Exercises to beat BACK PAIN that really work!
STRUGGLING with chronic back pain? Painkillers not helping? In last week’s Good Health, physiotherapist David Rogers and musculo-skeletal specialist Dr Grahame Brown, of the Royal Orthopaedic Hospital in Birmingham, set out their ground-breaking approach to persistent backache. Today, they reveal the simple steps that can liberate you from the spectre of pain for ever.
Persistent back pain blights many people’s lives and, because there is often no obvious cause, there is no clear ‘solution’, either.
Based on our combined 35 years’ experience in treating such patients, we’re convinced that the answer for these patients is not more scans or hundreds of pounds of physiotherapy or manipulation, or even surgery. the solution, instead, is a ‘biopsychosocial’ approach to pain.
What does this mean? it is a recognition that chronic pain is not so much about any injury or damage you might have sustained — after all, nothing may show on a scan.
rather, it’s the result of changes in your nervous system and how your body and brain respond (the ‘ bio’ bit), and what you think about your pain and how others around you respond to it (the ‘psychosocial’ bit).
tackling all these elements is the best solution to persistent pain. And key to this are subtle exercises and simple lifestyle changes that, while small individually, combine to make a huge difference overall to your level of pain and ability to function.
this idea, the so- called ‘ marginal gains solution’, was developed originally by sir David Brailsford, director of the highly successful British cycling team (who shaved fractions of a second off times by making minuscule adjustments in many areas of preparation and rehabilitation), and is now regularly used to improve performance in business and sport.
in last week’s Good Health, we introduced the idea of ‘ active relaxation’ and breathing exercises to calm the stress response and enhance the effectiveness of your body’s natural pain- relieving strategies. today, we focus on movement.
People with persistent back pain very often learn to avoid activity and find everyday movements such as bending, lifting and twisting difficult. the complex nerve connections from the brain to the muscles of the back soon become redundant, making these activities more difficult.
Without regular movement, the back muscles can start to waste, and the muscle fibres, ligaments and tendons that connect the muscles to the bones shorten.
this all contributes to the stiffness you feel in the part of your body that has been in pain, creating more pain.
the good news is these changes are reversible: muscles can be built up again, ligaments and tendons can — and should — be stretched regularly to allow more flexibility and movement.
the most important step anyone with persistent back pain can take is to get moving, no matter how you do it. As long as you start gradually and build over time, you will be altering the neural pathways, reinforcing healthy ‘i can do this’ messages from your spine to your brain and diluting the ‘this is very dangerous’ messages that trigger a stress response, which compounds your pain.
Pain is a protective response — it will encourage you to guard against moving too much. this may be helpful when you have a new injury, as it protects the area that needs to heal, but when pain is persistent, this response has outlived its usefulness.
You just need to set small, manageable goals, then commit to working through the gentle stretches and exercises (right) at least once a day.
if your pain has left you fearful of exercise, try building everyday activities first — climbing stairs, bending down to load the dishwasher, or moving from sitting to standing.
small beginnings such as this will reconnect neural circuits within your nervous system. the more they get used, the stronger the connections become.
SETTING GOALS
settinG meaningful goals is the first essential part of your recovery.
When you are blighted by persistent pain, the future can, at times, look bleak, but achieving meaningful goals (whether it’s walking to the shops, doing an aquarobics class, or cutting back on medication) can have a remarkable impact on your selfesteem, confidence and self-belief.
even if you still feel some pain, it helps you realise that pain doesn’t have to be a life-restricting problem. setting goals and visualising them helps trigger the release of powerful natural pain relievers that will help to turn down the dial on your pain and allow you to start feeling better.
Pick a goal, any goal, as long as it is sMArt — specific, Measurable, Achievable, rewarding, and timeoriented (it needs a clear time frame so it can’t be put off).
WHAT IF THE PAIN DOESN’T GO?
even if you notice dramatic improvements after trying the strategies we suggest, you may have to accept you won’t get rid of the pain completely.
this may seem depressing, but researchers have found that if you focus instead on getting back to
activities that give purpose to your life, you will enjoy improved quality of life, better function, and, curiously, you should feel less pain. Accepting some level of pain, and the feelings, thoughts and emotions that go with it, rather than getting angry about it, can be really helpful and can even boost your recovery. You may also have to be alert for flare-ups that can strike unexpectedly and drop you right back into remembered pain states, momentarily slashing your new-found confidence. It is important to be aware of possible triggers and have a plan in place to reduce the impact should a flare-up occur, so you can recover quickly and get back on track. Typical flare-up triggers are overdoing things (which is why setting small, manageable goals is so important) and stressful life events (such as an argument at work, or an unexpected family problem).
A particular location, perhaps the place where your back problem originally started, can trigger pain if your brain subconsciously registers threat and alarm. This is because the part of the brain responsible for danger-alert signals is always poised to protect you from danger.
Whatever the cause, if you are stressed or fearful, you will, without realising it, activate your ‘fight-flightfreeze’ response: this prompts the release of stress hormones (such as cortisol) and other chemicals that wind up your nervous system and increase muscle tension and pain.
The way that you respond to any flare-up is crucial to the amount of pain you experience.
MANAGING A FLARE-UP
IF PAIn strikes, try to keep calm. Pain is likely to stop you thinking rationally, as the ‘survival’ part of your brain hijacks the thinking part.
But the longer this goes on, the stronger the pain and the longer it will take for you to get over it, so do what you can to put an immediate stop to any catastrophising thoughts (‘here we go again, I’m back where I started, I’ll never be pain-free . . . ’)
As soon as possible, relax yourself using the 7:11 breathing technique outlined last week (breathe in for a count of seven and out for a count of 11 — as long as your exhale is longer than your inhale, you’ll be stimulating a natural relaxation effect). Accept that the flare-up has happened. This will lower your stress levels quickly and facilitate recovery. Battling the pain, getting cross or trying to ignore it will only increase stress and make you suffer more.
Remember, the flare-up is most likely due to your fight-flight-freeze system working overtime, rather than actual injury to your back.
If the pain feels familiar, it is unlikely you have new damage and you can start your recovery plan immediately. If the pain is unfamiliar, see your GP.
When you feel ready, start trying the gentle stretches and exercises outlined above and make time for short spells of active relaxation. Find something restful and relaxing that works for you — it might be singing, chatting with friends, fun exercise, gardening, solving puzzles — then ring-fence time to do it and stick to your plan. Watching Tv, playing computer games or any screen activity does not count. Short-term use of medication might be helpful to allow you to get moving.
Return to normal activities as soon as possible — this is a very important part of your recovery.
eXtraCted from Back to Life: how to unlock your pathway to recovery (when Back pain persists) by david rogers and grahame Brown, from vermilion at £12.99. to order for £9.74 (valid to august 8, p&p free for orders over £15), visit mailbookshop. co.uk or call 0844 571 0640.
BeFore following any exercises or recommendations mentioned in these pages, you must be sure that your back pain is not due to serious illness. please consult with your gp first.