating things.  The participants were sitting quietly through this period.  At best the warm-up (done wrongly anyway) has now been completely wasted.  In fact there have been studies that show if you warm-up and then sit around doing nothing for a while then you are at MORE risk of injury than if you hadn't bothered with the warm-up in the first place. 

When you warm-up do it right (dynamic not stretchy) and finish the warm-up as close to performance as possible.

"I've heard that the cool-down is more important for reducing injury"

Not exactly true.  If you are going to pick up an injury it will already have happened by the time you get to a cool-down.  

A good cool-down was said to have helped reduce what's known as DOMS (that's "delayed onset muscle soreness). The theory being that DOMS was because of an excess in lactic acid and the massaging effect of stretching helped reduce the levels of lactate.  This is probably rubbish because a few hours after exercise the lactate levels in the tissues have been shown to return to normal levels - hence there should be no pain.  But we know in DOMS that the pain can last for 2 or 3 days.

The next theory stated that the pain was down to "micro-trauma" within the muscles.  This again may not be true but is more likely than theory 1.  A final theory states that the pain is because of the body remodelling itself because of the work you made it do.  

Some research has been done looking into this problem and how it affects sportsmen.  One such paper was Herbert RD and Gabriel M – Effects of stretching before and after exercising on muscle soreness and risk of injury: Systematic review. BMJ 2002:325:468:  This concluded with these lines

“Stretching before and after exercising does not confer protection from muscle soreness and stretching before exercise does not seem to confer a practically useful reduction in the risk of injury.”

There are more studies than that but they tend to say the same thing.  So what to do to avoid post-exercise soreness?  Simple: get yourself fit to do what you want to do.  Practice it a lot and don't go for massive leaps in effort or skill level if that can be avoided.  As you get fitter to do that you'll get fewer problems associated with over-work.  People don't like this solution as it takes longer than stretching pre- or post-exercise does a: to explain and b: to work through to get a good effect.

In brief though: You are more likely to get DOMS after unaccustomed exercise.  Again we are back to specific fitness for the job in question.  Professional trapezists will not have DOMS after doing stuff occasional workshop participants try.

In short:

• Don't bother with stretches as a warm-up.
• Warm-ups should be just that, they're to get you warm and ready to perform.
• Don't expect to suddenly be able to do new and stressful things without some soreness at best.
• Do your stretches daily if you wish to increase flexibility (but don't think they "should" be part of a warm-up).

Ran my second ever juggling workshop on Saturday just gone.  After the previous session I decided it'd be best to stick to one area and the shoulder seems most likely to be of relevance to jugglers and others so that's what was picked.

I dropped the numbers to 12 max but only 9 showed up at the time.  This actually worked well and meant groups of 3 which I reckon worked out better than 2's would have.

One problem was that most of the attendees didn't see the ad's before the day so some didn't have suitable tops on but we worked around that pretty well.

Started with "normal" posture and how variances would change how the shoulder moved.  This was a good start and people could see what differences could come about from a minor alteration. I think this was the hook for most folk there. 

Following from this we looked at each other's shoulders to spot differences in the "normal".  So winging, pseudo-winging and poor scapular position were all noted.  Then moved onto control of the shoulder blade.  Many many thanks to all the attendees for letting us all look at them in such detail.  Particular thanks to Anwen and Hugh.

I'd allowed an hour but the session took 90 minutes and there was still plenty more to do.

Good feedback from some attendees and these were the ones most affected by the issues.  Enjoyable and I think it was useful.

Hi folks

This is a temporary post only.  I have attached a Word doc here which is a summary of the articles I've been looking at for work on stretches and their relevance or not to injury prevention.  It's not huge or detailed but tells you what the studies say even if it doesn't discuss details of the quality of that article.

Hope it's of use to those of you interested.

Have fun.

So what can be done for back pain?

People seem to think the answer is "Not a lot".  This is WRONG.

There are a number of areas to cover:

• What other people can do.
• What nature will do.
• What you can do.

I'll deal with these in order.

What other people can do.

These can get split even more into

1. General (family) doctors - most people's first choice.
2. Specialist doctors - orthopaedics, rheumatology and pain.
3. Physios - me and my ilk.
4. People who live with you.
5. Colleagues and bosses.

1 - General Doctors

I'll repeat this again: "A general doctor will not know huge amounts about musculo-skeletal problems".  Everyone should remember this.  You need to either get to a specialist doctor OR get yourself referred to a physio. 

What can a general doctor do?  General advice that would be useful in part for most cases of back pain.  They can also prescribe drugs for pain relief or for reducing inflammation or relaxing muscle spasm.

If you're in the UK they can also refer onwards to physio or orthopaedics or rheumatology.  I assume that's similar in other countries.

A general doctor SHOULD be able to make sure that you have nothing nasty happening.  Look at the "What is" back post to see what the worrying signs are.  If you have some of these make sure you tell the doc, don't wait to be asked.

2 - Specialist doctors

Specialist doctors, by definition, know plenty more about their area than generalists.  Having said that my experience is that specialists have egos the size of Belgium and they have their own preferred ways of doing stuff.  This means that one doc may want to operate whilst another may want to inject, a third may refer you on to a physio.  You may have noticed by now that there is rarely much agreement about specific treatments for back pain.

Some docs will suggest injections - these are not well proven to my knowledge.  Some people have good responses but that's not the norm.

Surgery - Really please avoid this if at all possible.  There is a general lay-person view that surgery will heal all their ills.  It really won't in most cases.  Back surgery should be avoided like little else.  "But there's new surgical techniques!"  That's true but the problem with new techniques is that the long-term success is very poor.  They have developed replacement discs but these invariably go wrong after a short while causing far more problems than there were before the op.

Think about what structures are in the area.  If the surgeon slightly nicks your central nervous system (CNS) then you'll be buggered (excuse the term but I don't think I'm being over dramatic).  If you wish to know how well the CNS repairs itself then take a look at Christopher Reeve.  CNS does NOT repair itself. 

I can't state this more urgently: Do NOT let a surgeon anywhere near your back until you have discussed everything about what might happen.  Ask about short-term prospects, long term prospects, chances of screw up etc...  And don't even think about surgery until you've exhausted as many other options as you can first.

Scans are another thing that people think are necessary.  They're really not that useful in 90% of cases.  They're a waste of your money or time.  In the UK whilst you're waiting for an NHS one you could be having some useful intervention.  If you pay for treatment directly you'd be better off spending less on physio treatment.

X-rays are generally even more useless than scans and not ony are they (usually) useless they increase your chances of getting cancer.  Do you still want a back x-ray?

3 - Physios

Now we're into my happy zone. 

"There is plenty a decent physio should be able to tell you about how to deal with your problem. "

Now have a look at that sentence again.  The first important word is "decent"; sadly there are poor physios just as there are bad doctors or even bad jugglers (like me).  If your physio treats you like my brother's did him then tell him to stuff his payment.  (My bro was told: "You've got a bad back mate, live with it".  Not bad from a person who supposedly spends his working life dealing with back pain.)

The next important words are "your problem".  Much as you want someone to do this for you it doesn't work like that.  This IS your problem, you are going to have to deal with it.  The physio should be able to tell you how YOU are going to get you better and then help YOU try to do it.  There is no magic trick that will suddenly take your pain away and keep it away.

First some myths:

I see people who have been to a local private physio.  He uses ultrasound, interferential therapy (electricity basically) and heat.  The heat MIGHT be vaguely useful but people are paying this guy through the nose to have their time wasted with useless treatment; they all say that they had no benefit.  Ultrasound has NEVER been shown to be particularly useful generally but it really has NEVER been used as a treatment for backs.  If you have had lots of sessions that you've paid for then go back and demand that your physio gives you your money back. 

In short - ultrasound or electrotherapy is no use for you.

Truth?  You need to work the right muscles and move and hold yourself correctly.  That's basically it but I'm sure you can appreciate there's quite some variation that needs to be addressed.  The physio should look at how far you can move into every different direction, how good the quality of that movement is, how poorly controlled the back is, the nerve supply to the legs and more.  In addition they should check for all the worrying signs as noted in the "What is" article.

You will most likely get quite a lot of explanation of what's happening and some exercises.  That's all I'll say for now.  Much of what you'll get will be an explanation of what's in the final section of this post only tailored precisely for your presentation.

4 - Those who live with you or friends that you see regularly

The first and most useful thing they can do for you is not to mollycoddle you (I like that word).  If you stop doing stuff or you're always asking for help then your back will be getting less fit and more likely to end up causing you chronic problems.  But people are generally nice and will want to help.  If you're the patient try and do as much as possible.  If you're the other person then make him/her get up off his backside occasionally to do some activity.  Just because their back hurts doesn't mean they can't do stuff. 

If you let someone sit in their own juices and complain there will be a few effects. 

• Firstly you'll get hacked off with doing everything for them quite quickly.  They are probably already grumpy because of the pain they have - you getting annoyed with them will not help.
• Second: they'll get less fit thus worsening their problem NOT easing it.  So by leaving them you're making their problem both worse and longer lasting.
• Third: their reduction in fitness will lead to increased weight which in turn leads to more back pain and less use of the right muscles.  Again this leads to increased chronicity.

Don't let someone with your basic back pain waste their time with inactivity but allow that they may not be able to help with heavy tasks.  Normal activity should not cause more injury although it may cause pain.

"Pain" is not the same as "harm".

5 - Boss and Colleagues

We spend a third of our lives working (unless you're very lucky) so work is probably the single most likely place you'll have problems.  We know that the longer you are off work the less likely you are to ever get back to work.  This should be prompting you to think about working as soon as you can.

The points for bosses are the same as for those who live with you.  Don't mollycoddle but don't expect full fitness at first.  Bosses also have legal responsibilities for the safety of all staff and if they don't think you can safely do your job they're not going to be happy about taking you back until you're better.  This leaves us in a Catch-22 situation.  You need to return to work to get active and fit but you can't until you're active and fit.  You need a good Occupational Health team or a pushy doctor.

Try and go back part-time at first.  Or go onto light duties.  Then build up to full-time and normal duties.  The process will probably cause you some pain.  Sorry that's how it goes.  If you're not doing anything stupid you're not doing damage.

Colleagues can help by not griping too much that they're doing all the heavy work.

Bosses (in the UK at least) have a responsibility to make sure all the physical tasks you do are safe.  If there is a code of practice, use it!  If there isn't, ask why not. 

Health and Safety law also requires that every worker has their own responsibility to themselves and to their colleagues.  So if you see someone trying to lift a large photocopier then it's worth suggesting they don't.  If they injure themselves and you saw it was likely and let them carry on then you are as culpable as they are.  If you specifically ordered them to do it then expect a legal action coming your way.

What Nature can do

This is easy to split into 2 parts.

1. What nature does that is helpful.
2. What is unhelpful.

1 - Helpful

Your body repairs itself - that's it really.  If you have damaged a structure then the body will heal it as well as it can.  This is why most back pain episodes last less than 6 weeks.

2 - Unhelpful

It'll make you want to do less - not good (see above).

The muscles that you need will stop working when you get pain.  This is normal for any area of the body.  If you bang your elbow your biceps won't pull as hard until the pain's gone.   But the back works slightly differently in that the muscles you need will NOT return to use when the pain goes.  You will need to specifically train them yourself.

Right this is loads longer than expected so I'm going to split the topic into 2 posts.  The next post is what you can do for yourself.

Related Posts

Back Pain - Myths and Truths

What is - Back Pain

Back Pain - Treatment 2 - What you can do

So another huge topic to be done succinctly.

Firstly the vast majority of back pain is not worrying medically.  Of course it may concern you but it doesn't mean there is a horrible problem underlying it.  For clarity we're talking about lower back pain here.

Let's talk about the common things that people have heard about:

1 - Lumbago

Definition: Lumbago: painful condition of the lower back.  In other words "back pain".

This is NOT a diagnosis.  It is a way of telling you that you have back pain.  You would probably already know that though.

2 - Sciatica

Definition:Sciatica: Pain along the sciatic nerve usually caused by a herniated disk of the lumbar region of the spine and radiating to the buttocks and to the back of the thigh. [from dictionary.com, def 1]

Firstly this definition is WRONG [Edit: actually there is some debate about this.  Technically you could argue that you need true nerve iritation to be "proper" sciatica which would mean that the above definition is correct.  However the term is generally used to mean "pain down the back of leg" by pretty much everyone except pedants].  Pain down the leg may be down to a disc problem but rarely is.  More commonly it's down to a problem with joints in the spine or possibly a muscular issue in the buttock.

3 -  Slipped Disc

Definition: Slipped disc: a painful rupture of the fibrocartilage of the disc between spinal vertebrae; occurs most often in the lumbar region [from dictionary.com]

So some anatomy.  If you want more there are loads of anatomy sites out there on t'interweb.

There are 24 seperate bones in the spine, the top 7 make up your neck, the next 12 have ribs coming off them, this is the "thoracic spine" and the last 5 bones are called the lumbar spine.  At the top is your skull, at the bottom is a bone called the sacrum which is like 5 of the spine bones all fused together, under the sacrum is the coccyx or tail bone, this is tiny but can cause real pain (if you've ever fallen and landed hard on it you'll know about it).

Inbetween the bones are what are known as the discs.  Think of them as a jam donut.  The outside is fibrous and strong and the inside is gooey.  They act as shock absorbers for the spine.

The name "slipped disc" is rather a misnomer giving the impression of the whole disc shifting somehow.  The definition above is correct for a change, the "jam" pushes backwards (in most cases).  In minor cases the back of the "donut" bulges backwards and pushes on nerves.  In extreme cases the disc ruptures causing massive pressure and chemical irritation of the nerves. This is a slipped disc.  The other notable thing about slipped discs is that they tend to come on in an instant (but not always).  Often this is during a normal activity that may even be much less strenuous than you'd expect problem movements to be.  Eg you work as a builder and lift heavy weights all day, one evening you bend down to pick up a pen and your back "goes"; that's the classic slipped disc pattern.

One of the benefits of getting old is that the "jam" dries up so leaving you less likely to have a slipped disc.  Most slipped discs happen in people aged 30-50.

4 - Mechanical back pain

The most common form of back pain by far.  The non-specific title tells you a lot about the mechanisms here.

Quote: "In the majority of cases, it is impossible to identify the exact cause of backache" [netdoctor.co.uk]

I'd agree with this.  People then assume that nothing can be done with it.  This is rubbish, almost all physical back pain can be treated.  It's a combination of muscular problems, joint problems, postural deficit and sometimes hormonal changes and anxiety/stress.

5 - Chronic back pain

Definition: chronic: Of long duration. Used of a disease of slow progress and long continuance. [dictionary.com]

This is distinct from recent onset back pain (aka acute back pain).  Chronic pain is a whole different area of medicine.  It involves physiological changes in the brain, perhaps some emotional difficulties either directly because of or not helping the pain, changes to the perception of self and your pain and numerous other things.  This is much harder to deal with if there is no specific pathology (as with most back pain).  Imagine being told that there's actually nothing much wrong physically if you've crippling pain.  The only demonstrable help there has been for this problem is a combined approach involving physio, doctors, psychologists and other medical profs eg occupational therapy.  You'll be damned lucky to find a service that'll help you out with this.

Please note that simply having back pain for a long while means that the pain is chronic (in time terms) but doesn't necessarily mean you go through all the physiological changes that result in nasty "chronic pain" meaning what's in the paragraph above.

Things you need to know.

Normal episodes of back pain.

• The vast majority of back pain is not medically concerning.
• Most episodes will last less than 6 weeks.
• Most back pain is called "simple, mechanical back pain".
• Treat it yourself (check the "treatment" posts).
• You need to get the muscles working.
• The worst thing to do is "nothing".
• You're not likely to injure your back further with normal unloaded activity.

Concerning things

• Nasty, unrelenting, unchanging pain.
• Sudden, significant and unplanned weight loss.
• Pain doesn't change at all (most will vary depending on position, posture or activity).
• Real difficulty sleeping because of the pain.
• Numbness around the inner thighs and groin.
• Inability to control bladder or bowel normally.
• Recent onset major muscle weakness in the legs.
• Pain started after major trauma.

These are what we call "Red Flags" they can indicate some pretty nasty things that need urgent checking.  If you have more than 1 of these then get yourself checked quick.

We also have "Yellow Flags" these are described as "factors increasing the risk of developing long term problems or disability".  These are:

• Belief that back pain is harmful or severely disabling.
• A legal or compensation claim in progress.
• Fear of movement or activity.
• Anxiety/depression.
• Expectation that someone will heal them rather than to play an active role in their own health.

So if you see these in someone without any serious pathology then give them a kick up the backside from me.

Related Posts

Back Pain - Myths and Truths

Back Pain - Treatment 1 - What others can do for you

Back Pain - Treatment 2 - What you can do

I'm thinking of setting up a workshop / lecture for circussy types and parkour-ers at maybe the University in Leicester.  The plan would be for a day session of lectures on injury, warm-ups and prevention of problems.  To sweeten the pill I'd lay on a massage workshop too. 

In addition I'd try and get a parkour expert in as well as trainers to do some actual physical training.  But assume this bit won't happen at first.

Does this sound doable?

How much could I charge for a day chock full of professional teaching/workshops?  I had a look at the Circus Space website and they charge £95 per person (!) for a circus taster day.  I was thinking something more like £10-15 (as an initial offer) with handouts extra.  I think a max of 12 people would be about right too.

Would anybody want to come?

Suggested plan for the day (Jugglers only):

10.00 - 10.30 Intro and questions answered.

10.30 - 11.00 Sudden injury (lecture) - What to do and how to avoid.

11.00 - 12.00 Repetitive injury (lecture) - What to do and how to avoid.

12.00 - 12.30 Warm-ups (Myths and falsehoods) (Lecture)

12.30 - 1.00 Break

1.00 - 2.00 Neck and back control (Workshop)

2.00 - 2.30 Practice and questions answered

2.30 - 3.30 Shoulder control (Workshop)

3.30 - 4.00 Practice and questions answered.

4.00 - finish Break then massage (Workshop).

I thought I'd put the sit down stuff at the start when people are alert and then the workshops at the end to get people moving and working rather than sitting listening again. 

Now whole books have been written about this and I'm trying to do it in a short form on a web-page.  Hmm?  May not work but we'll have a go. 

Myths:

• Back pain means something serious has happened.

"My back has broken"!  Well yes in a way.  Something has happened that's serious enough for you to have noticed a problem.  It's not likely serious enough to suggest a major medical or physical problem though.  The incidence of serious pathology is about 5% of those incidents of back pain.  By serious pathology I mean anythng from "slipped disc" to spinal tumours.  These are very rare and usually have some specific symptoms in addition to excruciating pain.  We'll come to those later.  Most back pain will get better without recourse to surgery, chemo or scans.

• My doctor says it's just lumbago and he's only given me some tablets.

Firstly, "Lumbago" is just another name for back pain.  It's like going to the doctor with head pain and he "diagnosis" it as "head ache".  Not very helpful.  Now most back pain will go within 6 weeks of onset.  That's why doctors don't bother too much with recent attacks of back pain.  They know things will improve just with time and the drugs are to tide you over.

• I feel I need an x-ray/a scan.

Not necessary in nearly all cases of back pain.  A lumbar spine x-ray is massively more powerful than a chest x-ray.  One study suggested that for every 20000 lumbar x-rays performed there was a new cancer in one of those patients (x-rays are carcinogenic).  The flip side is that a lumbar x-ray very rarely will show anything of note.  Most commonly they show nothing out of the ordinary.  So you're giving yourself a higher risk of cancer for no benefit.

Scans can be useful but they're only necessary if the medics suspect something worrying and also if the result of the scan is likely to affect future management.  In other words why do a scan if your treatment will not be affected by the result?

• I've had back pain so my back will always be "weak".

No no no.  It will remain weak if you ignore it between bouts of pain.  But like any muscles if you train your back support muscles then they will get fitter.  The problem is that most folk don't know how to.  We'll come onto that in the treatment posts.

• Sciatica is worse than back pain.

That's entirely a matter for each individual.  Sciatica is pain in the sciatic nerve, it doesn't always come from the back though.  If it does come from the back it may indeed be "worse" in terms of pain but is still generally dealable with.  Really bad disc problems can cause very nasty referred pain indeed and may need surgery.  That's probably where this myth comes from.

• My chiro/physio/doctor says one of my legs is longer than the other.

Rubbish.  It may well be but unless there's a huge difference you're very unlikely to get symptoms of severe back pain directly attributable to this.  Studies generally show that there is no increased risk of back pain in those with an actual leg length difference within about 2cm.

Note I said "actual leg length difference".  You can get an "apparent leg length difference" which may mean something else and seem to give back pain.  This is likely to be a problem with the joint between your back and pelvis.

• I need ultrasound/TENS/electrotherapy treatment of whatever ilk.

Ultrasound is a complete waste of your time for back pain (and I would argue for just about everything).

TENS is a pain relief modality that may help but is entirely symptom based, ie you'll get rid of pain for a while but you're not dealing with the underlying problem.  The same goes for any other electro modality.

• Don't use heat on it.

Why not?  Commonly the problem is muscle spasm rather than any inflammatory issue.  If it feels like the muscles have spasmed up then heat will help to relax things a little.  Don't make it too hot and don't continue if it's not helpful.

Some folk use ice.  This can work by relieving pain thus cutting down on muscle spasm.  I'd use heat and stretches myself.

• I must rest my back when it hurts.

Possibly the worst advice.  Yes give it a break for a day or so then get using it again.  Start gently and stretch it out.  You shouldn't feel too much pain but you should feel that you are stretching.

• I must sleep on the floor or a plank of wood.

No no no again.  Sleep wherever you find comfortable.  If you can actually get to sleep somewhere then you're getting basically a decent support for your back.  If the base is not appropriate for you you'll really struggle to sleep.

• If I look after my back properly, doing everything correctly, I won't get back pain.

Really not that simple I'm afraid.  1 in 4 of us will get back pain in any given year but some of us who specifically look after our backs will still get some problems with them in just the same way that life-long non-smokers may still get lung cancer.  But you will minimise your chances by looking after yourself.

That'll do for myths although there may well be more that I'll cover at a later date as and when they occur to me. 

So what is the truth?

• The vast majority of back pain is not medically concerning.
• The majority of back pain cases can not be accurately assessed - meaning we don't know exactly what is wrong in the vast majority of cases.  This is not a worrying fact.  In fact the standard term is now either "Mechanical back pain" or even "Non-specific back pain".
• Not knowing what exactly is wrong doesn't mean we can't successfully treat the condition fully.
• Back pain is more commonly lots of little problems with lots of structures rather than one thing gone badly wrong.  This is why we can't often say exactly which structures are the cause of symptoms.
• 95% of back pain episodes will end in less than 6 weeks.
• Your back is very powerful and won't "break" even if you use it whilst your back hurts.
• Your back is supported by some very effective muscles.
• Sadly these muscles pack up when you have episodes of back pain.  They also DON'T automatically come back into use after an episode of back pain, you need to specifically train them.  This, if ignored, is why many people get repetitive episodic back pain.
• Most back pain CAN be treated reasonably well.

Related Posts

What is - Back Pain

Back Pain - Treatment 1 - What others can do for you

Back Pain - Treatment 2 - What you can do

I ran the workshops for the first time yesterday at the Leeds Juggling Convention.

Thoughts about the workshop:

Goods:

• I finally got to run through both the lectures/workshops in front of people who haven't had to hear me wittering about it whilst they were being writ.
• People seemed interested and generally seemed to follow things.
• I got through it.
• Lap-top worked well.

Hmms:

• Complex stuff done too quickly. - Should this mean do less or be more specific?
• Too few of me- couldn't get round everyone to check things working as they should.
• Clurby suggests that the injuries stuff at the beginning wasn't desperately relevant to jugglers.  True but I had advertised it as such.  Will start on tendons and repetitious pain next time unless talking to trapezers and acro folk.

Bads:

• My voice died that afternoon and it still hurts.
• Nothing too heinous I don't think.  If you have any comments (and were there) please tell me what you thought.  If I don't know what was cack then I can't improve it.

Have fun.