Low Back Pain: Myths vs. Facts | Sid Anandkumar | TEDxChilliwack

Low Back Pain: Myths vs. Facts | Sid Anandkumar | TEDxChilliwack

Translator: Parvathi Pappu
Reviewer: Rhonda Jacobs Alright. This Egyptian papyrus
describes a medical problem which has affected us
for more than 4,000 years. The odds are that the doctor
who wrote this was likely 90% accurate
in his treatment prescription. Astonishing, isn’t it? Welcome to the world of low back pain. My name is Sid,
and I’m a physical therapist. It’s no secret that we have had
great advancements in the field of health care since then. But there seems to be a problem. Since the late 1990s, the disability rates
associated with low back pain have been consistently increasing. Back pain continues to place a serious
financial strain in North America, exceeding hundred billion dollars. Canada is the second highest consumer
of prescription opioids in the world. Opioid abuse is now among
the leading causes of death. One in five British Columbians
live with back pain and chronic pain. So things have gone wrong somewhere. The truth is, back pain
has become a pain in the neck. It’s been mismanaged,
and it’s time to stop the madness. In other words, it’s time to reboot
our understanding of low back pain. Control-Alt-Delete. Separating the facts from fiction
will give us clarity in this path. This is a fact. Sooner or later, eight out of ten of us
would be affected by back pain. It is the fifth most common reason
for visiting a physician. So here is the good news, folks. If you suffer from
an acute episode of back pain, there’s a 90% chance that you
will recover from it with no treatment in about three to four months’ time. Only a small number of people
develop long-standing problems. So experiencing back pain
is like catching a cold or feeling tired or exhausted. You may not like it, but it occurs to most of us
at some point of time in our lives. This is a myth: The longer you stay in bed,
the worse your back pain becomes. Just like any other injury
such as a wrist sprain or an ankle sprain, avoiding the aggravating activity for
the first few days might help with pain. But there’s a large body of research which shows that returning
to your daily levels of activity – work, hobbies, pleasure –
is critical in aiding recovery. It’s crucial that the increase
in these activity levels are done in a graded
and gradual manner. Even though it may be
painful for your back, it is better than prolonged bed rest. Scans such as CTs, MRIs, X-Rays, not only have a poor correlation
with back pain, but also people without low back pain
have changes such as disc bulges, disc prolapses, disc herniations,
degenerative changes which do not cause any symptoms at all. In pain-free individuals,
about 50 to 66% have disc bulges, about 30% have disc herniations
and up to 90% have degenerative changes. So all these changes
which you see in your scans are something like your hair
becoming white or your skin wrinkling or your worst nightmare – going bald. So all these are normal aging changes which do not have to be
necessarily painful. Avoid becoming a victim
of medical imaging technology. The truth is that the majority
of back pain, almost 85% is nonspecific, where no specific cause of pathology
can be attributed to the pain experience. What it means is after
all these years of research, we can’t pinpoint the exact structure
which is causing the pain, and we can’t reliably tell
where the pain is coming from. Hence, scans need
to be interpreted with caution as the amount of changes seen in them
may not necessarily correlate with pain. Only a small population, a tiny minority,
less than 5%, require scans, where most signs
of a serious problem are present. So consult with your doctor
or your physical therapist and they would usually be able
to tell you if scans are required. Remember, more is not necessarily better. Discs do not slip. What happens is they herniate,
and even when they herniate it does not mean
that they slip out of a spine. Our spine is one of the most strongest
structures in the human body with muscles, ligaments,
bones supporting them. And, as mentioned before, disc herniations
can occur in pain-free individuals. And even if you have a disc herniation,
there’s a spontaneous regression, or resorption, in the majority,
up to 80% of us. What it means is that the herniated disc
shrinks on its own over time. It is the body healing itself. All you need is actually
a simple clinical exam to know if referral
to a surgeon is necessary. Most specialists agree that conservative treatment
is the first line of defense. Only 10% are good candidates for surgery, and out of that only 2%
are likely to benefit from surgery. Think about the time
you had a small cut or a bruise that you do not remember getting. You had tissue damage but no pain. Pain is interpreted
and processed in our brain, and it has the ability to reduce
the volume and the intensity of pain. Pain acts like an alarm system. Danger, danger, tring, tring. It tells us that something
is wrong with the body but it is not an accurate
indicator of tissue injury. And people with similar injuries
have varying levels of pain. And this is dependent on many factors like the context or the environment
in which the pain occurs, like having a small cut or a bruise
while playing hockey vs. slipping on a banana peel
and falling down, or previous pain experiences,
memories of pain, stress, anxiety, depression, fear, avoidance of activities,
helplessness, hopelessness, all of which can ramp up and increase
the signals sent to the brain, resulting in more pain regardless
of how much tissue damage there is. So it’s like a radio. When you increase the volume, it does not mean that the announcer
is speaking louder, you’re just amplifying the sound. Our body has more than
400 individual nerves, which when combined,
extend more than 45 miles. So there’s a tremendous amount
of information processing happening at a particular time. And when you have pain
for a longer period of time, the more sensitive
these nerves get at processing them. It is like learning to play
a musical instrument such as a piano. Initially you may struggle,
but with practice you get better. Practice makes perfect. And when you experience emotional pain,
the same areas in our brain are activated as when you would experience
physical pain. So one can feed
into the loop of the other, and they may be connected. And remember things
which fire together, wire together. How often have you noticed
that when you think of food, your mouth starts drooling or watering? There’s no food, but yet
there is a response from the body. It is a conditioned response,
and the same thing is possible with pain. So whenever you experience back pain,
and say if you feel stressed or anxious, the same areas of the brain
get good at activating or firing together, and it is possible to experience pain
without danger signals sent from the tissue. Thankfully, there are a number
of strategies to manage this, like education, knowing that hurt
may not equal harm; exercises, graded activities,
graded exposure; cognitive behavioral therapy; mindfulness. Our brain has the most powerful drug
cabinet of pain relieving chemicals, which is 24/7, prescription free,
and for us to make use of with exercises. Yes, exercise is medicine too. Motion is lotion for your spine. (Laughter) If you run for six miles,
our brain produces opioids which are equivalent
to 10 milligrams of morphine. So exercise is a powerful drug
but one which is most underutilized. Core exercises such as planks,
crunches, abdominal bracing, have gained widespread acceptance
in the fitness industry for preventing as well as treating pain. Small benefits are found
in a very tiny population, but the truth is,
no differences have been shown between core exercises
and other forms of exercise in acute as well as chronic low back pain. In fact, when you suck your belly in,
when you pretense your back muscles, you’re increasing
the compressive loads on the spine, and it is one of the potential mechanisms
which can lead to chronic pain. So I want all of you to try this. Can I have your wrist up like that? So imagine this is your spine. Can I have you bend it down? That looks easy. Now, make a tight fist
and try bending down. Do you notice it’s more stiffer? Well, the same thing happens
with the spine. All forms of exercises are good
with no major differences between them, like walking, jogging, cycling, swimming, or even other forms like yoga or Tai Chi. So consult with your physical therapist and choose an exercise
which is affordable, which is convenient, which is enjoyable, and something which you can adhere
over a period of time. I know this is information overload,
and I see some of you sleeping over here, so shake your body, okay? And sit upright
and listen carefully, okay? Bending, twisting and lifting
are not dangerous for your spine. There is no evidence of back pain
caused by your joints or bones being out of place. In fact, when you get your back
cracked or manipulated, you’re not putting anything back in place
as there was nothing out of place. But you may feel better,
and that is due to reduced nervous system sensitivity
and improved activity of muscles. Thanks for sitting upright,
but the so called perfect sitting posture may not exist. Different postures suit different people. Slouching gets a bad press, but there is no evidence
linking it to back pain. What is important
is our ability to vary our posture and move in a confident,
fluid and relaxed manner. There is no universal agreement
in the management of back pain. That’s why we have
so many passive interventions like acupuncture, injections,
massage, medications. They all have limited effectiveness
as a stand-alone treatment as they address only one factor
and not other issues like your sleep, diet, fitness levels
or even management of your stress levels. But there is a broad consensus
in approaching back pain and that is have your doctor
or physical therapist rule out serious causes for your back. Once that’s done, avoid bed rest and gradually return
to your daily activity levels. Back pain is complex,
and the management varies with each of us. If you have higher levels of disability, you may need to work
with multiple disciplines. But for the majority of us
with lower levels of disability, a large body of treatment is not needed, and following a simple activity
or an exercise program is sufficient. Our body is plastic and changes continuously
throughout our life called neuroplasticity. Hence by identifying
the contributing factors for pain and by addressing them,
pain can be changed, pain can be reduced, and people can lead a happy
and healthier life. Thank you. (Applause)

13 comments on “Low Back Pain: Myths vs. Facts | Sid Anandkumar | TEDxChilliwack

  1. Rebecca Bussiere Post author

    It was a physical therapist that altered my life course with chronic pain and spinal damage. I was sent to PT with the order to "Evaluate and treat" so my well intending PT proceeded to do a spinal adjustment on me when I was relaxed from massage. You got it, I had severe radiating pain down my right leg. I am apposed to manipulation of any kind. I went on to have an extruded disc and went on to have my first fusion. You got it , it was the beginning of a down hill future with my spine. Would this have happened anyway? Who knows, I just know my life changed after that day. I have had over 20 spine surgeries or treatments to my spine over 30 years and am left to get my best pain relief from opiate medication. So for me I know that no 2 spines are alike, and no 2 outcomes the same. as for this mess that is called the opiate crisis of America the chronic pain patient has been mixed in the numbers with illicit drug users and our lives destabilized by the CDC taking our opiate meds away. This is all I have to stay productive I am not an addict and don't get high from the use of opiates. All I know is I feel better and am productive with the use of these meds. There fortunate people that have been lucky enough to not have experienced severe pain. Some are very negative to the use of opiate medications. I say until you have walked in my shoes one has no right to judge what I need. Now.. Someone has to fix the mess that has been done to defensless patients who have been so terribly wronged. This now has ruined the lives of people some by suicide because they cannot live with pain. In the other side of the coin, health care providers practices have been ruined by raids and license lose trying to treat us.
    Remember ..Do no harm.
    My background: I am an Registered Nurse of 40 years injured in the job at the age of 33.
    Thank you for listening

  2. KB Adams Post author

    Disc can't slip but your vertbrae can move enough to touch a nerve? I can assure you if you get a ruptured disc that keeps you from walking and sleeping you would say oh I am in the 10% that needs surgery. Don't wish it on anyone but until you feel the pain that some of us have felt you will never know and can't even imagine and your whole speech here would make you sick everytime you watch it. I understand your speech and it sounds good to anyone who has never had to endure extreme sciatic pain. By the way crunches are one of the worst exercise for low back and depending on the injury yoga too.

  3. Anita Long Post author

    Let me do a TED TAlK! walk a week in my shoes…..try to run i dare ya. oh so damn sick of this. Opiate crises! what the heck. Inhumane treatment of legitimate humans in agonizing pain and we are being profiled and discriminated against!

  4. badmiyagi .s Post author

    Very articulate speaker. Nice simple explanation of backpain issues and treatments sans surgery. VOMIT the acronym for Victims of medical imaging technology seems fitting, lol!
    Motion is lotion for the spine. The Brain has the capacity to deliver enough pain reducing and eliminating signals etc. wonderful wholistic self healing techniques and answers to back pain. Statistics seem accurate too, for the number or percentage of the population suffering from issues related to back pain, soreness and other discomforts. He clears up the differences between Myths and reality. Heavy Indian accent could be good or not, depending on the listener. Enjoyed it!

  5. Barefoot Rehab Post author

    A very comprehensive explanation, Thank you.
    If you're struggling with pain that isn't going away and considering surgery, I highly recommend trying to find an adhesion doctor near where you live. Adhesion treatment often gives PERMANENT pain relief to those who have had more than 6 months of pain and have seen a few doctors.

  6. YD60 Post author

    The presentation and video editing make it a little confusing, so just to be clear: the statements shown in the green boxes on screen are the "myths" being challenged.


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