Chronic Pain Rehab concepts/back pain

When I was about 26 years old I worked 2 summers as a roofer. I was lifting way too much weight up and down a ladder. I then went to Physical therapy graduate school for 2 and 1/2 years.  I was sitting about 12 hours a day in class or studying on my own. My back started to hurt significantly with sitting and bending forward.  I considered surgery, injections, physical therapy, and a whole array of treatments.  I ended up doing physical therapy 2 x a week, taking anti-inflammatories, ultrasound, massage, joint mobilization, lumbar traction, electrical stimulation, heat,  and ice.  The Doctor I saw performed an X-ray of my back and said it was a muscle strain. Nothing was helping the pain. My back hurt profoundly with trying to surf while I was sitting trying to catch waves, with sitting in Church, bending over to pick something up, and standing for a prolonged period.

The picture above is from the website: www.sportandspinalphysio.com.au

The pain was becoming unbearable.  One time I lifted a patient from their bed during a clinical and my back just gave out.There was a sharp pain in my left low back area.  My back was killing me. I consulted with Doctors, physical therapists, and nurse practicioners.  I could not get a clear diagnosis and I could not get any relief from my back pain. Also I was starting to get symptoms of numbness down my left lateral leg. In hindsight, it is pretty easy to see the diagnosis was a herniated disc at L4/5 in the lumbar /low back region.

My condition became chronic and it lasted for about 3 years.  Over the years I have had some similar patients where they saw a lot of different health care professionals and their pain just was not getting better. With some (not all) of these patients and with myself I found some secrets of sorts to overcome or reduce the pain. Here they are:

  1. Find the correct diagnoses as best you can with your Doctor, your physical therapist/occupational therapist, your own research on credible websites like emedicine.com/mayoclinic.com/webmd.com, experience, biomechanics, (finding an exact diagnosis can be important but in some cases you may not find it so you have to move forward and try something different for treatment like I am suggesting)
  2. Remodel the muscles with building over the tissue that is injured
  3. Work through the pain in some cases to re-wire the nervous system’s memory of pain
  4. Stop the activity that is creating biomechanical excess force
  5. Be careful is some cases – for example in the low back region if you have spondylolisthesis you should not do lumbar extension/really hyperextension because it can injure your back ( I will help you understand some of the major cases to be careful with

For back pain and my herniated disc I applied the secrets and my back is 90% better. It is not 100% better but it is so much more bearable and easy to deal with that I am thrilled about it. This is how I applied the secrets.

  1. I worked assiduously with many Doctors, nurse practicioners, physical therapists, researched a lot on my own, worked as a physical therapist for a while until I found the correct diagnosis.  It was an L4/5 herniated disc causing numbness down the lateral left leg. (An MRI is 30% inaccurate for herniated discs according to studies by Boden)
  2. Lumbar extension on a roman chair for strengthening the multifidus and erector spinae muscles. Overload of the back muscles against gravity helps to build muscle. This process  creates micro tears in the muscle and it changes its composition. The micro tears  signal satellite cells to fuse to muscle cells. These satellite cells can also divide themselves. The overall effect is for the muscle fibers to increase in size. It is like building a protective shield over the injured area.
  3. Same as above
  4. For my herniated disc I literally stopped sitting during the day in class, at Church, at work (at work I used a stand up desk), in the car I leaned my seat back about to 135 degrees as safely as I could (BBC article showed research that with leaning back 135 degrees it reduced the lumbar disc pressure). The reason I stopped sitting up straight in a chair puts excess pressure on the discs according to the research.
  5. I did not have spondylolysthesis so I was ok to do this exercise

 

The picture below is from the website: brentbrookbush.com It is a picture of the multifidus muscles. 

Image result for multifidus image

 

 

The picture below shows the erector spinae and is from the website: erectorspinaegroup.weebly.com

Image result for erector spinae image

 

The picture below is from the website: www.refinedguy.com The Roman chair exercise is shown below.  It is aggressive and for those that have fairly good coordination. The exercise consists of bringing the trunk and upper body down to about 70 degrees forward and then lifting the trunk and body back up to parallel to the ground.  Perform 10 x slowly, 5 x a week, 6 to 8 weeks. As it gets more easy you should increase the reps to 2 sets of 10. As that gets more easy you should hold a 5 pound weight to your arms at your chest.  As this gets easy increase the weight to 10 pounds holding the weight at your chest. It is very difficult and it will be painful.  Check with a physical therapist/occupational therapist, physician first before trying to do this exercise. Do not do this exercise if you have spondylolysthesis.  

Image result for Roman chair lumbar extension image exercise

This is one exercise for chronic pain in the lumbar region that I think is ahead of the curve and extremely effective.  I will be having more to come for different body parts.

 

 

 

 

 

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8 thoughts on “Chronic Pain Rehab concepts/back pain

  1. Wonderful information, and so pleased your own back condition is much improved. I would for many years sit.. Within textiles sewing. My back aches when I stand, say in a cue and do not move.. I feel I have to relieve pressure.. I manage fine though, its discomfort and nothing in the scheme of things I went through with FMS..
    Lovely to catch you post as I try in vain to catch up 😉
    Blessings ~Sue

    Liked by 1 person

      1. Thank you, its lower back pain that is aggravated when bending, or just stood in one position.. I did go to a Chiropractor who said I had one hip higher than the other, They gave me stretching exercises, I do find relief in acupuncture.. I am 120% better than I was With FMS Fibromyalgia it came on in stages over the years until a full blown melt down. Qi Gong saved me, believe it of not, as at one point I couldn’t climb my own stairs without going on all fours.. Now I am active, garden, but learnt to pace myself.. I ache most days its bearable.. Thank you for your kindness 🙂 Which is why I often say I am 120% healthier.. It was a rough few years..

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      2. FMS is brutal. It is extremely difficult to have some progress so that is fantastic you found success with Qu Gong- I will have to look into that in depth! I don’t know much about it – just a little bit. Most of the time if somebody is age 60> and standing hurts a lot it is consistent with lumbar stenosis- I have about 3 posts on lumbar stenosis. But if it is really sore with bending over that is usually more consistent with a herniated disc. So you are a really tricky case because standing hurts (stenosis usually) and bending forward hurts (that usually helps stenosis and hurts a herniated disc) I have on one of the first blog postings an app video and it goes through how to tell if you may have a herniated disc and exercises for that. The stenosis ones have exercises too. But you add on FMS on top of that and man that is tricky. If you can get into a warm pool and do some exercises as well that may be beneficial, a sauna, warms showers, aerobic exercises that are not pounding ie a recumbent bike that in the research can help FMS some. Hang in there I’m sorry you have had so much pain!

        Liked by 1 person

      3. Thank you so much.. Yes warm showers help.. the standing pressure has for the most part been with me since after having my two children.. The bending.. I am 62.. don’t feel it only some days lol.. Yes I found Spring Forest Qi Gong.. and started doing daily exercises.. If you look on line to Master Chunyi Lin think that is how it is spelt.. it was his tapes and video I got when I was in pain.. The FMS is nothing like it was.. as I would at one point walk with a stick.. I now walk and garden..but know not to push myself too much.. but also know its not good to sit and do nothing as I stiffen and feel worse.. balancing is the key and mind over matter I believe in and put into practice with meditation..
        I hope you do look into the website Spring Forest Qi gong and listen to the testimonials too of cures… He is genuine and has grown since I first had tapes before CDs were popular.. 😉 I will look out the herniated disc though as that is the most painful.. So thank you so much for this reply my friend

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  2. Hi, I have a herniated 4 & 5 (left) and a bulging 3rd (right). All my symptoms are left side. I had a discectomy on the 5th 6yrs ago following the birth of my son. I have significant nerve damage and have literally no reflexes in the ankle.

    I had a steroid epidural 2 weeks ago. It improved for a week, still a bit better now to be fair, but I need to be doing some sort of core exercises but obviously my pain is restricting. I will be having another epidural at some point, I’ll try anything to avoid another surgery. I’m 37. I prolapsed a disc at 17yrs, this is now the 3rd time.

    Any advice would be welcomed. I’m writing for physio but not hopeful. Also, would chiropractic help be advised?

    Cheers
    Gemma.

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    1. If you don’t have spondylolisthesis- your orthopedic Dr would have told you already you could try mckenzie exercises that are extension exercises in laying prone or on your stomach. It is on one of my first few blogs for back pain. It shows a person laying prone and pushing upwards 10 x every 2 hours. You can also try it in standing. With having cauda equina that is a medical emergency I am so sorry to hear this. It requires immediate surgery so your nerves aren’t permanently damaged for the bowel and bladder. It would also be good to find out what is causing the herniations- ie a lot of heavy lifting, sitting in a chair too much for work, driving too long during the day, I use a stand up desk to reduce back pain, walking is good for disc problems. Core exercises like the bird dog and dead bug exercises are great. The pictures are in the blogs for back pain for those exercises. To restate…
      1. Mckenzie extension exercises pictures on back pain blog every 2 hours – if the symptoms of numbness are reducing this is a good sign, if they are getting worse stop those exerciess. 10 x every 2 hours
      2. Avoiding things that are causing pain or numbness down leg, my guess sitting upright- try leaning back in chair 130 degrees or standing for work
      3. COre exercises from pictures from back pain other blogs on my site- there are about 6 blogs that I have on back pain that have the illustrations. Sometimes chiro can be effective and at times they get so aggressive. It is hit or miss in my opinion. I quite honestly would go to see an orthopedic spine Dr that only works with the spine and see what he/she says asap.

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