BY EOIN EVERARD
Successfully avoiding future back pain, managing current pain and achieving full potential from your back requires that you adhere to the “code”, that is, the “code” required for a resilient back and a pain-free lifestyle.
As Captain Barbosa stated in that famous line in the film “Pirates of the Caribbean” upon reneging his deal with Elizabeth, “Ah, the Pirate’s code – they’re more like guidelines!” The following principles aren’t the absolute rules for recovery but rather set of wise guidelines intended to be adaptable to you.
Here are some guidelines that form the code for achieving better back health.
Dedicate yourself to practicing healthful back activity everyday.
Appropriate movement positively influences the health of every body system. Make a conscious effort to engage in healthy movement every day, and soon enough this will become a habit.
Get the big picture right – maintain balance.
You will achieve optimal health and healing by creating a balance of appropriate sleep, good diet, and a matched activity/training program. Those who fail to recognize the importance of this balance will continue to rob Peter to pay Paul. Peter is opportunity and Paul is a lead weight dragging you down and thwarting your progress.
Remove the cause. Avoid painful and weakened postures.
There is a direct correlation between posture, position and pain. Avoiding painful and weakened postures is one of my paramount principles. Prepare the spine to bear load successfully by seeking and maintaining neutral spine posture.
Common sense corollary guideline #3: if certain postures and movements induce pain, identify these painful and weakened postures and avoid them!
The trick is in performing “spine hygiene”. This means moving well throughout the day, avoiding painful movements, expanding your pain-free repertoire of activity capacity, and building some capacity for corrective exercise. In other words, what you don’t do is just as important, if not more, as what you do do. With the Back-Aware Back plan we go over these movements in detail and show you how to use your belt to avoid the painful triggers for your spine.
Beware of clinicians whose “treatments” require numerous return visits.
If you are injured and in pain and seek professional help, expect the competent expert to address and heal the problem within a reasonable amount of time. If a clinician’s expertise lies in relieving pain without curing the cause of the pain, the patient ends up seeing the clinicians business, they do nothing (other than possibly offering temporary relief) to address the overriding issue. The best clinicians see you fewer times, as they teach you how to take responsibility for your healing, and give you the tools to do so.
Be aware of “passive treatments”.
Treatment falls into two broad categories:
Passive treatment: designed to cure the pain (the symptom)
Active treatment: designed to address and cure the cause
Passive treatment is having somebody do something to you. For example, having an ultrasound machine rubbed over your back is passive treatment: the patient simply sits, stands or lies down while someone does something to the patient. Passive therapies administered from devices do not address or correct the cause of the pain. Passive treatment rarely increases the likelihood of a long-term back pain cure. In contrast, there is occasion where passive approaches such as certain chiropractic manipulations, or muscle based treatments address part of the cause. They can enable a window of opportunity to enjoy a period of pain-free movement. But they must be combined with active patient engagement in enhancing movement quality to cure a patient.
Active treatment requires the patient to participate in some manner or fashion that works toward a cure. For example, learning to move in a way that avoids the pain triggers is an active treatment. Avoid becoming an ATM machine for ineffectual or incompetent clinicians: reserve your right to walk away if the clinician focuses all their efforts on relief and none on cure.
Buyer beware – not all clinicians are competent.
Many back pain sufferers presume all clinicians are competent. Just as there are good auto mechanics and bad auto mechanics, good professors and terrible ones, there are good clinicians and poor ones. Patients tend to place medical professionals on a pedestal and a few will use this to their advantage. They adopt authoritarian attitudes that subtly or overtly imply, “How dare you ask questions about my professional methods!” But the patient is the consumer, you have full right to question why, and how a particular treatment plan is best for you.
Ultrasound, for example, a very popular passive technique, has never been shown to cure back disorders better than placebo. Surgery rarely cures the individual if after the surgery the patient continues to repeat the faulty movement patterns that caused the original disorder. I believe it should be legislated that no surgery can proceed until the mechanical cause of the pain been shown to the patient – I will couch you to find the cause in the next chapter. There is no questions that some soft tissue treatments such as a trigger-point therapy, Active Release Technique and topflight chiropractic treatment can assist in a fully successful program – assuming the treatments are few in number and they are combined with active treatments.
If you’ve left the Doctor’s office with only pain pills and no plan for active treatment, you did not see a back expert.
Truth be known, many family doctors admit they don’t know what to do with back pain patients. They mean well, however, prescribing pain medications is what they know. Unfortunately, patients who have pharmaceutically numbed their pain often make matters worse in that they are able to continue using flawed and perturbed movement patterns. This makes a bad situation worse.
You need to know what good movement pattern is before you can start prescribing it. There is nothing in the training of family doctors that provides insight into the world of cutting-edge back health.
Establish the subtle balance between strength, power and endurance, mobility and stiffness.
If you add too much strength, you can “overpower” your back. The counterbalance for too much back strength and power is endurance and control. Endurance enables you to maintain perfect movement patterns as you get fatigued, repetition after repetition. Injury occurs when the perfect movement form is lost, causing stress and pain. Spine conserving movement requires spine stiffness (or firmness), coordinated with the centered motion of the hips and shoulders.
One therapeutic size does NOT fit all!
We all are unique creatures, we all have different backs and different hips that influence the back. The idea that a single magical exercise program exists that can be used in every instance is a ridiculous myth. Too often medical professionals and physical therapists use a single mode or method for every single patient regardless of individualized circumstance. While that is easy and convenient for the doctor or therapist, it is disastrous for the patient.
It is critical that the healthcare provider delve deeply into the patient’s injury history and create a customized remedial strategy:
The first order of business is to make the right functional diagnosis – determine the motions, postures and loads that cause the pain.
The second is to remove the cause.
The third step is to choose the appropriate rehabilitative strategy that includes movements that avoid pain and heal damaged tissue.
The fourth order of business is to enhance and broaden pain-free activities.
Be aware that there are fundamental patterns of movement. This book is loaded with guidelines for pain-free ways to sit, walk, lift, drive, sleep and live life. If you seek professional guidance to help execute this plan, demand determination, care, and great attention to finding the cause, the corrective starting points, creating logical progressions of exercises and selecting an appropriate dosage. Upon completion of this book, however, most will be able to successfully direct their own plan.
Success is achieved through continued personal re-assessment.
As recovery progresses, the program must evolve. Pain-free movement patterns will expand, as will the “dose” of the training. Your pain-free tolerance will increase. The objective is to create training regimens that operate below the threshold that causes pain. If your training session leads to pain, you’ve done too much, too soon. Thus, the final state of a program should be directed towards reducing pain. Subsequent stages are designed following re-assessment to increase pain-free activity.
Consider this case:
The patient can find very few pain-free activities. Getting up out of a chair and walking five steps might be painless, however six steps causes pain. Hence, their current pain capacity is five steps.
In this particular instance, the individual’s five-step pain capacity is so low that it is not feasible for them to work with a rehabilitative specialist. The patient does not have sufficient pain tolerance. One method for increasing this particular individual’s pain tolerance capacity is a common sense approach: every hour get up and walk five pain-free steps. Slowly, over time, the patient will build capacity and be able to walk six steps, then seven, then eight and so on. Once the patient is able to walk say twenty steps, we might begin walks up and down the patient’s driveway every hour. When the driveway is no longer challenging, walk around the block three times per day. The work/rest ratio changes to fewer, but more demanding sessions. The progression is guided by taking stock and reviewing progress through each stage.
We have now reviewed the guidelines that form the code! Simply put, as you take your own journey away from back pain and toward back health, the more of these guidelines you can follow, the more successful you will be.