Many people are familiar with the term "bulging disc" in regards to lower back pain. It can feel like an intense, sharp, stabbing sensation that can often travel down your leg through your hips and bum, sometimes as far as your feet.
This is a common diagnosis when you start to develop back pain. You get a scan which shows changes in the disc, and the pain matches the effected nerve area. It can be a scary diagnosis.
But you may be surprised to know that a lot of people who don't have pain have also been found to have changes in their discs. I find this study to be really encouraging, because it shows that people who have significant changes to their disc structure can still live a painfree life. It suggests that the disc changes may have already been there for some time before any painful symptoms even began, and gives hope that even if the structure doesn't change, that the pain can change.
Lets have a look at this interesting literature review, particularly in regards to the findings around disc degeneration, disc bulges and disc protrusions.
This is a literature review of 33 separate studies that investigated the imaging of spinal degeneration in painfree people ranging from their 20's to their 80's. It was published in the American Journal of Neuroradiology in 2014.
In total, the review takes into account MRI and CT scan imaging on 3110 individuals with no painful symptoms.
As you would likely predict, the number of findings increased with the participants age group, showing age-related degeneration occurs even in people who aren't experiencing pain.
Lets have a look at the imaging results for the disc degeneration, bulge and protrusion categories:
Disc degeneration - changes to the disc and surrounding vertebrae that result in loss of cushioning and support, may include signs of osteoarthritis at the joint.
Disc degeneration in painfree participants was identified in:
Disc bulge - changes that alter the shape of the disc and can make portions of it "bulge" out of place, which can apply pressure to nearby nerves.
Disc bulge in painfree participants was identified in:
Disc protrusion - changes to the annular membranes around the disc allows the disc nucleus to protrude and apply pressure to the nerves.
Disc protrusion in painfree participants was identified in:
What does this mean for your bulging disc?
It means that theres a good chance that your structural changes were already present before your back became painful. The area may be irritated or flared up right now, but these findings are a good indication that even if your scans don't change, your back pain still can settle down.
It means that a scan showing disc changes doesn't have to be a life sentence of pain.
Does this mean bulging discs DON'T cause pain, then?
Don't get me wrong, bulging discs can be painful, and for some people it can be severe. This study just helps to show us that theres more to back pain that what shows up on MRI or CT scans. Structural changes are just one layer in the complex onion that is back pain.
We can help!
There are lots of ways we can change your experience of back pain through massage and myotherapy techniques like dry needling, taping and support, strengthening the surrounding muscles with exercises that are appropriate for you, and supporting your understanding of how your back functions.
Book a time to come see us to talk about your back pain and creating a treatment plan to reduce it.
When you experience chronic pain, you just want to feel better. Unfortunately, there is no quick fix
for chronic pain – it can take time and effort. But there are lifestyle tweaks you can include in your
everyday life that can help with pain.
Some of these can alleviate pain, and some can help you to cope better with the pain. Since every
person is unique, some might work better for one person than another. So start with one, give it a
good go for a few weeks, and see how you go!
Try out meditation & mindfulness
Before you roll your eyes, hear me out! Meditation and mindfulness does not have to be sitting
cross-legged on the floor, chanting. It does not mean you need to ‘stop thinking’ or ‘clear your mind
of any thoughts ever’.
Meditation and mindfulness is more about being aware that your thoughts are just one part of you.
It allows you to tune into your body and senses, and most meditations use long, slow and deliberate breathing patterns. We know that taking time to focus on breathing and calming thoughts can help to slow down a really active nervous system. When it comes to meditations that are designed for
pain, they don’t stop pain, but they do help you to recognise where the pain is coming from and
what it might mean.
The research suggests that it’s worth giving meditation a go. A meta-analysis of 38 controlled trials found that meditation helps to reduce pain, improve symptoms of depression and increase the
overall quality of life.
Most apps and meditation websites have guided meditations for pain, anxiety, stress, or all of the
above. Our favourite nutritionist (who has a condition that can cause chronic pain) Sam is a big fan of the pain (#14) and stress (#31) meditations over at Meditation Oasis.
Introduce gentle movement
It can be tempting to avoid movement when you’re in pain. But gentle movement that doesn’t cause
severe discomfort or pain can be incredibly therapeutic.
The research shows that exercise can increase your pain tolerance and decrease your perception of
pain. It can relieve pain and improve quality of life in those who have chronic pain of some kind.
To start moving again:
Start slow. Begin with gentle movement, and work your way up over a period of weeks or months.
Use non-painful joints and muscles. Endorphins are systemic, so if your pain is in your back, moving
your arms or legs will still help to relieve that pain.
Get yourself a paced rehab program. Working with a practitioner is best for this, as we can monitor
your progress, adjust movements that are too painful or difficult, and cheer you on as you achieve
Seek social support
Feeling supported doesn’t just make you feel better mentally and emotionally – it can influence your
experience of pain. Countless research papers from the 1970s up until today have highlighted how
important it is for people with chronic pain to have social support.
The care of friends and family can make a big difference. Partners can play an important role in helping you to feel supported, too.
You don't even need to talk to people about your pain if you don't want to, but talking to people about anything can be helpful - even if its small talk about news, weather, music, films.
It can be tempting to push through and struggle, especially if you’re someone who doesn’t like to
bother or burden others. But asking for help or even just a chat with someone you trust can make all
Consider joining an interest group, like a coffee club, social group or walking group.
Spend time with pets
This is by far my favourite tip, as I’m a certified crazy cat lady! But it’s also backed by some science as
well. When you play with a pet, your body releases a hormone known as oxytocin. Oxytocin can
increase your pain threshold, drop your stress and anxiety levels and reduce inflammation. It can
also decrease blood pressure and heart rate by activating your ‘rest and digest’ mode.
The best part is that you don’t even have to own a pet – you can borrow a friend’s! And the benefits
go both ways. When you cuddle a furry friend, they also feel happier and healthier.
Work with practitioners who empower you
A good team can make a huge difference for someone who experiences chronic pain. It’s important to work with qualified practitioners who understand how complex pain is. But it’s also best to work with practitioners who want to give you the tools to recover from that pain.
We can’t ‘fix’ you, but we can empower you with the facts about pain, the latest research findings,
and the best quality care possible.
Want to work with a myotherapist/remedial massage therapist who fits that bill? Book in an
appointment with a Simple Wellness practitioner here.
You might be familiar with that sharp, shooting pain sensation in your lower back, hip and leg. It can also be felt as numbness, pins and needles, tingling or burning type of sensations. Whatever way the pain or symptoms present, it runs along the Sciatic nerve - which is why this is referred to as Sciatica.
But did you know theres more than one potential cause behind this pain?
Often this pain can be linked to muscle tension in the glutes and hips. The Sciatic nerve runs underneath the muscles of your glutes, and when it gets compressed there it can be a real pain in the bum - literally!
Because this nerve runs all the way down to your feet, the jolts of nerve pain can sometimes be felt anywhere from just localised in your buttocks and hip, to the back of your thigh, behind the knee, straight down your lower leg and even into the base of your foot.
The Sciatic nerve can be impacted at the root of the nerve near the spine, however this doesn't always mean there will be pain. Often this is called a Bulging Disc or Herniated Disc, but you might be surprised to learn that even though "Bulging Disc" sounds pretty awful, studies have shown that more than 50% of people over 40 with no pain symptoms at all can have a disc bulge show on scans.
Irritation or compression of the Sciatic nerve can be common after serious trauma to your leg or lower back. Things like car accidents, falls, and horse riding accidents are all common high impact incidents that can aggravate the nerve. If you've had an injury like this, its wise to seek treatment for it.
Do you have Sciatic nerve pain or nerve symptoms of numbness, tingling and pins and needles? Book an appointment with us to have an assessment and treatment. If we can resolve the issue, we'll create you a treatment plan that includes manual therapies and a take home exercise program.
More serious causes do exist, so if treatment of the muscles and joints is not relieving your pain, we'll refer you to see your GP to rule out any serious structural or pathological conditions.
Last week, I shared a bit about four interesting studies that look at pain. But I couldn’t stop at just four! So today, we’ll look at another four of the latest studies around how pain works, and what we can do about it.
Mindful people experience less pain
Some people just don’t seem to experience pain as much as others. One study has suggested that part of the reason why is mindfulness.
What is mindfulness? It’s being in the present moment, rather than the past or future. When you are mindful, you are an observer of your experience rather than reacting with emotions and judgements.
76 volunteers with varying levels of innate mindfulness took part. Their brains were scanned as they were exposed to painful heat of around 49 degrees Celcius (aka a typical Aussie summer day, right?)
The scans reveal that people who were more mindful did not activate an area of the brain called the posterior cingulate cortex as much as those who were less mindful. Those who reported high pain levels had a greater activation of the cortex.
The researchers concluded that mindful people are less caught up in the experience of pain.
You can’t change your in-born level of mindfulness, but there is other research that suggests that mindfulness practices can help with pain. This might explain why!
Being hungry shuts off perception of pain
Pain is a valuable experience for the human body. Without it, we would damage our bodies without realising the consequences! But chronic pain can lead to lethargy and exhaustion. So what if nature gave us a way to suppress chronic pain temporarily?
Turns out, nature might have done just that. Researchers have pinpointed a group of 300 brain cells that prioritise hunger over chronic pain. They found that hungry mice would respond to acute pain, but were less fussed about longer-term inflammatory pain compared to well-fed mice.
Further experiments revealed that the neurotransmitter NPY can block the inflammatory pain response when needed. This is a new area for more research, but it could reveal ways to inhibit chronic pain without shutting off acute pain.
'Tuning' the brain can alleviate pain
Previous research has found that alpha waves are associated with relief of pain from a placebo effect, and can influence how different parts of the brain process pain. So researchers looked into whether ‘tuning’ the brain to alpha waves can reduce pain.
The experiment involved flashing light or playing noise that were in the alpha range. Both of these interventions significantly reduced intensity of pain. The researchers are now looking into how effective these are for different pain conditions.
It’s early days. But soon, you could be watching YouTube videos or listening to meditations in the alpha range that are able to reduce your pain!
Does an exploding brain network cause chronic pain?
Hyperactive brain networks could be why people with fibromyalgia experience hypersensitivity. Their brain networks are primed to react with rapid and system-wide responses to minor in response to minor changes. This is known as explosive synchronisation.
The researchers looked at the electrical activity of women with fibromyalgia. There was a strong correlation between the hypersensitivity of the brain and the intensity of pain reported by the women.
This suggests that a chronic pain brain is electrically unstable and sensitive. So the next time someone asks you about your fibromyalgia, tell them it’s your exploding brain network!
In case you haven’t figured out, supporting people with chronic pain is my passion. If you’re looking to work with a health professional who will work with you on your journey to recovery, book a myotherapy appointment today.
It’s no secret that I’m a bit of a research geek. Scientists everywhere are exploring the experience of pain and how we can alleviate it. So I thought I’d share some of the most recent findings about pain.
Some of these you might be able to apply in your daily life. Some you might like to share with your healthcare providers. And some are just interesting to know!
Men and women remember pain differently
Scientists have theorised for years that chronic pain is related to memories of earlier pain. One team has found that men remembered a previous painful experience quite clearly. This made them hypersensitive when they were returned to the location of that experience. On the other hand, women were less stressed about their experience.
The same researchers did the same experiment on mice, and ‘blocked’ the memories of male mice. When they ran the experiment with the blocked mice, they did not show signs of being stressed by the previous pain.
The brain cells that make pain unpleasant
If you step on a sharp object, your nerve cells in the brain tell you two things – there’s a piercing sensation in your foot, and that it’s not a nice feeling. But a team of scientists have discovered the brain cells that tell you all about that not-so-nice feeling – these brain cells are responsible for the negative emotions of pain.
In an experiment with mice, they were able to identify a group of neurons in the basolateral area of the amygdala (often called the fear centre of the brain). When the mice experienced pain, these neurons would fire.
But when this bundle of neurons was turned off, the mice didn’t experience the discomfort of pain. They were still able to feel and respond to sensations, but pain was no longer unpleasant for them.
Pain as a self-fulfilling prophecy
Have you ever flinched at something that you expect to hurt? The latest research suggests that you probably will feel pain, even if it doesn’t cause pain. Say what?
If you expect pain, your brain will respond to that pain. Researchers scanned the brain of people who were exposed to low heat and high, painful heat. The participants were shown cues to suggest whether the heat was going to be low or high. When the heat was applied, they rated their pain.
But what they didn’t realise was that the cues didn’t always correlate to the heat they received. When they expected high heat, brain regions around threat and fear were activated while they waited. When the heat was applied, there was more activity in the pain regions of the brain – even if it was a low heat.
This may be part of why chronic pain lasts long after the damage to tissue has healed.
Genes associated with chronic back pain discovered
Chronic back pain is actually the number one cause of years lived with disability world-wide. So scientists are looking at all of the factors that might contribute to it. Recently, researchers have uncovered three gene variations that are associated with chronic back pain.
The study looked at the genes of 158,000 people, including 29,000 that had chronic back pain. Then they looked for the genes that popped up for those with chronic back pain.
One gene variant, SOX5, is involved with development of the body in the womb. If it’s turned off, it causes defects in cartilage and bone formation. A second gene that was already associated with disc herniation was linked to chronic back pain. The third was a gene that plays a role in the development of the spinal cord.
This might not cure your chronic back pain, but it does help researchers to pinpoint the structures and processes involved. In the meantime, make sure you get yourself booked for a myotherapy session!
There were so many interesting research papers that I have pt 2 coming up next week! If you don’t want to miss out, make sure you’re following my Facebook page. There, I share tips, info and insights into chronic pain management and myotherapy.
Mel is a Myotherapist based in Ferntree Gully.