You love playing golf, going to boot camp classes or CrossFit, running or perhaps it’s BJJ or tennis that is your thing. Regardless it is regularly interrupted by back pain.
You can’t think why as there is no obvious cause.
But you’ve got sharp, achy, persistent back pain that doesn’t seem to be going, it’s easy to just accept it, carry on with your life thinking it’s something that just “happens with age”.
You might have the odd occasion when your back pain frees up, you think that’s it, it won’t come back…
…Days, hours or even minutes later the pain has returned, and it’s even worse than before.
All you can think is “why is this lasting so long?” “How long will it take before it gets right?”
“Why is this happening to me?”
We understand how frustrating this can be, affecting your mood, energy and the way you’re moving every day.
Let’s start by taking a look at some of the misinformation around back pain.
It’s Very Common
▸ Approximately 80% of adults will experience back pain during their life.
▸ Back pain can be sudden onset and a short-term problem, however, left untreated it can develop into a chronic/persistent and debilitating issue.
▸ Back pain is the leading contributor to missed work days and the most common cause of work-related disability.
It all sounds pretty bad really, doesn’t it?
The thing is back pain is no different from any pain in other areas of the body.
It is, though, talked about differently.
With pinched nerves, slipped discs and all other manner of things being talked about as the cause of the pain. Yet most people will have experienced a disc bulge at some point, especially as we get older.
MRIs and CT scans do NOT always identify the cause of back pain.
Here are the surprising percentage of people whose MRI or CT scan shows “disc bulging” in adults WITHOUT back pain:
▸ 30% of 20 year olds
▸ 60% of 50 year olds
▸ 84% of 80 year olds
In other words, just because an MRI or CT scan says you have disc degeneration or disc bulging, this may not be the cause of your pain.
But you want to be able to continue going to Boot Camp, out for a run, going to your spin class so what are you to do?
What is important in back pain? What isn’t important?
Much talked about but almost irrelevant to your back pain is your posture.
It may be controversial but your posture doesn’t play much of a role in back pain. In fact, I make use of a lot of the types of positions that are supposed to be bad for you in treating back pain.
Why isn’t it important?
Posture isn’t important because in the case of what you are doing at your desk there isn’t enough happening to cause a problem.
In fact your back is almost entirely relaxed and unloaded. One of the reasons I use this position to help people with acute back pain.
One of the reasons we can get a sore back after spending time sitting at a computer is because we haven’t moved much.
We’ll talk about where posture is important in another post. The short answer is when you are doing something a bit more demanding than sitting at your desk.
A Strong Core
Having strong abdominal muscles is very helpful in a lot of things but isn’t something that helps in stopping back pain.
That’s crazy talk I hear you say.
Yet I have a client who has broken their back and then went on to deadlift 140kg. Anybody who has lifted anything heavy knows that your core needs to be strong to stop your body bending under the weight.
Yet for all this, she was still getting episodes of debilitating back pain for all that she was undoubtedly strong. And no she wasn’t doing more harm training as she was as the symptoms didn’t increase.
It also highlights that just because you’ve injured your back it doesn’t mean that your life is over.
Is avoidable in all but the most serious cases and not that successful most of the time.
Spinal surgery is fairly evenly split in terms of outcomes with a 1/3 getting better, a ⅓ seeing no change and a ⅓ actually getting worse after the surgery.
Yes, you have got a 1 in 3 chance of getting worse if you go down the surgery route!
The case for complete rest in any injury outside of the initial acute period immediately after it occurs is poor. There is always some level of work that can be done to the area or the those surrounding it.
Back pain is no exception.
In all cases where we aren’t talking about an injury but rather a flare up of a previous injury then there is always something that can be done. This might be very gentle isometrics when the pain is at it’s worst or more movement when it isn’t as bad.
Stress, Low Mood & Worry
These are all much more important to back pain, and any other persistent pain, than posture or many of the other things that you read about.
Work related stress is probably the biggest cause of back pain in the UK.
This brings us to sleep.
Sleep or the lack of sleep has a big impact on back pain.
When we sleep we recover from the stresses and strains of the day. It, along with what we eat, is what drives our recovery. If you sleep badly you’ll never be as “good” the following day.
You’ll be more cranky and irritable. You’ll notice all the little aches and pains and they will seem much worse.
Getting a good night’s sleep is something that helps a lot of different things. All of which means that you are much less likely to suffer from any recurrence of your back pain.
Exercise really isn’t to be avoided. Yes, on the days where you have an acute flare up you might not be able to do much but you can often do something easy and gentle. This might be going for a walk or you may be able to do a little gentle stretching of other areas.
When you don’t have a flare up then you shouldn’t approach exercise any differently to anyone else.
It’s all too easy to stop doing things when you have back pain that comes and goes on a regular basis but it is the worst thing that you can do.
If you have been avoiding exercise then start easy and gentle and work up from there.
DO YOU WANT TO UNDERSTAND YOUR BACK PAIN BETTER? THEN ENQUIRE ABOUT ONE OF OUR FREE BACK PAIN DISCOVERY SESSIONS.
What is going on?
We can be confident that there isn’t a serious injury in the overwhelming majority of back pain cases so what is going on?
To begin with, there has often been an incident in the past that was a genuine injury to something in the lower back area. We can also be pretty confident it wasn’t dealt with well.
Why so confident? Because you are routinely experiencing back pain.
When you get injured the body is pretty good at healing itself given a bit of time and a bit of rest. I said a bit of rest, as mentioned earlier prolonged complete rest is counterproductive. It doesn’t work because it means you end up stuck.
When you rest too much the body has no reason to adapt so remains the same. Post-injury this means you will get stuck at somewhere after there point where there is no pain.
What we need to happen is to expose you to more demanding tasks and greater ranges of movement in different directions. I doing so we n]make sure that you don’t lose movement capacity or strength.
I just bent over to pick up the paper
This refrain and others like it are so common and seem to come with many back pain cases.
So what has happened that just bending over to pick up the paper results in back pain?
When back pain is present for long periods of time and especially when there are repeated bouts of more severe pain, you tend to lose range of movement and the ability to tolerate many movements.
It is very common for someone in pain to slowly but surely to start avoiding certain movements because of painful experiences when they do them. This results in losing the ability to safely move in this manner. You effectively stiffen up.
If you lose the ability to move in a certain direction safely then there is always the chance that when you do that you will irritate something. Notice I did not say injure anything but rather irritate something be it a muscle, a ligament or a tendon.
What you need to do is gradually work at moving more and in different directions rather than avoiding certain movements.
Our spine is meant to move in all directions. Some parts of it move more than others but it is supposed to move and be comfortable doing so.
It is, for this reason, I’m not a massive fan of pilates for those with back pain as we tend to be compounding the idea of the need to be stiff.
Many people who have back pain have notably stiffer spines with less range of movement than those who don’t have back pain. It, therefore, makes no sense to start teaching you to be stiff when moving when you are already very stiff.
This doesn’t mean that pilates is useless but it does mean it shouldn’t be the starting point of any exercise program for those with back pain. I’m a much bigger fan of yoga because of how it teaches you to relax and explore more movement.
The PST way
Our 6 step system looks to identify these types of issues that I’ve just mentioned.
From how well you sleep to what exercise you do.
What injuries you’ve had in the past.
The fact you simply hurt your back bending over to pick something up.
These all give us important information about your back pain.
Your story is vitally important to understanding the cause of your back pain. Just as knowing your real goals are vital in ensuring a successful outcome for you.
Once we’ve identified the important points in your story it makes finding the true cause of your back pain so much easier.
Finding the true stressor
It can be easy to think of the source problem being from one area when it is actually from another one completely. You feel the pain most of the time in one particular area and think that weakness there is the issue.
This can be the case but often as not what you are noticing is simply a very overworked area. The area becomes tight and stiff as fatigue builds. As the area tightens it doesn’t tolerate movement well.
From digging into your story we can see what you’ve been doing. What you’ve been avoiding and where this started
A common one in back pain is that the issue begins in the hip.
The muscles around the hip stop working as well. It might be through injury to themselves or to another area and this affects the lower back.
The importance of the hip, and lateral glutes in particular, to the lower back, can’t be overstated.
The main job of glute medius and minimus on the side of the pelvis is to stabilise the pelvis and torso as we move. If they aren’t doing this then the muscles of the back have to take up the slack.
Similarly with the hamstrings. Anyone who is active from gardening to running needs the hamstrings working well. They play a very important role in absorbing and transmitting force. If there is something up here then the lower back will catch some of it.
Dealing with movement handbrakes
After highlighting these movement handbrakes in the assessment we need to deal with them.
This is the first part of the actual hands-on treatment process.
It is where we begin to peel back the layers and get you moving well again. Because they are the crux of the issue we spend more time on these than we do on the more painful areas.
It begins with soft tissue work and moves onto gradually more demanding tasks.
For a golfer, it will mean working on rotational drills to help ensure that the rib cage moves well. But also that their hips can tolerate the high rotational and lateral forces that come in the golf swing.
For a Crossfitter it means ensuring that they can engage their upper back and arms when lifting off the floor. Thus generating good stiffness in the torso.
If the previous step about identifying and removing your movement handbrakes then the next step is about creating resiliency.
We know people with back pain tend to be quite stiff. This means that you will lack the ability to create stiffness.
The ability to create stiffness is fundamental to good movement.
It sounds wrong, doesn’t it? But it isn’t a typo.
With every footstep when you are running the leg needs to instantly stiffen to absorb the forces involved. When you lift something heavy the torso needs to be stiff to allow the force you are generating with your legs to result in upward movement and so on and so on.
Having dealt with the inability to do this in the previous step we need to ensure that you can do it all the time.
To achieve this simply requires gradually more demanding tasks. It is as simple as that.
You need to challenge the areas to be able to tolerate the types of movement you have been avoiding. From stepping and hopping type drills to lifting.
Another of the steps in our system comes towards the end of the process. Here we start to reintroduce movements that actually mean something to your goals.
It is pointless to go through weeks of rehab feeling like everything is going well because there is no pain and your range of movement has improved significantly. The markers used, the standard range of movement tests or levels of perceived pain, are improving if things are not tested in the “real world” of what you want to do.
At this point, we need to begin using plyometric drills if you run. We use these because they subject the body to similar stresses to running and we can do them in a graded manner. In the case of a golfer, we’d start working in some of the smaller clubs.
This way we can gradually increase the amount of swing and effort being put into any shots. Regardless of what it is you want to be able t do we need to make the later stages of the process relevant to it.
Empowering you to live life to the full
After going through our step by step system we create you a plan to move forward with.
This covers warm ups and how to structure them so as to truly prepare yourself for what you are about to do. This can be as simple as a set of 3 or 4 of the rehab drills that gradually increase in the degree of challenge.
One of my clients, Heather, broke her back around 10 years ago. To be fair to her she didn’t let this get in the way and remained very active. Rowing at university, doing Crossfit and competing in powerlifting.
Through all of this, she would get episodes of mild to severe back pain.
When competing in powerlifting she deadlifted 140kg. Whatever she was doing she was finding some way to create stiffness in her torso under maximal loads. This we cannot dispute, you can’t deadlift 140kg and not be creating some torso stiffness.
Yet she was so stiff there was little flexion or extension in her spine. She had little tolerance for movement outside of a very narrow range.
We worked on improving this as a fundamental part of her rehab. Then when we reintroduced the likes of deadlifting and squatting back into her program she got really bad DOMS through her torso.
The main reason she was getting this was that she was now able to really use the core properly when she was lifting.
At the time of writing, she is feeling great and gradually upping the weights in the gym as things are feeling pretty good.
For all the sexy goals of being able to do this or that in the gym she told me at the weekend she now gets out of bed in the morning pain free.
DO YOU WANT TO UNDERSTAND YOUR BACK PAIN BETTER? THEN ENQUIRE ABOUT ONE OF OUR FREE BACK PAIN DISCOVERY SESSIONS.