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Defence Health HubManaging lower back pain
MAJ Raylene Grant, Commander of the Physical Performance Squadron, provides an introduction to the anatomy of the back.
Managing lower back pain
MAJ Raylene Grant, Commander of the Physical Performance Squadron, on managing lower back pain.
0:00
so I'll take so our takeaways for this part is just
0:07
around the importance of movement for Interval intervertebral discs the
0:13
importance of sleep and then also the importance of posture so as as humans we're we're designed to
0:22
move so if we are sitting in a seat all day this is really going to decrease the
0:29
strength of this wall at the back and this wall is not well protected because
0:37
we weren't designed to sit all day so if we are sitting all day and then get up
0:42
to do a more sort of heavy movement particularly a rotation movement the discs really don't like that so the key
0:49
takeaways discs are really strong but if we sit all day and then try to use them that's putting us at risk of injuring
0:57
these guys so if we can remain really fluid with our movement so it's good to stand it's good to sit it's good to bend
1:03
it's good to twist but if we're doing one of those activities for hour after hour after hour our backs don't really
1:11
like that so we really want to mix up that type of movement that we're doing
1:18
let's have a little bit of a talk about and we'll talk just really briefly about this part just so you're aware of
1:25
exactly all the different parts of our back and so there's no doubt you would have
1:34
heard about our spinal cord and our sciatic nerve which is a big nerve that
1:40
goes down the back part of our leg nerves Glide and slide so similarly
1:46
again it's really important that we do keep moving with our backs and if we do
1:52
have a nerve injury or sciatic type injury there's
1:58
um specific treatment and exercises that we do for these this is our electrical
2:04
network of the body and as you can see there's nerves that
2:10
exit at each level of the spine and then the last one that I wanted to
2:16
talk about is the muscular system so there's 70 different muscles that
2:25
makeup part of the back and all of which are really important
2:31
you may have been told by a physiotherapist osteopath chiropractor your treatment practitioner
2:38
um that you have you know a week back or a weak spine and for people managing low
2:44
back pain is probably incorrect in the way that most people with low back pain have hyperactivity and hyper
2:53
contraction of these muscles so treatment may be more around
2:59
balancing and retraining these muscles to work better so the key takeaway part for that is
3:06
that there's many muscles that work together to make the spine work really well and when we sustain a low back
3:14
injury some of these muscles switch off some of these muscles become hyperactive and there's a lot going on
3:22
so the key takeaway from this part of the session as I say it wasn't trying to
3:27
sort of diagnose exactly what was going on with your specific low back
3:32
but I want to just sort of help understand that the back is made up of
3:38
many different parts and when we have low back pain there's probably many
3:44
things that are going on the most important thing that we can do
3:49
is do what the body does best which is move and bend and I know you're thinking
3:55
oh man that's counter-intuitive that's the last thing that I want to do when my back is sore and I'll go on to the next
4:02
part of this presentation and we'll talk a little bit more about what we can do when we have a flare-up of our low back
4:10
pain and then at the end we'll talk a little bit more about persistent low back pain which is the area that I
4:18
specialize in just going to swap over to this
4:24
presentation now and
4:32
so the purpose of today is to empower you all with a little bit
4:37
of knowledge and education and with this the science shows us that by
4:43
understanding a little bit more about our backs it does actually decrease our symptoms and increase our function which
4:50
is definitely what we want if you take anything away from the
4:58
session this is the main one that I want us to take away is that um
5:06
oh sorry I'm just going to share the screen here apologies
5:13
right can you see that one okay
5:18
yes there's nothing good cool thank you apologies for that uh if you take anything away from this session
5:25
today I really want you to take away this one and just continue to sort of
5:30
repeat it in your head over and over again which is really powerful every single cell in your body is capable of
5:37
change until the day that you die and so you may have had low back pain
5:42
for a day a month a year 10 years and just think that oh well this is this is
5:48
my lot you know I'm stuck with this forever and if you can come back to that in that
5:55
every single cell is always renewing itself the femur bone over a period of
6:02
18 months will replace every cell of itself so there's no reason why your
6:08
back can't fix itself so I think I talked a little bit about my story in that I injured my back
6:17
thought it would come right and yeah since 2006 I haven't been I haven't had
6:22
low back pain and I'm just like man people need to know about this and if I
6:27
can help a couple of people along the way that will make me really happy and I really feel like I was in that sort of
6:34
mindset oh well this is just me forever you know my back this is you know like I can't fix it and
6:41
so I think as I say if you take anything away every single cell of your body is capable of change until the day that you
6:47
die so your current diagnosis doesn't Define you every day these cells are going to adapt and change
6:55
I've hurt my back what do I do so this part of the presentation talks about sort of the the flare wraps or our acute
7:03
low back pain you know when we're we're doing something and we hurt our back and
7:08
you know what what do we do so it wasn't that long ago when bed rest
7:14
was the way that we managed low back pain and now that we know now we know this is one of the worst things that we
7:20
can do when we enter our back so we have a flare up the best thing that we can do is keep moving and as we talked about
7:27
before the sometimes feel counter-intuitive and you're like man like that just doesn't make sense but see if you can get up see if you can
7:33
have a shower see if you can go to work if you can and you know modify your activities and that movement and just
7:41
keeping up without normal routine is really important in part of the managing
7:46
these flare-ups and when we do hurt our backs just taking paracetamol and ibuprofen or
7:54
anti-inflammatory medication really helps to keep us moving through that
7:59
initial part where there are those acute flare-ups and from what the study shows
8:06
taking stronger type of medication codeine and tramadol actually slows down our
8:12
recovery so we just really want to stick to those uh paracetamol and anti-inflammatories
8:18
these opioid-based medications release inflammatory markers so it just means
8:24
that you're going to be have more inflammation or you know more swelling than what is needed as you come through
8:30
that initial sort of flare up should I get a scan and yourself myself
8:36
particularly if you've had a sawback for a month a year five years you're like
8:41
man there's definitely something wrong here I definitely need a scan however there's a really poor
8:46
correlation of what we see on scans to what exactly is going on with your back
8:52
and there's no real consistency between what we see on the scans and what we see
8:58
in the clinic and when we talk about scans often often
9:03
it can be uh you know words that sound a little bit frightening and so if you
9:08
heard you know you have a disc herniation this could perhaps be frightening but it's actually a really
9:13
positive indicator of recovery the back is one of the strongest
9:19
structures in the body and it takes a lot to cause permanent injury to it if we fell off a roof for example it is
9:26
worth getting some scans because we want to know exactly what's going on there but if you caused your low back pain
9:34
lifting or twisting is quite unlikely that you've caused permanent injury there
9:39
Imaging is definitely not recommended in the first weeks uh first six weeks and
9:46
sometimes getting Imaging and seeing what's on the scan can have people to
9:52
have a lot longer recovery and this is why so this is a really large study of
9:58
people without low back pain that have gone to have a scan and if we look at for example in the 40-year age so 70 of
10:08
40 year olds are going to have disc degeneration and when you hear that you're like oh
10:14
man like I've got distant degeneration I definitely shouldn't be going to PT but
10:19
these are people with completely no pain in their backs so if
10:26
we're scanning everyone then you find out that you have disc degeneration it doesn't necessarily mean that that's
10:31
where the pain is coming from when we talk about different types of
10:37
treatment and what we should and shouldn't be doing so for those out there that have had injections into the
10:44
facet joint and maybe it's worked for you maybe it hasn't but one out of 22 respond positively to this and also for
10:53
what we would term as non-specific low back pain which is you know you've had
10:59
an injury and it probably should have come right but it's just sort of stuck around and um you know you've still got the low
11:05
back pain even though sort of time wise you'd think that it should or would be better by now surgery is no better than
11:13
Placebo for this non-specific low back pain if it's something more specific like
11:21
discs pressing on um nerves there is specific time for surgery but not just because oh well
11:28
I've tried everything else I'll try surgery so surgery is no better than Placebo for non-pacific low back pain
11:35
what do people want to know so this is a really good thing to take to your physio for example and because people when
11:42
they've hurt their backs you know we want to know what's going on and most
11:49
low back pain is caused by a strain and it's painful and we're going to have a
11:57
good prognosis you know we want to know exactly you know what's contributing to this what does the future look like for
12:04
us how we can manage the flare apps and what we can do to help ourselves so generally with pain as a physio myself
12:10
you know what can I do what can they do and what is their what does the future look like and I think that's quite nice
12:18
to know and understand and sort of demand I think in some ways as well
12:23
words matter so we talked before about what happens
12:29
when asymptomatic people go into have these MRIs and say hey look you've got
12:35
degenerative disc change this is actually normal age changes so if someone said to
12:44
you um you know you're back you've got normal age changes this that is a lot
12:49
more relieving than being told that you've got chronic degenerative changes we talk about this a little bit more as
12:56
we move through the session but words really matter when our brain is
13:02
subconsciously processing stuff and we want to send the brain calming words to
13:10
really calm the amygdala which is the amplifying part of the brain the brain
13:15
wants to protect us but when it goes into overprotective mode that's when we can get into quite an unhealthy
13:23
area of managing our low back pain so when we're talking about words regarding
13:28
our back we want to use normal age changes uh our bats need more strength
13:35
and control normal age changes everything's going to be okay you know there's pulling it's repairable harm and
13:41
these calming words are really really important so our brain doesn't uh
13:48
interpret it as more serious than what is is actually happening
13:54
most pain is linked to minor strains which are painful having back pain does
13:59
not mean that your back is damaged it means that it is sensitized
14:07
in terms of recurrence so 95 of the population at any time during our
14:13
lifetime will sustain a low back injury most of these come right there's an area of people that uh
14:20
they have sort of recurrent low back pain so they injure their back it gets right and then they'll injure it again
14:26
doing something and these are the things that cause recurrence so if you're in a job for example where there's awkward
14:33
postures and you're twisting and lifting such as being a mechanic under a car sitting for greater than five hours
14:41
increases the chance of having recurrent low back pain and if you've injured your
14:46
back more than two times before that's another reason for recurrence as well so
14:51
particularly for these people this that are in and out of having low back pain you know we definitely want to manage
14:57
these ones really well increasing spinal Mobility
15:02
so increasing spinal Mobility decreases low back pain which is really cool and
15:08
this one is Affliction and sitting so sitting down and then grabbing your ankles and leaning down and having a
15:15
four centimeter Improvement in this movement correlates to really good outcomes as you're coming through your
15:21
journey of low back pain rehabilitation what exercise is best
15:29
we were made to move exercise isn't anti-inflammatory and I know it does feel a little bit counter-intuitive when
15:34
we are sore exercise is what our backs need but what is the best exercise and a recent study
15:42
of 10 000 people compared yoga to Pilates to walking to going to the gym
15:49
and found that there was no Superior exercise program compared to another so
15:56
the real takeaway for this is just find something that you really love doing if you love walking and it fits into your
16:03
routine really well good do that if you find that yoga really helps your
16:10
mindfulness and also that spinal Mobility good do that if you enjoy doing Pilates good do that so there's no
16:17
magical or Superior type of exercise I guess in my individual uh journey of
16:24
low back pain yoga worked really effectively for me because my back had stiffened up so much over that 15 years
16:31
that I couldn't even tie my shoelaces so you know sort of mid-20s and unable to bend down to tie your shoelaces there's
16:37
a bit of a concern and so for me getting into yoga and teaching my body to move
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and it's pretty scary you know when your back has stiffened up so much that you know you're scared to bend over or it's
16:51
stiff and it's sore so you just don't but as I say so just find a type of
16:57
exercise which resonates for you and which you can fit into your routine is going to be really important
17:06
this is based on that sort of exercise stuff so photo rats had less nerve injury when clinically induced low back
17:14
pain was induced into them right to exercise straight after injury improved
17:19
quicker and also had faster recovery and in their nerve injury
17:27
this is an interesting one in that you know sometimes we think that if we rest it
17:34
will come right but you will see on this graph that's sitting on the couch and
17:42
doing Ultra marathons is a sort of a higher predictor of spine
17:51
degeneration than just being in the middle so if we sit on the couch it's not good for you know we get more
17:58
degeneration in the spine and this isn't necessarily correlated with pain
18:04
but we want to be somewhere in the middle of doing nothing and doing Ultra marathons every day in terms of um
18:11
looking after our spine you don't stop brushing your hair when it goes gray so why would you stop
18:17
exercising when your body goes gray as it goes through it's it's own aging type
18:22
process the body is an amazing self-modifying self-healing machine if we cut ourselves
18:30
the body fixes it if we load it with weights or walking or stretches or running it will change and adapt and
18:37
don't carry that diagnosis with you forever even though you may have had back pain for a day a month a year 10
18:43
years because every cell has the ability to change depending on what we're throwing at our body
18:51
and if we can get up to exercising regularly you know at least three times a week we're going to get adaptations in
18:59
the back in the muscles in the joints and it's going to take at least six weeks you know sticking with this
19:05
training program until we see actual long-term benefits
19:13
when we start exercising it just feels horrible particularly if our backs are really really stiff but if we can just
19:19
compare it to coming out of a cast and yeah things are a little bit stiff and
19:24
sore so it doesn't mean that you're doing damage to it it just means that everything has stiffened up and we just
19:29
want to do our return to exercise in a really gradual and build up type of way
19:37
and you know this is a normal adaptation so definitely stick with it
19:42
we're creatures of habits and routine so if we can get into a routine or you know work with a physio osteocyra you know
19:49
work with a coach to really help us through you know this part of our Rehabilitation is going to be really key
19:56
and when we're in a routine of regular Fitness and training you know generally
20:01
our sleeping is a lot better and our eating is a lot better so even though you know our backs are sore if we can
20:08
start leading off with some regular exercise that's going to be really key
20:13
and you might be thinking oh man like I am doing exercise and you know I'm my
20:19
back is still sore so let's have a little bit more of a talk about that in a couple of slides to come
20:27
painful backs have become dis coordinated and you may have been told that you've got a weak core and it's
20:32
probably not because people with low back pain will often have increased muscle contraction hyperactivity
20:38
co-contraction and the ability to inability to relax so we definitely want
20:43
some help to retrain the coordination for this part
20:48
what treatment do I need so if your back is really really hyper flexible I.E you
20:55
know you can bend over and get your hands onto the ground your joints probably move really really well and
21:02
you're very flexible and a training program to provide strength and
21:10
coordination is going to be really important for these people I fit in to that middle sort of category so if your
21:16
back is really stiff and treatment and stretching is going to be effective so for these people
21:23
Hands-On treatment will be effective but for the people that are really hyper
21:28
flexible you know you don't necessarily need that Hands-On treatment it's just going to be really strengthening up and
21:35
making sure you're back super strong and looked after through the air
21:40
and then if your back has become discordinated muscle retraining will be
21:46
effective so you know working with your health professional to work out how to
21:51
recoordinate those muscles after it's sort of tried to take over and fix itself and got a little bit confused in
21:58
the process there are so many muscles that control the low back and often muscles will
22:04
switch off to try to protect the injury area so as part of our um you know regaining becoming the boss
22:11
again we definitely want to get everything working in unison again
22:17
and I think this is the most important part and I was talking to one of the ladies the other day and she's like oh
22:23
look you know I've had low back pain for a long time like I'm still doing unit PT so every time she hears a flare up or
22:29
the back saw you know she doesn't feel like she wants to let the team down but you wouldn't do that if you had Achilles
22:35
tendinopathy for example you know you would go through you know managing the information then regaining full range of
22:42
motion then regaining strength and then return to functional movements so just remember to treat your back like any
22:50
normal sort of injury and go through these phases rather than jumping straight to regain functional movements
22:56
you know without actually getting on top of that swelling first or getting on top of your you know making sure that it's
23:03
back to full strength and full range this is the area that is my real
23:10
interest and I specialize in and hopefully from with anyone that is managing persistent low back pain
23:16
hopefully a couple of these takeaway messages are really going to resonate with you guys
23:22
so for those of us out there that have had low back pain for more than three months our neural wiring has changed and
23:33
our brains have become overprotective overactive and hypersensitive
23:41
and I know many of you are like no I've got a really strong pain threshold which I'm sure that you do but as our wiring
23:49
changes and our brain tries to protect us it really changes the way that we are
23:55
wired it wasn't so long ago that we thought pain was just a physical component so
24:01
something related to a rupture break or tear but pain is
24:08
a has a physical component a mental component and also a social component as
24:15
well it's a protective mechanism but rewiring can mean that pain is often created by
24:23
quite a lower stimulus when our neural pathways are rewired and this pain that
24:30
we're feeling is actually a long way off tissue damage and that's a real key one as well that our brain is trying to
24:38
protect us but that threshold between actual damage and when we're feeling the pain
24:44
is there's quite a big difference when when we're hypersensitized
24:54
pain processing and I think this one's really interesting as well in that if we were a meat suit then you know we would
25:01
have pain if there was a rupture break in tier but this is how we process pain
25:06
so if we stand on a drawing pin for example or if we have low back pain maybe we bend down to pick up a pin and
25:14
you know we get low back pain so the there's an Impulse that goes up to the
25:19
brain they pretty much have a board meeting about what type of stimulus they're going to send down so they talk
25:25
to the part of the brain that manages sort of previous experience in this area
25:31
it talks to how we're feeling are we stressed and everything is taken into
25:36
account until it sends down what it perceives as uh an acceptable or a
25:42
suitable pain impulse and so similarly you know you guys are be out there going
25:47
oh man you know I've got a pretty strong pretty high pain threshold this is
25:52
what's happening every time you your back is deciding how much pain it should be and it goes to a board meeting and
25:58
everyone's contributing to it it's not just a meat suit and it's not just about you it's about everything that you've
26:04
experienced up to here the pain you feel is completely unique
26:09
to you it's an experience based on what is going on with your body what's going on stress grief bereavement and also the
26:18
social environment what sort of information you have access to whether you're sort of searching on Google or
26:25
social media or you know whether you're working with someone who specializes in this area and can give you some really
26:31
accurate information as to what to do and not what not to do pain is an opinion it doesn't always
26:38
reflect reality and your brain decides when you need to be predicted and when you don't so for example
26:45
you've got a sprained ankle but you can still run away from a beer so your brain is always making judgment calls
26:52
it is a good thing it's a protection measure it's stored as a memory and so things that we've probably done before
26:57
we know not to do again so trying to stick our tongue in a Coke can walking on glass
27:03
um sticking your finger in caged animals we have this protection measure in our
27:09
brain that's going to protect us from harm but when we have for example low back
27:17
pain four more than three months there is an element of rewiring that has
27:23
happened to protect us and you know this can sound scary but I think the most the
27:29
coolest part about this is that the brain and nerves can be reprogrammed rewired and completely reversed which is
27:36
really cool for us we don't have to be in low back pain forever pain is a very subjective experience if
27:43
we tell the brain it's bad it sends down relevant pain messages if we tell the
27:49
brain it's okay then it's okay and interesting enough I was working with the youth development unit a few years
27:55
ago and for a lot of these students I'd never done PT before so having delayed
28:02
onset muscle soreness the day after doing a PT session was really frightening for them you know that come
28:08
to Physio and say look you know I'm sore here and here and here and here and here
28:13
and here and they're just like I'm sore all over like this is this is scary compared to an athlete who is
28:20
experiencing the same sort of delayed onset muscle soreness but it's got a completely different understanding of it
28:26
and yeah I'm sore because I know that there's micro tearing of you know the different cells of the muscles so it's
28:32
going to make me adapt and be stronger and we can take this same sort of concept for our backs which I think is
28:39
really cool so if we can reinterpret the pain as a harmless sensation so as we talked about
28:45
before often with a hypersensitized neural system you know
28:52
will get pain well before there's actual damage to the tissue so if we can
28:58
interpret you know bending down to pick up a pen as you know as a harmless
29:04
sensation so he might feel warmth or stiffness or discomfort uh and that can
29:09
override these higher control control centers and stop Out Among the freaking out which is the amplifier
29:16
whereas if we say you know I've got this stabbing pain in my back
29:22
um or like a knife-like pain in my back you know that's scary for the brain to interpret and and this is all done
29:30
subconsciously as well and you're like oh I'm not saying that you know it's a I'm having the stabbing pain but
29:36
subconsciously this is all going on the background and so if we can use these real calming words it's going to be our
29:43
first step in becoming the boss again so if we start getting back into our PT
29:49
and as we talked about we want to do it in a gradual sort of way and you know we've already saw afterwards you know we
29:55
can sort of really reinterpret I can feel my ligaments stretching you know from my stretch day I can really feel
30:00
the the blood bringing all those healing products to the area you know I'm I feel a bit of heat in my back and really need
30:06
to cool it down it's you know been feeling quite warm with the movements that I've been doing today and all you
30:12
know the sensations in my back today are strong because of instead of using words like uh you know it's a buy slight
30:19
knife-like stabbing you know type pain and if we can completely take pain out
30:27
of our vocab as well we're going to be really empowered from that so coming to our last page here and the
30:36
key takeaways that hopefully have resonated for some of you today is that
30:42
we every cell in our body is capable of change until the day that we diet and we
30:47
don't have to be in we don't have to have low back pain forever
30:54
um we can get treatment from a health professional you know potentially our physios at the camps and bases and if
31:02
we're you know if there's stiffness in our back we get treated for stiffness if we're really hyper mobile we need a good
31:08
stability program or if our back isn't working well and bending forward backwards side to side you know we can
31:14
do some motor retraining for that when we're returning back to exercise which is really important because our
31:22
exercise acts like in anti-inflammatory and can bring all those feel-good
31:28
hormones which we definitely need to as we're recovering from our low back pain and treat it like you would any other
31:34
injury so make sure that you go through those specific phases of recovery and
31:39
don't jump right to the last part as if um you know it's any different from any
31:44
other body part and the last one yeah I really challenge you to try some of
31:50
those disempowering of the amygdala exercises so see if you can you know even try to
31:57
take pain out of your vocab all together and start using more calming words like
32:02
heat or stiffness or warmth and although
32:08
you may think Ah that's a that's a simple one that's a silly one it really
32:13
is hugely empowering and if you're interested in knowing more there's a really good site called
32:20
curable which mainly more focuses on chronic low back pain which the area
32:28
that I guess sort of I specialize in is more that sort of persistent low back pain because it's like has an element of
32:35
you know you're going to have it forever but it talks about really good other Empower empowering
32:42
exercises for overcoming low back pain such as meditations and such as Journal
32:47
writing and different exercises like this so my advice to you
32:53
um yeah you know like you don't have to put up with this you know book in with your Physio and your camping base and
32:59
come up with a plan and you know have a coach to help work you through and if you're looking for some more sort of
33:05
exercises to help as well yeah check out this site called called curable and they
33:10
have some really really excellent resources as well it was really nice to talk to you today and I wish you all the
33:18
best in managing your low back pain and hope that some of these exercises will help you
33:30
just got a couple of questions in here um what were the signs of a
33:35
discordinated back be so that's a really good question and I
33:40
would answer that one so for example in our if we bent down to pick up a pin for
33:47
example you know our back should have a nice curve in it in that each joint
33:52
should have sort of between 8 and 12 degrees of movement in it and that if we
33:59
weren't moving well or you know if we had to sort of get you know twist around a couple of Corners to go down it just
34:07
means that the joints aren't moving well and the muscles aren't moving well and
34:12
so hopefully that answers that one would you have a specific website to
34:18
recommend for a training program to strengthen the lower back I suffered a disc bulge in 2012 and every once in a
34:25
while it reminds me that it is still there 10 days of taking it easy to get
34:31
back into life again I personally think that
34:39
seeing a medical professional to to you know to work out exactly you know whether it's sort of Mobility that you
34:46
need or specific sort of strengthening that you need I think will be more beneficial rather than just sort of
34:53
grabbing a program off um off the website
35:00
so would I have a specific website yeah I really like that curable site for
35:07
um you know different exercises to help our backs and yeah I think that is worth
35:15
seeing a health professional for specific strengthening and feedback exactly what
35:22
your um back is doing and then Anonymous says thank you this has been so
35:28
interesting as a sufferer of back pain for 10 years yep I'm um yeah shout out
35:34
shout out it's hugely emotionally effective so thank you for that Anonymous and then another one thanks
35:42
for the presentation any tips for lower back pain that flares up at bedtime and causes difficulty getting to sleep have
35:48
never been sure if it's worth getting up and stretching it out moving around or
35:54
whether there's another strategy that's a really good point that we haven't really talked about and that's
35:59
interesting potentially if you're back is not sore during the day and then is
36:04
sore at night and I would probably look at your mattress and people with sore
36:11
backs you know really like a harder mattress so whether it's something that you need to put down on your side and
36:18
you know particularly if it's sore or rolling at night there might still be an element of you know sort of information
36:24
there so yeah I again recommend seeing
36:29
someone about it and um yeah particularly looking at
36:36
exactly what it is you know why it would be sore when you
36:41
lie down if it's not sort of sort of during the day
36:48
thank you and that's all the questions yeah I've got one last question from me
36:54
what would be some good um signs to look out for for significant uh damaging pain versus just like
37:01
irregular ache or something that can be moved through yeah that's a really good question thank
37:07
you for asking that so what we would call our red flags is it you know as we
37:14
talked about low back pain is often related to a strain and it's sore and you know
37:20
there's certain things that we can do but things that I would definitely go to
37:25
your doctor about to be seen particularly that night pain is
37:31
generally an indicator that there is inflammation there and as our body rests
37:36
and regenerates overnight our backs shouldn't be sore during that
37:41
time so for what would cause sort of unremitting night pain that are definitely sort of get that scene uh
37:48
weight loss if your experience you know if you have lost you know like a change
37:54
in weight more than 5 kgs over a six month period and definitely get that
38:01
scene too uh and then yeah I guess sort of mainly in and around those
38:06
inflammatory yeah sort of night pain or a lot of really really noticeable stiffness uh you know with getting that
38:14
scene as well does that answer your question yes that's a good answer thank you very
38:19
much
38:27
cool thank you oh well if there's no other questions that concludes our presentation today and I'll stick around
38:32
for the next five or ten minutes if anyone wanted to ask anything else
38:38
thanks again
38:46
awesome thank you very much for that presentation really thank you cool I think we'll end that there and
38:52
then I'll get the recording up online half the recording yeah
38:58
um I had another question from someone in the chat would the slides that you're presenting I'll be able to be posted alongside the recording yeah no worries
39:06
it was cool um yeah I'll contact you to see if I can get those
39:11
easy cool thank you very much oh sorry I missed a couple of um
39:18
cool thank you
so I'll take so our takeaways for this part is just
0:07
around the importance of movement for Interval intervertebral discs the
0:13
importance of sleep and then also the importance of posture so as as humans we're we're designed to
0:22
move so if we are sitting in a seat all day this is really going to decrease the
0:29
strength of this wall at the back and this wall is not well protected because
0:37
we weren't designed to sit all day so if we are sitting all day and then get up
0:42
to do a more sort of heavy movement particularly a rotation movement the discs really don't like that so the key
0:49
takeaways discs are really strong but if we sit all day and then try to use them that's putting us at risk of injuring
0:57
these guys so if we can remain really fluid with our movement so it's good to stand it's good to sit it's good to bend
1:03
it's good to twist but if we're doing one of those activities for hour after hour after hour our backs don't really
1:11
like that so we really want to mix up that type of movement that we're doing
1:18
let's have a little bit of a talk about and we'll talk just really briefly about this part just so you're aware of
1:25
exactly all the different parts of our back and so there's no doubt you would have
1:34
heard about our spinal cord and our sciatic nerve which is a big nerve that
1:40
goes down the back part of our leg nerves Glide and slide so similarly
1:46
again it's really important that we do keep moving with our backs and if we do
1:52
have a nerve injury or sciatic type injury there's
1:58
um specific treatment and exercises that we do for these this is our electrical
2:04
network of the body and as you can see there's nerves that
2:10
exit at each level of the spine and then the last one that I wanted to
2:16
talk about is the muscular system so there's 70 different muscles that
2:25
makeup part of the back and all of which are really important
2:31
you may have been told by a physiotherapist osteopath chiropractor your treatment practitioner
2:38
um that you have you know a week back or a weak spine and for people managing low
2:44
back pain is probably incorrect in the way that most people with low back pain have hyperactivity and hyper
2:53
contraction of these muscles so treatment may be more around
2:59
balancing and retraining these muscles to work better so the key takeaway part for that is
3:06
that there's many muscles that work together to make the spine work really well and when we sustain a low back
3:14
injury some of these muscles switch off some of these muscles become hyperactive and there's a lot going on
3:22
so the key takeaway from this part of the session as I say it wasn't trying to
3:27
sort of diagnose exactly what was going on with your specific low back
3:32
but I want to just sort of help understand that the back is made up of
3:38
many different parts and when we have low back pain there's probably many
3:44
things that are going on the most important thing that we can do
3:49
is do what the body does best which is move and bend and I know you're thinking
3:55
oh man that's counter-intuitive that's the last thing that I want to do when my back is sore and I'll go on to the next
4:02
part of this presentation and we'll talk a little bit more about what we can do when we have a flare-up of our low back
4:10
pain and then at the end we'll talk a little bit more about persistent low back pain which is the area that I
4:18
specialize in just going to swap over to this
4:24
presentation now and
4:32
so the purpose of today is to empower you all with a little bit
4:37
of knowledge and education and with this the science shows us that by
4:43
understanding a little bit more about our backs it does actually decrease our symptoms and increase our function which
4:50
is definitely what we want if you take anything away from the
4:58
session this is the main one that I want us to take away is that um
5:06
oh sorry I'm just going to share the screen here apologies
5:13
right can you see that one okay
5:18
yes there's nothing good cool thank you apologies for that uh if you take anything away from this session
5:25
today I really want you to take away this one and just continue to sort of
5:30
repeat it in your head over and over again which is really powerful every single cell in your body is capable of
5:37
change until the day that you die and so you may have had low back pain
5:42
for a day a month a year 10 years and just think that oh well this is this is
5:48
my lot you know I'm stuck with this forever and if you can come back to that in that
5:55
every single cell is always renewing itself the femur bone over a period of
6:02
18 months will replace every cell of itself so there's no reason why your
6:08
back can't fix itself so I think I talked a little bit about my story in that I injured my back
6:17
thought it would come right and yeah since 2006 I haven't been I haven't had
6:22
low back pain and I'm just like man people need to know about this and if I
6:27
can help a couple of people along the way that will make me really happy and I really feel like I was in that sort of
6:34
mindset oh well this is just me forever you know my back this is you know like I can't fix it and
6:41
so I think as I say if you take anything away every single cell of your body is capable of change until the day that you
6:47
die so your current diagnosis doesn't Define you every day these cells are going to adapt and change
6:55
I've hurt my back what do I do so this part of the presentation talks about sort of the the flare wraps or our acute
7:03
low back pain you know when we're we're doing something and we hurt our back and
7:08
you know what what do we do so it wasn't that long ago when bed rest
7:14
was the way that we managed low back pain and now that we know now we know this is one of the worst things that we
7:20
can do when we enter our back so we have a flare up the best thing that we can do is keep moving and as we talked about
7:27
before the sometimes feel counter-intuitive and you're like man like that just doesn't make sense but see if you can get up see if you can
7:33
have a shower see if you can go to work if you can and you know modify your activities and that movement and just
7:41
keeping up without normal routine is really important in part of the managing
7:46
these flare-ups and when we do hurt our backs just taking paracetamol and ibuprofen or
7:54
anti-inflammatory medication really helps to keep us moving through that
7:59
initial part where there are those acute flare-ups and from what the study shows
8:06
taking stronger type of medication codeine and tramadol actually slows down our
8:12
recovery so we just really want to stick to those uh paracetamol and anti-inflammatories
8:18
these opioid-based medications release inflammatory markers so it just means
8:24
that you're going to be have more inflammation or you know more swelling than what is needed as you come through
8:30
that initial sort of flare up should I get a scan and yourself myself
8:36
particularly if you've had a sawback for a month a year five years you're like
8:41
man there's definitely something wrong here I definitely need a scan however there's a really poor
8:46
correlation of what we see on scans to what exactly is going on with your back
8:52
and there's no real consistency between what we see on the scans and what we see
8:58
in the clinic and when we talk about scans often often
9:03
it can be uh you know words that sound a little bit frightening and so if you
9:08
heard you know you have a disc herniation this could perhaps be frightening but it's actually a really
9:13
positive indicator of recovery the back is one of the strongest
9:19
structures in the body and it takes a lot to cause permanent injury to it if we fell off a roof for example it is
9:26
worth getting some scans because we want to know exactly what's going on there but if you caused your low back pain
9:34
lifting or twisting is quite unlikely that you've caused permanent injury there
9:39
Imaging is definitely not recommended in the first weeks uh first six weeks and
9:46
sometimes getting Imaging and seeing what's on the scan can have people to
9:52
have a lot longer recovery and this is why so this is a really large study of
9:58
people without low back pain that have gone to have a scan and if we look at for example in the 40-year age so 70 of
10:08
40 year olds are going to have disc degeneration and when you hear that you're like oh
10:14
man like I've got distant degeneration I definitely shouldn't be going to PT but
10:19
these are people with completely no pain in their backs so if
10:26
we're scanning everyone then you find out that you have disc degeneration it doesn't necessarily mean that that's
10:31
where the pain is coming from when we talk about different types of
10:37
treatment and what we should and shouldn't be doing so for those out there that have had injections into the
10:44
facet joint and maybe it's worked for you maybe it hasn't but one out of 22 respond positively to this and also for
10:53
what we would term as non-specific low back pain which is you know you've had
10:59
an injury and it probably should have come right but it's just sort of stuck around and um you know you've still got the low
11:05
back pain even though sort of time wise you'd think that it should or would be better by now surgery is no better than
11:13
Placebo for this non-specific low back pain if it's something more specific like
11:21
discs pressing on um nerves there is specific time for surgery but not just because oh well
11:28
I've tried everything else I'll try surgery so surgery is no better than Placebo for non-pacific low back pain
11:35
what do people want to know so this is a really good thing to take to your physio for example and because people when
11:42
they've hurt their backs you know we want to know what's going on and most
11:49
low back pain is caused by a strain and it's painful and we're going to have a
11:57
good prognosis you know we want to know exactly you know what's contributing to this what does the future look like for
12:04
us how we can manage the flare apps and what we can do to help ourselves so generally with pain as a physio myself
12:10
you know what can I do what can they do and what is their what does the future look like and I think that's quite nice
12:18
to know and understand and sort of demand I think in some ways as well
12:23
words matter so we talked before about what happens
12:29
when asymptomatic people go into have these MRIs and say hey look you've got
12:35
degenerative disc change this is actually normal age changes so if someone said to
12:44
you um you know you're back you've got normal age changes this that is a lot
12:49
more relieving than being told that you've got chronic degenerative changes we talk about this a little bit more as
12:56
we move through the session but words really matter when our brain is
13:02
subconsciously processing stuff and we want to send the brain calming words to
13:10
really calm the amygdala which is the amplifying part of the brain the brain
13:15
wants to protect us but when it goes into overprotective mode that's when we can get into quite an unhealthy
13:23
area of managing our low back pain so when we're talking about words regarding
13:28
our back we want to use normal age changes uh our bats need more strength
13:35
and control normal age changes everything's going to be okay you know there's pulling it's repairable harm and
13:41
these calming words are really really important so our brain doesn't uh
13:48
interpret it as more serious than what is is actually happening
13:54
most pain is linked to minor strains which are painful having back pain does
13:59
not mean that your back is damaged it means that it is sensitized
14:07
in terms of recurrence so 95 of the population at any time during our
14:13
lifetime will sustain a low back injury most of these come right there's an area of people that uh
14:20
they have sort of recurrent low back pain so they injure their back it gets right and then they'll injure it again
14:26
doing something and these are the things that cause recurrence so if you're in a job for example where there's awkward
14:33
postures and you're twisting and lifting such as being a mechanic under a car sitting for greater than five hours
14:41
increases the chance of having recurrent low back pain and if you've injured your
14:46
back more than two times before that's another reason for recurrence as well so
14:51
particularly for these people this that are in and out of having low back pain you know we definitely want to manage
14:57
these ones really well increasing spinal Mobility
15:02
so increasing spinal Mobility decreases low back pain which is really cool and
15:08
this one is Affliction and sitting so sitting down and then grabbing your ankles and leaning down and having a
15:15
four centimeter Improvement in this movement correlates to really good outcomes as you're coming through your
15:21
journey of low back pain rehabilitation what exercise is best
15:29
we were made to move exercise isn't anti-inflammatory and I know it does feel a little bit counter-intuitive when
15:34
we are sore exercise is what our backs need but what is the best exercise and a recent study
15:42
of 10 000 people compared yoga to Pilates to walking to going to the gym
15:49
and found that there was no Superior exercise program compared to another so
15:56
the real takeaway for this is just find something that you really love doing if you love walking and it fits into your
16:03
routine really well good do that if you find that yoga really helps your
16:10
mindfulness and also that spinal Mobility good do that if you enjoy doing Pilates good do that so there's no
16:17
magical or Superior type of exercise I guess in my individual uh journey of
16:24
low back pain yoga worked really effectively for me because my back had stiffened up so much over that 15 years
16:31
that I couldn't even tie my shoelaces so you know sort of mid-20s and unable to bend down to tie your shoelaces there's
16:37
a bit of a concern and so for me getting into yoga and teaching my body to move
16:43
and it's pretty scary you know when your back has stiffened up so much that you know you're scared to bend over or it's
16:51
stiff and it's sore so you just don't but as I say so just find a type of
16:57
exercise which resonates for you and which you can fit into your routine is going to be really important
17:06
this is based on that sort of exercise stuff so photo rats had less nerve injury when clinically induced low back
17:14
pain was induced into them right to exercise straight after injury improved
17:19
quicker and also had faster recovery and in their nerve injury
17:27
this is an interesting one in that you know sometimes we think that if we rest it
17:34
will come right but you will see on this graph that's sitting on the couch and
17:42
doing Ultra marathons is a sort of a higher predictor of spine
17:51
degeneration than just being in the middle so if we sit on the couch it's not good for you know we get more
17:58
degeneration in the spine and this isn't necessarily correlated with pain
18:04
but we want to be somewhere in the middle of doing nothing and doing Ultra marathons every day in terms of um
18:11
looking after our spine you don't stop brushing your hair when it goes gray so why would you stop
18:17
exercising when your body goes gray as it goes through it's it's own aging type
18:22
process the body is an amazing self-modifying self-healing machine if we cut ourselves
18:30
the body fixes it if we load it with weights or walking or stretches or running it will change and adapt and
18:37
don't carry that diagnosis with you forever even though you may have had back pain for a day a month a year 10
18:43
years because every cell has the ability to change depending on what we're throwing at our body
18:51
and if we can get up to exercising regularly you know at least three times a week we're going to get adaptations in
18:59
the back in the muscles in the joints and it's going to take at least six weeks you know sticking with this
19:05
training program until we see actual long-term benefits
19:13
when we start exercising it just feels horrible particularly if our backs are really really stiff but if we can just
19:19
compare it to coming out of a cast and yeah things are a little bit stiff and
19:24
sore so it doesn't mean that you're doing damage to it it just means that everything has stiffened up and we just
19:29
want to do our return to exercise in a really gradual and build up type of way
19:37
and you know this is a normal adaptation so definitely stick with it
19:42
we're creatures of habits and routine so if we can get into a routine or you know work with a physio osteocyra you know
19:49
work with a coach to really help us through you know this part of our Rehabilitation is going to be really key
19:56
and when we're in a routine of regular Fitness and training you know generally
20:01
our sleeping is a lot better and our eating is a lot better so even though you know our backs are sore if we can
20:08
start leading off with some regular exercise that's going to be really key
20:13
and you might be thinking oh man like I am doing exercise and you know I'm my
20:19
back is still sore so let's have a little bit more of a talk about that in a couple of slides to come
20:27
painful backs have become dis coordinated and you may have been told that you've got a weak core and it's
20:32
probably not because people with low back pain will often have increased muscle contraction hyperactivity
20:38
co-contraction and the ability to inability to relax so we definitely want
20:43
some help to retrain the coordination for this part
20:48
what treatment do I need so if your back is really really hyper flexible I.E you
20:55
know you can bend over and get your hands onto the ground your joints probably move really really well and
21:02
you're very flexible and a training program to provide strength and
21:10
coordination is going to be really important for these people I fit in to that middle sort of category so if your
21:16
back is really stiff and treatment and stretching is going to be effective so for these people
21:23
Hands-On treatment will be effective but for the people that are really hyper
21:28
flexible you know you don't necessarily need that Hands-On treatment it's just going to be really strengthening up and
21:35
making sure you're back super strong and looked after through the air
21:40
and then if your back has become discordinated muscle retraining will be
21:46
effective so you know working with your health professional to work out how to
21:51
recoordinate those muscles after it's sort of tried to take over and fix itself and got a little bit confused in
21:58
the process there are so many muscles that control the low back and often muscles will
22:04
switch off to try to protect the injury area so as part of our um you know regaining becoming the boss
22:11
again we definitely want to get everything working in unison again
22:17
and I think this is the most important part and I was talking to one of the ladies the other day and she's like oh
22:23
look you know I've had low back pain for a long time like I'm still doing unit PT so every time she hears a flare up or
22:29
the back saw you know she doesn't feel like she wants to let the team down but you wouldn't do that if you had Achilles
22:35
tendinopathy for example you know you would go through you know managing the information then regaining full range of
22:42
motion then regaining strength and then return to functional movements so just remember to treat your back like any
22:50
normal sort of injury and go through these phases rather than jumping straight to regain functional movements
22:56
you know without actually getting on top of that swelling first or getting on top of your you know making sure that it's
23:03
back to full strength and full range this is the area that is my real
23:10
interest and I specialize in and hopefully from with anyone that is managing persistent low back pain
23:16
hopefully a couple of these takeaway messages are really going to resonate with you guys
23:22
so for those of us out there that have had low back pain for more than three months our neural wiring has changed and
23:33
our brains have become overprotective overactive and hypersensitive
23:41
and I know many of you are like no I've got a really strong pain threshold which I'm sure that you do but as our wiring
23:49
changes and our brain tries to protect us it really changes the way that we are
23:55
wired it wasn't so long ago that we thought pain was just a physical component so
24:01
something related to a rupture break or tear but pain is
24:08
a has a physical component a mental component and also a social component as
24:15
well it's a protective mechanism but rewiring can mean that pain is often created by
24:23
quite a lower stimulus when our neural pathways are rewired and this pain that
24:30
we're feeling is actually a long way off tissue damage and that's a real key one as well that our brain is trying to
24:38
protect us but that threshold between actual damage and when we're feeling the pain
24:44
is there's quite a big difference when when we're hypersensitized
24:54
pain processing and I think this one's really interesting as well in that if we were a meat suit then you know we would
25:01
have pain if there was a rupture break in tier but this is how we process pain
25:06
so if we stand on a drawing pin for example or if we have low back pain maybe we bend down to pick up a pin and
25:14
you know we get low back pain so the there's an Impulse that goes up to the
25:19
brain they pretty much have a board meeting about what type of stimulus they're going to send down so they talk
25:25
to the part of the brain that manages sort of previous experience in this area
25:31
it talks to how we're feeling are we stressed and everything is taken into
25:36
account until it sends down what it perceives as uh an acceptable or a
25:42
suitable pain impulse and so similarly you know you guys are be out there going
25:47
oh man you know I've got a pretty strong pretty high pain threshold this is
25:52
what's happening every time you your back is deciding how much pain it should be and it goes to a board meeting and
25:58
everyone's contributing to it it's not just a meat suit and it's not just about you it's about everything that you've
26:04
experienced up to here the pain you feel is completely unique
26:09
to you it's an experience based on what is going on with your body what's going on stress grief bereavement and also the
26:18
social environment what sort of information you have access to whether you're sort of searching on Google or
26:25
social media or you know whether you're working with someone who specializes in this area and can give you some really
26:31
accurate information as to what to do and not what not to do pain is an opinion it doesn't always
26:38
reflect reality and your brain decides when you need to be predicted and when you don't so for example
26:45
you've got a sprained ankle but you can still run away from a beer so your brain is always making judgment calls
26:52
it is a good thing it's a protection measure it's stored as a memory and so things that we've probably done before
26:57
we know not to do again so trying to stick our tongue in a Coke can walking on glass
27:03
um sticking your finger in caged animals we have this protection measure in our
27:09
brain that's going to protect us from harm but when we have for example low back
27:17
pain four more than three months there is an element of rewiring that has
27:23
happened to protect us and you know this can sound scary but I think the most the
27:29
coolest part about this is that the brain and nerves can be reprogrammed rewired and completely reversed which is
27:36
really cool for us we don't have to be in low back pain forever pain is a very subjective experience if
27:43
we tell the brain it's bad it sends down relevant pain messages if we tell the
27:49
brain it's okay then it's okay and interesting enough I was working with the youth development unit a few years
27:55
ago and for a lot of these students I'd never done PT before so having delayed
28:02
onset muscle soreness the day after doing a PT session was really frightening for them you know that come
28:08
to Physio and say look you know I'm sore here and here and here and here and here
28:13
and here and they're just like I'm sore all over like this is this is scary compared to an athlete who is
28:20
experiencing the same sort of delayed onset muscle soreness but it's got a completely different understanding of it
28:26
and yeah I'm sore because I know that there's micro tearing of you know the different cells of the muscles so it's
28:32
going to make me adapt and be stronger and we can take this same sort of concept for our backs which I think is
28:39
really cool so if we can reinterpret the pain as a harmless sensation so as we talked about
28:45
before often with a hypersensitized neural system you know
28:52
will get pain well before there's actual damage to the tissue so if we can
28:58
interpret you know bending down to pick up a pen as you know as a harmless
29:04
sensation so he might feel warmth or stiffness or discomfort uh and that can
29:09
override these higher control control centers and stop Out Among the freaking out which is the amplifier
29:16
whereas if we say you know I've got this stabbing pain in my back
29:22
um or like a knife-like pain in my back you know that's scary for the brain to interpret and and this is all done
29:30
subconsciously as well and you're like oh I'm not saying that you know it's a I'm having the stabbing pain but
29:36
subconsciously this is all going on the background and so if we can use these real calming words it's going to be our
29:43
first step in becoming the boss again so if we start getting back into our PT
29:49
and as we talked about we want to do it in a gradual sort of way and you know we've already saw afterwards you know we
29:55
can sort of really reinterpret I can feel my ligaments stretching you know from my stretch day I can really feel
30:00
the the blood bringing all those healing products to the area you know I'm I feel a bit of heat in my back and really need
30:06
to cool it down it's you know been feeling quite warm with the movements that I've been doing today and all you
30:12
know the sensations in my back today are strong because of instead of using words like uh you know it's a buy slight
30:19
knife-like stabbing you know type pain and if we can completely take pain out
30:27
of our vocab as well we're going to be really empowered from that so coming to our last page here and the
30:36
key takeaways that hopefully have resonated for some of you today is that
30:42
we every cell in our body is capable of change until the day that we diet and we
30:47
don't have to be in we don't have to have low back pain forever
30:54
um we can get treatment from a health professional you know potentially our physios at the camps and bases and if
31:02
we're you know if there's stiffness in our back we get treated for stiffness if we're really hyper mobile we need a good
31:08
stability program or if our back isn't working well and bending forward backwards side to side you know we can
31:14
do some motor retraining for that when we're returning back to exercise which is really important because our
31:22
exercise acts like in anti-inflammatory and can bring all those feel-good
31:28
hormones which we definitely need to as we're recovering from our low back pain and treat it like you would any other
31:34
injury so make sure that you go through those specific phases of recovery and
31:39
don't jump right to the last part as if um you know it's any different from any
31:44
other body part and the last one yeah I really challenge you to try some of
31:50
those disempowering of the amygdala exercises so see if you can you know even try to
31:57
take pain out of your vocab all together and start using more calming words like
32:02
heat or stiffness or warmth and although
32:08
you may think Ah that's a that's a simple one that's a silly one it really
32:13
is hugely empowering and if you're interested in knowing more there's a really good site called
32:20
curable which mainly more focuses on chronic low back pain which the area
32:28
that I guess sort of I specialize in is more that sort of persistent low back pain because it's like has an element of
32:35
you know you're going to have it forever but it talks about really good other Empower empowering
32:42
exercises for overcoming low back pain such as meditations and such as Journal
32:47
writing and different exercises like this so my advice to you
32:53
um yeah you know like you don't have to put up with this you know book in with your Physio and your camping base and
32:59
come up with a plan and you know have a coach to help work you through and if you're looking for some more sort of
33:05
exercises to help as well yeah check out this site called called curable and they
33:10
have some really really excellent resources as well it was really nice to talk to you today and I wish you all the
33:18
best in managing your low back pain and hope that some of these exercises will help you
33:30
just got a couple of questions in here um what were the signs of a
33:35
discordinated back be so that's a really good question and I
33:40
would answer that one so for example in our if we bent down to pick up a pin for
33:47
example you know our back should have a nice curve in it in that each joint
33:52
should have sort of between 8 and 12 degrees of movement in it and that if we
33:59
weren't moving well or you know if we had to sort of get you know twist around a couple of Corners to go down it just
34:07
means that the joints aren't moving well and the muscles aren't moving well and
34:12
so hopefully that answers that one would you have a specific website to
34:18
recommend for a training program to strengthen the lower back I suffered a disc bulge in 2012 and every once in a
34:25
while it reminds me that it is still there 10 days of taking it easy to get
34:31
back into life again I personally think that
34:39
seeing a medical professional to to you know to work out exactly you know whether it's sort of Mobility that you
34:46
need or specific sort of strengthening that you need I think will be more beneficial rather than just sort of
34:53
grabbing a program off um off the website
35:00
so would I have a specific website yeah I really like that curable site for
35:07
um you know different exercises to help our backs and yeah I think that is worth
35:15
seeing a health professional for specific strengthening and feedback exactly what
35:22
your um back is doing and then Anonymous says thank you this has been so
35:28
interesting as a sufferer of back pain for 10 years yep I'm um yeah shout out
35:34
shout out it's hugely emotionally effective so thank you for that Anonymous and then another one thanks
35:42
for the presentation any tips for lower back pain that flares up at bedtime and causes difficulty getting to sleep have
35:48
never been sure if it's worth getting up and stretching it out moving around or
35:54
whether there's another strategy that's a really good point that we haven't really talked about and that's
35:59
interesting potentially if you're back is not sore during the day and then is
36:04
sore at night and I would probably look at your mattress and people with sore
36:11
backs you know really like a harder mattress so whether it's something that you need to put down on your side and
36:18
you know particularly if it's sore or rolling at night there might still be an element of you know sort of information
36:24
there so yeah I again recommend seeing
36:29
someone about it and um yeah particularly looking at
36:36
exactly what it is you know why it would be sore when you
36:41
lie down if it's not sort of sort of during the day
36:48
thank you and that's all the questions yeah I've got one last question from me
36:54
what would be some good um signs to look out for for significant uh damaging pain versus just like
37:01
irregular ache or something that can be moved through yeah that's a really good question thank
37:07
you for asking that so what we would call our red flags is it you know as we
37:14
talked about low back pain is often related to a strain and it's sore and you know
37:20
there's certain things that we can do but things that I would definitely go to
37:25
your doctor about to be seen particularly that night pain is
37:31
generally an indicator that there is inflammation there and as our body rests
37:36
and regenerates overnight our backs shouldn't be sore during that
37:41
time so for what would cause sort of unremitting night pain that are definitely sort of get that scene uh
37:48
weight loss if your experience you know if you have lost you know like a change
37:54
in weight more than 5 kgs over a six month period and definitely get that
38:01
scene too uh and then yeah I guess sort of mainly in and around those
38:06
inflammatory yeah sort of night pain or a lot of really really noticeable stiffness uh you know with getting that
38:14
scene as well does that answer your question yes that's a good answer thank you very
38:19
much
38:27
cool thank you oh well if there's no other questions that concludes our presentation today and I'll stick around
38:32
for the next five or ten minutes if anyone wanted to ask anything else
38:38
thanks again
38:46
awesome thank you very much for that presentation really thank you cool I think we'll end that there and
38:52
then I'll get the recording up online half the recording yeah
38:58
um I had another question from someone in the chat would the slides that you're presenting I'll be able to be posted alongside the recording yeah no worries
39:06
it was cool um yeah I'll contact you to see if I can get those
39:11
easy cool thank you very much oh sorry I missed a couple of um
39:18
cool thank you
Session 2 Fix My Back Bootcamp
MAJ Raylene Grant, Commander of the Physical Performance Squadron, provides an introduction to the anatomy of the back.