8 causes of LOW BACK PAIN that isn’t a weak core

Do you have low back pain, and you’ve been told that it’s from a weak core? Here are eight reasons why it may not be coming from your core.

One in four people experience low back pain in their lifetime, and it is also one of the number one causes of the opioid epidemic. Most people that are seeking pain medication are coming in initially for low back pain.

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One of the things that is important to recognize with acute low back pain is that it can be treated very easily. However, because of the nature of our medical system, we tend to go to our primary care, get a muscle relaxer and pain medication, and get referred potentially for an X-ray. The X-ray doesn’t show anything, but you still continue to have low back pain. Now you are referred for an MRI but still don’t show anything except for some degeneration, which everyone after the age of 35 is going to have. You still don’t have any answers, so you get an injection. Then three months after this acute low back pain episode, you’re still having pain. Now you are in a chronic pain state. 

Chronic pain is much different than acute pain. It is defined by having pain greater than three months and is referred to as central sensitization. Our nervous system becomes sensitized. We have no tissue damage, however, the brain is still interpreting that there is pain in, let’s say, for example, the low back.

Here are eight root causes of your low back pain, that isn’t simply a weak core. All these can also contribute to acute and/or chronic low back pain.

1) Poor Breathing

Our breath should be a diaphragmatic breath. We breathe 20 to 25,000 times a day. If we are not breathing from our diaphragm, then that means that the sequencing of our entire abdomen is affected. It also creates a stress response.  

2) Movement Compensations

When we think of how pain or injury ultimately happens, think it’s when anatomy meets opportunity. If you have an ankle sprain, let’s say three months ago, and although it’s getting better, there’s still some stiffness in the ankle. Now every time you are walking and striking the ground in dynamic movement, there is asymmetry. You have different forces that are being transferred up through your body.  That means that now you’re going to begin to compensate. You’ll change how my foot strikes the ground; how your pelvis is moving. This can be an example of how any movement-compensation, especially over a period of time, can ultimately lead to pain and or injury.

3) Stress

This can not be emphasized enough and how it’s one of the biggest factors in low back pain. Not only can we hold tension in our abdomen and our pelvic floor, but it also shifts our breathing to an upper chest breathing pattern. Additionally, stress is linked to inflammation. Without a doubt, I’ve seen in my clinical practice that this is one of the biggest driving factors of low back pain, especially chronic low back pain.

4) Poor Sleep

Inadequate or interrupted sleep is actually one of the biggest drivers of low back pain. Poor sleep also shuts down the release of our growth hormone, which is needed for repair and healing.

5) Chronic Inflammation

Ninety percent of all health conditions are linked to excessive or persistent inflammation; from eczema to anxiety, depression, and even Alzheimer’s. Now, when we think about inflammation as it relates to our musculoskeletal system or nervous system, inflammation will contribute to pain, joint stiffness, joint inflammation, osteoarthritis, and more. This can also consistent with chronic low back pain.

6) Sedentary Lifestyles

This can be one of the biggest drivers of recurring low back pain, per some of the research. We are meant to move; our bodies crave movement. We do not want to be in one position all day long. As you’re thinking about your day, think of it from a ‘movement mindset’. It doesn’t have to be exercising 30 to 60 minutes; you need to be moving all day long.

7) Poor Gut Health

Your gut is your second brain, and we have an entire nervous system located right there. If there are gut issues, that means there are inflammatory issues. Without a doubt, because we have 70 percent of our immune system in our gut, and we have this nervous system, when we are having visceral pain, this will influence the sequencing, timing, and coordination of all of our muscles and our abdomen and pelvis. It is definitely something that can contribute to low back pain, especially in the case of bloating and constipation. 

8) Lack of Movement Variability

As I mentioned earlier, our bodies crave movement. When we are in sustained postures all day long like sitting at a desk or crossing our legs in one direction, not changing positions consistently throughout the day, then our fascial tissue, our three-dimensional network, or ectoskeleton can get sticky. It is meant to be elastic, create tension, and transfer force efficiently. If we are sitting in sustained postures throughout the day and not changing positions, like getting down to the floor and getting back up, this can, unfortunately, contribute to low back pain.

There you have it; eight different root causes of why you might have low back pain. There are, of course, other things like pelvic pain and other medical conditions, but hopefully, you can appreciate that it is not necessarily because you have a weak core that you are having low back pain, and if you strengthen your core it’s going to get better. You want to look well beyond that. 

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Understanding Your Pain

We have all experienced pain in our lives. Perhaps it’s been acute pain where you roll your ankle, or it’s more chronic pain, something like low back pain that’s been around for months or even years. It could also be from surgery or some kind of procedure that you may have had done that could cause a considerable amount of pain. Therefore, it is important to understand pain—understand the pain in your own body, and what implications it has. Just for a quick statistic, 15 million U.S. adults suffer from some kind of chronic pain, and 80% of our global opioid supply is consumed in the U.S. There are 125 deaths per day due to opioids, which are most commonly prescribed for low back pain, which is why it’s such a powerful topic to talk about and understand implicitly.

What’s a common course of low back pain in America? You have an acute episode of low back pain, go to your medical doctor, and get some kind of prescription pain medication. The pain medication doesn’t work, so maybe you get a muscle relaxer, too. Now your primary care is going to refer you for an X-ray, and it shows nothing, or maybe some degeneration that everyone over 35 years old typically has. Then you’re referred to get an MRI, and it shows a herniated disc or some degeneration as well. Of course, that doesn’t give you any information either because imaging in most cases does not correlate to your symptoms. So, then you are referred for an injection. You get an injection that doesn’t really do much at all or lasts for a short period of time before your symptoms return, and you’re referred to physical therapy. The course of low back pain in America is problematic because this is what contributes to moving from acute pain to chronic, which we’ll discuss.

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Let’s start with the definition of pain. Pain is an unpleasant sensory and emotional experience associated with tissue damage or potential tissue damage. Essentially, pain is an alarm system. What it’s telling us is where the pain is, the amount of pain, the nature of the pain, and it is signaling to us, danger.

Now let’s talk about acute pain versus chronic pain. An example of acute pain is when you put your fingers on a hot stove. We have nociceptors, sensory receptors in the skin that will signal through the spinal cord to the different areas of the brain, to create a motor response or reaction. With somatic pain as described, we are signaling to the brain to pull back. Now we can also have visceral pain of the organs or the lining of the organs. Lastly, referred pain, which can be something like a heart attack referring pain to the left shoulder. All of these can be different forms of acute pain.

Chronic pain is much different. Chronic pain is defined as pain that you’ve had for three to six months or longer. With chronic pain, there is no tissue damage, however, your brain is sensitized and signaling that there’s still danger. This causes you to have a heightened sense of pain because your brain is still perceiving that this pain is happening even though the injury has healed. The key take home with this is that pain is not directly correlated to the amount of tissue damage. For example, someone that has had chronic pain for years would indicate that there is no tissue damage at that point, yet the pain can be very heightened. Conversely, someone with an acute tissue injury could have a very low level of pain.

Now that you know a little bit more about acute versus chronic pain and that it is not necessarily related to tissue damage, it’s important to know what you can do about it. It is not simply a matter of taking Advil or Tylenol, because we actually have our own natural painkillers. Endorphins, enkephalins, and serotonin are some of the best natural painkillers; better than NSAIDs.

Also, it is important to recognize that pain is not simply a sensory experience. It is always an emotional experience as well. It has been shown that if you are in a positive mental state, this can impact your ability to manage pain. So, what can you do about your pain?

1) Don’t Panic

Pain is information. Whether you’ve had it for a day or you’ve had it for three years, it is information that your nervous system is either on high alert, or you have some kind of potential tissue damage. Either way, you want to explore it with a gentle curiosity. You want to understand your alarm system because that is your nervous system that is giving you this powerful information to be able to do something about it. Recognizing that no matter how long you’ve had pain, you can continue to make improvements, and be able to be in a pain-free state. 

2) Improve your Movement

You should get evaluated to see what your movement patterns look like so you can limit compensations that are so common. The more that you compensate, you continue to alter your motor control, and the more you will have pain. When you have pain, you have more distorted motor control, so it ends up being this vicious cycle of pain.

3) Stress Management 

This is one of the key things that you want to think about as it relates to pain. Incorporating things like mindfulness, yoga, and meditation into your life to make sure that you are in a positive emotional state to be able to manage the pain. If you have pain, and it’s already heightened, and when you add stress on top of that your pain tolerance will decrease. So, your pain is actually higher. 

4) Graded Exercise

With all of the pain science research, one of the most important things is exercise, specifically, graded exercise. This means it has to be done at a very slow pace and returning to a comfortable state over time. For example, if you’ve had chronic low back pain for 10 years, then beginning a walking program starting at 45 minutes is way too much. Starting with 10 minutes is more appropriate and then every other day progressing to 12, 15, 20 minutes slowly and working your way up to a point that feels great for you. 

That’s just a quick taste of a little bit of pain science and how you can manage pain in your life. I hope this was helpful for you.

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