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Back Pain and Butterfingers

back pain back pain advice movement preventing back pain Mar 18, 2021
reaching awkwardly under a bed

Here's an idea for understanding cause and effect in the chaotic world of back pain.

Imagine you're with someone in a space with obstacles. A gym, a shop or perhaps a house. Your companion is holding something, but they keep dropping it. Each time they drop it, it lands in different places: in the middle of the floor, up against a large object, underneath another, yet each time you kindly pick it up for them.

How would you pick it up?

Let's say the item gets dropped and picked up 10 times. Butterfingers, you would say. But let's watch more closely. Depending on where it lands, you might expect to move differently to get close to it and pick it up each time. 

But would you?

 

How people with back pain cope

We all know what people with back pain look like. Sometimes hunched over, often rigid with tension. How would you expect them to pick that object up? Perhaps they would slowly and gingerly lower themselves to kneeling, prop their torso up by leaning on their leg and then reach slowly and carefully for the object. There's perhaps some grunting, a grimace here and there, and even a roll of the eyes when the object gets dropped again.

 

Is there a better way?

Now imagine how a child would pick that object up. It would be done more quickly, with greater ease, and with fewer sound effects. When the object then gets dropped somewhere else, you would also expect them to move differently depending on where it had landed.

For starters, an injured person would probably turn to face the object straight on each time, but the child would be more willing to twist and turn to get to it quickly.

 

A choice of strategies

What are we seeing here?

Variety of movement.

The child can move whichever way they want to. Forwards, backwards, sideways and twisting. They can combine these, and angle their body as they do it without a problem. It means they can deal with all sorts of obstacles, absorbing impacts and surprises without much of a care.

In contrast, the back pain sufferer has been reduced to a much more limited set of movements. Like trying to communicate with half your vocabulary.

Why does this happen?

Back pain typically makes us brace our bodies so we move the injured area less, and reduce the chance of further irritation. We do this throughout our body to be fair, not just in our backs, but we seem to hold on to such habits much longer with back pain than we do with ankle injuries, for example.

The truth is that this is a perfectly sensible short-term strategy, so we shouldn't;t immediately discourage it. Keeping the injured area relatively free of stress and strain will help the healing process.

But long term, keep that area rigid is bad news. A reduced vocabulary of movements leads to stiffness, and a lack of movement variety leaves us poorly equipped to deal with obstacles and surprises. We've lost our strategies, and are reduced to just a few.

 

So can we predict back pain?

Back pain is a chaotic battlefield, but imagine we tested groups of people without back pain by using our butterfingers test.

If we saw some people pick up the object in 10 different ways, we might deduce that they have a broad variety of movements options, and they're able to deal with whatever life throws at them.

But compare them to other people who only move in 2 or 3 ways when they pick the object up, and you might start to think that this lack of variety in their movement strategies is going to leave them less well equipped to cope with life's unexpected challenges.

It's the wealth of different movement possibilities that enables people to cope better with the little wobbles, slips and fumbles that seem to cause many cases of back pain.

 

What to do?

Perhaps we should change the messaging surrounding back pain from what to avoid, what to brace, what to keep strong, and instead encourage variety and freedom of movement.

A better attitude to back pain will trigger better behaviours, and better behaviours will allow us to cope better.

It's not as easy as it sounds when someone needs immediate help with back pain - changes take time, in individuals and in populations. But this has got to be a better path to success when back pain affects us, and it also provides a framework for helping people prevent back pain.

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