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This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2021. For the original video go to https://www.youtube.com/watch?v=4F6MP0l50uU
Bob: Today, we're going to talk about how to finally stop your back pain. We're going to have you answer 10 questions. All right, let's get started, Brad.
Brad: All right.
Bob: So, these questions were developed by Stuart McGill. He is probably the world's foremost expert on back pain.
Brad: That's right.
Bob: It's in his book. It's an excellent book. These questions are from his book called "The Back Mechanic." I think it's the best book out there right now.
Brad: Sure.
Bob: So, the most important thing you need to do when you're trying to get rid of back pain is you got to stop the cause.
Brad: Stop the irritating component, right.
Bob: A lot of people think like, “oh, I hurt my back. It's going to stay hurt.” That's not true. You've got something that's irritating you during the day, and if you stop those irritating things, the pain will calm down eventually. The nerves will calm down. Everything will calm down.
Brad: And you might think, I had a lot of patients say, "What irritates it," and the first response is everything.
Bob: Everything, exactly.
Brad: And then I talked to them some more, and finally we can figure out where the primary causes are, or maybe two different causes.
Bob: Yeah, we start off this process by basically doing the questions, but we're going to do another video that's going to show you some tests you can do on your own, to try to help narrow down what is the cause.
Brad: Right.
Bob: So you want to watch both of these videos, or all of our videos, you want to watch. So number one question, does the pain change in intensity? I like to see that it does, like there'll be times where maybe you have no pain or a little pain.
Brad: Right.
Bob: And then times where you have severe pain. That usually means you can control it then.
Brad: Sure.
Bob: I mean, if you can have times where there's no pain, well we're going to increase those.
Brad: Right, try and associate that with your activity then or just prior to that.
Bob: Yeah try to make note. It's not the worst thing to even have a log book.
Brad: Yes.
Bob: Okay, When you roll in bed, do you feel any catches? This is a really good sign of instability in the spine, and I'm going to explain that one Brad.
Brad: Right because that might not be clear.
Bob: So let's say you have a disc problem at one level. You have all of these vertebrae that stack up to make your back. If you are unstable at just one level, when you move, all of the movement's going to occur at that one level instead of all spread out among the other levels.
Brad: Sure.
Bob: It's hard to explain this without showing it, and we don't have a good model to show it. But, you just have to take our word for it. It's usually the sign of a disc problem, and it's a sign of instability in the back, and so what you're going to want to do is you're going to, when you try to get out of bed, you actually tighten your abdomen.
Brad: Right.
Bob: Like a corset.
Brad: Yep, like you're putting on a back belt, you just tighten up those core muscles and really try and keep your whole trunk, we call it log rolling.
Bob: Right.
Brad: So it's everything stabilized together by using those abdominal and back, or you know, core muscles we'll call it.
Bob: What a difference it makes. I've seen it with patients, like they were very skeptical. They thought it's not going to make any difference, and they're like, "Wow, I got out of bed without pain."
Brad: Sure.
Bob: And that's the first step, then. You start realizing hey, maybe I can control this pain. Maybe I do have control over it.
Brad: That's a big step, feeling confident that you can deal with this.
Bob: Right, exactly. So this is probably the most obvious question. What makes your pain worse? I mean, you start writing down. Generally, we find is that people are going to maybe have worse pain with bending forward. Which is a really common way, or maybe it's bending up straight and backward.
Brad: Yes, sir. You're not even bending forward. Sometimes it's bending over a bench while you're doing something perhaps at work or in the kitchen, and you don't even realize that you're bending forward, and a little bit can make a big difference.
Bob: Why don't you show twisting too, Brad? It might be with twisting, just turning.
Brad: Yeah, so when you turn, especially the low back pain, ooo. And just a little bit.
Bob: And maybe it might be in one direction. Might be mostly to the right, and when you go to the left, you're fine. And of course, we have to throw in things like load and fatigue.
Brad: So lifting, pushing, pulling heavier objects.
Bob: Or some things you might be fine with until you've done it for a long time. You might be fine sitting for 10 minutes, but at 15 minutes, it starts to hurt. You don't go to 15 minutes then. You have to stop at 10 minutes, and do something else in between. So there's ways around this. We brought this one in, too. Any history of osteoporosis, osteopenia? The reason we ask that is it's very common with osteoporosis or osteopenia, by the way. In some ways, they're not that much different. People think osteopenia, they're fine. You could be a higher risk for fracture with an osteopenia.
Brad: So we're talking about bone density loss. Your bones are becoming weaker. Typically, with older people, it's common.
Bob: So the problem is there's about 300,000 patients who go to the doctor each year, because of a fracture.
Brad: In their spine?
Bob: In their spine, yeah.
Brad: Compression fracture, whatever. Those are common.
Bob: Yeah, the bones squeeze together. But they estimate another 600,000 don't go to the doctor and don't even know that they have a compression fracture. It's called the silent fracture, and it's very, very common. So if you have osteoporosis, you probably want to have that checked out. A bone density test and also probably you might, if you're having pain, you should have an x-ray.
Brad: Of your spine.
Bob: Yep, of your spine.
Brad: Yeah, it's not a major fracture. It's something that has to be read oftentimes by a radiologist. The MD may not be able to see it. You have to get an expert, which is very common. They almost always do it.
Bob: They always do it anyway. Number five, Any trauma involved? If there was trauma involved like you're in a motor vehicle accident or if you fell, you should be seeing your medical provider just to make sure that no fractures occurred. Or nothing untoward happened. All right. Is your pain worse thing in the morning? If it is, this could be your sleeping posture.
Brad: Sure.
Bob: And quite often, that's what we point to. If you're sleeping in a good position and you're moving a little bit, you really shouldn't have increased pain at night, you know what I mean? Unless you irritate it during the day.
Brad: Right, right. Well, yeah, and we have videos on how to readjust your body or use some supports to help eliminate that.
Bob: Exactly, you might be putting pressure on that back all night long if you have, for example, if you have kind of a large buttock, and you sleep on your back. Actually, the back is going into flexion all night long.
Brad: Or side lying.
Bob: Or side lying, if you have a little bit wider hips, you could have your back sagging all night.
Bob: Or wide shoulders.
Bob: Right, right. Absolutely. All right, Does your pain worsen throughout the day? This usually indicates that you're putting your back into some poor positions. Or maybe too much load. I mean, maybe you're fine at a lighter load, but as soon as you start putting some stresses on the back, it can't handle it.
Brad: So if you have to move boxes throughout the day, and the lighter ones are, you're doing fine, and that's kind of a common sense one, I think. But just when you say load, I just wanted to clarify that.
Bob: Well, I think Brad, what we're trying to hammer home here is that something is causing your pain, and look for it, and if you can't find it, you aren't looking hard enough. I mean, really.
Brad: Right. It's one of those things as a therapist, we're trained and we have this experience. A lot of times, it's just sitting, you feel fine, but that sitting long-term sitting with poor posture kind of sneaks up on you, and it feels fine until you get up, and then it's like, oh, what was that, what did I do? And it was actually the seated posture that you're completely unaware of.
Bob: Or it might be you're seated in a perfectly fine position, but you sit too long. I mean, there's lengths of time, too, so you should get up and walk.
Brad: Which can be a problem depending on your job.
Bob: Well usually, you can walk to the bathroom anyway. All right, Is your back pain more concentrated in the middle back? This is for people, a lot of people Brad, they've developed poor positioning and movement patterns where they actually tend to, instead of bending at their hips and keeping their back straight, they bend at the mid back. They call it a hinging right where the ribs meet the low back.
Brad: Right. Below the shoulder blades, but above the low back, just right in the middle there kind of.
Bob: But they get into this movement pattern of going like this, and that's almost always causing the mid back pain.
Brad: And that's one of those things you're certainly almost certainly not aware of. It's a habit that's been going on for years and developed, and so that is one of, like a lot of these things, you're just not aware of what you're doing.
Bob: Yeah, I think back to a couple of patients I had who had mid back pain, and they had to lean over a fence to do something, and I'm like I knew right away what they were doing. They were doing that. They were bending at the mid back and hinging, and you want all the movement to occur at the hips, not the mid back.
Brad: Right.
Bob: All right. Does your pain also radiate into your buttocks and feet? If it goes all the way down into your feet, it's more likely a disc problem.
Brad: If it's past the knee, disc, if it's to the knee, then it could be SI. It's still a back thing, but then it's a little bit more challenging to fix it.
Bob: You're getting a pinched nerve somewhere. It could be piriformis, too, but somehow, you're getting that nerve pinched. You're definitely going to want to see the doctor in this case. Does your pain increase with fast walking, or does it decrease? Usually if it decreases with fast walking, it's often a disc problem because a disc problem will increase when you're walking slow. It just puts a little more load on the spine.
Brad: Stuart McGill, he talks about that as well.
Bob: But then, what case? Does it increase, Brad, when you're walking? That would be spinal stenosis, and that's such a common thing that they call it shopping cart syndrome, like you lean on a shopping cart, and it feels better, and if you have spinal stenosis, you may be only walk a hundred yards, and you have to sit down and give yourself relief.
Brad: And then when you sit, it feels good. Typically, right away, and that's more with the older population, 60 and over. It's not an uncommon diagnosis to have, but it's certainly nothing to get too excited about. There's some exercises that can help you out.
Bob: And you know, you deal with it, too. You manage it like Brad bandages his spondy. You figure things out, and Brad runs and bikes and swims.
Brad: Right, I just got to be careful.
Bob: And irritates people, so he does all those things.
Brad: I don't bike too far, Bob. It's still uncomfortable getting off the bike.
Bob: You don't let it bite too far.
Brad: You learn your limitations.
Bob: Yup, and that's the whole summary of this video, is let's find out what's bothering you. Let's calm it down. Let's not let it irritate you, and it can flare up to the point where you can't do anything.
Brad: So you need to either modify the irritant, maybe use a back support, change your body mechanics, or if you can avoid doing that activity which can be challenging.
Bob: You may have to avoid it for a while, but then we can eventually get you back into it, maybe with modifications.
Brad: Sure, yeah.
Bob: All right, remember, Brad and I can fix it about anything.
Brad: Except for.
Bob: A broken heart.
Brad: Right.
Bob: And I think I've been working on it harder than Brad to be honest with you.
Brad: Well, that's true. I kind of, you know.
Bob: I hate to be catty about it.
Brad: What's a guy going to do about it? Sometimes you have to take a break from the old heart thing.
Bob: All right, thanks.
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