Category Archives: Mental Health

The Stress of Lower Back Pain

What is lower back pain?

Unfortunately this isn’t a question that really needs to be greatly expanded on, as most of us have experienced some lower back pain at one time or another. It is said to be the second most common complaint heard by physicians in the US. It is usually experienced in the lumbar region of the spine. The lumbar region consists of five vertebrae (L1 to L5) between the lower ribs and the sacrum. The complex anatomy of the lumbar spine is a remarkable combination of these strong vertebrae, multiple bony elements linked by joint capsules, and flexible ligaments/tendons, large muscles, and highly sensitive nerves.[1]

What causes lower back pain?

There are a number of aggravating factors when it comes to lower back pain, including; physiological, environmental and personal factors.

Physiological conditions

Disc herniation can put pressure on the nerves branching from the spine

Diagnosable conditions of the lower back include but aren’t limited to; degenerative disc disease, ruptured or herniated disc, spinal compression fractures, spinal stenosis, sciatica, spondylolithesis, scoliosis, arthritis or other non-musculoskeletal causes such as kidney stones, shingles, or infection.

However, it has been proven that of all lower back complaints, as few as 1% of them are diagnosable.[2]

Meaning that more than 90% of all lower back complaints are ‘non-specific’, and inexplicable by medical imaging or testing. There is little doubt that muscular and myofascial pain is a major factor in non-specific lower back pain and orthopaedic testing by a physical therapist such as massage or myotherapist should be able to locate the muscle or ligament acting as the cause.

What causes non-specific lower back pain?

Strain to the muscles in the lower back can cause lower back pain

Initially lower back pain is likely to be triggered by a physiological factor, such as sprain or strain to ligament or muscles in the lower back. This could happen through improper or over use of the muscle or joint, irregular exercise, or poor posture. However, stress is such a big factor in exacerbating lower back pain that even the medical research is saying that the best treatments include mindfulness and movement, over medication.

What are those stressors?

Environmental factors

Environmental stressors that can attribute to causing low back pain may include employment, relationships and the external demands of life such as;

  • Noise – loud and constant low level noise
  • Pollution
  • Trauma
  • Injury
  • Foreign organisms (bacteria, viruses, fungi)
  • Toxins
  • Poor work conditions (low satisfaction, poor ergonomics, too much noise, poor air circulation, lack of privacy, excess demands, etc).
  • Relationships with others; bullying in the workplace, demanding family member, abusive relationship
  • Living situation
  • All the situations, challenges, difficulties, and expectations we are confronted with on a daily basis.

Stressful work environment can lead to exacerbated pain

Personal Factors

Internal stress comes from inside of us and determine our body’s ability to respond to, and deal with, the external stress-inducing factors or stressors:

  • Nutritional status
  • Attitudes & belief system
  • Thoughts
  • Feelings of anger, fear and worry
  • Anticipation
  • Imagination
  • Memory
  • Overall health and fitness levels
  • Presence of illness and infection
  • Emotional well-being
  • Amount of sleep and rest you get.

“Evidence suggests that fear avoidance beliefs are prognostic for poor outcome in subacute lower back pain.” [3] That is, those in fear of pain are likely to take longer to recover.

The fear of pain was assessed in 126 volunteers with a questionnaire before “inducing muscle injury to the shoulder.” The results found evidence that fear of pain before injury can predict recovery time. In other words: how well you respond to injury and recover is affected enough by fear that it can actually be predicted by measuring fear beforehand.[4]

Pain itself often modifies the way the central nervous system works, so that a patient actually becomes more sensitive and gets more pain with less provocation. It’s called “central sensitization” because it involves changes in the central nervous system (CNS) in particular — the brain and the spinal cord. Sensitized patients are not only more sensitive to things that should hurt, but sometimes to ordinary touch and pressure as well. Their pain also “echoes,” fading more slowly than in other people.[5]

Watch this great TED talk on ‘Why Things Hurt”

How is lower back pain diagnosed?

To diagnose the cause of low back pain, it is likely you will go through a series of diagnostic tests from your GP and then perhaps a series orthopaedic tests from your physical therapist. Imaging and blood tests will not show soft tissue injury, such as ligament sprain or muscle strain, so it is a good option to see a physical therapist if your tests come back negative.

Orthopaedic tests will include a range of simple postural back and leg tests to determine joints, ligaments and/or muscles that may be implicated in your pain. Communicate openly as best you can with your physical therapist about what you feel and when you feel it. If this is not completely obvious to you, then keep a pain diary, noting down when and where on your body you feel the pain, and what you have been doing in the time leading up to the pain. It’s also worth noting the external and environmental factors that might be surrounding the pain at the time. There’s even an ‘app for that’.[6] The therapist is looking for the actions and muscles that recreate the pain you are experiencing.

How is the best way to treat it?

Well, I guess that is the million-dollar question…


“For people with chronic low back pain, opioid analgesics provide modest short term pain relief but the effect is not likely to be clinically important within guideline recommended doses. Evidence on long-term efficacy is lacking, the efficacy of opioid analgesics on acute low back pain is unknown.” Unfortunately, the overuse of imaging, opioids, and surgery remains a widespread problem.[7] If pharmacological treatment is desired, clinicians and patients should select non-steroidal anti-inflammatory drugs or skeletal muscle relaxants.

Exercise, Physical Therapy & Mindfulness

Lower back massage

The reality is that medical research is now saying, the best medicine is no medicine. The evidence indicates that medication is found to reduce pain by approximately 10%, while a systematic review and meta-analysis of yoga for low back pain found there is strong evidence for short-term effects on pain (as much as 48% reduction) and long-term effect on pain (a reduction of 33%).[8]

The conclusion is that for patients with acute, sub-acute and chronic low back pain, clinicians and patients should initially select non-pharmacological treatment including exercise like yoga or tai chi, multidisciplinary rehabilitation including massage, spinal manipulation and acupuncture, and mindfulness based stress reduction such as cognitive behavioural therapy.[9]











Condition in Review: Panic Attacks and Anxiety

According to Beyond Blue, up to 40% of Australians will experience some kind of panic attack or panic disorder in their lifetime and up to 45% of Australians will suffer from some sort of mental illness. In any one year, around 1 million Australian adults have depression, and over 2 million have anxiety. (viewed 27/1/16,

What are panic attacks and anxiety?
Breslin defines panic attacks as “an episode of panic often accompanied by sweating, increased heart rate, rapid breathing, dizziness, feelings of unreality, fear of dying etc. usually as a symptom of mental illness or psychological disturbance” (Breslin M et al 2007 p. 266) and
anxiety as “apprehension and fear manifested as palpitations, sweating, tension and stress”. (Breslin M et al 2007 p. 27)

What causes panic attacks and anxiety?

There a number of factors contributing to the risk of developing panic attacks and anxiety;
Genetic factors – high levels of anxiety and anxiety disorders as such are generally not inherited, however what can be inherited is a general sensibility or learned behaviours
Physical factors – high intake of caffeine, nicotine, and using stimulant drugs such as LSD, cocaine, amphetamines and marijuana have been seen to increase anxiety in a person who has predisposition to it; withdrawal from drugs; poor nutrition; muscle tension are also contributing factors
Environmental factors – childhood experiences, cumulative stress, adverse life events or major loss or life changes such as exposure to abuse, loss of job or loved one
Behavioural factors – avoidance, recreational drugs, poor nutrition, lack of exercise
Physiological factors – negative, unrealistic & irrational thinking; unhealthy beliefs; types of beliefs (good and evil, dread, guilt)
•A combination of the above factors3

What are the signs and symptoms of a panic attack?
“Common somatic symptoms are facial flushing, hyperhydrosis (excessive sweating), muscle tension, parenthesis (numbness and tingling), shallow (or rapid) breathing, syncope (fainting) and tachycardia (rapid heart rate).

The emotional symptoms of anxiety disorder occur simultaneously with the somatic ones and include agitation, derealisation (feelings of unreality), fearfulness, feelings of ‘impending doom’, irritability, nervousness and shyness” (Prosy J., 2006, P. 15)

“I was unable to attend my children’s school concerts or take them to the pictures as I would have panic attacks…”

What is the treatment for panic attacks and anxiety?

Everyone’s experience of anxiety and panic attacks is as individual as the person. Treatment will be different for everyone, whether it be psychological, medical or other types of support it needs to be understood that treatment takes time and often a lot of trial and error before finding the right balance.

Treatment needs to be tailored to your condition, circumstances, needs and preferences. Most people with anxiety benefit from one or a combination of the following:

  • lifestyle changes and social support
  • psychological or ‘talking’ therapies
  • medical therapies

Can massage help?

“Relaxation techniques, breathing exercises, and biofeedback are often taught to anxiety disorder patients as coping mechanisms; it seems reasonable that massage and bodywork would fit under this heading as well. Indeed, several research projects under way have shown that touch in general and massage in particular are effective in reducing self-reported anxiety in various populations.” (Werner R., 2009, P. 258)

“Positive changes have been noted in biochemistry following massage therapy including reduced cortisol and increased serotonin and dopamine. Many conditions were positively affected by massage therapy including depression and depression-related conditions, pain syndromes, autoimmune and immune chronic illnesses, and stress conditions. The underlying mechanisms for their effects remain to be understood.”5

“Standard medical treatments include cognitive behavioural therapy, pharmacologic therapies, or a combination of both. Natural therapies include treating anxiety with nutrition, vitamins (such as B-3 and B-12), minerals and amino acids.” (Prousky J., 2006, p25) Referral to a clinical psychologist is usual, but a naturopath or nutritionist could also be beneficial.


Everyone’s different and it’s often a combination of factors that can contribute to developing anxiety. It’s important to remember that you can’t always identify the cause of anxiety or change difficult circumstances. The most important thing is to recognise the signs and symptoms and seek support.

If you or someone you know is suffering from anxiety please contact Beyond Blue to get the correct support you need.


1. Breskin M., Dumith K., Pearsons E., Seeman R., 2007, McGraw-Hill Medical Dictionary for Allied Health, Career Education, New York
4. Prosy, Dr. J., 2006, Anxiety; Orthomolecular Diagnosis and Treatment, tri-graphic Printing, Ottawa