Threat. The unrecognized element in most low back pain.
Many of us in the United States have fond memories of the 4th of July…fireworks, hot dogs and hamburgers in a backyard BBQ, time with family and friends. Others, however, have a different kind of memory around the 4th of July. Veterans who have seen combat, felt the concussion of bombs, heard the fire of weapons around them and have seen brothers and sisters in arms die in those conditions, are sometimes drawn back to those traumatic times when the fireworks start on July 4th. Most of us are aware of post traumatic stress disorder (PTSD) and the way a past traumatic experience can result in the survivor’s vulnerability in certain future situations. The paralyzing fear, racing heart, muscle tension, rigidity can return in innocuous situations when enough of the elements the person’s brain has flagged as associated with the original threat are present. Here, we’d like to introduce the thought that chronic severe back pain may actually result in a type of PTSD.
Trauma in psychological terms, is defined as an event which provokes extreme fear, and concern for one’s survival. When these events are paired with a lack of agency or control, post traumatic stress syndrome may develop in certain individuals when they are presented with situations that remind them of the threat of the original trauma. Activity in the brains of these PTSD sufferers is particularly high in two areas…the amygdala and the hippocampus.
The amygdala area of the brain is associated with fear and worry. When we go through such formative events in life, the amygdala flags those events so that we can associate appropriate emotions to them.
The hippocampus is involved in the processing of memory. When we are exposed to fear-provoking situations in which we lack control, the amygdala and hippocampus are working overtime in concert to record data about those events. The brain does this to protect the organism and to ensure survivability.
When a person has severe, chronic low back pain, they will often have a feeling that they are powerless to control when, and how, the next episode of debilitating back spasm might occur. These people live in fear of when “the other shoe will drop” and they will be laid up in bed for 3–5 days with 10/10 pain, barely able to crawl to the bathroom without assistance. We suggest that this represents a form of trauma by combining threat presentation and lack of agency.
Threat presentation in these people may be at the spine itself with a disc herniation encroaching on the spinal cord or nerve roots. It may also occur if prior injuries of muscles or ligaments around the spinal segments result in instability that presents threat to the spinal cord and nerve roots. These neurological elements are crucial to the survivability of the animal and the body places a high priority on their health and function. When that survival is threatened, the amygdala and hippocampus jump into overdrive so that you can remember all of the iota associated with that experience and try to avoid it in the future. This kind of threat presentation we might call “bottom up”, as in the threat is coming from the periphery. Other kinds of threat may be presented in a “top down” manner.
The accumulation of multiple episodes of severe pain, results in a neural engram to be formed. Known in some circles as a “pain neurotag”, is the summation of the internal and external experience and data collection around each of those events. We compare these pain neurotags to bad memories, not unlike those traumatic memories in the veteran with PTSD.
Back pain episodes may involve innocuous situations or genuinely threatening ones. In the FixYourOwnBack program we help to make sense of those episodes by clearly educating our students about movements and activities that may present threat to the spinal cord and nerve roots. We attempt to reduce exposure to those threatening movements while the body heals the injury. We then use principles learned from the evidence in psychology interventions for trauma survivors to help reduce top down threat. For those near Portland, OR our clinics, Solutions Sports and Spine, can provide relief and understanding of your condition. For healthcare providers looking to learn this innovative and effective treatment process, we travel all over the world teaching the NeuroCentric Approach®.
