back pain

A new view of pain

“A new view of pain as a homeostatic emotion Bud Craig”.

Neuroscientist Bud Craig wrote this research paper 20 years ago.

I just discovered in last year and was blown away by the explanation of pain through the lens of homeostasis and interoception.

It links the body and brain in a plausible and scientific explanation that is based on Mr Craig’s decades of pain staking anatomical dissection and innovative tracing methods.

Currently as a society we are going through a epidemic of pain.

Our traditional models are not helping.

It could be argued they are making the problem worse due to iatrogenic harm.

Once you are caught in the biomedical matrix, it is very challenging to escape.

I found this paper to be a game changer as it helps us to use a m0re accurate explanation of pain that links body and brain in a way that is much more empowering.

Subsequently I have been reading more of Mr Craig’s work as well as his amazing book.

Making sense of pain is arguably the greatest therapy there is.

I have included the full PDF in the link below.

Some of the highlights from the research paper I have also outlined below.

As it is written for a scientific lens, if you reading this and would likely to comment or connect to find out more - just leave a message below or send me an email dan@kinfolkwellness.com.au

“Pain is both an aspect of interoception (the sense of the physiological condition of the body) and a specific behavioral motivation. This striking conceptual shift incorporates the multiple facets of pain into one concrete framework, and it provides sound explanations for pain as both a specific sensation and a variable emotional state”.

“Changes in the mechanical, thermal and chemical status of the tissues of the body – stimuli that can cause pain – are important first of all for the homeostatic maintenance of the body.”

“Pain normally originates from a physiological condition in the body that automatic (subconscious) homeostatic systems alone cannot rectify, and it comprises a sensation and a behavioral drive with reflexive autonomic adjustments.”

“The behavioral drive that we call pain usually matches the intensity of the sensory input but it can vary under different conditions, and can become intolerable or, alternatively, disappear, just as hunger or thirst.”

“The new view of pain as a homeostatic emotion arises directly from functional anatomical findings in cat and monkey, rather than from philosophical considerations.”

“These results have identified specialized central substrates that represent pain, temperature, itch, muscle ache, sensual touch and other bodily feelings as discrete sensations within a common pathway.”

“These data indicate that in humans pain is an emotion that reflects specific primary homeostatic afferent activity.”

“Activity that produces pain in humans ascends in this pathway because its primary role has been homeostasis for millions of years.”

“Humans experience increasing discomfort at temperatures below 24C, but cold does not normally produce pain until 15C, where HPC activity accelerates and, significantly, cooling-specific lamina I cell activity plateaus.”

“This physiological evidence confirms the anatomical finding that homeostasis, rather than the heuristic simplification ‘nociception’, is the fundamental role of the small-diameter afferent fiber and lamina I system and is the essential nature of pain.”

“These findings indicate that pain in humans is a homeostatic emotion reflecting an adverse condition in the body that requires a behavioral response.”

“The new findings provide specific substrates for each of these aspects within a common framework of homeostasis.”

“This new view differs fundamentally from the prior conventional view in several ways. It incorporates specific sensory channels for different kinds of pain and for pain of different tissue origins. It provides a fast (sharp) pain channel that can elicit fight-or-flight behavior and a slow (burning) pain channel that can engage long-term responses, sickness behavior and immune function”.

“This perspective suggests new directions for research that could have strong impact on clinical therapy. For example, other homeostatic variables, such as salt and water balance, could have direct impact on the integrated activity that underlies the motivation called ‘pain’, as in the mysterious fibromyalgia syndrome.”

“Understanding the mechanisms underlying the augmentation of activity in the polymodal nociceptive channel could be particularly fruitful for identifying new therapies for chronic pain.”

When Biomechanics DOESN'T Matter

Greg Lehman has been a pioneer in helping us to understand pain and biomechanics and finding out when they matter.

He is a advocate for “Movement Optimism” - an approach that helps you build confidence in your body and avoid the common trap (fueled by well meaning health care professionals) of getting stuck in sometimes irrelevant biomechanical narratives that create fear and entanglement in the body.

I would encourage you to watch at least the first five minutes as he pulls apart the most common things you might hear coming from your health care professionals mouth.

“What I often say is, it’s not the pain science or neuroscience that challenges these biomechanical ideas, it’s the biomechanics itself. And if you know the biomechanics well, you can really see the holes in the common arguments.”

I hope you enjoy this eye opening lecture at the San Diego Pain Summit (click on image below to watch on youtube).

Could Qi Gong help with chronic pain?

As a physiotherapist, I'm always on the lookout for holistic approaches to complement traditional pain management techniques.

Qi Gong, an ancient Chinese practice that combines movement, breathing, and meditation, has shown remarkable benefits for individuals experiencing pain.

Here, I'll discuss three key benefits of Qi Gong that can be particularly helpful for those seeking relief from chronic pain conditions such as Fibromyalgia.

1. Enhanced Circulation: The Foundation of Healing

One of the primary principles of Qi Gong is the promotion of Qi, or life energy, throughout the body. This concept, while rooted in traditional Chinese medicine, parallels the Western understanding of the importance of circulation for health and healing.

The Qi Gong Approach to Circulation

Qi Gong exercises are designed to gently stimulate and encourage the flow of blood and lymphatic fluids. This is crucial because good circulation is essential for delivering nutrients to tissues and removing waste products that can contribute to pain and inflammation.

How It Helps with Pain

By enhancing circulation, Qi Gong can help reduce muscle stiffness and promote healing in injured tissues.

For individuals with conditions like arthritis or peripheral neuropathy, improved blood flow can lead to a reduction in pain and a greater range of motion.

2. Breathing: The Rhythm of Relief

Breathing is at the heart of Qi Gong practice.

The slow, deep, and intentional breaths characteristic of Qi Gong can have a profound impact on pain perception.

The Qi Gong Approach to Breathing

Qi Gong breathing techniques emphasize diaphragmatic breathing, which encourages full oxygen exchange and activates the parasympathetic nervous system, often referred to as the "rest and digest" system.

How It Helps with Pain

This type of breathing can help reduce the 'fight or flight' response, which is often heightened in people with chronic pain.

By promoting relaxation and reducing stress, Qi Gong breathing can help alleviate muscle tension and pain.

Additionally, the increased oxygenation of the blood can improve energy levels and facilitate the body's natural healing processes.

3. Regulating the Nervous System: The Path to Balance

Chronic pain is often associated with dys-regulation of the nervous system.

Qi Gong's meditative movements and focused breathing can help restore balance to the nervous system.

The Qi Gong Approach to Nervous System Regulation

Qi Gong practices encourage mindfulness and present-moment awareness, which can help shift the body away from the stress response and towards a state of equilibrium.

How It Helps with Pain

Regular Qi Gong practice can help downregulate the sympathetic nervous system (responsible for the 'fight or flight' response) and upregulate the parasympathetic nervous system, leading to a calming effect on the body.

This shift can be particularly beneficial for people with pain conditions, as it can reduce the sensation of pain, improve sleep quality, and enhance overall well-being.

The Intersection of Qi Gong and Fibromyalgia Management

Understanding Fibromyalgia and Autonomic Dysfunction

Fibromyalgia (FM) is a complex chronic condition characterized by widespread pain, fatigue, and a host of other symptoms that collectively degrade the quality of life.

Recognized in the early 1990s, FM is often seen alongside conditions like chronic fatigue syndrome (CFS) and irritable bowel syndrome (IBS), leading to the concept of central sensitivity syndromes (CSSs).

The underlying mechanisms of FM involve central pain pathway sensitization, stress response system dysregulation, genetic factors, and psychological influences.

The autonomic nervous system (ANS), which regulates vital functions like blood pressure and heart rate, has been implicated in FM due to its dysfunction.

Studies suggest a predominance of sympathetic nervous system (SNS) activity and a reduction in parasympathetic nervous system (PNS) activity in FM, which may contribute to the condition's symptomatology.

For individuals with FM, regular Qi Gong practice has shown consistent improvements in pain, sleep, and mental and physical function, with benefits persisting for months after the practice.

The Research on Qi Gong and FM

Research indicates that the benefits of Qi Gong are related to the amount of practice, with those adhering to a regular routine experiencing more significant improvements.

Systematic reviews and meta-analyses of Qi Gong for FM have been cautious but generally positive, although they often call for more stratification in trials based on the amount of practice.

Qi Gong's Mechanisms of Action

Contemporary theories suggest that Qi Gong may work through neurochemical, neuroendocrine, and neuroplastic changes, as well as through mind-body regulation within a biopsychosocial model.

Specifically, Qi Gong may regulate the ANS, enhancing PNS activity and sympatho-vagal balance.

Qi Gong and Vagal Nerve Activity

The vagus nerve, a crucial component of the PNS, plays a significant role in maintaining homeostasis and regulating pain and inflammation.

Qi Gong is thought to increase PNS activity and thus could potentially benefit the core symptoms of FM by interacting with the dysfunctional system.

Studies on vagal nerve stimulation (VNS) have shown promising results in FM, suggesting that Qi Gong's effects may be partly due to its influence on vagal activity.

Future Directions and Clinical Implications

The potential of Qi Gong to improve parasympathetic activity and autonomic function in FM is an exciting area for future research.

Studies should aim to assess the therapeutic regimens of Qi Gong on symptoms and autonomic parameters, exploring the durability of these effects and their clinical significance.

Conclusion

As a physiotherapist, I find Qi Gong to be a valuable addition to a pain management program.

Its focus on circulation, breathing, and nervous system regulation can provide a multi-faceted approach to pain relief.

For those living with pain, Qi Gong offers a gentle, yet powerful way to take control of their health and find relief.

It's a practice that not only eases the physical aspects of pain but also nourishes the mental and emotional sides, offering a comprehensive path to healing.

Want to try it for yourself?

One of my favourite online Qi Gong instructors is Jeff Chand. He has some simple youtube videos and he teaches in a very relatable and light hearted manner.

Check out the link below:

What’s been your experience with Qi Gong? I’d love to hear from you in the comments below…

My Pain Story - Joletta Belton

This is a brilliant insight of Joletta’s story of how she developed chronic pain and the long journey she took to a place of healing.

Joletta shares her wisdom and of the insights she gained from a roller coaster ride that started when she twinged her hip at work as a firefighter.

Hearing about her journey gives us all hope that there are solutions out there, and sometimes a shift in perspective and learning from the updated science of pain can be life changing.

PDF Download—> Joletta Belton: Explaining the Meanings of Pain, My Story

To hear more from Joletta, One Thing asked 10 experts in pain medicine to share the one thing they want people challenged by pain to know about.

View Joletta Belton’s response:


5 Things Everyone With A Disc Issue Needs To Know

The story:

You’re at home and reach down to pick something up and feel a twinge.

Ouch!

But you don’t think much of it.

Until the next morning when you are unable to get out of bed because of severe pain and muscle spasms.

You’ve never felt anything quite like it - even sitting on the toilet is just about impossible.

You ring your doctor and they order an MRI - you somehow you manage to stumble into the radiology centre (lying down for the scan isn’t all that much fun).

The next day you get the results - and it shows a disc in your back has been injured.

You jump on Google and are suddenly confronted with all sorts of pictures showing discs pushing on nerves. Every website you read says that you may need surgery and you should be avoiding heavy lifting, bending and twisting.

Sound familiar?

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When you have been diagnosed with a disc issue, you have two problems to deal with:

  1. The physical side of the pain that can be overwhelming in the early stages and

  2. The mental side, that can be equally as bad. It can very hard to think clearly when your life comes to a complete halt..(who knew back pain could stop you in your tracks so suddenly and cruelly?!)

All sorts of things can go through your head when you are lying in bed, unable to move due to pain.

That you might develop chronic pain. That you might need surgery. That you can’t go through daily life with the same care-free attitude about how you move your body as before. That life as you know it is over and you will be living in fear of recurrence.

But there are some problems with the above scenario.

Some assumptions and beliefs that need some clarifying.

A lot of clarifying.

Be careful who you take your advice from.

There are a lot of unhelpful beliefs out there and you need to avoid catching a 'thought-virus’ that can derail your recovery and unknowingly put you on a path of ongoing pain and dysfunction.


When you have injured your back, it’s amazing how all of a sudden you start receiving all sorts of (unsolicited) advice from every Tom, Dick and Harry on the street.

Everyone has their approach that works for them.

But because there is so much conflicting advice, the uncertainly can make you feel even more confused and scaredwhat do I do? and who do I see to help?

Recently on a facebook post, a local Adelaide media identify asked, “How do I fix my disc?”

There were around 1,300 comments and I counted at least 50 different types of treatment.

The main thing to ask yourself when hearing advice is,

  • Are they using an evidence-based science approach?

If you stop and really think about this, unfortunately many well meaning people (including health care professionals) are simply giving out terribly outdated advice that creates a huge amount of unnecessary fear in people with disc issues.

This blog post is an attempt to clarify some unhelpful beliefs about disc related back pain.

There are 5 things everyone with a disc issue needs to know:

  • Scans are often misleading (most people have some disc bulging but have no pain)

  • Disc issues generally have a favourable outcome (and like a good wine improve with age)

  • The bigger the bulge, the better

  • Slumping might actually help you recover faster

  • Running is very beneficial for the disc

Essentially discs are one of the most stable and resilient structures in our body.

As always the following information is general and please use in conjunction with your trusted health care professional.

If you have any questions or concerns, please reach out to dan@kinfolkwellness.com.au

Let’s explore each of these statements a little more closely…

  1. Scans can be misleading…you can have a disc problem and not even know about it

It must be understood that in the normal pain-free population, there is a high prevalence of abnormal findings on MRI scans (see table below).

Brinjikji et al 2014

Brinjikji et al 2014

This systematic review by Brinjiki and colleagues in 2014 studied closely the MRI’s of asymptomatic people i.e. they had NO current back pain (or any history of back symptoms).

They found that all the people in the study showed some level of disc problems.

For example, 30% of all 20 year olds had a disc bulge and no pain.

This percentage increased with age, with over 60% of 50 year olds having a disc bulge, (and these are people who had no symptoms whatsoever).

This indicates that many of these features—particularly when found incidentally — should not be considered pathological and instead be regarded as normal age-related changes.

This makes it difficult sometimes to find what it truly driving the pain experience.

Many doctors and health care professionals (knowingly or unknowingly) contribute to a heightened pain state and increase risk of catastrophization by doing a poor job of communicating scan results.

Once a fear has been created, adrenaline can surge continually through the body, creating anxiety and fear of movement.

Having an experienced clinician explain your scan findings is an absolutely critical part of your recovery.

Evidence shows that rushing too quickly into an MRI imaging for a back strain results in a poorer prognosis, (with an increased chance of surgery).

After an injury or episode of pain, the body will heal (often over 2-3 month period).

But sometimes the pain can persist because the person feels frightened and intimidated by the diagnosis and there is subsequent ongoing protective muscle spasm (see below).

Some of the muscles that can tighten up after a disc injury and stay locked up, causing ongoing tightness and pain

Some of the muscles that can tighten up after a disc injury and stay locked up, causing ongoing tightness and pain

2. Disc issues generally improve as you age 

Although they can be extremely painful in the initial phase, the natural history of disc issues is favourable and the majority of disc prolapses resolve with time.

Many people assume because they have had a few bad episodes of back pain that they will continue to deteriorate over time. Some people even fear they will end up in a wheelchair.

If you have had these thoughts, I would like to tell you…after 25 years of studying/working as a Physiotherapist, I have never once seen someone’s back pain progress to the point of requiring a wheelchair to get around.

Interestingly, studies (such as above) have shown that as you age, the degree of degeneration in the discs increases when scanned, but that does not correlate with pain, disability or clinical symptoms, which tend to reduce with age.

After the age of 40, your discs actually start to stiffen up and become more stable.

This stability leads to less chance of the disc causing ongoing pain.

So the take home message is once you have had a disc issue you may always have changes on scans. They can be thought of as ‘wrinkles on the inside’ - a normal part of ageing and nothing at all to be concerned about.

3. The bigger the bulge, the better

Some studies indicate that about 85% of lumbar and 90% cervical acute disc herniation will get better in an average of 6 weeks, (but sometimes take up to 3 months for symptoms to settle).

In 2014, Chiu and colleagues conducted a systematic review to determine the probability of a spontaneous disc regression.

The aim of the systematic review was to investigate the probability of disc herniation regression and complete resolution.

The different types of disc issues and severity can be seen in the picture below.

The different types of disc herniations

The study showed the probability of a spontaneous regression was:

  • 96% for disc sequestrations

  • 70% for disc extrusions

  • 41% for focal protrusions

  • 13% for disc bulges

Essentially, the study offers some very encouraging statistics to tell us that the larger or more severe disc herniations often have a higher chance of spontaneous recovery.

Lumbar disc herniation can regress or disappear spontaneously without surgical intervention.

4. Slumping might actually be good for you

A study done by Pape (2018) showed slouched sitting can rehydrate the lumbar discs and essentially ease the pressure off the discs.

This study showed slumped postures can provide a valuable alternative to upright sitting and “may be recommended for recovering spinal height in the working environment following periods of loading”.

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A simple way to think about this is if you were to clench your fist as hard as you can for 60 seconds.

Pretty soon the muscles in your arm start to fatigue and eventually, if you held it for long enough, you’d start to feel some pain from the constant contraction.

Exactly the same thing can happen with the muscles in your spine.

After you’ve had an episode of back pain, you may start to worry about your back, and a well meaning health care professional has told you to “be really be careful with your posture and never slump!”.

Sometimes people can take this literally, always trying to sit up straight and never giving the muscles in the spine a chance to actually relax.

This can lead to the ongoing muscle tightness and tension that we mentioned earlier.

With back pain, there is no perfect position.

You don’t have to sit up straight forever - in fact doing this trying to protect your back may overload the muscles and give you more pain.

The people who don’t get pain and the ones who explore a wide variety of movement and change positions frequently. “You’re best posture is your next posture”.


5. Running significantly benefits the human intervertebral discs

A study recently that showed people who run have stronger and more resilient discs than those that don’t run.

The study showed that long distance runners and joggers had better hydration and glycosaminoglycan levels than non-athletic individuals.

“We expect that tissues will adapt to loads placed upon them,” says lead author Daniel Belavy (Burwood, Australia).

Just like your muscles and bones need stress to grow stronger, your discs also respond and adapt in the same way.

This is great news if you are a runner, as previously it was thought that the impact of running was potentially aggravating to the discs.

Now we know that runners have healthier discs, if you are considering getting back into running I would encourage you to work closely with a Physiotherapist who can help guide you back safely.

Interestingly this study showed a long distance runners using a walk / run pattern seemed to be the best for the disc, as opposed to just walking or always running fast.

This suggest that knowing your ‘easy’ running pace and sticking to it during your recovery phase may be an important part of keeping your spine healthy.

If you would like to find out your easy pace, based on your current fitness levels, please use our free online running calculator.

To be very clear…

Disc issues can be extremely painful and limiting in the first days/weeks and you need to take care of yourself by visiting a Physiotherapist who you know and trust.

Realistically, disc issues can take some time to fully settle down - sometimes up to 3 months.

Disc issues CAN be serious 1-2% of the time.

It will really only start to cause you grief if it starts to contact and compress the nerve root.

If it gets to this point, you may have pins and needles, numbness, weakness of the area supplied by the nerve that is affected.

Some of the signs you may need to consult with a doctor include:

  • constant numbness / pain in the leg

  • extreme constant pain and not able to get any sleep at all

  • bladder or bowel incontinence

But that leaves 98% of disc issues that can be well managed with a personalised Physiotherapy program.

Some people are more susceptible to disc problems than others.

Risk factors include:

  • obesity

  • lack of fitness

  • lack of regular exercise

  • cigarette smoking

  • history of anxiety or depression

How Physio can help

We are experts in treating people with disc pain and can help you in two main ways:

  • designing an exercise program designed to improve strength, flexibility and fitness

  • provide short-term relief with massage, spinal mobilisation or manual therapy to reduce pain and get you moving well again

If you would like to find out more information or start your healing journey right away, please use our easy online booking system to find a time that suits you.

Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association.  Dan has a special interest in treating lower back pain.  He has been working in private practice for 15 years. He is passionate about helping people to move better, feel better and get back to doing what they love.

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