ISSUE 131 / 2021
CONNECTING THE DOTS
PTs are trained to treat body problems, but pain anywhere in the body might be the tip of the iceberg…
Today I saw Jack. I know Jack because about once a year, his back “goes out”. Here’s how the conversation goes:
“I really screwed up my back. I haven’t gotten a good night’s sleep all week.” Jack stated.
“When did your back start hurting?” I asked.
Jack replied “I was a little sore all week because I was sitting too much – getting ready for a big meeting – but then I had to rearrange furniture in the office to space us out and that’s when my back seized up. Figures, right before a meeting.”
“The moving caused your back problem?” I probed. “Pretty sure.” Jack said “I was in agony the next day.”
A s physical therapists, our “go to” is a physical exam. That’s important; we need to know if we are dealing with a structural problem. After a complete evaluation my primary finding is this: tight back muscles. Reflexes, strength and sensation are all normal. It really hurts for Jack to bend forward. He’s afraid to go further than a few inches, because the spasms increase. His low back muscles are very tender – I can barely touch them. Hmmm.
I’ve ruled out a major structural problem, so I probe a little deeper.
I ask “Were you under any stress when your back started hurting?”
“Yeah, like I said, that meeting was important, and I had a lot to do to get ready.” he said.
“Do you think stress might have something to do with your back pain?” I question.
“Maybe, but that furniture was heavy.” he replied.
Jack is starting to connect the dots…
Stress can be defined as any type of change that causes physical, emotional, or psychological strain. So, when we are under stress that feels physical – it’s natural to pin it on something we did. But it could just as easily be something we felt. It could just as easily be an output of the brain when the brain is trying to protect us from screwing up this important meeting. As you’ve heard before, all pain is activated by the brain. Read Pain Explained here. Pain can be generated by tissue damage – a body problem – or by neural pathways in the absence of tissue damage. And it can be both.
So, if we only ask about physical pain, we might be missing the boat, or at least only addressing one part of the problem. We might agree that moving furniture was your downfall. In the past, we might have even told you not to lift because you could hurt yourself even more. But now we know that increasing fear will only increase your pain.
I ask Jack to lie down, and I find some tender spots in his back. After some relaxing deep breaths, I guide Jack through some strategies to help his nervous system calm down. The tender spots ease. Then I ask him to imagine bending forward with ease.
He’s a little tentative at first, but then he gets into it.
After about 20 minutes of relaxing and just imagining moving, Jack gets up and tries a forward bend. It’s way better. No perfect, but way better. Why?
Because as Jack’s stress increased in anticipation of a big meeting, his brain sent out signals to keep him safe, and those signals caused muscle tightness. Most muscle activity is about making sense of the world and how to cope with and interact with it (Butler and Mosely, Explain Pain). When we can increase the sense of safety, muscles relax and we move with greater ease.
Use this exercise to increase your sense of safety.
Next time you have an ache or pain, you will naturally ask yourself what you might have done, but don’t forget to ask yourself what you might have felt. Or give us a call, we’ll help figure it out. PTs at ALTA have learned that we almost never address just the body; the mind always plays a role in our pain and in our recovery.
YOU’RE IN SAFE HANDS…
We’ve gotten so many Google reviews lately. Thanks to all of you who took the time to rate us and review. We really appreciate it. Many reviewers mentioned how safe they feel at ALTA. That is very important to us. We want to make sure you are safe. Here’s what you can do to help us maintain the safest environment possible:
- Complete paperwork, whenever possible, ahead of time. 2. Come into the building at your appointment time; if you are early, we may not have a treatment room ready for you. 3. Please be mindful that, though you may have been
vaccinated, only 7.4 % of Coloradans have received both doses and we are still following CDC guidelines.
Like you, we cannot wait to get back to some semblance of normal. Thanks for hanging in there with us – it feels like there’s a light at the end of the tunnel.