Chapter 1: What is the main topic discussed in this episode?
The Clare Byrne Show on Newstalk with Aviva Insurance.
Chapter 2: What percentage of people experience back pain in their lives?
Now, over 80% of us have back pain at some point in our lives, but a lot of people just live with it and we think, well, that's just wear and tear and there's nothing really that you can do about it. Well, physiotherapist Larry O'Mahony is with me now to tell us whether we're right or wrong in that assessment. Hello, Larry. Good morning, Clare. Lovely to have you with us.
Chapter 3: Is it normal to just accept back pain as wear and tear?
Is it right just to accept back pain ever?
So I suppose back pain is something that affects so many of us that people can assume that it's normal. But actually, there is a lot we can do about it, I suppose, particularly when we think of how it's managed. When somebody gets that initial diagnosis, it has a really profound effect on how it affects them actually for the rest of their life. You get used to an ache or a pain though, don't you?
I suppose you do for some pains and like you'll have an acute pain, which comes on maybe as a result of tissue damage. And then you'll have persistent pain, which is there for longer than three months. And so ideally, we want to try and get rid of pain before it turns into persistent pain, because that's a lot more difficult to manage.
They're the tricky ones. Are they the ones, the achy ones that have been around for a long time?
Yeah, so persistent pain actually affects about 40 to 43% of people and back pain will be one of the reasons. And it can happen because your brain becomes sensitized to the pain. So we maybe initially become hurt and that's our brain processing what's happened and creating pain to protect us. And so the pain then happens as a result of the harm.
But if you've had pain for a long time, your brain can become very sensitive to it. And it's a bit like a habit. Your brain actually holds on to it and can become very easily activated. So small movements can have a big response. And that's what we don't want to happen when people initially suffer from something like back pain. That's so interesting. So how do you break that cycle then?
That's a really good question. And so it's looking at our perception of pain. So first of all, we have like biologically, so what we're perceiving. And then we have psychologically, which is how we're feeling. And then we look at environmentally, which is our environment and our lifestyle. So to break the cycle, if our brain becomes afraid of pain,
normal activities and movements, we have to slowly start reintroducing those movements. So pacing is a really good way. So if you haven't walked in a long time, if you haven't moved, maybe you'll try and start doing maybe just 10 minutes a day of an activity. Because what can happen for people with persistent pain is that they might have a good day and then they do loads.
They do the garden and they clean the shelves and then the following day is a really bad day And then they don't do anything for a while and it reinforces this cycle. And so it's about slowly seeing, can you start to do maybe a 10 minute walk every day and not overreaching and then slowly building on that.
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Chapter 4: What is the difference between acute pain and persistent pain?
And some people will have minimal structural change and they might have a lot of pain. So we know that if we can actually start to get our brain involved because of neuroplasticity, which is our brain's ability to change, that we can actually retrain our brain to start to feel less painful.
I would imagine that you find it hard to convince people of that sometimes, that you can retrain your brain to deal with pain in a different way.
Yeah, and quite often people will say, oh, are you saying this is all in my head? Yes. Which absolutely it is not. But it's recognising that pain is so much more complex than perhaps we realised in the past. And so it's recognising that as it is more complex, there's other and more available ways to treat.
So painkillers are brilliant, maybe to allow you a window to become a little bit more active, maybe to engage in some exercises, maybe to... do a little bit more around the house. So it's definitely, it's your brain is all responsible for the pain. And if we think of, I don't know if you've ever heard of phantom limb pain. Yes. So when somebody has like an amputation. Yeah.
And so it's because your brain has mapped out in your head all the parts of your body. So, you know, if you have a pain, that's flashing red. So similarly, if somebody has an amputation, the brain still has that mapped out. And so therefore they can still get pain, which is just going to really underscore the fact that you can have pain without actually having a lot of damage.
And so you need to treat it, not just specifically by maybe treating specifically the area, but it's treating your well-being, you know. Also, research has showed us that if you think really bad thoughts, so if you think, oh, if I bend down now,
and I hurt my back that's desperate it's never going to get better then it's really unlikely that it's going to get better you know and that maybe that's going to stop you moving which is then going to start a spiral so part of how we approach pain is thinking right maybe I have a small pain now but harm and hurt are not the same thing that I can have a pain but actually it doesn't mean there's any damage so I can continue doing what I'm doing and the pain will go
And that's the first step in telling your brain, actually, it's OK.
So if you're working with someone, it's convincing them on an intellectual level. But yes, you can do that first stretch.
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Chapter 5: How does the brain influence our perception of pain?
And we probably need to have you here for half an hour. to go through all of that, Larry. But, you know, the good news is that Joe is at least going to try and move, which I suppose is positive thing number one, right? Yeah, brilliant, Joe. Well done. And can I give one or two exercises?
Absolutely. I'll give like kind of entry level exercises. So there's if you go into four point kneeling, so it's kneeling on your hands and your legs so you can arch your back up and down. And that's a lovely stretch. Sometimes people call it a cat camel. Or else you can stretch one leg and one hand away from each other and then bring them back in. So that's really good for your trunk strength.
And if that's too complicated, just do the arm first and then do the leg. And then as your trunk strength builds up, do the two together. Squatting is also brilliant. So if you're at home and you've reduced mobility, even just sit to stand for somebody who might be very limited and trying to do maybe 10 of those three times a day. So really small bite sized chunks.
And then if you're a gym goer, if you're more active, deadlifts are brilliant. So what we would call posterior chain exercises. So exercises that get the back of your legs, your hips and your lower back.
Okay, they're all going to help with the lower back.
Strengthening your back.
So really, when people say, well, the painkillers don't work for me anymore, they're never going to keep working for you, are they? You're going to have to try and move to make this better.
Yeah, so like what the research will tell us is that they're not effective as the only strategy for long-term pain. And that's because they're not addressing the root of the pain. And so they'll give you a window, but that window needs to be a window of opportunity that you engage in
maybe deep breathing exercises, maybe pacing, maybe going for a walk, maybe starting an exercise class, maybe sleeping more, reducing your stress. So it has to be taken as an opportunity as opposed to as a solution in itself.
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Chapter 6: What strategies can help break the cycle of persistent pain?
Conversation that counts.