This may come as a surprise to you, but maybe you were a believer in the bone-out theory. If you listened to the podcast episode in the lesson on diagnosis, you will know now that this is just a myth.
Why is the mechanism of damage important? Because it tells us how to avoid future problems.
IF clients don’t know how they can damage their backs, how will they know how to avoid it in future?
OK, let’s get into this. Please grab a hold of the forefinger of one hand, and push it back. Push it right back and hold it there. Now, if you hold it still at that point you will be loading the tissues down the front of the finger, and if you were to hold it there for 30 minutes that would be sustained load.
Alternatively you might hold it there for 10 seconds, then ease back, then push it again, and keep going with that. That would be cumulative or repetitive load.
Or someone might come along (or you may be stupid enough) to really push it hard right back – that would be peak load.
There you are – those are the only 3 ways of damaging tissue – sustained load, cumulative load and peak load.
In all of these circumstances you may exceed the loading capacity of those tissues and strain them.
This is what happens with the lower back. We can all think of a very common way of exerting sustained loads on the lower back – sitting still is probably the most common. It’s also probably the most common cumulative load.
Peak load is less common in sedentary people, but lunging, lifting, digging can all result in peak loading.
Now here’s an important thing to note about pain. When you bent your finger back, there was a little bit of discomfort, wasn’t there? At that end point. On a 0 to 10 pain scale you might describe that as a 1 or just a half. So in this case, mild pain actually kicks in before you damage the tissue. Yes? You didn’t damage your finger did you? But you can get that sense of discomfort before doing any damage. That very often happens in everyday life. And we’ll use sitting as an example. People will frequently admit that their lower back had been feeling “a bit stiff and tight” on getting up from sitting – and they had been aware of that for a few weeks before it all went badly wrong. And then when they bent over the bath it suddenly became very painful. That “stiffness” feeling was their back giving them a warning.
Because the biological purpose of pain is an alarm system. It’s there to warn you that there’s a problem. And if you don’t take note and do something about it, that alarm bell is likely to ring louder and louder.
So, in summary there are just 3 ways of damaging tissue – sustained load, cumulative load and peak load. This is referred to in lesson 10 of the main course. The different tissues can recover, at different rates. IF you stress the tissue too much while it’s recovering it will be painful (although not always in the case of the discs) and you will delay recovery, leading to prolonged pain.
However, as we’ll see in the next lesson, just because you’ve damaged tissue does not mean you will feel pain. There are a number of factors that determine whether and how much pain you experience and the amount of tissue damage is rarely the main factor in most people.