Mechanical Pain or Not

November 22nd 2019 |

Mechanical Pain or Not

I wrote an article recently for Shetland Life about my thoughts on what causes pain in some cases. Here is the article in full.

Around 80% of people in Western society have back pain at some point in their lives. If you are one of the 20% well done. You should work on keeping it that way. Back pain is so complex sometimes that there could even be links to how stressed your mother was before you were born. I was listening to a hugely interesting webinar recently (Biopsychosocial Influences in Movement Dysfunction & Chronic Pain with Dr Emily Splichal) which makes us realise how complex pain can be. We tend to look at the physical nature of pain a lot of the time but forget about psychosocial factors that may have contributed as well. An example of this can be someone who has a traumatic incident such as a bereavement of someone close. We often see this manifesting as musculoskeletal pain. Our aim in physical therapies is often to ascertain which physical structure is painful and what are the mechanical reasons for this.

So an example of a mechanical approach to this might be an office worker with low back pain. Typically, in the office the head protrudes forwards and people slump forwards (did you know the human head weighs between 4 and 5kg - that’s a lot of weight pulling forwards on the poor back muscles). That causes a stretch weakness in the muscles right down the whole spine (the muscles are too stretched – technically under tensile load). So what do we do for a sore back, stretch it. However, it is possible these muscles are actually stretched too much (this is only one theory in physical therapy here but an interesting argument none the less). So in physio we might start to stretch out the stiff muscles on the front and sides of the body which would be totally reasonable. However, let's consider a different approach.

Let’s say the office worker hates her job and slumps forwards because she is tired. Stress hormones such as cortisol may be rushing around her body and causing musculoskeletal pain. I’ll bet she doesn’t get as much pain when she is at her crafting class surrounded by friends, having a good chat and really focusing on getting the embroidery finished. She’s, probably in the same position under the same mechanical load though. So perhaps her rehab should include some deep breathing, mindfulness or relaxation techniques to get her out of that position. Perhaps we should also be considering a change in lifestyle or job so that she can enjoy her life more and stop getting back pain. Lying flat – for example on a foam roller – can help to open through the front of the body (mechanically inducing stretch), allow or lungs to open better and give us that opportunity to stop and focus on the here and now rather than the past or the future. Remember though, if you are already in any pain then you need to have a diagnosis and have professional input to determine if this is safe or not.

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Ross Smith