Why Back Pain Keeps Coming Back & How To Stop It

Issue 26

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When you have back pain or sciatica, the last thing you want is a relapse or flare up in symptoms. These injury setbacks knock us physically as well as knocking our confidence. The reality is however that due to the nature of back injuries compared to other injuries, such as ankle, knee or arm, they are simply more complex and require a different approach, one which leaves the back vulnerable whilst it is recovering.

If we first consider the injured ankle, a sprain or break, it matters little, what matters is that there is tissue damage, just like in the lower back. Where we have serious tissue injury the consequences are that we must avoid the movements that directly strain those injured tissues. For example the ligaments on the outer side of the ankle. Any movements that take place to strain these injured tissues will result in further damage. Short term this can mean isolation, for example in a boot. Then you must be very careful as you remove the boot after 6 weeks perhaps, that you rehabilitate and strengthen the ankle muscles so that the ligament is less likely to be exposed, during this time you might still have crutches and a good leg to take the pressure off the injured side. Slowly you go through the rest of this process to tissue healing. 

Now think of your back. 

No matter the symptoms, unlike in the case above, it was the tissues resisting bending the ankle one way, in the case of the back it is the tissues that load bear, primarily the discs. Can you isolate these, no you cannot with a cast, ok, well what about using your other back to share the load? That unfortunately won’t work either as you only have one spine. With our backs, instead we are left to live our lives day to day with pressure still being exerted through the particular tissues that are injured and the source of our pain. Therein lies the difficulty.

Relapses and flare ups are part of the process

Many originally join Back In Shape suffering from regular flare ups of their back pain, you see the ankle isn’t sore unless you stress those tissues which is less likely, a little movement might be ok, but with the back it is more common that the activities of daily living are problematic – primarily because they often put that extra bit of pressure through the very load bearing structures we’re trying to heal. 

Because there is so often an inadequacy when it comes to muscular support and control, we find that these activities are enough to push past our competence and strain the injured tissue leading to the flare up. At the end of the day, so long as you have not strengthened the tissues, is it really any wonder. 

The big thing about regular relapses regarding back pain is that it knocks your confidence and is frustrating. It is one of the few injuries that we get demoralised by in a quite unique manner. This comes very much down to a lack of education and awareness of the factors at play. For example, if you broke your leg after a nasty tackle playing football, it’s obvious, and if they healed up and then you did it again in an equally problematic circumstance, you would be irritated and in pain but it doesn’t affect people like back pain does. One of the reasons for this is because there is an obvious reason why; a specific cause. 

With back injuries, answers like: you’re moving incorrectly, have a bad daily routine and do numerous activities that are not conducive with back health, oh and by the way you have woefully inadequate muscle tissue and can’t do a complete squat to the floor without your knees wobbling all over the place and your back rounding, if you even come back up?

This is quite the list but that brings us neatly to the next part.

A back injury is not a problem, recurrent back injuries or persistent back injuries are.

We can all get injured, it’s part of living life, some of us are more lucky than others for whatever reason that may be. And by and large the human body is marvellous and will repair fantastically. 

That is assuming you look after your body. 

Nowadays we do not. Do an honest evaluation now of the amount of hours every day or week you spend sitting vs doing exercise. Sitting includes at work, the commute, the toilet, dinner, the evening, etc etc. Gradually we decondition ourselves over our most youthful years and fail to maintain reasonable muscular health. We develop habits which are not conducive with good health or wellbeing, they’re conducive with convenience. From the things we do on a daily basis to the ways we do them, it all gradually results in a weaker version of ourselves.

We are often barely holding things together, and then when an injury happens, all of a sudden all those things that you’ve been getting away with, from the way you get out of chairs, to the fact that you camp out at the desk for 3 hours at a time all start to become daily habits that get in the way of our recovery. Not to mention there is now even less stability as the injury has created a weak link in the chain of vertebral joints. 

Muscles? Well we didn’t really work these properly so they aren’t particularly strong, not particularly coordinated and if anything are just getting in the way, making the pain worse. 

Fundamentally the back is now exposed, and does not have the degree of protection required to keep it safe during daily activities so it can start to build some momentum healing.

The healing process takes time and needs safeguarding

The body has a “clock” that cannot be hijacked. Your tissues are trying to heal every single day no matter what. The issue as we’ve just discussed is that there are so many habits and factors that used to be insignificant, that now are “limiting factors”. For example, your habit of eating a loaf of bread with chocolate spread daily was fine when you were spending about 2-3 hours a day of formal strenuous exercise plus being active outside those hours and growing. Now when the most exercise you get is a short walk after 8 hours at the desk, that “habit” that you got away with before, is the source of major weight gain!

This is just like your back, those factors are problematic and your back needs time to heal. The process of healing tissues like the ligaments and the discs is very slow, first they need to “patch up” or scab over, this results, in many cases in the symptoms stabilising. However, they’re still very vulnerable to being compromised. 

Next, they will start to reconstitute material in the wound and lay down patches to try and provide a little more stability than was in the freshly injured tissue. Here again, they often will not be painful moment to moment, but things can easily disrupt this process as the back is still load bearing and you’re perhaps still doing all those things you’ve always done. 

From here the process progresses slowly, provided no interruptions, to start to reintegrate the old tissue with the new to further restore stability. 

Finally the tissues continue to evolve responding to stresses and strains, controlled stress is required to direct the strengthening of these tissues for the long term. In its absence they will simply stop strengthening. 

This whole process takes time and aside from you starting to be more conscientious, your muscles strengthening is also providing more protection so the odds of you doing something that exploits the weaknesses is continuing to decrease.

Decrease, not eliminate though!

Your muscles help you during this process, reduce relapses

The great thing about your muscles and learning to use your body better is that it can take place ahead of the healing and remodelling of the tissues previously mentioned. So as you start strengthening you’re working to bolster your back and protect it more effectively. It is however important to note that strengthening takes time too and is not an instant process, it requires weeks of consistency and months to make really transformative changes, but my goodness it is required in so many of us.

Weakness is never a strength.

We see so many who join the program in their Phase 2 unable to do a simple squat to parallel with good form – god knows what’s happening in the back when they sit down on all the chairs that are at that level every day? 

This is an example of what I would term, quality of life limiting weakness and frankly it is unacceptable. 

So why are relapses happening?

Hopefully you can see by now why this is, perhaps you’ve had a chance to take stock of your own situation. Healing is something that takes time, and with back injuries, we are forced to contend with life in ways which are hardly ideal but that’s just the way it is. 

So long as you are still weaker than you should be, which is quite likely, there is a risk. 

So long as you are doing habits that are unhelpful for your lower back, which is likely considering it takes real evaluation to look at everything, plus some things you just cannot eliminate, there is a risk.

So long as you haven’t completed the healing process, there is a risk.

The good news is, that the more actions you take, the less likely relapse becomes and the less severe the relapses will be!

So I can stop all this when I’m fixed or pain free?

No!

A big part of this is addressing the epidemic of weakness within the population, we just are not as active as we used to be, and too many do not partake in regular resistance training in spite of the obvious benefit for people of all ages! Ironically the older you are the more important it is – but we needn’t explore that rabbit hole…

A successful rehabilitation instills new habits, values and practices that are life long, why? Because your body is changing and listening!

If you tail off your resistance work thinking everything’s great, I can go back to whatever leisure activities you’d like, you’d be making a mistake. Your body will gradually break down the tissue you’d developed over those hard months of consistency in a heartbeat if you cut out the stimulation to retain it.

Use it or lose it.

It is expensive to keep that muscular tissue and ligament and tendon strength up and maintained.

The reality is, that it might have taken you months or longer of consistency to build strength sufficient to allow your back to really recover and gather momentum, but it does not take the same amount of time to maintain what you have and steadily progress from there. 

It is perfectly reasonable to spend 3 to 5 30-45 minute workouts a week and continue to do well. This less than 5 hours out of 168 every week, you have the time. 

Do it! It is a small price to pay for what you receive in return. 

The result of this will be that you are more resilient, but can your back get injured again, of course it could! Just like because you recovered from that cold, you will still be able to get another one. The difference is that when you’re healthy and have taken all the steps we’ve talked about in this article, and the steps we cover in much greater detail in the program, you will find that you bounce back from injuries and illness alike in what one would consider a normal, healthy way.

So next time you have a relapse, don’t worry, it is part of the process. Here are some steps you can take in addition to reaching out to us if you’re in the Premium Membership too.

  1. Where are you in the recovery process, still what we would call Phase 1 to 3 or have you really made significant progress strengthening with resistance in Phases 3 and 4?
  2. What specifically did you do to cause this – be specific and inquisitive – when the pain came on and don’t jump to conclusions.
  3. Evaluate if you’ve really worked on your daily activities or are they still a source of relapse and pressure.
  4. Start immediately with your Phase 1, with additional towel and icing to help.
  5. Gently go through a reduced version of your latest workout be it Phase 2 or Phase 3 or Phase 4, do not necessarily go back a Phase. 
  6. Steadily build back up to where you were.
Back Pain Keeps Coming Back

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