unraveling the brain-body back pain connection

Aug 5

Patient: "It hurts when I do this (moves arm) doc"

Doctor: "don't do that then"

It's the classic doctor-patient meme, a one-liner originally attributed to comedian Henny Youngman, but the more we learn, the more it seems to capture how a critical component of common and long-lasting aches and pains might go astray; the complex two way street of the nervous system and its many brain-body connections that produce human movement.

In the last 100 years our understanding of human movement has progressed by leaps and bounds. We have moved from the purely mechanical components - the levers and pulleys of muscles pulling on bones to move them at joints - to the contributions of living tissue and the many "little things" that help them to stay healthy, perform near their best and recover well enough to repeat the feat each next day for a lifetime. In the last 10 years another major contribution has come to light; the wider lens of the whole-person and how their unique interactions with their environment, including their perceptions, beliefs and previous experiences (context) impacts their movement, pain and recovery.

It sounds super complex and at some level it is but it's not uncommon. Say for example we over-do some weekend-warrior chores or have gotten to an age as an athlete where our mind thinks we still "can" but our body is less sure (so I'm told ) and we enter into the somewhat grey area of something that "hurts" but is not "harmed", that is, we experience some level of discomfort or pain, but no signs of injury so we try to ignore it, maybe with a little hitch in our movement patterns to minimize the irritation until things get back to normal. Not only is this a natural instinct, but it usually serves us well by giving the area a relative break and allowing it to calm down so we can get back to normal movement and life-as-usual.

But what if we've had this discomfort once or twice in the past and it was intense enough that it left us a little scared to go through it again? What if someone we cared about had something similar that turned out to be longer-lasting and it worried us? Could our unique context and history cause us to respond differently, maybe in a more exaggerated way? If so, could this have more pronounced effects on how we move and therefore (in an ironic twist) actually INCREASE our odds for future and worse episodes of the exact discomfort we're trying to avoid? If so, it would seem that deliberate efforts to restore normal movement patterns and the brain-body connections in the central nervous system that produce them, might actually improve things more fully than an isolated approach to reduce local discomfort. That is, when we retrain a body to move like it "should", we might also retrain the brain's expectations and baseline "settings"...and, so says some new research out of Australia, when it comes to chronic lower back pain, improve healing.

Specifically, the new approach focuses on helping people who suffer with chronic lower back pain (typically defined as lasting >90 days) to achieve 3 goals:

(1) to understand the latest and best information about the causes of chronic lower back pain (and debunk a bunch of outdated and disproven scary stories)

(2) reintegrate the way the brain and back communicate with each other

(3) gradually retrain the brain to reset its "pain radar" and the body to resume normal movement.

Of course, as a first-of-its-kind study, this is just the beginning of a conversation, but, based on everything we know about the impact of movement on health and quality of life, it makes total sense - the way we move plays a major role in how we experience the world. Maintaining, protecting, strengthening and occasionally restoring it when needed is critical to making sure it's a great experience.

If you've had back pain that has lasted for a while and maybe even has you moving differently than you think you should, feel free to reply back and we'll start a conversation to sort it out. Keep moving...well.

Have a great weekend,

Mike E.