thank you all right
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 Syd 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 part 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
scans such as CDs 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 this
prolapses disc herniations degenerative
changes which do not cause any symptoms
at all
in pain-free individuals about fifty to
sixty six percent have disc bulges about
30 percent have disc herniations and up
to 90 percent 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 we’re 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 five percent requires 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 what
happens
they herniate and even when they
herniate it does not mean that they slip
out of a spine a spine is one of the
most strongest structures in the human
body with muscles ligaments bones
supporting them and as mentioned before
disc herniation scan 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 percent 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 ten percent
are good candidates for surgery and out
of that only two percent 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
drink drink 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 was 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 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 is no food but at there
is a response from the body it is the
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 ham 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 – motion is lotion for your
spine 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
planche 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 are 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
bend it down that looks easy now make a
tight fist and try bending down do you
notice it’s Mustafar well the same thing
happens with this pine 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 add here 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 that
acupuncture injections massage
medications they all have limited
effectiveness as a standalone treatment
as they address only one factor and not
other issues like you 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 a wide 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]
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 Syd 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 part 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
scans such as CDs 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 this
prolapses disc herniations degenerative
changes which do not cause any symptoms
at all
in pain-free individuals about fifty to
sixty six percent have disc bulges about
30 percent have disc herniations and up
to 90 percent 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 we’re 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 five percent requires 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 what
happens
they herniate and even when they
herniate it does not mean that they slip
out of a spine a spine is one of the
most strongest structures in the human
body with muscles ligaments bones
supporting them and as mentioned before
disc herniation scan 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 percent 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 ten percent
are good candidates for surgery and out
of that only two percent 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
drink drink 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 was 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 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 is no food but at there
is a response from the body it is the
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 ham 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 – motion is lotion for your
spine 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
planche 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 are 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
bend it down that looks easy now make a
tight fist and try bending down do you
notice it’s Mustafar well the same thing
happens with this pine 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 add here 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 that
acupuncture injections massage
medications they all have limited
effectiveness as a standalone treatment
as they address only one factor and not
other issues like you 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 a wide 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]
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