- In an era where we rely mostly on X-Rays and MRIs, asking the right questions is still key to finding simple solutions to chronic back pain.
- The 3 main questions for any pain: What triggered the pain the first time? What movement makes the pain better? What movement worsens the pain?
- Repetitive movements such as pulling, straining, reaching, twisting, and bending can weaken and stress the structures of the spine.
My patient Andrew (not his real name) had chronic lower back pain on his right side for 30 years, but in the last 18 months, his lower back pain became more pronounced, to the point of not being able to sit down anymore on any chair because the pain was too intense. Anti-inflammatories worked for a while then stopped working.
Andrew never had his back X-Rayed, nor did he have any MRI of his lower spine despite his doctors recommending those.
Was there a simple, easy-to-fix cause of the pain, or was it a complex difficult-to-solve problem? Could Andrew even have bone cancer?
I thought that if Andrew had bone cancer, the pain would have gotten worse in the last 18 months, but since Andrew’s pain was about the same as 18 months prior, I decided not to insist on pushing him to get his back X-Rayed.
Instead, I asked Andrew the question,“What makes your back pain worse?”
Andrew’s answer was, “When I sit on the toilet, I am okay, but when I get up from the toilet seat, I am in acute pain, and then, I have pain whenever I sit on a chair or on a sofa.”
As a result, Andrew had decided not to sit down anymore, even during family meals.
Unfortunately, he still had to sit down on a toilet for a bowel movement. He tried different toilet seats, some higher, others that were lower, but nothing changed. Each morning, as soon as he got up from his toilet seat, his pain was aggravated.
It became a puzzling problem.
What was happening on Andrew’s toilet seat, that was hurting his lower back, especially on the right side?
Did Andrew sit too long on his toilet seat every day? Did he push too much while sitting?
All those were good questions.
The answer to those questions was: Even if Andrew only sat a few minutes on his toilet seat and even if he didn’t push, he still had excruciating pain in his right lower back after getting up from his toilet seat.
So, what was going on?
The mystery remained intact until I asked him one last question, which solved the problem.
I asked, “Which hand do you use to wipe yourself after your bowel movement, and do you twist your back doing this?”
Andrew answered, “ I use my right hand, and I guess I probably do twist my back to the right to do this.”
For as long as he could remember, Andrew had used his right hand while twisting his back to wipe himself after a bowel movement.
I now understood the whole picture. Day after day, year after year, bending and twisting his back towards the right was probably compressing a nerve between two of Andrew’s vertebrae. If Andrew had a slightly herniated disc, bending his back towards the right was probably making the disk herniate more.
If that was the problem, the solution was simple. Andrew had to stop using his right hand and start using his left hand to wipe himself after a bowel movement, which Andrew did immediately.
Ever since Andrew did that hand shift, his lower back stopped hurting and hasn’t hurt since.
The Moral of Andrew’s Story
If you have any pain, always look for a simple origin of your problem first, and ask yourself the questions: When did my pain start? What could have triggered it? What makes my pain worse? What makes my pain better?
Remember the old adage? “Doctor, it hurts when I do this,” and the doctor mimics the patient and says, “Well, stop doing this.” It is still important even in 2021 when we have CT scans and MRIs.
Lower back problems are persistent. Research by Murray and Colleagues from the University of Washington shows that lower back pain is one of the leading causes of disability in the United States.
What are those lower back problems due to?
Dr. Mazanek, associate director of the center for the spine at the Cleveland Clinic in Ohio, explains, “Repetitive movements such as pulling, straining, reaching, twisting, and bending can weaken and stress the structures of the spine.”
Indeed reaching and twisting were the cause of Andrew’s chronic back pain.
Twisting your back while wiping after a bowel movement is only one of the possible causes of chronic lower back pain.
There are several other obvious and more frequent causes.
Other Frequent Causes of Chronic Lower Back Pain
1. Sitting on a couch leaning on one side
Do you always lean on the same side when you sit down on your couch at home? If you do, try not to lean on one side and try to keep your back straight. This simple change will probably improve your back pain.
2. Bending on one side to rinse your mouth after brushing your teeth
When you brush your teeth, do you take sips of water from the bathroom faucet while bending your body to one side to rinse your mouth? If you do, try bending your body to the other side. You will be surprised to see how difficult it is for your body to bend to the other side. The best way to rinse your mouth is to pour water from the faucet into a glass and rinse your mouth, keeping your back straight.
3. Lifting heavy weights
Do you lift heavy packages bending down using your arched back as leverage? If you do, try bending your knees instead while keeping your back straight.
Do you go to the gym and lift heavy weights while standing up or sitting down? If you do, lift those heavy weights while lying down with your legs up.
Again, you will be amazed at how much those simple changes can improve your back pain.
4. Sleeping on an old mattress
Do you go to bed every night without any back pain, and do you wake up every morning with lower back pain? If that’s the case, your mattress might be the culprit. Ensure you sleep on a firm mattress that is not too old and doesn’t have a big slump in the middle.
5. Being overweight
Of course, another cause of chronic lower back pain is being overweight, so losing weight is the obvious way to improve the pain, but that takes more time and dedication.
And there are many more possible causes of lower back pain, including muscle tension from stress.
The Bottom Line
If you start having lower back pain, be mindful of the kind of movements you are making, and always remember to address those three questions:
- What happened just before your pain started?
- What makes your pain worse?
- What improves your pain?
More often than not, the solution to get rid of your pain will be simple once you answer those questions.
And don’t hesitate to get a lower back X-Ray and/or MRI if your doctor recommends it. It’s always better to be safe than sorry.
Copyright Chris Gilbert, MD, PhD 2021