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8/12/15

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It is often downright frustrating, and even scary, when back pain strikes seemingly out of the blue.  What seems to add to the stress of flare-ups is the feeling that a problem that seemed to have cleared comes back with a vengeance.  It's not nice to feel out of control and to feel that a mysterious and malign event can be triggered at any time.

So this blog is about triggers.

First, I can't resist the science bit.  Sorry...

Pain comes about when enough specialised nerves somewhere in your body are stimulated sending a barrage of impulses to your spinal cord and to the brain leading to the experiencing of pain.  

Pain is usually short lived and once the stimulus is removed, the barrage of impulses fade away and pain resolves.  In certain circumstances the nerves are stimulated continuously and the barrage doesn't fade quickly meaning the pain hangs around a while.  If you're really unlucky the nerves are bombarded for a few weeks - and this is where something groovy happens: the nerves get really good at processing the impulses and rather than needing (lets' say) 1000 neurons to create an ouch, it now only takes one.  

It's like your nervous system is fine tuning a signal to make it as clear and as sharp as possible.  Frustrating when all you want to do is tie your shoelaces.

Most of the time, we have 'coupled' triggers.  An example of this is a low back pain patient who gets a flare up when washing up, brushing their teeth, stroking the dog, sleeping curled up and so on - all involving a curving of the lower back.  Regardless of context, the spine is being put into the same position, stimulating the over-sensitive nerves and creating pain.  In this case we should see a great deal of improvement by simply uncoupling the movements - changing the bending and sleeping technique for a while usually de-sensitises the sore structures allowing the pain to settle down.

For some people, their pain is coupled to stress -  so that any time their stress levels start peaking they're at risk of a pain episode.

Mike Stewart, the eminent physio and pain educator, recalls a patient whose pain was triggered by standing at a bus stop each morning despite not having any pain standing at any other time.  The solution was to encourage the patient to wait at a different bus stop a few hundred yards away.  Result? Pain gone.  What was her trigger?  Who knows really - but it does prove that pain triggers can be pretty much anything - you perhaps just need to play detective to work out what yours are. 

Thanks for reading

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