Get Rid of the Hammer*
In his book, Low Back Disorders: Evidence-based Prevention and Rehabilitation, Dr. Stuart McGill mentions on several occasions that no back is alike. Nonspecific “backache” is nearly impossible to quantify and, even if it could be quantified, offers no guidance for intervention. Some backs suffer with discogenic problems for example, and will respond quite differently from those with ligamentous damage or facet-based problems.
As well, how we would approach someone with flexion based intolerance as opposed to someone with extension based intolerance varies quite dramatically as well. This is why I hate a one-size fits all, cookie-cutter approach to corrective exercise. Just telling someone to go do a few planks isn’t going to cut it in this sense. All backs aren’t created equal.
That being said, sometimes the best approach isn’t therapy or worse yet, surgery. Rather, it’s sometimes best to just take a step back and figure out what daily event is exacerbating the individual’s symptoms. Simply put: find the cause and remove that cause.
As McGill mentions, consider lightly hitting the thumb with a hammer repeatedly–eventually the slightest touch causes pain. This is symptom magnification because the tissue is hypersensitized. Reduction of hypersensitivity in the thumb only occurs following a substantial amount of time after the hammering has stopped. It’s kind of like when you’re flipping through the channels on a Sunday afternoon and you happen to come across the show The Pick-Up Artist on VH1. It’s only after you stop watching it that you feel less inclined to want to jump in front of a lawnmower.
Anyways, back to hammers. Tissues in the back are continually “hit with the hammer” because of the aberrant motion or motor patterns. For example, those people with flexion based back pain (flexion intolerance) may replicate their symptoms every time they get up from their chair. Once they correct this faulty movement pattern and “get rid of the hammer,” then and only then, will the tissue be less sensitized, and said person will be able to return to a pain-free (hopefully) lifestyle.
The point is, sometimes we have to remember the KISS (Keep It Simple, Stupid) principle. More often than not, the key to solving your back pain could simply be looking at your daily motor patterns and correcting them.
*that’s what she said
UPDATE: Just wanted to say congratulations to the Tampa Bay Rays. I’m not pissed. Point blank, they were the best team last night and played an awesome series. Now excuse me while I go kick a puppy in the mouth.