So you’ve had back pain for quite some time and aren’t sure what to do. You’ve been dealing with it for months, or maybe even years, and it has kept you from enjoying the activities you love. You may have tried several treatments to improve your condition, but at times it seems difficult to understand your body and know if what you are doing is safe and good for you. Your doctor may have said you need more exercise, but exercise hurts and you aren’t sure where to start.
Many people will begin an exercise program but stop short of completing it due to the increase in pain they feel either during or after it. There are several approaches to managing our pain, but first, we must understand what our body is telling us before we get any relief. Knowledge is important to reduce pain and fear.
“No Pain No Gain”
Often times people will begin an exercise regiment with the concept of “no pain no gain”, thinking that if they push through the pain that it will go away. In reality what they find out is that their body cannot tolerate the amount of stress and load they are placing on it. In this approach, the person will push through the pain barrier. This pain barrier is present to protect our bodies. With multiple tries at this approach to make their pain go away, they will become overwhelmed with the failure and give up on exercise altogether because “it didn’t work”. This will lead to further avoidance of activity.
Example: You begin a walking program in hopes to improve blood flow and decrease stress. However, you walk too long to begin with (depending on your tolerance it could be 5 minutes or 20 minutes). You then experience immense pain when you come home and cannot do any of your regular household chores. To no avail, you try again but with the same result, each time flaring up your condition with no improvement.
“If It Hurts Don’t Do It”
This approach will do more harm than good and can be characterized by avoiding any meaningful activity or exercise that can be beneficial to the body. It is often accompanied by fear, anxiety, and uncertainty about what might happen if “too much” activity occurs. You will become hypersensitive about any movements you perform and in turn, avoid the very movements that can help reduce your pain. Tolerance to activity and movements will decrease, limiting exercise and movement. But the key is that the body and tissues need to be stressed a little so they can adapt over time, which will allow for high tolerance for certain activities.
Example: Having experienced pain during walking you decide that this exercise is bad for you and you may be fearful that it will continue to harm you. However, this will not improve your body’s ability to perform certain activities and will decondition it further.
“Tease It, Touch It, Nudge It”
What does this entail you might ask? This approach is the happy medium between the prior two approaches. “No pain no gain” is too aggressive and “If it hurts don’t do it” is too passive. “Tease it, touch it, nudge it” lies in the middle of the prior approaches. It entails performing a specific exercise or certain tasks into a little discomfort. There will be some soreness and maybe an ache here or there, but this is necessary for the body to adapt to new thresholds of activity. Over time, as the task or exercise is performed, the body adapts to new activity levels. This will allow you to perform the exercise for longer periods of time or at heavier loads. You have successfully gradually improved your ability to perform tasks with less pain and at longer durations.
Example: You decide to begin a walking regiment. Your first walk can last 6 minutes or whenever you start to feel some aching/soreness in your low back. You decide to not push through into further pain. That afternoon you have a noticeable soreness in your back as if “you have definitely worked it a little bit” but it doesn’t keep you from carrying on your chores and work for the day. This soreness or slight increase in pain would be a normal response to an appropriate amount of exercise. So do not fret if this is what you feel. You progressively add a minute to your walk and slowly build up your activity tolerance so that you can now walk 15 minutes without any pain.
When dealing with pain it can be difficult to know what will benefit you and what will keep you in a state of persistent pain. Some important ideas to remember include: “hurt does not always equal harm” and “soreness is ok”. In other words, you want to exercise, but not in the “no pain no gain” range and not in the “if it hurts don’t do it” range. Instead, your body will need a certain dosing of exercise all the while respecting the body and your pain. This will allow for you to begin tolerating other activities in your life that are normally painful. So the next time someone tells you “You just need to exercise”, they better have a good suggestion on what type of exercise will benefit you most!
Dr. Nick Scotto is a leading and trusted physical therapist in Jacksonville, Fl. He founded River City Physical Therapy to better serve the active adults in Jacksonville who want to remain fit, healthy, and happy. Many fitness enthusiasts, runners, and active adults have consulted with Nick looking for a permanent solution to their pain. Through education and specific treatment plans he helps them to heal their body naturally and achieve their goals of returning to the activities they love.