The Nervous System and Low Back Pain: How the nervous system can act like a faulty smoke alarm that goes off every time you light a match!
By osteopathic therapist Inka Weisell
Pam, an office worker in her early 50s, presented Inka with a three-year history of low back pain that radiated into her legs. Pam had previously been very active as a cyclist, and she owned and enjoyed riding horses.
Her problems began a few years ago when she changed jobs. She found that repetitive twisting movements at her desk started and then aggravated the low back pain. When she first came to see Inka, Pam had been limping for two years and was unable to bear weight on her left leg. She was taking strong medication to block the pain signals from the nerves in her back and legs, as well as common anti-inflammatories. She also received regular local anaesthetic and steroid injections into her low back.
Pam had tried various treatments ranging from physiotherapy and massage to acupuncture, but had not gotten results. Her condition only seemed to be worsening. It was clear this was not going to be an easy fix.
Through a series of specific muscle and reflex tests, Inka found two issues. First, Pam had a severe problem with her left sciatic nerve, which is a long nerve that runs from the lower back all the way into the foot. Second, what had started as a local problem in her lower back caused by repetitive movements had over time been transformed by her nervous system into a more widespread problem.
When pain persists beyond normal healing times, changes occur both in the local nerves in the affected area, and in the brain and spinal cord. The whole system becomes more wired to feel pain in that area; it is almost like a smoke alarm that goes off every time you light a match. Because of this, even light touch in the affected area can be painful, and the pain can persist even after the original injury has healed!
After doing the initial testing and diagnosis, Inka began her treatment by explaining pain to Pam so that she would understand exactly what was going on. Inka then moved on to hands-on osteopathic treatment focused on getting movement into Pam’s lower back and left leg without causing her pain. This was crucial because her problem was mainly driven by her nervous system, and any treatment that caused more pain in these areas would trigger the nervous system and only accentuate the problem.
Inka also looked at other areas of the body, to see if she could find other restrictions that put strain onto Pam’s low back.
From the start, Inka supported her hands-on treatment with a home exercise program. The program incorporated easy movements of the back but also started desensitizing the left sciatic nerve to give it more tolerance for movement and stretch. At first Pam found it difficult to be patient with the exercises because she had been very fit before the onset of this problem. But as she tried a gentle and non-painful approach to movement, and tracked the improvement, she found she was able to bear weight on her left leg again after only four sessions with Inka.
Next they worked on improving Pam’s movement skills. After two years of not walking normally there was a lot of work to do! They re-established a range of normal movements with squats, lunges, reaches, pushes and pulls. More specifically for Pam, they identified certain goals, such as getting back to cycling, and shoveling and brushing horses. They then came up with movement progressions that slowly worked towards those goals.
For example, for brushing horses, they had to be sure Pam was able to control the trunk and core of her body while it was being destabilized with arm movements. She started with very easy exercises where she could help her balance by holding on to the wall. She then gradually decreased the stability offered from the outside and saw her body be able to find that stability on the inside. With every session they could add more challenge to the program
After four months, Pam was able to start cycling again. She was cleaning up after the horses and brushing them. She was walking normally and was able to get through daily activities pain-free. Inka and she then incorporated some weight training into her program so she could build her strength. Pam is a great example of how recovery from severe long term problems is possible with a good strategy, the right motivation and effort.
