Is back pain interfering with the life you once had? The recovery may all be down to your mind. Leading physiotherapist and author of new book, Back to Life David Rogers uncovers his 10 rules to apply to your daily life to regain control…
Back pain affects nearly all of us in one way or another, whether it is a sudden flare-up which stops us in our tracks, or having to deal with persistent pain that stops us doing the things that make us tick. It can often vary from day to day, making it difficult to plan things. Most of us will know of friends or relatives who struggle to live an active life due to back pain, and it’s common to feel helpless in being able to assist them back to the life they had before. But the way we help people recover from back pain is changing, thanks to a large body of research which has helped us to re-write the rules on persistent back pain.
Understanding these new rules and applying them to your own or others’ back problems will promote recovery and help you get back to doing the things in life you enjoy.
However, before you apply these rules, it’s important to make sure that your back pain isn’t due to anything serious. A very small percentage of people with back pain (less than 1 percentage), have a serious medical condition. The symptoms are detailed below:
If you have any of these, we suggest you visit your GP for further assessment
- Ongoing back pain following a violent injury – for example a fall downstairs or a fall from a height
- Back pain which has gradually got progressively worse week by week
- A previous history of cancer, drug abuse, HIV or long long-term steroid use
- You feel generally unwell or, have an ongoing high temperature, or have lost weight for no clear reason
- Your spine has developed a very obvious unusual shape which has not corrected itself over several months
- You are unable to control your bladder or bowel at all or you feel numb in this area
- You have pins and needles, numbness or weakness in both arms or both legs
- Your back is stiff for several hours in the morning
- Your walking pattern has become unsteady or uncoordinated
- Your back pain is always much worse at night.
But if you don’t have any of these symptoms, the following new rules for back pain will promote your recovery…
Don’t bother seeking a diagnosis
Most of the time it is impossible to diagnose a particular structure in your back which is causing your pain. Some common changes found on MRI scans in people with back pain, including slipped discs, worn or degenerative discs or trapped nerves are just as common in people who have never had back pain. So if you haven’t got any of the serious medical conditions mentioned above, your back pain will be classified as ‘non-specific’. This means it is caused by a number of different factors which are all closely linked to your pain experience
2. Calm any worries you may have about damage
When back pain persists it feels like something is seriously damaged, but it rarely is. Worrying about damage, and how it might influence your future, plays a major role in preventing recovery when back pain persists. So keep any negative thoughts about damage to your back in check, and give yourself a reassuring word that it’s safe to get moving.
3. Return to activity gradually
It is common for people to become fearful of activity when back pain persists, particularly if it hurts. Returning to activity, initially at low levels, and building up gradually is the best approach, safe in the knowledge that any ongoing back pain isn’t harming you. It might hurt more to begin with, but remember this isn’t causing you any damage. It will feel easier as you repeat the activities over a few days and weeks.
People who think the worst when they experience a flare-up in back pain take longer to recover
4. Check your thoughts
Research tells us that people who think the worst when they experience a flare-up in back pain take longer to recover. So if, when your back goes, you find thoughts going through your head such as ‘I’ll never get over this’ or ‘how can I ever get back to normal again’ try to re-frame them, to focus on recovery. Thoughts such as ‘I can get over this’ or ‘this will pass’ will focus your attention on recovery from a flare-up in back pain.
5. Do some breathing exercises
When back pain persists, it is common for muscles to feel tense and tight. You may experience sudden spasms of pain without reason. These frequent episodes are due to your nervous system being oversensitive, like a volume dial for pain being turned up too high. Breathing exercises, such as the 7/11 method described below, will calm down the nervous system, and the muscles they supply, relaxing tense muscles and preventing sudden spasms of back pain.
The breathing 7/11 method:
- Take in a deep breath, allow the stomach and lower ribcage to expand as you breathe in.
- Breathe out controlling the flow so that it is steady and slow, emptying out a little more fully than normal.
- Continue taking deep breaths in and long slow breaths out. When you have got used to the feeling of this you can count the length of your breaths.
- Breathe in for a count of 7 and out for a count of 11 (both through the nose, if possible).
- Adjust the speed of your counting so that it is comfortable for you. The important thing is to make sure that the out breath is longer than the in breath. This triggers the automatic relaxation response in the body.
- Continue this for 5 to 10 minutes or however long you wish, focusing on the feeling and sound of your breathing. As you breathe slowly, be aware of where your body is supported and think of allowing your muscles to let go of the weight of your body onto whatever you are resting upon.
6. Exercise regularly
Protecting your back from exercise long term will prevent recovery
The back is designed to move and bend and twist in variety of ways. Protecting your back from these movements might seem like the logical thing to do at first. But continuing to protect your back from exercise in the medium to longer term will prevent recovery. It doesn’t matter what exercise you do – swimming, cycling, walking the dog, joining a gym class or doing yoga are all excellent types of exercise. But make sure it’s something you enjoy doing, otherwise you are less likely to continue with it in the long term
7. Manage the stressors in your life
Ongoing unresolved distress in your life will wind up your body’s fight and flight system, raising tension in your back muscles, which is likely to cause more frequent flare-ups. Some of your daily stressors within your home or work life can be difficult to keep on top of but if you can find ways to manage these better, you will find that your back will be much less troublesome .
8. Involve your family and friends in your recovery
Those close to you want to do the best for you when you are suffering with back pain. Sometimes they can be over-protective and do everything for you. Whilst they have good intentions, it can prevent you from trying things out that may promote recovery. Remember the back likes all types of movement, so tell those close to you that it’s safe to get going, and encourage them to help you work towards recovery in function.
9. Plan to ensure you get a refreshing nights’ sleep regularly
Avoid using technology before sleep
Refreshing sleep is essential for our general health and well-being. Avoiding using technology including computers, mobile phones and television; having a bedtime routine leading up to sleep and calming your mind through 7/11 breathing are all simple strategies you can use to make refreshing sleep more likely.
10. Be prepared for some bumps along the road to recovery
Applying these new rules will make a difference but it probably won’t cure your back pain forever. So having a plan for when things go wrong with your back is really helpful. Below details an emergency plan to put in place when you are having a bad day. Keep this close at hand because when flare-ups happen it can feel overwhelming and it’s difficult to think straight.
In emergency flare-ups:
- Keep calm
- Accept the flare-up has happened
- Check your symptoms are familiar
- Check your thoughts
- Do some 7/11 breathing
- Stretch gently
- Modify your activity for a short period of time
- Use some medication to help you get going again
- Return to normal activity as soon as possible
Applying these 10 rules in your daily life will give you the best chance of promoting recovery when back pain persists, and will help you get to get Back To Life
Back to Life was published by Vermilion in August and is available from Amazon for £12.99
David Rogers is a chartered physiotherapist with over 20 years’ experience of helping people with musculoskeletal pain to recover function, return to work and regain their quality of life. After completing a degree in Sports Studies, in 1994 he qualified as a chartered physiotherapist from the University of Birmingham and in 2010 gained his Masters degree in Pain Science and Management from Keele University. He has worked in many different healthcare environments, including the NHS, the occupational health industry and sports medicine, and is currently playing an active role in large research trials relating to back pain. He is based at the Royal Orthopaedic Hospital in Birmingham, where he has established a functional restoration service for people with back pain. His work is focused on applying a biopsychosocial approach to recovery, using cognitive behavioural principles aimed at maximising recovery and he gains excellent results in helping people to get Back To Life when back pain persists.
Follow David Rogers on Twitter: @DavidRogers94