CTH Healthcare Articles

6 Facts about Back Pain: things you may not know about Posture, Movement and Exercise

solution to chronic back pain image

I’m constantly fascinated by the variety of people who come into clinic for help with pain and injury.

One of the most consistent problems is the mis-information that they have picked up and a huge part of my role is re-educating people about what is ‘good’ and ‘bad’ for us and our bodies. So often people are in ‘protect mode’ because they’re nervous about doing damage: they haven’t realised how robust and adaptable we are.

So this blog is just a few golden nuggets which I hope will be useful. As always, if you have any questions about the post or anything else get in touch.

1. Exercise and movement are useful if you have back pain.

Whether it’s a long term problem or your back has suddenly ‘gone’ for no apparent reason causing acute pain, returning to normal movement is important for a quicker recovery. If you avoid moving your muscles and joints, you become less used to movement and you can get yourself into a bit of a catch-22 situation where moving causes pain but moving less causes more pain, this can be a pretty scary place to be.

Start with simple walking and as your confidence grows try other movement or exercise that is predictable, like using a static bike. This way you’re in control and you can move without worrying about having to respond to anything unexpected. If you can relax in movement then your muscles will relax and do their job without tightening up in ‘protect’ mode.

If you are scared about moving or fear something is seriously wrong seek help. If you feel reassured it’s much easier to have the confidence to move normally, and this is can be incredibly helpful in avoiding a long term problem.

(Click HERE for signs and symptoms that indicate you need to be checked out in case of more serious problems – keep in mind this only affects 1-2% of people with back pain, if that!)

2. Keeping your back straight may seem like a useful way to protect your back but it’s counterproductive.

Joints and muscles (and everything in between) respond to movement. Joints exist for movement, because of movement; this includes the spine, which has 24 bones creating many joints which are supposed to bend and move in 3D! So bending and twisting are a normal part of whole-body function and keep your spine healthy, the more conditioned your joints are to normal 3D movement (i.e. the stuff we all do every day, without thinking too much about it), the better. If you put a lot of effort into keeping your spine straight you’ll end up exhausted, with tense, tight muscles, and you’ll more likely prolong any back problem. It’s not a sustainable strategy and ultimately it won’t help.

3. Rest isn’t helpful, especially long term, and won’t help you recover quicker.

Spinal joints and muscles recover better from sprains, strains and injury with movement. Some rest is ok, but gentle movement and walking helps to relax tight muscles and also helps drain inflammation (an essential part of healing).

If someone comes into clinic with a sprained ankle, straight away we’ll look at movement strategies that are comfortable and encourage confidence. This is the same with back pain or any other joint problem. The key is finding movement that is comfortable, which can look quite different from one person to the next, and creates powerful strategies that help people respond to pain proactively so they can recover quicker.

5. You can’t damage your back with ‘normal’ movements like bending, or by sitting, or even slouching.

‘Bad’ posture isn’t dangerous, it reflects what the body has adapted to. I see a lot of people who say they have terrible posture and that is causing all their pain. But often this isn’t the case at all, after all, there are many people who don’t have ‘perfect’ posture with no issues.

If all you do is sit hunched over a desk all day, your posture may reflect this because our bodies adapt to whatever we ask of them, it doesn’t mean you will necessarily have pain. My mum’s a case in point: 30 years of long hours at a desk but no back pain. If you do have pain think of it as useful information telling you that something needs to change – it may well be more to do with stress and tight muscles than actual damage in your back … everyone is different and the reason you have pain is specific to you. One thing is for sure: we’re very good at adapting which means there’s a lot of scope for improvement, whatever the cause.

4. The majority of back pain is due to muscular response as part of a protective mechanism.

Our ‘protect’ response is the result of stress (physical or emotional). It depends on the person and the state of their body and biology. If you are are adapting well to the demands placed on your mind-body then you’ll feel confident in movement, you won’t be thinking about your body too much and you can get on with what you want to do. Conversely, if you’re not adapting well you might feel you are fragile, broken or injured because you have pain. To protect yourself is a normal response to pain but for the vast majority pain isn’t due to damage, and causes maladaptation – behaviour that becomes more harmful than helpful. For example if you stop moving because you are scared of pain and damage, you become less used to movement which creates it’s own set of problems.

Strategies that help muscles relax rather than protect during movement are the most effective short term and long term.

6. Pain doesn’t automatically mean there is structural damage.

This is especially if there has been no recent physical trauma, such as a significant fall or physical impact, and there are no underlying health problems. We are highly adaptable and recover amazingly from injury, especially if we make movement part of how we live and heal.

This doesn’t mean ignoring pain or just ‘pushing through’. Most of the time we get over pain and injury fairly quickly on our own, especially if we automatically turn to normal movement as part of the healing process. But if you’re not recovering as well as you’d hoped then seeking new strategies that enable progress and movement confidence may be a good option.

STRATEGIES for dealing with back pain:

– Think about back spasms like cramp: horribly painful but not necessarily dangerous.

– Abdominal breathing is a useful tool to relax your back muscles. Practice while lying down or sitting (relax into the chair back), think about expanding your abdomen on the in-breath rather than the movement happening in your chest.

– Aim to move around gently in a smooth relaxed way, this sends useful signals to your pain system to help ease muscles spasms.

– Experiment: try out different movement to see what feels best, see if your symptoms improve the more you relax in movement.

NB. Seek help if you have severe pain as a result of recent trauma such as a physical impact or fall, if your pain isn’t improving or you have other new symptoms.

Click HERE to find out more about symptoms that require medical investigation.

Pain and Running

For the non-runners out there the words pain and running may be synonymous, but that’s a conversation for another time…

Today I received this great feedback from Beth, a seasoned runner who came into clinic a while ago, unable to run:

“Carry, I hope you are well! I’ve been meaning to message to say how grateful I am for the advice you have given me… I’m 5 weeks into marathon training and have had no issues so far which is a miracle for me, considering my previous injuries and the mileage I’ve been clocking up! I did a 25km run last weekend and only felt muscle soreness!! … I’m so thankful for your advice… I’ve never gone this long without an old injury playing up or doing something new to myself!”

Do you have ongoing pain? Do you have 5 minutes?

It’s Time to Rethink Persistent Pain

How we think about pain is really important – there’s a reason that chronic pain has become a huge burden on the NHS, and it’s not that people are more ‘broken’ than they used to be.

Painful Misconceptions: The Good News about Chronic Pain

When Dr Cath Spencer Smith, fantastic Sports Medicine Doctor in London, asked me to write a guest blog for her, I of course jumped at the chance to write about the subject I’m most passionate about. Pain.

Here it is…

Pain is a BIG topic. The science and research around pain have been rapidly evolving over the last 10 years or so; it can be complex to deal with but we know more now than ever before, and that means we are better at understanding and dealing with it.

Chronic back pain? Forget posture!

Are you constantly trying to sit ‘well’? Sit ‘better’? Sit up straight? Stand tall? Pin your shoulders back?

Do you have chronic or on-going back pain?

The best advice I can give you is to relax.

Relax more. And relax in movement.

Do you really have Sciatica?

I’ve had many people walk into my clinic telling me “I have sciatica”, when actually, they probably don’t. There are numerous things that can cause buttock / leg pain, which may resemble something like sciatica, and they can be agonizing – nerve impingement or not. But the reality is that it’s pretty hard to compress a big old thing like the sciatic nerve.

The Solution to Chronic Back Pain?

Back pain is a big problem; it’s ranked as the highest contributor to disability in the world. Cost of treatment is rising, there are forever new and improved technologies but the relative benefits aren’t actually growing. So something is amiss.

Great article in The Times today… Exercise is Powerful Medicine

The Times published an article today: “Pilates not painkillers the best cure for backache”. Hopefully this will fast become common practice advice given by anyone helping those with back pain. Because we agree, there is no substitute for movement – it has been our philosophy for a while. Here are some quotes from the article and my take on things…

Is Running Really as Bad for You as Some People Say?

Are you trying to talk yourself into or out of running? As is the case with most health related related questions, everything in moderation isn’t a bad rule of thumb. But it depends on the individual, their history, their goals, etc… it also depends on whose opinion you are listening to. There will always be different schools of thought.

How to Avoid Old-Age Disability (this isn’t aimed at old people!)

Research demonstrates that disease and disability are not an inevitable part of ageing and it is thought that genetics account for about 35 percent of lifespan. So modifiable environmental factors contribute more: that means you actually hold much of the power in determining your fate in later years.

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