In a previous blog, we discussed concepts related to the neuroscience of pain. These concepts are essential for you to understand before diving into a pain recovery program. So if you haven’t yet (but we know everyone is an avid reader of Rehab Renegade), check out a previous blog post. Now that we’re all caught up, let’s focus on strategies to improve back pain.
As Butler and Mosely so cleverly put:
“KNOW pain, or no gain.”
A common misconception in the chronic low back pain field is that people often do not manage their pain. Family and friends grow tired of hearing about their loved one’s debilitating ailments. Eventually, these people are labeled “unwilling” to fix their symptoms. Based on our clinical experience and literature, we would disagree with that assumption. For us, people typically fall into one or two categories: avoiding pain or beating pain.
“(When) Avoiding pain…the natural response is to stop activity when pain starts. (When) trying to beat pain… pain comes on but you persevere…until suddenly your pain is unbearable and you bust” (Butler, Moseley, 2003)
Both approaches are incorrect. Why? It’s because both strategies eventually lead to the same level of activity before pain occurs. You guessed it… it’s low.
For a better understanding of how these two strategies pan out for pain sufferers, check out the graphs below:
(Explain Pain, pg 107)
As a quick reminder: low back pain does NOT equal damage to your body. Pain is the body’s response to what is perceived as damage. In cases of chronic back pain, the brain is perceiving a non-threatening activity, like bending over, as threatening, and is reacting with intense pain. We know with persistent chronic pain (more than 6 months) nearly all tissues in the body have healed adequately, but pain is still present.
We must respect the pain experience, but not cater to it. In our last blog, we discussed the benefits of graded exposure. Let’s take it a step further into ways to implement this technique properly. So go ahead and pull out the technology of your choice (or notebook if you’re old school) and jot this down.
First, select an activity that you enjoy or would like to enjoy. You then need to determine your baseline for activity. How does a half hour of walking feel? Way too much? Okay, how about 5 minutes? Still too much? How about 2-3 minutes? No amount of exercise is too small and no initial baseline is wrong. Maybe you’re unable to sit on the porcelain and hum “Love Yourself” by Justin Bieber, but maybe you can hum half of it. Make that your starting point.
Next, you need to plan your steps of progression. Note: you have to plan it in advance! If your progression is to increase your walking time by 30 seconds every week, then that is what you do. Even if you feel great that day or you feel bad. Remember, pain is NOT a proper indicator of damage.
Respect your back pain, but do not cater to it.
On the other hand, do not continue to push through if you reached your daily goal. Progress is slow and conscious.
Remember we are attempting to avoid flare-ups, but it can be common to experience them while you progress. It’s important not to get frustrated with yourself. Remind yourself that the exercise you provided just activated the warning system, but did not cause damage to your body. As you continue to progress, the threat system will decrease in sensitivity and you will be able to perform more activity without back pain.
-Chronic pain individuals typically follow a push through pain or avoid pain mentality, which tends to end at the same level of discomfort.
-The proper way to progress pain is to respect pain to a point that the individual does not overdo it, but does not avoid painful stimuli.
-Find an activity that you enjoy, determine your baseline, plan a progression in advance, and don’t get discouraged from flare-ups!
Keep in mind your doctor is always there to help; do not hesitate to reach out with questions.
Brendan Glackin, DPT, CSCS
Glackin Physiotherapy, LLC
Butler, David S, and G L. Moseley. Explain Pain. Adelaide: Noigroup Publications, 2003. Print.