My LBP experience (day one)

I remember the date my LBP began. It was the 20th of February, 2016. That date is significant to me because it was the day after my sister’s 30th birthday. Being a Saturday, she had organised a breakfast at a café, followed by some games (and cake!) in the park.

I woke up that morning like any other, and as I hopped out of bed, I noticed a tingling sensation along the outside part of my leg (shin), and slightly in the top of my foot. I figured I must have slept in a ‘funny’ position and casually ignored it. However, it soon become apparent that this wasn’t normal. Each time I put weight through my R leg, the neural sensation intensified (it almost felt like a strong charge of static electricity). At this stage I had no pain (or stiffness) in my back whatsoever.

I tried a few stretches and moving my foot/leg/thigh/pelvis and back around, but nothing seemed to help. I even massaged parts of my leg and performed a lower limb nerve ‘flossing’ technique. Still no difference. Working as a clinician, I was familiar with numbness and tingling, however, these cases were more uncommon in the lower limbs, and even more so without a history of LBP. Furthermore, these lower limb sensory phenomena were usually associated with more severe LBP cases (e.g. disc pathology). And even though I had seen plenty of examples where people had hurt their lower back with little to no trauma per se, in my mind I was convinced that the problem lay in my leg, rather than in my lower back. This was because: 1) I hadn’t had any LBP 2) The only symptoms I had were in my leg and foot and could be explained by a problem in the leg (common fibular nerve) and 3) The atypical presentation, in particular the fact that it was aggravated by weightbearing. (In hindsight I suspect it was also just wishful thinking!) Therefore, while I knew sensory changes weren’t ideal, in my mind I wasn’t too concerned. I had even briefly considered multiple sclerosis (I have a strong family history of this condition), however, I shook that off as again it seemed too mechanical and also because I hadn’t experienced any other symptoms, like fatigue.

So, I went to breakfast and afterwards we walked up the hill to find a suitable place to have a picnic and play some games. I remember noticing some soreness in my leg by this stage (deep ache in my calf and the back of my thigh). This is when I knew that the problem was almost certainly coming from my lower back. A short time later, some of the men and children decided to play cricket. I’m a pretty competitive person and I love playing sports too, so I wasn’t going to let a bit of discomfort stop me. However, after 25 minutes of running around and bending over to pick up the tennis ball (etc.), I knew I had aggravated it further. My lower back on the right-hand side began feeling uncomfortable, along with my entire right leg (ache). Not bad, but enough to know it was there. I still had the neural sensation too, although from memory at least it wasn’t as bad as before.

As my sister drove me home I started to think that my LBP must have had something to do with the week I’d had at work. While working as an osteopath isn’t the most physical job, when you’re treating back to back patients for long periods of the day, it can certainly take its toll. It had also been an especially hectic week as I’d just returned from two weeks off after having a tonsillectomy. It’s possible I was out of condition which contributed to this episode. However, at no point during the week had I noticed any LBP, or anything unusual for that matter. Weird.

By the time we got home the pain had increased in my lower back to the point where I could trace a distinct line of pain from my lower back all the way to my right foot. It was definitely difficult to get comfortable. And while I don’t remember everything that happened that afternoon, I can tell you what didn’t happen. I didn’t just choose to see this as a growth experience, and then get on with my life. Far from it! In truth, the rest of the day was filled with a mixture of frustration, stoicism, denial, fear, gentle stretching, and a healthy measure of watching movies while I ate yummy snacks and wallowed in self-pity! Was I in that much pain!? No! I would hazard a guess that it never went past 5/10 on the pain scale. I know I had it easy compared to a lot of the people I treat. Heck, I even knew it at the time! But just as painful as the physical pain (in my case) was the perceived threat of this injury (which usually doesn’t help the physical pain either!). It’s easy to look back and think oh I could have handled that so much better. However, you can’t spend your life looking in the rear-view mirror. Sure, if it happens again I will do things differently, but that’s because of the knowledge I’ve acquired since that day.

In my next blog post I’ll share the next chapter of this story.

Last time I said I’d share with you some websites I rate in terms of quality LBP information.

Anyway, here they are:

NHS Choices
https://www.nhs.uk/conditions/back-pain/
Excellent website. Government department so independent (+ evidence based). Lots of helpful info about LBP, including treatments.

Health Center for Low Back Pain – Move Forward by American Physical Therapy Association (APTA)
https://www.moveforwardpt.com/LowBackPain
Great site – has LOTS of links to useful resources.

Painscience.com
https://www.painscience.com/
I really like this site. The author is obviously a clever cookie and he places a heavy emphasis on ‘science based’ material. One of the few private websites I’d recommend (definitely independent). I bought his tutorial on LBP after my own troubles started (jam packed with info!).

Patient.info
https://patient.info/health/lower-back-pain
Wonderful explanation of LBP in layman’s terms. Also has a ‘practitioner’ page which is really good. Another solid site from the Brits – well done!

Australian Institute of Health and Wellbeing
https://www.aihw.gov.au/reports/arthritis-other-musculoskeletal-conditions/back-problems/what-are-back-problems
I guess this is kind of like the Australian Government’s version of the NHS Choices website, although less practical and with a heavier emphasis on statistics. Nice graphs!

National Institute of Neurological Disorders and Stroke (NIH) Low Back Pain Fact Sheet
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
Very detailed information sheet on LBP.

Better Health Channel
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back-pain
Another government site. Solid.

Beyond Mechanical Pain
http://beyondmechanicalpain.com/pain-blog-2/
I’ve put this one last only because it’s designed for health practitioners, not the general public. Its central theme is pain science which is 100% applicable to LBP. Probably going to be too heavy for someone without a background in the subject matter (jargon!), but if you’re really keen give the blog component a read. In the interest of full disclosure, I’m friends with the author of this site. But that doesn’t change the fact that Alison is one very smart person!

Enjoy!

Try some of this delicious snake oil…

Hey you! Yeah, YOU! For only $29.99 you can CURE YOUR LBP with these 3 simple exercises used by Tibetan monks for thousands of years! Also, if you sign up today, I’ll include an ancient blend of herbal tea also used by these monks to give themselves super-human strength (at only half price)! 😉

Okay, so most websites advertising ‘LBP cures’ or ‘#1 LBP exercises’ (and the like) don’t seem that over the top (at least compared to the example above). In actual fact they can be quite compelling, and I wouldn’t be at all surprised if they are successful in attracting a lot of customers. Besides, when you’re in pain, you’re surely more vulnerable to these too-good-to-be-true claims. Why is that? My guess is pain makes us more emotional, which by definition means we are less rational and therefore less capable of accurate decision making. Just as I suspect that these websites intentionally take full advantage of this, employing clever marketing strategies to exploit our human tendencies. If I’m honest, I’ve been sucked into an online purchase like this before (regretting it later). So, what have I learnt since then?

In general, beware of any website that tries to sell you something. It’s not that selling online is inherently bad, after all, people need to make a living somehow. You just need to ensure that the seller’s agenda doesn’t conflict with your own. This sounds simple enough, but it isn’t always the case. As a rule of thumb, the more objective (unbiased) a website is, the more trustworthy their information will be. Bias comes in all shapes and sizes, and while you can’t avoid it, it’s useful to at least try and identify it. That’s why whenever I visit a site I ask myself “How does this website make money?”. By following the money, you can usually get an idea of their motivations, and subsequently what their bias is likely to be (at least the obvious stuff). And while sometimes they may have a clear agenda, at other times the water is murkier. It might be that what they’re NOT telling you is more important (hidden agendas). I’ve encountered websites claiming to be independent when it was clear to me that they weren’t. Instead, they would have received commission for underhandedly promoting certain products or services (kind of like an ‘infomercial’ only more deceitful). Subtle is the art of deception!

Some more yellow flags (warning signs) of shonky websites!
If you come across websites which use phrases like ‘secret cure’ or ‘best kept secrets’ in their marketing…RUN! Ha ha. These are what I consider modern-day snake oil salesmen. They lure you in with this hyperbole and false promises, safe in the knowledge that you’ll have to hand over your money before you realise the truth. I would wager a bet that given the relative affordability of a lot of these purchases, most consumers are more likely to just write it off as an error of judgement, rather than asking for their money back. And I’d bet even more that these shonky websites count on this behaviour (again, taking advantage of our human tendencies)! Even if they do refund a portion of their customers, they still end up way out in front!

Other marketing phrases on a website that irk me include ‘scientifically proven’ or ‘backed by science’. It’s not that I’m against science (on the contrary, I LOVE it), however, in my experience any site that feels compelled to use phrases like that, probably doesn’t deserve to. Websites promoting material that is legitimately and substantially supported by evidence, shouldn’t feel the need to loudly proclaim ‘This is backed by science!’. Instead, they can let their products do the talking for themselves.

Finally, there is the issue of referencing. How do you know if the facts or figures quoted by a website are reliable (read: real/fake)? References, of course! No references, no further consideration! Unfortunately, these shonky website people have caught onto that and tend to either fake their references, or, (and I have seen this plenty of times) use references that are so terrible that they may as well be fake. Note: Blogs like this which are subjective (opinion based), don’t require referencing unless I’m using facts, information or data to support any of my arguments. 🙂

In my next blog post I’ll share with you some of the websites I’ve found useful when it comes to LBP.

Summary (simple, practical tips):
– There are no silver bullets when it comes to treating LBP (especially the chronic variety). Period.
– Beware of websites that use exaggerated or sensationalised claims in their marketing.
– Pain can impair our judgement by making us more emotional. This means we are less rational and therefore less likely to make the best decisions (I don’t have the science to back up these assertions but I think it’s pretty intuitive).
– Shonky websites employ clever marketing strategies to take advantage of our human tendencies.
– To help identify these websites, always question the motives of the website’s author. Ask yourself, “How do they make money?”.
– Beware of deceitful ‘informercial’ style websites that masquerade as being independent but are subtly promoting particular brands of products or services for revenue.
– Make sure that any arguments or assertions made on a website are backed up with REAL references (using reliable sources). Anything without references should be taken with a grain of salt!

Arrggh! So much confusion!

You might have already noticed how much conflicting information there is when it comes to LBP treatment. A quick google will reveal that seemingly no two websites say the same thing. Website A claims you have to do one type of exercise while Website B recommends something entirely different. Which one’s right? Maybe neither! This confusion can make it a bit of a lottery as to whether you end up on a site containing quality information or a bunch of pseudo-science. And while Mylowerbackpain.com is still being built, it’s important to me that you can still access some of the ‘good stuff’. Therefore, in my next blog post I’ll give you some pointers on how you can find quality (credible) websites to assist you with your LBP.