Individual Differences In Low-Back Pain Recovery

In my last post about low-back pain I highlighted many of the similarities in recovery for those recovering from low back pain.  It was by far my most popular piece of writing, which, as the stats would suggest, tells me that lots of people are in the same boat as me, or worse where I used to be.  It’s comforting to know that other people are suffering too

This got me thinking that I need to write more about back pain. Not for the likes or exposure that comes with it, but to actually help people. Now, I’m not a therapist and I can’t technically provide a diagnosis, especially over the internet, but through my experience as a strength coach I can offer some proven methods that can help you troubleshoot your pain and get yourself moving again.

I wrote that the diagnosis of non-specific low back pain is a cop out.  The reason for that is that all low back pain has a cause.  Most clinicians just don’t know how to find it.  Backs don’t just hurt for the sake of hurting.  There will always be specific things that cause pain and absolutely a reason why.

Diagnosis is far beyond the scope of the article so if you do want to get yourself a diagnosis find yourself a therapist familiar with the McGill Method that will take you through a full pain-provocation assessment.  While you’re all motivated to fix your back pick up a copy of Back Mechanic here.  (I get nothing from this plug other than knowing I am suggesting an unbelievably valuable resource).

Even if you don’t have a specific term for your back pain, knowing what hurts and how to move through life around it is an excellent place to start.  Whether your spine is flexion intolerant, extension intolerant, intolerant to sheering forces or rotation – there will be some similarities in recovery.

At the risk of sounding like I’m rewriting the original post (which lets be honest, could use another read) we need to follow the same format.

  1. Let your back rest: Stop picking the scab by constantly moving in ways that cause you pain. Also known as virtual surgery.
  2. Reprogram your movement: find better ways to complete daily tasks that protect your back from poor patterns that causeyou pain.
  3. Improve your mobility especially at the hips and upper back.
  4. Increase the stability of your low back to prevent micro movements that cause pain. Also referred to as stiffness.
  5. Left out last time but always important is WALKING. No other activity has been shown to be as effective as simply walking – with a purpose – as walking has. Very few activities stress the hips and low back muscles in the way walking does that leads to a positive outcome.

So, the approach is the same but how we execute is where the individual differences come in.  Much like any training program I design, the approach is the

same but the methods may differ person to person.

Every spine is different and will have different tolerances to flexion, extension, rotation and sheering forces.  Anatomical neutral – what you see in the spinebooks, and what a brand-new trainer will work so hard to make you perfect – may differ from what your blown-up back can handle.  Your back may be comfortable in a slightly more flexed position or if you have a posterior disc bulge, extension will likely be more comfortable.

Don’t get too caught up in how perfect your posture is.  A solid strategy is to approach neutral and then play around, flexing and extending different sections of your spine, shifting your weight back and forth.  When you find a position that you are comfortable with and no muscles are over-active then you have found a starting point.

From your new neutral position, you can start to rebuild your movement patterns, using supports when needed and finding positions that allow you move pain-free.

Another area that will differ greatly is walking duration.  A reasonable goal to set your sights on is 20 minutes at a brisk pace – or walking with a purpose – with good arm swing that allows your torso to store energy and recoil step to step.  You might be far from this point.  You might only be able to take 6 steps before the pain is too much.  We start with 4 or 5 steps multiple times throughout the day, staying below your pain threshold.  We want to avoid picking at the scab.  When you are able, you will increase the steps to keep pushing your threshold higher until you can maintain and progress through a walking program.

Your walking program may also be 5 minutes at a time, 3 to times per day, or 10 minutes twice per day.  Perhaps you walk for 5 minutes, squat down deep a few times to relieve any unwanted tension then continue for another 5 and repeat later in the day. There really are endless options and the approach should be tailored to the individual.

Even the parameters of the Daily Big 3 can be modified to fit the individual.  From the exercises themselves to the duration of holds, it can all be changed.  You might be a rock star with the modified curl up, but a complete dud with the bird-dog.  That’s also ok, just keep working at your weak link until it’s on par with the rest.

The most important area to recognise individual differences is recovery time.  While many doctors offices and return-to-work programs will put something like a 6 week timeline on a recovery, this is not only unrealistic, but in some cases unsafe and creates an environment for failure.

Recovery time can vary from a few weeks to many months.  So many factors should be taken into consideration with regard to timeline.  Just to name a few:

  1. Individual’s condition pre-injury
  2. How long has the injury or condition been a problem
  3. Personality type
  4. What the individual will be recovering for – are they returning to a desk job or a labour job? Both will have numerous considerations afterward.
  5. What the injury is

Therapists, doctors and trainers alike should all be taking a more individual approach towards helping people with low-back pain.  Being the back-pain-sufferer you shouldn’t be comparing yourself to others with regards to time line.

Your road to recovery is your own road.  Following someone else’s timeline would be a mistake, setting you up for possible failure.  The framework can remain the same, but each section should be adjusted over and over to fit the individual’s current state and where they need to get to.

Everybody shits all over cookie-cutter programs and stresses how they need an individual approach to achieving their peak performance state but with things like weight-loss and injury recovery we seem to try to fit ourselves into a tiny box with predetermined check points, time lines and outcomes. For the sake of the low-back pained patient, this needs to stop and the approach needs to be centered around them.

If you are someone who has suffered from back pain, tried “low back programs” and ended up getting nowhere, consider an assessment from someone qualified to take you through proper pain-provocation tests and work to develop an individualized recovery program.

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