Introducing back pain
Back-pain is a problem that most people experience in their lives.
Some of us experience it a lot!
If you have pain that lasts for longer than 12-weeks this is officially termed chronic pain, chronic meaning long lasting.
It can be debilitating and affect your quality of life.
It’s no joke being in pain all the time, having limited mobility and, of course, that can affect your mental health as well!
There are few things in life more depressing than being in pain and not being able to do the things you enjoy.
But, is what we have always been told about back pain correct?
A while ago I wrote this blog which explains why the diagnosis of back-pain is important and that your beliefs play a big role.
Pain is multifaceted but there is now a compelling body of evidence that shows us the best medication for chronic back pain is exercise.
Yep, bed rest can do one, being inactive won’t make your pain go away and, in fact, it might be making it worse!
Science journal ‘The Lancet’ released an in-depth series of reviews on the current literature on effective back-pain treatments.
The following table shows some of the effective and ineffective popular interventions:
As you can see, exercise and education – meaning education on pain management techniques and management of expectations, plus correct exercise form – are top of the list of effective interventions.
Pharmacological (drugs) and non-pharmacological (injections and surgery) are not recommended as first-line courses of action any longer:
Interventional procedures and surgery have a very limited role, if any, in the management of low back pain.
Exercise is recommended for chronic low back pain.
Foster et al (2018) – See full reference at the bottom of this article.
Therefore, it is clear that rather than being given a prescription for pain medication and told to rest, you should be doing the opposite!
Manage your expectations and beliefs about your pain and then get yourself moving.
Let me expand…
Exercise for back pain
Combining my personal experience of dealing with back pain, training clients with back pain and studying empirical evidence, an approach along the following lines is ideal…
- Managing expectations – accentuate the positive!
- Remove pain trigger movements and postures.
- Correct breathing patterns – use the diaphragm.
- Improve proprioception (movement awareness).
- Improve hip and spine mobility and create core stiffness.
- Get stronger.
Point one may include the use of cognitive behavioural therapy or mindfulness-based practices.
Points two to four are what Dr Stu McGill would refer to as ‘spine hygiene’. This is basic care of your spine by applying mindfulness to your movement. You know when you’re demonstrating to someone how it always hurts when you do *THIS? Well, stop doing *THIS (*THIS being whatever causes you pain).
Points five and six are where exercise come into play.
I wrote a blog series on exercises for lower back-pain which you can find here.
As a guide to the kinds of exercises you should be looking to do in the early stages of your rehab, take a look at this graphic:
The three exercises shown above are just examples, there are progressions and regressions available depending on what your current level of pain or mobility is.
Here is how I would recommend you approach exercise intervention for lower-back pain:
- Stop intense exercise for a few days and focus on gentle mobility and walking. Allow the sensory pain experience to dissipate.
- Introduce a daily hip/spine mobility routine.
- Address any weaknesses in core stability or motor-patterning under load.
- Begin a progressive strength program focussing on squat-hinge-push-pull exercise patterns.
If you are unsure then I advise you to seek expert guidance from an evidence-based practitioner; either a reputable physiotherapist or corrective exercise specialist.
These principles are explained in great detail in my online program The Back-Pain Solution.
Finally, accept that you have pain and that this is often an unavoidable part of living.
Whether you are active or sedentary, the chances of experiencing back pain at some point in your life are very high.
But you are NOT your pain and YOU ARE in control of the situation, don’t let your pain control you!
Sure, it can be a pain in the arse… well back… but, as any Buddhist will tell you; life is suffering, deal with it!
A Buddhist might not frame quite like that, they don’t tend to be as blunt as me!
Laters, Coach Troy.
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., … Woolf, A. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368–2383.doi:10.1016/s0140-6736(18)30489-6